Re-evaluating the merits of decentralization as a core strategy for effective delivery of drug-resistant tuberculosis care in Pakistan

Khan, Uzma; Lotia-Farrukh, Ismat; Akhtar, Ahwaz; Khowaja, Saira; Khan, Salman A.; Madhani, Falak; Parekh, Asra; Adnan, Sana; Ahmed, Saman; Chaudhry, M.Y.; Hussain, Hamidah; Ali, Habib; Butt, Shahid; Siddiqui, M. R.; Ijaz, Raafia; Jamal, Saba; Khan, Abdul Bari; Keshavjee, Salmaan; Khan, Aamir; Salahuddin, Naseem; Khan, Palwasha

doi:10.1093/heapol/czac038

Cited by 4 publications

(3 citation statements)

References 45 publications

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“…Based on Lesotho’s national drug-resistant TB guidelines, all bacteriologically confirmed drug-resistant TB patients should be referred to a specialised hospital for treatment initiation [ 30 , 31 ]. Centralised approaches may lead to delays along the care cascade, resulting in morbidity, mortality, and ongoing TB transmission [ 32 , 33 ]. An approach where care and treatment are decentralised to the district hospitals where patients are initiated on treatment once diagnosed may be a solution to delayed treatment initiation among MDR/RR-TB patients in the country.…”

Section: Discussionmentioning

confidence: 99%

Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho

Oyewusi,

Zeng,

Seung

et al. 2024

Global Health Action

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Background A low body mass index (BMI) at the start of treatment for rifampicin- or multidrug-resistant tuberculosis (MDR/RR-TB) is associated with poor treatment outcomes and may contribute to delayed sputum culture conversion, thereby prolonging the period of potential transmission to others. Whether the relative importance of low BMI in predicting treatment outcomes differs by HIV status is unclear. Objectives We evaluated the association between low BMI and two dependent variables, sputum culture conversion and end-of-treatment outcome, among patients receiving treatment for MDR/RR-TB in Lesotho, a setting with a high prevalence of HIV infection. Methods Secondary data from a prospective cohort of patients initiating a longer (18–20 months) treatment containing bedaquiline and/or delamanid under routine programmatic conditions in Lesotho were analysed. Risk ratios and differences were adjusted for potential confounders using multivariable logistic regression, and estimates were stratified by HIV status. Results Of 264 patients, 105 and 250 were eligible for culture conversion and end-of-treatment analyses, respectively. Seventy-one per cent of patients (74/105) experienced culture conversion within six months, while 74% (184/250) experienced a favourable end-of-treatment outcome. Low BMI was associated with a lower frequency of culture conversion at six months among those who were not living with HIV (relative risk [RR]: 0.50 [95% CI: 0.21, 0.79]); this association was attenuated among those living with HIV (RR: 0.88 [95% CI: 0.68, 1.23]). A low BMI was moderately associated with a lower frequency of treatment success (RR = 0.89 [95% CI: 0.77, 1.03]), regardless of HIV status. Conclusions Low BMI was common and associated with the frequency of six-month culture conversion and end-of-treatment outcomes. The association with culture conversion was more pronounced among those not living with HIV. Addressing the myriad factors that drive low BMI in this setting could hasten culture conversion and improve end-of-treatment outcomes. This will require a multipronged approach focused on alleviating food insecurity and enabling prompt diagnosis and treatment of HIV and TB.

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Section: Discussionmentioning

confidence: 99%

Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho

Oyewusi,

Zeng,

Seung

et al. 2024

Global Health Action

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“…At the time of this study, enrolment and treatment initiation was done at the NTI. We believe it's relevant to examine if the decentralization of RR-TB treatment and care strategies, successfully implemented elsewhere to increase RR-TB treatment uptake while reducing the burden associated with a long-term follow-up of patients, could also be implemented in Iraq [37][38][39].…”

Section: Plos Onementioning

confidence: 99%

Management of rifampicin-resistant tuberculosis in conflict-affected areas: The case of Iraq

