scholarly journals The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Osman Abdullahi ◽  
Ngari Moses ◽  
Deche Sanga ◽  
Willetts Annie
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Clinical Signs ◽  
World Health ◽  
Routine Practice ◽  
Public And Private ◽  
Systematic Screening ◽  
Tb Treatment ◽  
Resource Limited ◽  
Health Organization

AbstractThe World Health Organization (WHO) criteria for diagnosing and treating Tuberculosis (TB) includes clinical signs, therefore not requiring bacteriological laboratory confirmation. In resource-limited settings, including Kenya, this empirical TB treatment is routine practice however limited data exist on patient clinical outcomes when comparing the method of diagnosis. We evaluated TB treatment outcomes comparing clinically diagnosed and bacteriologically confirmed TB, 6 months after starting treatment of TB in a rural county in Kenya. Our analysis compared patients with a clinical versus a bacteriologically confirmed TB diagnosis. In this retrospective analysis, we included all adults (≥ 18 years) starting treatment of TB and followed up for 6 months, within the County TB surveillance database from 2012 to 2018. Patients included from both public and private facilities. The TB treatment outcomes assessed included treatment success, treatment failure, death, defaulted and transferred out. We used survival regression models to assess effect of type of diagnosis on TB treatment outcome defining time at risk from date of starting treatment to experiencing one of the treatment outcomes or completing 6-months of treatment. A total of 12,856 patients; median age 37 [IQR 28 − 50] years were included. 7639 (59%) were male while 11,339 (88%) were pulmonary TB cases. Overall, 11,633 (90%) were given first-line TB treatment and 3791 (29%) were HIV infected. 6472 (50%) of the patients were clinically diagnosed of whom 4521/6472 (70%) had a negative sputum/GeneXpert test. During the study 5565 person-years (PYs) observed, treatment success was 82% and 83% amongst clinically and bacteriologically diagnosed patients (P = 0.05). There were no significant differences in defaulting (P = 0.70) or transfer out (P = 0.19) between clinically and bacteriologically diagnosed patients. Mortality was significantly higher among clinically diagnosed patients: 639 (9.9%) deaths compared to 285 (4.5%) amongst the bacteriologically diagnosed patients; aHR 5.16 (95%CI 2.17 − 12.3) P < 0.001. Our study suggests survival during empirical TB treatment is significantly lower compared to patients with laboratory evidence, irrespective of HIV status and age. To improve TB treatment outcomes amongst clinically diagnosed patients, we recommend systematic screening for comorbidities, prompt diagnosis and management of other infections.

scholarly journals Two diseases, same person: moving toward a combined HIV and tuberculosis continuum of care

2018 ◽  
Vol 29 (9) ◽  
pp. 873-883 ◽  
Author(s):  
Reuben Granich ◽  
Somya Gupta
Keyword(s):  
Public Health ◽  
Disease Control ◽  
Treatment Success ◽  
World Health ◽  
People Living With Hiv ◽  
Global Public Health ◽  
Tb Treatment ◽  
Immunodeficiency Virus ◽  
Health Organization ◽  
Living With Hiv

The human immunodeficiency virus (HIV) and Mycobacterium tuberculosis syndemic remains a global public health threat. Separate HIV and tuberculosis (TB) global targets have been set; however, success will depend on achieving combined disease control objectives and care continua. The objective of this study was to review available policy, budgets, and data to reconceptualize TB and HIV disease control objectives by combining HIV and TB care continua. For 22 World Health Organization (WHO) TB and TB/HIV priority countries, we used 2015 data from the HIV90–90–90watch website, UNAIDS AIDSinfo, and WHO 2016 and 2017 Global TB Reports. Global resources available in TB and HIV/TB activities for 2003–2017 were collected from publicly available sources. In 22 high-burden countries, people living with HIV on antiretroviral therapy ranged from 9 to 70%; viral suppression was 38–63%. TB treatment success ranged from 71 to 94% with 14 (81% HIV/TB burden) countries above 80% TB treatment success. From 2003 to 2017, reported global international and domestic resources for HIV-associated TB and TB averaged $2.85 billion per year; the total for 2003–2017 was 43 billion dollars. Reviewing combined HIV and TB targets demonstrate disease control progress and challenges. Using an integrated HIV and TB continuum supports HIV and TB disease control efforts focused on improving both individual and public health.

scholarly journals A Snapshot of Grassroots Primary Care and Tuberculosis Control in India—a US Fulbright–Nehru Scholar Program Experience

