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Susanto TD, Widysanto A, Cipta DA, Tanara A, Wirawan GR, Kosim AB, Djoni CM, Tantri E, Kumar C, Angelius C. Anxiety and depression level of patients with multidrug-resistant tuberculosis (MDR-TB) in two hospitals in Banten province, Indonesia. DIALOGUES IN HEALTH 2023; 2:100115. [PMID: 38515492 PMCID: PMC10953925 DOI: 10.1016/j.dialog.2023.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/26/2023] [Accepted: 02/12/2023] [Indexed: 03/23/2024]
Abstract
Purpose Anxiety and depression can be found in patients diagnosed with multidrug-resistant Tuberculosis (MDR-TB). The purpose of this research is to measure the level of anxiety and depression in new patients with MDR-TB. Methods One hundred two new patients newly diagnosed with MDR TB in two hospitals in Banten province, Indonesia, are measured for depression and anxiety symptoms. The measurements used the Indonesian language version of the Zung Anxiety Self-Assessment Scale Questionnaire and the Indonesian version of Zung Self-Rating Depression Scale Questionnaire for Pulmonary Tuberculosis Patients that have been validated. The results include the demographic data presented descriptively as tables and charts. Results The mean age of the patients is 39,57+12,48 years. The monthly income of the patients is 54,9% low and 45,1% medium with no high income. Male is 61,8%, and 38,2% are female. The mean score of the anxiety index is 57,32+10,23. The mean score of the depression index is 55,02+12,36. The percentage of patients with no anxiety is 13,7%, minimal to moderate anxiety 46,1%, marked to severe anxiety 33,3%, and most extreme anxiety 6,9%. Conclusions A significant proportion of patients newly diagnosed with MDR-TB experience anxiety and depression.
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Affiliation(s)
| | - Allen Widysanto
- Department of Internal Medicine, Universitas Pelita Harapan, Banten, Indonesia
| | - Darien Alfa Cipta
- Department of Psychiatry, Universitas Pelita Harapan, Banten, Indonesia
| | - Arron Tanara
- Faculty of Medicine, Universitas Pelita Harapan, Banten, Indonesia
| | | | | | | | - Ervinna Tantri
- Faculty of Medicine, Universitas Pelita Harapan, Banten, Indonesia
| | - Chandni Kumar
- Faculty of Medicine, Universitas Pelita Harapan, Banten, Indonesia
| | - Chelsie Angelius
- Faculty of Medicine, Universitas Pelita Harapan, Banten, Indonesia
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Putnis N, Riches N, Nyamayaro A, Boucher D, King R, Walker IF, Burger A, Southworth P, Mwanjali V, Walley J. Evaluation of a Depression Intervention in People With HIV and/or TB in Eswatini Primary Care Facilities: Implications for Southern Africa. GLOBAL HEALTH: SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00016. [PMID: 37116919 PMCID: PMC10141428 DOI: 10.9745/ghsp-d-22-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/14/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Depression associated with chronic illnesses is common in Southern Africa, yet there are major treatment gaps. This study assesses the feasibility and acceptability of the Healthy Activity Program intervention for depression among people with HIV and/or TB. The intervention involves training nonspecialist nurses in depression, including identification, counseling based on behavioral activation theory, and structured referral. METHODS This is a mixed methods evaluation of a pilot counseling service integrated within routine HIV and TB care from 2018 to 2019. Participants included people living with HIV and/or patients with TB in rural Eswatini. RESULTS A total of 324 people living with HIV and/or TB were screened for depression, with 19% (62/324) screening positive. The median number of sessions attended was 3 (interquartile range: 1-5), with 16/60 (26%) attending the minimum 5 sessions. Qualitative results indicated acceptability, but there were concerns about feasibility. CONCLUSIONS The Healthy Activity Program is a promising option to manage the treatment gap for depression in people with HIV and/or TB. However, task-shifting to nonspecialist health care professionals without increasing staff capacity is a barrier to implementation. Realistic and pragmatic assessments of capacity and workforce are essential.
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Affiliation(s)
- Nina Putnis
- Nuffield Institute of International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Nick Riches
- Nuffield Institute of International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Archibald Nyamayaro
- Nuffield Institute of International Health and Development, University of Leeds, Leeds, United Kingdom
- Good Shepherd Hospital, Siteki, Eswatini
| | | | - Rebecca King
- Nuffield Institute of International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Ian F. Walker
- Nuffield Institute of International Health and Development, University of Leeds, Leeds, United Kingdom
| | | | - Paul Southworth
- Nuffield Institute of International Health and Development, University of Leeds, Leeds, United Kingdom
| | | | - John Walley
- Nuffield Institute of International Health and Development, University of Leeds, Leeds, United Kingdom
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Thungana Y, Wilkinson R, Zingela Z. Comorbidity of mental ill-health in tuberculosis patients under treatment in a rural province of South Africa: a cross-sectional survey. BMJ Open 2022; 12:e058013. [PMID: 36410818 PMCID: PMC9680183 DOI: 10.1136/bmjopen-2021-058013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Tuberculosis (TB) remains prevalent despite the availability of effective anti-TB medications, and accumulating evidence suggests a high rate of mental disorders in people with TB. This is because TB and psychiatric disorders share several risk factors, such as poverty, homelessness and substance use disorder. Moreover, psychiatric comorbidities in patients with TB are associated with poor treatment outcomes. This study explored the psychiatric comorbidity and clinical correlates in individuals receiving TB treatment. DESIGN A cross-sectional survey over 10 months. SETTING Two primary care clinics at King Sabata Dalindyebo district, Mthatha, Eastern Cape, South Africa. PARTICIPANT Patients receiving TB treatment in the two clinics. INTERVENTION The Mini-International Neuropsychiatric Interview was used to screen for psychiatric disorders. PRIMARY AND SECONDARY OUTCOME MEASURES Rates of mental disorders in patients with TB over a 10-month period. Variation in rates by sex, employment status and HIV comorbidity. RESULTS In a sample of 197 participants, most patients were men (62%) and screened positive for a mental disorder (82%) with anxiety (48%), depression (38%) and substance use disorders (43%) being the most common psychiatric conditions. On average, individuals had 4 (SD 2) mental disorders. Females had higher rates of depression (p=0.005) and non-adherence to TB treatment (p=0.003), and alcohol use disorder was more common in males (p<0.001) and in those non-adherent to TB treatment. Additionally, low education levels and unemployment were associated with depressive and anxiety disorders (p<0.05). CONCLUSIONS Mental disorders are common in patients with TB, and mental health services need to be integrated into the management of patients with TB. Factors linked to mental disorders in this cohort, such as low education, gender and unemployment, may be useful for compiling a risk profile to help identify those with TB who may require more intensive support for their mental health.
