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Htet KKK, Phyu AN, Zayar NN, Chongsuvivatwong V. Active Tuberculosis Screening via a Mobile Health App in Myanmar: Incremental Cost-Effectiveness Evaluation. JMIR Form Res 2023; 7:e51998. [PMID: 37948119 PMCID: PMC10674145 DOI: 10.2196/51998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND A mobile app that calculates a tuberculosis (TB) risk score based on individual social and pathological characteristics has been shown to be a better predictor of the risk of contracting TB than conventionally used TB signs and symptoms (TBSS) in Myanmar, where the TB burden is high. Its cost-effectiveness, however, has not yet been assessed. OBJECTIVE This study aimed to determine the incremental costs of this mobile app and of chest x-rays (CXRs) in averting disability-adjusted life years (DALYs) among missed cases of active TB in the population being screened. METHODS Elements of incremental costs and effectiveness of 3 initial TB screening strategies were examined, including TBSS followed by CXR, the mobile app followed by CXR, and universal CXR. The incremental cost-effectiveness ratio (ICER; ie, the additional cost for each additional DALY averted) was compared to TBSS screening. Based on the latest 2020 gross domestic product (GDP) per capita of Myanmar (US $1477.50), the ICER was compared to willingness-to-pay (WTP) thresholds of 1, 2, and 3 times the GDP per capita. Probabilistic sensitivity analysis was conducted with a Monte Carlo simulation to compute the levels of probability that the ICER for each strategy was below each WTP threshold. RESULTS For each 100,000 population, the incremental cost compared to TBSS of active TB screening was US $345,942 for the mobile app and US $1,810,712 for universal CXR. The incremental effectiveness was 325 DALYs averted for the mobile app and 576 DALYs averted for universal CXR. For the mobile app, the estimated ICER was US $1064 (72% of GDP per capita) per 1 DALY averted. Furthermore, 100% of the simulated values were below an additional cost of 1 times the GDP per capita for 1 additional DALY averted. The universal CXR strategy has an estimated ICER of US $3143 (2.1 times the GDP per capita) per 1 DALY averted and an additional 77.2% DALYs averted compared to the app (ie, 576 - 325 / 325 DALYs); however, 0.5% of the simulated values were higher than an additional expenditure of 3 times the GDP per capita. CONCLUSIONS Based on the status of the economy in 2020, the mobile app strategy is affordable for Myanmar. The universal CXR strategy, although it could prevent an additional 77% of DALYs, is probably unaffordable. Compared to the TBSS strategy, the mobile app system based on social and pathological characteristics of TB has potential as a TB screening tool to identify missing TB cases and to reduce TB morbidity and mortality, thereby helping to achieve the global goal of "End TB" in resource-limited settings with a high TB burden.
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Affiliation(s)
- Kyaw Ko Ko Htet
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Aye Nyein Phyu
- Department of Public Health, National Tuberculosis Programme, Ministry of Health and Sports, Mandalay, Myanmar
| | - Nyi Nyi Zayar
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Narayan G, Vasudevan K, Rajagopal A, Gunasekaran K, Savla H, Suvvari TK. Active Screening for Pulmonary Tuberculosis Among Jail Inmates: A Mixed Method Study From Puducherry, South India. Cureus 2023; 15:e39749. [PMID: 37398710 PMCID: PMC10310892 DOI: 10.7759/cureus.39749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Sustainable Development Goal 3 (SDG) aims to end the epidemic of TB by 2030. To achieve this goal, active screening should be initiated in the target populations. These target populations are those without access to proper healthcare like jail inmates. With pulmonary tuberculosis (PTB) being cosmopolitan in India, passive case finding alone cannot suffice to achieve the above-mentioned goal. Thus, active case finding (ACF) becomes the need of the hour. So, we aimed to conduct a mixed methods study that has a quantitative component, i.e., to actively screen the prison inmates for PTB, and a qualitative component, i.e., to know the perceptions of jail inmates towards PTB and the stigmas associated with it. METHODOLOGY This was a mixed-method study conducted in the Central Jail, Puducherry. The quantitative component involved a facility-based cross-sectional study design and the qualitative component involved a focused group discussion (FGD). Participants were screened for PTB and diabetes mellitus (DM) and their anthropometry (weight, height, body mass index {BMI}, waist-to-hip ratio {WHR}) was noted. Presumptive cases were identified as those with symptoms of cough for more than two weeks with or without other concomitant symptoms. They were subjected to cartridge-based nucleic acid amplification test (CB-NAAT) assay. Data were entered in