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Wademan DT, Saule Z, Marthinus A, Viljoen L, Nortier E, Hughes J, Courtney I, Palmer M, Garcia-Prats AJ, Hesseling AC, Hoddinott G. Acceptability of clofazimine capsules in children and adolescents with rifampicin-resistant TB. Int J Tuberc Lung Dis 2024; 28:256-258. [PMID: 38659140 DOI: 10.5588/ijtld.23.0517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Affiliation(s)
- D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Z Saule
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A Marthinus
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - L Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - E Nortier
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - J Hughes
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - I Courtney
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa;, University of Wisconsin-Madison, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, USA
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa;, University of Wisconsin-Madison, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, USA
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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Hesseling AC, Garcia-Prats AJ, Inabathina KR. A novel home-based method for preparing suspensions of anti-TB drugs. Int J Tuberc Lung Dis 2023; 27:810-815. [PMID: 37880886 PMCID: PMC10599413 DOI: 10.5588/ijtld.23.0165] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/08/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND: Tablets are the most widely available dosage form for the treatment of TB; however, adult tablets fail to meet the needs of young children who cannot swallow these tablets or require dose titration. We tested a new, simple device (XTEMP-R®) and the methodology for converting tablets of TB drugs into a homogeneous suspension for home use by children and caregivers.METHODS: XTEMP-R is a new device used for converting tablets into liquid preparations. Four TB drugs - pretomanid, delamanid, clofazimine and bedaquiline - were dispersed in the device utilizing water and simple syrup. The reproducibility of accurately delivering aliquots from the suspension upon preparation and upon redispersion after storing for 2 days was studied.RESULTS: Suspensions of each of the drugs tested were easily prepared in about 10 min and were visually uniform in consistency. Dosages in 2 and 5 mL were assessed in suspension, and those in 5 mL tested upon redispersion after 2 days. The observed range for these dosages spanned from 94.6% to 101.1% of the theoretical concentration for the suspensions under examination. The cleaned device had no detectable residual drug.CONCLUSION: XTEMP-R can be used at home by caregivers to prepare doses of suspensions accurately for children and patients who cannot swallow tablets.
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Affiliation(s)
- R Taneja
- Global Alliance for TB drug Development (TB Alliance), New York, NY
| | - M C Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, The Ohio State University, Columbus, OH
| | | | - P G Pande
- Global Alliance for TB drug Development (TB Alliance), New York, NY
| | | | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - C L Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R K Jew
- Institute for Safe Medication Practices, Plymouth Meeting, PA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - K Rao Inabathina
- Global Alliance for TB drug Development (TB Alliance), New York, NY
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Myburgh H, Meehan SA, Wademan DT, Osman M, Hesseling AC, Hoddinott G. TB programme stakeholder views on lessons from the COVID-19 response in South Africa. Public Health Action 2023; 13:97-103. [PMID: 37736584 PMCID: PMC10446663 DOI: 10.5588/pha.23.0015] [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] [Received: 03/28/2023] [Accepted: 06/21/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The global COVID-19 pandemic has reversed many of the hard-won gains made in TB programmes and the associated reduction in the number of TB deaths, case notifications and incidence over the last three decades. Modelling estimates show that the impact will be lasting. There are global calls to recover the shortfalls along the TB care cascade that have resulted from COVID-19, with the recognition that the COVID-19 response holds lessons to inform more robust and comprehensive TB programmes and services. OBJECTIVE To explore lessons from response measures to the COVID-19 pandemic in two high TB burden South African provinces. DESIGN This was an exploratory qualitative study. We conducted interviews with TB programme stakeholders (managers and facility-level staff: n = 35) between February and June 2022. RESULTS We identified eight facilitators of the COVID-19 response, including political will, rapid policy development, multi-sectoral collaboration, patient-centred models of care delivery, community engagement, mHealth and telehealth technologies, rigorous contact tracing and widespread mask wearing. Political will was singled out as a critical driver of the response. CONCLUSION Leveraging COVID-19 inspired collaborations, technologies and avenues for health service delivery is an opportunity to maximise benefits for the TB programme. Reinvestment in national TB programmes and political prioritisation of TB are critical.
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Affiliation(s)
- H Myburgh
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam; Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, Netherlands
| | - S-A Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Human Sciences, Faculty of Education, Health & Human Sciences, University of Greenwich, London, UK
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Viljoen L, Acaba J, Agbassi YJP, Beko B, Goslett C, Hoddinott G, Kumar B, Kumar RG, McKenna L, Moses G, Sachs T, Seidel S, von Delft A. Community perspective on child-friendly medications for drug-resistant TB: importance, priorities and advocacy. Int J Tuberc Lung Dis 2023; 27:655-657. [PMID: 37608482 PMCID: PMC10443785 DOI: 10.5588/ijtld.23.0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/23/2023] [Indexed: 08/24/2023] Open
Affiliation(s)
- L Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - J Acaba
- The BENEFIT Kids Community Advisory Board (CAB), Asia Pacific Council of AIDS Service Organizations, Bangkok, Thailand
| | - Y J P Agbassi
- Global Tuberculosis Community Advisory Board (TB CAB)
| | - B Beko
- TB Proof, Cape Town, South Africa
| | - C Goslett
- The BENEFIT Kids Community Advisory Board (CAB), Desmond Tutu TB Centre CAB, Cape Town, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - B Kumar
- The BENEFIT Kids Community Advisory Board (CAB), Global Coalition of TB Advocates
| | - R G Kumar
- Touched by TB, National Coalition of People Affected by TB, India
| | - L McKenna
- Treatment Action Group, New York, NY
| | - G Moses
- Global Tuberculosis Community Advisory Board (TB CAB)
| | - T Sachs
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | - A von Delft
- The BENEFIT Kids Community Advisory Board (CAB), TB Proof, Cape Town, South Africa
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Chiang SS, Graham SM, Schaaf HS, Marais BJ, Sant'Anna CC, Sharma S, Starke JR, Triasih R, Achar J, Amanullah F, Armitage LY, Aurilio RB, Buck WC, Centis R, Chabala C, Cruz AT, Demers AM, du Preez K, Enimil A, Furin J, Garcia-Prats AJ, Gonzalez NE, Hoddinott G, Isaakidis P, Jaganath D, Kabra SK, Kampmann B, Kay A, Kitai I, Lopez-Varela E, Maleche-Obimbo E, Malaspina FM, Velásquez JN, Nuttall JJC, Oliwa JN, Andrade IO, Perez-Velez CM, Rabie H, Seddon JA, Sekadde MP, Shen A, Skrahina A, Soriano-Arandes A, Steenhoff AP, Tebruegge M, Tovar MA, Tsogt B, van der Zalm MM, Welch H, Migliori GB. Clinical standards for drug-susceptible TB in children and adolescents. Int J Tuberc Lung Dis 2023; 27:584-598. [PMID: 37491754 PMCID: PMC10365562 DOI: 10.5588/ijtld.23.0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND: These clinical standards aim to provide guidance for diagnosis, treatment, and management of drug-susceptible TB in children and adolescents.METHODS: Fifty-two global experts in paediatric TB participated in a Delphi consensus process. After eight rounds of revisions, 51/52 (98%) participants endorsed the final document.RESULTS: Eight standards were identified: Standard 1, Age and developmental stage are critical considerations in the assessment and management of TB; Standard 2, Children and adolescents with symptoms and signs of TB disease should undergo prompt evaluation, and diagnosis and treatment initiation should not depend on microbiological confirmation; Standard 3, Treatment initiation is particularly urgent in children and adolescents with presumptive TB meningitis and disseminated (miliary) TB; Standard 4, Children and adolescents should be treated with an appropriate weight-based regimen; Standard 5, Treating TB infection (TBI) is important to prevent disease; Standard 6, Children and adolescents should receive home-based/community-based treatment support whenever possible; Standard 7, Children, adolescents, and their families should be provided age-appropriate support to optimise engagement in care and clinical outcomes; and Standard 8, Case reporting and contact tracing should be conducted for each child and adolescent.CONCLUSION: These consensus-based clinical standards, which should be adapted to local contexts, will improve the care of children and adolescents affected by TB.
