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Kılıç A, Clarke AL, Moon Z, Hamada Y, Chan AHY, Rahman A, Layton C, Griffiths CJ, Zenner D, Powell E, Kunst H, Lipman M, Mandelbaum M, Papineni P, Tattersall T, Duong T, Abubakar I, Rangaka MX, Horne R. Health and illness beliefs in adults with tuberculosis infection during the COVID-19 pandemic in the UK. Dialogues Health 2024; 4:100162. [PMID: 38516222 PMCID: PMC10953974 DOI: 10.1016/j.dialog.2023.100162] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 03/23/2024]
Abstract
Background COVID-19 disrupted the TB prevention programme in the UK, especially for TB infection (TBI) care. We explore whether experience of the COVID-19 pandemic impacted on patients' perceptions of TBI and its treatment. Methods Semi-structured interviews were conducted as part of the Research to Improve Detection and Treatment of TBI (RID-TB) programme, exploring perceptual and practical barriers to TBI treatment. Nineteen people diagnosed with TBI were interviewed between August 2020 and April 2021. Recordings were transcribed and analysed using a constant comparative approach, allowing for a dynamic and iterative exploration of themes. Themes are organised using the Perceptions and Practicalities Approach. Findings Some participants perceived TBI as a risk factor for increased susceptibility to COVID-19, while some thought that treatment for TBI might protect against COVID-19 or mitigate its effects. Adaptations to TB services (e.g., remote follow-up) and integrated practices during the COVID-19 restrictions (e.g., medication being posted) addressed some practical barriers to TBI treatment. However, we identified beliefs about TBI and COVID-19 that are likely to act as barriers to engagement with TBI treatment, including: interpreting service delays as an indication of TBI not being serious enough for treatment and concerns about contracting COVID-19 in TB clinics. Interpretation COVID-19 and TBI service delays influence people's perceptions and practical barriers to TBI treatment adherence. Failure to address these beliefs may lead to people's concerns about their treatment not being fully addressed. Utilised service adaptations like remote consultations to address practical barriers may be relevant beyond COVID-19. Funding NIHR RID-TB Program (RP-PG-0217-20009).
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Affiliation(s)
- Ayşenur Kılıç
- School of Pharmacy, University College London, London, UK
| | - Amy L. Clarke
- School of Pharmacy, University College London, London, UK
| | - Zoe Moon
- School of Pharmacy, University College London, London, UK
| | - Yohhei Hamada
- Institute for Global Health, University College London, London, UK
| | - Amy Hai Yan Chan
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Ananna Rahman
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | | | - Chris J. Griffiths
- Centre for Primary Care, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dominik Zenner
- Centre for Primary Care, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ellen Powell
- MRC Clinical Trials Unit, University College London, UK
| | - Heinke Kunst
- Respiratory Medicine, Queen Mary University of London, London, UK
| | - Marc Lipman
- Royal Free London NHS Foundation Trust, London, UK
- UCL-TB and UCL Respiratory, University College London, London, UK
| | | | | | | | - Trinh Duong
- MRC Clinical Trials Unit, University College London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Molebogeng X. Rangaka
- Institute for Global Health, University College London, London, UK
- Division of Epidemiology and Biostatistics & CIDRI-AFRICA, University of Cape Town, Cape Town, South Africa
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
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2
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Fernández-García S, Del Campo-Albendea L, Sambamoorthi D, Sheikh J, Lau K, Osei-Lah N, Ramkumar A, Naidu H, Stoney N, Sundaram P, Sengupta P, Mehta S, Attarde S, Maddock S, Manning M, Meherally Z, Ansari K, Lawson H, Yap M, Kew T, Punnoose A, Knight C, Sadeqa E, Cherian J, Ravi S, Chen W, Walker K, O'Donoghue K, van Wely M, van Leeuwen E, Kostova E, Kunst H, Khalil A, Brizuela V, Kara E, Kim CR, Thorson A, Oladapo OT, Mofenson L, Gottlieb SL, Bonet M, Moss N, Zamora J, Allotey J, Thangaratinam S. Effectiveness and safety of COVID-19 vaccines on maternal and perinatal outcomes: a systematic review and meta-analysis. BMJ Glob Health 2024; 9:e014247. [PMID: 38580375 PMCID: PMC11002410 DOI: 10.1136/bmjgh-2023-014247] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/26/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE To assess the effects of COVID-19 vaccines in women before or during pregnancy on SARS-CoV-2 infection-related, pregnancy, offspring and reactogenicity outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES Major databases between December 2019 and January 2023. STUDY SELECTION Nine pairs of reviewers contributed to study selection. We included test-negative designs, comparative cohorts and randomised trials on effects of COVID-19 vaccines on infection-related and pregnancy outcomes. Non-comparative cohort studies reporting reactogenicity outcomes were also included. QUALITY ASSESSMENT, DATA EXTRACTION AND ANALYSIS Two reviewers independently assessed study quality and extracted data. We undertook random-effects meta-analysis and reported findings as HRs, risk ratios (RRs), ORs or rates with 95% CIs. RESULTS Sixty-seven studies (1 813 947 women) were included. Overall, in test-negative design studies, pregnant women fully vaccinated with any COVID-19 vaccine had 61% reduced odds of SARS-CoV-2 infection during pregnancy (OR 0.39, 95% CI 0.21 to 0.75; 4 studies, 23 927 women; I2=87.2%) and 94% reduced odds of hospital admission (OR 0.06, 95% CI 0.01 to 0.71; 2 studies, 868 women; I2=92%). In adjusted cohort studies, the risk of hypertensive disorders in pregnancy was reduced by 12% (RR 0.88, 95% CI 0.82 to 0.92; 2 studies; 115 085 women), while caesarean section was reduced by 9% (OR 0.91, 95% CI 0.85 to 0.98; 6 studies; 30 192 women). We observed an 8% reduction in the risk of neonatal intensive care unit admission (RR 0.92, 95% CI 0.87 to 0.97; 2 studies; 54 569 women) in babies born to vaccinated versus not vaccinated women. In general, vaccination during pregnancy was not associated with increased risk of adverse pregnancy or perinatal outcomes. Pain at the injection site was the most common side effect reported (77%, 95% CI 52% to 94%; 11 studies; 27 195 women). CONCLUSION COVID-19 vaccines are effective in preventing SARS-CoV-2 infection and related complications in pregnant women. PROSPERO REGISTRATION NUMBER CRD42020178076.
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Affiliation(s)
- Silvia Fernández-García
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Laura Del Campo-Albendea
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBERESP, Madrid, Spain
| | | | - Jameela Sheikh
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Karen Lau
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Nana Osei-Lah
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Anoushka Ramkumar
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Harshitha Naidu
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Nicole Stoney
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Paul Sundaram
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | - Samay Mehta
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Shruti Attarde
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sophie Maddock
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Millie Manning
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | - Kehkashan Ansari
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Heidi Lawson
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Magnus Yap
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Tania Kew
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Andriya Punnoose
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Chloe Knight
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Eyna Sadeqa
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Jiya Cherian
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sangamithra Ravi
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Wentin Chen
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | | | - Madelon van Wely
- Amsterdam UMC Location AMC Center for Reproductive Medicine, Amsterdam, The Netherlands
| | - Elizabeth van Leeuwen
- Amsterdam UMC Location AMC Department of Obstetrics Gynecology, Amsterdam, The Netherlands
| | - Elena Kostova
- Amsterdam UMC Location AMC Center for Reproductive Medicine, Amsterdam, The Netherlands
| | - Heinke Kunst
- Queen Mary University of London Blizard Institute, London, UK
- Barts Health NHS Trust, London, UK
| | - Asma Khalil
- St George's University of London, London, UK
| | - Vanessa Brizuela
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Edna Kara
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Caron Rahn Kim
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Anna Thorson
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Olufemi T Oladapo
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Lynne Mofenson
- Research, Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USA
| | - Sami L Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Mercedes Bonet
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | | | - Javier Zamora
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBERESP, Madrid, Spain
- NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK
| | - John Allotey
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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3
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van Baar JAC, Kostova EB, Allotey J, Thangaratinam S, Zamora JR, Bonet M, Kim CR, Mofenson LM, Kunst H, Khalil A, van Leeuwen E, Keijzer J, Strikwerda M, Clark B, Verschuuren M, Coomarasamy A, Goddijn M, van Wely M. COVID-19 in pregnant women: a systematic review and meta-analysis on the risk and prevalence of pregnancy loss. Hum Reprod Update 2024; 30:133-152. [PMID: 38016805 PMCID: PMC10905512 DOI: 10.1093/humupd/dmad030] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/01/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are more likely to experience preterm birth and their neonates are more likely to be stillborn or admitted to a neonatal unit. The World Health Organization declared in May 2023 an end to the coronavirus disease 2019 (COVID-19) pandemic as a global health emergency. However, pregnant women are still becoming infected with SARS-CoV-2 and there is limited information available regarding the effect of SARS-CoV-2 infection in early pregnancy on pregnancy outcomes. OBJECTIVE AND RATIONALE We conducted this systematic review to determine the prevalence of early pregnancy loss in women with SARS-Cov-2 infection and compare the risk to pregnant women without SARS-CoV-2 infection. SEARCH METHODS Our systematic review is based on a prospectively registered protocol. The search of PregCov19 consortium was supplemented with an extra electronic search specifically on pregnancy loss in pregnant women infected with SARS-CoV-2 up to 10 March 2023 in PubMed, Google Scholar, and LitCovid. We included retrospective and prospective studies of pregnant women with SARS-CoV-2 infection, provided that they contained information on pregnancy losses in the first and/or second trimester. Primary outcome was miscarriage defined as a pregnancy loss before 20 weeks of gestation, however, studies that reported loss up to 22 or 24 weeks were also included. Additionally, we report on studies that defined the pregnancy loss to occur at the first and/or second trimester of pregnancy without specifying gestational age, and for second trimester miscarriage only when the study presented stillbirths and/or foetal losses separately from miscarriages. Data were stratified into first and second trimester. Secondary outcomes were ectopic pregnancy (any extra-uterine pregnancy), and termination of pregnancy. At least three researchers independently extracted the data and assessed study quality. We calculated odds ratios (OR) and risk differences (RDs) with corresponding 95% CI and pooled the data using random effects meta-analysis. To estimate risk prevalence, we performed meta-analysis on proportions. Heterogeneity was assessed by I2. OUTCOMES We included 120 studies comprising a total of 168 444 pregnant women with SARS-CoV-2 infection; of which 18 233 women were in their first or second trimester of pregnancy. Evidence level was considered to be of low to moderate certainty, mostly owing to selection bias. We did not find evidence of an association between SARS-CoV-2 infection and miscarriage (OR 1.10, 95% CI 0.81-1.48; I2 = 0.0%; RD 0.0012, 95% CI -0.0103 to 0.0127; I2 = 0%; 9 studies, 4439 women). Miscarriage occurred in 9.9% (95% CI 6.2-14.0%; I2 = 68%; 46 studies, 1797 women) of the women with SARS CoV-2 infection in their first trimester and in 1.2% (95% CI 0.3-2.4%; I2 = 34%; 33 studies; 3159 women) in the second trimester. The proportion of ectopic pregnancies in women with SARS-CoV-2 infection was 1.4% (95% CI 0.02-4.2%; I2 = 66%; 14 studies, 950 women). Termination of pregnancy occurred in 0.6% of the women (95% CI 0.01-1.6%; I2 = 79%; 39 studies; 1166 women). WIDER IMPLICATIONS Our study found no indication that SARS-CoV-2 infection in the first or second trimester increases the risk of miscarriages. To provide better risk estimates, well-designed studies are needed that include pregnant women with and without SARS-CoV-2 infection at conception and early pregnancy and consider the association of clinical manifestation and severity of SARS-CoV-2 infection with pregnancy loss, as well as potential confounding factors such as previous pregnancy loss. For clinical practice, pregnant women should still be advised to take precautions to avoid risk of SARS-CoV-2 exposure and receive SARS-CoV-2 vaccination.
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Affiliation(s)
- Janneke A C van Baar
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Elena B Kostova
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Cochrane Gynaecology and Fertility Satellite, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - John Allotey
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- NIHR Biomedical Research Center, University Hospitals Birmingham, Birmingham, UK
| | - Shakila Thangaratinam
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- NIHR Biomedical Research Center, University Hospitals Birmingham, Birmingham, UK
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Javier R Zamora
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Caron Rahn Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | | | - Elisabeth van Leeuwen
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Women and Childrens Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Julia Keijzer
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marije Strikwerda
- Department Vrouw & Baby, Utrecht UMC, location University of Utrecht, Utrecht, The Netherlands
| | - Bethany Clark
- Department Vrouw & Baby, Utrecht UMC, location University of Utrecht, Utrecht, The Netherlands
| | - Maxime Verschuuren
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arri Coomarasamy
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- NIHR Biomedical Research Center, University Hospitals Birmingham, Birmingham, UK
- Tommy's Centre for Miscarriage Research, Birmingham, UK
| | - Mariëtte Goddijn
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Madelon van Wely
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Cochrane Gynaecology and Fertility Satellite, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Malhotra AM, Arias M, Backx M, Gadsby J, Goodman A, Gourlay Y, Milburn H, Moncayo-Nieto OL, Shimmin D, Dedicoat M, Kunst H. Extrapulmonary nontuberculous mycobacterial infections: a guide for the general physician. Clin Med (Lond) 2024; 24:100016. [PMID: 38350409 PMCID: PMC11024835 DOI: 10.1016/j.clinme.2024.100016] [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] [Indexed: 02/15/2024]
Abstract
Non-tuberculous mycobacteria (NTM) infections predominantly present as pulmonary disease. Although relatively rare, 20-30 % originate from extrapulmonary sites resulting in a wide range of clinical syndromes. Immunocompromised individuals are particularly susceptible. Clinical manifestations include skin and soft-tissue infections, lymphadenitis, musculoskeletal infections and disseminated disease. Diagnosing extrapulmonary NTM is challenging, and management is complex, often involving multiple radiological and microbiological investigations, long courses of combination antibiotic regimens and may require adjuvant surgical interventions. We highlight both the importance of involving NTM experts at an early stage and the role of a multidisciplinary approach in the diagnosis and management of these infections.
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Affiliation(s)
- Akanksha Mimi Malhotra
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK.
| | | | | | - Jessica Gadsby
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Anna Goodman
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
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5
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Vasiliu A, Köhler N, Altpeter E, Ægisdóttir TR, Amerali M, de Oñate WA, Bakos Á, D'Amato S, Cirillo DM, van Crevel R, Davidaviciene E, Demuth I, Domínguez J, Duarte R, Günther G, Guthmann JP, Hatzianastasiou S, Holm LH, Herrador Z, Hribar U, Huberty C, Ibraim E, Jackson S, Jensenius M, Josefsdottir KS, Koch A, Korzeniewska-Kosela M, Kuksa L, Kunst H, Lienhardt C, Mahler B, Makek MJ, Muylle I, Normark J, Pace-Asciak A, Petrović G, Pieridou D, Russo G, Rzhepishevska O, Salzer HJF, Marques MS, Schmid D, Solovic I, Sukholytka M, Svetina P, Tyufekchieva M, Vasankari T, Viiklepp P, Villand K, Wallenfels J, Wesolowski S, Mandalakas AM, Martinez L, Zenner D, Lange C. Tuberculosis incidence in foreign-born people residing in European countries in 2020. Euro Surveill 2023; 28:2300051. [PMID: 37855907 PMCID: PMC10588305 DOI: 10.2807/1560-7917.es.2023.28.42.2300051] [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: 01/24/2023] [Accepted: 05/12/2023] [Indexed: 10/20/2023] Open
Abstract
BackgroundEuropean-specific policies for tuberculosis (TB) elimination require identification of key populations that benefit from TB screening.AimWe aimed to identify groups of foreign-born individuals residing in European countries that benefit most from targeted TB prevention screening.MethodsThe Tuberculosis Network European Trials group collected, by cross-sectional survey, numbers of foreign-born TB patients residing in European Union (EU) countries, Iceland, Norway, Switzerland and the United Kingdom (UK) in 2020 from the 10 highest ranked countries of origin in terms of TB cases in each country of residence. Tuberculosis incidence rates (IRs) in countries of residence were compared with countries of origin.ResultsData on 9,116 foreign-born TB patients in 30 countries of residence were collected. Main countries of origin were Eritrea, India, Pakistan, Morocco, Romania and Somalia. Tuberculosis IRs were highest in patients of Eritrean and Somali origin in Greece and Malta (both > 1,000/100,000) and lowest among Ukrainian patients in Poland (3.6/100,000). They were mainly lower in countries of residence than countries of origin. However, IRs among Eritreans and Somalis in Greece and Malta were five times higher than in Eritrea and Somalia. Similarly, IRs among Eritreans in Germany, the Netherlands and the UK were four times higher than in Eritrea.ConclusionsCountry of origin TB IR is an insufficient indicator when targeting foreign-born populations for active case finding or TB prevention policies in the countries covered here. Elimination strategies should be informed by regularly collected country-specific data to address rapidly changing epidemiology and associated risks.
