“When Treatment Is More Challenging than the Disease”: A Qualitative Study of MDR-TB Patient Retention

Shringarpure, Kalpita; Isaakidis, Petros; Sagili, Karuna D.; Baxi, R. K.; Das, Mrinalini; Daftary, Amrita

doi:10.1371/journal.pone.0150849

Cited by 73 publications

(89 citation statements)

References 25 publications

(32 reference statements)

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“…It is also unclear the manner in which shorter treatment regimens with more potent antimicrobials would impact this outcome. While it is theorized that the newer short-course, all oral, RR-TB regimen will improve adherence and reduce loss to follow-up, the treatment related adverse events (14), drug-drug interactions (15) and pill burden (16) of an all oral regimen may complicate treatment needs. Despite these challenges, data from SA and other Sub-Saharan African countries on task-sharing between MOs and nurses is clear for both HIV (17,18) and drug-susceptible TB (19) -outcomes are equivalent.…”

Section: Discussionmentioning

confidence: 99%

Preparing the healthcare workforce in South Africa for short-course rifampicin-resistant TB treatment: Inter-professional training and task-sharing considerations

Stamper

Mlandu

Lowensen

et al. 2020

Preprint

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Background: Treatment for rifampicin-resistant Mycobacterium tuberculosis (RR-TB) is complex, however, shorter treatment, with newer antimicrobials are improving treatment outcomes. The South African National Department of Health (NDoH) recently accelerated the rollout of 9-month, all oral, RR-TB short-course regimens. We sought to evaluate an inter-professional training program using pre-test and post-test performance of Professional Nurses (PNs), Advanced Practice Professional Nurses (APPNs) and Medical Officers (MOs) to inform: a) training needs across cadres; b) knowledge performance, by cadres; and c) training differences in knowledge by nurse type. Methods: A 4-day didactic and case-based clinical decision support course for RR-TB regimens in South Africa (SA) was developed, reviewed and nationally accredited. Between February 2017 and July 2018, 12 training events were held. Clinicians who may initiate RR-TB treatment, specifically MOs and PN/APPNs with matched pre-post tests and demographic surveys were analyzed. Descriptive statistics are provided. Pre-post test evaluations included 25 evidence-based clinically related questions about RR-TB diagnosis, treatment, and care. Results: Participants (N=842) participated in testing, and matched evaluations were received for 800 (95.0%) training participants. Demographic data was available for 793 (99.13%) participants, of whom 762 (96.1%) were MOs, or nurses, either PN or APPNs. Average correct response pre-test and post-test scores were 61.7% (range 7-24 correct responses) and 85.9% (range 12-25), respectively. Overall, 95.8% (730/762) of participants demonstrated improved knowledge. PNs improved on average 25% (6.22 points) whereas MOs improved 10% (2.89 points) with better mean test scores on both pre- and post-test (p<0.000). APPNs performed the same as the MOs on post-test scores (p=NS). Conclusions: The inter-professional training program in short-course RR-TB treatment improved knowledge for participants. MOs had significantly greater pre-test scores. Of the nurses, APPNs outperformed other PNs, and performed equally to MOs on post-test scores, suggesting this advanced cadre of nurses might be the most appropriate to initiate and monitor treatment in close collaboration with MOs. All cadres of nurse reported the need for additional clinical training and mentoring prior to managing such patients.

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Section: Discussionmentioning

confidence: 99%

Preparing the healthcare workforce in South Africa for short-course rifampicin-resistant TB treatment: Inter-professional training and task-sharing considerations

Stamper

Mlandu

Lowensen

et al. 2020

Preprint

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“…The high multidrug-resistant or rifampicin-resistant tuberculosis burden and poor patient outcomes highlight the need for safe and effective, less toxic, shorter, and less costly treatment regimens for these populations. 67,[259][260][261][262] Encouragingly, two new drugs (bedaquiline and delamanid) are available for use in the treatment of multidrug-resistant or rifampicin-resistant tuberculosis. [263][264][265] These drugs, along with drugs repurposed for tuberculosis (including linezolid and clofazimine) and pretomanid (a similar drug to delamanid), are included in a range of new, shorter, all-oral regimens being tested in clinical trials for multidrug-resistant or rifampicin-resistant tuberculosis.…”

