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Lee H, Bea S, Kim JH, Jeong HE, Jang SH, Son H, Shin JY. Predictors, mortality, and health outcomes of intensive phase non-adherence to a regimen in patients with drug-susceptible tuberculosis: a nationwide linkage database. Public Health 2024; 229:167-175. [PMID: 38452561 DOI: 10.1016/j.puhe.2024.01.021] [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: 08/08/2023] [Revised: 12/29/2023] [Accepted: 01/22/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES The clinical importance of adhering to the regimen in tuberculosis patients has been widely investigated, but most studies were conducted in controlled settings and in limited populations. We aimed to measure the level of real-world adherence during intensive phase and investigate the predictors and the risk of mortality and health outcomes of intensive phase non-adherence in tuberculosis patients. STUDY DESIGN We conducted a nationwide cohort study by linking the Korean National Tuberculosis Surveillance System and the National Health Information Database. METHODS We included all incident drug-susceptible tuberculosis patients who initiated the regimens recommended by the World Health Organization from 2013 to 2018. Adherence was measured using the proportion of days covered (poor [<50%], moderate [50%-79%], and high [≥80%]). We used logistic regression model to assess predictors and the Cox proportional hazard model to evaluate the risk of mortality and health outcomes with intensive phase non-adherence. RESULTS Of 46,818 patients, there were 8% and 11% with poor and moderate adherent groups, respectively. Age ≥45 years, insulin use, and history of renal failure were predictors of non-adherence. Compared with high adherent group, poor and moderate adherent groups were associated with a substantial risk of mortality (poor: hazard ratio, 2.14 [95% confidence interval, 1.95-2.34]; moderate: 1.76 [1.62-1.92]). Similar trends were observed for health outcomes. Stratified analyses showed a higher risk of mortality in patients with medical aid, low income, and history of renal failure, systematic corticosteroids, and immunomodulators. CONCLUSIONS Non-adherence during intensive phase increased mortality risk by twofold, underscoring targeted intervention for high-risk population, including advanced diabetes, and immunocompromised patients.
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Affiliation(s)
- Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea; Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Sungho Bea
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea; Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Han Eol Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea; Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, College of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Hyunjin Son
- Department of Preventive Medicine, College of Medicine, Dong-A University, Busan, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea; Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea; Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea.
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2
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Campbell JR, Brode SK, Barry P, Bastos ML, Bonnet M, Guglielmetti L, Kempker R, Klimuk D, Laniado Laborín R, Milanov V, Singla R, Skrahina A, Trajman A, van der Werf TS, Viiklepp P, Menzies D. Association of indicators of extensive disease and rifampin-resistant tuberculosis treatment outcomes: an individual participant data meta-analysis. Thorax 2024; 79:169-178. [PMID: 38135489 DOI: 10.1136/thorax-2023-220249] [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: 03/15/2023] [Accepted: 10/29/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Indicators of extensive disease-acid fast bacilli (AFB) smear positivity and lung cavitation-have been inconsistently associated with clinical rifampin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB) outcomes. We evaluated the association of these indicators with end-of-treatment outcomes. METHODS We did an individual participant data meta-analysis of people treated for RR/MDR-TB with longer regimens with documented AFB smear and chest radiography findings. We compared people AFB smear-negative without cavities to people: (1) smear-negative with lung cavities; (2) smear-positive without lung cavities and (3) AFB smear-positive with lung cavities. Using multivariable logistic regression accounting for demographic, treatment and clinical factors, we calculated adjusted ORs (aOR) for any unfavourable outcome (death, lost to follow-up, failure/recurrence), and mortality and treatment failure/recurrence alone. RESULTS We included 5596 participants; included participants significantly differed from excluded participants. Overall, 774 (13.8%) were AFB smear-negative without cavities, 647 (11.6%) only had cavities, 1424 (25.4%) were AFB smear-positive alone and 2751 (49.2%) were AFB smear-positive with cavities. The median age was 37 years (IQR: 28-47), 3580 (64%) were male and 686 (12.5%) had HIV. Compared with participants AFB smear-negative without cavities, aOR (95% CI) for any unfavourable outcome was 1.0 (0.8 to 1.4) for participants smear-negative with lung cavities, 1.2 (0.9 to 1.5) if smear-positive without cavities and 1.6 (1.3 to 2.0) if AFB smear-positive with lung cavities. Odds were only significantly increased for mortality (1.5, 95% CI 1.1 to 2.1) and failure/recurrence (2.2, 95% CI 1.5 to 3.3) among participants AFB smear-positive with lung cavities. CONCLUSION Only the combination of AFB smear-positivity and lung cavitation was associated with unfavourable outcomes, suggesting they may benefit from stronger regimens.
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Affiliation(s)
- Jonathon R Campbell
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Montreal Chest Institute & McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Sarah K Brode
- West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Pennan Barry
- Tuberculosis Control Branch, California Department of Public Health, Richmond, California, USA
| | - Mayara Lisboa Bastos
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | | | | | - Russell Kempker
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dzmitry Klimuk
- Republican Scientific and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | | | - Vladimir Milanov
- Occupational Diseases, Medical University-Sofia, Sofia, Bulgaria
| | - Rupak Singla
- Tuberculosis and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Alena Skrahina
- Republican Scientific and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Anete Trajman
- Montreal Chest Institute & McGill International TB Centre, McGill University, Montreal, Quebec, Canada
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tjip S van der Werf
- Departments of Internal Medicine, Infectious Diseases, Pulmonary Diseases, and Tuberculosis, UMC Groningen, Groningen, The Netherlands
| | - Piret Viiklepp
- Department of Registries, National Institute for Health Development, Tallinn, Estonia
| | - Dick Menzies
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Montreal Chest Institute & McGill International TB Centre, McGill University, Montreal, Quebec, Canada
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3
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Iskandar D, Pradipta IS, Anggriani A, Postma MJ, van Boven JFM. Multidisciplinary tuberculosis care: leveraging the role of hospital pharmacists. BMJ Open Respir Res 2023; 10:e001887. [PMID: 37949612 PMCID: PMC10649469 DOI: 10.1136/bmjresp-2023-001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Optimal pharmacological treatment of tuberculosis (TB) requires a multidisciplinary team, yet the hospital pharmacist's role is unclear. We aimed to analyse hospital pharmacist-provided clinical pharmacy services (CPS) implementation in TB care. METHOD A nationwide survey-based online cross-sectional study was conducted on hospital pharmacists in Indonesia from 1 November 2022 to 22 November 2022. Outcomes were the extent of pharmacists' involvement in multidisciplinary TB care, TB-related CPS provided and views on TB-related CPS. The probability of pharmacists' involvement in multidisciplinary TB teams was assessed using logistic regression. RESULTS In total, 439 pharmacists (mean age 31.2±6.22 years, 78% female) completed the survey. Thirty-six per cent were part of multidisciplinary TB care, and 23% had TB-related tasks. Adherence monitoring (90%) and drug use evaluation (86%) were the most conducted TB-related CPS. Pharmacists' views on TB-related CPS implementation were generally positive, except for financial incentives. Work experience (OR 1.99, 95% CI 1.09 to 3.61), ever received TB-related training (OR 3.51, 95% CI 2.03 to 6.14) and specific assignments to provide TB-related CPS (OR 8.42, 95% CI 4.99 to 14.59) significantly increased pharmacist involvement in multidisciplinary TB care. CONCLUSION Around one-third of hospital pharmacists are part of multidisciplinary TB care, with medication adherence and drug use monitoring as primary tasks. Pharmacists' experience, training, assignment to provide TB-related CPS and financial incentives are key elements for further implementation in multidisciplinary TB care. Pharmacists should proactively support current TB care and conduct operational research, sharing data with healthcare peers and fostering a collaborative multidisciplinary TB care team.
