Leaving the street and reconstructing lives: impact of DOTS in empowering homeless people in Tokyo, Japan

Kawatsu, Lisa; Sato, Noriko; Ngamvithayapong-Yanai, Jintana; Ishikawa, Nobukatsu

doi:10.5588/ijtld.12.0503

Cited by 10 publications

(22 citation statements)

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“…For PTB treatment, focus on DOT strategy together with incentives at each visit and bonuses after completion were associated with positive results in the USA [ 8 , 27 ]. In Japan, the combination of DOT with social support was associated not only with better outcomes but also empowerment of homeless patients [ 63 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of being homeless on the unsuccessful outcome of treatment of pulmonary TB in São Paulo State, Brazil

Ranzani

Carvalho

Waldman

et al. 2016

BMC Med

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BackgroundTuberculosis (TB) is a major public health problem requiring complex treatment, the success of which depends on biological, social, and institutional factors. São Paulo State (SPS), in Brazil, has a high TB burden. Because of high socioeconomic heterogeneity and chaotic urbanisation, homelessness might play an important role in the TB burden in SPS. Our aim was to determine the association between homelessness and outcome of treatment of pulmonary TB (PTB) in SPS.MethodsA historical cohort from the routine SPS TB database for 2009-2013 was analysed. The study population was newly diagnosed adult patients with PTB. Homelessness was ascertained at notification or when treatment started. Our outcome was unsuccessful outcome of treatment. We used logistic regression to adjust for potential confounders and multiple imputation for missing data.ResultsWe analysed 61,817 patients; 1726 (2.8 %, 95%CI 2.7-2.9 %) were homeless. Homeless patients were concentrated in bigger cities, were more frequently middle-aged males, had black/brown skin colour, and had received less education (P < 0.001, for all). Alcohol and drug use was three times more frequent in homeless patients (43.2 % vs 14.4 %, 30.2 % vs. 9.4 %, P < 0.001, respectively). HIV testing was less common among the homeless, of whom 17.3 % were HIV positive compared with 8.5 % among the not homeless population (P < 0.001). Microbiologic confirmation was more frequent among the homeless (91.6 % vs. 84.8 %, P < 0.001). Unsuccessful outcome of treatment was 57.3 % among the homeless and 17.5 % among the not homeless (OR = 6.32, 95%CI 5.73-6.97, P < 0.001), mainly due to loss to follow-up (39 %) and death (10.5 %). After full-adjustment for potential confounders, homelessness remained strongly associated with lower treatment success (aOR = 4.96, 95 % CI 4.27-5.76, P < 0.001). HIV status interacted with homelessness: among HIV-infected patients, the aOR was 2.45 (95%CI 1.90-3.16, Pinteraction < 0.001). The population attributable fraction for the joint effect of homelessness, alcohol and drug use was almost 20 %.ConclusionsConfirming our hypothesis, homelessness led to a marked reduction in the successful treatment of newly diagnosed pulmonary tuberculosis. Homelessness and associated conditions were important contributors to lack of treatment success in pulmonary tuberculosis in São Paulo. A multifaceted intervention must be implemented to target this vulnerable population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0584-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The impact of being homeless on the unsuccessful outcome of treatment of pulmonary TB in São Paulo State, Brazil

Ranzani

Carvalho

Waldman

et al. 2016

BMC Med

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“…Publications were from the USA [ 29 , 31 , 53 , 64 , 65 , 35 , 36 , 41 , 42 , 44 , 46 , 47 , 50 ], the UK [ 9 , 43 , 51 , 54 , 57 , 61 ], Spain [ 30 , 32 , 38 , 40 ], Japan [ 52 , 56 , 59 ], Turkey [ 37 , 48 , 63 ], Canada [ 34 , 62 ], Australia [ 39 ], Greece [ 49 ], Italy [ 45 ], the Netherlands [ 28 ], New Zealand [ 60 ], Norway [ 58 ], Saudi Arabia [ 66 ] and Switzerland [ 33 ]. One study was multi-national, participating countries being Armenia, Australia, Central African Republic, India, Philippines, South Africa, Swaziland, Uganda and the UK [ 55 ].…”

Section: Resultsmentioning

confidence: 99%

“…Of the 40 publications on TB patient support, 36 included treatment supervision options [ 9 , 28 , 39 – 48 , 30 , 49 , 50 , 52 – 54 , 56 – 60 , 31 , 62 , 64 – 67 , 32 , 33 , 35 – 38 ] (19 as the sole patient support intervention [ 9 , 29 , 39 , 41 , 42 , 45 , 48 , 50 , 58 , 64 , 30 – 33 , 35 – 38 ]), 12 included SE support [ 34 , 43 , 61 , 62 , 46 , 47 , 52 , 53 , 56 , 57 , 59 , 60 ] (1 as the sole intervention [ 61 ]), 11 included PE support [ 34 , 40 , 62 , 51 , 53 – 57 , 59 , ...…”

Section: Resultsmentioning

confidence: 99%

“…Levels of intervention implementation, providers and target populations of patients support were specified in 33 [ 28 , 29 , 40 , 41 , 43 – 49 , 51 , 30 , 52 – 56 , 58 , 60 – 63 , 33 , 64 – 66 , 34 – 39 ], 20 [ 28 , 33 , 56 – 64 , 66 , 39 – 41 , 49 , 51 – 54 ] and 26 [ 28 , 30 , 46 , 47 , 49 , 51 , 52 , 54 – 58 , 34 , 59 – 61 , 63 , 64 , 66 , 35 , 38 , 40 , 41 , 43 – 45 ] publications, respectively ( Table 1 ). Interventions were organized mostly on a local [ 29 , 34 , 62 , 63 ...…”