2017 ◽  
Vol 12 (02) ◽  
pp. 26
Author(s):  
Sonal Shah Parikh ◽  
Juzar Ali ◽  
Sanjay Bhatt ◽  
DV Bala ◽  
◽  
...  
Keyword(s):  
Primary Care ◽  
Treatment Success ◽  
Tertiary Care ◽  
World Health ◽  
Tuberculosis Control ◽  
District Health ◽  
Public And Private ◽  
Rural And Urban ◽  
Organization Strategy ◽  
Health Organization

The Department of Community Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Medical College, Ahmedabad, India, under the aegis of the US Fulbright–Nehru Scholar Program, reviewed the rural and urban primary and district health delivery system, with focus on primary care, child and maternal health and tuberculosis control. The National Health Mission program in India utilizes public and private resources and partnerships to optimally increase access, referrals and improve quality of care. As a collateral, the Revised National Tuberculosis Program, within its broader umbrella, incorporates digital-based locally applicable innovative approaches to tuberculosis (TB) control, to implement the World Health Organization strategy of the Directly Observed Treatment Short-course (DOTS) program. With this approach the program has consistently maintained a high treatment success rate. However, the deficiencies in the program include the loss to follow-up of missing persons with TB, incomplete data in some cases, and erratic coordination between private, academic, public health primary and tertiary care centers.

scholarly journals Glycated hemoglobin screening identifies patients admitted for retreatment of tuberculosis at risk for diabetes in Tanzania

2016 ◽  
Vol 10 (04) ◽  
pp. 423-426 ◽  
Author(s):  
Margaretha L. Sariko ◽  
Stellah G. Mpagama ◽  
Jean Gratz ◽  
Riziki Kisonga ◽  
Queen Saidi ◽  
...  
Keyword(s):  
Glycated Hemoglobin ◽  
Multidrug Resistant ◽  
Referral Hospital ◽  
World Health ◽  
Tb Treatment ◽  
Number Needed To Screen ◽  
Resource Limited ◽  
Northern Tanzania ◽  
Mdr Tb ◽  
Health Organization

Introduction: World Health Organization recommendations of bidirectional screening for tuberculosis (TB) and diabetes have been met with varying levels of uptake by national TB programs in resource-limited settings. Methodology: Kibong’oto Infectious Diseases Hospital (KIDH) is a referral hospital for TB from northern Tanzania, and the national referral hospital for multidrug-resistant (MDR)-TB. Glycated hemoglobin (HgbA1c) testing was done on patients admitted to KIDH for newly diagnosed TB, retreatment TB, and MDR-TB, to determine the point prevalence of diabetes (HgbA1c ≥ 6.5%) and prediabetes (HgbA1c 5.7%–6.4%). Results: Of 148 patients hospitalized at KIDH over a single week, 59 (38%) had no prior TB treatment, 22 (15%) were retreatment cases, and 69 (47%) had MDR-TB. Only 3 (2%) had a known history of diabetes. A total of 144 (97%) had successful screening, of which 110 (77%) had an HgbA1c ≤ 5.6%, 28 (19%) had ≥ 5.7 < 6.5, and 6 (4%) had ≥ 6.5. Comparing subjects with prediabetes or diabetes to those with normal A1c levels, retreatment patients were significantly more likely to have a A1c ≥ 5.7% (odds ratio: 3.2, 95% CI: 1.2–9.0; p = 0.02) compared to those without prior TB treatment. No retreatment case was a known diabetic, thus the number needed to screen to diagnose one new case of diabetes among retreatment cases was 11. Conclusions: Diabetes prevalence by HgbA1c was less common than expected, but higher HgA1c values were significantly more frequent among retreatment cases, allowing for a rational, resource-conscious screening approach.

scholarly journals Tuberculosis Notification Trends and Treatment Outcomes in Penitentiary and Civilian Health Care Sectors in the WHO European Region

2021 ◽  
Vol 18 (18) ◽  
pp. 9566
Author(s):  
Andrei Dadu ◽  
Ana Ciobanu ◽  
Araksya Hovhannesyan ◽  
Natavan Alikhanova ◽  
Oleksandr Korotych ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
World Health ◽  
European Region ◽  
Correctional Institutions ◽  
Success Rates ◽  
Relative Risks ◽  
Average Annual Change ◽  
Health Organization ◽  
Substantial Decline