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Affiliation(s)
- Deni Iskandar
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center, Groningen, The Netherlands
- Faculty of Pharmacy, Bhakti Kencana University, Bandung, Indonesia
| | - Ivan S Pradipta
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Bandung, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Bandung, Indonesia
- Indonesian Tuberculosis Research Network/JetSet TB, Bandung, Indonesia
| | - Ani Anggriani
- Faculty of Pharmacy, Bhakti Kencana University, Bandung, Indonesia
| | - Maarten J Postma
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center, Groningen, The Netherlands
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Bandung, Indonesia
- Research Institute Science in Healthy Aging and healthcaRE (SHARE), University of Groningen, University Medical Center, Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economic & Business, University of Groningen, Groningen, Netherlands
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center, Groningen, The Netherlands
- Center for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
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Li W, Su M, Zhang W, Fan X, Li R, Gao Y, Wei X. Barriers and facilitators of implementing electronic monitors to improve adherence and health outcomes in tuberculosis patients: protocol for a systematic review based on the Consolidated Framework for Implementation Research. Health Res Policy Syst 2023; 21:115. [PMID: 37915089 PMCID: PMC10621129 DOI: 10.1186/s12961-023-01054-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) has been regarded as 'a relentless scourge', increasing morbidity and mortality and burdening vulnerable populations. Poor adherence to TB treatment and ineffective traditional interventions hinders TB control. A novel TB approach called 'electronic monitors', equipping medication boxes with daily audio or visual reminders for electronically monitoring medication intake, seems promising in improving adherence and health outcomes and overcoming the weaknesses of traditional interventions. However, no review has systematically examined and synthesized the influencing factors of implementing electronic monitors. Implementation research offers the means to analyse the influencing factors of the implementation and its process, fitting well with the aim of this review. Therefore, the widely recognized Consolidated Framework for Implementation Research (CFIR), which offers a common taxonomy for evaluating intervention implementation, will be adopted to systematically identify barriers and facilitators of the electronic monitors for improving adherence and health outcomes in patients with TB. METHODS AND ANALYSIS The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature research will be conducted in five electronic databases (Ovid MEDLINE, CINAHL, EMBASE, Cochrane Library and Web of Science) to identify the barriers and facilitators of implementing electronic monitors in patients with TB. The CFIR will be used as a guide for categorizing and synthesizing the barriers and facilitators. Study screening, data extraction, quality appraisal and data analysis will be conducted by two independent reviewers. The use of additional reviewers will solve any disagreements between the two reviewers. DISCUSSION Given the increased prominence of TB epidemiology and the adherence problem of electronic monitors, there is a solid rationale for synthesizing the existing studies via the CFIR. The findings and conclusion of this review will lay bare the achievements and effectiveness of implementing electronic monitors, as well as the attendant gaps and limitations. Further strategies for facilitating the implementation of electronic monitors will also be explored. This review will be of essential significance for research and practice, supporting future academic research initiatives centred on patients with TB and aiding electronic monitor design in lowering the morbidity and mortality associated with TB disease. TRIAL REGISTRATION NUMBER PROSPERO: CRD42023395747.
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Affiliation(s)
- Wenhui Li
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, China.
| | - Weile Zhang
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Xiaojing Fan
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Renzhong Li
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yulong Gao
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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5
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Hafez G, van Boven JFM. Digital adherence technologies in tuberculosis. Lancet Glob Health 2023; 11:e1341-e1342. [PMID: 37591581 DOI: 10.1016/s2214-109x(23)00308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/23/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul 34140, Türkiye.
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, Medication Adherence Expertise Center of the Northern Netherlands, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Irfan A, Faisal S, Zahoor AF, Noreen R, Al-Hussain SA, Tuzun B, Javaid R, Elhenawy AA, Zaki MEA, Ahmad S, Abdellattif MH. In Silico Development of Novel Benzofuran-1,3,4-Oxadiazoles as Lead Inhibitors of M. tuberculosis Polyketide Synthase 13. Pharmaceuticals (Basel) 2023; 16:829. [PMID: 37375776 DOI: 10.3390/ph16060829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Benzofuran and 1,3,4-oxadiazole are privileged and versatile heterocyclic pharmacophores which display a broad spectrum of biological and pharmacological therapeutic potential against a wide variety of diseases. This article reports in silico CADD (computer-aided drug design) and molecular hybridization approaches for the evaluation of the chemotherapeutic efficacy of 16 S-linked N-phenyl acetamide moiety containing benzofuran-1,3,4-oxadiazole scaffolds BF1-BF16. This virtual screening was carried out to discover and assess the chemotherapeutic efficacy of BF1-BF16 structural motifs as Mycobacterium tuberculosis polyketide synthase 13 (Mtb Pks13) enzyme inhibitors. The CADD study results revealed that the benzofuran clubbed oxadiazole derivatives BF3, BF4, and BF8 showed excellent and remarkably significant binding energies against the Mtb Pks13 enzyme comparable with the standard benzofuran-based TAM-16 inhibitor. The best binding affinity scores were displayed by 1,3,4-oxadiazoles-based benzofuran scaffolds BF3 (-14.23 kcal/mol), BF4 (-14.82 kcal/mol), and BF8 (-14.11 kcal/mol), in comparison to the binding affinity score of the standard reference TAM-16 drug (-14.61 kcal/mol). 2,5-Dimethoxy moiety-based bromobenzofuran-oxadiazole derivative BF4 demonstrated the highest binding affinity score amongst the screened compounds, and was higher than the reference Pks13 inhibitor TAM-16 drug. The bindings of these three leads BF3, BF4, and BF8 were further confirmed by the MM-PBSA investigations in which they also exhibited strong bindings with the Pks13 of Mtb. Moreover, the stability analysis of these benzofuran-1,3,4-oxadiazoles in the active sites of the Pks13 enzyme was achieved through molecular dynamic (MD) simulations at 250 ns virtual simulation time, which indicated that these three in silico predicted bio-potent benzofuran tethered oxadiazole molecules BF3, BF4, and BF8 demonstrated stability with the active site of the Pks13 enzyme.