MS Excel 2017 and analyzed using SPSS version 16 (Armonk, NY: IBM Corp). For the qualitative exercise, purposive sampling with maximum variation technique was done to enroll a diverse subset of population for the FGD. Iterative analysis of the content was performed by the team to generate codes and themes. RESULTS Out of all the 187 inmates screened, 10.7% were symptomatic. On CB-NAAT examination of the symptomatic inmates, none turned positive. The inmates with presumptive TB were older by age and had a higher proportion of illiteracy and existing co-morbidity (p≤0.05). While random blood sugar (RBS) levels of >140 mg/dL were recorded in 19.7% of inmates, RBS levels of >200 mg/dL considered diagnostic were noted in 5.34% of inmates. A total of 2.67% of the inmates were newly diagnosed with diabetes mellitus. The further management of the newly diagnosed inmates was taken over by the medical supervision team of the Central Jail. From the FGD, thematic manual content analysis was performed. A total of 24 codes were generated. After merging similar codes and removing duplications, the remaining 16 codes were grouped into six broad themes. Conclusions were drawn by interpretation of these themes. CONCLUSION ACF is important as it is associated with early detection and treatment. It must be done periodically. During the FGD, we came across negative ideologies and stigmas associated with PTB among jail inmates. We used the same platform to clear those ideologies and recommend frequent health education exercises even in socially ostracized communities like jail inmates.
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Affiliation(s)
- Gaurang Narayan
- Department of Medical Law and Ethics, National Law School of India University, Bengaluru, IND
- Department of Obstetrics and Gynecology, Indira Gandhi Government Medical College, Nagpur, IND
| | - Kavita Vasudevan
- Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Pondicherry, IND
| | - Anandaraj Rajagopal
- Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Pondicherry, IND
| | - Kalaipriya Gunasekaran
- Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Pondicherry, IND
| | - Hritik Savla
- Department of Surgery and Community Medicine, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
| | - Tarun Kumar Suvvari
- Department of Medicine, Squad Medicine and Research (SMR), Visakhapatnam, IND
- Department of General Medicine, Rangaraya Medical College, Kakinada, IND
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Aung ST, Nyunt WW, Moe MM, Aung HL, Lwin T. The fourth national tuberculosis prevalence survey in Myanmar. PLOS Glob Public Health 2022; 2:e0000588. [PMID: 36962394 PMCID: PMC10021272 DOI: 10.1371/journal.pgph.0000588] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022]
Abstract
Tuberculosis (TB) remains a significant cause of morbidity and mortality in Myanmar. The fourth National TB Prevalence Survey was conducted in 2017-2018 to determine the actual burden of TB not only at the national level but also for three subnational strata (the states, regions other than Yangon, and the Yangon region) and develop a more efficacious country strategy on TB care and control. One hundred and thirty eight clusters were selected by population proportionate sampling. Adult (≥15 years of age) residents having lived for 2 weeks or more in the households of the selected clusters were invited to participate in the survey. The survey participants were screened for TB by a questionnaire and digital chest X-ray (CXR) after providing written informed consent. Individuals with a positive symptom screen and/or chest X-ray suggestive of TB were asked to provide sputum samples to test for Mycobacterium tuberculosis (Mtb) by Ziehl-Neelsen direct light microscopy, Xpert MTB/RIF Ultra (Xpert), and culture (Ogawa media). Bacteriologically confirmed TB cases were defined by an expert panel. Of 75 676 eligible residents, 66 480 (88%) participated, and 10 082 (15%) screened positive for TB. Among these, 322 participants were defined as bacteriologically confirmed TB cases. Cough lasting for two weeks or longer, one of the criteria used for screening for symptoms, could detect only 14% (45/322) of the study cases. The estimated prevalence of bacteriologically confirmed adult pulmonary TB was 468 (95% CI: 391-546) per 100,000. The prevalence was much higher among males, the older age group, urban Yangon and remote villages. In-depth interview with the participants on TB treatment showed that none of them was diagnosed in a TB health centre (primary care facilities). The prevalence of TB in Myanmar is still high due to challenges such as uncontrolled urbanization, an ageing population, migration, and poor access to health facilities in remote areas. New screening and diagnostic tools might help to detect more TB patients. There is a need to lay greater emphasis on multisectoral approaches, decentralization and the integration of basic TB services into primary care facilities.
