Community-based MDR-TB care project improves treatment initiation in patients diagnosed with MDR-TB in Myanmar

Wai, Pyae Phyo; Shewade, Hemant Deepak; Kyaw, Nang Thu Thu; Thein, Soe; Thu, Aung; Kyaw, Khine Wut Yee; Aye, Nyein Nyein; Phyo, Aye Mon; Maung, Htet Myet Win; Soe, Kyaw; Aung, Si Thu

doi:10.1371/journal.pone.0194087

Cited by 13 publications

(14 citation statements)

References 12 publications

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“…This may be tried at least for those patients who are not ill at diagnosis [16]. A community-based MDR-TB care model may be tried to improve treatment initiation as reported in Myanmar [26]. There is a need to move towards reducing the mandatory inpatient care for two months which could be a potential barrier to take treatment.…”

Section: Discussionmentioning

confidence: 99%

Attrition and delays before treatment initiation among patients with MDR-TB in China (2006-13): Magnitude and risk factors

Xu¹,

Li²,

Shewade

et al. 2019

PLoS ONE

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Background China’s national tuberculosis programme does not have cohort wise information regarding attrition and delays in the multidrug resistant tuberculosis (MDR-TB) diagnosis and treatment pathway. Objective Under the Global Fund programmatic management of drug-resistant TB (2006–13), we assessed the attrition and delay in the pathway and the factors associated. Methods Cohort study involving secondary programme data. All patients identified as presumptive MDR-TB (defined as i) previously treated TB patients which included recurrent TB, return after loss to follow up, treatment after failure and ii) new TB patients that were non-converters at three months of treatment or in close contact with a known MDR-TB patient) during October 2006 to June 2013 were eligible for phenotypic drug susceptibility testing (DST). Pre-diagnosis attrition (presumptive MDR-TB not undergoing culture and DST) and pre-treatment attrition (confirmed MDR-TB patients not initiated on treatment) was calculated. Diagnosis delay was the time interval from DST eligibility to DST result, treatment initiation delay was fom DST result to treatment initiation and total delay was from DST eligbility to treatment initiation. Factors associated with attrition and delay were identified using log binomial regression and linear regression, respectively. Results Of 78 564 presumptive MDR-TB patients, 2 470 (3.1%) underwent pre-diagnosis attrition. Of 9 283 MDR-TB patients, 3 361 (36.2%) underwent pre-treatment attrition. Median(IQR) diagnosis delay was 84 (64, 114) days; treatment initation delay was 23(6,68) days and total delay was 117(77,187) days. Long diagnosis delay was an independent predictor of pre-treatment attrition in a dose response relationship. While pre-treatment attrition was less likely among presumptive criterion ‘previously treated’ and with increasing time period, it was more likey among elderly and in east and west region. While the diagnosis delay increased with time period, treatment initiation delay and total delay reduced with time period. Short diagnosis delay was associated with west region, smear negative patients and presumptive criterion ‘treatment after lost to follow up’. Short treatment initiation delay was associatied with east and west regions while long treatment initiation delay was associated with elderly and presumptive criterion ‘recurrent TB’. Total delay predictors were similar to treatment initiation delay. In addition, short total delay was associated with presumptive criterion ‘treatment after failure’. Conclusion The diagnosis and treatment delay were long and the pre-treatment attrition was considerable high. Long diagnosis delay is likely to predict pre-treatment attrition.

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Section: Discussionmentioning

confidence: 99%

Attrition and delays before treatment initiation among patients with MDR-TB in China (2006-13): Magnitude and risk factors

Xu¹,

Li²,

Shewade

et al. 2019

PLoS ONE

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“…The CBMDR-TBC project was started in 2015 in collaboration with The Union and NTP to support the treatment initiation and adherence among MDR-TB patients in 33 townships across four states/regions in the upper part of Myanmar. Details of the CBMDR-TBC project have been described elsewhere [10]. Briefly, under the project, each township has a focal nurse who visits the index MDR-TB patients' house monthly to monitor treatment adherence and side effects and provide health education and psychosocial support.…”

Section: Project Description and The Implementation Of Systematic Scrmentioning

confidence: 99%

Outcomes of Community-Based Systematic Screening of Household Contacts of Patients with Multidrug-Resistant Tuberculosis in Myanmar

Kyaw¹,

Aung²,

Satyanarayana

et al. 2019

TropicalMed

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Screening of household contacts of patients with multidrug-resistant tuberculosis (MDR-TB) is a crucial active TB case-finding intervention. Before 2016, this intervention had not been implemented in Myanmar, a country with a high MDR-TB burden. In 2016, a community-based screening of household contacts of MDR-TB patients using a systematic TB-screening algorithm (symptom screening and chest radiography followed by sputum smear microscopy and Xpert-MTB/RIF assays) was implemented in 33 townships in Myanmar. We assessed the implementation of this intervention, how well the screening algorithm was followed, and the yield of active TB. Data collected between April 2016 and March 2017 were analyzed using logistic and log-binomial regression. Of 620 household contacts of 210 MDR-TB patients enrolled for screening, 620 (100%) underwent TB symptom screening and 505 (81%) underwent chest radiography. Of 240 (39%) symptomatic household contacts, 71 (30%) were not further screened according to the algorithm. Children aged <15 years were less likely to follow the algorithm. Twenty-four contacts were diagnosed with active TB, including two rifampicin- resistant cases (yield of active TB = 3.9%, 95% CI: 2.3%–6.5%). The highest yield was found among children aged <5 years (10.0%, 95% CI: 3.6%–24.7%). Household contact screening should be strengthened, continued, and scaled up for all MDR-TB patients in Myanmar.

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“…Patients with MDR-TB on domiciliary care in programmatic settings in Myanmar: Effect of a support package on preventing early deaths 13 This study found that among 261 patients initiated on multidrug-resistant TB (MDR-TB) treatment in study townships, "receiving support" and "receiving partial support" from community-based MDR-TB Care Project had 20% [aHR (0.95 CI: 0.8 (0.2-3.1)] and 90% lower hazard [aHR (0.95 CI: 0.1 (0.02-0.9)] of death compared to those who did not receive support. The author concluded that the support may prevent early death and recommended the expansion of a similar type of support to other townships.…”

Section: Plos Onementioning

confidence: 99%

Operational Research Capacity Building through the Structured Operational Research and Training Initiative (SORT IT) Model in Myanmar: National Operational Research Course (2016-17)

2019

myanmarhsrj

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Community-based MDR-TB care project improves treatment initiation in patients diagnosed with MDR-TB in Myanmar

Cited by 13 publications

References 12 publications

Attrition and delays before treatment initiation among patients with MDR-TB in China (2006-13): Magnitude and risk factors

Attrition and delays before treatment initiation among patients with MDR-TB in China (2006-13): Magnitude and risk factors

Outcomes of Community-Based Systematic Screening of Household Contacts of Patients with Multidrug-Resistant Tuberculosis in Myanmar

Operational Research Capacity Building through the Structured Operational Research and Training Initiative (SORT IT) Model in Myanmar: National Operational Research Course (2016-17)

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