Diabetes and poor tuberculosis treatment outcomes: issues and implications in data interpretation and analysis

Tuberculosis (TB) remains one of the 10 leading causes of death worldwide, especially in low- and middle-income countries. We conducted a systematic review and meta-analysis including 88 studies examining the association between diabetes mellitus (DM) and TB treatment outcomes. However, we found several common methodological problems among them, including inappropriate adjustments for confounding factors, not using optimal statistical methods for ‘time to event' data, misclassification in exposure (DM) and outcomes (TB treatment outcomes) due to study design and non-standardisation of definitions, misunderstanding of basic study design concept, standardisation of TB treatment outcomes and quality control of publications. Many of these problems would apply more broadly to other ‘risk factors' for poor TB treatment outcomes. These issues need to be addressed and resolved to improve the quality of the studies and provide more accurate results for policy makers in the future to tackle the burden of TB.

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Effects of social protection on tuberculosis treatment outcomes in low or middle-income and in high-burden countries: systematic review and meta-analysis

Cadernos de Saúde Pública ◽

10.1590/0102-311x00153116 ◽

2018 ◽

Vol 34 (1) ◽

Cited By ~ 9

Author(s):

Kaio Vinicius Freitas de Andrade ◽

Joilda Silva Nery ◽

Ramon Andrade de Souza ◽

Susan Martins Pereira

Keyword(s):

Treatment Outcomes ◽

Social Protection ◽

Meta Analysis ◽

Treatment Success ◽

Qualitative Synthesis ◽

Middle Income ◽

High Burden ◽

Tb Treatment ◽

Protection Strategies ◽

Meta Analyses

Tuberculosis (TB) is a poverty infectious disease that affects millions of people worldwide. Evidences suggest that social protection strategies (SPS) can improve TB treatment outcomes. This study aimed to synthesize such evidences through systematic literature review and meta-analysis. We searched for studies conducted in low- or middle-income and in high TB-burden countries, published during 1995-2016. The review was performed by searching PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect and LILACS. We included only studies that investigated the effects of SPS on TB treatment outcomes. We retained 25 studies for qualitative synthesis. Meta-analyses were performed with 9 randomized controlled trials, including a total of 1,687 participants. Pooled results showed that SPS was associated with TB treatment success (RR = 1.09; 95%CI: 1.03-1.14), cure of TB patients (RR = 1.11; 95%CI: 1.01-1.22) and with reduction in risk of TB treatment default (RR = 0.63; 95%CI: 0.45-0.89). We did not detect effects of SPS on the outcomes treatment failure and death. These findings revealed that SPS might improve TB treatment outcomes in lower-middle-income economies or countries with high burden of this disease. However, the overall quality of evidences regarding these effect estimates is low and further well-conducted randomized studies are needed.

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Chronic hepatitis C treatment outcomes in low- and middle-income countries: a systematic review and meta-analysis

Bulletin of the World Health Organization ◽

10.2471/blt.11.097147 ◽

2012 ◽

Vol 90 (7) ◽

pp. 540-550 ◽

Cited By ~ 39

Author(s):

Nathan Ford ◽

Catherine Kirby ◽

Kasha Singh ◽

Edward J Mills ◽

Graham Cooke ◽

...

Keyword(s):

Systematic Review ◽

Chronic Hepatitis ◽

Hepatitis C ◽

Treatment Outcomes ◽

Chronic Hepatitis C ◽

Meta Analysis ◽

Hepatitis C Treatment ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Systematic review of therapeutic outcomes of multidrug resistant tuberculosis and their predictors in adults receiving integrated treatment of tuberculosis and human immuno-deficiency virus in low- and middle-income countries: a study protocol

Systematic Reviews ◽

10.1186/s13643-020-01493-5 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Benjamin Momo Kadia ◽

Desmond Aroke ◽

Kevin Pene Njefi ◽

Joel Noutakdie Tochie ◽

Frank-Leonel Tianyi ◽

...