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Affiliation(s)
- Anca Vasiliu
- Baylor College of Medicine, Department of Pediatrics, Global and Immigrant Health, Global Tuberculosis Program, Houston, Texas, United States
| | - Niklas Köhler
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), TTU-TB, Borstel, Germany
- Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
| | - Ekkehardt Altpeter
- Swiss Federal Office of Public Health, Division of Communicable Diseases, Bern, Switzerland
| | - Tinna Rán Ægisdóttir
- The National University Hospital of Iceland, Pharmaceutical Services, Reykjavik, Iceland
| | - Marina Amerali
- Tuberculosis Control Office, Department of Respiratory Infections, Directorate for Epidemiological Surveillance & Intervention, National Public Health Organization (NPHO), Athens, Greece
| | - Wouter Arrazola de Oñate
- Belgian Lung and Tuberculosis Association, Brussels, Belgium
- Flemish Association of Respiratory Health and TB Control, Leuven, Belgium
| | - Ágnes Bakos
- Koranyi National Institute for Pulmonology, Budapest, Hungary
| | - Stefania D'Amato
- Prevention of Communicable Diseases and International Prophylaxis, General Direction of Health Prevention, Ministry of Health of Italy, Rome, Italy
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Edita Davidaviciene
- Vilnius University hospital Santaros Klinikos, Department of Tuberculosis State information system, Vilnius, Lithuania
| | | | - Jose Domínguez
- Institut d'Investigació Germans Trias i Pujol; Universitat Autònoma de Barcelona; CIBER Enfermedades Respiratorias; INNOVA4TB consortium Badalona, Barcelona, Spain
| | - Raquel Duarte
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto
- ISPUP - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Gunar Günther
- Department of Pulmonary Medicine and Allergology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Jean-Paul Guthmann
- Division of Infectious Diseases, Santé publique France, Saint-Maurice, France
| | - Sophia Hatzianastasiou
- Tuberculosis Control Office, Department of Respiratory Infections, Directorate for Epidemiological Surveillance & Intervention, National Public Health Organization (NPHO), Athens, Greece
| | - Louise Hedevang Holm
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Zaida Herrador
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Urška Hribar
- Tuberculosis Register of the Republic of Slovenia, University Clinic Golnik, Golnik, Slovenia
| | | | - Elmira Ibraim
- Marius Nasta Institute of Pulmonology, Bucharest, Romania
| | - Sarah Jackson
- Infectious Diseases; Health Service Executive Health Protection Surveillance Centre, Dublin, Ireland
| | - Mogens Jensenius
- Department of Infectious Diseases, Oslo University Hospital, Ullevaal, Norway
| | | | - Anders Koch
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Maria Korzeniewska-Kosela
- Department of Tuberculosis Epidemiology and Surveillance, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Liga Kuksa
- Riga East University Hospital, TB and Lung Disease Clinic, Riga, Latvia
| | - Heinke Kunst
- Blizard Institute, The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Christian Lienhardt
- Unité Unité Mixte Internationale 233 IRD - U1175 INSERM - Université de Montpellier, Institut de Recherche pour le Développement (IRD), Montpellier, France
- Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beatrice Mahler
- Marius Nasta Institute of Pulmonology, Bucharest, Romania
- Department Cardio-thoracic, Pneumophtisiology II, University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
| | - Mateja Janković Makek
- University of Zagreb, School of Medicine Zagreb, Croatia
- University Hospital Centre Zagreb, Department for Lung diseases, Zagreb, Croatia
| | - Inge Muylle
- Division of Pneumology, Onze-Lieve-Vrouw Ziekenhuis (OLV) Aalst, Aalst, Belgium
| | - Johan Normark
- Department of Clinical Microbiology, Umeå University, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Sweden
| | - Analita Pace-Asciak
- Infectious Disease Prevention and Control Unit, Health Promotion and Disease Prevention Directorate, Superintendence of Public Health, Ministry for Health of Malta, La Valetta, Malta
| | - Goranka Petrović
- Respiratory Diseases and Travel Medicine Department with Vaccination Unit, Infectious Diseases Epidemiology ServiceDepartment, Croatian Institute of Public Health, Zagreb, Croatia
| | - Despo Pieridou
- Cyprus National Reference Laboratory for Mycobacteria, Microbiology Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Giulia Russo
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Olena Rzhepishevska
- Department of Chemistry, Department of Clinical Microbiology, Umeå University, Sweden
| | - Helmut J F Salzer
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine 4- Pneumology, Kepler University Hospital, Linz, Austria
- Faculty of Medicine, Johannes-Kepler-University, Linz, Austria and Ignaz Semmelweis Institut, Interuniversity Institute for Infection Resarch, Vienna, Austria
| | | | - Daniela Schmid
- Unit for Infectious Diseases Diagnostics and Infectious Diseases Epidemiology, Centre for Pathophysiology, Infectious Diseases and Immunology, Medical University of Vienna, Vienna, Austria
| | - Ivan Solovic
- National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Slovakia
- Catholic University Ruzomberok, Ruzomberok, Slovakia
| | - Mariya Sukholytka
- First Faculty of Medicine and Faculty Thomayer Hospital Prague, Czechia
| | - Petra Svetina
- National TB Program and Tuberculosis Registry of Republic of Slovenia, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Mariya Tyufekchieva
- Health Promotion and Prevention Unit, Directorate Public Health Protection and Health Control, Ministry of Health of Bulgaria, Sofia, Bulgaria
| | - Tuula Vasankari
- University of Turku, Division of Medicine, Department of Pulmonary Diseases and Clinical Allergology, Turku, Finland
- Finnish Lung Health Association (Filha ry), Helsinki, Finland
| | - Piret Viiklepp
- Estonian Tuberculosis Register, Dept. of Registries, National Institute for Health Development, Tallinn, Estonia
| | - Kersti Villand
- Estonian Tuberculosis Register, Dept. of Registries, National Institute for Health Development, Tallinn, Estonia
| | - Jiri Wallenfels
- National TB Surveillance Unit, University Hospital Bulovka, Prague, Czechia
| | - Stefan Wesolowski
- Department of Tuberculosis Epidemiology and Surveillance, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Anna-Maria Mandalakas
- Baylor College of Medicine, Department of Pediatrics, Global and Immigrant Health, Global Tuberculosis Program, Houston, Texas, United States
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - Leonardo Martinez
- Boston University, School of Public Health, Department of Epidemiology, Boston, Massachusetts, United States
| | - Dominik Zenner
- Global Public Health Unit, Wolfson Institute of Population Health Barts
- The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Christoph Lange
- Baylor College of Medicine, Department of Pediatrics, Global and Immigrant Health, Global Tuberculosis Program, Houston, Texas, United States
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), TTU-TB, Borstel, Germany
- Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
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Malhotra AM, Bryant S, Kunst H, Haworth CS, Lipman M. Management of nontuberculous mycobacteria-pulmonary disease: Results from the first UK survey of clinical practice. J Infect 2023; 87:64-67. [PMID: 37080255 DOI: 10.1016/j.jinf.2023.04.009] [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: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/22/2023]
Affiliation(s)
| | - Sarah Bryant
- NTM Network UK, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, 4 Newark St, London E1 2AT, UK
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge CB2 0AY, UK
| | - Marc Lipman
- UCL Respiratory, Division of Medicine, University College London, London WC1E 6JJ, UK; Respiratory Medicine, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
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7
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Rangaka MX, Hamada Y, Duong T, Bern H, Calvert J, Francis M, Clarke AL, Ghanouni A, Layton C, Hack V, Owen-Powell E, Surey J, Sanders K, Booth HL, Crook A, Griffiths C, Horne R, Kunst H, Lipman M, Mandelbaum M, White PJ, Zenner D, Abubakar I. Evaluating the effect of short-course rifapentine-based regimens with or without enhanced behaviour-targeted treatment support on adherence and completion of treatment for latent tuberculosis infection among adults in the UK (RID-TB: Treat): protocol for an open-label, multicentre, randomised controlled trial. BMJ Open 2022; 12:e057717. [PMID: 36691120 PMCID: PMC9454004 DOI: 10.1136/bmjopen-2021-057717] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/24/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The successful scale-up of a latent tuberculosis (TB) infection testing and treatment programme is essential to achieve TB elimination. However, poor adherence compromises its therapeutic effectiveness. Novel rifapentine-based regimens and treatment support based on behavioural science theory may improve treatment adherence and completion. METHODS AND ANALYSIS A pragmatic multicentre, open-label, randomised controlled trial assessing the effect of novel short-course rifapentine-based regimens for TB prevention and additional theory-based treatment support on treatment adherence against standard-of-care. Participants aged between 16 and 65 who are eligible to start TB preventive therapy will be recruited in England. 920 participants will be randomised to one of six arms with allocation ratio of 5:5:6:6:6:6: daily isoniazid +rifampicin for 3 months (3HR), routine treatment support (control); 3HR, additional treatment support; weekly isoniazid +rifapentine for 3 months (3HP), routine treatment support; weekly 3HP, additional treatment support ; daily isoniazid +rifapentine for 1 month (1HP), routine treatment support; daily 1HP, additional treatment support. Additional treatment support comprises reminders using an electronic pillbox, a short animation, and leaflets based on the perceptions and practicalities approach. The primary outcome is adequate treatment adherence, defined as taking ≥90% of allocated doses within the pre-specified treatment period, measured by electronic pillboxes. Secondary outcomes include safety and TB incidence within 12 months. We will conduct process evaluation of the trial interventions and assess intervention acceptability and fidelity and mechanisms for effect and estimate the cost-effectiveness of novel regimens. The protocol was developed with patient and public involvement, which will continue throughout the trial. ETHICS AND DISSEMINATION Ethics approval has been obtained from The National Health Service Health Research Authority (20/LO/1097). All participants will be required to provide written informed consent. We will share the results in peer-reviewed journals. TRIAL REGISTRATION NUMBER EudraCT 2020-004444-29.
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Affiliation(s)
- Molebogeng X Rangaka
- Institute for Global Health, University College London, London, UK
- School of Public Health, and Clinical Infectious Disease Research Institute-AFRICA, University of Cape Town, Cape Town, South Africa
| | - Yohhei Hamada
- Institute for Global Health, University College London, London, UK
| | - Trinh Duong
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Henry Bern
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Joanna Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Marie Francis
- Institute for Global Health, University College London, London, UK
| | | | - Alex Ghanouni
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK
| | - Charlotte Layton
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Vanessa Hack
- Institute for Global Health, University College London, London, UK
| | - Ellen Owen-Powell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Julian Surey
- Institute for Global Health, University College London, London, UK
| | - Karen Sanders
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Helen L Booth
- North Central London Tuberculosis Service, Whittington Health NHS Trust and University College London Hospitals NHS Foundation Trust, London, UK
| | - Angela Crook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Chris Griffiths
- Wolfson Institute for Population Health Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Marc Lipman
- UCL Respiratory, Division of Medicine, University College, London, UK
- Royal Free London Hospital NHS Foundation Trust, London, UK
| | | | - Peter J White
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College, London, UK
| | - Dominik Zenner
- Institute for Global Health, University College London, London, UK
- Wolfson Institute for Population Health Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
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8
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García-García JM, Blanc FX, Buonsenso D, Centis R, Codecasa LR, D'Ambrosio L, Goletti D, Gualano G, Kunst H, Pontali E, Tadolini M, Tiberi S, Ong CWM, Sotgiu G, Migliori GB. COVID-19 Hampered Diagnosis of TB Infection in France, Italy, Spain and the United Kingdom. Arch Bronconeumol 2022; 58:783-785. [PMID: 36064681 PMCID: PMC9393764 DOI: 10.1016/j.arbres.2022.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Affiliation(s)
| | - François-Xavier Blanc
- Nantes Université, CHU Nantes, Department of Respiratory Medicine, L'Institut du thorax, Nantes, France
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosella Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | | | | | - Delia Goletti
- National Institute for Infectious Diseases (INMI) 'L. Spallanzani' - IRCCS, Rome, Italy
| | - Gina Gualano
- National Institute for Infectious Diseases (INMI) 'L. Spallanzani' - IRCCS, Rome, Italy
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Marina Tadolini
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Catherine W M Ong
- Infectious Disease Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore; Institute for Health Innovation & Technology (iHealthtech), National University of Singapore, Singapore
| | - Giovanni Sotgiu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Giovanni Battista Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy.
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Migliori GB, Thong PM, Alffenaar JW, Denholm J, Tadolini M, Alyaquobi F, Al-Abri S, Blanc FX, Buonsenso D, Chakaya J, Cho JG, Codecasa LR, Danila E, Duarte R, Dukpa R, García-García JM, Gualano G, Kurhasani X, Manika K, Mello FCDQ, Pahl K, Rendon A, Sotgiu G, Souleymane MB, Thomas TA, Tiberi S, Kunst H, Udwadia ZF, Goletti D, Centis R, D’Ambrosio L, Silva DR. Country-specific lockdown measures in response to the COVID-19 pandemic and its impact on tuberculosis control: a global study. J Bras Pneumol 2022; 48:e20220087. [PMID: 35475873 PMCID: PMC9064628 DOI: 10.36416/1806-3756/e20220087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/13/2022] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to describe country-specific lockdown measures and tuberculosis indicators collected during the first year of the COVID-19 pandemic. Data on lockdown/social restrictions (compulsory face masks and hand hygiene; international and local travel restrictions; restrictions to family visits, and school closures) were collected from 24 countries spanning five continents. The majority of the countries implemented multiple lockdowns with partial or full reopening. There was an overall decrease in active tuberculosis, drug-resistant tuberculosis, and latent tuberculosis cases. Although national lockdowns were effective in containing COVID-19 cases, several indicators of tuberculosis were affected during the pandemic.
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Affiliation(s)
| | - Pei Min Thong
- . National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Jan-Willem Alffenaar
- . The University of Sydney, Pharmacy School, Sydney (NSW) Australia
- . The University of Sidney at Westmead Hospital, Sydney (NSW) Australia
- . Sydney Institute for Infectious Diseases, The University of Sydney, Sydney (NSW) Australia
| | - Justin Denholm
- . Melbourne Health Victorian Tuberculosis Program, Melbourne (VIC) Australia
- . Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne (VIC) Australia
| | - Marina Tadolini
- . Infectious Diseases Unit, Istituti Clinici Scientifici Maugeri - IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italia
- . Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Fatma Alyaquobi
- . TB and Acute Respiratory Diseases Section, Department of Communicable Diseases, Directorate General of Disease Surveillance and Control, National TB Programme, MoH Oman, Muscat, Sultanate of Oman
| | - Seif Al-Abri
- . Directorate General for Disease Surveillance and Control, MoH Oman, Muscat, Sultanate of Oman
| | - François-Xavier Blanc
- . Nantes Université, CHU Nantes, Service de Pneumologie, L’Institut du Thorax, Nantes, France
| | - Danilo Buonsenso
- . Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli - IRCCS - Roma, Italia
| | - Jeremiah Chakaya
- . Department of Medicine, Dermatology and Therapeutics, Kenyatta University, Nairobi, Kenya
- . Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jin-Gun Cho
- . The University of Sidney at Westmead Hospital, Sydney (NSW) Australia
- . Parramatta Chest Clinic, Parramatta (NSW) Australia
| | - Luigi Ruffo Codecasa
- . TB Reference Centre of Villa Marelli Institute, Niguarda Hospital, Milano, Italia
| | - Edvardas Danila
- . Vilnius University Hospital Santaros Kilinkos, Vilinius, Lithuania
| | - Raquel Duarte
- . National Reference Centre for MDR-TB, Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal e Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rada Dukpa
- . National TB Control Program, Ministry of Health, Timbu, Bhutan
| | - José-María García-García
- . Programa Integrado de Investigación en Tuberculosis - PII-TB - Sociedad Española de Neumología y Cirugía Torácica - SEPAR - Barcelona, España
| | - Gina Gualano
- . Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani” - INMI - IRCCS, Roma, Italia
| | - Xhevat Kurhasani
- . UBT - Higher Education Institution, Prishtina, Kosovo
- . NGO KeA, Prishtina, Kosovo
| | - Katerina Manika
- . Pulmonary Department, Aristotle University of Thessaloniki, “G. Papanikolaou” Hospital, Thessaloniki, Greece
| | | | - Kristin Pahl
- . Clinton Health Access Initiative, Phnom Penh, Cambodia
| | - Adrian Rendon
- . Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias -CIPTIR - Hospital Universitario de Monterrey, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Giovanni Sotgiu
- . Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Tania A. Thomas
- . Division of Infectious Diseases and International Health, University of Virginia, Charlottesville (VA) USA
| | - Simon Tiberi
- . Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- . Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Heinke Kunst
- . Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- . Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Zarir F. Udwadia
- . P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Delia Goletti
- . Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani” - INMI - IRCCS, Roma, Italia
| | - Rosella Centis
- . Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia
| | | | - Denise Rossato Silva
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS- Porto Alegre, Brasil
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10
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Rahman A, Thangaratinam S, Copas A, Zenner D, White PJ, Griffiths C, Abubakar I, McCourt C, Kunst H. A feasibility study evaluating the uptake, effectiveness and acceptability of routine screening of pregnant migrants for latent tuberculosis infection in antenatal care: a research protocol. BMJ Open 2022; 12:e058734. [PMID: 35379641 PMCID: PMC8981348 DOI: 10.1136/bmjopen-2021-058734] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Globally, tuberculosis (TB) is a leading cause of death in women of reproductive age and there is high risk of reactivation of latent tuberculosis infection (LTBI) in pregnancy. The uptake of routine screening of migrants for LTBI in the UK in primary care is low. Antenatal care is a novel setting which could improve uptake and can lend insight into the feasibility and acceptability of offering opt-out screening for LTBI. METHODS AND ANALYSIS This is an observational feasibility study with a nested qualitative component. The setting will be the antenatal clinics in three hospitals in East London, UK . Inclusion criteria are pregnant migrant women aged 16-35 years attending antenatal clinics who are from countries with a TB incidence of greater than 150/100 000 including sub-Saharan Africa, and who have been in the UK for less than 5 years. Participants will be offered LTBI screening with an opt-out interferon gamma release assay blood test, and be invited to complete a questionnaire. Both participants and healthcare providers will be invited to participate in semistructured interviews or focus groups to evaluate understanding, feasibility and acceptability of routine opt-out LTBI screening. The primary analysis will focus on estimating the uptake of the screening programme along with the corresponding 95% CI. Secondary analysis will focus on estimating the test positivity. Qualitative analysis will evaluate the acceptability of offering routine opt-out LTBI screening to participants and healthcare providers. ETHICS AND DISSEMINATION The study has received the following approvals: Health Research Authority (IRAS 247388) and National Health Service Ethics Committee (19/LO/0557). The results will be made available locally to antenatal clinics and primary care physicians, nationally to NHS England and Public Health England and internationally through conferences and journals. TRIAL REGISTRATION NUMBER NCT04098341.
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Affiliation(s)
- A Rahman
- Blizard Institute, Queen Mary University of London, London, UK
| | | | | | - D Zenner
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Peter J White
- MRC Centre for Global Infectious Disease Analysis and NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College, London, UK
- Modelling and Economics Unit, Public Health England, London, UK
| | - Chris Griffiths
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Ibrahim Abubakar
- Tuberculosis Section, Centre for Infections, Health Protection Agency, London, UK
| | - Christine McCourt
- Department of Midwifery and Child Health, City University London, London, UK
| | - Heinke Kunst
- Department of Respiratory Medicine, Queen Mary University of London, London, UK
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11
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Allotey J, Chatterjee S, Kew T, Gaetano A, Stallings E, Fernández-García S, Yap M, Sheikh J, Lawson H, Coomar D, Dixit A, Zhou D, Balaji R, Littmoden M, King Y, Debenham L, Llavall AC, Ansari K, Sandhu G, Banjoko A, Walker K, O'Donoghue K, van Wely M, van Leeuwen E, Kostova E, Kunst H, Khalil A, Brizuela V, Broutet N, Kara E, Kim CR, Thorson A, Oladapo OT, Zamora J, Bonet M, Mofenson L, Thangaratinam S. SARS-CoV-2 positivity in offspring and timing of mother-to-child transmission: living systematic review and meta-analysis. BMJ 2022; 376:e067696. [PMID: 35296519 PMCID: PMC8924705 DOI: 10.1136/bmj-2021-067696] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the rates of SARS-CoV-2 positivity in babies born to mothers with SARS-CoV-2 infection, the timing of mother-to-child transmission and perinatal outcomes, and factors associated with SARS-CoV-2 status in offspring. DESIGN Living systematic review and meta-analysis. DATA SOURCES Major databases between 1 December 2019 and 3 August 2021. STUDY SELECTION Cohort studies of pregnant and recently pregnant women (including after abortion or miscarriage) who sought hospital care for any reason and had a diagnosis of SARS-CoV-2 infection, and also provided data on offspring SARS-CoV-2 status and risk factors for positivity. Case series and case reports were also included to assess the timing and likelihood of mother-to-child transmission in SARS-CoV-2 positive babies. DATA EXTRACTION Two reviewers independently extracted data and assessed study quality. A random effects model was used to synthesise data for rates, with associations reported using odds ratios and 95% confidence intervals. Narrative syntheses were performed when meta-analysis was inappropriate. The World Health Organization classification was used to categorise the timing of mother-to-child transmission (in utero, intrapartum, early postnatal). RESULTS 472 studies (206 cohort studies, 266 case series and case reports; 28 952 mothers, 18 237 babies) were included. Overall, 1.8% (95% confidence interval 1.2% to 2.5%; 140 studies) of the 14 271 babies born to mothers with SARS-CoV-2 infection tested positive for the virus with reverse transcriptase polymerase chain reaction (RT-PCR). Of the 592 SARS-CoV-2 positive babies with data on the timing of exposure and type and timing of tests, 14 had confirmed mother-to-child transmission: seven in utero (448 assessed), two intrapartum (18 assessed), and five during the early postnatal period (70 assessed). Of the 800 SARS-CoV-2 positive babies with outcome data, 20 were stillbirths, 23 were neonatal deaths, and eight were early pregnancy losses; 749 babies were alive at the end of follow-up. Severe maternal covid-19 (odds ratio 2.4, 95% confidence interval 1.3 to 4.4), maternal death (14.1, 4.1 to 48.0), maternal admission to an intensive care unit (3.5, 1.7 to 6.9), and maternal postnatal infection (5.0, 1.2 to 20.1) were associated with SARS-CoV-2 positivity in offspring. Positivity rates using RT-PCR varied between regions, ranging from 0.1% (95% confidence interval 0.0% to 0.3%) in studies from North America to 5.7% (3.2% to 8.7%) in studies from Latin America and the Caribbean. CONCLUSION SARS-CoV-2 positivity rates were found to be low in babies born to mothers with SARS-CoV-2 infection. Evidence suggests confirmed vertical transmission of SARS-CoV-2, although this is likely to be rare. Severity of maternal covid-19 appears to be associated with SARS-CoV-2 positivity in offspring. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020178076. READERS' NOTE This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.
