Determinants of treatment outcomes in patients with multidrug-resistant TB

Burhan, Erlina; Soepandi, Priyanti Zuswayudha; Isbaniah, Fathiyah; Damayanti, Kusmadewi Eka; Edwar, S Q; Maruli, M F; Ralena, Nadhira Anindita; Susanto, AP

doi:10.5588/ijtld.21.0351

Cited by 6 publications

(6 citation statements)

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“…While age 44 years or over (15.7%), HIV positive status (14.7%), earning some income (24.7%), and being on long regimen at the end of treatment (14.3%) were associated with increased odds of dying from DR-TB, in the adjusted regression, only HIV and earning some income signi cantly predicted DR-TB fatality. These nding are similar to those reported in another study where advancing age, HIV infection and diabetes mellitus were associated with poor outcomes and death (27). The WHO also reported that T2DM, HIV, undernutrition, advancing age (> 45 years) and the effects of alcohol abuse were associated with poor outcomes (1) and may re ect immune dysfunction among patients.…”

Section: Discussionsupporting

confidence: 87%

“…Research conducted in Tanzania, Indonesia and elsewhere have reported similar ndings. In terms of time-to-event for poor treatment outcomes among DR-TB patients, Silva et al (37) found that advanced age (> 45 years), DM and HIV were independently associated with poor outcomes within seven months of treatment, while low BMI (< 18kg/m 2 ) and history of LTFU predicted poor outcomes after seven months of treatment (27,37,38).…”

Section: Discussionmentioning

confidence: 99%

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Determinants and Outcomes of the Decentralised Management of Patients With Drug-resistant Tuberculosis in the O.r Tambo District Municipality, Eastern Cape, South Africa, a Cohort Study

JO,

PATHER

2024

Preprint

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Background Drug resistant tuberculosis (DR-TB) continues to plague the global community, particularly sub-Saharan Africa, with South Africa bearing a high burden of the disease. Several strategies have been developed and recommended for implementation to improve the outlook of DR-TB management. In 2018, the O.R. Tambo District Municipality implemented a decentralised community-based DR-TB care model. This study aimed to evaluate the effectiveness of the model, with the specific objective of identifying the determinants of successful community-based DR-TB management in the district. Methods A prospective longitudinal cohort study was conducted, enrolling all patients diagnosed with DR-TB in the O.R. Tambo District Municipality, with most managed at five decentralised sites in the district and some managed at the centralised Nkqubela Chest Hospital in the Buffalo City Metropolitan Municipality. Results A total of 454 patients from six facilities (five decentralised and one centralised) from 2018 to 2020 participated in the study. Their average age was 37.54 years (SD=14.94). There was a preponderance of males in the cohort, at 56.2%, and 62.9% were HIV positive. The combined treatment success was 62.4%, with 34.3% of patients being cured of DR-TB and 28.1% completing their treatment. In total, 11.1% of the cohort died during the study period, and 9.6% were reported as loss to follow-up (LTFU). There were no statistically significant differences between outcomes among patients seen at the decentralised district level and those managed at the centralised specialist hospital. Conclusion The decentralised community DR-TB care model was effective, as revealed in the treatment success rate of 62.4% and low reported deaths and patient LTFU. In addition, the decentralised care model was not inferior in any respect to the centralised management of DR-TB. Contribution: This study furthered our understanding of the impact and effectiveness (improved treatment success and low loss to follow up) of the decentralised community management of DR-TB in the OR Tambo district.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Determinants and Outcomes of the Decentralised Management of Patients With Drug-resistant Tuberculosis in the O.r Tambo District Municipality, Eastern Cape, South Africa, a Cohort Study

JO,

PATHER

2024

Preprint

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“…This is similar to ndings from a systematic review and meta-analysis on treatment outcomes for DR-TB patients on a communitybased model of careof studies on found that age was not a signi cant contributor to treatment outcomes irrespective of the model of care (20). However, in some instances, advanced age has been found to be signi cantly associated with unfavorable outcomes among MDR-TB (32)(33)(34). The ndings in our study could be explained by the fact that the majority (78.9%) of the study participants were less than 45 years of age.…”

Section: Discussionsupporting

confidence: 85%

Community-based directly observed therapy is effective and results in better treatment outcomes for patients with multi-drug resistant tuberculosis in Uganda