Setting: Tuberculosis (TB) morbidity in penitentiary sectors is one of the major barriers to ending TB in the World Health Organization (WHO) European Region. Objectives and design: a comparative analysis of TB notification rates during 2014–2018 and of treatment outcomes in the civilian and penitentiary sectors in the WHO European Region, with an assessment of risks of developing TB among people experience incarceration. Results: in the WHO European Region, incident TB rates in inmates were 4–24 times higher than in the civilian population. In 12 eastern Europe and central Asia (EECA) countries, inmates compared to civilians had higher relative risks of developing TB (RR = 25) than in the rest of the region (RR = 11), with the highest rates reported in inmates in Azerbaijan, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, and Ukraine. The average annual change in TB notification rates between 2014 and 2018 was −7.0% in the civilian sector and −10.9% in the penitentiary sector. A total of 15 countries achieved treatment success rates of over 85% for new penitentiary sector TB patients, the target for the WHO European Region. In 10 countries, there were no significant differences in treatment outcomes between civilian and penitentiary sectors. Conclusion: 42 out of 53 (79%) WHO European Region countries reported TB data for the selected time periods. Most countries in the region achieved a substantial decline in TB burden in prisons, which indicates the effectiveness of recent interventions in correctional institutions. Nevertheless, people who experience incarceration remain an at-risk population for acquiring infection, developing active disease and unfavourable treatment outcomes. Therefore, TB prevention and care practices in inmates need to be improved.

Treatment outcomes of adults with new onset pulmonary tuberculosis in Pretoria, South Africa

2020 ◽  
Vol 50 (2) ◽  
pp. 130-134
Author(s):  
Meisie A Nkoane ◽  
Adegoke O Adefolalu ◽  
Gboyega A Ogunbanjo
Keyword(s):  
South Africa ◽  
Treatment Outcomes ◽  
Healthcare Workers ◽  
Treatment Success ◽  
World Health ◽  
Sputum Smear ◽  
Standard Regimen ◽  
Tb Treatment ◽  
Complete Treatment ◽  
Cure Rates

A persistently high burden of tuberculosis (TB) and low cure rates in South Africa call for frequent assessment of the effectiveness of the TB programme. We conducted a retrospective cohort study to evaluate treatment outcomes and associated factors among new TB patients taking standard regimen 1 TB treatment during 2010 in Pretoria, using the World Health Organization’s six treatment outcomes classification. The 85 participants (of whom 59% were female) had co-infection with HIV in 70%. A total of 52% completed treatment, but only 15% were officially cured; 13% died and only 35% had an end-of-treatment sputum test. The treatment success rate (cured and complete treatment) was 67%. Completion of TB treatment was associated with HIV status ( P = 0.02) and TB diagnosis using only sputum smear test ( P = 0.02). Our results suggest non-compliance with standard TB guidelines by healthcare workers. We therefore advise future interventions should target both patients and healthcare workers.

scholarly journals Treatment Outcomes of Isoniazid-Resistant (Rifampicin Susceptible) Tuberculosis Patients in Uzbekistan, 2017–2018

2021 ◽  
Vol 18 (6) ◽  
pp. 2965
Author(s):  
Zayniddin Sayfutdinov ◽  
Ajay Kumar ◽  
Dilyara Nabirova ◽  
Jamshid Gadoev ◽  
Laziz Turaev ◽  
...  
Keyword(s):  
Sample Size ◽  
Treatment Outcomes ◽  
Controlled Trial ◽  
Treatment Success ◽  
Secondary Analysis ◽  
World Health ◽  
Future Research ◽  
Control Group ◽  
Tuberculosis Patients ◽  
Health Organization

Tuberculosis patients “resistant to isoniazid and susceptible to rifampicin (Hr-TB)” remain neglected, despite a high burden and poor outcomes. The World Health Organization (WHO) recommends a 6 month regimen consisting of levofloxacin, rifampicin, ethambutol, and pyrazinamide (LRZE) to treat Hr-TB. In contrast, Uzbekistan uses a 9 month regimen (LRZE plus a second-line injectable in the first 3 months). We aimed to assess the treatment outcomes of this novel regimen among Hr-TB patients treated in two regions of Uzbekistan (Fergana and Bukhara) in 2017–2018. We conducted a cohort study involving secondary analysis of routine surveillance data. Of 132 Hr-TB patients, 105 (80%) were successfully treated. Death was the predominant unsuccessful outcome (13, 10%) followed by “treatment failure” (10, 8%) and “lost to follow-up” (4, 2%). High treatment success is an indicator of the potential effectiveness of the novel regimen and adds to the limited global evidence on this issue. However, the sample size was small and there was no comparison group. Since the study was conducted in two regions of Uzbekistan only, the findings have limited generalizability. We recommend future research using an adequate sample size and an appropriate study design (randomized controlled trial or prospective cohort with a control group receiving the WHO-recommended regimen).