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Affiliation(s)
- Si Thu Aung
- Department of Public Health, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Wint Wint Nyunt
- National Tuberculosis Reference Laboratory, National Tuberculosis Programme, Ministry of Health and Sports, Yangon, Myanmar
| | - Myat Myat Moe
- National Tuberculosis Programme, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Htin Lin Aung
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Thandar Lwin
- Department of Public Health, Ministry of Health and Sports, Naypyitaw, Myanmar
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Potty RS, Kumarasamy K, Adepu R, Reddy RC, Singarajipura A, Siddappa PB, Sreenivasa PB, Thalinja R, Lakkappa MH, Swamickan R, Shah A, Panibatla V, Dasari R, Washington R. Community health workers augment the cascade of TB detection to care in urban slums of two metro cities in India. J Glob Health 2021; 11:04042. [PMID: 34326992 PMCID: PMC8285758 DOI: 10.7189/jogh.11.04042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Tuberculosis Health Action Learning Initiative (THALI) funded by USAID is a person-centered initiative, supporting vulnerable urban populations to gain access to TB services. THALI trained and placed 112 Community health workers (CHWs) to detect and support individuals with TB symptoms or disease within urban slums in two cities, Hyderabad and Bengaluru, covering a population of about 3 million. Methods CHWs visited the slums once in a fortnight. They conducted TB awareness activities. They referred individuals with TB symptoms for sputum testing to nearest public sector laboratories. They visited those testing TB positive, once a fortnight in the intensive phase, and once a month thereafter. They supported TB patients and families with counselling, contact screening and social scheme linkages. They complemented the shortfall in urban TB government field staff numbers and their capacity to engage with TB patients. Data on CHWs’ patient referral for TB diagnosis and treatment support activities was entered into a database and analyzed to examine CHWs’ role in the cascade of TB care. We compared achievements of six monthly referral cohorts from September 2016 to February 2019. Results Overall, 31 617 (approximately 1%) of slum population were identified as TB symptomatic and referred for diagnosis. Among the referred persons, 23 976 (76%) underwent testing of which 3841 (16%) were TB positive. Overall, 3812 (99%) were initiated on treatment and 2760 (72%) agreed for regular follow up by the CHWs. Fifty-seven percent of 2952 referred were tested in the first cohort, against 86% of 8315 in the last cohort. The annualized case detection rate through CHW referrals in Bengaluru increased from 5.5 to 52.0 per 100 000 during the period, while in Hyderabad it was 35.4 initially and increased up to 118.9 per 100 000 persons. The treatment success rate was 87.1% among 193 in the first cohort vs 91.3% among 677 in the last cohort. Conclusions CHWs in urban slums augment TB detection to care cascade. Their performance and TB treatment outcomes improve over time. It would be important to examine the cost per TB case detected and successfully treated.
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Affiliation(s)
| | | | - Rajesham Adepu
- Office of the Joint Director (TB), Commissionerate of Health and Family Welfare, Hyderabad, Telangana, India
| | - Ramesh Chandra Reddy
- Office of the Joint Director (TB), Lady Willingdon State TB Centre, Bengaluru, Karnataka, India
| | - Anil Singarajipura
- Office of the Joint Director (TB), Lady Willingdon State TB Centre, Bengaluru, Karnataka, India
| | | | | | | | | | - Reuben Swamickan
- Tuberculosis and Infectious Diseases Division, USAID/India, New Delhi, India
| | - Amar Shah
- Tuberculosis and Infectious Diseases Division, USAID/India, New Delhi, India
| | | | | | - Reynold Washington
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,St John's Research Institute, Bengaluru, India
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Ul Haq M, Hinderaker SG, Fatima R, Shewade HD, Heldal E, Latif A, Kumar AMV. Extending contact screening within a 50-m radius of an index tuberculosis patient using Xpert MTB/RIF in urban Pakistan: Did it impact treatment outcomes? Int J Infect Dis 2021; 104:634-40. [PMID: 33515773 DOI: 10.1016/j.ijid.2021.01.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Pakistan implemented initiatives to detect tuberculosis (TB) patients through extended contact screening (ECS); it improved case detection but treatment outcomes need assessment. OBJECTIVES To compare treatment outcomes of pulmonary TB (PTB) patients detected by ECS with those detected by routine passive case finding (PCF). METHODS A cohort study using secondary program data conducted in Lahore, Faisalabad and Rawalpindi districts and Islamabad in 2013-15. We used log binomial regression models to assess if ECS was associated with unfavorable treatment outcomes (death, loss-to-follow-up, failure, not evaluated) after adjusting for potential confounders. RESULTS We included 79,431 people with PTB; 4604 (5.8%) were detected by ECS with 4052 (88%) bacteriologically confirmed. In all PTB patients the proportion with unfavorable outcomes was not significantly different in ECS group (9.6%) compared to PCF (9.9%), however, among bacteriologically confirmed patients unfavorable outcomes were significantly lower in ECS (9.9%) than PCF group (11.6%, P = 0.001). ECS was associated with a lower risk of unfavorable outcomes (adjusted relative risk (aRR) 0.90; 95% CI 0.82-0.99) among 'all PTB' patients and bacteriologically confirmed PTB patients (aRR 0.91; 95% CI 0.82-1.00). CONCLUSION In PTB patients detected by ECS the treatment outcomes were not inferior to those detected by PCF.
