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Njiro BJ, Kisonga R, Joachim C, Sililo GA, Nkiligi E, Ibisomi L, Chirwa T, Francis JM. Epidemiology and treatment outcomes of recurrent tuberculosis in Tanzania from 2018 to 2021 using the National TB dataset. PLoS Negl Trop Dis 2024; 18:e0011968. [PMID: 38359088 PMCID: PMC10901333 DOI: 10.1371/journal.pntd.0011968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/28/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Patients with recurrent TB have an increased risk of higher mortality, lower success rate, and a relatively feeble likelihood of treatment completion than those with new-onset TB. This study aimed to assess the epidemiology of recurrent TB in Tanzania; specifically, we aim to determine the prevalence of TB recurrence and factors associated with unfavourable treatment outcomes among patients with recurrent TB in Tanzania from 2018 to 2021. METHODS In this cross-sectional study, we utilized Tanzania's routinely collected national TB program data. The study involved a cohort of TB patients over a fixed treatment period registered in the TB and Leprosy case-based District Health Information System (DHIS2-ETL) database from 2018 to 2021 in Tanzania. We included patients' sociodemographic and clinical factors, facility characteristics, and TB treatment outcomes. We conducted bivariate analysis and multivariable multi-level mixed effects logistic regression of factors associated with TB recurrence and TB treatment outcomes to account for the correlations at the facility level. A purposeful selection method was used; the multivariable model included apriori selected variables (Age, Sex, and HIV status) and variables with a p-value <0.2 on bivariate analysis. The adjusted odds ratio and 95% confidence interval were recorded, and a p-value of less than 0.05 was considered statistically significant. FINDINGS A total of 319,717 participants were included in the study; the majority were adults aged 25-49 (44.2%, n = 141,193) and above 50 years (31.6%, n = 101,039). About two-thirds were male (60.4%, n = 192,986), and more than one-fifth of participants (22.8%, n = 72,396) were HIV positive. Nearly two in every hundred TB patients had a recurrent TB episode (2.0%, n = 6,723). About 10% of patients with recurrent TB had unfavourable treatment outcomes (9.6%, n = 519). The odds of poor treatment outcomes were two-fold higher for participants receiving treatment at the central (aOR = 2.24; 95% CI 1.33-3.78) and coastal zones (aOR = 2.20; 95% CI 1.40-3.47) than the northern zone. HIV-positive participants had 62% extra odds of unfavourable treatment outcomes compared to their HIV-negative counterparts (aOR = 1.62; 95% CI 1.25-2.11). Bacteriological TB diagnosis (aOR = 1.39; 95% CI 1.02-1.90) was associated with a 39% additional risk of unfavourable treatment outcomes as compared to clinical TB diagnosis. Compared to community-based DOT, patients who received DOT at the facility had 1.39 times the odds of poor treatment outcomes (aOR = 1.39; 95%CI 1.04-1.85). CONCLUSION TB recurrence in Tanzania accounts for 2% of all TB cases, and it is associated with poor treatment outcomes. Unfavourable treatment outcomes were recorded in 10% of patients with recurrent TB. Poor TB treatment outcome was associated with HIV-positive status, facility-based DOT, bacteriologically confirmed TB and receiving treatment at the hospital level, differing among regions. We recommend post-treatment follow-up for patients with recurrent TB, especially those coinfected with HIV. We also propose close follow-up for patients treated at the hospital facility level and strengthening primary health facilities in TB detection and management to facilitate early treatment initiation.