Makabayi-Mugabe,

Musaazi,

Zawedde-Muyanja

et al. 2023

Preprint

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Background: Health facility-based directly observed therapy (HF DOT) is the main strategy for the management of patients with drug-resistant tuberculosis (DR TB) in Uganda, however, this still yields sub-optimal treatment outcomes. We set out to assess the effectiveness of community-based directly observed therapy (CB DOT) for the treatment of DR TB in Uganda. Methods: Using a previously developed patient-centered model for CB DOT, we assigned community health workers (CHWs) as primary caregivers to patients diagnosed with DR TB. CHWs administered daily DOT to patients in their homes. Once a month, patients received travel vouchers to attend clinic visits for treatment monitoring. We assessed the effectiveness of this model using a quasi-experimental pre and post-study. From December 2020 to March 2022, we enrolled adult DR-TB patients on the CB DOT model. We collected retrospective data from patients who had received care using the HF DOT model during the year before the study started. The adjusted effect of CB DOT versus HF DOT on DR TB treatment success was estimated using modified Poisson regression model with robust cluster variance estimator. Results: We analyzed data from 264 DR TB patients (152 HF DOT, 112 CB DOT). The majority were males (67.8%) with a median age of 36 years (IQR 29 to 44 years). Baseline characteristics were similar across the comparison groups, except for educational level. The treatment success rate in the CB DOT group was 12% higher than that in the HF DOT (adjusted prevalence ratio (aPR)= 1.12 [95%CI 1.01, 1.24], P-value=0.03). Males were less likely to achieve treatment success compared to their female counterparts (aPR=0.87 [95% CI 0.78, 0.98], P-value=0.02). A total of 126 (47.7%) of 264 patients reported at least one adverse event. The HF DOT group had a higher proportion of patients with at least one adverse event compared to the CB DOT group (90/152 [59.2%] versus 36/112 [32.1], P-value<0.01). The model was acceptable among patients (93.6%) and health workers (94.1%). Conclusions: CB DOT for DR-TB care is effective and results in better treatment outcomes than HF DOT. The cost-effectiveness of this model of care should be further evaluated.

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“…All subjects were given antiviral therapy either remdesivir, favipiravir, or oseltamivir based on clinical judgement and according to Indonesia National Guideline of Covid-19. 24 One patient was given oseltamivir because remdesivir or favipiravir was contraindicated (GFR <30 ml/min/1,73 m 2 ), and one patient was not in either antiviral because both remdesivir and favipiravir were contraindicated and oseltamivir was not available.…”

Section: Resultsmentioning

confidence: 99%

“…Severe cases was defined as patient with clinical signs and symptoms of pneumonia, and one of the following: 1) respiratory rate > 30 times per minute, 2) signs of respiratory distress, or SpO 2 < 93% with room air. 23,24 Patients included in this study were patients who initially classified as moderate or severe disease. Patients were then observed up to day 14th or concluded earlier if the patients improved and discharged earlier, or worsened and passed away before day 14th.…”

Section: Assessment Patients' Severitymentioning

confidence: 99%

The role of IL-6, ferritin, and coagulopathy in Covid-19 clinical progression

Harahap,

Irawan,

Susilo

et al. 2023

F1000Res

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Background In Covid-19 infection, the release of pro-inflammatory mediators in the setting of cytokine storm, primarily interleukin-6 (IL-6), has been hypothesized to induce pulmonary intravascular thrombosis and eventually systemic coagulopathy. However, the relationship between IL-6 and coagulopathy remains unclear in Covid-19 progression. We aimed to investigate the correlation of IL-6 with D-dimer, fibrinogen, prothrombin time (PT), and ferritin. Furthermore, we also analysed the changes of those parameters in relation with progression of Covid-19 disease. Methods A prospective cohort study was conducted in moderate and severe Covid-19 patients from June 2020 to January 2021. A serial evaluation of IL-6, D-dimer, fibrinogen, ferritin, and PT was performed and correlated with the patient's condition at admission and on the 14th day. The outcomes (improvement, worsening, or discharged patients) were recorded during the study. Results Of 374 patients, 73 study subjects (61 severe and 12 moderate Covid-19) were included in this study. A total of 35 out of 61 severe illness and one out of 12 moderate illness subjects had experienced worsening. Spearman-rank correlation of IL-6 with with ferritin, D-dimer, fibrinogen, and PT was 0.08 ( p=0.5), −0.13 ( p=0.27), 0.01 ( p=0.91), and 0.03 ( p=0.77), respectively. In ROC analysis, D-dimer (74,77%) and IL-6 (71,32%) were the highest among other variables (>60%). Conclusions In Covid-19 patients, there was a correlation between elevated IL-6 and D-dimer levels with clinical deterioration. There was no correlation between elevated IL-6 levels with ferritin, D-dimer, fibrinogen, and PT levels. In conclusion, changes in IL-6 and D-dimer can be independent predictor of disease progression in moderate and severe Covid-19 patients.

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Determinants of treatment outcomes in patients with multidrug-resistant TB

Cited by 6 publications

References 0 publications

Determinants and Outcomes of the Decentralised Management of Patients With Drug-resistant Tuberculosis in the O.r Tambo District Municipality, Eastern Cape, South Africa, a Cohort Study

Determinants and Outcomes of the Decentralised Management of Patients With Drug-resistant Tuberculosis in the O.r Tambo District Municipality, Eastern Cape, South Africa, a Cohort Study

Community-based directly observed therapy is effective and results in better treatment outcomes for patients with multi-drug resistant tuberculosis in Uganda

The role of IL-6, ferritin, and coagulopathy in Covid-19 clinical progression

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