Community-Based Ototoxicity Monitoring for Drug-Resistant Tuberculosis in South Africa: An Evaluation Study

Stevenson, Lucia Jane; Jager, Leigh Biagio–de; Graham, Marien Alet; Swanepoel, De Wet

doi:10.3390/ijerph182111342

Cited by 7 publications

(3 citation statements)

References 29 publications

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“…As clear as this goal is, achieving it is not easy and has been met by numerous challenges. Evidence suggests that this failure is because of the lack of South African standardised investigative methods and ototoxicity monitoring practises, as well as an absence of a South African government mandate (Khoza-Shangase 2010aStevenson et al 2021).…”

Section: Contextmentioning

confidence: 99%

“…As far as the capacity versus demand challenge is concerned, the use of trained nonaudiological screeners (paraprofessionals) to implement OMPs adhering to recommended guidelines should be seriously considered. In a recent retrospective record review study by Stevenson et al (2021), an OMP conducted by CHWs was found to be limited as it fell short of meeting recommended guidelines such as performance of baseline measures, conducting repeated measures at recommended intervals and timeframes, inclusion of ultra high-frequency (UHF) measures, and other important recommendations, including efficient record-keeping that is crucial in an OMP. The author believes that this could have been because of the lack of training of CHWs and the lack of audiologists' involvement in the running and management of the programme that has been raised about this particular programme.…”

Section: Solutions and Recommendationsmentioning

confidence: 99%

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Tele-audiology and preventive audiology: A capacity versus demand challenge imperative in South Africa

Khoza-Shangase¹,

Sebothoma²

2022

Preventive Audiology: An African Perspective

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Peer review declarationThe publisher (AOSIS) endorses the South African 'National Scholarly Book Publishers Forum Best Practice for Peer Review of Scholarly Books'. The manuscript underwent an evaluation to compare the level of originality with other published works and was subjected to rigorous two-step peer review before publication, with the identities of the reviewers not revealed to the editor(s) or author(s). The reviewers were independent of the publisher, editor(s), and author(s). The publisher shared feedback on the similarity report and the reviewers' inputs with the manuscript's editor(s) or author(s) to improve the manuscript. Where the reviewers recommended revision and improvements, the editor(s) or author(s) responded adequately to such recommendations. The reviewers commented positively on the scholarly merits of the manuscript and recommended that the manuscript be published. v Research justificationPreventive health care, where preventive audiology is positioned, contains strategies adopted and implemented for disease and disorder prevention. Hearing function can be negatively impacted by numerous factors, including lifestyle choices, environmental factors, genetic predisposition, the burden of disease and other causes. Frequently, hearing impairment can be prevented and its consequences significantly minimised by preventive measures. Such prevention commands conscientiously deliberate anticipatory actions that can fall under primordial, primary, secondary or tertiary levels of prevention. South Africa, as a resource-constrained low-and middle-income country (LMIC), still has a challenge of high numbers of individuals with preventable hearing impairment from the cradle to the grave. Numerous strategies exist for the prevention of hearing impairment across all ages and in various contexts. Preventive Audiology: An African Perspective is an original scholarly book that introduces the concept of preventive audiology, with a specific focus on the African context, which is in line with the South African re-engineered primary health care strategy and the World Health Organization's approach. The book reflects on contextually relevant and responsive evidence-based perspectives, grounded in an African context on preventive audiology, in four major ear-and-hearing burdens of disease within the South African context, namely, (1) early hearing detection and intervention (EHDI), (2) middle ear pathologies, (3) ototoxicity and (4) noise-induced hearing loss (NIHL). The book represents innovative research, seen from both South African and global perspectives. It offers new discourse and argues for a paradigm shift in how audiology is theorised and performed, particularly in LMIC contexts. The goal of this book is to motivate for a paradigm shift in how ear-and-hearing health care is approached within this LMIC context, while also arguing for Afrocentric best practice evidence that leads to next practice. For Afrocentric epistemology, which is a different narrative that is deliberately removed from Western epi...