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Affiliation(s)
- Belinda J Njiro
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Riziki Kisonga
- National Tuberculosis and Leprosy Program, Ministry of Health, Dodoma, Tanzania
| | - Catherine Joachim
- Programs and Health Systems Strengthening, Ministry of Health, Dodoma, Tanzania
| | | | - Emmanuel Nkiligi
- National Tuberculosis and Leprosy Program, Ministry of Health, Dodoma, Tanzania
| | - Latifat Ibisomi
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Tobias Chirwa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Zhang L, Han X, Ge Q, Shu W, Sun Y, Gao J, Xie S, Wang J, Gao W. Treatment outcomes of retreated patients with isoniazid/rifampicin resistant pulmonary tuberculosis. BMC Infect Dis 2024; 24:7. [PMID: 38166793 PMCID: PMC10759463 DOI: 10.1186/s12879-023-08909-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND About 8% of TB cases worldwide are estimated to have rifampicin-susceptible, isoniazid-resistant tuberculosis (Hr-TB), ranging from 5 to 11% regions. However, Hr-TB has not received much attention while comparing to be given high priority to the management of rifampicin-resistant tuberculosis (RR-TB). This study aimed to compare the differences of treatment effects for Hr-TB and RR-TB, so as to intensify the treatment and management of Hr-TB. METHODS A retrospective study was used to collect bacteriologically positive retreated patients with isoniazid/rifampicin resistant pulmonary tuberculosis, who were conducted at 29 tuberculosis control institutions in China from July 2009 to June 2021. We assessed effectiveness and safety of retreated patients with isoniazid/ rifampicin resistant pulmonary tuberculosis. RESULTS A total of 147 with either positive smear or cultures were enrolled, and 80 cases were in Hr-TB group and 67 cases were in RR-TB group. There was no significant difference in terms of age, sex, body mass, type of retreatment and comorbid diabetes between the two groups (P > 0.05). The rate of number of lesions involving lung fields ≥ 3 in Hr-TB group 75.9% (60/79) was significantly higher than RR-TB group 56.7% (38/67) (χ2 = 6.077, P = 0.014). There was no statistically significant difference (P = 0.166) with regard to the treatment outcomes of the two groups, the cure rates were 54.7% (41/75) and 53.6% (30/56), respectively, and the failure rate in Hr-TB group 22.7% (17/75) was 10% higher than RR-TB group 10.7% (6/56). The rate of negative sputum smear at the end of the second month (65.7%) in the Hr-TB group was significantly lower than that in the RR-TB group (85.7%) (P = 0.025). There were no significant differences in the incidences of serious adverse reactions and chest X-ray changes between the two groups (P > 0.05). During the 5-year follow-up, recurrence in the Hr-TB group (7 cases, 14.9%) was no significantly lower than that in the RR-TB group (4 cases, 11.8%) (P = 0.754). CONCLUSION The treatment of retreated Hr-TB patients was difficult and could be statistically similar or considerably worse than RR-TB. It's urgent to conduct further evaluation of the treatment status quo to guide the guideline development and clinical practice of Hr-TB patients.
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Affiliation(s)
- Lijie Zhang
- Clinical Center on Tuberculosis, Beijing Chest Hospital, Capital Medical University/ Beijing Tuberculosis and Thoracic Tumor Research Institute, No. 9, Beiguan, Tongzhou District, Beijing, 101149, P. R. China
| | - Xiqin Han
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101149, P.R. China
| | - Qiping Ge
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101149, P.R. China
| | - Wei Shu
- Clinical Center on Tuberculosis, Beijing Chest Hospital, Capital Medical University/ Beijing Tuberculosis and Thoracic Tumor Research Institute, No. 9, Beiguan, Tongzhou District, Beijing, 101149, P. R. China
| | - Yuxian Sun
- Clinical Center on Tuberculosis, Beijing Chest Hospital, Capital Medical University/ Beijing Tuberculosis and Thoracic Tumor Research Institute, No. 9, Beiguan, Tongzhou District, Beijing, 101149, P. R. China
| | - Jingtao Gao
- Clinical Center on Tuberculosis, Beijing Chest Hospital, Capital Medical University/ Beijing Tuberculosis and Thoracic Tumor Research Institute, No. 9, Beiguan, Tongzhou District, Beijing, 101149, P. R. China
| | - Shiheng Xie
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101149, P.R. China
| | - Jingping Wang
- Clinical Center on Tuberculosis, Beijing Chest Hospital, Capital Medical University/ Beijing Tuberculosis and Thoracic Tumor Research Institute, No. 9, Beiguan, Tongzhou District, Beijing, 101149, P. R. China.
| | - Weiwei Gao
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101149, P.R. China.
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Araújo-Pereira M, Arriaga MB, Carvalho ACC, Spener-Gomes R, Schmaltz CAS, Nogueira BMF, Figueiredo MC, Turner MM, Cordeiro-Santos M, Rolla VC, Sterling TR, Andrade BB, Kritski AL. Isoniazid Monoresistance and Antituberculosis Treatment Outcome in Persons With Pulmonary Tuberculosis in Brazil. Open Forum Infect Dis 2024; 11:ofad691. [PMID: 38221983 PMCID: PMC10785213 DOI: 10.1093/ofid/ofad691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024] Open
Abstract
Background The high burden of drug-resistant tuberculosis (TB) is a problem to achieve the goals of the End TB Strategy by 2035. Whether isoniazid monoresistance (Hr) affects anti-TB treatment (ATT) outcomes remains unknown in high-burden countries. Methods We evaluated determinants of ATT outcome among pulmonary TB cases reported to the National Notifiable Disease Information System (SINAN) between June 2015 and June 2019, according to drug sensitivity testing (DST) results. Binomial logistic regression models were employed to evaluate whether Hr was associated with an unfavorable ATT outcome: death or failure, compared to cure or treatment completion. Results Among 60 804 TB cases reported in SINAN, 21 197 (34.9%) were included in the study. In this database, the frequency of unfavorable outcomes was significantly higher in those with Hr in contrast to isoniazid-sensitive persons with pulmonary TB (9.1% vs 3.05%; P < .001). Using a binomial logistic regression model, Hr was independently associated with unfavorable outcomes (odds ratio, 3.34 [95% confidence interval, 2.06-5.40]; P < .001). Conclusions Hr detected prior to ATT was predictive of unfavorable outcomes at the national level in Brazil. Our data reinforce the need for high-TB-burden countries to prioritize DST to detect Hr. Effective treatment regimens for Hr-TB are needed to improve outcomes.