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Affiliation(s)
- Ali Irfan
- Department of Chemistry, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Shah Faisal
- Department of Chemistry, Islamia College University Peshawar, Peshawar 25120, Pakistan
| | - Ameer Fawad Zahoor
- Department of Chemistry, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Razia Noreen
- Department of Biochemistry, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Sami A Al-Hussain
- Department of Chemistry, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13623, Saudi Arabia
| | - Burak Tuzun
- Plant and Animal Production Department, Technical Sciences Vocational School of Sivas, Sivas Cumhuriyet University, Sivas 58140, Turkey
| | - Rakshanda Javaid
- Department of Chemistry, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Ahmed A Elhenawy
- Chemistry Department, Faculty of Science, Al-Azhar University, Nasr City, Cairo 11884, Egypt
- Chemistry Department, Faculty of Science and Art, AlBaha University, Mukhwah, Al Bahah 65731, Saudi Arabia
| | - Magdi E A Zaki
- Department of Chemistry, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13623, Saudi Arabia
| | - Sajjad Ahmad
- Department of Health and Biological Sciences, Abasyn University, Peshawar 25000, Pakistan
| | - Magda H Abdellattif
- Department of Chemistry, College of Science, Taif University, Taif 21944, Saudi Arabia
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Dwivedi V, Gautam S, Beamer G, Stromberg PC, Headley CA, Turner J. IL-10 Modulation Increases Pyrazinamide's Antimycobacterial Efficacy against Mycobacterium tuberculosis Infection in Mice. Immunohorizons 2023; 7:412-420. [PMID: 37279084 PMCID: PMC10580111 DOI: 10.4049/immunohorizons.2200077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/03/2023] [Indexed: 06/08/2023] Open
Abstract
Mechanisms to shorten the duration of tuberculosis (TB) treatment include new drug formulations or schedules and the development of host-directed therapies (HDTs) that better enable the host immune system to eliminate Mycobacterium tuberculosis. Previous studies have shown that pyrazinamide, a first-line antibiotic, can also modulate immune function, making it an attractive target for combinatorial HDT/antibiotic therapy, with the goal to accelerate clearance of M. tuberculosis. In this study, we assessed the value of anti-IL-10R1 as an HDT along with pyrazinamide and show that short-term anti-IL-10R1 blockade during pyrazinamide treatment enhanced the antimycobacterial efficacy of pyrazinamide, resulting in faster clearance of M. tuberculosis in mice. Furthermore, 45 d of pyrazinamide treatment in a functionally IL-10-deficient environment resulted in sterilizing clearance of M. tuberculosis. Our data suggest that short-term IL-10 blockade with standard TB drugs has the potential to improve clinical outcome by reducing the treatment duration.
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Affiliation(s)
- Varun Dwivedi
- Disease Intervention & Prevention Program, Texas Biomedical Research Institute, San Antonio, TX
| | - Shalini Gautam
- Host Pathogen Interactions Program, Texas Biomedical Research Institute, San Antonio, TX
| | - Gillian Beamer
- Host Pathogen Interactions Program, Texas Biomedical Research Institute, San Antonio, TX
| | - Paul C. Stromberg
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State Institute, Columbus, OH
| | - Colwyn A. Headley
- Host Pathogen Interactions Program, Texas Biomedical Research Institute, San Antonio, TX
| | - Joanne Turner
- Host Pathogen Interactions Program, Texas Biomedical Research Institute, San Antonio, TX
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8
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Jiang W. Addressing the adherence challenge in tuberculosis treatment: more than digital technologies. Lancet Glob Health 2023; 11:e634-e635. [PMID: 37061297 DOI: 10.1016/s2214-109x(23)00160-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/15/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Weixi Jiang
- School of Public Health, Fudan University, Shanghai 200031, China.
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9
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Liu X, Thompson J, Dong H, Sweeney S, Li X, Yuan Y, Wang X, He W, Thomas B, Xu C, Hu D, Vassall A, Huan S, Zhang H, Jiang S, Fielding K, Zhao Y. Digital adherence technologies to improve tuberculosis treatment outcomes in China: a cluster-randomised superiority trial. Lancet Glob Health 2023; 11:e693-e703. [PMID: 37061308 PMCID: PMC10126227 DOI: 10.1016/s2214-109x(23)00068-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 12/12/2022] [Accepted: 02/02/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Drug-sensitive tuberculosis treatment requires 6 months of therapy, so adherence problems are common. Digital adherence technologies might improve tuberculosis treatment outcomes. We aimed to evaluate the effect of a daily reminder medication monitor, monthly review of adherence data by the health-care provider, and differentiated care for patients with adherence issues, on tuberculosis treatment adherence and outcomes. METHODS We did a cluster-randomised superiority trial across four prefectures in China. 24 counties or districts (clusters) were randomly assigned (1:1) to intervention or control groups. We enrolled patients aged 18 years or older with GeneXpert-positive, rifampicin-sensitive pulmonary tuberculosis, who were receiving daily fixed-dose combination treatment. Patients in the intervention group received a medication monitor for daily drug-dosing reminders, monthly review of adherence data by health-care provider, and management of poor adherence; and patients in the control group received routine care (silent-mode monitor-measured adherence). Only the independent endpoints review committee who assessed endpoint data for some participants were masked to study group assignment. Patients were followed up (with sputum solid culture) at 12 and 18 months. The primary outcome was a composite of death, loss to follow-up, treatment failure, switch to multidrug-resistant tuberculosis treatment, or tuberculosis recurrence by 18 months from treatment start, analysed in the intention-to-treat population. Analysis accounted for study design with multiple imputation for the primary outcome. This trial is now complete and is registered with ISRCTN, 35812455. FINDINGS Between Jan 26, 2017, and April 3, 2019, 15 257 patients were assessed for eligibility and 3074 were enrolled, 2686 (87%) of whom were included in the intention-to-treat population. 1909 (71%) of 2686 patients were male, 777 (29%) were female, and the median age was 44 years (IQR 29-58). By 18 months from treatment start, using multiple imputation for missing outcomes, 239 (16% [geometric mean of cluster-level proportion]) of 1388 patients in the control group and 224 (16%) of 1298 in the intervention group had a primary composite outcome event (289 [62%] of 463 events were loss to follow-up during treatment and 42 [9%] were tuberculosis recurrence). The intervention had no effect on risk of the primary composite outcome (adjusted risk ratio 1·01, 95% CI 0·73-1·40). INTERPRETATION Our digital medication monitor intervention had no effect on unfavourable outcomes, which included loss to follow-up during treatment, tuberculosis recurrence, death, and treatment failure. There was a failure to change patient management following identification of treatment non-adherence at monthly reviews. A better understanding of adherence patterns and how they relate to poor outcomes, coupled with a more timely review of adherence data and improved implementation of differentiated care, may be required. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Xiaoqiu Liu