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Affiliation(s)
- S S Chiang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, Center for International Health Research, Rhode Island Hospital, Providence, RI, USA
| | - S M Graham
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Burnet Institute, Melbourne, VIC, Australia
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - B J Marais
- Department of Paediatrics and Child Health and the Sydney Infectious Diseases Institute (Sydney ID), Sydney, NSW, Department of Infectious Diseases, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - C C Sant'Anna
- Department of Paediatrics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - S Sharma
- Department of Paediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - J R Starke
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, Section of Infectious Diseases, Texas Children's Hospital, Houston, TX, USA
| | - R Triasih
- Department of Paediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - J Achar
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - F Amanullah
- Department of Paediatrics, The Indus Hospital and Health Network, Karachi, Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan
| | - L Y Armitage
- Heartland National TB Center, University of Texas Health Science Center at Tyler, San Antonio, TX, USA
| | - R B Aurilio
- Department of Paediatrics, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Department of Paediatrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - W C Buck
- Department of Pediatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - R Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italy
| | - C Chabala
- School of Medicine, Department of Paediatrics and Child Health, University of Zambia, Lusaka, Children's Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - A T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - A-M Demers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Division of Microbiology, Department of Laboratory Medicine, CHU Sainte-Justine, Montreal, Canada
| | - K du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Enimil
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
| | - N E Gonzalez
- División Neumotisiología, Hospital de Niños Pedro de Elizalde, Buenos Aires, Dirección General de Posgrado, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - P Isaakidis
- Southern Africa Medical Unit (SAMU), Médecins Sans Frontières, Cape Town, South Africa, Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - D Jaganath
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - S K Kabra
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - B Kampmann
- Charite Centre for Global Health, Charite Universitatsmedizin Berlin, Berlin, Germany, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - A Kay
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - I Kitai
- Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - E Lopez-Varela
- Hospital Clínic and ISGlobal, Universitat de Barcelona, Barcelona, Spain, Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - E Maleche-Obimbo
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | - F Mestanza Malaspina
- Department of Paediatrics, Hospital San Bartólome, Lima, Red Peruana de Tuberculosis Pediátrica, Dirección de Prevención y Control de Tuberculosis, Ministerio de Salud, Lima, Perú
| | - J Niederbacher Velásquez
- Department of Paediatrics, Universidad Industrial de Santander, Bucaramanga, Board of Directors, Asociación Colombiana de Neumología Pediátrica, Bogotá, Colombia
| | - J J C Nuttall
- Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - J N Oliwa
- Faculty of Health Sciences, Department of Paediatrics and Child Health, The University of Nairobi, Nairobi, Health Services Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - I Orozco Andrade
- Center of Diagnosis and Integral Treatment for Tuberculosis, Servicios Médicos de la Frontera, Juárez, Medical Coordination, Juntos Binational Tuberculosis Project, Juárez, México
| | - C M Perez-Velez
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - H Rabie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Infectious Disease, Imperial College London, London, UK
| | - M P Sekadde
- National TB and Leprosy Program, Ministry of Health, Kampala, Uganda
| | - A Shen
- Beijing Paediatric Research Institute, National Centre for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, Pediatric Research Institute, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - A Skrahina
- Clinical Department, The Republican Scientific and Practical Centre for Pulmonology and TB, Minsk, Belarus
| | - A Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Infection and Immunity in Children, Vall d'Hebron Research Institute, Barcelona, Spain
| | - A P Steenhoff
- Global Health Center and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA, Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - M Tebruegge
- Department of Infection, Immunity & Inflammation, University College London, Great Ormond Street Institute of Child Health, London, UK, Department of Paediatrics, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
| | - M A Tovar
- Socios En Salud Sucursal Perú, Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - B Tsogt
- Research and Innovation, Mongolian Anti-TB Coalition, Ulaanbaatar, Mongolia
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H Welch
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, Department of Paediatrics, The University of Papua New Guinea School of Medicine and Health Sciences, Port Moresby, Papua New Guinea
| | - G B Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italy
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Wademan DT, Viljoen L, Jacobs S, Meyerson K, Nombewu Y, Busakwe L, Schaaf HS, Hesseling AC, Winckler J, Garcia-Prats AJ, Hoddinott G. Children´s priorities to improve the acceptability of MDR-TB treatment: qualitative data from South Africa. Int J Tuberc Lung Dis 2023; 27:543-550. [PMID: 37353869 DOI: 10.5588/ijtld.22.0573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND: Multidrug-resistant TB (MDR-TB) treatment for children frequently includes unpalatable drugs with low overall acceptability. This can negatively impact children and their caregivers´ treatment experiences and is an important contributor to poor adherence, and potentially, poor treatment outcomes. Children and their caregivers´ preferences for MDR-TB treatment are not well documented. We describe children and caregivers´ priorities to inform future MDR-TB treatment regimens.METHODS: We conducted a cross-sectional qualitative study at a TB hospital in South Africa using semi-structured interviews and participatory research activities with caregivers and children routinely diagnosed and treated for MDR-TB between June and August 2018.RESULTS: We conducted 15 interviews with children and their caregivers. Children ranged from 2 to 17 years of age (median age: 8.3 years). Children and caregivers had an overall negative experience of MDR-TB treatment. Children and caregivers described how future MDR-TB drugs and regimens should prioritise sweeter flavours, fewer pills, brighter colours, and formulations that are easy to prepare and administer and dispensed in colourful, small and discrete packaging.CONCLUSIONS: MDR-TB treatment acceptability remains low, and negatively impacts children and their caregivers´ treatment experiences. Improving the overall acceptability of MDR-TB treatment requires engaging with children and their caregivers to better understand their priorities for new treatment regimens and child-friendly formulations.
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Affiliation(s)
- D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - L Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - S Jacobs
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - K Meyerson
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Y Nombewu
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - L Busakwe
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - J Winckler
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa, Department of Paediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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7
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Strauss M, Wademan DT, Mcinziba A, Hoddinott G, Rafique M, Jola LN, Streicher C, du Preez K, Osman M, Boffa J, Hausler H, Hesseling AC, Hirsch-Moverman Y. TB preventive therapy preferences among children and adolescents. Int J Tuberc Lung Dis 2023; 27:520-529. [PMID: 37353873 DOI: 10.5588/ijtld.22.0645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND: TB preventive therapy (TPT) is critical for ending TB, yet implementation remains poor. With new global guidelines expanding TPT eligibility and regimens, we aimed to understand TPT preferences among children, adolescents and caregivers.METHODS: We undertook a discrete choice experiment among 131 children, 170 adolescents and 173 caregivers, and conducted 17 in-depth interviews in 25 clinics in Cape Town, South Africa. The design included attributes for location, waiting time, treatment duration, dosing frequency, formulation/size, side effects, packaging and taste. Mixed-effects logistic regression models were used for analysis.RESULTS: Among children and caregivers, the number and size of pills, taste and side effects were important drivers of preferences. Among adolescents and caregivers, clinic waiting times and side effects were significant drivers of preferences. Adolescents expressed concerns about being stigmatised, and preferred services from local clinics to services delivered in the community. Dosing frequency and treatment duration were only significant drivers of choice among adolescents, and only if linked to fewer clinic visits.CONCLUSIONS: Introducing shorter TPT regimens in isolation without consideration of preferences and health services may not have the desired effect on uptake and completion. Developing TPT delivery models and formulations that align with preferences must be prioritised.