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Affiliation(s)
- John Allotey
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | - Tania Kew
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Andrea Gaetano
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Elena Stallings
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Magnus Yap
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Jameela Sheikh
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Heidi Lawson
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Dyuti Coomar
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Anushka Dixit
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Dengyi Zhou
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Rishab Balaji
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Megan Littmoden
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Luke Debenham
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Kehkashan Ansari
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Gurimaan Sandhu
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Adeolu Banjoko
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | | | - Madelon van Wely
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Elizabeth van Leeuwen
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Elena Kostova
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | | | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Edna Kara
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Caron Rahn Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Javier Zamora
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lynne Mofenson
- Elizabeth Glaser Paediatric AIDS Foundation, Washington DC, USA
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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12
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Galvin J, Tiberi S, Akkerman O, Kerstjens HAM, Kunst H, Kurhasani X, Ambrosino N, Migliori GB. Pulmonary tuberculosis in intensive care setting, with a focus on the use of severity scores, a multinational collaborative systematic review. Pulmonology 2022; 28:297-309. [PMID: 35227650 PMCID: PMC9420544 DOI: 10.1016/j.pulmoe.2022.01.016] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background and aim Tuberculosis (TB) is associated with a high mortality in the intensive care unit (ICU), especially in subjects with Acute Respiratory Distress Syndrome (ARDS) requiring mechanical ventilation. Despite its global burden on morbidity and mortality, TB is an uncommon cause of ICU admission, however mortality is disproportionate to the advances in diagnosis and treatment made. Herein we report a systematic review of published studies. Methods Our Literature search was conducted to identify studies on outcomes of individuals with TB admitted to ICU. We report and review in-hospital mortality, predictors of poorer outcomes, usefulness of severity scoring systems and potential benefits of intravenous antibiotics. Searches from Pubmed, Embase, Cochrane and Medline were conducted from inception to March 2020. Only literature in English was included. Results Out of 529 potentially relevant articles, 17 were included. Mortality across all studies ranged from 29-95% with an average of 52.9%. All severity scores underestimated average mortality. The most common indication for ICU admission was acute respiratory failure (36.3%). Negative predictors of outcome included hospital acquired infections, need of mechanical ventilation and vasopressors, delay in initiation of anti-TB treatment, more than one organ failure and a higher severity score. Low income, high incidence countries showed a 23.4% higher mortality rate compared to high income, low TB incidence countries. Conclusion Mortality in individuals with TB admitted to ICU is high. Earlier detection and treatment initiation is needed.
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Affiliation(s)
- J Galvin
- Department of Infection, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom
| | - S Tiberi
- Department of Infection, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom
| | - O Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherland; University of Groningen, University Medical Center Groningen, Tuberculosis center Beatrixoord, Haren, the Netherlands
| | - H A M Kerstjens
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherland; University of Groningen, University Medical Center Groningen, Tuberculosis center Beatrixoord, Haren, the Netherlands
| | - H Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom; Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | | | - N Ambrosino
- Pneumology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, Italy
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, IRCCS, Via Roncaccio 16, Tradate 21049, Italy.
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13
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Giesbers S, Goh E, Kew T, Allotey J, Brizuela V, Kara E, Kunst H, Bonet M, Thangaratinam S. Treatment of COVID-19 in pregnant women: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 267:120-128. [PMID: 34768118 PMCID: PMC8527829 DOI: 10.1016/j.ejogrb.2021.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 12/15/2022]
Abstract
Objective Clinical trials evaluating
pharmacological and non-pharmacological treatment of COVID-19, either
excluded pregnant women or included very few women. Unlike the numerous
systematic reviews on prevalence, symptoms and adverse outcomes of
COVID-19 in pregnancy, there are very few on the effects of treatment on
maternal and neonatal outcomes in pregnancy. We undertook a systematic
review of all published and unpublished studies on the effects of
pharmacological and non-pharmacological interventions for COVID-19 on
maternal and neonatal pregnancy outcomes. Data sources We performed a systematic literature
search of the following databases: Medline, Embase, Cochrane database,
WHO (World Health Organization) COVID-19 database, China National
Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December
2019 to 1 December 2020. Study eligibility criteria Studies were only included if they
involved pregnant or postnatal women who were exposed to pregnancy
specific interventions like the mode of delivery and type of anaesthesia,
pharmacological or non-pharmacological interventions. Study appraisal and synthesis
methods We first screened the titles and
abstracts of studies and then assessed the full text of the selected
studies in detail for eligibility. Data on study design, population, type
of screening for COVID-19, country, hospital, country status (high or low
and middle income), treatment given (mode of delivery, type of
anaesthesia, type of pharmacological and non-pharmacological treatment
was extracted. The pre-defined maternal outcomes we collected were mode
of delivery (vaginal or by caesarean section), severe or critical
COVID-19 (as defined by the authors), symptomatic COVID-19, maternal
death, maternal hospital admission, ICU admission, mechanical
ventilation, ECMO and maternal pneumonia. The pre-defined neonatal
outcomes we extracted were preterm birth (<37 weeks), stillbirth,
neonatal death, NICU admission, neonatal COVID-19 positive, neonatal
acidosis (pH<7.0) and Apgar scores (<8 after 5 minutes). Study
quality assessment was performed. Results From a total of 342 potential
eligible studies, we included 27 studies in our systematic review,
including 4943 pregnant women (appendix 3). Sixteen studies had a
retrospective cohort design and 11 a prospective cohort design. There
were no randomised controlled trials. There was a significant association
between caesarean section and admission to ICU (OR 4.99, 95% CI 1.24 to
20.12; 4 studies, 153 women, I2=0%), and
diagnosis of maternal COVID-19 pneumonia as defined by study authors (OR
3.09, 95% CI 1.52 to 6.28; 2 studies, 228 women, I2=0%). Women who had a preterm birth were more likely to
have the baby via caesarean section (OR 3.03, 95% CI 1.71 to 5.36, 12
studies; 314 women, I2=0%). For
pharmacological and non-pharmacological we provided estimates of the
expected rates of outcomes in women exposed to various treatment of
COVID-19. Comparative data for pregnant women, in particular for
treatments proven to be effective in the general population, however, is
lacking to provide clinically meaningful interpretation. Conclusions We found associations for pregnancy
specific interventions, like mode of delivery and outcomes of the
disease, but there were too few data on pharmacological and
non-pharmacological treatments in pregnant women with COVID-19. We report
the rates of complications found in the literature. We encourage
researchers to include pregnant women in their trials and report the data
on pregnant women separately.
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Affiliation(s)
- Steven Giesbers
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Edwina Goh
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Tania Kew
- Birmingham Medical School, Birmingham, United Kingdom
| | - John Allotey
- University of Birmingham, WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, United Kingdom; Institute of Applied Health Research, Birmingham, United Kingdom
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Edna Kara
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts Health NHS Trust, London, United Kingdom
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shakila Thangaratinam
- University of Birmingham, WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, United Kingdom; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom.
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14
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Kloprogge F, Abubakar I, Esmail H, Hack V, Kunst H, McHugh TD, Noursadeghi M, Surey J, Tiberi S, Lipman M. Exploring a combined biomarker for tuberculosis treatment response: protocol for a prospective observational cohort study. BMJ Open 2021; 11:e052885. [PMID: 34244287 PMCID: PMC8268918 DOI: 10.1136/bmjopen-2021-052885] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/21/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION An improved understanding of factors explaining tuberculosis (TB) treatment response is urgently needed to help clinicians optimise and personalise treatment and assist scientists undertaking novel treatment regimen trials. Promising outcome proxy measures, including sputum bacillary load and host immune response, are widely reported with variable results. However, they have not been studied together in combination with antibiotic exposure. The aim of this observational cohort study is to investigate which antibiotic exposures correlate with sputum bacillary load and which with the host immune response. Subsequently, we will explore if these correlations can be used to inform a candidate combined biomarker predicting cure. METHODS AND ANALYSIS All patients aged ≥ 18, diagnosed with drug-sensitive pulmonary TB (culture or molecular test), eligible for standard anti-TB treatment, at selected London, UK TB Services, will be invited to participate in this observational cohort study (target sample size=210). Patients will be asked to give blood for host transcriptomics and antibiotic plasma exposure, in addition to standard of care sputum samples for bacillary load. Antibiotic plasma concentrations will be quantified using a validated liquid chromatograph triple quadrupole mass spectrometer (LC-MS/MS) assay and sputum bacillary load by mycobacterial growth incubator tube time to positivity. Expression from a total of 35 prespecified host blood genes will be quantified using NanoString®. Antibiotic exposure, sputum bacillary load and host blood transcriptomic time series data will be analysed using nonlinear mixed-effects models. Correlations between combinations of longitudinal biomarkers and microbiological cure at the end of treatment and remaining relapse free for 1 year thereafter will be analysed using logistic regression and Cox proportional hazard models. ETHICS AND DISSEMINATION The observational cohort study has been approved by the UK's HRA REC (20/SW/0007). Written informed consent will be obtained. Results will be disseminated via publication, presentation and through engagement with institutes/companies developing novel anti-TB treatment combinations.
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Affiliation(s)
- Frank Kloprogge
- Institute for Global Health, University College London, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Hanif Esmail
- Institute for Global Health, University College London, London, UK
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Vanessa Hack
- Institute for Global Health, University College London, London, UK
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Timothy D McHugh
- UCL Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, London, UK
| | - Julian Surey
- Institute for Global Health, University College London, London, UK
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Marc Lipman
- Respiratory medicine, Royal Free London NHS Foundation Trust, London, UK
- UCL Respiratory, Division of Medicine, University College London, London, UK
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15
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Jones ASK, Bidad N, Horne R, Stagg HR, Wurie FB, Kielmann K, Karat AS, Kunst H, Campbell CNJ, Darvell M, Clarke AL, Lipman MCI. Determinants of non-adherence to anti-TB treatment in high income, low TB incidence settings: a scoping review. Int J Tuberc Lung Dis 2021; 25:483-490. [PMID: 34049611 DOI: 10.5588/ijtld.21.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Improving adherence to anti-TB treatment is a public health priority in high-income, low incidence (HILI) regions. We conducted a scoping review to identify reported determinants of non-adherence in HILI settings.METHODS: Key terms related to TB, treatment and adherence were used to search MEDLINE, EMBASE, Web of Science, PsycINFO and CINAHL in June 2019. Quantitative studies examining determinants (demographic, clinical, health systems or psychosocial) of non-adherence to anti-TB treatment in HILI settings were included.RESULTS: From 10,801 results, we identified 24 relevant studies from 10 countries. Definitions and methods of assessing adherence were highly variable, as were documented levels of non-adherence (0.9-89%). Demographic factors were assessed in all studies and clinical factors were frequently assessed (23/24). Determinants commonly associated with non-adherence were homelessness, incarceration, and alcohol or drug misuse. Health system (8/24) and psychosocial factors (6/24) were less commonly evaluated.CONCLUSION: Our review identified some key factors associated with non-adherence to anti-TB treatment in HILI settings. Modifiable determinants such as psychosocial factors are under-evidenced and should be further explored, as these may be better targeted by adherence support. There is an urgent need to standardise definitions and measurement of adherence to more accurately identify the strongest determinants.
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Affiliation(s)
- A S K Jones
- Centre for Behavioural Medicine, Research Department of Practice and Policy, University College London (UCL) School of Pharmacy, London, UK
| | - N Bidad
- Centre for Behavioural Medicine, Research Department of Practice and Policy, University College London (UCL) School of Pharmacy, London, UK
| | - R Horne
- Centre for Behavioural Medicine, Research Department of Practice and Policy, University College London (UCL) School of Pharmacy, London, UK
| | - H R Stagg
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - F B Wurie
- Research Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, UCL, London, UK, Migrant Health, Public Health England, London, UK
| | - K Kielmann
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
| | - A S Karat
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland, TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - H Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - M Darvell
- UCL Respiratory, Division of Medicine, UCL, London, UK
| | - A L Clarke
- Centre for Behavioural Medicine, Research Department of Practice and Policy, University College London (UCL) School of Pharmacy, London, UK
| | - M C I Lipman
- UCL Respiratory, Division of Medicine, UCL, London, UK, Royal Free London NHS Foundation Trust, London, UK
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16
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Sotgiu G, Rosales-Klintz S, Centis R, D'Ambrosio L, Verduin R, Correia AM, Cirule A, Duarte R, Gadzheva B, Gualano G, Kunst H, Palmieri F, Riekstina V, Stefanova D, Tiberi S, van der Werf MJ, Migliori GB. TB management in the European Union/European Economic Area: a multi-centre survey. Int J Tuberc Lung Dis 2021; 25:126-133. [PMID: 33656424 PMCID: PMC7849393 DOI: 10.5588/ijtld.20.0849] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Essential TB care in the European Union/European Economic Area (EU/EEA) comprises 21 standards for the diagnosis, treatment and prevention of TB that constitute the European Union Standards for Tuberculosis Care (ESTC). METHODS: In 2017, we conducted an audit on TB management and infection control measures against the ESTC standards. TB reference centres in five EU/EEA countries were purposely selected to represent the heterogeneous European TB burden and examine geographic variability. RESULTS: Data from 122 patients, diagnosed between 2012 and 2015 with multidrug-resistant TB (n = 49), extensively drug-resistant TB (XDR-TB) (n = 11), pre-XDR-TB (n = 29) and drug-susceptible TB (n = 33), showed that TB diagnosis and treatment practices were in general in agreement with the ESTC. CONCLUSION: Overall, TB management and infection control practices were in agreement with the ESTC in the selected EU/EEA reference centres. Areas for improvement include strengthening of integrated care services and further implementation of patient-centred approaches.
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Affiliation(s)
- G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - S Rosales-Klintz
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate, Italy
| | - L D'Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - R Verduin
- Verduin Public Health Consult, Oegstgeest, the Netherlands
| | - A M Correia
- Regional Health Administration of the North, Department of Public Health, Porto, Portugal
| | - A Cirule
- Centre of TB and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - R Duarte
- National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Department of Pneumology; Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - B Gadzheva
- The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) Programme, Department of Management of Specialized Donor-Funded Programmes, Ministry of Health, Sofia, Bulgaria
| | - G Gualano
- Respiratory Infectious Diseases Unit, L Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - H Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - F Palmieri
- Respiratory Infectious Diseases Unit, L Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - V Riekstina
- Centre of TB and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - D Stefanova
- St Sofia University Hospital for Active Treatment of Respiratory Diseases, Sofia, Bulgaria
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK, Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M J van der Werf
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate, Italy
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Crocker-Buque T, Williams S, Brentnall AR, Gabe R, Duffy S, Prowle JR, Orkin C, Kunst H, Cutino-Moguel T, Zenner D, Bloom B, Melzer M, de Freitas S, Darmalingam M, McCafferty K, Kapil V, Pfeffer P, Martin J, Gourtsoyannis Y, Chandran S, Dhariwal A, Rachman R, Milligan I, Mabayoje D, Adobah E, Falconer J, Nugent H, Yaqoob M, Collier D, Pearse R, Caulfield M, Tiberi S. The Barts Health NHS Trust COVID-19 cohort: characteristics, outcomes and risk scoring of patients in East London. Int J Tuberc Lung Dis 2021; 25:358-366. [PMID: 33977903 DOI: 10.5588/ijtld.20.0926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Barts Health National Health Service Trust (BHNHST) serves a diverse population of 2.5 million people in London, UK. We undertook a health services assessment of factors used to evaluate the risk of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection.METHODS: Patients with confirmed polymerase chain reaction (PCR) test results admitted between 1 March and 1 August 2020 were included, alongwith clinician-diagnosed suspected cases. Prognostic factors from the 4C Mortality score and 4C Deterioration scores were extracted from electronic health records and logistic regression was used to quantify the strength of association with 28-day mortality and clinical deterioration using national death registry linkage.RESULTS: Of 2783 patients, 1621 had a confirmed diagnosis, of whom 61% were male and 54% were from Black and Minority Ethnic groups; 26% died within 28 days of admission. Mortality was strongly associated with older age. The 4C mortality score had good stratification of risk with a calibration slope of 1.14 (95% CI 1.01-1.27). It may have under-estimated mortality risk in those with a high respiratory rate or requiring oxygen.CONCLUSION: Patients in this diverse patient cohort had similar mortality associated with prognostic factors to the 4C score derivation sample, but survival might be poorer in those with respiratory failure.
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Affiliation(s)
- T Crocker-Buque
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - S Williams
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - A R Brentnall
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, Mile End Road, London, UK
| | - R Gabe
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, Mile End Road, London, UK, Barts Clinical Trials Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Mile End Road, London, UK
| | - S Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, Mile End Road, London, UK
| | - J R Prowle
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK, The William Harvey Research Institute, Queen Mary University of London Charterhouse Square, London, UK
| | - C Orkin
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - H Kunst
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - T Cutino-Moguel
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - D Zenner
- Centre for Global Public Health, Queen Mary University of London, Mile End Road, London, UK
| | - B Bloom
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - M Melzer
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK, Whipps Cross University Hospital, Barts Health NHS Trust, Leytonstone, London, UK
| | - S de Freitas
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - M Darmalingam
- Whipps Cross University Hospital, Barts Health NHS Trust, Leytonstone, London, UK
| | - K McCafferty
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - V Kapil
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK, The William Harvey Research Institute, Queen Mary University of London Charterhouse Square, London, UK, St Bartholomew´s Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - P Pfeffer
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK, The William Harvey Research Institute, Queen Mary University of London Charterhouse Square, London, UK
| | - J Martin
- Newham University Hospital, Barts Health NHS Trust, London, UK
| | - Y Gourtsoyannis
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - S Chandran
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - A Dhariwal
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - R Rachman
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - I Milligan
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - D Mabayoje
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - E Adobah
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - J Falconer
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - H Nugent
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - M Yaqoob
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - D Collier
- Barts Clinical Trials Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Mile End Road, London, UK, The William Harvey Research Institute, Queen Mary University of London Charterhouse Square, London, UK
| | - R Pearse
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK, The William Harvey Research Institute, Queen Mary University of London Charterhouse Square, London, UK
| | - M Caulfield
- The William Harvey Research Institute, Queen Mary University of London Charterhouse Square, London, UK
| | - S Tiberi
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK, Newham University Hospital, Barts Health NHS Trust, London, UK
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18
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Abstract
OBJECTIVES To describe characteristics, details of diagnosis and outcomes of urogenital tuberculosis (UGTB) in a low-prevalence country. METHODS We conducted a retrospective observational study of 37 consecutive patients diagnosed with UGTB between 1st January 2014 and 31st October 2019 in an East London hospital. RESULTS 68% (25/37) of patients were male and the median age was 42 years (IQR 34-55). 89% (33/37) of patients were born outside the United Kingdom with 65% (24/37) born in the South Asian region. Renal (32.4%), epididymal (24.3%) and endometrial TB (21.6%) were the most prevalent forms of UGTB. Only 13.5% of UGTB patients had concurrent pulmonary TB. The median length of time from symptom onset to treatment was 163 days, while endometrial TB had an average delay to diagnosis of 564 days. Approximately half of patients with UGTB were culture positive (51.4%). However, 70% of early morning urines (EMUs) sent in urinary TB were culture positive. 11 patients (30.6%) underwent two or more invasive procedures, such as biopsy to obtain specimen samples. The mean treatment length for all UGTB cases was 7.3 months (SD 3.1). Notably, 25% of patients with endometrial TB required surgery despite antituberculous treatment. CONCLUSIONS UGTB is challenging to diagnose as early disease is often asymptomatic. Clinicians faced with non-specific symptoms, or features suggestive of urogenital malignancy amongst patients from TB-endemic areas, should maintain a high suspicion of UGTB.
