scholarly journals Interventions to improve retention-in-care and treatment adherence among patients with drug-resistant tuberculosis: a systematic review

2018 ◽  
Vol 53 (1) ◽  
pp. 1801030 ◽  
Author(s):  
Stephanie Law ◽  
Amrita Daftary ◽  
Max O'Donnell ◽  
Nesri Padayatchi ◽  
Liviana Calzavara ◽  
...  
Keyword(s):  
Systematic Review ◽  
Psychosocial Support ◽  
Retention In Care ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Material Support ◽  
Loss To Follow Up ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Likelihood Approach

The global loss to follow-up (LTFU) rate among drug-resistant tuberculosis (DR-TB) patients remains high at 15%. We conducted a systematic review to explore interventions to reduce LTFU during DR-TB treatment.We searched for studies published between January 2000 and December 2017 that provided any form of psychosocial or material support for patients with DR-TB. We estimated point estimates and 95% confidence intervals of the proportion LTFU. We performed subgroup analyses and pooled estimates using an exact binomial likelihood approach.We included 35 DR-TB cohorts from 25 studies, with a pooled proportion LTFU of 17 (12–23)%. Cohorts that received any form of psychosocial or material support had lower LTFU rates than those that received standard care. Psychosocial support throughout treatment, via counselling sessions or home visits, was associated with lower LTFU rates compared to when support was provided through a limited number of visits or not at all.Our review suggests that psychosocial support should be provided throughout DR-TB treatment in order to reduce treatment LTFU. Future studies should explore the potential of providing self-administered therapy complemented with psychosocial support during the continuation phase.

scholarly journals The effect of human immunodeficiency virus infection on adverse events during treatment of drug-resistant tuberculosis: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248017
Author(s):  
Gilbert Lazarus ◽  
Kevin Tjoa ◽  
Anthony William Brian Iskandar ◽  
Melva Louisa ◽  
Evans L. Sagwa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Human Immunodeficiency Virus ◽  
Adverse Events ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Immunodeficiency Virus

Background Adverse events (AEs) during drug-resistant tuberculosis (DR-TB) treatment, especially with human immunodeficiency virus (HIV) co-infection, remains a major threat to poor DR-TB treatment adherence and outcomes. This meta-analysis aims to investigate the effect of HIV infection on the development of AEs during DR-TB treatment. Methods Eligible studies evaluating the association between HIV seropositivity and risks of AE occurrence in DR-TB patients were included in this systematic review. Interventional and observational studies were assessed for risk of bias using the Risk of Bias in Nonrandomized Studies of Intervention and Newcastle-Ottawa Scale tool, respectively. Random-effects meta-analysis was performed to estimate the pooled risk ratio (RR) along with their 95% confidence intervals (CIs). Results A total of 37 studies involving 8657 patients were included in this systematic review. We discovered that HIV infection independently increased the risk of developing AEs in DR-TB patients by 12% (RR 1.12 [95% CI: 1.02–1.22]; I2 = 0%, p = 0.75). In particular, the risks were more accentuated in the development of hearing loss (RR 1.44 [95% CI: 1.18–1.75]; I2 = 60%), nephrotoxicity (RR 2.45 [95% CI: 1.20–4.98], I2 = 0%), and depression (RR 3.53 [95% CI: 1.38–9.03]; I2 = 0%). Although our findings indicated that the augmented risk was primarily driven by antiretroviral drug usage rather than HIV-related immunosuppression, further studies investigating their independent effects are required to confirm our findings. Conclusion HIV co-infection independently increased the risk of developing AEs during DR-TB treatment. Increased pharmacovigilance through routine assessments of audiological, renal, and mental functions are strongly encouraged to enable prompt diagnosis and treatment in patients experiencing AEs during concomitant DR-TB and HIV treatment.

scholarly journals Trends, Characteristics and Treatment Outcomes of Patients with Drug-Resistant Tuberculosis in Uzbekistan: 2013–2018