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Affiliation(s)
- Mariana Araújo-Pereira
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Instituto de Pesquisa Clínica e Translacional, Curso de Medicina, Curso Universitário Faculdades de Tecnologias e Ciência, Salvador, Brazil
| | - María B Arriaga
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Anna Cristina C Carvalho
- Programa Acadêmico de Tuberculose da Faculdade de Medicina, Complexo hospitalar Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Renata Spener-Gomes
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, Brazil
| | - Carolina A S Schmaltz
- Laboratório de Pesquisa Clínica em Micobacteriose, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Betânia M F Nogueira
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Instituto de Pesquisa Clínica e Translacional, Curso de Medicina, Curso Universitário Faculdades de Tecnologias e Ciência, Salvador, Brazil
| | - Marina C Figueiredo
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Megan M Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Marcelo Cordeiro-Santos
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Faculdade de Medicina, Universidade Nilton Lins, Manaus, Brazil
| | - Valeria C Rolla
- Laboratório de Pesquisa Clínica em Micobacteriose, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Bruno B Andrade
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Instituto de Pesquisa Clínica e Translacional, Curso de Medicina, Curso Universitário Faculdades de Tecnologias e Ciência, Salvador, Brazil
| | - Afrânio L Kritski
- Programa Acadêmico de Tuberculose da Faculdade de Medicina, Complexo hospitalar Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Iskandar D, Suryanegara FDA, van Boven JFM, Postma MJ. Clinical pharmacy services for tuberculosis management: a systematic review. Front Pharmacol 2023; 14:1186905. [PMID: 37484021 PMCID: PMC10360183 DOI: 10.3389/fphar.2023.1186905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/26/2023] [Indexed: 07/25/2023] Open
Abstract
Objective: This study aims to systematically review the content and potential effects of clinical pharmacy services in tuberculosis (TB) care management. Methods: Searches were performed in PubMed, Embase, Cochrane, Scopus, and Web of Science databases following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Study characteristics and outcomes were extracted, and clinical pharmacy service components were characterized using the Descriptive Elements of Pharmacist Intervention Characterization Tool. Results: Twenty articles were included for full-text assessment, of which 10 fulfilled inclusion criteria, comprising 1,168 patients (N = 39 to 258 per study). These articles included five prospective cohort studies, two case-control studies, two quasi-experimental studies, and one cross-sectional study. Intervention foci within clinical pharmacy services were medication adherence (50%), medication safety (40%), education to patients/caregivers regarding needs/beliefs (30%), optimizing medication/therapy effectiveness (30%), emphasizing HRQoL (10%), and drug selections (10%). The three most frequently applied interventions were drug information/patient counseling (80%), adverse drug reaction monitoring (50%), and drug use evaluation (20%). Based on the World Health Organization (WHO) outcome classification, treatment success ranged from 72% to 93%, with higher cure outcomes (53%-86%) than treatment completion (7%-19%). Other outcomes, including isoniazid metabolites, medication counts, sputum conversion, adherence/compliance, knowledge, and quality of life, were better in the intervention group than those in comparator groups, and/or they improved over time. Risk of bias analysis indicated that the included studies were not comparable to a randomized clinical trial. Conclusion: Clinical pharmacy services as single or composite interventions potentially improve TB outcomes, but its evidence is still inconsistent and limited due to the lack of randomized controlled studies using the WHO outcome classification. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=199028, identifier CRD42020199028.