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Affiliation(s)
- M Strauss
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Mcinziba
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Rafique
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - L N Jola
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - C Streicher
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - K du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, School of Human Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
| | - J Boffa
- TB Think Tank, The Aurum Institute, Johannesburg, South Africa, Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - H Hausler
- TB HIV Care, Cape Town, South Africa, Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Nightingale R, Carlin F, Meghji J, McMullen K, Evans D, van der Zalm MM, Anthony MG, Bittencourt M, Byrne A, du Preez K, Coetzee M, Feris C, Goussard P, Hirasen K, Bouwer J, Hoddinott G, Huaman MA, Inglis-Jassiem G, Ivanova O, Karmadwala F, Schaaf HS, Schoeman I, Seddon JA, Sineke T, Solomons R, Thiart M, van Toorn R, Fujiwara PI, Romanowski K, Marais S, Hesseling AC, Johnston J, Allwood B, Muhwa JC, Mortimer K. Post-TB health and wellbeing. Int J Tuberc Lung Dis 2023; 27:248-283. [PMID: 37035971 PMCID: PMC10094053 DOI: 10.5588/ijtld.22.0514] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 04/11/2023] Open
Abstract
TB affects around 10.6 million people each year and there are now around 155 million TB survivors. TB and its treatments can lead to permanently impaired health and wellbeing. In 2019, representatives of TB affected communities attending the '1st International Post-Tuberculosis Symposium´ called for the development of clinical guidance on these issues. This clinical statement on post-TB health and wellbeing responds to this call and builds on the work of the symposium, which brought together TB survivors, healthcare professionals and researchers. Our document offers expert opinion and, where possible, evidence-based guidance to aid clinicians in the diagnosis and management of post-TB conditions and research in this field. It covers all aspects of post-TB, including economic, social and psychological wellbeing, post TB lung disease (PTLD), cardiovascular and pericardial disease, neurological disability, effects in adolescents and children, and future research needs.
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Affiliation(s)
- R Nightingale
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Respiratory Medicine, Liverpool University Hospitals NHS foundation Trust, Liverpool, UK
| | - F Carlin
- Department of Infectious Diseases, Liverpool University Hospitals NHS foundation Trust, Liverpool, UK
| | - J Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Respiratory Medicine, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - K McMullen
- Division of Neurology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - D Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M G Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M Bittencourt
- University Hospital, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | - A Byrne
- Department of Thoracic Medicine, St Vincent´s Hospital Clinical School University of New South Wales, Sydney, NSW, Australia
| | - K du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M Coetzee
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - C Feris
- Occupational Therapy Department, Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Namibia, Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Tygerberg, South Africa
| | - P Goussard
- Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - K Hirasen
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Paediatric Pulmonology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - J Bouwer
- Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M A Huaman
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - G Inglis-Jassiem
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - O Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, German Centre for Infection Research, Partner Site Munich, Munich, Germany
| | - F Karmadwala
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa, Department of Infectious Diseases, Imperial College London, London, UK
| | - T Sineke
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Solomons
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - M Thiart
- Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - R van Toorn
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - P I Fujiwara
- Task Force, Global Plan to End TB, 2023-2030, Stop TB Partnership, Geneva, Switzerland
| | - K Romanowski
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada, Provincial TB Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - S Marais
- Division of Neurology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa, Neurology Research Group, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - J Johnston
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada, Provincial TB Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - B Allwood
- Division of Pulmonology, Department of Medicine, Faculty of Medicine, Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J C Muhwa
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya
| | - K Mortimer
- Department of Respiratory Medicine, Liverpool University Hospitals NHS foundation Trust, Liverpool, UK, Department of Medicine, University of Cambridge, Cambridge, UK, Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Garcia-Prats AJ, Hesseling AC. Stable, compounded bedaquiline suspensions to support practical implementation of pediatric dosing in the field. Int J Tuberc Lung Dis 2023; 27:189-194. [PMID: 36855042 PMCID: PMC9983625 DOI: 10.5588/ijtld.22.0440] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND: Bedaquiline (BDQ) tablets are indicated as part of a combination regimen for the treatment of multidrug-resistant TB in adults, adolescents and children. A dispersible tablet formulation is now approved but is not currently available in all settings. The aim of this study was to develop stable extemporaneous liquid formulations of BDQ that can be stored at room temperature or 30°C for several weeks, to support pragmatic pediatric dosing in the field and reduce wastage.METHODS: BDQ tablets were suspended in simple syrup and a sugar-free vehicle. Each 20 mg/mL formulation was stored at room temperature or 30°C for 30 days in amber dispensing bottles. Appearance, BDQ potency, pH and microbial counts were determined on Days 0, 15 and 30.RESULTS: The BDQ potency in both formulations remained at 98-101% of the theoretical concentration for 30 days. The appearance, pH and microbial count of sugar-free formulation did not change during the 30-day storage. The simple syrup formulation was stable for 15 days as microbial growth was observed on Day 30.CONCLUSIONS: BDQ may be prepared in syrup or sugar-free suspensions: syrup suspensions can be stored for 15 days at room temperature and 30C, whereas sugar-free suspensions can be stored for 30 days at room temperature and 30C. This information will support practical BDQ dosing for children in the field.
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Affiliation(s)
- R Taneja
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - M C Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, The Ohio State University, Columbus, OH, USA
| | - J Scarim
- JSAS Services Inc Tucson, AZ, USA
| | - P G Pande
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - A Scarim
- JSAS Services Inc Tucson, AZ, USA
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - C L Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R K Jew
- Institute for Safe Medication Practices (ISMP), Plymouth Meeting, PA, USA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A J Garcia-Prats
- Department of Pediatrics University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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10
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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Hesseling AC, Garcia-Prats AJ. Extemporaneously compounded liquid formulations of clofazimine. Int J Tuberc Lung Dis 2023; 27:106-112. [PMID: 36853102 PMCID: PMC9904399 DOI: 10.5588/ijtld.22.0331] [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] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND: Clofazimine (CFZ) is routinely used worldwide for the treatment of leprosy and TB. However, no liquid or dispersible tablet formulations of CFZ are currently available commercially for patients with challenges ingesting soft gelatin capsules or solid formulations. The aim of this research was to develop stable extemporaneous liquid formulations of CFZ that can be stored at room temperature for several weeks to enable practical dosing in the field.METHODS: Two formulations were prepared in syrup and sugar-free vehicles with CFZ tablets using a simple method that can be used in a routine pharmacy. Suspensions were stored at room temperature and at 30°C for 30 days. Formulation aliquots were tested on Days 0, 15 and 30 for appearance, pH, potency and microbial counts.RESULTS: Appearance remained unchanged during storage. The pH of both formulations was between 4.0 and 6.0. Potency was between 90% and 110% for 30 days in the syrup formulation and for 15 days in the sugar-free formulation. Microbial counts met United States Pharmacopeia <1111> limits for oral aqueous liquids and specific organisms were absent.CONCLUSIONS: A simple field-friendly method was successfully developed for the preparation of CFZ liquid formulations using commonly available ingredients. This will permit practical dosing and titration for children and other patients with swallowing challenges.