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Affiliation(s)
- Yanga Thungana
- Department of Psychiatry, Nelson Mandela University, Port Elizabeth, South Africa
- Department of Psychiatry and Behavioural Sciences, Walter Sisulu University, Mthatha, Eastern Cape, South Africa
| | - Robert Wilkinson
- Department of Infectious Disease, Imperial College London, London, UK
- Pathology, Frans Crick Institute, London, UK
- Wellcome Center for Infectious Diseases Research in Africa. Institute of Infect. Disease and Mol. Med and Dept. Med, University of Cape Town, Cape Town, South Africa
| | - Zukiswa Zingela
- Executive Dean's Office, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, Eastern Cape, South Africa
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Laxmeshwar C, Das M, Mathur T, Israni T, Jha S, Iyer A, Morales M, Decroo T, Gils T, Ferlazzo G, Iakovidi K, Garcia M, Isaakidis P. Psychiatric comorbidities among patients with complex drug-resistant tuberculosis in Mumbai, India. PLoS One 2022; 17:e0263759. [PMID: 35148328 PMCID: PMC8836323 DOI: 10.1371/journal.pone.0263759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND People with drug-resistant tuberculosis (DR-TB) are known to suffer from many mental-health disorders. This study aims to describe the proportion of patients diagnosed with psychiatric comorbidities, the different psychiatric diagnoses made, and treatment outcomes among DR-TB patients with or without psychiatric comorbidity and initiated on DR-TB treatment between January 2012 and March 2019 at Médecins Sans Frontières independent clinic in Mumbai, India. METHODS This is a retrospective study using routinely collected clinical data. DR-TB care included individualised treatment, psychosocial support, and integrated psychiatric care. RESULTS During the study period, 341 DR-TB patients were enrolled, with a median age of 25 years (IQR:20.0-36.5 years), 185 (54.2%) females, 143 (41.9%) with PreXDR-TB, and 140 (41.0%) with XDR-TB. All 341 patients were screened by a counsellor, 119 (34.9%) were referred for psychiatric evaluation, and 102 (29.9% of 341) were diagnosed with a psychiatric comorbidity. Among 102 diagnosed with a psychiatric comorbidity, 48 (47.0%) were diagnosed at baseline, and 86 (84.3%), or 25.2% of all 341 patients enrolled, were treated with psychotropic drugs. Depressive disorders were diagnosed in 49 (48.0%), mixed anxiety and depression in 24 (23.5%), neurocognitive disorders and anxiety in five (4.9%), and medication induced psychosis in two (2.0%). No anti-TB drugs were significantly associated with psychiatric comorbidities developed during treatment. Of 102 DR-TB patients with a psychiatric comorbidity, 75.5% (77) had successful DR-TB treatment outcomes, compared to 61.1% (146/239) not diagnosed with a psychiatric comorbidity (p = 0.014). CONCLUSION In our setting, among people started on DR-TB treatment, and with a complex TB resistance profile, about one in three patients experienced a psychiatric comorbidity, of which half developed this comorbidity during treatment. With comprehensive psychiatric care integrated into DR-TB care delivery, treatment outcomes were at least as good among those with psychiatric comorbidities compared to those without such comorbidities.
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Affiliation(s)
| | | | | | | | | | | | | | - Tom Decroo
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Tinne Gils
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Gabriella Ferlazzo
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - Kleio Iakovidi
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - Mariana Garcia
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - Petros Isaakidis
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
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Akpobolokemi T, Martinez-Nunez RT, Raimi-Abraham BT. Tackling the global impact of substandard and falsified and unregistered/unlicensed anti-tuberculosis medicines. MEDICINE ACCESS @ POINT OF CARE 2022; 6:23992026211070406. [PMID: 36204519 PMCID: PMC9413333 DOI: 10.1177/23992026211070406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Substandard and falsified (SF) medicines are a global health challenge with the
World Health Organization (WHO) estimating that 1 in 10 of medicines in low- and
middle-income countries (LMICs) are SF. Antimicrobials (i.e. antimalarials,
antibiotics) are the most commonly reported SF medicines. SF medicines
contribute significantly to the global burden of infectious diseases and
antimicrobial resistance (AMR). This article discusses the challenges associated
with the global impact of SF and unregistered/unlicensed antimicrobials with a
focus on anti-TB medicines. Tuberculosis (TB) is the 13th leading cause of death
worldwide, and is currently the second leading cause of death from a single
infectious agent, ranking after COVID-19 and above HIV/AIDS. Specifically in the
case of TB, poor quality of anti-TB medicines is among the drivers of the
emergence of drug-resistant TB pathogens. In this article, we highlight and
discuss challenges including the emergence of SF associated AMR, patient
mistrust and lack of relevant data. We also present study reports to inform
meaningful change. Recommended solutions involve the adaptation of interventions
from high-income countries (HICs) to LMICS, the need for improvement in the
uptake of medication authentication tools in LMICs, increased stewardship, and
the need for global and regional multidisciplinary legal and policy cooperation,
resulting in improved legal sanctions.