Keyword(s):

Systematic Review ◽

Treatment Outcomes ◽

Meta Analysis ◽

Integrated Treatment ◽

Hiv Treatment ◽

Middle Income ◽

Middle Income Countries ◽

Resistant Tuberculosis ◽

Therapeutic Outcomes ◽

Mdr Tb

Abstract Background Programs that integrate tuberculosis (TB) and human immunodeficiency virus (HIV) treatment aim to provide efficient treatment services and maximize successful treatment outcomes through the delivery of both TB and HIV treatment by one provider at the same time and location. However, multi-drug resistant tuberculosis (MDR-TB) is more difficult to treat as compared to drug-sensitive TB, and in low- and middle-income countries (LMICs), the potential of programs integrating TB/HIV treatment to sustain favourable MDR-TB treatment outcomes is poorly elucidated. The objective of this review is to perform a systematic collection, critical appraisal and synthesis of existing evidence on therapeutic outcomes of MDR-TB and their predictors among adults receiving integrated treatment for TB/HIV in LMICs. Methods A systematic review of quantitative evidence from observational cohort studies will be performed. MEDLINE, Embase, and Global Health electronic databases will be searched for relevant studies published from March 2004 to December 2019. Two investigators will independently screen the search output, review the eligible studies, and assess the quality of the eligible studies using quality assessment tools of the National Heart Lung and Blood Institute. Random-effects meta-analysis will be used to obtain summary estimates. Heterogeneity across studies will be assessed using the I2 statistic. The confidence in the summary estimates will be rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The final review will be reported following the guidelines of the Preferred Reporting System for Systematic Reviews and Meta-analysis, presented at scientific conferences and published in a peer-reviewed journal. Discussion This study is expected to report the performance of integrated TB/HIV treatment programs as regards their potential to uphold successful MDR-TB treatment outcomes in LMICs. Furthermore, the review will indicate patient-related and healthcare-related factors that should be addressed to improve on survival of patients with MDR-TB/HIV co-infection in LMICs. Systematic review registration This review has been registered with the International Prospective Register of Systematic Reviews and the reference ID is CRD42020159745

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Psychiatric disorders among people with cancer in low- and lower-middle-income countries: study protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-017043 ◽

2017 ◽

Vol 7 (8) ◽

pp. e017043 ◽

Cited By ~ 2

Author(s):

Zoe J Walker ◽

Michael P Jones ◽

Arun V Ravindran

Keyword(s):

Systematic Review ◽

Treatment Outcomes ◽

Psychiatric Comorbidity ◽

Psychiatric Treatment ◽

Meta Analysis ◽

Public Health Problem ◽

Assessment Tools ◽

Primary Data ◽

Middle Income ◽

Middle Income Countries

IntroductionCancer is a rapidly growing public health problem in low- and lower-middle-income countries (LLMICs). There is evidence from upper-income countries that comorbid mental illness is common and can adversely impact cancer outcomes. Little is known about this burden in LLMICs. This systematic review has two aims. The first is to review the prevalence and patterns of psychiatric comorbidity in adults with cancer in LLMICs. The second is to review psychiatric treatment outcomes in this population.Methods and analysisThe review will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A systematic search of electronic databases (MEDLINE, PsycInfo, Embase and CINAHL) will be conducted. Studies will be included if they report the prevalence of psychiatric comorbidity, or if they evaluate psychiatric treatment outcomes, in adults with cancer living in LLMICs. The search will be limited to studies published in peer-reviewed journals between March 2002 and March 2017. The reference lists of included studies will be hand searched. Critical appraisal will be performed using Quality Assessment Tools from the National Institute of Health. Pooled prevalence meta-analysis is planned.Ethics and disseminationEthics approval is not required as no primary data will be collected. The results will be presented at conferences and published in a peer-reviewed journal.Systematic review registrationPROSPERO CRD42017057103.

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Systematic review of therapeutic outcomes of multi-drug resistant tuberculosis and their predictors in adults receiving integrated treatment of tuberculosis and Human Immuno-deficiency Virus in low and middle-income countries: a study protocol

10.21203/rs.2.18219/v1 ◽

2019 ◽

Author(s):

Benjamin Momo Kadia ◽

Desmond Aroke ◽

Kevin Pene Njefi ◽

Yves Joel Tochie Noutakdie ◽

Frank-Leonel Tianyi ◽

...