scholarly journals Socio-Demographic Profile and Prevalence of Tuberculosis (TB) Treatment Outcomes among Tuberculosis/Human Immunodeficiency Virus (TB/HIV) Co-Infected Patients in Kelantan

2021 ◽  
Vol 29 (4) ◽  
Author(s):  
Siti Romaino Mohd Nor ◽  
Mohd Rozi Husin ◽  
Mat Zuki Mat Jaeb ◽  
Nyi Nyi Naing
Keyword(s):  
Research Ethics ◽  
Treatment Outcomes ◽  
Treatment Success ◽  
Ethics Committee ◽  
World Health ◽  
Care Providers ◽  
Demographic Profile ◽  
Research Ethics Committee ◽  
Tb Treatment ◽  
The Mean

In Kelantan, the prevalence of Tuberculosis (TB) treatment success rate among TB/HIV co-infection is still below the success target of the World Health Organisation (WHO). Our objective was to assess the socio-demographic profile and determine the prevalence of TB treatment outcomes among TB/HIV co-infected patients in Kelantan. The cross-sectional study involved secondary data from the MyTB online system from January 2014 to December 2018, carried out at TB/Leprosy Sector, State Health Department of Kelantan. The data were analysed using SPSS version 25.0 and STATA version 14. The ethics approval was obtained from the UniSZA Human Research Ethics Committee (UHREC) and Medical Research Ethics Committee (MREC) of Ministry of Health (MOH). There were 6,313 TB cases in Kelantan. Of these, 703 (11.1%) cases were TB/HIV co-infection. However, 36 cases were excluded, and 667 cases were evaluated based on inclusion and exclusion criteria. The mean (SD) age was 38.7 (7.9) years, and the mean duration of TB treatment was 202.8 (131.27) days. The prevalence of successful treatment was 57.1%, with 19.8% cases were cured, and another 37.3% cases were completed treatment. While the unsuccessful were 42.9%, with 10.1% cases were defaulted, and 32.8% cases died. The successful outcomes were significantly associated with the educational level, the anatomy of TB location, smoking status, DOTS by health care providers, source of notification, the place of treatment and method of detection. This study provides the basic data of patient’s socio-demographic profiles, and the prevalence of TB treatment success in Kelantan is under international target by WHO of ≥ 90.0%.

scholarly journals Treatment outcomes of Gene Xpert positive tuberculosis patients in KwaMashu Community Health Centre, KwaZulu-Natal, South Africa: A retrospective review

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Sarusha Pillay ◽  
Nombulelo P. Magula
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Multiple Logistic Regression Analysis ◽  
Health Centre ◽  
World Health ◽  
Unsuccessful Treatment ◽  
Kwazulu Natal ◽  
Sputum Conversion ◽  
Health Organization ◽  
Lost To Follow Up

Background: We sought to investigate the relationship between tuberculosis (TB) treatment outcomes and its predictors in the KwaMashu region in KwaZulu-Natal (KZN). This area is currently a hotbed for TB and human immunodeficiency virus (HIV) co-infection.Method: A retrospective study design was adopted to characterise adult patients diagnosed with Gene Expert (GXP) positive pulmonary TB from 01 January 2016 to 31 December 2017. Tuberculosis treatment outcomes were assessed after two months and five months according to the standard World Health Organization (WHO) criteria. Multiple logistic regression analysis was used to calculate the odds ratio (OR) of the possible determinants associated with unsuccessful treatment outcomes.Results: Amongst the 596 patients diagnosed, 57.4% (95% confidence interval [CI]: 53.3–61.4; 342 of 596) had successful treatment outcomes. Of these reported cases, 88.89% (85.1–92.0; 304 of 342) were cured. For the unsuccessful treatment outcomes, 52.4% (46.0–58.6; 133 of 254) patients were lost to follow-up, 20.9% (16.0–26.4; 53 of 254) failed treatment, 1.2% (0.2–3.4; 3 of 254) died and 25.6% (20.3–31.4; 65 of 254) of the patients could not be accounted for. Patients with unknown HIV status were more likely to have unsuccessful treatment outcomes (adjusted OR [aOR] = 4.94 [1.83–13.36]). Patients who had sputum conversion at 2 months (aOR = 1.94 [1.27–2.96]) were significantly more likely to exhibit unsuccessful treatment outcomes.Conclusion: Treatment success rate was 57.4% which was below the target set by the WHO. This underscores the urgent need to strengthen treatment adherence strategies to improve outcomes, especially in high HIV burden settings.