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Affiliation(s)
- Tamara Akpobolokemi
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Rocio Teresa Martinez-Nunez
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, Guy’s Hospital, London, UK
| | - Bahijja Tolulope Raimi-Abraham
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
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Kherabi Y, Mollo B, Gerard S, Lescure FX, Rioux C, Yazdanpanah Y. Patient-centered approach to the management of drug-resistant tuberculosis in France: How far off the mark are we? PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000313. [PMID: 36962203 PMCID: PMC10021739 DOI: 10.1371/journal.pgph.0000313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022]
Abstract
Drug-resistant tuberculosis (DR-TB) is a major public health concern worldwide. The prolonged isolation required is a source of challenges for both healthcare workers and patients, especially in high-income countries where DR-TB patients are frequently migrants with vulnerabilities. However, data on the needs of these vulnerable patients are scarce. Our objective was to identify and quantify conflict or inappropriate care situations experienced by both DR-TB patients and healthcare workers. This 10-year retrospective observational study (01/2008 to 10/2018) was conducted in a referral center for resistant tuberculosis management in Paris, France. Sixty-five DR-TB patients were hospitalized during the study period. Their demographic, clinical and social characteristics and any conflict or inappropriate care situations they experienced with healthcare workers while hospitalized were analyzed. Conflict or inappropriate care situations with healthcare workers were reported for 24 patients during their stay (36.9%). Eleven patients (16.9%) had difficulty adhering to respiratory isolation rules, 15 (23.1%) were discharged against medical advice, 9 (13.8%) were excluded from hospital for disciplinary reasons, verbal or physical violence was reported for 7 patients (10.8%), and 4 arrests (6.2%) were made by the police. Conflict situations were reported more often when there was a language barrier (70.8%, p<0.0001). More than one-third of patients with DR-TB in this referral center experienced at least one inappropriate care situation with healthcare workers. This study illustrates the urgent need to promote a patient-centered approach and to respond to the challenges of its practical implementation.
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Affiliation(s)
- Yousra Kherabi
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- Inserm U1137, IAME, Université de Paris, Paris, France
| | - Bastien Mollo
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- Inserm U1137, IAME, Université de Paris, Paris, France
| | - Sandrine Gerard
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
| | - François-Xavier Lescure
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- Inserm U1137, IAME, Université de Paris, Paris, France
| | - Christophe Rioux
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- Inserm U1137, IAME, Université de Paris, Paris, France
| | - Yazdan Yazdanpanah
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- Inserm U1137, IAME, Université de Paris, Paris, France
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Theingi P, Kamiya Y, Myat Moe M, Cho San C, Cox SE. Depression and its associated factors among people with multidrug-resistant tuberculosis in Myanmar. Trop Med Int Health 2021; 26:1117-1126. [PMID: 34110669 DOI: 10.1111/tmi.13637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Depression is an important potential comorbidity in persons with tuberculosis (TB), yet data in many settings are scarce. OBJECTIVE To estimate the prevalence and risk factors of depression in persons with multidrug-resistant tuberculosis (MDR-TB) in Myanmar. METHODS A cross-sectional survey among MDR-TB participants at Aung San MDR-TB treatment centre in Yangon during routine clinic follow-up visits. Patients Health Questionnaire-9 (PHQ-9) in the local language was used to screen for depression and structured questionnaires conducted. Univariable and multivariable logistic regression models were performed to identify associations. RESULTS Three-hundred and twenty-nine participants were enrolled between 19th December 2019 and 31st January 2020; 33% (111/329) in the intensive treatment phase. The prevalence of depressive symptoms (PHQ-9 ≥ 10) was (34/329) 10.33%. Multivariable analysis indicated financial hardship as a result of MDR-TB symptoms/treatment (aOR = 2.63, 95%CI: 1.12-6.67), suffering ≥1 respiratory symptoms (aOR = 6.72, 95%CI: 2.41-18.76), high education level (aOR = 4.26, 95%CI: 1.70-10.70), reported diabetes (aOR = 3.05, 95%CI: 1.16-7.99) as associated with depressive symptoms, with weak evidence of an association in females (aOR = 2.09, 95%CI: 0.94-4.65). CONCLUSION Depressive symptoms are more common in those with comorbidities/TB symptoms. Further research is required to determine the effects of interventions to support persons with depressive symptoms identified using simple, standardised validated tools like PHQ-9.
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Affiliation(s)
- Phyo Theingi
- National Tuberculosis Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Yasuhiko Kamiya
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Myat Myat Moe
- National Tuberculosis Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Cho Cho San
- National Tuberculosis Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Sharon E Cox
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Faculty of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
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Pasha A, Siddiqui H, Ali S, Brooks MB, Maqbool NR, Khan AJ. Impact of integrating mental health services within existing tuberculosis treatment facilities. MEDICINE ACCESS @ POINT OF CARE 2021; 5:23992026211011314. [PMID: 36204497 PMCID: PMC9413619 DOI: 10.1177/23992026211011314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/01/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Depression and anxiety among tuberculosis (TB) patients can adversely affect
TB treatment adherence and completion. Aim: We studied whether integrating mental health services into existing TB
treatment programs would reduce symptoms of depression and anxiety and
improve treatment completion among patients with drug-susceptible TB. Methods: Integrated practice units (IPUs) for TB and mental health were established
within six existing TB treatment facilities in Karachi, Pakistan. Patients
were screened for depression and anxiety and, if symptomatic, offered a
mental health intervention consisting of at least four counseling sessions.
We measured changes in reported levels of depression and anxiety symptoms
from baseline following completion of counseling sessions, and rates of TB
treatment completion. Results: Between February 2017 and June 2018, 3500 TB patients were screened for
depression and anxiety. 1057 (30.2%) symptomatic patients received a
baseline adherence session. 1012 enrolled for a mental health intervention
received at least 1 counseling session. 522 (51.5%) reported no symptoms
after four to six sessions. Symptomatic patients who completed at least four
counseling sessions had higher rates of TB treatment completion than those
who did not (92.9% vs 75.1%; p < 0.0001). Conclusion: Mental health interventions integrated within TB programs can help reduce
symptoms of depression and anxiety and improve TB treatment completion.