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Affiliation(s)
- R Taneja
- Global Alliance for TB drug Development (TB Alliance), New York, NY, USA
| | - M C Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, The Ohio State University, Columbus, OH, USA
| | - J Scarim
- JSAS Services Inc, Tucson, AZ, USA
| | - P G Pande
- Global Alliance for TB drug Development (TB Alliance), New York, NY, USA
| | - A Scarim
- JSAS Services Inc, Tucson, AZ, USA
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - C L Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R K Jew
- Institute for Safe Medication Practices, Plymouth Meeting, PA, USA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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11
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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Garcia-Prats AJ, Hesseling AC. Sugar and sugar-free liquid formulations of delamanid for patients with rifampicin-resistant TB. Int J Tuberc Lung Dis 2023; 27:13-18. [PMID: 36853133 PMCID: PMC9879082 DOI: 10.5588/ijtld.22.0329] [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] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND: Delamanid (DLM) tablets are recommended for the treatment of rifampicin-resistant TB. However, no liquid or dispersible tablet formulation of DLM is currently commercially available for patients with challenges ingesting these tablets. The aim of this study was to develop stable extemporaneous liquid formulations of DLM that can be stored at room temperature for several weeks.METHODS: DLM tablets were suspended in 1) simple syrup and 2) a specially formulated sugar-free vehicle. These suspensions containing DLM 5 mg/mL were stored in plastic prescription bottles at room temperature or 30°C for 30 days. These suspensions were evaluated for appearance, potency, pH, and microbial counts at Days 0, 15, and 30.RESULTS: The potency of DLM in each formulation remained at 98-104% of the theoretical concentration for 30 days. The appearance, pH, and microbial count did not change for the sugar-free formulation during the 30-day storage period. Microbial growth, however, was observed in the simple syrup formulation on Day 30 but not on Day 15.CONCLUSION: DLM can be formulated in sugar or sugar-free suspensions and stored at room temperature or 30°C for at least 15 and 30 days, respectively.
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Affiliation(s)
- R Taneja
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - M C Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, The Ohio State University, Columbus, OH, USA
| | - J Scarim
- JSAS Services Inc, Tucson, AZ, USA
| | - P G Pande
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - A Scarim
- JSAS Services Inc, Tucson, AZ, USA
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - C L Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R K Jew
- Institute for Safe Medication Practices, Horsham, PA, USA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A J Garcia-Prats
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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12
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Anthony MG, Hoddinott G, Van Niekerk M, Mtshabe A, Pienaar A, Dewandel I, Mckenzie C, Goussard P, Hesseling AC, van der Zalm MM. Caregivers' perspectives on health-related quality of life in young children with TB and respiratory illnesses. Public Health Action 2022; 12:201-205. [PMID: 36561904 PMCID: PMC9716816 DOI: 10.5588/pha.22.0038] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is a lack of holistic health-related quality of life (HRQoL) measures for young children with respiratory disease, especially in low- and middle-income countries (LMICs). We aimed to understand caregivers' perceptions of the relevance of common HRQoL domains for children with respiratory diseases, including TB. METHODS This study was nested in a prospective observational cohort of children presenting with respiratory symptoms presumptive of pulmonary TB. We conducted 10 semi-structured interviews to explore caregivers' perceptions of the five commonly measured HRQoL domains: physical health, social support, emotional and psychological wellbeing, and schooling. We used case descriptive analysis and thematic coding. RESULTS Caregivers considered all five domains to be relevant. The socio-economic context framed their responses, with QoL requiring sufficient basic resources for children. HRQoL experiences varied according to the severity of the child's symptoms, but not between TB and non-TB illnesses. Manifestations in the psychological domain were difficult to distinguish from the emotional domain. Social support included broad support for family members, indirectly benefiting the children. Caregivers were concerned about their children's early developmental milestones and future schooling. CONCLUSION This exploratory study shows that HRQoL domains are relevant but require adaptation to be applicable for young children affected by respiratory illnesses living in LMICs.
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Affiliation(s)
- M. G. Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - G. Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - M. Van Niekerk
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - A. Mtshabe
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - A. Pienaar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - I. Dewandel
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - C. Mckenzie
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - P. Goussard
- Paediatric Pulmonology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A. C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - M. M. van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
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Baloyi DP, Anthony MG, Meyerson KA, Mazibuko S, Wademan D, Viljoen L, Myburgh H, du Preez K, Osman M, Hirsch-Moverman Y, Charalambous S, Hausler H, Hesseling AC, Hoddinott G. Reasons for poor uptake of TB preventive therapy in South Africa. Public Health Action 2022; 12:159-164. [PMID: 36561901 PMCID: PMC9716815 DOI: 10.5588/pha.22.0030] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/19/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND South Africa has one the highest TB and HIV burdens globally. TB preventive therapy (TPT) reduces the risk of TB disease and TB-related mortality in adults and children living with HIV and is indicated for use in TB-exposed HIV-negative individuals and children. TPT implementation in South Africa remains suboptimal. METHODS We conducted a pragmatic review of TPT implementation using multiple data sources, including informant interviews (n = 134), semi-structured observations (n = 93) and TB patient folder reviews in 31 health facilities purposively selected across three high TB burden provinces. We used case descriptive analysis and thematic coding to identify barriers and facilitators to TPT implementation. RESULTS TPT programme implementation was suboptimal, with inadequate monitoring even in health districts with well-functioning TB services. Health workers reported scepticism about TPT effectiveness, deprioritised TPT in practice and expressed divergent opinions about the cadres of staff responsible for implementation. Service- and facility-level barriers included ineffective contact tracing, resource shortages, lack of standardised reporting mechanisms and insufficient patient education on TPT. Patient-level barriers included socio-economic factors. CONCLUSIONS Improving TPT implementation will require radically simplified and more feasible systems and training for all cadres of health workers. Partnership with communities to stimulate demand driven service uptake can potentially facilitate implementation.
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Affiliation(s)
- D. P. Baloyi
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M. G. Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - K. A. Meyerson
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - S. Mazibuko
- Department of Psychology, University of KwaZulu-Natal, Durban, South Africa
| | - D. Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - L. Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - H. Myburgh
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - K. du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M. Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
, School of Human Sciences, University of Greenwich, London, UK
| | - Y. Hirsch-Moverman
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
| | | | | | - A. C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - G. Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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14
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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Garcia-Prats AJ, Hesseling AC. Stable sugar and sugar-free suspensions of pretomanid. Int J Tuberc Lung Dis 2022; 26:1112-1117. [PMID: 36447311 PMCID: PMC9728945 DOI: 10.5588/ijtld.22.0330] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND: Pretomanid (PMD) tablets are indicated as part of a combination regimen for the treatment of adults with pulmonary extensively drug-resistant, treatment-intolerant or non-responsive multidrug-resistant TB. No commercial liquid formulation is currently available for patients unable to swallow these tablets.OBJECTIVE: To develop stable extemporaneous liquid formulations of PMD that can be stored at room temperature or 30°C for at least 4 weeks.METHODS: Crushed PMD tablets were formulated into 20 mg/mL suspensions in a simple syrup and sugar-free formulation. The PMD formulations were stored at room temperature and at 30°C for 30 days in dispensing bottles. Appearance, pH, potency and microbial counts of the suspensions were determined on Days 0, 15 and 30.RESULTS: The potency of PMD remained at 99.7-103.4% of the theoretical concentration in each formulation. The appearance, pH and microbial count did not change during the 30-day storage period. Simple syrup formulations did not require preservatives for microbial stability.CONCLUSIONS: PMD oral suspension formulations in simple syrup or in sugar-free vehicle were easily prepared by utilising commonly available equipment and ingredients and were stable for 30 days. These formulations are appropriate alternatives for patients with swallowing difficulties.