2021 ◽  
Vol 18 (9) ◽  
pp. 4663
Author(s):  
Khasan Safaev ◽  
Nargiza Parpieva ◽  
Irina Liverko ◽  
Sharofiddin Yuldashev ◽  
Kostyantyn Dumchev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Outcomes ◽  
Treatment Success ◽  
National Level ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Loss To Follow Up ◽  
Resistant Tuberculosis ◽  
Mdr Tb

Uzbekistan has a high burden of drug-resistant tuberculosis (TB). Although conventional treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) has been available since 2013, there has been no systematic documentation about its use and effectiveness. We therefore documented at national level the trends, characteristics, and outcomes of patients with drug-resistant TB enrolled for treatment from 2013–2018 and assessed risk factors for unfavorable treatment outcomes (death, failure, loss to follow-up, treatment continuation, change to XDR-TB regimen) in patients treated in Tashkent city from 2016–2017. This was a cohort study using secondary aggregate and individual patient data. Between 2013 and 2018, MDR-TB numbers were stable between 2347 and 2653 per annum, while XDR-TB numbers increased from 33 to 433 per annum. At national level, treatment success (cured and treatment completed) for MDR-TB decreased annually from 63% to 57%, while treatment success for XDR-TB increased annually from 24% to 57%. On multivariable analysis, risk factors for unfavorable outcomes, death, and loss to follow-up in drug-resistant TB patients treated in Tashkent city included XDR-TB, male sex, increasing age, previous TB treatment, alcohol abuse, and associated comorbidities (cardiovascular and liver disease, diabetes, and HIV/AIDS). Reasons for these findings and programmatic implications are discussed.

scholarly journals The Prevalence of Drug-Resistant Tuberculosis in Mainland China: An Updated Systematic Review and Meta-Analysis

PLoS ONE ◽  
2016 ◽  
Vol 11 (2) ◽  
pp. e0148041 ◽  
Author(s):  
Qionghong Duan ◽  
Zi Chen ◽  
Cong Chen ◽  
Zhengbin Zhang ◽  
Zhouqin Lu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Mainland China ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis

Status of drug-resistant tuberculosis in China: A systematic review and meta-analysis

2016 ◽  
Vol 44 (6) ◽  
pp. 671-676 ◽  
Author(s):  
Jingya Zhang ◽  
Haimei Gou ◽  
Xuejiao Hu ◽  
Xin Hu ◽  
Mengqiao Shang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis

scholarly journals Addressing the drug resistant tuberculosis challenge through implementing a mixed model of care in Uganda, 2012- 2017

2019 ◽  
Author(s):  
Samuel Kasozi ◽  
Nicholas Sebuliba Kirirabwa ◽  
Derrick Kimuli ◽  
Henry Luwaga ◽  
Enock Kizito ◽  
...  
Keyword(s):  
Mixed Model ◽  
Treatment Initiation ◽  
Treatment Success ◽  
Scale Up ◽  
Sub Saharan Africa ◽  
Drug Resistant ◽  
Model Of Care ◽  
Drug Resistant Tuberculosis ◽  
Tb Treatment ◽  
Resistant Tuberculosis