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Affiliation(s)
- Aneeta Pasha
- IRD Pakistan, Karachi, Pakistan
- Anthropology, Division of Social Sciences, The University of Chicago, Chicago, IL, USA
| | - Hasha Siddiqui
- IRD Pakistan, Karachi, Pakistan
- Clinical Psychology, Karachi University, Karachi, Pakistan
| | - Shiza Ali
- IRD Pakistan, Karachi, Pakistan
- Environmental Economics and Policy, University of California, Berkeley, Berkeley, CA, USA
| | - Meredith B Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Center for Global Health Delivery—Dubai, Harvard Medical School, Boston, MA, USA
- Population Health, School of Public Health, Northeastern University, Boston, MA, USA
| | - Naveen R Maqbool
- IRD Pakistan, Karachi, Pakistan
- Family and Child Psychology, University of Chester, Chester, UK
| | - Aamir J Khan
- IRD Pakistan, Karachi, Pakistan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- International Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lee G, Scuffell J, Galea JT, Shin SS, Magill E, Jaramillo E, Sweetland AC. Impact of mental disorders on active TB treatment outcomes: a systematic review and meta-analysis. Int J Tuberc Lung Dis 2020; 24:1279-1284. [PMID: 33317672 PMCID: PMC7740071 DOI: 10.5588/ijtld.20.0458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND: Comorbid mental disorders in patients with TB may exacerbate TB treatment outcomes. We systematically reviewed current evidence on the association between mental disorders and TB outcomes.METHODS: We searched eight databases for studies published from 1990 to 2018 that compared TB treatment outcomes among patients with and without mental disorders. We excluded studies that did not systematically assess mental disorders and studies limited to substance use. We extracted study and patient characteristics and effect measures and performed a meta-analysis using random-effects models to calculate summary odds ratios (ORs) with 95% confidence intervals (CIs).RESULTS: Of 7687 studies identified, 10 were included in the systematic review and nine in the meta-analysis. Measurement of mental disorders and TB outcomes were heterogeneous across studies. The pooled association between mental disorders and any poor outcome, loss to follow-up, and non-adherence were OR 2.13 (95%CI 0.85-5.37), 1.90 (95%CI 0.33-10.91), and 1.60 (95%CI 0.81-3.02), respectively. High statistical heterogeneity was present.CONCLUSION: Our review suggests that mental disorders in TB patients increase the risk of poor TB outcomes, but pooled estimates were imprecise due to small number of eligible studies. Integration of psychological and TB services might improve TB outcomes and progress towards TB elimination.
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Affiliation(s)
- G Lee
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - J Scuffell
- School of Population Health and Environmental Sciences, King´s College London, London, UK
| | - J T Galea
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, College of Public Health, University of South Florida, Tampa, FL
| | - S S Shin
- Sue & Bill Gross School of Nursing, University of California at Irvine, Irvine, CA
| | - E Magill
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | - E Jaramillo
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - A C Sweetland
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
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Lee GE, Scuffell J, Galea JT, Shin SS, Magill E, Jaramillo E, Sweetland AC. Impact of mental disorders on active tuberculosis treatment outcomes: a systematic review and meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.06.19.20135913. [PMID: 33173879 PMCID: PMC7654862 DOI: 10.1101/2020.06.19.20135913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Comorbid mental disorders in patients with tuberculosis (TB) may exacerbate TB treatment outcomes. We systematically reviewed current evidence on the association between mental disorders and TB outcomes. METHODS We searched eight databases for studies published from 1990-2018 that compared TB treatment outcomes among patients with and without mental disorders. We excluded studies that did not systematically assess mental disorders and studies limited to substance use. We extracted study and patient characteristics and effect measures and performed a meta-analysis using random-effects models to calculate summary odds ratios (OR) with 95% confidence intervals (CI). FINDINGS Of 7,687 studies identified, ten were included in the systematic review and nine in the meta-analysis. Measurement of mental disorders and TB outcomes were heterogeneous across studies. The pooled association between mental disorders and any poor outcome, loss to follow-up, and non-adherence were OR 2.13 (95% CI: 0.85-5.37), 1.90 (0.33-10.91), and 1.60 (0.81-3.02), respectively. High statistical heterogeneity was present. INTERPRETATION Our review suggests that mental disorders in TB patients increase the risk of poor TB outcomes, but pooled estimates were imprecise due to small number of eligible studies. Integration of psychological and TB services might improve TB outcomes and progress towards TB elimination.
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Using a rapid environmental scan methodology to map country-level global health research expertise in Canada. Health Res Policy Syst 2020; 18:37. [PMID: 32272941 PMCID: PMC7146898 DOI: 10.1186/s12961-020-0543-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/21/2020] [Indexed: 12/22/2022] Open
Abstract
Background Many countries are currently rethinking their global health research funding priorities. When resources are limited, it is important to understand and use information about existing research strengths to inform research strategies and investments and to drive impact. This study describes a method to rapidly assess a country’s global health research expertise and applies this method in the Canadian context. Methods We developed a three-pronged rapid environmental scan to evaluate Canadian global health research expertise that focused on research funding inputs, research activities and research outputs. We assessed research funding inputs from Canada’s national health research funding agency and identified the 30 Canadian universities that received the most global health research funding. We systematically searched university websites and secondary databases to identify research activities, including research centres, research chairs and research training programmes. To evaluate research outputs, we searched PubMed to identify global health research publications by Canadian university-affiliated researchers. We used these three perspectives to develop a more nuanced understanding of Canadian strengths in global health research from different perspectives. Results Canada’s main global health research funder, the Canadian Institutes of Health Research, invested a total of $314 M from 2000 to 2016 on global health research grants. This investment has contributed to Canada’s wealth of global health research expertise, including 12 training programmes, 27 Canada Research Chairs, 6 research centres and 30 WHO Collaborating Centres across 27 universities. Research activities were concentrated in Canada’s biggest cities and most commonly focused on health equity and globalisation issues. Canadian-affiliated researchers have contributed to a research output of 822 unique publications on PubMed. There is an opportunity to build global health expertise in regions not already concentrated with research activity, focusing on transnational risks and neglected conditions research. Conclusions Our three-pronged approach allowed us to rapidly identify clear geographic and substantive areas of strength in Canadian global health research, including urban regions and research focused on health equity and globalisation topics. This information can be used to support research policy directives, including to inform a Canadian global health research strategy, and to allow relevant academic institutions and funding organisations to make more strategic decisions regarding their future investments.