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Affiliation(s)
- R. Taneja
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - M. C. Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, Ohio State University, Columbus, OH, USA
| | | | - P. G. Pande
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | | | - G. Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - C. L. Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R. K. Jew
- Institute for Safe Medication Practices, Horsham, PA, USA
| | - H. S. Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A. J. Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
,Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - A. C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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15
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Viljoen L, Hendricks P, Hoddinott G, Vanqa N, Osman M, Hesseling AC, Meehan SA. Early interactions with newly diagnosed TB patients in hospital can support linkage to care. Public Health Action 2022; 12:121-127. [PMID: 36160718 PMCID: PMC9484593 DOI: 10.5588/pha.22.0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 03/08/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: In South Africa, failure to link individuals diagnosed with TB to care remains an important gap in the TB care cascade. Compared to people diagnosed at primary healthcare (PHC) facilities, people diagnosed in hospitals are more likely to require additional support to be linked with PHC TB treatment services. We describe a patient interaction process to support linkage to TB care. METHODS: We implemented a step-by-step early patient interaction process with 84 adults newly diagnosed with TB in one district hospital in Khayelitsha, Cape Town, South Africa (August 2020–March 2021). We confirmed patient contact details, provided TB and health information, shared information on accessing care at PHC facilities and answered patients’ questions in their home language. RESULTS: Most patients (54/84, 64%) provided updated telephone numbers, and 19/84 (23%) reported changes in their physical address. Patients welcomed practical and health information in their home language. The majority (74/84, 88%) were linked to care after hospital discharge. CONCLUSIONS: A simple early patient interaction process implemented as part of routine care is a feasible strategy to facilitate early TB treatment initiation and registration.
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Affiliation(s)
- L. Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - P. Hendricks
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - G. Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - N. Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - M. Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa, School of Human Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich,
Greenwich, UK
| | - A. C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - S-A. Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Sabapathy K, Stöckl H, Mulubwa C, Mubekapi-Musadaidzwa C, Hoddinott G, Floyd S, Seeley J, Bond V, Bock P, Fidler S, Ayles H, Hayes R. Intimate Partner Violence (IPV) and Associated Factors in HPTN 071 (PopART) Study Communities in Zambia and South Africa-A Comparison by HIV Status. AIDS Behav 2022; 26:1355-1365. [PMID: 35165795 PMCID: PMC9001629 DOI: 10.1007/s10461-021-03492-6] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
The HPTN 071(PopART) study was a community-randomised trial in Zambia and South Africa, examining the impact of combination-prevention including universal testing and treatment (UTT), on HIV-incidence. This sub-study evaluated factors associated with IPV (physical and/or sexual) to identify differences by HIV status. During 2015-16, a random subset of adults who participated in the first year of the PopART intervention were recruited and standardised questionnaires were administered. Logistic regression was performed to estimate odds ratios of factors associated with IPV. Among > 700 women studied (300 HIV-negative;400 HIV-positive), ~ 20% reported experiencing physical and/or sexual violence in the last 12-months. Sexual violence was similar by HIV status, but physical violence and reporting both physical/sexual violence was more common among HIV-positive women. Spending nights away from the community in the last 12-months was associated with higher odds of IPV among both HIV-negative (aOR 3.17, 95% CI 1.02-9.81) and HIV-positive women (aOR 1.79, 95% CI 0.99-3.24). Among HIV-positive women, financial autonomy was associated with reduced IPV (aOR:0.41,95%CI:0.23-0.75) while pregnancy in the last 12-months (aOR 2.25, 95% CI 1.07-4.74), risk of alcohol dependence (aOR 2.75, 95% CI 1.51-5.00) and risk of mental distress (aOR 2.62, 95% CI 1.33-5.16) were associated with increased IPV. Among HIV-negative women reporting sex in the last 12-months, transactional sex (aOR 3.97, 95% CI 1.02-15.37) and not knowing partner's HIV status (aOR 3.01, 95% CI 1.24-7.29) were associated with IPV. IPV was commonly reported in the study population and factors associated with IPV differed by HIV status. The association of mobility with IPV warrants further research. The high prevalence of harmful alcohol use and mental distress, and their association with IPV among HIV-positive women require urgent attention.
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Affiliation(s)
- K. Sabapathy
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - H. Stöckl
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Ludwig-Maximilians-University, Munich, Germany
| | - C. Mulubwa
- Zambia AIDS Related TB Project, University of Zambia, Lusaka, Zambia
| | | | - G. Hoddinott
- Desmond Tutu TB Centre, Stellenbosch University, Stellenbosch, Western Cape South Africa
| | - S. Floyd
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - J. Seeley
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - V. Bond
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Zambia AIDS Related TB Project, University of Zambia, Lusaka, Zambia
| | - P. Bock
- Desmond Tutu TB Centre, Stellenbosch University, Stellenbosch, Western Cape South Africa
| | | | - H. Ayles
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Zambia AIDS Related TB Project, University of Zambia, Lusaka, Zambia
| | - R. Hayes
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - on behalf of HPTN 071 (PopART) Study Team
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Ludwig-Maximilians-University, Munich, Germany
- Zambia AIDS Related TB Project, University of Zambia, Lusaka, Zambia
- Desmond Tutu TB Centre, Stellenbosch University, Stellenbosch, Western Cape South Africa
- Imperial College London, London, UK
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17
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Marx FM, Meehan SA, Jivan D, Dunbar R, Hoddinott G, Hesseling AC, Osman M. Use of interactive messaging to reduce pre-diagnosis loss to follow-up for TB care. Int J Tuberc Lung Dis 2022; 26:26-32. [PMID: 34969425 DOI: 10.5588/ijtld.21.0332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE: To investigate the uptake and usage of a WhatsApp-based interactive communication strategy to avert pre-diagnosis loss to follow-up (LTFU) from TB care in a high-incidence setting.METHODS: We enrolled adults (≥18 years) who underwent routine sputum TB testing in two primary healthcare clinics in Khayelitsha, Cape Town, South Africa. The intervention consisted of structured WhatsApp-based reminders (prompts) sent prior to a routine clinic appointment scheduled 2-3 days after the diagnostic visit. Pre-diagnosis LTFU was defined as failure to return for the scheduled appointment and within 10 days.RESULTS: We approached 332 adults with presumptive TB, of whom 103 (31%) were successfully enrolled; 213 (64%) did not own a WhatsApp-compatible phone. Of 103 participants, 74 (72%) actively responded to WhatsApp prompts; 69 (67%) opted to include a close contact in group communication to co-receive reminders. Pre-diagnosis LTFU was low overall (n = 7, 6.8%) and was not associated with failure to respond to WhatsApp prompts.CONCLUSION: In this high-incidence setting, enrolment in a WhatsApp-based communication intervention among adults with presumptive TB was low, mainly due to low availability of WhatsApp-compatible phones. Among participants, we observed high message response rates and low LTFU, suggesting potential for interactive messaging services to support pre-diagnosis TB care.
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Affiliation(s)
- F M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, DSI-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - S-A Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - D Jivan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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18
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Migliori GB, Marx FM, Ambrosino N, Zampogna E, Schaaf HS, van der Zalm MM, Allwood B, Byrne AL, Mortimer K, Wallis RS, Fox GJ, Leung CC, Chakaya JM, Seaworth B, Rachow A, Marais BJ, Furin J, Akkerman OW, Al Yaquobi F, Amaral AFS, Borisov S, Caminero JA, Carvalho ACC, Chesov D, Codecasa LR, Teixeira RC, Dalcolmo MP, Datta S, Dinh-Xuan AT, Duarte R, Evans CA, García-García JM, Günther G, Hoddinott G, Huddart S, Ivanova O, Laniado-Laborín R, Manga S, Manika K, Mariandyshev A, Mello FCQ, Mpagama SG, Muñoz-Torrico M, Nahid P, Ong CWM, Palmero DJ, Piubello A, Pontali E, Silva DR, Singla R, Spanevello A, Tiberi S, Udwadia ZF, Vitacca M, Centis R, D Ambrosio L, Sotgiu G, Lange C, Visca D. Clinical standards for the assessment, management and rehabilitation of post-TB lung disease. Int J Tuberc Lung Dis 2021; 25:797-813. [PMID: 34615577 PMCID: PMC8504493 DOI: 10.5588/ijtld.21.0425] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR).METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement).RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR.CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD.