- National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jennifer Thompson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sedona Sweeney
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Xue Li
- National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanli Yuan
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Xiaomeng Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Wangrui He
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, China
| | | | - Caihong Xu
- National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dongmei Hu
- National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Shitong Huan
- Bill & Melinda Gates Foundation China Office, Beijing, China
| | - Hui Zhang
- National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shiwen Jiang
- National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Yanlin Zhao
- National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Ghimire S, Iskandar D, van der Borg-Boekhout R, Zenina M, Bolhuis MS, Kerstjens HAM, van Rossum M, Touw DJ, Zijp TR, van Boven JFM, Akkerman OW. Combining digital adherence technology and therapeutic drug monitoring for personalised tuberculosis care. Eur Respir J 2022; 60:2201690. [PMID: 36356974 DOI: 10.1183/13993003.01690-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Samiksha Ghimire
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Deni Iskandar
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Roelina van der Borg-Boekhout
- TB center Beatrixoord, Haren, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marina Zenina
- TB center Beatrixoord, Haren, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mathieu S Bolhuis
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Huib A M Kerstjens
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke van Rossum
- TB center Beatrixoord, Haren, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Medication Adherence Expertise Center Of the northern Netherlands (MAECON), Groningen, The Netherlands
- Institute of Pharmacy, Department of Pharmaceutical Analysis, University of Groningen, Groningen, The Netherlands
| | - Tanja R Zijp
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Medication Adherence Expertise Center Of the northern Netherlands (MAECON), Groningen, The Netherlands
| | - Onno W Akkerman
- TB center Beatrixoord, Haren, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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11
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Lippincott CK, Perry A, Munk E, Maltas G, Shah M. Tuberculosis treatment adherence in the era of COVID-19. BMC Infect Dis 2022; 22:800. [PMID: 36289485 PMCID: PMC9607764 DOI: 10.1186/s12879-022-07787-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/23/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background In-person directly observed therapy (DOT) is commonly used for tuberculosis (TB) treatment monitoring in the US, with increasing usage of video-DOT (vDOT). We evaluated the impact of COVID-19 on TB treatment adherence, and utilization and effectiveness of vDOT. Methods We abstracted routinely collected data on individuals treated for TB disease in Baltimore, Maryland between April 2019 and April 2021. Our primary outcomes were to assess vDOT utilization and treatment adherence, defined as the proportion of prescribed doses (7 days/week) verified by observation (in-person versus video-DOT), comparing individuals in the pre-COVID and COVID (April 2020) periods. Results Among 52 individuals with TB disease, 24 (46%) received treatment during the COVID-19 pandemic. vDOT utilization significantly increased in the COVID period (18/24[75%]) compared to pre-COVID (12/28[43%], p = 0.02). Overall, median verified adherence was similar pre-COVID and COVID periods (65% versus 68%, respectively, p = 0.96). Adherence was significantly higher overall when using vDOT (median 86% [IQR 70–98%]) compared to DOT (median 59% [IQR 55-64%], p < 0.01); this improved adherence with vDOT was evident in both the pre-COVID (median 98% vs. 58%, p < 0.01) and COVID period (median 80% vs. 62%, p = 0.01). Conclusion vDOT utilization increased during the COVID period and was more effective than in-person DOT at verifying ingestion of prescribed treatment.
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Affiliation(s)
- Christopher K. Lippincott
- grid.21107.350000 0001 2171 9311Division of Infectious Diseases, Johns Hopkins School of Medicine, 1550 Orleans St, CRB-II, 1M-10, 21287 Baltimore, MD USA
| | - Allison Perry
- grid.137628.90000 0004 1936 8753Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, NY USA
| | - Elizabeth Munk
- grid.21107.350000 0001 2171 9311Division of Infectious Diseases, Johns Hopkins School of Medicine, 1550 Orleans St, CRB-II, 1M-10, 21287 Baltimore, MD USA
| | - Gina Maltas
- grid.21107.350000 0001 2171 9311Division of Infectious Diseases, Johns Hopkins School of Medicine, 1550 Orleans St, CRB-II, 1M-10, 21287 Baltimore, MD USA
| | - Maunank Shah
- grid.21107.350000 0001 2171 9311Division of Infectious Diseases, Johns Hopkins School of Medicine, 1550 Orleans St, CRB-II, 1M-10, 21287 Baltimore, MD USA
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12
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Muniyandi M, Karikalan N, Velayutham B, Rajsekar K, Padmapriyadarsini C. Cost Effectiveness of a Shorter Moxifloxacin Based Regimen for Treating Drug Sensitive Tuberculosis in India. Trop Med Infect Dis 2022; 7:tropicalmed7100288. [PMID: 36288029 PMCID: PMC9607110 DOI: 10.3390/tropicalmed7100288] [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: 09/14/2022] [Revised: 09/29/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Globally efforts are underway to shorten the existing 6-month tuberculosis (TB) treatment regimen for drug-sensitive patients, which would be equally effective and safe. At present, there is a lack of evidence on the cost implications of a shorter 4-month TB regimen in India. This economic modeling study was conducted in the Indian context with a high TB burden. We used a hybrid economic model comprising of a decision tree and Markov analysis. The study estimated the incremental costs, life years (LYs), and quality-adjusted life years (QALYs) gained by the introduction of a Moxifloxacin-based shorter 4-month treatment regimen for pulmonary TB patients. The outcomes are expressed in incremental cost-effectiveness ratios (ICERs) per QALYs gained. The cost per case to be treated under the 4-month regimen was USD 145.94 whereas for the 6-month regimen it was USD 150.39. A shorter 4-month TB regimen was cost-saving with USD 4.62 per LY and USD 5.29 per QALY. One-way sensitivity analysis revealed that the cost of the drugs for the 4-month regimen, hospitalization cost for adverse drug reactions, and human resources incurred for the 6-month regimen had a higher influence on the ICER. The probability sensitivity analysis highlighted that the joint incremental cost and effectiveness using QALY were less costly and more effective for 67% of the iteration values. The cost-effectiveness acceptability curve highlights that the 4-month regimen was dominant to both patients and the National TB Elimination Programme in India as compared to the 6-month regimen at different cost-effectiveness threshold values.