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Janse Van Rensburg A, Dube A, Curran R, Ambaw F, Murdoch J, Bachmann M, Petersen I, Fairall L. Comorbidities between tuberculosis and common mental disorders: a scoping review of epidemiological patterns and person-centred care interventions from low-to-middle income and BRICS countries. Infect Dis Poverty 2020; 9:4. [PMID: 31941551 PMCID: PMC6964032 DOI: 10.1186/s40249-019-0619-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/23/2019] [Indexed: 12/22/2022] Open
Abstract
Background There is increasing evidence that the substantial global burden of disease for tuberculosis unfolds in concert with dimensions of common mental disorders. Person-centred care holds much promise to ameliorate these comorbidities in low-to-middle income countries (LMICs) and emerging economies. Towards this end, this paper aims to review 1) the nature and extent of tuberculosis and common mental disorder comorbidity and 2) person-centred tuberculosis care in low-to-middle income countries and emerging economies. Main text A scoping review of 100 articles was conducted of English-language studies published from 2000 to 2019 in peer-reviewed and grey literature, using established guidelines, for each of the study objectives. Four broad tuberculosis/mental disorder comorbidities were described in the literature, namely alcohol use and tuberculosis, depression and tuberculosis, anxiety and tuberculosis, and general mental health and tuberculosis. Rates of comorbidity varied widely across countries for depression, anxiety, alcohol use and general mental health. Alcohol use and tuberculosis were significantly related, especially in the context of poverty. The initial tuberculosis diagnostic episode had substantial socio-psychological effects on service users. While men tended to report higher rates of alcohol use and treatment default, women in general had worse mental health outcomes. Older age and a history of mental illness were also associated with pronounced tuberculosis and mental disorder comorbidity. Person-centred tuberculosis care interventions were almost absent, with only one study from Nepal identified. Conclusions There is an emerging body of evidence describing the nature and extent of tuberculosis and mental disorders comorbidity in low-to-middle income countries. Despite the potential of person-centred interventions, evidence is limited. This review highlights a pronounced need to address psychosocial comorbidities with tuberculosis in LMICs, where models of person-centred tuberculosis care in routine care platforms may yield promising outcomes.
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Affiliation(s)
- André Janse Van Rensburg
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal Howard College, Berea, Durban, South Africa.
| | - Audry Dube
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Mowbray, Cape Town, South Africa
| | - Robyn Curran
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Mowbray, Cape Town, South Africa
| | - Fentie Ambaw
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Jamie Murdoch
- University of East Anglia School of Health Sciences, Norwich Research Park, Norwich, Norfolk, UK
| | - Max Bachmann
- University of East Anglia School of Health Sciences, Norwich Research Park, Norwich, Norfolk, UK
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal Howard College, Berea, Durban, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Mowbray, Cape Town, South Africa.,King's Global Health Institute, King's College London, Stamford Street, London, UK
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Tatés-Ortega N, Álvarez J, López L, Mendoza-Ticona A, Alarcón-Arrascue E. [Loss to follow-up in patients treated for multidrug-resistant tuberculosis in EcuadorA Perda de seguimento de pacientes tratados para tuberculose multirresistente a medicamentos no Equador]. Rev Panam Salud Publica 2019; 43:e91. [PMID: 31892925 PMCID: PMC6922079 DOI: 10.26633/rpsp.2019.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/09/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Determine the incidence of loss to follow-up (LTFU) in patients treated for rifampicin-resistant tuberculosis (RR-TB) or multidrug-resistant tuberculosis (RR/MDR-TB), and the factors associated with this discharge status in Ecuador. METHODS Retrospective cohort study of patients with RR/MDR-TB who followed the World Health Organization's 18-24-month treatment regimen in 2014 and 2015, as reported by the Ministry of Health of Ecuador. The incidence of LTFU was determined, and clinical and epidemiological manifestations of cases discharged as LTFU were compared with those discharged as successfully treated. Survival was analyzed with Cox regression in order to evaluate factors associated with LTFU. RESULTS Of 328 cases, 270 (82.3%) were analyzed because they had a reported discharge status. Discharge as LTFU accounted for 39.6% of cases, and as successfully treated, 50.4%. The risk factors associated with LTFU were: previous discharge as LTFU in a previous TB episode [hazard ratio (HR): 2.96 (1.53-5.73), P < 0.001]; addiction to alcohol or drugs [HR: 2.82 (1.10-7.23), P = 0.031]; and having an Xpert® diagnosis (TB-RR) [HR: 1.53 (1.0-2.35), P = 0.048]. Of the total LTFU, 43% occurred after nine months of treatment. CONCLUSION The incidence of LTFU in patients with RR/MDR-TB in Ecuador is above the average for the Region of the Americas. The three identified factors support implementation of shorter regimens and patient-centered care, in line with the End TB Strategy.
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Affiliation(s)
- Nelly Tatés-Ortega
- Estrategia Zonal de Prevención y Control de TuberculosisCoordinación Zonal 9-Salud, Ministerio de Salud Pública del EcuadorEcuadorEstrategia Zonal de Prevención y Control de Tuberculosis. Coordinación Zonal 9-Salud. Ministerio de Salud Pública del Ecuador, Ecuador.
| | - Jorge Álvarez
- Vigilancia Epidemiológica ZonalCoordinación Zonal 9-Salud, Ministerio de Salud Pública del EcuadorEcuadorVigilancia Epidemiológica Zonal. Coordinación Zonal 9-Salud. Ministerio de Salud Pública del Ecuador, Ecuador.
| | - Lucelly López
- Universidad Pontificia BolivarianaUniversidad Pontificia BolivarianaMedellínColombiaUniversidad Pontificia Bolivariana, Medellín, Colombia.
| | - Alberto Mendoza-Ticona
- Universidad Nacional de San AgustínUniversidad Nacional de San AgustínArequipaPerúUniversidad Nacional de San Agustín, Arequipa, Perú.
| | - Edith Alarcón-Arrascue
- Organización Panamericana de la SaludOrganización Panamericana de la SaludWashington D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud, Washington D.C., Estados Unidos de América.
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Pujol-Cruells A, Vilaplana C. Specific Interventions for Implementing a Patient-Centered Approach to TB Care in Low-Incidence Cities. Front Med (Lausanne) 2019; 6:273. [PMID: 31850353 PMCID: PMC6901950 DOI: 10.3389/fmed.2019.00273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/11/2019] [Indexed: 12/02/2022] Open
Abstract
Background: According to the latest Guidelines from the World Health Organization, there is an increasing need for patient-centered tuberculosis disease management given the socio-economic factors influencing the tuberculosis epidemic. In the present study, we aimed to study TB in Barcelona city from an anthropological point of view and to devise a series of specific proposals to implement a patient-centered approach in our setting. Methods: We carried out a qualitative study using an anthropological approach in Barcelona in the period between November 2017 and November 2018 and proposed specific interventions based on our observations. Results: In practice, in our environment (a low-incidence European country where tuberculosis tends to present in patients with multiple social problems), and despite the goodwill of the care teams, there are no established and stable circuits, or specific tools to ensure that this is done routinely. Based on our observations, we have devised a series of specific proposals to implement a patient-centered approach. With these interventions we aim to (a) directly ameliorate TB patients well-being in any diagnostic/healthcare management center and (b) at more general level, to increase TB detection and treatment adherence. Conclusions: The patient-centered TB management recommended by the WHO might be essential for patients' well-being, but there is a lack of circuits or working protocols that ensure its implementation in a regulated manner. In the present manuscript we explain the various concrete measures that we propose in our region and which could be put into practice in other cities or geographic regions with similar epidemiological characteristics.