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Affiliation(s)
- Shruthi Chandran
- Department of Infection, Royal London Hospital, Barts NHS Health Trust, London, UK
| | - Ananna Rahman
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Joseph M Norris
- UCL Division of Surgery & Interventional Science, University College London, London, UK
| | - Simon Tiberi
- Department of Infection, Royal London Hospital, Barts NHS Health Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
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19
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Karat AS, Jones AS, Abubakar I, Campbell CN, Clarke AL, Clarke CS, Darvell M, Hill AT, Horne R, Kunst H, Mandelbaum M, Marshall BG, McSparron C, Rahman A, Stagg HR, White J, Lipman MC, Kielmann K. " You have to change your whole life": A qualitative study of the dynamics of treatment adherence among adults with tuberculosis in the United Kingdom. J Clin Tuberc Other Mycobact Dis 2021; 23:100233. [PMID: 33898764 PMCID: PMC8059079 DOI: 10.1016/j.jctube.2021.100233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Maintaining adherence to treatment for tuberculosis (TB) is essential if the disease is to be eliminated. As part of formative research to develop an intervention to improve adherence, we documented the lived experiences of adults receiving anti-TB treatment (ATT) in three UK cities and examined how personal, social, and structural circumstances interacted to impact on individuals’ adherence to treatment. Using a topic guide that explored social circumstances and experiences of TB care, we conducted in-depth interviews with 18 adults (six women) who were being or had been treated for TB (patients) and four adults (all women) who were caring for a friend, relative, or partner being treated for TB (caregivers). We analysed transcripts using an adapted framework method that classified factors affecting adherence as personal, social, structural, health systems, or treatment-related. Eleven of 18 patients were born outside the UK (in South, Central, and East Asia, and Eastern and Southern Africa); among the seven who were UK-born, four were Black, Asian, or Minority Ethnic and three were White British. TB and its treatment were often disruptive: in addition to debilitating symptoms and side effects of ATT, participants faced job insecurity, unstable housing, stigma, social isolation, worsening mental health, and damaged relationships. Those who had a strong support network, stable employment, a routine that could easily be adapted, a trusting relationship with their TB team, and clear understanding of the need for treatment reported finding it easier to adhere to ATT. Changes in circumstances sometimes had dramatic effects on an individual’s ability to take ATT; participants described how the impact of certain acute events (e.g., the onset of side effects or fatigue, episodes of stigmatisation, loss of income) were amplified by their timing or through their interaction with other elements of the individual’s life. We suggest that the dynamic and fluctuating nature of these factors necessitates comprehensive and regular review of needs and potential problems, conducted before and during ATT; this, coupled with supportive measures that consider (and seek to mitigate) the influence of social and structural factors, may help improve adherence.
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Affiliation(s)
- Aaron S. Karat
- Institute for Global Health and Development, Queen Margaret University, Queen Margaret University Way, Musselburgh, Edinburgh EH21 6UU, United Kingdom
- TB Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
- Corresponding authors at: Institute for Global Health and Development, Queen Margaret University, Queen Margaret University Way, Musselburgh, Edinburgh EH21 6UU, United Kingdom (A.S. Karat).
| | - Annie S.K. Jones
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, BMA House, Tavistock Square, London WC1H 9JP, United Kingdom
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Colin N.J. Campbell
- Institute for Global Health, University College London, Gower Street, London WC1E 6BT, United Kingdom
- Respiratory Diseases Department, National Infection Service, Public Health England, Wellington House, 133–155 Waterloo Road, London SE1 8UG, United Kingdom
| | - Amy L. Clarke
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, BMA House, Tavistock Square, London WC1H 9JP, United Kingdom
| | - Caroline S. Clarke
- Research Department of Primary Care and Population Health, University College London, UCL Medical School, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
- Priment Clinical Trials Unit, University College London, UCL Medical School, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Marcia Darvell
- UCL Respiratory, Division of Medicine, University College London, UCL Medical School, Level 1, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Adam T. Hill
- Queen’s Medical Research Institute, University of Edinburgh Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Robert Horne
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, BMA House, Tavistock Square, London WC1H 9JP, United Kingdom
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, 4 Newark Street, London E1 2AT, United Kingdom
| | | | - Ben G. Marshall
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Ceri McSparron
- NHS Lothian, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom
| | - Ananna Rahman
- Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1FR, United Kingdom
| | - Helen R. Stagg
- Usher Institute, University of Edinburgh, MacKenzie House, 30 West Richmond Street, Edinburgh EH8 9DX, United Kingdom
| | - Jacqui White
- Whittington Health NHS Trust, The Whittington Hospital, Magdala Avenue, London N19 5NF, United Kingdom
| | - Marc C.I. Lipman
- UCL Respiratory, Division of Medicine, University College London, UCL Medical School, Level 1, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
- Royal Free London NHS Foundation Trust, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University, Queen Margaret University Way, Musselburgh, Edinburgh EH21 6UU, United Kingdom
- Corresponding authors at: Institute for Global Health and Development, Queen Margaret University, Queen Margaret University Way, Musselburgh, Edinburgh EH21 6UU, United Kingdom (A.S. Karat).
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20
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Gupta RK, Lule SA, Krutikov M, Gosce L, Green N, Southern J, Imran A, Aldridge RW, Kunst H, Lipman M, Lynn W, Burgess H, Rahman A, Menezes D, Rahman A, Tiberi S, White PJ, Abubakar I. Screening for tuberculosis among high-risk groups attending London emergency departments: a prospective observational study. Eur Respir J 2021; 57:13993003.03831-2020. [PMID: 33737408 PMCID: PMC8223173 DOI: 10.1183/13993003.03831-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/23/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Rishi K Gupta
- Institute for Global Health, University College London, London, UK
| | - Swaib A Lule
- Institute for Global Health, University College London, London, UK
| | - Maria Krutikov
- Institute for Global Health, University College London, London, UK
| | - Lara Gosce
- Institute for Global Health, University College London, London, UK
| | - Nathan Green
- MRC Centre for Global Infectious Disease Analysis and NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, London, UK
| | - Jo Southern
- TB Unit, Public Health England, Colindale, London, UK
| | | | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, UK
| | - Marc Lipman
- Royal Free London NHS Foundation Trust, London, UK.,UCL-TB and UCL Respiratory, University College London, London, UK
| | - William Lynn
- London North West University NHS Trust, London, UK
| | - Helen Burgess
- West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Asif Rahman
- Imperial College London NHS Trust, London, UK
| | - Dee Menezes
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Ananna Rahman
- Blizard Institute, Queen Mary University of London, London, UK
| | - Simon Tiberi
- Blizard Institute, Queen Mary University of London, London, UK.,Division of Infection, Barts Health NHS Trust, London, UK
| | - Peter J White
- MRC Centre for Global Infectious Disease Analysis and NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, London, UK.,Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
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21
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Koirala S, Borisov S, Danila E, Mariandyshev A, Shrestha B, Lukhele N, Dalcolmo M, Shakya SR, Miliauskas S, Kuksa L, Manga S, Aleksa A, Denholm JT, Khadka HB, Skrahina A, Diktanas S, Ferrarese M, Bruchfeld J, Koleva A, Piubello A, Koirala GS, Udwadia ZF, Palmero DJ, Munoz-Torrico M, Gc R, Gualano G, Grecu VI, Motta I, Papavasileiou A, Li Y, Hoefsloot W, Kunst H, Mazza-Stalder J, Payen MC, Akkerman OW, Bernal E, Manfrin V, Matteelli A, Mustafa Hamdan H, Nieto Marcos M, Cadiñanos Loidi J, Cebrian Gallardo JJ, Duarte R, Escobar Salinas N, Gomez Rosso R, Laniado-Laborín R, Martínez Robles E, Quirós Fernandez S, Rendon A, Solovic I, Tadolini M, Viggiani P, Belilovski E, Boeree MJ, Cai Q, Davidavičienė E, Forsman LD, De Los Rios J, Drakšienė J, Duga A, Elamin SE, Filippov A, Garcia A, Gaudiesiute I, Gavazova B, Gayoso R, Gruslys V, Jonsson J, Khimova E, Madonsela G, Magis-Escurra C, Marchese V, Matei M, Moschos C, Nakčerienė B, Nicod L, Palmieri F, Pontarelli A, Šmite A, Souleymane MB, Vescovo M, Zablockis R, Zhurkin D, Alffenaar JW, Caminero JA, Codecasa LR, García-García JM, Esposito S, Saderi L, Spanevello A, Visca D, Tiberi S, Pontali E, Centis R, D'Ambrosio L, van den Boom M, Sotgiu G, Migliori GB. Outcome of treatment of MDR-TB or drug-resistant patients treated with bedaquiline and delamanid: Results from a large global cohort. Pulmonology 2021; 27:403-412. [PMID: 33753021 DOI: 10.1016/j.pulmoe.2021.02.006] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 01/08/2023] Open
Abstract
The World Health Organization (WHO) recommends countries introduce new anti-TB drugs in the treatment of multidrug-resistant tuberculosis. The aim of the study is to prospectively evaluate the effectiveness of bedaquiline (and/or delamanid)- containing regimens in a large cohort of consecutive TB patients treated globally. This observational, prospective study is based on data collected and provided by Global Tuberculosis Network (GTN) centres and analysed twice a year. All consecutive patients (including children/adolescents) treated with bedaquiline and/or delamanid were enrolled, and managed according to WHO and national guidelines. Overall, 52 centres from 29 countries/regions in all continents reported 883 patients as of January 31st 2021, 24/29 countries/regions providing data on 100% of their consecutive patients (10-80% in the remaining 5 countries). The drug-resistance pattern of the patients was severe (>30% with extensively drug-resistant -TB; median number of resistant drugs 5 (3-7) in the overall cohort and 6 (4-8) among patients with a final outcome). For the patients with a final outcome (477/883, 54.0%) the median (IQR) number of months of anti-TB treatment was 18 (13-23) (in days 553 (385-678)). The proportion of patients achieving sputum smear and culture conversion ranged from 93.4% and 92.8% respectively (whole cohort) to 89.3% and 88.8% respectively (patients with a final outcome), a median (IQR) time to sputum smear and culture conversion of 58 (30-90) days for the whole cohort and 60 (30-100) for patients with a final outcome and, respectively, of 55 (30-90) and 60 (30-90) days for culture conversion. Of 383 patients treated with bedaquiline but not delamanid, 284 (74.2%) achieved treatment success, while 25 (6.5%) died, 11 (2.9%) failed and 63 (16.5%) were lost to follow-up.
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Affiliation(s)
- S Koirala
- Damien Foundation Nepal, Kathmandu, Nepal
| | - S Borisov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation
| | - E Danila
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - A Mariandyshev
- Northern State Medical University, Northern (Arctic) Federal University, Arkhangelsk, Russian Federation
| | - B Shrestha
- Kalimati Chest Hospital/GENETUP/Nepal Anti Tuberculosis Association, Kathmandu, Nepal
| | - N Lukhele
- TB/HIV, Hepatitis, & PMTCT Department, World Health Organization, Eswatini WHO Country Office, Mbabane, Eswatini
| | - M Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz)/Ministry of Health, Rio de Janeiro, Brazil
| | - S R Shakya
- Lumbini Provincial Hospital, Butwal, Nepal
| | - S Miliauskas
- Department of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - L Kuksa
- MDR-TB Department, Riga East University Hospital for TB and Lung Disease Centre, Riga, Latvia
| | - S Manga
- Department of Infectious Diseases, University National San Antonio Abad Cusco, Cusco, Peru
| | - A Aleksa
- Department of Phthisiology and Pulmonology, Grodno State Medical University, Grodno, Belarus
| | - J T Denholm
- Victorian Tuberculosis Program, Melbourne Health, Department of Infectious Diseases, University of Melbourne, Melbourne, Australia
| | - H B Khadka
- Nepalgjunj TB Referral Center, TB Nepal, Nepalgunj, Nepal
| | - A Skrahina
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - S Diktanas
- Tuberculosis Department, 3rd Tuberculosis Unit, Republican Klaipėda Hospital, Klaipėda, Lithuania
| | - M Ferrarese
- TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
| | - J Bruchfeld
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institute, Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - A Koleva
- Pulmonology and Physiotherapy Department, Gabrovo Lung Diseases Hospital, Gabrovo, Bulgaria
| | | | - G S Koirala
- Nepal Anti Tuberculosis Association, Morang Branch, TB Clinic, Biratnagar, Province 1, Nepal
| | - Z F Udwadia
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India
| | - D J Palmero
- Pulmonology Division, Municipal Hospital F. J. Muñiz, Buenos Aires, Argentina
| | - M Munoz-Torrico
- Clínica de Tuberculosis, Instituto Nacional De Enfermedades Respiratorias Ismael Cosio Villegas, Ciudad De Mexico, Mexico
| | - R Gc
- Damien Foundation, Midpoint District Community Memorial Hospital, Danda, Nawalparasi, Nepal
| | - G Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - V I Grecu
- National Programme for Prevention, Surveillance and Control of Tuberculosis, Dolj Province, Romania
| | - I Motta
- Department of Medical Science, Unit of Infectious Diseases, University of Torino, Italy
| | - A Papavasileiou
- Department of Tuberculosis, Sotiria Athens Hospital of Chest Diseases, Athens, Greece
| | - Y Li
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - W Hoefsloot
- Radboud University Medical Center, Center Dekkerswald, Nijmegen, The Netherlands
| | - H Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - J Mazza-Stalder
- Division of Pulmonary Medicine, University Hospital of Lausanne CHUV, Lausanne, Switzerland
| | - M-C Payen
- Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - 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, Haren, The Netherlands
| | - E Bernal
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Reina Sofia, Murcia, Spain
| | - V Manfrin
- Infectious and Tropical Diseases Operating Unit, S. Bortolo Hospital, Vicenza, Italy
| | - A Matteelli
- Clinic of Infectious and Tropical Diseases, WHO Collaborating Centre for TB Elimination and TB/HIV Co-infection, University of Brescia, Brescia, Italy
| | | | - M Nieto Marcos
- Internal Medicine Department, Hospital Doctor Moliner, Valencia, Spain
| | - J Cadiñanos Loidi
- Internal Medicine Department, Hospital General de Villalba, Collado Villalba, Spain
| | | | - R Duarte
- National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Department of Pneumology, Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - N Escobar Salinas
- Division of Disease Prevention and Control, Department of Communicable Diseases, National Tuberculosis Control and Elimination Programme, Ministry of Health, Santiago, Chile
| | - R Gomez Rosso
- National Institute of Respiratory and Environmental Diseases ¨Prof. Dr. Juan Max Boettner¨ Asunción, Paraguay
| | - R Laniado-Laborín
- Universidad Autónoma de Baja California, Baja California, Mexico; Clínica de Tuberculosis del Hospital General de Tijuana, Tijuana, Baja California, Mexico
| | - E Martínez Robles
- Internal Medicine Department, Hospital de Cantoblanco- Hospital General Universitario La Paz, Madrid, Spain
| | - S Quirós Fernandez
- Pneumology Department, Tuberculosis Unit, Hospital de Cantoblanco- Hospital General Universitario La Paz, Madrid, Spain
| | - A Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias CIPTIR, University Hospital of Monterrey UANL (Universidad Autonoma de Nuevo Leon), Monterrey, Mexico
| | - I Solovic
- National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Catholic University Ruzomberok, Slovakia
| | - M Tadolini
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy; Department of Medical and Surgical Sciences Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - P Viggiani
- Reference Center for MDR-TB and HIV-TB, Eugenio Morelli Hospital, Sondalo, Italy
| | - E Belilovski
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation
| | - M J Boeree
- Radboud University Medical Center, Center Dekkerswald, Nijmegen, The Netherlands
| | - Q Cai
- Zhejiang Integrated Traditional and Western Medicine Hospital, Hangzhou, China
| | - E Davidavičienė
- National TB Registry, Public Health Department, Ministry of Health, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - L D Forsman
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institute, Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - J De Los Rios
- Centro de Excelencia de TBMDR, Hospital Nacional Maria Auxiliadora, Lima, Peru
| | - J Drakšienė
- Tuberculosis Department, 3rd Tuberculosis Unit, Republican Klaipėda Hospital, Klaipėda, Lithuania
| | - A Duga
- Baylor College of Medicine, Children's Foundation, Mbabane, Eswatini; National Pharmacovigilance Center, Eswatini Ministry of Health, Matsapha, Eswatini
| | - S E Elamin
- MDR-TB Department, Abu Anga Teaching Hospital, Khartoum, Sudan
| | - A Filippov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation
| | - A Garcia
- Pulmonology Division, Municipal Hospital F. J. Muñiz, Buenos Aires, Argentina
| | - I Gaudiesiute
- Department of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - B Gavazova
- Improve the Sustainability of the National TB Programme, Sofia, Bulgaria
| | - R Gayoso
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz)/Ministry of Health, Rio de Janeiro, Brazil
| | - V Gruslys
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - J Jonsson
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
| | - E Khimova
- Northern State Medical University, Northern (Arctic) Federal University, Arkhangelsk, Russian Federation
| | - G Madonsela
- Eswatini National Aids Programme, Mbabane, Eswatini
| | - C Magis-Escurra
- Radboud University Medical Center, Center Dekkerswald, Nijmegen, The Netherlands
| | - V Marchese
- Clinic of Infectious and Tropical Diseases, WHO Collaborating Centre for TB Elimination and TB/HIV Co-infection, University of Brescia, Brescia, Italy
| | - M Matei
- Hospital of Pneumophtisiology Leamna, Dolj Province, Romania; University of Medicine and Pharmacy, Craiova, Romania
| | - C Moschos
- Department of Tuberculosis, Sotiria Athens Hospital of Chest Diseases, Athens, Greece
| | - B Nakčerienė
- National TB Registry, Public Health Department, Ministry of Health, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - L Nicod
- Division of Pulmonary Medicine, University Hospital of Lausanne CHUV, Lausanne, Switzerland
| | - F Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - A Pontarelli
- Respiratory Infectious Diseases Unit, Cotugno Hospital, A.O.R.N. dei Colli, Naples, Italy
| | - A Šmite
- MDR-TB Department, Riga East University Hospital for TB and Lung Disease Centre, Riga, Latvia
| | | | - M Vescovo
- Pulmonology Division, Municipal Hospital F. J. Muñiz, Buenos Aires, Argentina
| | - R Zablockis
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - D Zhurkin
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - J-W Alffenaar
- University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, Australia; Westmead Hospital, Sydney, Australia; Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - J A Caminero
- Pneumology Department, Hospital General de Gran Canaria "Dr. Negrin", Las Palmas de Gran Canaria, Spain; Vital Strategies, New York, USA
| | - L R Codecasa
- TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
| | | | - S Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - L Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of z, University of Sassari, Sassari, Italy
| | - 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
| | - 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
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Department of Infection, Royal London and Newham Hospitals, Barts Health NHS Trust, London, United Kingdom
| | - E Pontali
- Department of Infectious Diseases, Galliera Hospital, Genova, Italy
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - L D'Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - M van den Boom
- World Health Organization Regional office for Europe, Copenhagen, Denmark
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of z, University of Sassari, Sassari, Italy
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
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22
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Surey J, Stagg HR, Yates TA, Lipman M, White PJ, Charlett A, Muñoz L, Gosce L, Rangaka MX, Francis M, Hack V, Kunst H, Abubakar I. An open label, randomised controlled trial of rifapentine versus rifampicin based short course regimens for the treatment of latent tuberculosis in England: the HALT LTBI pilot study. BMC Infect Dis 2021; 21:90. [PMID: 33478428 PMCID: PMC7818935 DOI: 10.1186/s12879-021-05766-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 10/15/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ending the global tuberculosis (TB) epidemic requires a focus on treating individuals with latent TB infection (LTBI) to prevent future cases. Promising trials of shorter regimens have shown them to be effective as preventative TB treatment, however there is a paucity of data on self-administered treatment completion rates. This pilot trial assessed treatment completion, adherence, safety and the feasibility of treating LTBI in the UK using a weekly rifapentine and isoniazid regimen versus daily rifampicin and isoniazid, both self-administered for 12 weeks. METHODS An open label, randomised, multi-site pilot trial was conducted in London, UK, between March 2015 and January 2017. Adults between 16 and 65 years with LTBI at two TB clinics who were eligible for and agreed to preventative therapy were consented and randomised 1:1 to receive either a weekly combination of rifapentine/isoniazid ('intervention') or a daily combination of rifampicin/isoniazid ('standard'), with both regimens taken for twelve weeks; treatment was self-administered in both arms. The primary outcome, completion of treatment, was self-reported, defined as taking more than 90% of prescribed doses and corroborated by pill counts and urine testing. Adverse events were recorded. RESULTS Fifty-two patients were successfully enrolled. In the intervention arm 21 of 27 patients completed treatment (77.8, 95% confidence interval [CI] 57.7-91.4), compared with 19 of 25 (76.0%, CI 54.9-90.6) in the standard of care arm. There was a similar adverse effect profile between the two arms. CONCLUSION In this pilot trial, treatment completion was comparable between the weekly rifapentine/isoniazid and the daily rifampicin/isoniazid regimens. Additionally, the adverse event profile was similar between the two arms. We conclude that it is safe and feasible to undertake a fully powered trial to determine whether self-administered weekly treatment is superior/non-inferior compared to current treatment. TRIAL REGISTRATION The trial was funded by the NIHR, UK and registered with ISRCTN ( 26/02/2013-No.04379941 ).