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Saini V, Garg K. Case finding strategies under National Tuberculosis Elimination Programme (NTEP). Indian J Tuberc 2020; 67:S101-6. [PMID: 33308653 DOI: 10.1016/j.ijtb.2020.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022]
Abstract
Case finding, an important parameter in fight against Tuberculosis (TB) has always remained a challenge despite advances in diagnostic modalities, access to health care and administrative commitment. We are still far from reaching the goals so set as per End TB Strategy and National Strategic Plan 2017–2025, and case finding is of paramount importance for achieving the said targets. This article, after identifying the obstacles faced in case finding, explores the various case finding strategies in the perspective of diagnostics, feasibility, resource utilization and current recommendations. Need for prioritization of case finding in different settings with involvement and active participation of one and all has been discussed. Role of health education in an individual, general public and health care worker in the context of case finding has been highlighted. Research areas to strengthen case finding have been enumerated. The review concludes by bringing out the need for heightened efforts for case finding in TB as the resources are significantly diverted as the world is facing the corona virus disease 2019 (COVID-19) pandemic. Early case finding and prompt treatment is very important for eliminating Tuberculosis but has always remained a challenge. Ongoing passive case finding needs to be strictly complemented with active case finding especially in vulnerable population. Efforts for case finding in TB should not be neglected despite the present corona virus disease 2019 (COVID-19) pandemic.
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Singh M, Sagili KD, Tripathy JP, Kishore S, Bahurupi YA, Kumar A, Kala V, Yadav V, Murmu S. Are Treatment Outcomes of Patients with Tuberculosis Detected by Active Case Finding Different From Those Detected by Passive Case Finding? J Glob Infect Dis 2020; 12:28-33. [PMID: 32165799 PMCID: PMC7045756 DOI: 10.4103/jgid.jgid_66_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/29/2019] [Accepted: 10/03/2019] [Indexed: 11/04/2022] Open
Abstract
Context India has adopted active case finding (ACF) as an additional strategy to find its missing tuberculosis (TB) cases since 2017. Treatment outcomes of patients identified through ACF may be similar or different from those detected through routine passive case finding (PCF); currently, there are limited studies on this in India. Aim The aim of this study was to assess differences in treatment outcomes of patients detected through ACF and PCF under the national TB program. Study Design A study was conducted in six TB units of Haridwar district where ACF campaigns were conducted in 2017-2018. Methods Data from patients detected by ACF (n = 72) and PCF (n = 184) were extracted from program records. Results Of 72 patients detected by ACF, only 54 (75%) were initiated on treatment. A high proportion of initial loss to follow-up (25% vs. 0%) and delay in treatment initiation (4 days vs. 0 days) was observed in ACF patients as compared to PCF. The proportion of unsuccessful treatment outcome was 33% (n = 18) among ACF patients compared to 14% (n = 25) among PCF patients (adjusted relative risk: 2.6, 95% confidence interval: 1.7-4.0). Conclusion High initial loss to follow-up, delay in treatment initiation, and poor treatment outcome among ACF patients are a major concern. The study results call for active follow-up after diagnosis and close monitoring during treatment for patients detected by ACF.