Abstract Background Worldwide, Drug resistant Tuberculosis (DR-TB) remains a big problem; the diagnostic capacity has superseded the DR-TB clinical management capacity thereby causing ethical challenges. In Sub-Saharan Africa, treatment is either inadequate or lacking and some diagnosed patients are on treatment waiting lists. In Uganda, various health system challenges impeded scale up of DR-TB care in 2012; only three treatment initiation facilities existed, with only 41 of the estimated 1010 cases enrolled on treatment yet 300 were on the waiting list and there was no DR-TB treatment scale up plan. To scale up care, National TB/Leprosy Program (NTLP) with partners rolled out a DR-TB mixed model of care. In this paper, we share achievements and outcomes resulting from the implementation of this mixed Model of DR-TB care. Methods Routine NTLP DR-TB program data from 2013 to 2017 cohorts was collected from all the 15 DR-TB treatment initiation sites and analyzed using STATA version 14.2. We presented outcomes as the number of patient backlog cleared, DR-TB initiation sites, cumulative patients enrolled, percentage of co-infected patients on co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) as well as the six, twelve interim and 24 months treatment outcomes as per the Uganda NTLP 2016 Programmatic Management of drug Resistant Tuberculosis (PMDT) guidelines. Results Over the period 2013-2017, DR-TB treatment initiation sites increased from three to 15, cumulative patient enrollment rose from 41 to 1,311 and the 300-patient backlog was cleared. Treatment success rate (TSR) of 73% was achieved above the global TSR average rate of 50%. Conclusions The Uganda DR-TB mixed model of care coupled with early application of continuous improvement approaches, enhanced cohort reviews and use of multi-disciplinary teams allowed for rapid DR-TB program expansion, rapid clearance of patient backlog, attainment of high cumulative enrollment and high treatment success rates. Sustainability of these achievements is needed to further reduce the DR-TB burden in the country. We highly recommend this mixed model of care in settings with similar challenges.

scholarly journals Combined treatment of drug-resistant tuberculosis with bedaquiline and delamanid: a systematic review

2018 ◽  
Vol 52 (1) ◽  
pp. 1800934 ◽  
Author(s):  
Emanuele Pontali ◽  
Giovanni Sotgiu ◽  
Simon Tiberi ◽  
Marina Tadolini ◽  
Dina Visca ◽  
...  
Keyword(s):  
Systematic Review ◽  
Combined Treatment ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis

scholarly journals Prevalence and factors associated with non-adherence to multi-drug resistant tuberculosis (MDR-TB) treatment at Mulago National Referral Hospital, Kampala, Uganda

2021 ◽  
Vol 21 (1) ◽  
pp. 238-47
Author(s):  
Charles Batte ◽  
Martha S Namusobya ◽  
Racheal Kirabo ◽  
John Mukisa ◽  
Susan Adakun ◽  
...  
Keyword(s):  
Mulago Hospital ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Factors Associated ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb ◽  
History Of ◽  
Previously Treated

Background: In Uganda, 12% of previously treated TB cases and 1.6% of new cases have MDR-TB and require specialized treatment and care. Adherence is crucial for improving MDR-TB treatment outcomes. There is paucity of information on the extent to which these patients adhere to treatment and what the drivers of non-adherence are. Methods: We conducted a cohort study using retrospectively collected routine program data for patients treated for MDR- TB between January 2012 – May 2016 at Mulago Hospital. We extracted anonymized data on non-adherence (missing 10% or more of DOT), socio-economic, demographic, and treatment characteristics of the patients. All participants were sen- sitive to MDR-TB drugs after second line Drug Susceptible Testing (DST) at entry into the study. Factors associated with non-adherence to MDR-TB treatment were determined using generalized linear models for the binomial family with log link and robust standard errors. We considered a p- value less than 0.05 as statistically significant. Results: The records of 227 MDR- TB patients met the inclusion criteria, 39.4% of whom were female, 32.6% aged be- tween 25 – 34 years, and 54.6% living with HIV/AIDS. About 11.9% of the patients were non-adherent. The main driver for non-adherence was history of previous DR-TB treatment; previously treated DR-TB patients were 3.46 (Adjusted prev- alence ratio: 3.46, 95 % CI: 1.68 - 7.14) times more likely to be non-adherent. Conclusion: One in 10 MDR-TB patients treated at Mulago hospital is non-adherent to treatment. History of previous DR- TB treatment was significantly associated with non-adherence in this study. MDR-TB program should strengthen adherence counselling, strengthen DST surveillance, and close monitoring for previously treated DR-TB patients. Keywords: Non-adherence; multi-drug resistant tuberculosis; treatment.

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