Tesfahun,

Al-Salihi,

Abdulkareem Al-Ani

et al. 2024

PLoS ONE

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Since December 2019, the World Health Organization (WHO) has encouraged National Tuberculosis Programs to deprioritize the use of injectable-containing regimens and roll-out all-oral bedaquiline-containing regimens for rifampicin-resistant tuberculosis (RR-TB) treatment. Consequently, Iraq gradually replaced the injectable-containing regimen with an all-oral regimen, including bedaquiline. To assess treatment enrolment and outcomes of both regimens during a transitioning phase in Iraq, where health system services are recovering from decades of war, we conducted a nationwide retrospective cohort study using routinely collected programmatic data for patients enrolled between 2019–2021. We describe treatment enrolment and use logistic regression to identify predictors of unfavorable treatment outcomes (failure, death, or lost to follow-up), including regimen type. Nationwide, a total of 301 RR-TB patients started treatment, of whom 167 concluded treatment. The proportion of patients enrolled on the all-oral regimen increased from 53.2% (50/94) in 2020, to 75.5% (80/106) in 2021. Successful treatment was achieved in 82.1% (32/39) and 63.3% (81/128), for all-oral and injectable-containing regimens respectively. Moreover, the proportion of lost to follow-up was lower among those treated with the all-oral versus the long injectable-containing regimen; respectively 2.6% (1/39) versus 17.9% (23/128: p = 0.02). Unfavorable treatment outcome was associated with male gender (aOR 2.12, 95%CI:1.02–4.43) and age <15 years (vs 30–49 years, aOR 5.80, 95%CI:1.30–25.86). Regimen type (aOR 2.37, 95%CI: 0.91–6.13) was not significantly associated with having an unfavorable treatment outcome. In Iraq, the use of bedaquiline-containing all-oral regimen resulted in a high treatment success and reduced lost to follow-up.

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“…There was failure to change patient management following identification of medication nonadherence at monthly reviews. This may occur due to a lack of timely compliance data, and due to failure to change management after discovery of non-compliance at monthly reviews (Khan et al, 2022). Rather than performing monthly adherence assessments (Shokri et al, 2023), more frequent review of adherence data by healthcare personnel and initiation of intensive management to assist patients who have adherence problems may be necessary to reduce loss to follow-up (Bashshur et al, 2019).…”

Section: Bivariate Analysismentioning

confidence: 99%

SOWANS E-TB Application Innovation on Quality of Life and Medication Compliance in MDR-TB Patients

Saleh,

Condeng,

Nuzul

2023

J. Adv. Zool.

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Background: Tuberculosis (TB) is a direct infectious disease caused by Mycobacterium Tuberculosis. WHO reported that during 2014 – 2016, almost 89% of the world's population suffered from TB. Furthermore, the 2017 WHO report showed that there were 14 countries in the world that experienced a double burden of TB such as sensitive TB, MDR-TB and TB/HIV. WHO estimates that there are 23,000 cases of MDR/RR in Indonesia. Purpose: The general aim of this research is to determine the effectiveness of the telemedicine system on the quality of life and medication adherence of MDR-TB patients. Creation of the SOWANS E-TBS telemedicine system in the form of an application and website that helps treat MDR-TB patients. Methods: This research method is quasi experimental. Where a treatment group and a control group will be formed. The treatment group will be given the E-TB SOWANS application. Then compared with the control group. Both groups will be given quality of life questionnaires and medication adherence before and after treatment. Results: The distribution of MDR TB patients based on the intervention and control groups showed that 20 MDR TB patients received treatment (53.6%), while the number of patients in the control group was 18 people (47.4%). MDR TB patients based on treatment compliance showed that MDR TB patients who had non-adherence to treatment were 11 (28.9%) patients, and those who were adherent to treatment. Conclusion: Based on the research results and discussion by referring back to the problem formulation and hypothesis, it can be concluded that there is an influence of the E-TBCS application innovation on the quality of life of MDR-TB patients. Current advances in technology 4.0 can help improve the quality of life of MDR-TB patients. Keywords: Application; Telemedicine; Counseling; SOWANS; Tuberculosis

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Re-evaluating the merits of decentralization as a core strategy for effective delivery of drug-resistant tuberculosis care in Pakistan

Cited by 4 publications

References 45 publications

Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho

Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho

Management of rifampicin-resistant tuberculosis in conflict-affected areas: The case of Iraq

SOWANS E-TB Application Innovation on Quality of Life and Medication Compliance in MDR-TB Patients

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