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Affiliation(s)
- Adrià Pujol-Cruells
- Experimental Tuberculosis Unit, Fundació Institut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Cristina Vilaplana
- Experimental Tuberculosis Unit, Fundació Institut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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15
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Arroyo LH, Ramos ACV, Yamamura M, Berra TZ, Alves LS, Belchior ADS, Santos DT, Alves JD, Campoy LT, Arcoverde MAM, Bollela VR, Bombarda S, Nunes C, Arcêncio RA. Predictive model of unfavorable outcomes for multidrug-resistant tuberculosis. Rev Saude Publica 2019; 53:77. [PMID: 31553380 PMCID: PMC6752648 DOI: 10.11606/s1518-8787.2019053001151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/26/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE to analyze the temporal trend, identify the factors related and elaborate a predictive model for unfavorable treatment outcomes for multidrug-resistant tuberculosis (MDR-TB). METHODS Retrospective cohort study with all cases diagnosed with MDR-TB between the years 2006 and 2015 in the state of São Paulo. The data were collected from the state system of TB cases notifications (TB-WEB). The temporal trend analyzes of treatment outcomes was performed through the Prais-Winsten analysis. In order to verify the factors related to the unfavorable outcomes, abandonment, death with basic cause TB and treatment failure, the binary logistic regression was used. Pictorial representations of the factors related to treatment outcome and their prognostic capacity through the nomogram were elaborated. RESULTS Both abandonment and death have a constant temporal tendency, whereas the failure showed it as decreasing. Regarding the risk factors for such outcomes, using illicit drugs doubled the odds for abandonment and death. Besides that, being diagnosed in emergency units or during hospitalizations was a risk factor for death. On the contrary, having previous multidrug-resistant treatments reduced the odds for the analyzed outcomes by 33%. The nomogram presented a predictive model with 65% accuracy for dropouts, 70% for deaths and 80% for failure. CONCLUSIONS The modification of the current model of care is an essential factor for the prevention of unfavorable outcomes. Through predictive models, as presented in this study, it is possible to develop patient-centered actions, considering their risk factors and increasing the chances for cure.
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Affiliation(s)
- Luiz Henrique Arroyo
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | | | - Mellina Yamamura
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Thais Zamboni Berra
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Luana Seles Alves
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | | | - Danielle Talita Santos
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Josilene Dália Alves
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Laura Terenciani Campoy
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | | | - Valdes Roberto Bollela
- Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Sidney Bombarda
- Secretaria de Estado da Saúde de São Paulo. São Paulo, SP, Brasil
| | - Carla Nunes
- Universidade NOVA de Lisboa. Escola Nacional de Saúde Pública. Lisboa, Portugal
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Arroyo LAH, Arcoverde MAM, Alves JD, Fuentealba-Torres M, Cartagena-Ramos D, Scholze AR, Ramos ACV, Arcêncio RA. Spatial analysis of cases of Tuberculosis with Mental Disorders in São Paulo. Rev Bras Enferm 2019; 72:654-662. [DOI: 10.1590/0034-7167-2017-0949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/16/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To analyze the spatial distribution of Tuberculosis cases with Mental Disorders, identifying factors that determine its occurrence. Method: Ecological study, conducted in the municipalities of São Paulo State. Secondary data were used, with the incidence of Tuberculosis and Mental Disorders as dependent variables in the years 2012 to 2015 and independent variables, socioeconomic, health and income transfer data. The Geographically Weighted Regression was applied in this study. Results: It was observed a distinct distribution between cases of Tuberculosis and Mental Disorders in the municipalities of São Paulo State. Among the explanatory factors, the Primary Care Coverage, population of freedom and income inequality were spatially associated with Mental Illness (R2= 0.12); Alcoholism (R2= 0.12) Illicit Drugs (R2= 0.50) and Smoking (R2= 0.50). Conclusion / Final considerations: The study advances in knowledge by evidencing the spatial distribution of cases of Tuberculosis and Mental Disorders, evidencing the determining factors for its occurrence in São Paulo State.
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17
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Walker IF, Shi O, Hicks JP, Elsey H, Wei X, Menzies D, Lan Z, Falzon D, Migliori GB, Pérez-Guzmán C, Vargas MH, García-García L, Sifuentes Osornio J, Ponce-De-León A, van der Walt M, Newell JN. Analysis of loss to follow-up in 4099 multidrug-resistant pulmonary tuberculosis patients. Eur Respir J 2019; 54:13993003.00353-2018. [DOI: 10.1183/13993003.00353-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/10/2019] [Indexed: 11/05/2022]
Abstract
Loss to follow-up (LFU) of ≥2 consecutive months contributes to the poor levels of treatment success in multidrug-resistant tuberculosis (MDR-TB) reported by TB programmes. We explored the timing of when LFU occurs by month of MDR-TB treatment and identified patient-level risk factors associated with LFU.We analysed a dataset of individual MDR-TB patient data (4099 patients from 22 countries). We used Kaplan–Meier survival curves to plot time to LFU and a Cox proportional hazards model to explore the association of potential risk factors with LFU.Around one-sixth (n=702) of patients were recorded as LFU. Median (interquartile range) time to LFU was 7 (3–11) months. The majority of LFU occurred in the initial phase of treatment (75% in the first 11 months). Major risk factors associated with LFU were: age 36–50 years (HR 1.3, 95% CI 1.0–1.6; p=0.04) compared with age 0–25 years, being HIV positive (HR 1.8, 95% CI 1.2–2.7; p<0.01) compared with HIV negative, on an individualised treatment regimen (HR 0.7, 95% CI 0.6–1.0; p=0.03) compared with a standardised regimen and a recorded serious adverse event (HR 0.5, 95% CI 0.4–0.6; p<0.01) compared with no serious adverse event.Both patient- and regimen-related factors were associated with LFU, which may guide interventions to improve treatment adherence, particularly in the first 11 months.