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Section: Contextmentioning

confidence: 99%

Section: Solutions and Recommendationsmentioning

confidence: 99%

Tele-audiology and preventive audiology: A capacity versus demand challenge imperative in South Africa

Khoza-Shangase¹,

Sebothoma²

2022

Preventive Audiology: An African Perspective

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“…The data collection procedure for this study was the same as for the larger study (Stevenson et al, 2021). The OMP protocol implemented at the time of data collection was as follows: all patients who received ototoxic medication for treatment of DRTB were identified and referred by their managing doctor and included in the OMP as part of the package of care.…”

Section: Data Collection Proceduresmentioning

confidence: 99%

A longitudinal community-based ototoxicity monitoring programme and treatment effects for drug-resistant tuberculosis treatment, Western Cape

Stevenson

Jager

Graham

et al. 2022

South African Journal of Communication Disorders

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Background: South Africa has a high burden of drug-resistant tuberculosis (DRTB) and until recently, ototoxic aminoglycosides were predominant in treatment regimens. Community-based ototoxicity monitoring programmes (OMPs) have been implemented for early detection of hearing loss and increased patient access.Objectives: A longitudinal study was conducted to describe the service delivery characteristics of a community-based OMP for DRTB patients facilitated by CHWs as well as observed ototoxic hearing loss in this population.Method: A descriptive retrospective record review of longitudinal ototoxicity monitoring of 194 DRTB patients undergoing treatment at community-based clinics in the city of Cape Town between 2013 and 2017.Results: Follow-up rates between consecutive monitoring assessments reached as high as 80.6% for patients assessed by CHWs. Few patients (14.2% – 32.6%) were assessed with the regularity (≥ 6 assessments) and frequency required for effective ototoxicity monitoring, with assessments conducted, on average, every 53.4–64.3 days. Following DRTB treatment, 51.5% of patients presented with a significant ototoxic shift meeting one or more of the American Speech-Language-Hearing Association (ASHA) criteria. Deterioration in hearing thresholds was bilateral and most pronounced at high frequencies (4 kHz – 8 kHz). The presence of pre-existing hearing loss, human immunodeficiency virus co-infection and a history of noise exposure were significant predictors of ototoxicity in patients.Conclusion: DRTB treatment with kanamycin resulted in significant deterioration of hearing longitudinally, predominantly at high frequencies. With ongoing training and supportive supervision, CHWs can facilitate community-based ototoxicity monitoring of DRTB patients. Current protocols and guidelines may require reassessment for appropriate community-based ototoxicity monitoring.

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Extended High-Frequency Audiometry for Ototoxicity Monitoring: A Longitudinal Evaluation of Drug-Resistant Tuberculosis Treatment

et al. 2023

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Purpose: The aim of this study was to describe extended high-frequency (EHF) pure-tone audiometry monitoring of ototoxicity in a longitudinal treatment program for drug-resistant tuberculosis (DRTB). Method: This was a retrospective record review of longitudinal conventional (0.25–8 kHz) and EHF (9–16 kHz) audiometry for ototoxicity monitoring of DRTB patients undergoing treatment at community-based clinics between 2013 and 2017. Data from 69 patients with an average age of 37.9 years ( SD = 11.2, range: 16.0–63.8 years) were included. Patients were assessed by primary health care audiologists (87%) or community health workers (13%) using portable audiological equipment. The average length of time between initial and exit assessments was 84.6 days ( SD = 74.2, range: 2–335 days). Results: EHF ototoxicity of a mild or greater degree of hearing loss (> 25 dB HL in one or both ears across frequencies) was evident in 85.5% of patients' posttreatment, compared with 47.8% of patients across conventional frequencies. EHF audiometry demonstrated an ototoxic shift (American Speech-Language-Hearing Association criteria) in 56.5% of cases compared with 31.9% when only conventional audiometry was considered. Mean hearing deterioration for patients was significant across EHFs (9–16 kHz) bilaterally ( p < .05). Absent EHF thresholds at the initial assessment, owing to maximum output limits, was a limitation that occurred most frequently at 16 kHz (17.4%, 24/138). Conclusions: EHF audiometry is most sensitive for the early detection of ototoxicity and should be included in monitoring programs. Clinical ototoxicity monitoring protocols should consider shortened assessment approaches that target frequencies most sensitive to ototoxicity, including EHFs. Supplemental Material: https://doi.org/10.23641/asha.21651242

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Community-Based Ototoxicity Monitoring for Drug-Resistant Tuberculosis in South Africa: An Evaluation Study

Cited by 7 publications

References 29 publications

Tele-audiology and preventive audiology: A capacity versus demand challenge imperative in South Africa

Tele-audiology and preventive audiology: A capacity versus demand challenge imperative in South Africa

A longitudinal community-based ototoxicity monitoring programme and treatment effects for drug-resistant tuberculosis treatment, Western Cape

Extended High-Frequency Audiometry for Ototoxicity Monitoring: A Longitudinal Evaluation of Drug-Resistant Tuberculosis Treatment

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