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Affiliation(s)
- Mahendra Singh
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Karuna D Sagili
- Department of TB and Communicable Diseases, The Union South East Asia Office, New Delhi, India
| | - Jaya P Tripathy
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Surekha Kishore
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Yogesh A Bahurupi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ajay Kumar
- Department of Medical Health and Family Welfare, District Tuberculosis Office, Haridwar, Uttarakhand, India
| | - Vagish Kala
- Department of Medical Health and Family Welfare, State Tuberculosis Office, Uttarakhand, India
| | - Vikas Yadav
- Department of Community Medicine, Government Medical College, Vidisha, Madhya Pradesh, India
| | - Shikha Murmu
- District Mental Health Programme Medinipur, Directorate of Health Services, West Bengal, India
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Shewade HD, Gupta V, Satyanarayana S, Kumar S, Pandey P, Bajpai UN, Tripathy JP, Kathirvel S, Pandurangan S, Mohanty S, Ghule VH, Sagili KD, Prasad BM, Singh P, Singh K, Jayaraman G, Rajeswaran P, Biswas M, Mallick G, Naqvi AJ, Bharadwaj AK, Sathiyanarayanan K, Pathak A, Mohan N, Rao R, Kumar AMV, Chadha SS. Active versus passive case finding for tuberculosis in marginalised and vulnerable populations in India: comparison of treatment outcomes. Glob Health Action 2020; 12:1656451. [PMID: 31475635 PMCID: PMC6735288 DOI: 10.1080/16549716.2019.1656451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Community-based active case finding (ACF) for tuberculosis (TB) implemented among marginalised and vulnerable populations in 285 districts of India resulted in reduction of diagnosis delay and prevalence of catastrophic costs due to TB diagnosis. We were interested to know whether this translated into improved treatment outcomes. Globally, there is limited published literature from marginalised and vulnerable populations on the independent effect of community-based ACF on treatment outcomes when compared to passive case finding (PCF). Objectives: To determine the relative differences in unfavourable treatment outcomes (death, loss-to-follow-up, failure, not evaluated) of ACF and PCF-diagnosed people. Methods: Cohort study involving record reviews and interviews in 18 randomly selected districts. We enrolled all ACF-diagnosed people with new smear-positive pulmonary TB, registered under the national TB programme between March 2016 and February 2017, and an equal number of randomly selected PCF-diagnosed people in the same settings. We used log binomial models to adjust for confounders. Results: Of 572 enrolled, 275 belonged to the ACF and 297 to the PCF group. The proportion of unfavourable outcomes were 10.2% (95% CI: 7.1%, 14.3%) in the ACF and 12.5% (95% CI: 9.2%, 16.7%) in the PCF group (p = 0.468). The association between ACF and unfavourable outcomes remained non-significant after adjusting for confounders available from records [aRR: 0.83 (95% CI: 0.56, 1.21)]. Due to patient non-availability at their residence, interviews were conducted for 465 (81.3%). In the 465 cohort too, there was no association after adjusting for confounders from records and interviews [aRR: 1.05 (95% CI: 0.62, 1.77)]. Conclusion: We did not find significant differences in the treatment outcomes. Due to the wide CIs, studies with larger sample sizes are urgently required. Studies are required to understand how to translate the benefits of ACF to improved treatment outcomes.