Section: Improving Drug-resistant Tuberculosis Treatmentmentioning

confidence: 99%

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

et al. 2019

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growing political momentum to definitively address tuberculosis, could all make ending the pandemic within a generation more feasible than ever before. Moving forward with bold, comprehensive strategies Globally, the priority must be to deliver person-centred and family-centred services to all individuals with tuberculosis who present to care. This approach means ensuring that high-quality diagnostics, treatment, and prevention modalities are available to all, wherever they seek care. Improving quality of tuberculosis care in the private sector is crucial to end tuberculosis in high incidence countries such as India, the country with the highest tuberculosis burden. Modelling shows that optimising private sector engagement in India could avert 8 million deaths from tuberculosis between 2019 and 2045 (appendix p 3). In high drug-resistant tuberculosis burden countries, access to rapid drug susceptibility testing (DST) and second-line drugs is essential to success. In Moldova, where more than 25% of all tuberculosis cases are drug-resistant, improving access to DST and second-line drugs would reduce mortality from drug-resistant tuberculosis by 44% in the coming generation (appendix p 3). Secondly, tuberculosis programme budgets must increase to enable reaching these people and populations at high risk of tuberculosis. In Kenya, for example, where the proportions of HIV and tuberculosis coinfection are high, scaling up access to both antiretroviral therapy and tuberculosis preventive therapy can help save an additional 3 million lives over the next generation (appendix p 3). However, ultimately, the fight against tuberculosis will not be won unless countries also ensure that everyone, not just high-risk groups, can access essential health Key messages The Commission recommends five priority investments to achieve a tuberculosis-free world within a generation. These investments are designed to fulfil the mandate of the UN High Level Meeting on tuberculosis. In addition, they answer the question of how countries with high-burden tuberculosis and their development partners should target their future investments to ensure that ending tuberculosis is achievable. Invest first to ensure that high quality rapid diagnostics and treatment are provided to all individuals receiving care for tuberculosis, wherever they seek care This priority includes rapid drug susceptibility testing and second-line treatment for resistant forms of tuberculosis. Achieving universal, high-quality person-centred and family-centred care-including sustained improvement in the performance of private sector providers-usually should be the top policy and budget priority. Reach people and populations at high risk for tuberculosis (such as household and other close contacts of people with tuberculosis, and people with HIV) and bring them into care Active case-finding and treatment in high-risk populations demands adequate resources to reach and care for these populations. At the same time, reaching certain high-risk populations, such as people co-infec...

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“…Treatment regularity is believed and expected to reduce the incidences of resistance to TB medications (Eastment et al, 2017;Tupasi et al, 2017;Zhang et al, 2015). Shringarpure et al (2016) mentioned that geographic location also influence patients' adherence in TB treatment. The road condition makes it difficult to go to healthcare facilities or because the distance is too far makes TB patients are reluctant to have medical examination in reliable health care facilities.…”

Section: The Association Between Perceivedmentioning

confidence: 99%

Health Belief Model and PRECEDE PROCEED on the Risk Factors of Multidrug Resistant Tuberculosis in Surakarta, Central Java

Vera

Rahardjo

Murti

2017

J EPIDEMIOL PUBLIC HEALTH

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Background: Tuberculosis (TB) is one of the lethal infectious diseases in the world. One of the current biggest challenges of Tuberculosis control is the widespread emergence of Multidrug Resistant Tuberculosis (MDR-TB). There are several potential risk factors of MDR-TB that can be explained by Health Belief Model and PRECEDE PROCEED model framework. This study aimed to analyzed factors associated with MDR-TB using Health Belief Model and PRECEDE PROCEED. Subjects and Method:This was an analytic observational study with case control design. The study was conducted at Dr. Moewardi Hospital and BBKPM, Surakarta, from September to November 2017. The study subjects were selected using fixed disease sampling, consisting of 76 MDR-TB patients and 228 TB patients. The dependent variable was MDR-TB. The independent variables were educational level, self-efficacy, drug-taking adherence, smoking, nutritional status, perceived of susceptibility, perceived barrier, perceived severity, perceived benefit, and drug-taking supervisor. The data were collected using questionnaire and analyzed by path analysis. Results: The risk of MDR-TB was increased by lack of drug-taking adherence (b= -1.69; 95% CI= -2.28 to -1.09; p <0.001), poor nutritional status (b= 1.32; 95% CI= 0.72 to 1.92; p<0.001), and smoking (b= 1.32; 95% CI= 0.72 to 1.92; p <0.001). Drug-taking adherence was increased by perceived susceptibility (b= 0.91; 95% CI= 0.18 to 1.63; p=0.015), perceived severity (b= 1.01; 95% CI= 0.28 to 1.74; p=0.007), perceived benefit (b= 1.69; 95% CI= 0.97 to 2.41; p<0.001), drugtaking advisor (b= 2.16; 95% CI= 1.44 to 2.88; p<0.001), self efficacy (b= 1.58; 95% CI= 0.86 to 2.31; p<0.001), and low perceived barrier (b= -1.10; 95% CI= -1.82 to -0.38; p=0.003). Conclusion:The risk of MDR-TB is increased by the lack of drug-taking adherence, poor nutritional status, and smoking.

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“When Treatment Is More Challenging than the Disease”: A Qualitative Study of MDR-TB Patient Retention

Cited by 73 publications

References 25 publications

Preparing the healthcare workforce in South Africa for short-course rifampicin-resistant TB treatment: Inter-professional training and task-sharing considerations

Preparing the healthcare workforce in South Africa for short-course rifampicin-resistant TB treatment: Inter-professional training and task-sharing considerations

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

Health Belief Model and PRECEDE PROCEED on the Risk Factors of Multidrug Resistant Tuberculosis in Surakarta, Central Java

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