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Affiliation(s)
- G B Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - F M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, DSI-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - N Ambrosino
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | - E Zampogna
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - B Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, South Africa
| | - A L Byrne
- Heart Lung Clinic St Vincent´s Hospital and Clinical School, University of New South Wales, Sydney, NSW, Australia, Partners In Health (Socios En Salud Sucursal), Lima, Peru
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - R S Wallis
- Aurum Institute, Johannesburg, South Africa
| | - G J Fox
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - C C Leung
- Hong Kong Tuberculosis, Chest and Heart Diseases Association, Hong Kong
| | - J M Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - B Seaworth
- Heartland National TB Center of Excellence, San Antonio, TX, University of Texas Health Science Center, Tyler, TX, USA
| | - A Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany, German Center for Infection Research (DZIF), Partner Site Munich, Germany
| | - B J Marais
- The Children´s Hospital at Westmead and the University of Sydney WHO Collaborating Center in Tuberculosis, University of Sydney, Sydney, NSW, Australia
| | - J Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA
| | - O W Akkerman
- University of Groningen, University Medical Center Groningen, department of Pulmonary diseases and Tuberculosis, Groningen, the Netherlands, University of Groningen, University Medical Center Groningen, TB center Beatrixoord, Groningen, the Netherlands
| | - F Al Yaquobi
- TB and Acute Respiratory Diseases Section, Department of Communicable Diseases, Directorate General of Disease Surveillance and Control, Ministry of Health, Oman
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
| | - S Borisov
- Moscow Research and Clinical Center for Tuberculosis Control, Moscow Health Department, Moscow, Russian Federation
| | - J A Caminero
- Mycobacterial Unit, Pneumology Department. University General Hospital of Gran Canaria "Dr. Negrin", Las Palmas, Gran Canaria, ALOSA TB Academy, Spain
| | - A C C Carvalho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - D Chesov
- Department of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - L R Codecasa
- TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
| | - R C Teixeira
- National Institute of Respiratory Diseases and the Environment (INERAM), Asunción, Paraguay, Radboud University Medical Center, TB Expert Center Dekkerswald, Department of Respiratory Diseases, Nijmegen - Groesbeek, The Netherlands
| | - M P Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - S Datta
- Department of clinical sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Innovation For Health And Development (IFHAD) Laboratory for Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru, Innovacion Por la Salud Yel Desarollo, (IPSYD) Asociación Benéfica PRISMA, Lima, Peru
| | - A-T Dinh-Xuan
- Université de Paris, APHP Centre, Lung Function Unit, Department of Respiratory Diseases, Cochin Hospital, Paris, France
| | - R Duarte
- Institute of Public Health, Porto University; Medical School, Porto University; Hospital Centre of Vila Nova de Gaia/Espinho, Porto, Portugal
| | - C A Evans
- Innovation For Health And Development (IFHAD) Laboratory for Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru, Innovacion Por la Salud Yel Desarollo, (IPSYD) Asociación Benéfica PRISMA, Lima, Peru, Department of Infectious Diseases, Imperial College London, London, UK
| | | | - G Günther
- Department of Pulmonology, Inselspital Bern, University of Bern, Switzerland
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - S Huddart
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, UCSF Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - O Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany, German Center for Infection Research (DZIF), Partner Site Munich, Germany
| | - R Laniado-Laborín
- Clínica de Tuberculosis, Hospital General Tijuana, Universidad Autónoma De Baja California, Mexico
| | - S Manga
- Medecins Sans Frontieres (MSF), Operational Center, Paris, France
| | - K Manika
- Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - A Mariandyshev
- Northern State Medical University, Northern Arctic Federal University, Arkhangelsk, Russian Federation
| | - F C Q Mello
- Thoracic Diseases Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - S G Mpagama
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro, Tanzania
| | - M Muñoz-Torrico
- Tuberculosis Clinic, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City
| | - P Nahid
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, UCSF Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - C W M Ong
- Infectious Disease Translational Research Programme, Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, National University of Singapore Institute for Health Innovation & Technology (iHealthtech), Singapore
| | - D J Palmero
- Pulmonology Division, Municipal Hospital F.J. Muñiz and Instituto Vaccarezza, Buenos Aires, Argentina
| | | | - E Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - D R Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - R Singla
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - A Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy
| | - S Tiberi
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK, Blizard Institute, Queen Mary University of London, London, UK
| | - Z F Udwadia
- Department of Respiratory Medicine, Hinduja Hospital & Research Center, Mumbai, India
| | - M Vitacca
- Respiratory Unit, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane (BS), Italy
| | - R Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - L D Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany, German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Germany, Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
| | - D Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy
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19
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Zimri K, Casper R, Hoddinott G, Schaaf HS, Garcia-Prats AJ, Rose PC, Hesseling AC, Viljoen L. A novel approach for eliciting adolescent MDR-TB treatment tolerability: qualitative data from South Africa. Int J Tuberc Lung Dis 2021; 24:43-47. [PMID: 32005306 DOI: 10.5588/ijtld.19.0207] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Treatment tolerability among adolescents diagnosed with multidrug-resistant tuberculosis (MDR-TB) is underexplored. We present qualitative study data from adolescents participating in an observational cohort in the Western Cape, South Africa.OBJECTIVE: To elicit adolescent experiences of MDR-TB diagnosis and treatment with qualitative body-mapping activities and discussions.DESIGN: Adolescents in an observational MDR-TB cohort received routine toxicity and audiology screenings from clinicians. We enrolled eight participants (age 10-16 years) to participate in additional body-mapping activities and in-depth interviews. A thematic deductive analysis was conducted. We present a comparison of the clinical assessments and qualitative discussions.RESULTS: Adolescent participants reported few adverse effects on standard toxicity and audiology reports. Only nausea and vomiting were reported in >10% of cases, all of which were grade 1 (causing no/minimal interference) adverse effects (AEs). However, when comparing toxicity reports with qualitative body-mapping activities and interviews, we found previously unreported AEs (neurosensory alteration, neuromuscular weakness, pain); underestimated severity of AEs (nausea, itching); and missed psychosocial symptoms (signs of depression).CONCLUSION: Adolescents receiving treatment for MDR-TB experienced treatment-related AEs that were not reported during routine clinical assessments. Psychosocial experiences of adolescents are not taken into account. More research is needed to understand the experiences of this vulnerable group. We recommend that drug safety monitoring be adapted to include more creative and patient-driven reporting mechanisms for vulnerable groups, including children.