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18
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Walker IF, Kanal S, Baral SC, Farragher TM, Joshi D, Elsey H, Newell JN. Depression and anxiety in patients with multidrug-resistant tuberculosis in Nepal: an observational study. Public Health Action 2019; 9:42-48. [PMID: 30963041 DOI: 10.5588/pha.18.0047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 12/07/2018] [Indexed: 01/20/2023] Open
Abstract
Setting Multidrug-resistant tuberculosis (MDR-TB) patients in the national TB treatment programme of Nepal. Objective To estimate the prevalence of depression and anxiety in people receiving treatment for MDR-TB, identify potential risk factors for depression and anxiety and determine temporal changes in their severity during treatment. Design An observational study using a screening tool, the Hopkins Symptom Checklist (HSCL-25) for depression and anxiety, administered monthly to a group of 135 patients in Nepal. Logistic and multilevel linear regression models were used to identify any patient characteristics associated with depression and anxiety. Results Most of the 135 patients were male (76%) and living with their families (68%). The period prevalences of depression and anxiety were respectively 22.2% and 15.6%. Patients reporting physical side effects of MDR-TB treatment had a higher depression score on HSCL by 2.63 points (95%CI 0.77-4.48) and a 1.59 point higher anxiety score (95%CI 0.45-2.73) than those who did not report any side effects. Being single was associated with having anxiety (aOR 0.2, 95%CI 0.03-1.0). Conclusion Given the high rates of depression observed among MDR-TB patients, national TB treatment programmes should ensure their patients are routinely screened for depression and anxiety, and effective treatment offered.
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Affiliation(s)
- I F Walker
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - S Kanal
- Health Research and Social Development Forum, Kathmandu, Nepal
| | - S C Baral
- Health Research and Social Development Forum, Kathmandu, Nepal
| | - T M Farragher
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - D Joshi
- Health Research and Social Development Forum, Kathmandu, Nepal
| | - H Elsey
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - J N Newell
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
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Puchner KP, Rodriguez-Fernandez R, Oliver M, Solomos Z. Non-communicable diseases and tuberculosis: Anticipating the impending global storm. Glob Public Health 2019; 14:1372-1381. [PMID: 30785858 DOI: 10.1080/17441692.2019.1580760] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The epidemiological transitions that have occurred in low and middle income countries (LMIC) during the past decades have led to an increased prevalence on non-communicable diseases (NCDs) in these countries, where the burden of infectious diseases (IDs), especially tuberculosis (TB), remains high. Although the true dimensions of this comorbidity have not yet been fully understood, there is a growing amount of data, over the last 10 years, that suggest a clear association between NCDs and TB. In particular, there is a continuously increasing body of evidence that diabetes mellitus, chronic respiratory conditions, tobacco use, mental health illnesses and chronic kidney disease increase TB morbidity and mortality and vice versa. This bidirectional negative association between diseases may jeopardise the achievement of the Sustainable Development Goals (SDGs) specific TB targets, thus underlying the importance of integrated public health responses towards both epidemics. Population as well as individual based approaches are required, along with both strategic and operation integration on a global scale. This year's United Nations High Level Meetings (ΗLMs) presented a rare opportunity for the political foundations of the TB and NCD responses to be dug together, thus creating a potential breakthrough in the global response to both epidemics.
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Affiliation(s)
- Karl Philipp Puchner
- a German Leprosy and TB Relief Association , Wuerzburg , Germany.,e Medecins du Monde , Athens , Greece
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20
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Sweetland AC, Jaramillo E, Wainberg ML, Chowdhary N, Oquendo MA, Medina-Marino A, Dua T. Tuberculosis: an opportunity to integrate mental health services in primary care in low-resource settings. Lancet Psychiatry 2018; 5:952-954. [PMID: 30241700 PMCID: PMC6489124 DOI: 10.1016/s2215-0366(18)30347-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Annika C Sweetland
- Department of Psychiatry, Columbia College of Physicians and Surgeons/New York State Psychiatric Institute, New York, NY 10032, USA.
| | | | - Milton L Wainberg
- Department of Psychiatry, Columbia College of Physicians and Surgeons/New York State Psychiatric Institute, New York, NY 10032, USA
| | - Neerja Chowdhary
- Department of Mental Health and Substance Abuse, WHO, Geneva, Switzerland
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Tarun Dua
- Department of Mental Health and Substance Abuse, WHO, Geneva, Switzerland
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21
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Walker IF, Khanal S, Hicks JP, Lamichhane B, Thapa A, Elsey H, Baral SC, Newell JN. Implementation of a psychosocial support package for people receiving treatment for multidrug-resistant tuberculosis in Nepal: A feasibility and acceptability study. PLoS One 2018; 13:e0201163. [PMID: 30048495 PMCID: PMC6062069 DOI: 10.1371/journal.pone.0201163] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/10/2018] [Indexed: 11/19/2022] Open
Abstract
Background and objectives People receiving treatment for multidrug-resistant tuberculosis (MDR-TB) have high rates of depression. Psychosocial support in general, and treatments for depression in particular, form an important but neglected area of patient-centred care, and a key pillar in the global End TB strategy. We assessed the feasibility and acceptability of a psychosocial support package for people receiving treatment for MDR-TB in Nepal. Methods This feasibility study used a mixed quantitative and qualitative approach. We implemented the intervention package in two National Tuberculosis Programme (NTP) MDR-TB treatment centres and 8 sub-centres. We screened patients monthly for depression and anxiety (cut-off ≥24 and ≥17 respectively on the Hopkins Symptom Checklist) and also for low social support (cut-off ≤3 on the Multidimensional Scale of Perceived Social Support). Those who screened positive on either screening tool received the Healthy Activity Program (HAP), which uses brief counselling based on behavioural activation theory. Other aspects of the psychosocial package were information/education materials and group interactions with other patients. Results We screened 135 patients, of whom 12 (9%) received HAP counselling, 115 (85%) received information materials, 80 (59%) received an education session and 49 (36%) received at least one group session. Eight group sessions were conducted in total. All aspects of the intervention package were acceptable to patients, including the screening, information, group work and counselling. Patients particularly valued having someone to talk to about their concerns and worries. We were able to successfully train individuals with no experience of psychological counselling to deliver HAP. Conclusion This psychosocial support package is acceptable to patients. The information materials we developed are feasible to deliver in the current NTP. However, the structured psychological counselling (HAP), is not feasible in the current NTP due to time constraints. This requires additional investment of counsellors in TB clinics.