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Affiliation(s)
- J Surey
- Institute for Global Health, University College London, London, UK.
- Faculty of Medicine, Universidad Autónoma Madrid, Madrid, Spain.
| | - H R Stagg
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - T A Yates
- Institute for Global Health, University College London, London, UK
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, W2 1NY, UK
| | - M Lipman
- UCL-TB and UCL Respiratory, UCL, London, Royal Free London National Health Service Foundation Trust, London, UK
| | - P J White
- National Infection Service, Public Health, England, UK
- Department of Infectious Disease Epidemiology, Imperial College School of Public Health, MRC Centre for Global Infectious Disease Analysis and NIHR Health Protection Research Unit in Modelling Methodology, London, UK
| | - A Charlett
- National Infection Service, Public Health, England, UK
| | - L Muñoz
- Clinical Sciences Department. School of Medicine, University of Barcelona and Internal Medicine Department, Parc Sanitari Sant Joan de Déu. Sant Boi, Barcelona, Spain
| | - L Gosce
- Institute for Global Health, University College London, London, UK
| | - M X Rangaka
- Institute for Global Health, University College London, London, UK
| | - M Francis
- Institute for Global Health, University College London, London, UK
| | - V Hack
- Institute for Global Health, University College London, London, UK
| | - H Kunst
- Blizard Institute, Queen Mary University of London, London, UK
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - I Abubakar
- Institute for Global Health, University College London, London, UK
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23
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Yap M, Debenham L, Kew T, Chatterjee SR, Allotey J, Stallings E, Coomar D, Lee SI, Qiu X, Yuan M, Clavé Llavall A, Dixit A, Zhou D, Balaji R, van Wely M, Kostova E, van Leeuwen E, Mofenson L, Kunst H, Khalil A, Tiberi S, Thomas J, Brizuela V, Broutet N, Kara E, Kim C, Thorson A, Rayco-Solon P, Pardo-Hernandez H, Oladapo OT, Zamora J, Bonet M, Thangaratinam S. Clinical manifestations, prevalence, risk factors, outcomes, transmission, diagnosis and treatment of COVID-19 in pregnancy and postpartum: a living systematic review protocol. BMJ Open 2020; 10:e041868. [PMID: 33268430 PMCID: PMC7712931 DOI: 10.1136/bmjopen-2020-041868] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Rapid, robust and continually updated evidence synthesis is required to inform management of COVID-19 in pregnant and postpartum women and to keep pace with the emerging evidence during the pandemic. METHODS AND ANALYSIS We plan to undertake a living systematic review to assess the prevalence, clinical manifestations, risk factors, rates of maternal and perinatal complications, potential for mother-to-child transmission, accuracy of diagnostic tests and effectiveness of treatment for COVID-19 in pregnant and postpartum women (including after miscarriage or abortion). We will search Medline, Embase, WHO COVID-19 database, preprint servers, the China National Knowledge Infrastructure system and Wanfang databases from 1 December 2019. We will supplement our search with studies mapped by Cochrane Fertility and Gynaecology group, Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), COVID-19 study repositories, reference lists and social media blogs. The search will be updated every week and not be restricted by language. We will include observational cohort (≥10 participants) and randomised studies reporting on prevalence of COVID-19 in pregnant and postpartum women, the rates of clinical manifestations and outcomes, risk factors in pregnant and postpartum women alone or in comparison with non-pregnant women with COVID-19 or pregnant women without COVID-19 and studies on tests and treatments for COVID-19. We will additionally include case reports and series with evidence on mother-to-child transmission of SARS-CoV-2 in utero, intrapartum or postpartum. We will appraise the quality of the included studies using appropriate tools to assess the risk of bias. At least two independent reviewers will undertake study selection, quality assessment and data extraction every 2 weeks. We will synthesise the findings using quantitative random effects meta-analysis and report OR or proportions with 95% CIs and prediction intervals. Case reports and series will be reported as qualitative narrative synthesis. Heterogeneity will be reported as I2 and τ2 statistics. ETHICS AND DISSEMINATION Ethical approval is not required as this is a synthesis of primary data. Regular updates of the results will be published on a dedicated website (https://www.birmingham.ac.uk/research/who-collaborating-centre/pregcov/index.aspx) and disseminated through publications, social media and webinars. PROSPERO REGISTRATION NUMBER CRD42020178076.
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Affiliation(s)
- Magnus Yap
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Luke Debenham
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tania Kew
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Shaunak Rhiju Chatterjee
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - John Allotey
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Elena Stallings
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Dyuti Coomar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Xiu Qiu
- Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Mingyang Yuan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Anna Clavé Llavall
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anushka Dixit
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Dengyi Zhou
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rishab Balaji
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Madelon van Wely
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Elena Kostova
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Elisabeth van Leeuwen
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, Maryland, USA
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, UK
| | - Asma Khalil
- Department of Obstetrics and Gynaecology, St George's University London, London, UK
| | - Simon Tiberi
- Blizard Institute, Queen Mary University of London, London, UK
- Department of Infectious Diseases, Barts Health NHS Trust, London, UK
| | - James Thomas
- UCL Institute of Education, University College London, London, UK
| | - Vanessa Brizuela
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Edna Kara
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Caron Kim
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Anna Thorson
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Pura Rayco-Solon
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Hector Pardo-Hernandez
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Olufemi Taiwo Oladapo
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Javier Zamora
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Migliori GB, Thong PM, Akkerman O, Alffenaar JW, Álvarez-Navascués F, Assao-Neino MM, Bernard PV, Biala JS, Blanc FX, Bogorodskaya EM, Borisov S, Buonsenso D, Calnan M, Castellotti PF, Centis R, Chakaya JM, Cho JG, Codecasa LR, D'Ambrosio L, Denholm J, Enwerem M, Ferrarese M, Galvão T, García-Clemente M, García-García JM, Gualano G, Gullón-Blanco JA, Inwentarz S, Ippolito G, Kunst H, Maryandyshev A, Melazzini M, de Queiroz Mello FC, Muñoz-Torrico M, Njungfiyini PB, Palmero DJ, Palmieri F, Piccioni P, Piubello A, Rendon A, Sabriá J, Saporiti M, Scognamiglio P, Sharma S, Silva DR, Souleymane MB, Spanevello A, Tabernero E, Tadolini M, Tchangou ME, Thornton ABY, Tiberi S, Udwadia ZF, Sotgiu G, Ong CWM, Goletti D. Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January-April 2020. Emerg Infect Dis 2020; 26:2709-2712. [PMID: 32917293 PMCID: PMC7588533 DOI: 10.3201/eid2611.203163] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Coronavirus disease has disrupted tuberculosis services globally. Data from 33 centers in 16 countries on 5 continents showed that attendance at tuberculosis centers was lower during the first 4 months of the pandemic in 2020 than for the same period in 2019. Resources are needed to ensure tuberculosis care continuity during the pandemic.
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25
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O'Brien K, Ikram S, Burman M, Kunst H. Barriers and facilitators of a latent tuberculosis screening and treatment programme of recent migrants. Tuberculosis (Edinb) 2020. [DOI: 10.1183/13993003.congress-2020.508] [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: 11/05/2022]
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26
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Gordon H, Rahman A, Dominic C, White V, Langmead L, Tiberi S, Kunst H. Oesophageal TB secondary to mediastinal lymphadenitis: a London tertiary centre experience. Tuberculosis (Edinb) 2020. [DOI: 10.1183/13993003.congress-2020.1560] [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: 11/05/2022]
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27
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Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, Debenham L, Llavall AC, Dixit A, Zhou D, Balaji R, Lee SI, Qiu X, Yuan M, Coomar D, Sheikh J, Lawson H, Ansari K, van Wely M, van Leeuwen E, Kostova E, Kunst H, Khalil A, Tiberi S, Brizuela V, Broutet N, Kara E, Kim CR, Thorson A, Oladapo OT, Mofenson L, Zamora J, Thangaratinam S. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020; 370:m3320. [PMID: 32873575 PMCID: PMC7459193 DOI: 10.1136/bmj.m3320] [Citation(s) in RCA: 1154] [Impact Index Per Article: 288.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019 (covid-19). DESIGN Living systematic review and meta-analysis. DATA SOURCES Medline, Embase, Cochrane database, WHO COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 6 October 2020, along with preprint servers, social media, and reference lists. STUDY SELECTION Cohort studies reporting the rates, clinical manifestations (symptoms, laboratory and radiological findings), risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed covid-19. DATA EXTRACTION At least two researchers independently extracted the data and assessed study quality. Random effects meta-analysis was performed, with estimates pooled as odds ratios and proportions with 95% confidence intervals. All analyses will be updated regularly. RESULTS 192 studies were included. Overall, 10% (95% confidence interval 7% to 12%; 73 studies, 67 271 women) of pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed covid-19. The most common clinical manifestations of covid-19 in pregnancy were fever (40%) and cough (41%). Compared with non-pregnant women of reproductive age, pregnant and recently pregnant women with covid-19 were less likely to have symptoms (odds ratio 0.28, 95% confidence interval 0.13 to 0.62; I2=42.9%) or report symptoms of fever (0.49, 0.38 to 0.63; I2=40.8%), dyspnoea (0.76, 0.67 to 0.85; I2=4.4%) and myalgia (0.53, 0.36 to 0.78; I2=59.4%). The odds of admission to an intensive care unit (odds ratio 2.13, 1.53 to 2.95; I2=71.2%), invasive ventilation (2.59, 2.28 to 2.94; I2=0%) and need for extra corporeal membrane oxygenation (2.02, 1.22 to 3.34; I2=0%) were higher in pregnant and recently pregnant than non-pregnant reproductive aged women. Overall, 339 pregnant women (0.02%, 59 studies, 41 664 women) with confirmed covid-19 died from any cause. Increased maternal age (odds ratio 1.83, 1.27 to 2.63; I2=43.4%), high body mass index (2.37, 1.83 to 3.07; I2=0%), any pre-existing maternal comorbidity (1.81, 1.49 to 2.20; I2=0%), chronic hypertension (2.0, 1.14 to 3.48; I2=0%), pre-existing diabetes (2.12, 1.62 to 2.78; I2=0%), and pre-eclampsia (4.21, 1.27 to 14.0; I2=0%) were associated with severe covid-19 in pregnancy. In pregnant women with covid-19, increased maternal age, high body mass index, non-white ethnicity, any pre-existing maternal comorbidity including chronic hypertension and diabetes, and pre-eclampsia were associated with serious complications such as admission to an intensive care unit, invasive ventilation and maternal death. Compared to pregnant women without covid-19, those with the disease had increased odds of maternal death (odds ratio 2.85, 1.08 to 7.52; I2=0%), of needing admission to the intensive care unit (18.58, 7.53 to 45.82; I2=0%), and of preterm birth (1.47, 1.14 to 1.91; I2=18.6%). The odds of admission to the neonatal intensive care unit (4.89, 1.87 to 12.81, I2=96.2%) were higher in babies born to mothers with covid-19 versus those without covid-19. CONCLUSION Pregnant and recently pregnant women with covid-19 attending or admitted to the hospitals for any reason are less likely to manifest symptoms such as fever, dyspnoea, and myalgia, and are more likely to be admitted to the intensive care unit or needing invasive ventilation than non-pregnant women of reproductive age. Pre-existing comorbidities, non-white ethnicity, chronic hypertension, pre-existing diabetes, high maternal age, and high body mass index are risk factors for severe covid-19 in pregnancy. Pregnant women with covid-19 versus without covid-19 are more likely to deliver preterm and could have an increased risk of maternal death and of being admitted to the intensive care unit. Their babies are more likely to be admitted to the neonatal unit. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020178076. READERS' NOTE This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This version is update 1 of the original article published on 1 September 2020 (BMJ 2020;370:m3320), and previous updates can be found as data supplements (https://www.bmj.com/content/370/bmj.m3320/related#datasupp). When citing this paper please consider adding the update number and date of access for clarity.
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Affiliation(s)
- John Allotey
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Elena Stallings
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Magnus Yap
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Tania Kew
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Luke Debenham
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Anushka Dixit
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Dengyi Zhou
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Rishab Balaji
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
- Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
- Department of Obstetrics and Gynaecology, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - Mingyang Yuan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - Dyuti Coomar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jameela Sheikh
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Heidi Lawson
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Kehkashan Ansari
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Madelon van Wely
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Elizabeth van Leeuwen
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Elena Kostova
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Asma Khalil
- St George's, University of London, London, UK
| | - Simon Tiberi
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Edna Kara
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Caron Rahn Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lynne Mofenson
- Elizabeth Glaser Paediatric AIDS Foundation, Washington DC, USA
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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28
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Gupta RK, Lipman M, Jackson C, Sitch AJ, Southern J, Drobniewski F, Deeks JJ, Tsou CY, Griffiths C, Davidson J, Campbell C, Stirrup O, Noursadeghi M, Kunst H, Haldar P, Lalvani A, Abubakar I. Quantitative IFN-γ Release Assay and Tuberculin Skin Test Results to Predict Incident Tuberculosis. A Prospective Cohort Study. Am J Respir Crit Care Med 2020; 201:984-991. [PMID: 31825645 DOI: 10.1164/rccm.201905-0969oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 11/16/2022] Open
Abstract
Rationale: Development of diagnostic tools with improved predictive value for tuberculosis (TB) is a global research priority.Objectives: We evaluated whether implementing higher diagnostic thresholds than currently recommended for QuantiFERON Gold-in-Tube (QFT-GIT), T-SPOT.TB, and the tuberculin skin test (TST) might improve prediction of incident TB.Methods: Follow-up of a UK cohort of 9,610 adult TB contacts and recent migrants was extended by relinkage to national TB surveillance records (median follow-up 4.7 yr). Incidence rates and rate ratios, sensitivities, specificities, and predictive values for incident TB were calculated according to ordinal strata for quantitative results of QFT-GIT, T-SPOT.TB, and TST (with adjustment for prior bacillus Calmette-Guérin [BCG] vaccination).Measurements and Main Results: For all tests, incidence rates and rate ratios increased with the magnitude of the test result (P < 0.0001). Over 3 years' follow-up, there was a modest increase in positive predictive value with the higher thresholds (3.0% for QFT-GIT ≥0.35 IU/ml vs. 3.6% for ≥4.00 IU/ml; 3.4% for T-SPOT.TB ≥5 spots vs. 5.0% for ≥50 spots; and 3.1% for BCG-adjusted TST ≥5 mm vs. 4.3% for ≥15 mm). As thresholds increased, sensitivity to detect incident TB waned for all tests (61.0% for QFT-GIT ≥0.35 IU/ml vs. 23.2% for ≥4.00 IU/ml; 65.4% for T-SPOT.TB ≥5 spots vs. 27.2% for ≥50 spots; 69.7% for BCG-adjusted TST ≥5 mm vs. 28.1% for ≥15 mm).Conclusions: Implementation of higher thresholds for QFT-GIT, T-SPOT.TB, and TST modestly increases positive predictive value for incident TB, but markedly reduces sensitivity. Novel biomarkers or validated multivariable risk algorithms are required to improve prediction of incident TB.
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Affiliation(s)
| | - Marc Lipman
- UCL-TB.,UCL Respiratory, and.,Royal Free London National Health Service (NHS) Foundation Trust, London, United Kingdom
| | | | - Alice J Sitch
- National Institute for Health Research Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom.,Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jo Southern
- Tuberculosis Unit, Public Health England, Colindale, London, United Kingdom
| | | | - Jonathan J Deeks
- National Institute for Health Research Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom.,Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Chuen-Yan Tsou
- Tuberculosis Unit, Public Health England, Colindale, London, United Kingdom
| | | | - Jennifer Davidson
- Tuberculosis Unit, Public Health England, Colindale, London, United Kingdom
| | - Colin Campbell
- Tuberculosis Unit, Public Health England, Colindale, London, United Kingdom
| | | | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Respiratory Medicine, Barts Health NHS Trust, London, United Kingdom; and
| | - Pranab Haldar
- Respiratory Biomedical Research Centre, Institute for Lung Health, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Ajit Lalvani
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College, London, United Kingdom
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29
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McGuire E, Rajagopal S, Vaikunthanathan T, Krutikov M, Burman M, Rahman A, White V, Tiberi S, Rosmarin C, Kunst H. Extraspinal articular tuberculosis: An 11-year retrospective study of demographic features and clinical outcomes in East London. J Infect 2020; 81:383-389. [PMID: 32579987 DOI: 10.1016/j.jinf.2020.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/18/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe demographic features, clinical outcomes and diagnostic delay amongst patients with extra-spinal articular tuberculosis (TB) in a low-incidence setting. METHODS Cases of TB treated at our institution between 2004 and 2014 were identified via the London TB register (LTBR). Demographic features of extra-spinal articular TB cases were compared to controls with TB at all other sites. For articular cases (excluding individuals <16 years or with spinal TB without peripheral joint involvement) clinical data were retrospectively collected. RESULTS 6,146 TB patients were identified over the study period; 146 (2.4%) cases had extra-spinal articular infection. There was no difference in median age between extra-spinal articular TB cases and controls with TB at other sites (31 vs 32 years, p = 0.57). Articular cases were more likely to be male (70.6% vs 59.5%, p = 0.007), Bangladeshi (28.7% vs 18.0%) or Pakistani (24.0% vs 16.1%) and were less likely to be Black-African (9.5% vs 19.8%) (p < 0.001). 93 cases were included in the case series; 85 (88.5%) were migrants and 83 (89.2%) were South Asian. Knee and elbow joints were affected in 22 (23.7%) and 18 (19.4%) cases respectively. The median durations of pre-healthcare and healthcare associated delay were 16 and 6 weeks respectively. Where mycobacterial culture was performed, 57/75 (76%) were positive for Mycobacterium tuberculosis. 86 (92.5%) cases received standard quadruple therapy for a median of 6 months (IQR 6-9). Recurrence of TB infection occurred in 4 (4.3%) cases and there were no TB related deaths. Seven (7.6%) cases required surgical intervention. CONCLUSIONS Extra-spinal articular TB more commonly affected men and people of South Asian ethnicity. Significant diagnostic delays were identified, including avoidable healthcare-associated delays.