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Affiliation(s)
- K Zimri
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - R Casper
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - P C Rose
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - L Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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20
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Allwood BW, Stolbrink M, Baines N, Louw E, Wademan DT, Lupton-Smith A, Nel S, Maree D, Mpagama S, Osman M, Marx FM, Hoddinott G, Lesosky M, Rylance J, Mortimer K. Persistent chronic respiratory symptoms despite TB cure is poorly correlated with lung function. Int J Tuberc Lung Dis 2021; 25:262-270. [PMID: 33762069 PMCID: PMC8009599 DOI: 10.5588/ijtld.20.0906] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 12/14/2022] Open
Abstract
BACKGROUND: Persistent respiratory symptoms and lung function deficits are common after patients with TB. We aimed to define the burden of post-TB lung disease (PTLD) and assess associations between symptoms and impairment in two high TB incidence communities.METHODS: This was a cross-sectional survey of adults in Cape Town, South Africa who completed TB treatment 1-5 years previously. Questionnaires, spirometry and 6-minute walking distance (6MWD) were used to assess relationships between outcome measures and associated factors.RESULTS: Of the 145 participants recruited (mean age: 42 years, range: 18-75; 55 [38%] women), 55 (38%) had airflow obstruction and 84 (58%) had low forced vital capacity (FVC); the mean 6MWD was 463 m (range: 240-723). Respiratory symptoms were common: chronic cough (n = 27, 19%), wheeze (n = 61, 42%) and dyspnoea (modified MRC dyspnoea score 3 or 4: n = 36, 25%). There was poor correlation between FVC or obstruction and 6MWD. Only low body mass index showed consistent association with outcomes on multivariable analyses. Only 19 (13%) participants had a diagnosis of respiratory disease, and 16 (11%) currently received inhalers.CONCLUSION: There was substantial burden of symptoms and physiological impairment in this "cured" population, but poor correlation between objective outcome measures, highlighting deficits in our understanding of PTLD.
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Affiliation(s)
- B W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - M Stolbrink
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - N Baines
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - E Louw
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Lupton-Smith
- Department of Science and Innovation-National Research Foundation South African Centre for Excellence in Epidemiological Modelling and Analysis (SACEMA), Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - S Nel
- Department of Physical Medicine and Rehabilitation, School of Medicine, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - D Maree
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - S Mpagama
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - F M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Science and Innovation-National Research Foundation South African Centre for Excellence in Epidemiological Modelling and Analysis (SACEMA), Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J Rylance
- Lung Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK
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21
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Allwood BW, van der Zalm MM, Amaral AFS, Byrne A, Datta S, Egere U, Evans CA, Evans D, Gray DM, Hoddinott G, Ivanova O, Jones R, Makanda G, Marx FM, Meghji J, Mpagama S, Pasipanodya JG, Rachow A, Schoeman I, Shaw J, Stek C, van Kampen S, von Delft D, Walker NF, Wallis RS, Mortimer K. Post-tuberculosis lung health: perspectives from the First International Symposium. Int J Tuberc Lung Dis 2020; 24:820-828. [PMID: 32912387 DOI: 10.5588/ijtld.20.0067] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
ALTHOUGH CURABLE, TB frequently leaves the individual with chronic physical and psycho-social impairment, but these consequences have been largely neglected. The 1st International Post-Tuberculosis Symposium (Stellenbosch, South Africa) was held to discuss priorities and gaps in addressing this issue. A barrier to progress has been the varied terminology and nomenclature, so the Delphi process was used to achieve consensus on definitions. Lack of sufficient evidence hampered definitive recommendations in most domains, including prevention and treatment of post-TB lung disease (PTLD), but the discussions clarified the research needed. A consensus was reached on a toolkit for future PTLD measurement and on PTLD patterns to be considered. The importance of extra-pulmonary consequences and progressive impairment throughout the life-course was identified, including TB recurrence and increased mortality. Patient advocates emphasised the need to address the psychological and social impacts post TB and called for clinical guidance. More generally, there is an urgent need for increased awareness and research into post-TB complications.
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Affiliation(s)
- B W Allwood
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
| | - A Byrne
- Heart Lung Clinic, St Vincent´s Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - S Datta
- Department of Infectious Disease, Imperial College London, London, UK, Innovation For Health And Development, Laboratory for Research and Development, Universidad Peruana Cayetano Heredia, Lima, Innovacion por la Salud y el Desarollo, Asociación Benéfica Prisma, Lima, Peru
| | - U Egere
- IMPALA Consortium and Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - C A Evans
- Department of Infectious Disease, Imperial College London, London, UK, Innovation For Health And Development, Laboratory for Research and Development, Universidad Peruana Cayetano Heredia, Lima, Innovacion por la Salud y el Desarollo, Asociación Benéfica Prisma, Lima, Peru
| | - D Evans
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - D M Gray
- Division of Paediatric Pulmonology, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - O Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - R Jones
- Faculty of Health, Plymouth University, Plymouth, UK
| | | | - F M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa, DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Faculty of Science, Stellenbosch University, Johannesburg, South Africa
| | - J Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S Mpagama
- Kibong´oto Infectious Diseases Hospital, Kibong´oto, Tanzania
| | - J G Pasipanodya
- Center for Infectious Diseases Research & Experimental Therapeutics, Texas Tech University Health Sciences Center, Dallas, TX, USA
| | - A Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany, German Centre for Infection Research (DFIZ), Partner Site Munich, Munich, Germany
| | | | - J Shaw
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - C Stek
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - S van Kampen
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - N F Walker
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - R S Wallis
- Aurum Institute, Johannesburg, South Africa
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK, International Union against Tuberculosis and Lung Disease, Paris, France
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22
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Wademan DT, Busakwe L, Nicholson TJ, van der Zalm M, Palmer M, Workman J, Turkova A, Crook AM, Thomason MJ, Gibb DM, Seeley J, Hesseling A, Hoddinott G. Acceptability of a first-line anti-tuberculosis formulation for children: qualitative data from the SHINE trial. Int J Tuberc Lung Dis 2019; 23:1263-1268. [PMID: 31931909 PMCID: PMC6903808 DOI: 10.5588/ijtld.19.0115] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/12/2019] [Indexed: 12/24/2022] Open
Abstract
SETTING: We conducted a qualitative exploration into the palatability and acceptability of a novel fixed-dose combination (FDC) anti-tuberculosis drug. This study was nested in the SHINE (Shorter treatment for minimal TB in children) trial, which compares the safety and efficacy of treating non-severe drug-susceptible tuberculosis (TB) with a 6 vs. 4 months anti-tuberculosis regimen in children aged 0-16 years. Participants were recruited in Cape Town, South Africa.OBJECTIVE: To describe the palatability and acceptability of a FDC of rifampicin, isoniazid and pyrazinamide among South African children and their caregivers in the SHINE trial.METHODS: We conducted 20 clinic observations of treatment administration, during which we conducted 16 semi-structured interviews with children and their caregivers. Data were organised thematically to report on experiences with administering and ingesting the FDC.RESULTS: Children and caregivers' experiences varied from delight to disgust. In general, participants said that the FDC compared favourably to other formulations. Pragmatic challenges such as dissolving the FDC and the time required to administer the FDC impeded caregivers' ability to integrate treatment into their daily routines. Drug manipulation was common among caregivers to improve TB treatment administration.CONCLUSION: This novel FDC appears acceptable for children, albeit with practical challenges to administration. Scale-up of FDC use should include supplementary intervention components to support caregivers.