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Affiliation(s)
- D. Iskandar
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Faculty of Pharmacy, Bhakti Kencana University, Bandung, Indonesia
| | - F. D. A. Suryanegara
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Islam Indonesia, Yogyakarta, Indonesia
| | - J. F. M. van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - M. J. Postma
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Economics, Econometrics, and Finance, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
- Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
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Izudi J, Sheira LA, Bajunirwe F, McCoy SI, Cattamanchi A. Effect of 6-month vs. 8-month regimen on retreatment success for pulmonary TB. Int J Tuberc Lung Dis 2022; 26:1188-1190. [PMID: 36447325 PMCID: PMC9728952 DOI: 10.5588/ijtld.22.0357] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- J. Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
,Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
,African Population and Health Research Center, Nairobi, Kenya
| | - L. A. Sheira
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - F. Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - S. I. McCoy
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - A. Cattamanchi
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, CA, USA
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Gadoev J, Asadov D, Harries AD, Kumar AMV, Boeree MJ, Hovhannesyan A, Kuppens L, Yedilbayev A, Korotych O, Hamraev A, Kudaybergenov K, Abdusamatova B, Khudanov B, Dara M. Factors Associated with Unfavourable Treatment Outcomes in Patients with Tuberculosis: A 16-Year Cohort Study (2005-2020), Republic of Karakalpakstan, Uzbekistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12827. [PMID: 34886554 PMCID: PMC8657882 DOI: 10.3390/ijerph182312827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022]
Abstract
Tuberculosis (TB) remains a public health burden in the Republic of Karakalpakstan, Uzbekistan. This region-wide retrospective cohort study reports the treatment outcomes of patients registered in the TB electronic register and treated with first-line drugs in the TB Programme of the Republic of Karakalpakstan from 2005-2020 and factors associated with unfavourable outcomes. Among 35,122 registered patients, 24,394 (69%) patients were adults, 2339 (7%) were children, 18,032 (51%) were male and 19,774 (68%) lived in rural areas. Of these patients, 29,130 (83%) had pulmonary TB and 7497 (>22%) had been previously treated. There were 7440 (21%) patients who had unfavourable treatment outcomes. Factors associated with unfavourable treatment outcomes included: increasing age, living in certain parts of the republic, disability, pensioner status, unemployment, being HIV-positive, having pulmonary TB, and receiving category II treatment. Factors associated with death included: being adult and elderly, living in certain parts of the republic, having a disability, pensioner status, being HIV-positive, and receiving category II treatment. Factors associated with failure included: being adolescent, female, having pulmonary TB. Factors associated with loss to follow-up included: being male, disability, pensioner status, unemployment, receiving category II treatment. In summary, there are sub-groups of patients who need special attention in order to decrease unfavourable treatment outcomes.
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Affiliation(s)
- Jamshid Gadoev
- WHO Country Office in Uzbekistan, 16-Tarobiy, Tashkent 100100, Uzbekistan;
| | - Damin Asadov
- Center of Development of Professional Qualification of Medical Personnel, Tashkent 100007, Uzbekistan; (D.A.); (A.H.)
| | - Anthony D. Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (A.D.H.); (A.M.V.K.)
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Ajay M. V. Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (A.D.H.); (A.M.V.K.)
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6, Qutub Institutional Area, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575018, India
| | - Martin Johan Boeree
- Department of Lung Diseases, Radboudumc, 6500 HB Nijmegen/TB Expert Centre Dekkerswald, 6561KE Groesbeek, The Netherlands;
| | - Araksya Hovhannesyan
- World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark; (A.H.); (A.Y.); (O.K.); (M.D.)
| | - Lianne Kuppens
- WHO Country Office in Uzbekistan, 16-Tarobiy, Tashkent 100100, Uzbekistan;
| | - Askar Yedilbayev
- World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark; (A.H.); (A.Y.); (O.K.); (M.D.)
| | - Oleksandr Korotych
- World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark; (A.H.); (A.Y.); (O.K.); (M.D.)
| | - Atadjan Hamraev
- Center of Development of Professional Qualification of Medical Personnel, Tashkent 100007, Uzbekistan; (D.A.); (A.H.)
| | - Kallibek Kudaybergenov
- Republican Phthisiology and Pulmonology Center Named after Sultanov, Nukus 1735401, Republic of Karakalpakstan;
| | - Barno Abdusamatova
- Ministry of Health of Republic of Uzbekistan, Tashkent 100011, Uzbekistan; (B.A.); (B.K.)
| | - Bakhtinur Khudanov
- Ministry of Health of Republic of Uzbekistan, Tashkent 100011, Uzbekistan; (B.A.); (B.K.)
| | - Masoud Dara
- World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark; (A.H.); (A.Y.); (O.K.); (M.D.)