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Affiliation(s)
- Emma McGuire
- Division of Infection, Barts Health NHS Trust, London, United Kingdom.
| | - Swathi Rajagopal
- Division of Infection, Barts Health NHS Trust, London, United Kingdom
| | | | - Maria Krutikov
- Division of Infection, Barts Health NHS Trust, London, United Kingdom
| | - Matthew Burman
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Ananna Rahman
- Department of Respiratory Medicine, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Veronica White
- Department of Respiratory Medicine, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Simon Tiberi
- Division of Infection, Barts Health NHS Trust, London, United Kingdom
| | - Caryn Rosmarin
- Division of Infection, Barts Health NHS Trust, London, United Kingdom
| | - Heinke Kunst
- Department of Respiratory Medicine, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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30
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van den Elsen SH, Sturkenboom MG, Akkerman O, Barkane L, Bruchfeld J, Eather G, Heysell SK, Hurevich H, Kuksa L, Kunst H, Kuhlin J, Manika K, Moschos C, Mpagama SG, Muñoz Torrico M, Skrahina A, Sotgiu G, Tadolini M, Tiberi S, Volpato F, van der Werf TS, Wilson MR, Zúñiga J, Touw DJ, Migliori GB, Alffenaar JW. Prospective evaluation of improving fluoroquinolone exposure using centralised therapeutic drug monitoring (TDM) in patients with tuberculosis (PERFECT): a study protocol of a prospective multicentre cohort study. BMJ Open 2020; 10:e035350. [PMID: 32554740 PMCID: PMC7304807 DOI: 10.1136/bmjopen-2019-035350] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Global multidrug-resistant tuberculosis (MDR-TB) treatment success rates remain suboptimal. Highly active WHO group A drugs moxifloxacin and levofloxacin show intraindividual and interindividual pharmacokinetic variability which can cause low drug exposure. Therefore, therapeutic drug monitoring (TDM) of fluoroquinolones is recommended to personalise the drug dosage, aiming to prevent the development of drug resistance and optimise treatment. However, TDM is considered laborious and expensive, and the clinical benefit in MDR-TB has not been extensively studied. This observational multicentre study aims to determine the feasibility of centralised TDM and to investigate the impact of fluoroquinolone TDM on sputum conversion rates in patients with MDR-TB compared with historical controls. METHODS AND ANALYSIS Patients aged 18 years or older with sputum smear and culture-positive pulmonary MDR-TB will be eligible for inclusion. Patients receiving TDM using a limited sampling strategy (t=0 and t=5 hours) will be matched to historical controls without TDM in a 1:2 ratio. Sample analysis and dosing advice will be performed in a centralised laboratory. Centralised TDM will be considered feasible if >80% of the dosing recommendations are returned within 7 days after sampling and 100% within 14 days. The number of patients who are sputum smear and culture-negative after 2 months of treatment will be determined in the prospective TDM group and will be compared with the control group without TDM to determine the impact of TDM. ETHICS AND DISSEMINATION Ethical clearance was obtained by the ethical review committees of the 10 participating hospitals according to local procedures or is pending (online supplementary file 1). Patients will be included after obtaining written informed consent. We aim to publish the study results in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03409315).
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Affiliation(s)
- Simone Hj van den Elsen
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke Gg Sturkenboom
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Onno Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Tuberculosis Center Beatrixoord, University of Groningen, University Medical Center Groningen, Haren, The Netherlands
| | - Linda Barkane
- Department of Multidrug Resistant Tuberculosis, Riga East University Hospital TB and Lung Disease Clinic, Riga, Latvia
| | - Judith Bruchfeld
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Geoffrey Eather
- Department of Respiratory Medicine and Metro South Clinical Tuberculosis Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Scott K Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Henadz Hurevich
- The Republican Scientific and Practical Center for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Liga Kuksa
- Department of Multidrug Resistant Tuberculosis, Riga East University Hospital TB and Lung Disease Clinic, Riga, Latvia
| | - Heinke Kunst
- Department of Respiratory Medicine, Blizard Institute, Queen Mary University of London, Barts Health NHS Trust, London, UK
| | - Johanna Kuhlin
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Katerina Manika
- Pulmonary Department, Respiratory Infections Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Moschos
- Drug-Resistant Tuberculosis Unit, 'Sotiria' Hospital for Chest Diseases, Athens, Greece
| | - Stellah G Mpagama
- Kibong'oto Infectious Diseases Hospital, Kilimanjaro, United Republic of Tanzania
| | - Marcela Muñoz Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Alena Skrahina
- The Republican Scientific and Practical Center for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Giovanni Sotgiu
- Department of Medical, Surgical and Experimental Sciences, Clinical Epidemiology and Medical Statistics Unit, University of Sassari, Sassari, Italy
| | - Marina Tadolini
- Department of Medical and Surgical Sciences, Unit of Infectious Diseases, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simon Tiberi
- Department of Infection, Blizard Institute, Queen Mary University of London, Barts Health NHS Trust, London, UK
| | - Francesca Volpato
- Department of Medical and Surgical Sciences, Unit of Infectious Diseases, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tjip S van der Werf
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Malcolm R Wilson
- Department of Respiratory Medicine and Metro South Clinical Tuberculosis Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Joaquin Zúñiga
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de Salud, Mexico City, Mexico
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Giovanni B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Jan-Willem Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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31
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Potter JL, Burman M, Tweed CD, Vaghela D, Kunst H, Swinglehurst D, Griffiths CJ. The NHS visitor and migrant cost recovery programme - a threat to health? BMC Public Health 2020; 20:407. [PMID: 32306938 PMCID: PMC7169002 DOI: 10.1186/s12889-020-08524-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Received: 07/18/2019] [Accepted: 03/13/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In April 2014 the UK government launched the 'NHS Visitor and Migrant Cost Recovery Programme Implementation Plan' which set out a series of policy changes to recoup costs from 'chargeable' (largely non-UK born) patients. In England, approximately 75% of tuberculosis (TB) cases occur in people born abroad. Delays in TB treatment increase risk of morbidity, mortality and transmission in the community. We investigated whether diagnostic delay has increased since the Cost Recovery Programme (CRP) was introduced. METHODS There were 3342 adult TB cases notified on the London TB Register across Barts Health NHS Trust between 1st January 2011 and 31st December 2016. Cases with missing relevant information were excluded. The median time between symptom onset and treatment initiation before and after the CRP was calculated according to birthplace and compared using the Mann Whitney test. Delayed diagnosis was considered greater or equal to median time to treatment for all patients (79 days). Univariable logistic regression was used to manually select exposure variables for inclusion in a multivariable model to test the association between diagnostic delay and the implementation of the CRP. RESULTS We included 2237 TB cases. Among non-UK born patients, median time-to-treatment increased from 69 days to 89 days following introduction of CRP (p < 0.001). Median time-to-treatment also increased for the UK-born population from 75.5 days to 89.5 days (p = 0.307). The multivariable logistic regression model showed non-UK born patients were more likely to have a delay in diagnosis after the CRP (adjOR 1.37, 95% CI 1.13-1.66, p value 0.001). CONCLUSION Since the introduction of the CRP there has been a significant delay for TB treatment among non-UK born patients. Further research exploring the effect of policies restricting access to healthcare for migrants is urgently needed if we wish to eliminate TB nationally.
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Affiliation(s)
- J L Potter
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, England.
| | - M Burman
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, England
| | - C D Tweed
- MRC Clinical Trials Unit, University College London, London, England
| | - D Vaghela
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, England
| | - H Kunst
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, England
| | - D Swinglehurst
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, England
| | - C J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, England
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32
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Borisov S, Danila E, Maryandyshev A, Dalcolmo M, Miliauskas S, Kuksa L, Manga S, Skrahina A, Diktanas S, Codecasa LR, Aleksa A, Bruchfeld J, Koleva A, Piubello A, Udwadia ZF, Akkerman OW, Belilovski E, Bernal E, Boeree MJ, Cadiñanos Loidi J, Cai Q, Cebrian Gallardo JJ, Dara M, Davidavičienė E, Forsman LD, De Los Rios J, Denholm J, Drakšienė J, Duarte R, Elamin SE, Escobar Salinas N, Ferrarese M, Filippov A, Garcia A, García-García JM, Gaudiesiute I, Gavazova B, Gayoso R, Gomez Rosso R, Gruslys V, Gualano G, Hoefsloot W, Jonsson J, Khimova E, Kunst H, Laniado-Laborín R, Li Y, Magis-Escurra C, Manfrin V, Marchese V, Martínez Robles E, Matteelli A, Mazza-Stalder J, Moschos C, Muñoz-Torrico M, Mustafa Hamdan H, Nakčerienė B, Nicod L, Nieto Marcos M, Palmero DJ, Palmieri F, Papavasileiou A, Payen MC, Pontarelli A, Quirós S, Rendon A, Saderi L, Šmite A, Solovic I, Souleymane MB, Tadolini M, van den Boom M, Vescovo M, Viggiani P, Yedilbayev A, Zablockis R, Zhurkin D, Zignol M, Visca D, Spanevello A, Caminero JA, Alffenaar JW, Tiberi S, Centis R, D'Ambrosio L, Pontali E, Sotgiu G, Migliori GB. Surveillance of adverse events in the treatment of drug-resistant tuberculosis: first global report. Eur Respir J 2019; 54:13993003.01522-2019. [PMID: 31601711 DOI: 10.1183/13993003.01522-2019] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/17/2019] [Indexed: 11/05/2022]
Abstract
The World Health Organization (WHO) recommends that countries implement pharmacovigilance and collect information on active drug safety monitoring (aDSM) and management of adverse events.The aim of this prospective study was to evaluate the frequency and severity of adverse events to anti-tuberculosis (TB) drugs in a cohort of consecutive TB patients treated with new (i.e. bedaquiline, delamanid) and repurposed (i.e. clofazimine, linezolid) drugs, based on the WHO aDSM project. Adverse events were collected prospectively after attribution to a specific drug together with demographic, bacteriological, radiological and clinical information at diagnosis and during therapy. This interim analysis included patients who completed or were still on treatment at time of data collection.Globally, 45 centres from 26 countries/regions reported 658 patients (68.7% male, 4.4% HIV co-infected) treated as follows: 87.7% with bedaquiline, 18.4% with delamanid (6.1% with both), 81.5% with linezolid and 32.4% with clofazimine. Overall, 504 adverse event episodes were reported: 447 (88.7%) were classified as minor (grade 1-2) and 57 (11.3%) as serious (grade 3-5). The majority of the 57 serious adverse events reported by 55 patients (51 out of 57, 89.5%) ultimately resolved. Among patients reporting serious adverse events, some drugs held responsible were discontinued: bedaquiline in 0.35% (two out of 577), delamanid in 0.8% (one out of 121), linezolid in 1.9% (10 out of 536) and clofazimine in 1.4% (three out of 213) of patients. Serious adverse events were reported in 6.9% (nine out of 131) of patients treated with amikacin, 0.4% (one out of 221) with ethionamide/prothionamide, 2.8% (15 out of 536) with linezolid and 1.8% (eight out of 498) with cycloserine/terizidone.The aDSM study provided valuable information, but implementation needs scaling-up to support patient-centred care.
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Affiliation(s)
- Sergey Borisov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.,These authors contributed equally
| | - Edvardas Danila
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Margareth Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz)/Ministry of Health, Rio de Janeiro, Brazil
| | - Skaidrius Miliauskas
- Dept of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Liga Kuksa
- MDR-TB Dept, Riga East University Hospital for TB and Lung Disease Centre, Riga, Latvia
| | - Selene Manga
- Dept of Infectious Diseases, University National San Antonio Abad Cusco, Cusco, Peru
| | - Alena Skrahina
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Saulius Diktanas
- Tuberculosis Dept, 3rd Tuberculosis Unit, Republican Klaipėda Hospital, Klaipėda, Lithuania
| | | | - Alena Aleksa
- Dept of Phthisiology and Pulmonology, Grodno State Medical University, Grodno, Belarus
| | - Judith Bruchfeld
- Division of Infectious Diseases, Dept of Medicine, Karolinska Institute, Solna, Sweden.,Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,These authors contributed equally
| | - Antoniya Koleva
- Pulmonology and Physiotherapy Dept, Gabrovo Lung Diseases Hospital, Gabrovo, Bulgaria
| | - Alberto Piubello
- Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France.,Tuberculosis Division, Damien Foundation, Niamey, Niger.,These authors contributed equally
| | - Zarir Farokh Udwadia
- Dept of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India
| | - Onno W Akkerman
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, TB Center Beatrixoord, Haren, The Netherlands.,These authors contributed equally
| | - Evgeny Belilovski
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation
| | - Enrique Bernal
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Reina Sofia, Murcia, Spain
| | - Martin J Boeree
- Radboud University Medical Center, Center Dekkerswald, Nijmegen, The Netherlands
| | | | - Qingshan Cai
- Zhejiang Integrated Traditional and Western Medicine Hospital, Hangzhou, China
| | | | - Masoud Dara
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Edita Davidavičienė
- National TB Registry, Public Health Dept, Ministry of Health, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Lina Davies Forsman
- Division of Infectious Diseases, Dept of Medicine, Karolinska Institute, Solna, Sweden.,Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jorge De Los Rios
- Centro de Excelencia de TB "Niño Jesus", Servicio de Neumologia, Hospital Maria Auxiliadora, Lima, Peru
| | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, Australia.,Dept of Microbiology and Immunology, University of Melbourne, Melbourne, Australia.,These authors contributed equally
| | - Jacinta Drakšienė
- Tuberculosis Dept, 3rd Tuberculosis Unit, Republican Klaipėda Hospital, Klaipėda, Lithuania
| | - Raquel Duarte
- National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Dept of Pneumology, Public Health Science and Medical Education Dept, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Nadia Escobar Salinas
- Division of Disease Prevention and Control, Dept of Communicable Diseases, National Tuberculosis Control and Elimination Programme, Ministry of Health, Santiago, Chile
| | - Maurizio Ferrarese
- TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
| | - Alexey Filippov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation
| | - Ana Garcia
- Pulmonology Division, Municipal Hospital F.J. Muñiz, Buenos Aires, Argentina
| | | | - Ieva Gaudiesiute
- Dept of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Regina Gayoso
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz)/Ministry of Health, Rio de Janeiro, Brazil
| | - Roscio Gomez Rosso
- National Institute of Respiratory and Environmental Diseases "Prof. Dr. Juan Max Boettner" Asunción, Paraguay
| | - Vygantas Gruslys
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Wouter Hoefsloot
- Radboud University Medical Center, Center Dekkerswald, Nijmegen, The Netherlands
| | - Jerker Jonsson
- Dept of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
| | - Elena Khimova
- Northern State Medical University, Arkhangelsk, Russian Federation
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rafael Laniado-Laborín
- Universidad Autónoma de Baja California, Baja California, Mexico; Clínica de Tuberculosis del Hospital General de Tijuana, Tijuana, Mexico.,These authors contributed equally
| | - Yang Li
- Dept of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Cecile Magis-Escurra
- Radboud University Medical Center, Center Dekkerswald, Nijmegen, The Netherlands
| | | | - Valentina Marchese
- Clinic of Infectious and Tropical Diseases, WHO Collaborating Centre for TB elimination and TB/HIV co-infection, University of Brescia, Brescia, Italy
| | - Elena Martínez Robles
- Internal Medicine Dept, Tuberculosis Unit, Hospital de Cantoblanco - Hospital General Universitario La Paz, Madrid, Spain
| | - Alberto Matteelli
- Clinic of Infectious and Tropical Diseases, WHO Collaborating Centre for TB elimination and TB/HIV co-infection, University of Brescia, Brescia, Italy
| | - Jesica Mazza-Stalder
- Division of Pulmonary Medicine, University Hospital of Lausanne CHUV, Lausanne, Switzerland.,These authors contributed equally
| | - Charalampos Moschos
- Dept of Tuberculosis, Sotiria Athens Hospital of Chest Diseases, Athens, Greece
| | - Marcela Muñoz-Torrico
- Clínica de Tuberculosis, Instituto Nacional De Enfermedades Respiratorias Ismael Cosio Villegas, Ciudad De Mexico, Mexico.,These authors contributed equally
| | | | - Birutė Nakčerienė
- National TB Registry, Public Health Dept, Ministry of Health, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Laurent Nicod
- Division of Pulmonary Medicine, University Hospital of Lausanne CHUV, Lausanne, Switzerland
| | | | | | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | | | - Marie-Christine Payen
- Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Agostina Pontarelli
- Reference Center for MDR-TB and HIV-TB, Eugenio Morelli Hospital, Sondalo, Italy
| | - Sarai Quirós
- Pneumology Dept, Tuberculosis Unit, Hospital de Cantoblanco - Hospital General Universitario La Paz, Madrid, Spain
| | - Adrian Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias CIPTIR, University Hospital of Monterrey UANL (Universidad Autonoma de Nuevo Leon), Monterrey, Mexico
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,These authors contributed equally
| | - Agnese Šmite
- MDR-TB Dept, Riga East University Hospital for TB and Lung Disease Centre, Riga, Latvia
| | - Ivan Solovic
- National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Catholic University Ruzomberok, Ruzomberok, Slovakia
| | | | - Marina Tadolini
- Unit of Infectious Diseases, Dept of Medical and Surgical Sciences Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Martin van den Boom
- World Health Organization Regional Office for Europe, Copenhagen, Denmark.,These authors contributed equally
| | - Marisa Vescovo
- Pulmonology Division, Municipal Hospital F.J. Muñiz, Buenos Aires, Argentina
| | - Pietro Viggiani
- Reference Center for MDR-TB and HIV-TB, Eugenio Morelli Hospital, Sondalo, Italy
| | - Askar Yedilbayev
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Rolandas Zablockis
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Dmitry Zhurkin
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Matteo Zignol
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy.,Dept of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Italy.,These authors contributed equally
| | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy.,Dept of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Italy
| | - José A Caminero
- Pneumology Dept, Hospital General de Gran Canaria "Dr. Negrin", Las Palmas de Gran Canaria, Spain.,MDR-TB Unit, Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France.,These authors contributed equally
| | - Jan-Willem Alffenaar
- University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, Australia.,Westmead Hospital, Sydney, Australia.,University of Groningen, University Medical Center Groningen, Dept of Pharmacy and Pharmacology, Groningen, The Netherlands.,These authors contributed equally
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Dept of Infection, Royal London and Newham Hospitals, Barts Health NHS Trust, London, UK.,These authors contributed equally
| | - Rosella Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.,These authors contributed equally
| | - Lia D'Ambrosio
- Public Health Consulting Group, Lugano, Switzerland.,These authors contributed equally
| | - Emanuele Pontali
- Dept of Infectious Diseases, Galliera Hospital, Genova, Italy.,These authors contributed equally
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,These authors contributed equally
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy .,These authors contributed equally
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Stagg HR, Abubakar I, Campbell CN, Copas A, Darvell M, Horne R, Kielmann K, Kunst H, Mandelbaum M, Pickett E, Story A, Vidal N, Wurie FB, Lipman M. IMPACT study on intervening with a manualised package to achieve treatment adherence in people with tuberculosis: protocol paper for a mixed-methods study, including a pilot randomised controlled trial. BMJ Open 2019; 9:e032760. [PMID: 31852704 PMCID: PMC6937100 DOI: 10.1136/bmjopen-2019-032760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Compared with the rest of the UK and Western Europe, England has high rates of the infectious disease tuberculosis (TB). TB is curable, although treatment is for at least 6 months and longer when disease is drug resistant. If patients miss too many doses (non-adherence), they may transmit infection for longer and the infecting bacteria may develop resistance to the standard drugs used for treatment. Non-adherence may therefore risk both their health and that of others. Within England, certain population groups are thought to be at higher risk of non-adherence, but the factors contributing to this have been insufficiently determined, as have the best interventions to promote adherence. The objective of this study was to develop a manualised package of interventions for use as part of routine care within National Health Services to address the social and cultural factors that lead to poor adherence to treatment for TB disease. METHODS AND ANALYSIS This study uses a mixed-methods approach, with six study components. These are (1) scoping reviews of the literature; (2) qualitative research with patients, carers and healthcare professionals; (3) development of the intervention; (4) a pilot randomised controlled trial of the manualised intervention; (5) a process evaluation to examine clinical utility; and (6) a cost analysis. ETHICS AND DISSEMINATION This study received ethics approval on 24 December 2018 from Camberwell St. Giles Ethics Committee, UK (REC reference 18/LO/1818). Findings will be published and disseminated through peer-reviewed publications and conference presentations, published in an end of study report to our funder (the National Institute for Health Research, UK) and presented to key stakeholders. TRIAL REGISTRATION NUMBER ISRCTN95243114 SECONDARY IDENTIFYING NUMBERS: University College London/University College London Hospitals Joint Research Office 17/0726.National Institute for Health Research, UK 16/88/06.