scholarly journals Associated Factors of the Results of Pulmonary Tuberculosis Treatment During the COVID-19 Pandemic in Makassar City

2021 ◽  
Vol 9 (B) ◽  
pp. 1001-1005
Author(s):  
Syahridha Syahridha ◽  
Nasrum Massi ◽  
Ahyar Ahmad ◽  
Irawaty Djaharuddin
Keyword(s):  
Family History ◽  
Treatment Outcomes ◽  
Associated Factors ◽  
World Health ◽  
Pulmonary Tb ◽  
Tb Treatment ◽  
Diabetes Status ◽  
Diabetes Mellitus Status ◽  
History Of ◽  
Health Organization

BACKGROUND: A regimen directly observed treatment-short course is recommended by the World Health Organization as a strategy for controlling tuberculosis (TB). AIM: This treatment was carried out for 6 months despite the COVID-19 pandemic situation. The purpose of the study was to determine the factors associated with the treatment outcomes of pulmonary TB undergoing treatment during the COVID-19 pandemic, with the research target was Category I pulmonary TB patients. METHOD: The type of research was observational analytic with a cohort study design. This research was conducted at the Pulmonary Center in October 2020-May 2021 involved 62 samples. RESULTS: About 75.8% (47 respondents) successfully treated and 24.2% (15 respondents) decided unsuccessful. There was a significant association between diabetes status (p = 0.014), anemia status (p = 0.035), knowledge of TB (p = 0.009), knowledge of COVID-19 (p = 0.014), and family history of COVID-19 exposure (p = 0.011) to the treatment outcomes of pulmonary TB treatment during the pandemic. CONCLUSION: Associated factors to the outcome of treatment for pulmonary TB patients undergoing TB treatment during a pandemic included diabetes mellitus status, anemia status, knowledge of TB, knowledge of COVID-19, and family history of exposure to COVID-19.

scholarly journals Evaluation of Two Techniques for Viral Load Monitoring Using Dried Blood Spot in Routine Practice in Vietnam (French National Agency for AIDS and Hepatitis Research 12338)

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Fabien Taieb ◽  
Tran Hong Tram ◽  
Hien Thi Ho ◽  
Van Anh Pham ◽  
Huong Lan Nguyen ◽  
...  
Keyword(s):  
Viral Load ◽  
Dried Blood Spot ◽  
World Health ◽  
Hiv Care ◽  
Routine Practice ◽  
National Agency ◽  
Resource Limited ◽  
Load Monitoring ◽  
Health Organization ◽  
Blood Spot

Abstract Background.  Although it is the best method to detect early therapeutic failure, viral load (VL) monitoring is still not widely available in many resource-limited settings because of difficulties in specimen transfer, personnel shortage, and insufficient laboratory infrastructures. Dried blood spot (DBS) use, which was introduced in the latest World Health Organization recommendations, can overcome these difficulties. This evaluation aimed at validating VL measurement in DBS, in a laboratory without previous DBS experience and in routine testing conditions. Methods.  Human immunodeficiency virus (HIV)-infected adults were observed in a HIV care site in Hanoi, and each patient provided 2 DBS cards with whole blood spots and 2 plasma samples. Viral load was measured in DBS and in plasma using the COBAS Ampliprep/TaqMan and the Abbott RealTime assays. To correctly identify those with VL ≥ 1000 copies/mL, sensitivity and specificity were estimated. Results.  A total of 198 patients were enrolled. With the Roche technique, 51 plasma VL were ≥1000 copies/mL; among these, 28 presented a VL in DBS that was also ≥1000 copies/mL (sensitivity, 54.9; 95% confidence interval [CI], 40.3–68.9). On the other hand, all plasma VL &lt; 1000 copies/mL were also &lt;1000 copies/mL in DBS (specificity, 100; 95% CI, 97.5–100). With the Abbott technique, 45 plasma VL were ≥1000 copies/mL; among these, 42 VL in DBS were also ≥1000 copies/mL (sensitivity, 93.3%; 95% CI, 81.7–98.6); specificity was 94.8 (95% CI, 90.0–97.7). Conclusions.  The Abbott RealTime polymerase chain reaction assay provided adequate VL results in DBS, thus allowing DBS use for VL monitoring.

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