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Affiliation(s)
- Malaisamy Muniyandi
- ICMR—National Institute for Research in Tuberculosis, Chennai 600031, India
- Correspondence:
| | | | | | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi 110001, India
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13
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Fox WS, Strydom N, Imperial MZ, Jarlsberg L, Savic RM. Examining non-adherence in the treatment of tuberculosis; the patterns that lead to failure. Br J Clin Pharmacol 2022. [PMID: 36036095 DOI: 10.1111/bcp.15515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 08/12/2022] [Accepted: 08/21/2022] [Indexed: 11/26/2022] Open
Abstract
AIM Adherence has been shown to be a major predictor of tuberculosis treatment failure and relapse. The current adherence metrics can be improved to provide higher resolution of adherence patterns and identify patients in need of alternative treatment interventions. We investigated how adherence patterns affect treatment outcomes, when adherence is likely to decrease during treatment and which patients are at risk of being non-adherent. METHODS Individual-level data were pooled from three clinical trials (N=3724) for treatment of drug susceptible tuberculosis where monthly or weekly adherence patterns were collected and adherence patterns were quantified to assess the impact of clustered missed doses versus randomly missed doses on tuberculosis treatment outcomes. Significance was determined through univariate and multivariate cox regression models. RESULTS Patients who miss doses in clusters have an increased hazard risk for unfavorable outcomes and missing as little as 4 treatment days in one month resulted in 61% higher risk of unfavorable outcomes compared to patients who missed no treatment days (p < 0.01). Patients older than 50, and patients that experienced an adverse event were associated with lower adherence. CONCLUSION Our results show that the pattern in which patients miss their drugs is important to their overall outcomes and missing treatment days in clusters rather than randomly increases the risk of poor outcomes. In the future more intensive and longitudinal adherence measurements will be valuable for clinical trials and regimen design and interpretation.
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Affiliation(s)
- William S Fox
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - Natasha Strydom
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - Marjorie Z Imperial
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - Leah Jarlsberg
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - Radojka M Savic
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
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14
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Kwon SH, Nam JH, Kim HL, Park HY, Kwon JW. Real-world association of adherence with outcomes and economic burden in patients with tuberculosis from South Korea claims data. Front Pharmacol 2022; 13:918344. [PMID: 36052137 PMCID: PMC9424769 DOI: 10.3389/fphar.2022.918344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives: We analyzed tuberculosis (TB)-related costs according to treatment adherence, as well as the association between treatment adherence, treatment outcomes, and costs related to drug-susceptible TB in South Korea. Methods: Patients who had newly treated TB in South Korea between 2006 and 2015 were selected from nationwide sample claims data and categorized into adherent and non-adherent groups using the proportion of days TB drugs covered. Patients were followed-up from the initiation of TB treatment. The mean five-year cumulative costs per patient were estimated according to adherence. Moreover, we evaluated the relative ratios to identify cost drivers such as adherence, treatment outcomes, and baseline characteristics using generalized linear models. Four treatment outcomes were included: treatment completion, loss to follow-up, death, and the initiation of multidrug-resistant TB treatment. Results: Out of the 3,799 new patients with TB, 2,662 were adherent, and 1,137 were non-adherent. Five years after initiating TB treatment, the mean TB-related costs were USD 2,270 and USD 2,694 in the adherent and non-adherent groups, respectively. The TB-related monthly cost per patient was also lower in the adherent than in the non-adherent (relative ratio = 0.89, 95% CI 0.92–0.98), while patients who were lost to follow-up spent more on TB-related costs (2.52, 2.24–2.83) compared to those who completed the treatment. Conclusion: Non-adherent patients with TB spend more on treatment costs while they have poorer outcomes compared to adherent patients with TB. Improving patient adherence may lead to effective treatment outcomes and reduce the economic burden of TB. Policymakers and providers should consider commitment programs to improve patient’s adherence.
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Affiliation(s)
- Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Jin Hyun Nam
- Division of Big Data Science, Korea University Sejong Campus, Sejong, South Korea
| | - Hye-Lin Kim
- College of Pharmacy, Sahmyook University, Seoul, South Korea
| | - Hae-Young Park
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
| | - Jin-Won Kwon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
- *Correspondence: Jin-Won Kwon,
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15
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Bachina P, Lippincott CK, Perry A, Munk E, Maltas G, Bohr R, Rock RB, Shah M. Programmatic Adoption and Implementation of Video-Observed Therapy in Minnesota: Prospective Observational Cohort Study. JMIR Form Res 2022; 6:e38247. [PMID: 35834671 PMCID: PMC9359306 DOI: 10.2196/38247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/24/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background In-person directly observed therapy (DOT) is standard of care for tuberculosis (TB) treatment adherence monitoring in the US, with increasing use of video-DOT (vDOT). In Minneapolis, vDOT became available in 2019. Objective In this paper, we aimed to evaluate the use and effectiveness of vDOT in a program setting, including comparison of verified adherence among those receiving vDOT and in-person DOT. We also sought to understand the impact of COVID-19 on TB treatment adherence and technology adoption. Methods We abstracted routinely collected data on individuals receiving therapy for TB in Minneapolis, MN, between September 2019 and June 2021. Our primary outcomes were to assess vDOT use and treatment adherence, defined as the proportion of prescribed doses (7 days per week) verified by observation (in person versus video-DOT), and to compare individuals receiving therapy in the pre–COVID-19 (before March 2020), and post–COVID-19 (after March 2020) periods; within the post–COVID-19 period, we evaluated early COVID-19 (March-August 2020), and intra–COVID-19 (after August 2020) periods. Results Among 49 patients with TB (mean age 41, SD 19; n=27, 55% female and n=47, 96% non–US born), 18 (36.7%) received treatment during the post–COVID-19 period. Overall, verified adherence (proportion of observed doses) was significantly higher when using vDOT (mean 81%, SD 17.4) compared to in-person DOT (mean 54.5%, SD 10.9; P=.001). The adoption of vDOT increased significantly from 35% (11/31) of patients with TB in the pre–COVID-19 period to 67% (12/18) in the post–COVID-19 period (P=.04). Consequently, overall verified (ie, observed) adherence among all patients with TB in the clinic improved across the study periods (56%, 67%, and 79%, P=.001 for the pre–, early, and intra–COVID-19 periods, respectively). Conclusions vDOT use increased after the COVID-19 period, was more effective than in-person DOT at verifying ingestion of prescribed treatment, and led to overall increased verified adherence in the clinic despite the onset of the COVID-19 pandemic.