Keyword(s):

Treatment Outcomes ◽

Meta Analysis ◽

Integrated Treatment ◽

Hiv Treatment ◽

Middle Income ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Therapeutic Outcomes ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb

Abstract Background: Programs that integrated tuberculosis (TB) and Human Immunodeficiency Virus (HIV) treatment aim to provide efficient treatment services and maximize successful treatment outcomes through the delivery of both TB and HIV treatment by one provider at the same time and location. However, multi-drug resistant tuberculosis (MDR-TB) is more difficult to treat as compared to drug-sensitive TB, and in low and middle-income countries (LMICs), the potential of programs integrating TB/HIV treatment to sustain favourable MDR-TB treatment outcomes is poorly elucidated. The objective of this review is to perform a systematic collection, critical appraisal and synthesis of existing evidence on therapeutic outcomes of MDR-TB and their predictors among adults receiving integrated treatment for TB/HIV in LMICs.Methods: A systematic review of evidence from published observational and interventional studies will be performed. The evidence will be obtained by searching Medline, Embase, and Global Health electronic databases with date limits being March 2004 and December 2019. Two investigators will independently screen the search output, review the eligible studies, and assess the quality of the eligible studies using appropriate quality assessment tools. Analysis and synthesis of data on TB treatment outcomes will be performed using random-effects meta-analysis on STATA-15 software. Data on predictors of TB treatment outcomes will be analysed using thematic analysis and synthesised using a descriptive approach and where appropriate, random-effects meta-analysis will be performed to obtain pooled effect sizes. The confidence in cumulative quantitative and qualitative evidence will be assessed using the appropriate versions of the Grading of Recommendations, Assessment, Development and Evaluation approach. The final review will be reported following the guidelines of the Preferred Reporting System for Systematic Reviews and Meta-analysis, presented at scientific conferences and published in a peer-reviewed journal.Discussion: This study is expected to highlight the quality of integrated TB/HIV treatment programs and their potential to uphold successful MDR-TB treatment outcomes. Furthermore, the review will indicate patient-related and healthcare-related factors that should be addressed to improve on survival of patients with MDR-TB/HIV co-infection in LMICs.Systematic review registration: This review has been submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO)

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Systematic review of therapeutic outcomes of multi-drug resistant tuberculosis and their predictors in adults receiving integrated treatment of tuberculosis and Human Immuno-deficiency Virus in low and middle-income countries: a study protocol

10.21203/rs.2.18219/v2 ◽

2020 ◽

Author(s):

Benjamin Momo Kadia ◽

Desmond Aroke ◽

Kevin Pene Njefi ◽

Joel Noutakdie Tochie ◽

Frank-Leonel Tianyi ◽

...

Keyword(s):

Systematic Review ◽

Treatment Outcomes ◽

Meta Analysis ◽

Integrated Treatment ◽

Hiv Treatment ◽

Middle Income ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb

Abstract Background: Programs that integrated tuberculosis (TB) and Human Immunodeficiency Virus (HIV) treatment aim to provide efficient treatment services and maximize successful treatment outcomes through the delivery of both TB and HIV treatment by one provider at the same time and location. However, multi-drug resistant tuberculosis (MDR-TB) is more difficult to treat as compared to drug-sensitive TB, and in low and middle-income countries (LMICs), the potential of programs integrating TB/HIV treatment to sustain favourable MDR-TB treatment outcomes is poorly elucidated. The objective of this review is to perform a systematic collection, critical appraisal and synthesis of existing evidence on therapeutic outcomes of MDR-TB and their predictors among adults receiving integrated treatment for TB/HIV in LMICs. Methods: A systematic review of evidence from published observational and interventional studies will be performed. The evidence will be obtained by searching Medline, Embase, and Global Health electronic databases with date limits being March 2004 and December 2019. Two investigators will independently screen the search output, review the eligible studies, and assess the quality of the eligible studies using appropriate quality assessment tools. Analysis and synthesis of data on TB treatment outcomes will be performed using random-effects meta-analysis on STATA-15 software. Data on predictors of TB treatment outcomes will be analysed using thematic analysis and synthesised using a descriptive approach and where appropriate, random-effects meta-analysis will be performed to obtain pooled effect sizes. The confidence in cumulative quantitative and qualitative evidence will be assessed using the appropriate versions of the Grading of Recommendations, Assessment, Development and Evaluation approach. The final review will be reported following the guidelines of the Preferred Reporting System for Systematic Reviews and Meta-analysis, presented at scientific conferences and published in a peer-reviewed journal. Discussion: This study is expected to highlight the quality of integrated TB/HIV treatment programs and their potential to uphold successful MDR-TB treatment outcomes. Furthermore, the review will indicate patient-related and healthcare-related factors that should be addressed to improve on survival of patients with MDR-TB/HIV co-infection in LMICs. Systematic review registration: This review has been submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO)

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