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Affiliation(s)
- Helen R Stagg
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | | | - Andrew Copas
- Centre for Pragmatic Global Health Trials, Institute of Global Health, University College London, London, UK
| | | | - Robert Horne
- UCL School of Pharmacy, University College London, London, UK
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Heinke Kunst
- Department of Respiratory Medicine, Queen Mary University of London, London, UK
| | | | - Elisha Pickett
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Alistair Story
- Find&Treat, University College Hospitals NHS Foundation Trust, London, UK
| | - Nicole Vidal
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Fatima B Wurie
- Institute for Global Health, University College London, London, UK
| | - Marc Lipman
- UCL Respiratory, University College London, London, UK
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
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34
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Burman M, Copas A, Zenner D, Hickson V, Gosce L, Trathen D, Ashcroft R, Martineau AR, Abubakar I, Griffiths C, Kunst H. Protocol for a cluster randomised control trial evaluating the efficacy and safety of treatment for latent tuberculosis infection in recent migrants within primary care: the CATAPuLT trial. BMC Public Health 2019; 19:1598. [PMID: 31783742 PMCID: PMC6884916 DOI: 10.1186/s12889-019-7983-7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background The identification and treatment of LTBI is a key component of the WHO’s strategy to eliminate TB. Recent migrants from high TB-incidence countries are recognised to be at risk TB reactivation, and many high-income countries have focused on LTBI screening and treatment programmes for this group. However, migrants are the group least likely to complete the LTBI cascade-of-care. This pragmatic cluster-randomised, parallel group, superiority trial investigates whether a model of care based entirely within a community setting (primary care) will improve treatment completion compared with treatment in specialist TB services (secondary care). Methods The CATAPuLT trial (Completion and Acceptability of Treatment Across Primary Care and the community for Latent Tuberculosis) randomised 34 general practices in London, England, to evaluate the efficacy and safety of treatment for LBTI in recent migrants within primary care. GP practices were randomised to either provide management for LTBI entirely within primary care (GPs and community pharmacists) or to refer patients to secondary care. The target recruitment number for individuals is 576. The primary outcome is treatment completion (defined as taking at least 90% of antibiotic doses). The secondary outcomes assess adherence, acceptance of treatment, the incidence of adverse effects including drug-induced liver injury, the rates of active TB, patient satisfaction and cost-effectiveness of LTBI treatment. This protocol adheres to the SPIRIT Checklist. Discussion The CATAPuLT trial seeks to provide implementation research evidence for a patient-centred intervention to improve treatment completion for LTBI amongst recent migrants to the UK. Trial registration NCT03069807, March 2017, registered retrospectively.
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Affiliation(s)
- M Burman
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK.
| | - A Copas
- Institute for Global Health, University College London, London, UK
| | - D Zenner
- Institute for Global Health, University College London, London, UK
| | - V Hickson
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - L Gosce
- Institute for Global Health, University College London, London, UK
| | - D Trathen
- Newham Clinical Commissioning Group, London, UK
| | - R Ashcroft
- School of Law, Queen Mary University of London, London, UK
| | - A R Martineau
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - I Abubakar
- Institute for Global Health, University College London, London, UK
| | - C Griffiths
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - H Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Barts Health NHS Trust, London, UK
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35
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Stagg HR, Bothamley GH, Davidson JA, Kunst H, Lalor MK, Lipman MC, Loutet MG, Lozewicz S, Mohiyuddin T, Abbara A, Alexander E, Booth H, Creer DD, Harris RJ, Kon OM, Loebinger MR, McHugh TD, Milburn HJ, Palchaudhuri P, Phillips PPJ, Schmok E, Taylor L, Abubakar I. Fluoroquinolones and isoniazid-resistant tuberculosis: implications for the 2018 WHO guidance. Eur Respir J 2019; 54:13993003.00982-2019. [PMID: 31371444 PMCID: PMC6785706 DOI: 10.1183/13993003.00982-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/15/2019] [Accepted: 07/01/2019] [Indexed: 01/15/2023]
Abstract
Introduction 2018 World Health Organization (WHO) guidelines for the treatment of isoniazid (H)-resistant (Hr) tuberculosis recommend a four-drug regimen: rifampicin (R), ethambutol (E), pyrazinamide (Z) and levofloxacin (Lfx), with or without H ([H]RZE-Lfx). This is used once Hr is known, such that patients complete 6 months of Lfx (≥6[H]RZE-6Lfx). This cohort study assessed the impact of fluoroquinolones (Fq) on treatment effectiveness, accounting for Hr mutations and degree of phenotypic resistance. Methods This was a retrospective cohort study of 626 Hr tuberculosis patients notified in London, 2009–2013. Regimens were described and logistic regression undertaken of the association between regimen and negative regimen-specific outcomes (broadly, death due to tuberculosis, treatment failure or disease recurrence). Results Of 594 individuals with regimen information, 330 (55.6%) were treated with (H)RfZE (Rf=rifamycins) and 211 (35.5%) with (H)RfZE-Fq. The median overall treatment period was 11.9 months and median Z duration 2.1 months. In a univariable logistic regression model comparing (H)RfZE with and without Fqs, there was no difference in the odds of a negative regimen-specific outcome (baseline (H)RfZE, cluster-specific odds ratio 1.05 (95% CI 0.60–1.82), p=0.87; cluster NHS trust). Results varied minimally in a multivariable model. This odds ratio dropped (0.57, 95% CI 0.14–2.28) when Hr genotype was included, but this analysis lacked power (p=0.42). Conclusions In a high-income setting, we found a 12-month (H)RfZE regimen with a short Z duration to be similarly effective for Hr tuberculosis with or without a Fq. This regimen may result in fewer adverse events than the WHO recommendations. WHO has assessed regimen recommendations for isoniazid-resistant TB to be of very low certainty. The addition of fluoroquinolones to a 12-month (isoniazid, rifamycin, ethambutol, short-duration pyrazinamide) regimen may be unnecessary in certain settings.http://bit.ly/2XoTgNL
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Affiliation(s)
- Helen R Stagg
- Institute for Global Health, University College London, London, UK .,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Graham H Bothamley
- Respiratory Medicine, Homerton University Hospital, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Jennifer A Davidson
- Tuberculosis Unit, National Infection Service, Public Health England, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Maeve K Lalor
- Institute for Global Health, University College London, London, UK.,Tuberculosis Unit, National Infection Service, Public Health England, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Marc C Lipman
- Respiratory Medicine, Royal Free Hospital, London, UK.,UCL Respiratory, Division of Medicine, University College London.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Miranda G Loutet
- Tuberculosis Unit, National Infection Service, Public Health England, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Stefan Lozewicz
- Respiratory Medicine, North Middlesex University Hospital, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Tehreem Mohiyuddin
- Tuberculosis Unit, National Infection Service, Public Health England, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Aula Abbara
- Infectious Diseases, London North West University Healthcare NHS Trust, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Eliza Alexander
- National Mycobacterial Reference Service South, Public Health England, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Helen Booth
- Tuberculosis Service, University College London Hospitals/Whittington Health, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Dean D Creer
- Respiratory Medicine, Barnet General Hospital, Royal Free London NHS Foundation Trust, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Ross J Harris
- Statistics, Modelling and Economics Department, Public Health England, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Onn Min Kon
- TB Service, Imperial College Healthcare, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Michael R Loebinger
- Respiratory Medicine, Chelsea and Westminster Hospital, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Timothy D McHugh
- Centre for Clinical Microbiology, University College London, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Heather J Milburn
- Respiratory Medicine, Guy's and St Thomas' Hospital, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Paramita Palchaudhuri
- Respiratory Services, Queen Elizabeth Hospital, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Patrick P J Phillips
- Dept of Medicine and Dept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Erik Schmok
- Respiratory Medicine, Homerton University Hospital, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Lucy Taylor
- National Mycobacterial Reference Service South, Public Health England, London, UK.,These authors contributed equally to this manuscript and are presented alphabetically
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
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Lange B, Arend SM, Armbruster C, Arias-Guillén M, Bakker M, Berastegui C, Babiker M, Charif R, Duarte R, Flick H, Hofland RW, Ismail J, Krishnan N, Kniepeiss D, Kunst H, Kuijpers D, Lange C, Lezaic V, Los Arcos I, Machova J, Milburn H, Kon OM, Osoro Suarez C, Pesut D, Rahman A, Reischig T, Sanchez Montalva A, Spohn HE, Stegenga M, De Vries A, Wagner D, Wobser R, Sester M. Posttransplant tuberculosis in Europe – a TBnet study. Tuberculosis (Edinb) 2019. [DOI: 10.1183/13993003.congress-2019.oa3820] [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: 11/05/2022]
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Johnson E, Shah K, Rahman A, Mccafferty K, Tiberi S, Kunst H. Extrapulmonary tuberculosis in patients with chronic kidney disease receiving renal replacement therapy. Tuberculosis (Edinb) 2019. [DOI: 10.1183/13993003.congress-2019.pa2976] [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: 11/05/2022]
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38
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Pang D, Skyllberg E, Waite M, Rahman A, Burman M, Tiberi S, Kunst H. Unusual presentations of tuberculosis in East London. Tuberculosis (Edinb) 2019. [DOI: 10.1183/13993003.congress-2019.pa2968] [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: 11/05/2022]
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Sundaralingam A, Kilic Y, Burman M, Rahman A, White V, Jayasekera N, Darmalingam M, Tiberi S, Kunst H. A Case Series of Pericardial TB in a large European Centre. Tuberculosis (Edinb) 2019. [DOI: 10.1183/13993003.congress-2019.pa2985] [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: 11/05/2022]
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40
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Gupta R, Lipman M, Jackson C, Sitch A, Southern J, Drobniewski F, Deeks J, Tsou CY, Griffiths C, Davidson J, Campbell C, Stirrup O, Noursadeghi M, Kunst H, Haldar P, Lalvani A, Abubakar I. Do higher quantitative interferon gamma release assay or tuberculin skin test results help to predict incident tuberculosis? Data from the UK PREDICT study. Tuberculosis (Edinb) 2019. [DOI: 10.1183/13993003.congress-2019.oa3822] [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: 11/05/2022]
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Günther G, van Leth F, Alexandru S, Altet N, Avsar K, Bang D, Barbuta R, Bothamley G, Ciobanu A, Crudu V, Danilovits M, Dedicoat M, Duarte R, Gualano G, Kunst H, de Lange W, Leimane V, McLaughlin AM, Magis-Escurra C, Muylle I, Polcová V, Popa C, Rumetshofer R, Skrahina A, Solodovnikova V, Spinu V, Tiberi S, Viiklepp P, Lange C. Clinical Management of Multidrug-Resistant Tuberculosis in 16 European Countries. Am J Respir Crit Care Med 2019; 198:379-386. [PMID: 29509468 DOI: 10.1164/rccm.201710-2141oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 11/16/2022] Open
Abstract
RATIONALE Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower. OBJECTIVES To document the management and treatment outcome in patients with MDR-TB in Europe. METHODS We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR-TB in Europe. Treatment outcomes were compared by World Health Organization and alternative simplified definitions by the Tuberculosis Network European Trialsgroup (TBNET). MEASUREMENTS AND MAIN RESULTS A total of 380 patients with MDR-TB were recruited and followed up between 2010 and 2014 in 16 European countries. Patients in high-incidence countries compared with low-incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median, 111 vs. 28 d), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying World Health Organization outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high-incidence countries. Simplified outcome definitions that include 1 year of follow-up after the end of treatment showed similar frequency of relapse-free cure in low- (58.3%), intermediate- (55.8%), and high-incidence (57.1%) countries, but highest frequency of failure in high-incidence countries (24.1% vs. 14.6%). CONCLUSIONS Conventional standard MDR-TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR-TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.
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Affiliation(s)
- Gunar Günther
- 1 Research Center Borstel, Clinical Infectious Diseases, German Center for Infection Research, Borstel, Germany.,2 Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia
| | - Frank van Leth
- 3 Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,4 Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - Sofia Alexandru
- 5 Institute of Phthisiopneumology, Chisinau, Republic of Moldova
| | - Neus Altet
- 6 Hospital Universitari Vall d'Hebron, Research Institute-IDIAP Jordi Gol, Barcelona, Spain
| | | | - Didi Bang
- 8 Statens Serum Institut, Copenhagen, Denmark
| | - Raisa Barbuta
- 9 Balti Municipal Hospital, Balti, Republic of Moldova
| | | | - Ana Ciobanu
- 5 Institute of Phthisiopneumology, Chisinau, Republic of Moldova
| | - Valeriu Crudu
- 5 Institute of Phthisiopneumology, Chisinau, Republic of Moldova.,11 National Tuberculosis Reference Laboratory, Chisinau, Republic of Moldova
| | | | - Martin Dedicoat
- 13 Heart of England Foundation Trust, Birmingham, United Kingdom.,14 University of Warwick, Coventry, United Kingdom
| | - Raquel Duarte
- 15 EpiUnit, Institute of Public Health, Porto University, Porto, Portugal.,16 Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Gina Gualano
- 17 National Institute for Infectious Diseases "L, Spallanzani," Rome, Italy
| | - Heinke Kunst
- 18 Queen Mary University, London, United Kingdom
| | - Wiel de Lange
- 19 University of Groningen, University Medical Center Groningen, Tuberculosis Centre Beatrixoord, Haren, the Netherlands
| | - Vaira Leimane
- 20 Riga East University Hospital, Tuberculosis and Lung Diseases Centre, Riga, Latvia
| | | | - Cecile Magis-Escurra
- 22 Radboud University Medical Centre-TB Expert Centre UCCZ Dekkerswald, Nijmegen-Groesbeek, the Netherlands
| | - Inge Muylle
- 23 University Medical Center St. Pieter, Brussels, Belgium
| | | | | | | | - Alena Skrahina
- 27 Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Varvara Solodovnikova
- 27 Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | | | - Simon Tiberi
- 28 Ospedale Eugenio Morelli Reference Hospital for MDR and HIV-TB, Sondalo, Italy.,29 Barts Health NHS Trust, London, United Kingdom
| | - Piret Viiklepp
- 30 National Institute for Health Development, Tallinn, Estonia
| | - Christoph Lange
- 1 Research Center Borstel, Clinical Infectious Diseases, German Center for Infection Research, Borstel, Germany.,31 International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.,32 Department of Medicine, Karolinska Institute, Stockholm, Sweden; and.,33 German Center for Infection Research, Borstel, Germany
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Turner RD, Birring SS, Darmalingam M, Hooper RL, Kunst H, Matos S, Bothamley GH. Daily cough frequency in tuberculosis and association with household infection. Int J Tuberc Lung Dis 2019; 22:863-870. [PMID: 29991394 DOI: 10.5588/ijtld.17.0652] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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 Although cough in tuberculosis (TB) is presumed to be important for transmission, there is little objective supporting evidence. OBJECTIVE To describe 24-h cough frequency in a group with TB, and investigate associations with household rates of infection. DESIGN Patients with a new diagnosis of pulmonary TB underwent 24-h cough frequency measurement at or just before initiation of anti-tuberculosis treatment. A group with latent Mycobacterium tuberculosis infection (LTBI) acted as controls. Rates of infection among household contacts of sputum smear-positive TB were measured using the interferon-gamma release assay and the tuberculin skin test, and compared with variables relating to the contacts themselves, and to the index case, including cough frequency. RESULTS Daily cough frequency in TB patients (n = 44) was variable (geometric mean [GM] 174, interquartile range [IQR] 68-475 coughs/24 h), higher than in LTBI (n = 17; GM 19 coughs/24 h, IQR 8-53; P < 0.001), and higher during the day than overnight (GM 8.9 coughs/h, IQR 4.1-19.0 vs. GM 2.9 coughs/h, IQR 0.7-13.4; P < 0.0001). Also, 24-h cough frequency in TB was associated with sputum smear status (P = 0.040), but not smoking (P = 0.475). Multivariable logistic regression confirmed that infection in contacts was independently associated with index case sputum smear grade (P = 0.014) and cough frequency (P = 0.022). CONCLUSION Measurement of 24-h cough frequency in pulmonary TB helps predict infectiousness and transmission patterns.
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Affiliation(s)
- R D Turner
- Department of Respiratory Medicine, Homerton University Hospital, London, Department of Respiratory Medicine
| | - S S Birring
- Department of Respiratory Medicine, School of Basic & Medical Biosciences, King's College London, London
| | - M Darmalingam
- Department of Respiratory Medicine, Whipps Cross University Hospital, London
| | - R L Hooper
- Blizard Institute, Barts and the London School of Medicine and Dentistry
| | - H Kunst
- Department of Respiratory Medicine, Queen Mary University of London, London, UK
| | - S Matos
- Departamento de Eletrónica, Telecomunicações e Informática, Institute of Electronics and Informatics Engineering, University of Aveiro, Aveiro, Portugal
| | - G H Bothamley
- Department of Respiratory Medicine, Homerton University Hospital, London
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McGuire E, Carey L, Tiberi S, Rahman A, Jayasekera N, White V, Kunst H. Breast tuberculosis in East London: A 13-year retrospective observational study. Breast J 2019; 26:235-239. [PMID: 31486176 DOI: 10.1111/tbj.13517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/16/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/29/2022]
Abstract
SETTING Breast tuberculosis (TB) is rare in Western Europe, and its diagnosis may be delayed through lack of awareness of presenting features. Our institution serves a large East London population with a high incidence of TB. OBJECTIVE To characterize presenting features and avoidable diagnostic delay in breast TB patients. DESIGN We conducted a 13-year retrospective study of breast TB patients treated at our institution including demographic, clinical, microbiology, and pathology data. RESULTS Forty-seven cases were included; 44 (94%) were female, with a median age of 33 years (IQR 28.5-39.5). The main presenting feature was a breast lump in 41 cases (87%); which were predominantly solitary unilateral lesions (25, 61%) and frequently located in the upper outer quadrant (28, 68%). Where performed, Mycobacterium tuberculosis was cultured in 15/36 (42%) cases. Granulomata were present on biopsy or aspirate in 21 (47%) and 17 (36%) cases, respectively. The median duration between symptom onset and treatment was 20 weeks (IQR 15-30). Forty-six (98%) completed treatment successfully and one relapsed. CONCLUSION A high index of suspicion for TB is required for individuals presenting with breast symptoms from countries where TB is endemic. Development of standardized pathways may improve detection and management of breast TB may reduce diagnostic delay.