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Affiliation(s)
- Ian F. Walker
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
- * E-mail:
| | - Sudeepa Khanal
- Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - Joe P. Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | | | - Anil Thapa
- National Tuberculosis Centre, Government of Nepal, Kathmandu, Nepal
| | - Helen Elsey
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Sushil C. Baral
- Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - James N. Newell
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
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22
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Sweetland AC, Kritski A, Oquendo MA, Sublette ME, Norcini Pala A, Silva LRB, Karpati A, Silva EC, Moraes MO, Silva JRLE, Wainberg ML. Addressing the tuberculosis-depression syndemic to end the tuberculosis epidemic. Int J Tuberc Lung Dis 2018; 21:852-861. [PMID: 28786792 DOI: 10.5588/ijtld.16.0584] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Tuberculosis (TB) and depression act synergistically via social, behavioral, and biological mechanisms to magnify the burden of disease. Clinical depression is a common, under-recognized, yet treatable condition that, if comorbid with TB, is associated with increased morbidity, mortality, community TB transmission, and drug resistance. Depression may increase risk of TB reactivation, contribute to disease progression, and/or inhibit the physiological response to anti-tuberculosis treatment because of poverty, undernutrition, immunosuppression, and/or negative coping behaviors, including substance abuse. Tuberculous infection and/or disease reactivation may precipitate depression as a result of the inflammatory response and/or dysregulation of the hypothalamic-pituitary-adrenal axis. Clinical depression may also be triggered by TB-related stigma, exacerbating other underlying social vulnerabilities, and/or may be attributed to the side effects of anti-tuberculosis treatment. Depression may negatively impact health behaviors such as diet, health care seeking, medication adherence, and/or treatment completion, posing a significant challenge for global TB elimination. As several of the core symptoms of TB and depression overlap, depression often goes unrecognized in individuals with active TB, or is dismissed as a normative reaction to situational stress. We used evidence to reframe TB and depression comorbidity as the 'TB-depression syndemic', and identified critical research gaps to further elucidate the underlying mechanisms. The World Health Organization's Global End TB Strategy calls for integrated patient-centered care and prevention linked to social protection and innovative research. It will require multidisciplinary approaches that consider conditions such as TB and depression together, rather than as separate problems and diseases, to end the global TB epidemic.
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Affiliation(s)
- A C Sweetland
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | - A Kritski
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil TB Research Network (REDE-TB), Rio de Janeiro, Rio de Janeiro, Brazil
| | - M A Oquendo
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M E Sublette
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | - A Norcini Pala
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | - L R Batista Silva
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Rio de Janeiro, Brazil
| | - A Karpati
- Vital Strategies, New York, New York, USA
| | - E C Silva
- State University of North Fluminense Darcy Ribeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - M O Moraes
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Rio de Janeiro, Brazil
| | - J R Lapa E Silva
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - M L Wainberg
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
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Comorbidities and treatment outcomes in multidrug resistant tuberculosis: a systematic review and meta-analysis. Sci Rep 2018; 8:4980. [PMID: 29563561 PMCID: PMC5862834 DOI: 10.1038/s41598-018-23344-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/09/2018] [Indexed: 01/14/2023] Open
Abstract
Little is known about the impact of comorbidities on multidrug resistant (MDR) and extensively drug resistant (XDR) tuberculosis (TB) treatment outcomes. We aimed to examine the effect of human immunodeficiency virus (HIV), diabetes, chronic kidney disease (CKD), alcohol misuse, and smoking on MDR/XDRTB treatment outcomes. We searched MEDLINE, EMBASE, Cochrane Central Registrar and Cochrane Database of Systematic Reviews as per PRISMA guidelines. Eligible studies were identified and treatment outcome data were extracted. We performed a meta-analysis to generate a pooled relative risk (RR) for unsuccessful outcome in MDR/XDRTB treatment by co-morbidity. From 2457 studies identified, 48 reported on 18,257 participants, which were included in the final analysis. Median study population was 235 (range 60-1768). Pooled RR of unsuccessful outcome was higher in people living with HIV (RR = 1.41 [95%CI: 1.15-1.73]) and in people with alcohol misuse (RR = 1.45 [95%CI: 1.21-1.74]). Outcomes were similar in people with diabetes or in people that smoked. Data was insufficient to examine outcomes in exclusive XDRTB or CKD cohorts. In this systematic review and meta-analysis, alcohol misuse and HIV were associated with higher pooled OR of an unsuccessful outcome in MDR/XDRTB treatment. Further research is required to understand the role of comorbidities in driving unsuccessful treatment outcomes.
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Scuffell J, Boccia D, Garcia Velarde F, Leon SR, Raviola G, Lecca L, Galea JT. Mental disorders and drug/alcohol use in patients commencing extensively drug-resistant tuberculosis treatment. Public Health Action 2017; 7:237-239. [PMID: 29201659 DOI: 10.5588/pha.17.0044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
Mental disorders and alcohol/drug use worsen treatment outcomes for multidrug-resistant tuberculosis (TB), but data are lacking for extensively drug-resistant (XDR) TB. We investigated the association of baseline mental disorders and alcohol/drug use on XDR-TB treatment outcomes in a retrospective study of 53 XDR-TB Peruvian patients during 2010-2012. Logistic regression estimated the odds ratios for unfavourable XDR-TB treatment outcomes. Overall treatment success was 25%. Mental disorders and drug/alcohol use were found in respectively 22.4% and 20.4% of patients; neither were associated with unfavourable treatment outcomes. Future research should explore the relationship between mental health and drug/alcohol use in XDR-TB treatment outcomes.
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Affiliation(s)
- J Scuffell
- Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - D Boccia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - G Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - L Lecca
- Socios En Salud, Lima, Peru.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - J T Galea
- Socios En Salud, Lima, Peru.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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