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Affiliation(s)
- Preetham Bachina
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | - Allison Perry
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Elizabeth Munk
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Gina Maltas
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Rebecca Bohr
- Hennepin County Public Health, Minneapolis, MN, United States
| | - Robert Bryan Rock
- Division of Infectious Disease, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Maunank Shah
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States
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16
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Pradipta IS, Khairunnisa K, Bahar MA, Kausar MN, Fitriana E, Ruslami R, Aarnoutse RE, Abdulah R. Knowledge, attitude and practice of community pharmacy personnel in tuberculosis patient detection: a multicentre cross-sectional study in a high-burden tuberculosis setting. BMJ Open 2022; 12:e060078. [PMID: 35790331 PMCID: PMC9258488 DOI: 10.1136/bmjopen-2021-060078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Control of tuberculosis (TB) is hampered by suboptimal case detection and subsequent delays in treatment, which is worsened by the COVID-19 pandemic. The community pharmacy is reported as the place for first aid medication among patients with TB. We, therefore, analysed knowledge, attitude and practice (KAP) on TB patient detection (TBPD) of community pharmacy personnel, aiming to find innovative strategies to engage community pharmacies in TBPD. METHODS A multicentre cross-sectional study was performed in four areas of Indonesia's eastern, central and western parts. Pharmacists and pharmacy technicians who worked in community pharmacies were assessed for their characteristics and KAP related to TBPD. Descriptive analysis was used to assess participant characteristics and their KAP, while multivariable regression analyses were used to analyse factors associated with the KAP on TBPD. RESULTS A total of 1129 participants from 979 pharmacies, comprising pharmacists (56.6%) and pharmacy technicians (43.4%), were included. Most participants knew about TB. However, knowledge related to TB symptoms, populations at risk and medication for TB were still suboptimal. Most participants showed a positive attitude towards TBPD. They believed in their professional role (75.1%), capacity in TB screening (65.4%) and responsibility for TBPD (67.4%). Nevertheless, a lack of TBPD practice was identified in most participants. Several factors significantly associated with performing the TBPD practice (p<0.05), such as TB training experience (p<0.001), provision of a drug consultation service (p<0.001), male gender (p<0.05), a positive attitude towards TBPD (p<0.001), short working hours (p<0.001) and central city location of the pharmacy (p<0.05). CONCLUSIONS Most participants had good knowledge and attitude, which did not translate into actual TBPD practice. We identified that TB educational programmes are essential in improving the KAP. A comprehensive assessment is needed to develop effective strategies to engage the community pharmacy in TBPD activities.
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Affiliation(s)
- Ivan Surya Pradipta
- Departement of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | | | - Muh Akbar Bahar
- Departement of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia
| | - Mersa Nurain Kausar
- Departement of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Master of Clinical Pharmacy Program, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Efi Fitriana
- Department of General and Experimental Psychology, Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia
| | - Rovina Ruslami
- Department of Biomedical Sciences, Division of Pharmacology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Rob E Aarnoutse
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rizky Abdulah
- Departement of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
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de Groot LM, Straetemans M, Maraba N, Jennings L, Gler MT, Marcelo D, Mekoro M, Steenkamp P, Gavioli R, Spaulding A, Prophete E, Bury M, Banu S, Sultana S, Onjare B, Efo E, Alacapa J, Levy J, Morales MLL, Katamba A, Bogdanov A, Gamazina K, Kumarkul D, Ekaterina OL, Cattamanchi A, Khan A, Bakker MI. Time Trend Analysis of Tuberculosis Treatment While Using Digital Adherence Technologies-An Individual Patient Data Meta-Analysis of Eleven Projects across Ten High Tuberculosis-Burden Countries. Trop Med Infect Dis 2022; 7:tropicalmed7050065. [PMID: 35622692 PMCID: PMC9145978 DOI: 10.3390/tropicalmed7050065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/04/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023] Open
Abstract
Worldwide, non-adherence to tuberculosis (TB) treatment is problematic. Digital adherence technologies (DATs) offer a person-centered approach to support and monitor treatment. We explored adherence over time while using DATs. We conducted a meta-analysis on anonymized longitudinal adherence data for drug-susceptible (DS) TB (n = 4515) and drug-resistant (DR) TB (n = 473) populations from 11 DAT projects. Using Tobit regression, we assessed adherence for six months of treatment across sex, age, project enrolment phase, DAT-type, health care facility (HCF), and project. We found that DATs recorded high levels of adherence throughout treatment: 80% to 71% of DS-TB patients had ≥90% adherence in month 1 and 6, respectively, and 73% to 75% for DR-TB patients. Adherence increased between month 1 and 2 (DS-TB and DR-TB populations), then decreased (DS-TB). Males displayed lower adherence and steeper decreases than females (DS-TB). DS-TB patients aged 15−34 years compared to those >50 years displayed steeper decreases. Adherence was correlated within HCFs and differed between projects. TB treatment adherence decreased over time and differed between subgroups, suggesting that over time, some patients are at risk for non-adherence. The real-time monitoring of medication adherence using DATs provides opportunities for health care workers to identify patients who need greater levels of adherence support.
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Affiliation(s)
- Liza M. de Groot
- KIT Royal Tropical Institute, Global Health, 1092 AD Amsterdam, The Netherlands; (L.M.d.G.); (M.S.)
| | - Masja Straetemans
- KIT Royal Tropical Institute, Global Health, 1092 AD Amsterdam, The Netherlands; (L.M.d.G.); (M.S.)
| | - Noriah Maraba
- The Aurum Institute, Parktown, Johannesburg 2193, Gauteng, South Africa;
| | - Lauren Jennings
- Desmond Tutu Health Foundation, P.O. Box 13801, Mowbray, Cape Town 7705, Western Cape, South Africa;
| | - Maria Tarcela Gler
- De La Salle Medical and Health Sciences Institute, City of Dasmariñas Cavite 4114, Philippines; (M.T.G.); (D.M.)
| | - Danaida Marcelo
- De La Salle Medical and Health Sciences Institute, City of Dasmariñas Cavite 4114, Philippines; (M.T.G.); (D.M.)
| | - Mirchaye Mekoro
- Health Poverty Action, London EC1V 2NX, UK; (M.M.); (P.S.); (R.G.)
| | - Pieter Steenkamp
- Health Poverty Action, London EC1V 2NX, UK; (M.M.); (P.S.); (R.G.)
| | - Riccardo Gavioli
- Health Poverty Action, London EC1V 2NX, UK; (M.M.); (P.S.); (R.G.)
| | - Anne Spaulding
- Health Through Walls, Port-au-Prince HT 6110, Haiti; (A.S.); (E.P.); (M.B.)
| | - Edwin Prophete
- Health Through Walls, Port-au-Prince HT 6110, Haiti; (A.S.); (E.P.); (M.B.)
| | - Margarette Bury
- Health Through Walls, Port-au-Prince HT 6110, Haiti; (A.S.); (E.P.); (M.B.)
| | - Sayera Banu
- Icddr,b, GPO Box 128, Dhaka 1000, Bangladesh; (S.B.); (S.S.)
| | - Sonia Sultana
- Icddr,b, GPO Box 128, Dhaka 1000, Bangladesh; (S.B.); (S.S.)
| | - Baraka Onjare
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Egwuma Efo
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Jason Alacapa
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Jens Levy
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Mona Lisa L. Morales
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Achilles Katamba
- Department of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda;
| | | | | | - Dzhumagulova Kumarkul
- The Red Crescent National Society of the Kyrgyz Republic, Bishkek 720040, Kyrgyzstan; (D.K.); (O.-L.E.)
| | - Orechova-Li Ekaterina
- The Red Crescent National Society of the Kyrgyz Republic, Bishkek 720040, Kyrgyzstan; (D.K.); (O.-L.E.)
| | - Adithya Cattamanchi
- School of Medicine, University of California San Francisco, San Francisco, CA 94110, USA;
| | - Amera Khan
- Stop TB Partnership, 1218 Geneva, Switzerland
- Correspondence: (A.K.); (M.I.B.)
| | - Mirjam I. Bakker
- KIT Royal Tropical Institute, Global Health, 1092 AD Amsterdam, The Netherlands; (L.M.d.G.); (M.S.)