Section: Resultsmentioning

confidence: 99%

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Patient support for tuberculosis patients in low-incidence countries: A systematic review

et al. 2018

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BackgroundPatient support during tuberculosis treatment is expected to be more often available and more customized in low tuberculosis incidence, high-resource settings than in lower-resource settings. The aim of this systematic review is to provide an overview of tuberculosis patient support interventions implemented in low-incidence countries and an evaluation of their effects on treatment-related outcomes as well as their acceptability by patients and providers.MethodsPubMed, Social Science Citation Index and Cumulative Index to Nursing and Allied Health and Literature were searched for the period 01.2006–05.2016 on publications describing tuberculosis patient support interventions in low-incidence countries (<20 patients per 100,000 population).ResultsThrough our search strategy, 1875 unique publications were identified. Forty publications were included: 17 evaluated patient support quantitatively, 9 qualitatively and 14 only described the patient support. Nineteen publications assessed treatment supervision options only, 21 assessed (combinations of) treatment supervision, socio-economic, psycho-emotional, health-educational and other support. Of eight studies quantitatively evaluating the effects of support with a control group, four showed positive effects: two out of three that used combinations of patient support and two out of five that compared treatment supervision options. Heterogeneity of interventions precluded pooling of results. Qualitative and descriptive studies showed that patients appreciated individualized support including treatment supervision, psycho-emotional and socio-economic support; and digital health interventions.ConclusionOur review shows that a variety of patient support interventions is implemented in low-incidence countries. Although only a few interventions were evaluated quantitatively, we identified potential best practices. The scarcity of evidence on effectiveness, however, indicates the need for further research to evaluate potential best practices.

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“…O reconhecimento dos entrevistados a respeito da importância do TDO é confirmado em outros estudos que demonstram baixa taxa de abandono nesta modalidade de tratamento, quando comparado ao tratamento autoadministrado (Ferreira et al, 2011;Ibanês et al, 2013;Latrilha, 2014 (Kawatsu et al, 2013).…”

Section: Ii: Condições De Vida Das Pessoas Acometidas Pela Tuberculoseunclassified

Medidas de apoio ao tratamento da tuberculose: percepção de profissionais de saúde da Atenção Básica do município de São Paulo

Orlandi¹

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A caminhada em busca do conhecimento não é fácil e, tampouco, breve. Minha jornada a esta busca não está finalizada e, possivelmente, nunca estará, pois sempre estarei em busca de novos conhecimentos. Neste pequeno trajeto percorrido foram muitas as pessoas que me acompanharam, guiaram e contribuíram para realização deste trabalho. Deixo, portanto, meus agradecimentos a todas estas pessoas que acompanharam meu crescimento em meio a esta caminhada. À Deus, que me abençoou em todos os caminhos que percorri e que me deu forças quando pensei que não as teria mais. A minha querida orientadora, Prof.ª Dr.ª Maria Rita Bertolozzi, que me acolheu e acreditou em meu potencial, pelo carinho, apoio, confiança e todo conhecimento compartilhado. Sua participação foi fundamental para a realização deste trabalho. Não posso deixar de mencionar que sua trajetória profissional, humildade e competência são inspiradoras! Aos meus avós, Aymar, Dovoani e Sônia, pelo amor incondicional e palavras de conforto e carinho. À minha prima Ana, seu marido Mark e filho John, por me acolherem em sua casa no início desta jornada. Ao meu amado Hugo pelo apoio e compreensão deste momento em minha vida. A todos os meus familiares pelo carinho e compreensão. Aos membros do grupo de pesquisa GPTB, pelo conhecimento compartilhado e, em especial, Érica, Mariana, Rosângela e Kuitéria, pelo carinho, amizade e por toda ajuda provida. Aos membros do grupo de pesquisa "Vulnerabilidade, adesão e necessidades em saúde coletiva" pelos momentos de discussão e reflexão. Às professoras Dr.ª Renata Ferreira Takahashi e Dr. Tânia Maria Ribeiro Monteiro de Figueiredo pelas valiosas contribuições no Exame de Qualificação. Á Dr.ª Paula Hino pelo carinho e pelas contribuições a este trabalho. A todos os meus colegas da pós-graduação por deixarem mais agradáveis os dias de estudos intensos.

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Leaving the street and reconstructing lives: impact of DOTS in empowering homeless people in Tokyo, Japan

Abstract: PHC-based DOTS not only successfully controlled TB, it also empowered homeless patients by addressing their emotional needs. The interpersonal skills of the nurses played a critical role in this process.

Cited by 10 publications

References 0 publications

The impact of being homeless on the unsuccessful outcome of treatment of pulmonary TB in São Paulo State, Brazil

The impact of being homeless on the unsuccessful outcome of treatment of pulmonary TB in São Paulo State, Brazil

Patient support for tuberculosis patients in low-incidence countries: A systematic review

Medidas de apoio ao tratamento da tuberculose: percepção de profissionais de saúde da Atenção Básica do município de São Paulo

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