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Affiliation(s)
- Emma McGuire
- Department of Infection, Barts Health NHS Trust, London, UK
| | - Laura Carey
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Simon Tiberi
- Department of Infection, Barts Health NHS Trust, London, UK.,Blizard Institute, Queen Mary University of London, London, UK
| | - Ananna Rahman
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | | | - Veronica White
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Heinke Kunst
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Blizard Institute, Queen Mary University of London, London, UK
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Tiberi S, Torrico MM, Rahman A, Krutikov M, Visca D, Silva DR, Kunst H, Migliori GB. Managing severe tuberculosis and its sequelae: from intensive care to surgery and rehabilitation. ACTA ACUST UNITED AC 2019; 45:e20180324. [PMID: 31038649 PMCID: PMC6733754 DOI: 10.1590/1806-3713/e20180324] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 10/16/2018] [Accepted: 01/12/2019] [Indexed: 01/09/2023]
Abstract
Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) continue to challenge physicians and public health specialists. Global treatment outcomes continue to be unsatisfactory, positive outcomes being achieved in only 54% of patients. Overall outcomes are even worse in patients infected with highly resistant strains. Treating MDR-/XDR-TB is difficult because of frequent adverse events, the long duration of drug regimens, the high costs of second-line drugs, chronic post-infectious sequelae, and loss of organ function. Ongoing research efforts (studies and trials) have various aims: increasing the rates of treatment success; understanding the potentialities of new and repurposed drugs; shortening the treatment duration; and reducing the rates of adverse events. It is hoped that better access to rapid diagnostics, increased awareness, and treatments that are more effective will reduce the rate of complications and of lung function impairment. This article aims to discuss the management of severe tuberculosis (defined as that which is potentially life threatening, requiring higher levels of care) and its sequelae, from intensive care to the postoperative period, rehabilitation, and recovery. We also discuss the nonpharmacological interventions available to manage chronic sequelae and improve patient quality of life. Because the majority of MDR-/XDR-TB cases evolve to lung function impairment (typically obstructive but occasionally restrictive), impaired quality of life, and low performance status (as measured by walk tests or other metrics), other interventions (e.g., smoking cessation, pulmonary rehabilitation, vaccination/prevention of secondary bacterial infections/exacerbations, complemented by psychological and nutritional support) are required.
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Affiliation(s)
- Simon Tiberi
- . Barts Health NHS Trust, Royal London Hospital, Division of Infection, London, United Kingdom.,. Blizard Institute, Barts and the London School of Medicine and Dentistry, Centre for Primary Care and Public Health, London, United Kingdom
| | - Marcela Muñoz Torrico
- . Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, DF, México
| | - Ananna Rahman
- . Barts Health NHS Trust, Royal London Hospital, Division of Infection, London, United Kingdom
| | - Maria Krutikov
- . Barts Health NHS Trust, Royal London Hospital, Division of Infection, London, United Kingdom
| | - Dina Visca
- . Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia
| | - Denise Rossato Silva
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Heinke Kunst
- . Blizard Institute, Barts and the London School of Medicine and Dentistry, Centre for Primary Care and Public Health, London, United Kingdom
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Akkerman O, Aleksa A, Alffenaar JW, Al-Marzouqi NH, Arias-Guillén M, Belilovski E, Bernal E, Boeree MJ, Borisov SE, Bruchfeld J, Cadiñanos Loidi J, Cai Q, Caminero JA, Cebrian Gallardo JJ, Centis R, Codecasa LR, D'Ambrosio L, Dalcolmo M, Danila E, Dara M, Davidavičienė E, Davies Forsman L, De Los Rios Jefe J, Denholm J, Duarte R, Elamin SE, Ferrarese M, Filippov A, Ganatra S, Garcia A, García-García JM, Gayoso R, Giraldo Montoya AM, Gomez Rosso RG, Gualano G, Hoefsloot W, Ilievska-Poposka B, Jonsson J, Khimova E, Kuksa L, Kunst H, Laniado-Laborín R, Li Y, Magis-Escurra C, Manfrin V, Manga S, Marchese V, Martínez Robles E, Maryandyshev A, Matteelli A, Migliori GB, Mullerpattan JB, Munoz-Torrico M, Mustafa Hamdan H, Nieto Marcos M, Noordin NM, Palmero DJ, Palmieri F, Payen MC, Piubello A, Pontali E, Pontarelli A, Quirós S, Rendon A, Skrahina A, Šmite A, Solovic I, Sotgiu G, Souleymane MB, Spanevello A, Stošić M, Tadolini M, Tiberi S, Udwadia ZF, van den Boom M, Vescovo M, Viggiani P, Visca D, Zhurkin D, Zignol M. Surveillance of adverse events in the treatment of drug-resistant tuberculosis: A global feasibility study. Int J Infect Dis 2019; 83:72-76. [PMID: 30953827 DOI: 10.1016/j.ijid.2019.03.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 03/22/2019] [Revised: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022] Open
Abstract
The World Health Organization launched a global initiative, known as aDSM (active TB drug safety monitoring and management) to better describe the safety profile of new treatment regimens for drug-resistant tuberculosis (TB) in real-world settings. However, comprehensive surveillance is difficult to implement in several countries. The aim of the aDSM project is to demonstrate the feasibility of implementing national aDSM registers and to describe the type and the frequency of adverse events (AEs) associated with exposure to the new anti-TB drugs. Following a pilot study carried out in 2016, official involvement of TB reference centres/countries into the project was sought and cases treated with bedaquiline- and/or delamanid-containing regimens were consecutively recruited. AEs were prospectively collected ensuring potential attribution of the AE to a specific drug based on its known safety profile. A total of 309 cases were fully reported from 41 centres in 27 countries (65% males; 268 treated with bedaquiline, 20 with delamanid, and 21 with both drugs) out of an estimated 781 cases the participating countries had committed to report by the first quarter of 2019.
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Affiliation(s)
- Onno Akkerman
- University of Groningen, University Medical Center Groningen, Tuberculosis Center Beatrixoord, Haren, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases & Tuberculosis, Groningen, The Netherlands.
| | - Alena Aleksa
- Department of Phthisiology, Grodno State Medical University, GRCC "Phthisiology", Grodno, Belarus.
| | - Jan-Willem Alffenaar
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Westmead Hospital, Sydney, Australia; Dept. Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands.
| | - Nada Hassan Al-Marzouqi
- Preventive Medicine Department, Ministry of Health and Prevention, Dubai, United Arab Emirates.
| | - Miguel Arias-Guillén
- Servicio de Neumología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias CIBER-Enfermedades Respiratorias. Instituto de Salud Carlos III, Oviedo Spain.
| | - Evgeny Belilovski
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.
| | - Enrique Bernal
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Reina Sofia, Murcia, Spain.
| | - Martin J Boeree
- Department of Pulmonary Diseases, Radboud Center of Infectious Diseases, Tuberculosis Center Dekkerswald Groesbeek, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Sergey E Borisov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.
| | - Judith Bruchfeld
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institute, Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
| | - Julen Cadiñanos Loidi
- Internal Medicine Department, Hospital General de Villalba, Collado Villalba, Spain.
| | - Qingshan Cai
- Zhejiang Integrated Traditional and Western Medicine Hospital, Hangzhou, China.
| | - Jose A Caminero
- Pneumology Department, Hospital General de Gran Canaria "Dr. Negrin", Las Palmas de Gran Canaria, Spain; MDR-TB Unit, Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France.
| | | | - Rosella Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
| | | | | | - Margareth Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz)/Ministry of Health, Rio de Janeiro, Brazil.
| | - Edvardas Danila
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
| | - Masoud Dara
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark.
| | - Edita Davidavičienė
- National TB registry, Public Health Department, Ministry of Health; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
| | - Lina Davies Forsman
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institute, Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
| | | | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health; Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
| | - Raquel Duarte
- National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Department of Pneumology; Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal.
| | | | - Maurizio Ferrarese
- TB Reference Centre, Villa Marelli Institute/Niguarda Hospital, Milan, Italy.
| | - Alexey Filippov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.
| | - Shashank Ganatra
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India.
| | - Ana Garcia
- Pulmonology Division, Municipal Hospital F.J. Muñiz, Buenos Aires, Argentina.
| | | | - Regina Gayoso
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz)/Ministry of Health, Rio de Janeiro, Brazil.
| | | | - Roscio Gomez Gomez Rosso
- National Institute of Respiratory and Environmental Diseases "Prof. Dr. Juan Max Boettner" Asunción, Paraguay.
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy.
| | - Wouter Hoefsloot
- Department of Pulmonary Diseases, Radboud Center of Infectious Diseases, Tuberculosis Center Dekkerswald Groesbeek, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Jerker Jonsson
- National TB Surveillance Unit, Public Health Agency, Stockholm, Sweden.
| | - Elena Khimova
- Northern State Medical University, Arkhangelsk, Russian Federation.
| | - Liga Kuksa
- MDR-TB department, Riga East University Hospital for TB and Lung Disease Centre, Riga, Latvia.
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
| | - Rafael Laniado-Laborín
- Universidad Autónoma de Baja California, Baja California, Mexico; Clínica de Tuberculosis del Hospital General de Tijuana, Tijuana, Baja California, Mexico.
| | - Yang Li
- Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
| | - Cecile Magis-Escurra
- Department of Pulmonary Diseases, Radboud Center of Infectious Diseases, Tuberculosis Center Dekkerswald Groesbeek, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Selene Manga
- Department of Infectious Diseases, University National San Antonio Abad Cusco, Cusco, Peru.
| | - Valentina Marchese
- University Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV co-infection and for TB elimination, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy.
| | - Elena Martínez Robles
- Internal Medicine Department, Tuberculosis Hospital de Cantoblanco- Hospital La Paz, Madrid, Spain
| | | | - Alberto Matteelli
- University Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV co-infection and for TB elimination, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy.
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
| | - Jai B Mullerpattan
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India.
| | - Marcela Munoz-Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, Mexico.
| | | | | | | | | | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy.
| | - Marie-Christine Payen
- Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Alberto Piubello
- Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France; Tuberculosis Division, Damien Foundation, Niamey, Niger.
| | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Genova, Italy.
| | - Agostina Pontarelli
- Reference Centre for MDR and HIV-TB, Eugenio Morelli Hospital, Sondalo, Italy.
| | - Sarai Quirós
- Pneumology Department, Tuberculosis Unit, Hospital de Cantoblanco- Hospital General Universitario La Paz, Madrid, Spain.
| | - Adrian Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias CIPTIR, University Hospital of Monterrey UANL (Universidad Autonoma de Nuevo Leon), Monterrey, Mexico.
| | - Alena Skrahina
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.
| | - Agnese Šmite
- MDR-TB department, Riga East University Hospital for TB and Lung Disease Centre, Riga, Latvia.
| | - Ivan Solovic
- National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Catholic University Ruzomberok, Slovakia.
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of z, University of Sassari, Sassari, Italy.
| | | | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese, Italy.
| | - Maja Stošić
- TB Programme and Surveillance Unit, National Public Health Institute, Belgrade, Serbia.
| | - Marina Tadolini
- Unit of Infectious Diseases, Deparment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
| | - Zarir Farokh Udwadia
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India.
| | | | - Marisa Vescovo
- Pulmonology Division, Municipal Hospital F.J. Muñiz, Buenos Aires, Argentina.
| | - Pietro Viggiani
- Reference Centre for MDR and HIV-TB, Eugenio Morelli Hospital, Sondalo, Italy.
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese, Italy.
| | - Dmitry Zhurkin
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.
| | - Matteo Zignol
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland.
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Zweijpfenning SM, van Groningen H, van Ingen J, Magis-Escurra C, Boeree MJ, Wagner D, Bax H, Andrejak C, Wener R, Rahman A, Kunst H, Lorent N, Brouwer MA, Hoefsloot W. Clofazimine does not lead to significant QT interval prolongation: a multicentre study. Eur Respir J 2018; 52:52/5/1801386. [DOI: 10.1183/13993003.01386-2018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/22/2018] [Indexed: 11/05/2022]
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Abubakar I, Drobniewski F, Southern J, Sitch AJ, Jackson C, Lipman M, Deeks JJ, Griffiths C, Bothamley G, Lynn W, Burgess H, Mann B, Imran A, Sridhar S, Tsou CY, Nikolayevskyy V, Rees-Roberts M, Whitworth H, Kon OM, Haldar P, Kunst H, Anderson S, Hayward A, Watson JM, Milburn H, Lalvani A. Prognostic value of interferon-γ release assays and tuberculin skin test in predicting the development of active tuberculosis (UK PREDICT TB): a prospective cohort study. Lancet Infect Dis 2018; 18:1077-1087. [PMID: 30174209 PMCID: PMC6192014 DOI: 10.1016/s1473-3099(18)30355-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/27/2018] [Accepted: 05/25/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tackling tuberculosis requires testing and treatment of latent tuberculosis in high-risk groups. The aim of this study was to estimate the predictive values of the tuberculin skin test (TST) and two interferon-γ release assays (IGRAs) for the development of active tuberculosis in high-risk groups-ie, people in recent contact with active tuberculosis cases and from high-burden countries. METHOD In this prospective cohort study, we recruited participants from 54 centres (eg, clinics, community settings) in London, Birmingham, and Leicester in the UK. Participants were eligible if they were aged 16 years or older and at high risk for latent tuberculosis infection (ie, recent contact with someone with active tuberculosis [contacts] or a migrant who had arrived in the UK in the past 5 years from-or who frequently travelled to-a country with a high burden of tuberculosis [migrants]). Exclusion criteria included prevalent cases of tuberculosis, and participants who were treated for latent tuberculosis after a positive test result in this study. Each participant received three tests (QuantiFERON-TB Gold-In Tube, T-SPOT.TB, and a Mantoux TST). A positive TST result was reported using three thresholds: 5 mm (TST-5), 10 mm (TST-10), and greater than 5 mm in BCG-naive or 15 mm in BCG-vaccinated (TST-15) participants. Participants were followed up from recruitment to development of tuberculosis or censoring. Incident tuberculosis cases were identified by national tuberculosis databases, telephone interview, and review of medical notes. Our primary objective was to estimate the prognostic value of IGRAs compared with TST, assessed by the ratio of incidence rate ratios and predictive values for tuberculosis development. The study was registered with ClinicalTrials.gov, NCT01162265, and is now complete. FINDINGS Between May 4, 2010, and June 1, 2015, 10 045 people were recruited, of whom 9610 were eligible for inclusion. Of this cohort, 4861 (50·6%) were contacts and 4749 (49·4%) were migrants. Participants were followed up for a median of 2·9 years (range 21 days to 5·9 years). 97 (1·0%) of 9610 participants developed active tuberculosis (77 [1·2%] of 6380 with results for all three tests). In all tests, annual incidence of tuberculosis was very low in those who tested negatively (ranging from 1·2 per 1000 person-years, 95% CI 0·6-2·0 for TST-5 to 1·9 per 1000 person-years, 95% CI 1·3-2·7, for QuantiFERON-TB Gold In-Tube). Annual incidence in participants who tested positively were highest for T-SPOT.TB (13·2 per 1000 person-years, 95% CI 9·9-17·4), TST-15 (11·1 per 1000 person-years, 8·3-14·6), and QuantiFERON-TB Gold In-Tube (10·1 per 1000 person-years, 7·4-13·4). Positive results for these tests were significantly better predictors of progression than TST-10 and TST-5 (eg, ratio of test positivity rates in those progressing to tuberculosis compared with those not progressing T-SPOT.TB vs TST-5: 1·99, 95% CI 1·68-2·34; p<0·0001). However, TST-5 identified a higher proportion of participants who progressed to active tuberculosis (64 [83%] of 77 tested) than all other tests and TST thresholds (≤75%). INTERPRETATION IGRA-based or BCG-stratified TST strategies appear most suited to screening for potential disease progression among high-risk groups. Further work will be needed to assess country-specific cost-effectiveness of each screening test, and in the absence of highly specific diagnostic tests, cheap non-toxic treatments need to be developed that could be given to larger groups of people at potential risk. FUNDING National Institute for Health Research Health Technology Assessment Programme 08-68-01.
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Affiliation(s)
- Ibrahim Abubakar
- UCL Institute for Global Health, University College London, London, UK.
| | - Francis Drobniewski
- Section of Infectious Diseases and Immunity, Imperial College London, London, UK
| | | | - Alice J Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Charlotte Jackson
- UCL Institute for Global Health, University College London, London, UK
| | - Marc Lipman
- Department of Medicine, University College London, London, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chris Griffiths
- Blizard Institute, Queen Mary University of London, London, UK
| | - Graham Bothamley
- Department of Respiratory Medicine, Homerton University Hospital, London, UK
| | - William Lynn
- Department of Infectious Diseases and Tropical Medicine, Ealing Hospital, London, UK
| | - Helen Burgess
- Department of Medicine, West Middlesex Hospital, London, UK
| | - Bobby Mann
- Department of Medicine, West Middlesex Hospital, London, UK
| | - Ambreen Imran
- UCL Institute for Global Health, University College London, London, UK
| | - Saranya Sridhar
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - Melanie Rees-Roberts
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK
| | - Hilary Whitworth
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK
| | - Onn Min Kon
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK
| | - Pranab Haldar
- Respiratory Biomedical Research Centre, Institute for Lung Health, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, UK
| | | | - Andrew Hayward
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | | | - Heather Milburn
- Respiratory Medicine Department, Guy's and St Thomas' Hospital, London, UK
| | - Ajit Lalvani
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK
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Burman M, Rahman A, Bothamley G, Lange C, Kunst H. From policy to practice in Europe: a TBNET survey on the delivery of LTBI screening and treatment amongst migrants. Tuberculosis (Edinb) 2018. [DOI: 10.1183/13993003.congress-2018.pa3867] [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: 11/05/2022]
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Williams E, Potter JL, Duff F, Burman M, Tiberi S, White V, Kunst H. Hepatic tuberculosis – a case series. Tuberculosis (Edinb) 2018. [DOI: 10.1183/13993003.congress-2018.pa4771] [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: 11/05/2022]
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Rosales-Klintz S, D’ambrosio L, Centis R, Verduin R, Amicosante M, Correia AM, Cirule A, Duarte R, Gadzheva B, Gualano G, Kunst H, Palmieri F, Riekstina V, Stefanova D, Tiberi S, Sotgiu G, Migliori GB, Van Der Werf MJ. Management of tuberculosis in the European Union: a multicentre audit. Tuberculosis (Edinb) 2018. [DOI: 10.1183/13993003.congress-2018.oa1958] [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: 11/05/2022]
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