- Correspondence: (A.K.); (M.I.B.)
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Truong CB, Tanni KA, Qian J. Video-Observed Therapy Versus Directly Observed Therapy in Patients With Tuberculosis. Am J Prev Med 2022; 62:450-458. [PMID: 34916094 DOI: 10.1016/j.amepre.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION This systematic review and meta-analysis synthesized evidence in the effects of video-observed therapy versus that of directly observed therapy on medication adherence, treatment completion, and tuberculosis resolution among patients with tuberculosis. METHODS Potential studies were identified from MEDLINE, Embase, CINAHLdirect, and Cochrane from inception to February 1, 2021. Inclusion criteria included (1) tuberculosis-infected population, (2) video-observed therapy as an intervention, (3) directly observed therapy as the comparison group, and (4) patient's medication adherence or clinical outcomes. Data were collected in 2021. Random-effects meta-analyses were conducted using Mantel-Haenszel methods with RR for dichotomous outcomes (medication adherence, treatment completion, and bacteriological resolution) and generic inverse variance methods with a weighted mean difference for continuous outcomes (proportion of doses observed). RESULTS A total of 9 studies were included in the systematic review and meta-analysis. Compared with patients receiving directly observed therapy, patients with video-observed therapy were associated with improved medication adherence (RR=2.79, 95% CI=2.26, 3.45, I2=25%), the proportion of doses observed (weighted mean difference=0.22, 95% CI=0.06, 0.39, I2=96%), and bacteriological resolution (RR=1.06, 95% CI=1.01, 1.11, I2=0%) but with similar treatment completion (RR=1.33, 95% CI=0.73, 2.43, I2=98%). DISCUSSION Implementation of video-observed therapy improved medication adherence and bacteriological resolution compared with that of directly observed therapy in tuberculosis-infected patients.
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Affiliation(s)
- Cong B Truong
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, Alabama
| | - Kaniz A Tanni
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, Alabama
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, Alabama.
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Ridho A, Alfian SD, van Boven JFM, Levita J, Yalcin EA, Le L, Alffenaar JW, Hak E, Abdulah R, Pradipta IS. Digital Health Technologies to Improve Medication Adherence and Treatment Outcomes in Patients With Tuberculosis: Systematic Review of Randomized Controlled Trials. J Med Internet Res 2022; 24:e33062. [PMID: 35195534 PMCID: PMC8908199 DOI: 10.2196/33062] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/30/2021] [Accepted: 01/07/2022] [Indexed: 02/06/2023] Open
Abstract
Background Nonadherence to medication in tuberculosis (TB) hampers optimal treatment outcomes. Digital health technology (DHT) seems to be a promising approach to managing problems of nonadherence to medication and improving treatment outcomes. Objective This paper systematically reviews the effect of DHT in improving medication adherence and treatment outcomes in patients with TB. Methods A literature search in PubMed and Cochrane databases was conducted. Randomized controlled trials (RCTs) that analyzed the effect of DHT interventions on medication adherence outcomes (treatment completion, treatment adherence, missed doses, and noncompleted rate) and treatment outcomes (cure rate and smear conversion) were included. Adult patients with either active or latent TB infection were included. The Jadad score was used for evaluating the study quality. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was followed to report study findings. Results In all, 16 RCTs were selected from 552 studies found, and 6 types of DHT interventions for TB were identified: 3 RCTs examined video directly observed therapy (VDOT), 1 examined video-observed therapy (VOT), 1 examined an ingestible sensor, 1 examined phone call reminders, 2 examined medication monitor boxes, and 8 examined SMS text message reminders. The outcomes used were treatment adherence, including treatment completion, treatment adherence, missed dose, and noncompleted rate, as well as clinical outcomes, including cure rate and smear conversion. In treatment completion, 4 RCTs (VDOT, VOT, ingestible sensor, SMS reminder) found significant effects, with odds ratios and relative risks (RRs) ranging from 1.10 to 7.69. Treatment adherence was increased in 1 study by SMS reminders (RR 1.05; 95% CI 1.04-1.06), and missed dose was reduced in 1 study by a medication monitor box (mean ratio 0.58; 95% CI 0.42-0.79). In contrast, 3 RCTs of VDOT and 3 RCTs of SMS reminders did not find significant effects for treatment completion. Moreover, no improvement was found in treatment adherence in 1 RCT of VDOT, missed dose in 1 RCT of SMS reminder, and noncompleted rate in 1 RCT of a monitor box, and 2 RCTs of SMS reminders. For clinical outcomes such as cure rate, 2 RCTs reported that phone calls (RR 1.30; 95% CI 1.07-1.59) and SMS reminders (OR 2.47; 95% CI 1.13-5.43) significantly affected cure rates. However, 3 RCTs found that SMS reminders did not have a significant impact on cure rate or smear conversion. Conclusions It was found that DHT interventions can be a promising approach. However, the interventions exhibited variable effects regarding effect direction and the extent of improving TB medication adherence and clinical outcomes. Developing DHT interventions with personalized feedback is required to have a consistent and beneficial effect on medication adherence and outcomes among patients with TB.
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Affiliation(s)
- Abdurahman Ridho
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Doctor Program in Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Sofa D Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Medication Adherence Expertise Center of the Northern Netherlands, Groningen, Netherlands
| | - Jutti Levita
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Esin Aki Yalcin
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - Ly Le
- Vingroup Big Data Institute, Hanoi, Vietnam
| | - Jan-Willem Alffenaar
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, Australia.,Sydney Institute for Infectious Diseases, Sydney, Australia.,Westmead Hospital, Sydney, Australia
| | - Eelko Hak
- Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics, Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Ivan S Pradipta
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
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Wekunda PW, Aduda DSO, Guyah B. Determinants of tuberculosis treatment interruption among patients in Vihiga County, Kenya. PLoS One 2021; 16:e0260669. [PMID: 34855844 PMCID: PMC8638988 DOI: 10.1371/journal.pone.0260669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite robust Tuberculosis (TB) program with effective chemotherapy and high coverage, treatment interruption remains a serious problem. Interrupting TB treatment means that patients remain infectious for longer time and are at risk of developing drug resistance and death. This study was conducted to identify and describe predictors of TB treatment interruption. METHODS A cohort of 291 notified TB patients from 20 selected health facilities in Vihiga County were enrolled in to the study and followed up until the end of treatment. Patient characteristics that potentially predict treatment interruption were recorded during treatment initiation using structured questionnaires. Patients who interrupted treatment were traced and reasons for stoppage of treatment recorded. Kaplan Meier method was used to estimate probabilities of treatment interruption by patient characteristics and determine time intervals. The Log rank test for the equality of survival distributions analyzed significance of survival differences among categorical variables. For multivariable analysis, Cox proportional hazard model, was fitted to identify predictors of TB treatment interruption through calculation of hazard ratios with 95% Confidence Intervals (CIs). For variable analysis, statistical significance was set at P ≤ 0.05. Reasons for treatment interruption were categorized according to most recurrent behavioral or experiential characteristics. RESULTS Participants' median age was 40 years (IQR = 32-53) and 72% were male. Of the 291 patients, 11% (n = 32) interrupted treatment. Incidences of treatment interruption significantly occurred during intensive phase of treatment. Independent predictors of treatment interruption included alcohol consumption (HR = 9.2, 95% CI; 2.6-32.5, p < 0.001), being female (HR = 5.01, 95% CI; 1.68-15.0, p = 0.004), having primary or lower education level (HR = 3.09, 95% CI; 1.13-8.49, p < 0.029) and having a treatment supporter (HR = 0.33, 95% CI; 0.14-0.76, p = 0.009). Reasons for interrupting treatment were categorized as: alcoholism, feeling better after treatment initiation, associated TB stigma, long distance to health facility, lack of food, perception of not having TB and pill burden. CONCLUSION TB treatment interruption was high and largely associated with patients' socio-demographic and behavioral characteristics. These multidimensional factors suggest the need for interventions that not only target individual patients but also environment in which they live and receive healthcare services.