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Affiliation(s)
- D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - L Busakwe
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - T J Nicholson
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - M Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - J Workman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - A Turkova
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London
| | - A M Crook
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London
| | - M J Thomason
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London
| | - D M Gibb
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London
| | - J Seeley
- Department of Global Health, London School of Hygiene & Tropical Medicine, London, UK
| | - A Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
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Sabapathy K, Mulubwa C, Mathema H, Mubekapi‐Musadaidzwa C, Schaap A, Hoddinott G, Hargreaves J, Floyd S, Ayles H, Hayes R. Is home-based HIV testing universally acceptable? Findings from a case-control study nested within the HPTN 071 (PopART) trial. Trop Med Int Health 2018; 23:678-690. [PMID: 29608231 PMCID: PMC6001569 DOI: 10.1111/tmi.13055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The HPTN 071 (PopART) trial is examining the impact of a package including universal testing and treatment on community-level HIV incidence in Zambia and South Africa. We conducted a nested case-control study to examine factors associated with acceptance of home-based HIV testing and counselling (HB-HTC) delivered by community HIV-care providers (CHiPs) in PopART intervention communities. METHODS Of 295 447 individuals who were offered testing, random samples of individuals who declined HB-HTC (cases) and accepted HB-HTC (controls), stratified by gender and community, were selected. Odds ratios comparing cases and controls were estimated using multivariable logistic regression. RESULTS Data from 642 participants (313 cases, 329 controls) were analysed. There were no differences between cases and controls by demographic or behavioural characteristics including age, marital or socio-economic position. Participants who felt they could be open with CHiPs (AOR: 0.46, 95% CI: 0.30-0.71, P < 0.001); self-reported as not previously tested (AOR: 0.64; 95% CI: 0.43-0.95, P = 0.03); considered HTC at home to be convenient (AOR: 0.38, 95% CI: 0.27-0.54, P = 0.001); knowing others who had accepted HB-HTC from the CHiPs (AOR: 0.49, 95% CI: 0.31-0.77, P = 0.002); or were motivated to get treatment without delay (AOR: 0.60, 95% CI: 0.43-0.85, P = 0.004) were less likely to decline the offer of HB-HCT. Those who self-reported high-risk sexual behaviour were also less likely to decline HB-HCT (AOR: 0.61, 95% CI: 0.39-0.93, P = 0.02). Having stigmatising attitudes about HB-HTC was not an important barrier to HB-HCT uptake. Men who reported fear of HIV were more likely to decline HB-HCT (AOR: 2.68, 95% CI: 1.33-5.38, P = 0.005). CONCLUSION Acceptance of HB-HTC was associated with lack of previous HIV testing, positive attitudes about HIV services/treatment and perception of high sexual risk. Uptake of HB-HCT among those offered it was similar across a range of demographic and behavioural subgroups suggesting it was 'universally' acceptable.
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Affiliation(s)
- K. Sabapathy
- London School of Hygiene and Tropical MedicineLondonUK
| | - C. Mulubwa
- Zambia AIDS Related TB ProjectLusakaZambia
| | - H. Mathema
- Desmond Tutu TB CentreDepartment of Paediatric and Child HealthStellenbosch University
- Present address:
Division of Public Health Surveillance and ResponseNational Institute for Communicable DiseasesNational Health Laboratory ServiceSouth Africa
| | | | - A. Schaap
- Zambia AIDS Related TB ProjectLusakaZambia
| | - G. Hoddinott
- Desmond Tutu TB CentreDepartment of Paediatric and Child HealthStellenbosch University
| | - J. Hargreaves
- London School of Hygiene and Tropical MedicineLondonUK
| | - S. Floyd
- London School of Hygiene and Tropical MedicineLondonUK
| | - H. Ayles
- London School of Hygiene and Tropical MedicineLondonUK
- Zambia AIDS Related TB ProjectLusakaZambia
| | - R. Hayes
- London School of Hygiene and Tropical MedicineLondonUK
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Hoddinott G, Staples S, Brown R, Simwinga M, Mubekapi-Musadaidzwa C, Hesseling AC, Hendricks G, De Koker P, McKenna L. Community engagement for paediatric MDR-TB clinical trials: principles to support ethical trial implementation. Int J Tuberc Lung Dis 2018; 22:40-45. [PMID: 29665952 DOI: 10.5588/ijtld.17.0356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The paediatric tuberculosis (TB) prevention and treatment landscape is moving into a new and exciting era, with knowledge from clinical trials offering real benefit to children. Community engagement is key to optimising the success of these trials. However, the clinical profile, epidemiology and social perceptions for paediatric multidrug-resistant TB (MDR-TB) complicate the operationalisation of this community engagement. We reflect on a diversity of recent experiences attempting to implement this type of research and the community engagement around it. We describe four recommendations and argue that these should guide the implementation of the community engagement agenda in the new landscape of paediatric MDR-TB clinical trials. Specifically, we argue for 1) dynamic, long-term continuity in community engagement platforms; 2) tiers of TB and research literacy; 3) multiple separate and joint platforms for holding 'stakes'; and 4) addressing the social/structural implications of family participation. We conclude that community-level stakeholders, such as health workers, parents and children, are willing to collaborate in paediatric MDR-TB clinical trials. Using these recommendations, there is considerable opportunity for effective community engagement in this new era of paediatric MDR-TB research.
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Affiliation(s)
- G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine, Stellenbosch University, Cape Town
| | - S Staples
- TB and HIV Investigative Network, Durban, South Africa
| | - R Brown
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine, Stellenbosch University, Cape Town
| | - M Simwinga
- Zambia AIDS Related Tuberculosis (ZAMBART) School of Medicine, Lusaka, Zambia
| | - C Mubekapi-Musadaidzwa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine, Stellenbosch University, Cape Town
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine, Stellenbosch University, Cape Town
| | - G Hendricks
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine, Stellenbosch University, Cape Town
| | - P De Koker
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine, Stellenbosch University, Cape Town
| | - L McKenna
- Treatment Action Group, New York, New York, USA
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Spies G, Hoddinott G, Beyers N, Seedat S. Effects of Hazardous Alcohol use on Neurocognition in HIV Positive Individuals. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IntroductionThere is significant evidence that HIV is brain degenerative and long-term infection can impair cognitive functioning. In South Africa, alcohol remains the dominant substance of abuse and lifetime alcohol dependence has been found to impair memory, executive function and visuospatial capabilities. The individual liability of alcohol and HIV on neurocognitive function have been well demonstrated, however there is relatively little evidence of the potentially aggravating effects of this dual burden on neurocognitive outcomes.ObjectivesThe present study is ongoing and sought to identify the effects of hazardous alcohol use on neurocognitive functioning in the context of HIV infection.AimsTo describe the association between HIV and harmful alcohol use on neuropsychological test performance in a cohort of adults in the Western Cape of South africa.Methodsparticipants (n = 50) were tested using a battery of neuropsychological tests sensitive to the effects of HIV on the brain. Self-reported alcohol use was recorded using the alcohol use identification test (AUDIT). Results The sample consisted of 47 females and 3 males. All participants were HIV-positive and on antiretroviral therapy. A total of 23 (46%) participants reported no alcohol use and 27 (54%) reported drinking alcohol on the AUDIT.Resultsrevealed a significant difference between groups on the Stroop colour word test, with poorer performance evident among the alcohol users (P = 0.008).ConclusionAlcohol use in the context of HIV infection contributes to poorer executive function. These preliminary data provide evidence for a synergistic relationship between HIV infection and alcohol use.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Hargreaves JR, Stangl A, Bond V, Hoddinott G, Krishnaratne S, Mathema H, Moyo M. P14.14 Intersecting stigmas: a framework for data collection and analysis of stigmas faced by people living with hiv and key populations. Sex Transm Infect 2015. [DOI: 10.1136/sextrans-2015-052270.526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Hargreaves JR, Stangl A, Bond V, Hoddinott G, Krishnaratne S, Mathema H, Moyo M, Viljoen L, Brady L, Sievwright K, Horn L, Sabapathy K, Ayles H, Beyers N, Bock P, Fidler S, Griffith S, Seeley J, Hayes R. P14.13 Hiv-related stigma and universal testing and treatment for hiv prevention and care: design of an implementation science evaluation nested in the hptn 071 (popart) cluster-randomised trial in zambia and south africa. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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