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Affiliation(s)
- Hemant Deepak Shewade
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union) , Paris , France.,Department of Operational Research , The Union South-East Asia (USEA) , New Delhi, India.,Karuna Trust , Bengaluru , India
| | - Vivek Gupta
- Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS) , New Delhi , India
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union) , Paris , France
| | - Sunil Kumar
- State TB Cell , Department of Health & Family Welfare, Government of Kerala, Thiruvananthapuram , India
| | - Prabhat Pandey
- Department of TB and Communicable Diseases , The Union South-East Asia (USEA), New Delhi , India
| | - U N Bajpai
- Voluntary Health Association of India (VHAI) , New Delhi , India
| | - Jaya Prasad Tripathy
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union) , Paris , France.,Department of Operational Research , The Union South-East Asia (USEA) , New Delhi, India
| | - Soundappan Kathirvel
- Department of Operational Research , The Union South-East Asia (USEA) , New Delhi, India.,Department of Community Medicine and School of Public Health , Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh , India
| | - Sripriya Pandurangan
- Department of TB and Communicable Diseases , The Union South-East Asia (USEA), New Delhi , India
| | - Subrat Mohanty
- Department of TB and Communicable Diseases , The Union South-East Asia (USEA), New Delhi , India
| | - Vaibhav Haribhau Ghule
- Joint Efforts for Elimination of TB (JEET) Project , Foundation for Innovate New Diagnostics (FIND), New Delhi , India
| | - Karuna D Sagili
- Department of TB and Communicable Diseases , The Union South-East Asia (USEA), New Delhi , India
| | | | - Priyanka Singh
- MAMTA Health Institute for Mother and Child , New Delhi , India
| | - Kamlesh Singh
- Catholic Health Association of India (CHAI) , Telangana , India
| | - Gurukartick Jayaraman
- Resource Group for Education & Advocacy for Community Health (REACH) , Chennai , India
| | - P Rajeswaran
- Resource Group for Education & Advocacy for Community Health (REACH) , Chennai , India
| | - Moumita Biswas
- Department of TB and Communicable Diseases , The Union South-East Asia (USEA), New Delhi , India
| | - Gayadhar Mallick
- Department of TB and Communicable Diseases , The Union South-East Asia (USEA), New Delhi , India
| | - Ali Jafar Naqvi
- MAMTA Health Institute for Mother and Child , New Delhi , India
| | | | - K Sathiyanarayanan
- Resource Group for Education & Advocacy for Community Health (REACH) , Chennai , India
| | - Aniruddha Pathak
- Department of TB and Communicable Diseases , The Union South-East Asia (USEA), New Delhi , India
| | - Nisha Mohan
- Karuna Trust , Bengaluru , India.,IIHMR University, Jaipur , India
| | - Raghuram Rao
- Central TB Division, Revised National Tuberculosis Control Programme, Ministry of Health and Family Welfare , Government of India , New Delhi, India
| | - Ajay M V Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union) , Paris , France.,Department of Operational Research , The Union South-East Asia (USEA) , New Delhi, India.,Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru , India
| | - Sarabjit Singh Chadha
- Infectious Diseases, Foundation for Innovate New Diagnostics (FIND), New Delhi , India
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Chaves Torres NM, Quijano Rodríguez JJ, Porras Andrade PS, Arriaga MB, Netto EM. Factors predictive of the success of tuberculosis treatment: A systematic review with meta-analysis. PLoS One 2019; 14:e0226507. [PMID: 31881023 PMCID: PMC6934297 DOI: 10.1371/journal.pone.0226507] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/27/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To produce pooled estimates of the global results of tuberculosis (TB) treatment and analyze the predictive factors of successful TB treatment. METHODS Studies published between 2014 and 2019 that reported the results of the treatment of pulmonary TB and the factors that influenced these results. The quality of the studies was evaluated according to the Newcastle-Ottawa quality assessment scale. A random effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) in February 2019 under number CRD42019121512. RESULTS A total of 151 studies met the criteria for inclusion in this review. The success rate for the treatment of drug-sensitive TB in adults was 80.1% (95% CI: 78.4-81.7). America had the lowest treatment success rate, 75.9% (95% CI: 73.8-77.9), and Oceania had the highest, 83.9% (95% CI: 75.2-91.0). In children, the success rate was 84.8% (95% CI: 77.7-90.7); in patients coinfected with HIV, it was 71.0% (95% CI: 63.7-77.8), in patients with multidrug-resistant TB, it was 58.4% (95% CI: 51.4-64.6), in patients with and extensively drug-resistant TB it was 27.1% (12.7-44.5). Patients with negative sputum smears two months after treatment were almost three times more likely to be successfully treated (OR 2.7; 1.5-4.8), whereas patients younger than 65 years (OR 2.0; 1.7-2.4), nondrinkers (OR 2.0; 1.6-2.4) and HIV-negative patients (OR 1.9; 1.6-2.5 3) were two times more likely to be successfully treated. CONCLUSION The success of TB treatment at the global level was good, but was still below the defined threshold of 85%. Factors such as age, sex, alcohol consumption, smoking, lack of sputum conversion at two months of treatment and HIV affected the success of TB treatment.
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Affiliation(s)
- Ninfa Marlen Chaves Torres
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Medicine, Nueva Granada Military University, Bogotá, D.C., Colombia
| | | | | | - María Belen Arriaga
- Gonzalo Moniz Institute, Gonzalo Cruz Foundation, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
| | - Eduardo Martins Netto
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
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