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Nava-Ruelas R, Jarde A, Elsey H, Siddiqi K, Todowede O, Zavala G, Siddiqi N. Pharmacological and psychological interventions for depression in people with tuberculosis. Hippokratia 2021. [DOI: 10.1002/14651858.cd014848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Helen Elsey
- Department of Health Sciences; University of York; York UK
| | - Kamran Siddiqi
- Department of Health Sciences; University of York; York UK
- Hull York Medical School; University of York; York UK
| | | | - Gerardo Zavala
- Department of Health Sciences; University of York; York UK
| | - Najma Siddiqi
- Department of Health Sciences; University of York; York UK
- Hull York Medical School; University of York; York UK
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Perumal R, Padayatchi N, Yende-Zuma N, Naidoo A, Govender D, Naidoo K. A Moxifloxacin-based Regimen for the Treatment of Recurrent, Drug-sensitive Pulmonary Tuberculosis: An Open-label, Randomized, Controlled Trial. Clin Infect Dis 2020; 70:90-98. [PMID: 30809633 PMCID: PMC10686245 DOI: 10.1093/cid/ciz152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/20/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The substitution of moxifloxacin for ethambutol produced promising results for improved tuberculosis treatment outcomes. METHODS We conducted an open-label, randomized trial to test whether a moxifloxacin-containing treatment regimen was superior to the standard regimen for the treatment of recurrent tuberculosis. The primary and secondary outcomes were the sputum culture conversion rate at the end of 8 weeks and the proportion of participants with a favorable outcome, respectively. RESULTS We enrolled 196 participants; 69.9% were male and 70.4% were co-infected with human immunodeficiency virus (HIV). There was no significant difference between the study groups in the proportion of patients achieving culture conversion at the end of 8 weeks (83.0% [moxifloxacin] vs 78.5% [control]; P = .463); however, the median time to culture conversion was significantly shorter (6.0 weeks, interquartile range [IQR] 4.0-8.3) in the moxifloxacin group than the control group (7.9 weeks, IQR 4.0- 11.4; P = .018). A favorable end-of-treatment outcome was reported in 86 participants (87.8%) in the moxifloxacin group and 93 participants (94.9%) in the control group, for an adjusted absolute risk difference of -5.5 (95% confidence interval -13.8 to 2.8; P = .193) percentage points. There were significantly higher proportions of participants with Grade 3 or 4 adverse events (43.9% [43/98] vs 25.5% [25/98]; P = .01) and serious adverse events (27.6% [27/98] vs 12.2% [12/98]; P = .012) in the moxifloxacin group. CONCLUSIONS The replacement of ethambutol with moxifloxacin did not significantly improve either culture conversion rates at the end of 8 weeks or treatment success, and was associated with a higher incidence of adverse events. CLINICAL TRIALS REGISTRATION NCT02114684.
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Affiliation(s)
- Rubeshan Perumal
- Centre for the AIDS Programme of Research in South Africa, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Congella
- Department of Pulmonology and Critical Care, Groote Schuur Hospital, University of Cape Town, Western Cape
- South African Medical Research Council–Centre for the AIDS Programme of Research in South Africa, human immunodeficiency viruses-tuberculosis Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Congella, South Africa
| | - Nesri Padayatchi
- Centre for the AIDS Programme of Research in South Africa, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Congella
- South African Medical Research Council–Centre for the AIDS Programme of Research in South Africa, human immunodeficiency viruses-tuberculosis Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Congella, South Africa
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Congella
- South African Medical Research Council–Centre for the AIDS Programme of Research in South Africa, human immunodeficiency viruses-tuberculosis Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Congella, South Africa
| | - Anushka Naidoo
- Centre for the AIDS Programme of Research in South Africa, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Congella
- South African Medical Research Council–Centre for the AIDS Programme of Research in South Africa, human immunodeficiency viruses-tuberculosis Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Congella, South Africa
| | - Dhineshree Govender
- Centre for the AIDS Programme of Research in South Africa, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Congella
- South African Medical Research Council–Centre for the AIDS Programme of Research in South Africa, human immunodeficiency viruses-tuberculosis Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Congella, South Africa
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Congella
- South African Medical Research Council–Centre for the AIDS Programme of Research in South Africa, human immunodeficiency viruses-tuberculosis Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Congella, South Africa
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Auld SC, Gandhi NR, Shah NS. Closing the book on Category II: time for individualized regimens for patients with recurrent tuberculosis. Int J Tuberc Lung Dis 2018; 22:1113-1114. [PMID: 30236175 DOI: 10.5588/ijtld.18.0569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sara C Auld
- Emory University School of Medicine, Emory University Rollins School of Public Health
| | - Neel R Gandhi
- Emory University School of Medicine, Emory University Rollins School of Public Health
| | - N Sarita Shah
- Emory University Rollins School of Public Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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