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Affiliation(s)
- Paul Waliaula Wekunda
- Department of Health, Tuberculosis, Leprosy and Lung Disease Control, Vihiga County, Kenya
| | - Dickens S. Omondi Aduda
- Directorate of Research, Innovation and Partnerships, School of Health Sciences, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Bernard Guyah
- Department of Biomedical Sciences, Maseno University, Kisumu, Kenya
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21
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22
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Pradipta IS, Idrus LR, Probandari A, Lestari BW, Diantini A, Alffenaar JWC, Hak E. Barriers and strategies to successful tuberculosis treatment in a high-burden tuberculosis setting: a qualitative study from the patient's perspective. BMC Public Health 2021; 21:1903. [PMID: 34670527 PMCID: PMC8529853 DOI: 10.1186/s12889-021-12005-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 10/11/2021] [Indexed: 02/07/2023] Open
Abstract
Background Previously treated tuberculosis (TB) patients are a widely reported risk factor for multidrug-resistant tuberculosis. Identifying patients’ problems during treatment is necessary to control TB, especially in a high-burden setting. We therefore explored barriers to successful TB treatment from the patients’ perspective, aiming to identify potential patient-centred care strategies to improve TB treatment outcome in Indonesia. Methods A qualitative study was conducted in a province of Indonesia with high TB prevalence. Participants from various backgrounds (i.e., TB patients, physicians, nurses, pharmacists, TB activist, TB programmers at the district and primary care levels) were subject to in-depth interviews and focus group discussions (FGDs). All interviews and FGDs were transcribed verbatim from audio and visual recordings and the respective transcriptions were used for data analysis. Barriers were constructed by interpreting the codes’ pattern and co-occurrence. The information’s trustworthiness and credibility were established using information saturation, participant validation and triangulation approaches. Data were inductively analysed using the Atlas.ti 8.4 software and reported following the COREQ 32-items. Results We interviewed 63 of the 66 pre-defined participants and identified 15 barriers. The barriers were classified into three themes, i.e., socio-demography and economy; knowledge and perception and TB treatment. Since the barriers can be interrelated, we determined five main barriers across all barrier themes, i.e., lack of TB knowledge, stigmatisation, long distance to the health facility, adverse drug reaction and loss of household income. Conclusion The main treatment barriers can be considered to strengthen patient-centred care for TB patients in Indonesia. A multi-component approach including TB patients, healthcare providers, broad community and policy makers is required to improve TB treatment success. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12005-y.
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Affiliation(s)
- Ivan S Pradipta
- Groningen Research Institute of Pharmacy, Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTE2), University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands. .,Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia. .,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia.
| | - Lusiana R Idrus
- Groningen Research Institute of Pharmacy, Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTE2), University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands.,Bekasi General Hospital, West Java Local Government, Bekasi, Indonesia
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.,Disease Control Research Group, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Bony W Lestari
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ajeng Diantini
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Jan-Willem C Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, Groningen, The Netherlands.,Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, Australia.,Werstmead Hospital, Sydney, Australia
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTE2), University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands
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Ahn BS, Kang S, Lee KH, Kim S, Park JS, Seo HS. A Literature Analysis on Medicinal Use and Research of Cannabis in the Meiji Era of Japan. J Pharmacopuncture 2020; 23:142-157. [PMID: 33072412 PMCID: PMC7540234 DOI: 10.3831/kpi.2020.23.3.142] [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: 08/24/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 11/17/2022] Open
Abstract
Cannabis is a historical plant which has been used as a medicine in East Asia. These days, there are active debates about using cannabis in clinical field. Collecting and comparing cannabis research articles which had been published in the Opening of Japan to spot the interactions between the traditional medicine of Japan, Rangaku which was established in Edo Period and the European medicine which is transferred after Perry Expedition is academically meaningful. This study searched publications, which were listed on Open-Access databases by Dec. 11th, 2019. We collected research articles which had been published from January 3rd, 1867 to July 30th, 1912 also known as Meiji era and uploaded on Open-Access databases. Our searching databases were J-stage, CiNii (Scholarly and Academic Information Navigator), Tokyo Metropolitan Library, The National Diet Library, IRDB (Institutional Repositories DataBase) and KAKEN (Grant-in-Aid for Scientific Research Database). Searching keywords were cannabis, hemp and all their Japanese synonyms and available combinations. We selected final 15 studies which met every selection criteria in the 346,393 collected studies. Cannabis was prescribed in Meiji era of Japan to alleviate pain and cure the digestive, respiratory, urinary, and nervous system diseases such as indigestion, asthma, tuberculosis, gonorrhea and its complications, insomnia, and nervous prostration. Cannabis was medically used in Meiji era of Japan and the reporting and sharing of its clinical effect was published on the medical journals like present days. There were already Cannabis regulations in that era, but its medicinal use was more liberated than nowadays. It may be a chance to reconsider the current legal system, which strictly controls the use of Cannabis.
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Affiliation(s)
- Byung-Soo Ahn
- Korean Pharmacopuncture Institute, Seoul,
Korea
- College of Pharmacy, Ajou University, Suwon,
Korea
| | - Seokhyun Kang
- Medical Association of Pharmacopuncture Institute, Seoul,
Korea
| | - Kyung Hoon Lee
- AJ Research Institute for Integrative Medicine, Seoul,
Korea
| | - Seoyoon Kim
- Korean Pharmacopuncture Institute, Seoul,
Korea
| | | | - Hyung-Sik Seo
- Department of Opthalmology, Otolaryngology and
Dermatology, Korean Medicine Hospital, Pusan National University, Yangsan,
Korea
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