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du Cros P, Greig J, Alffenaar JWC, Cross GB, Cousins C, Berry C, Khan U, Phillips PPJ, Velásquez GE, Furin J, Spigelman M, Denholm JT, Thi SS, Tiberi S, Huang GKL, Marks GB, Turkova A, Guglielmetti L, Chew KL, Nguyen HT, Ong CWM, Brigden G, Singh KP, Motta I, Lange C, Seddon JA, Nyang'wa BT, Maug AKJ, Gler MT, Dooley KE, Quelapio M, Tsogt B, Menzies D, Cox V, Upton CM, Skrahina A, McKenna L, Horsburgh CR, Dheda K, Marais BJ. Standards for clinical trials for treating TB. Int J Tuberc Lung Dis 2023; 27:885-898. [PMID: 38042969 PMCID: PMC10719894 DOI: 10.5588/ijtld.23.0341] [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: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND: The value, speed of completion and robustness of the evidence generated by TB treatment trials could be improved by implementing standards for best practice.METHODS: A global panel of experts participated in a Delphi process, using a 7-point Likert scale to score and revise draft standards until consensus was reached.RESULTS: Eleven standards were defined: Standard 1, high quality data on TB regimens are essential to inform clinical and programmatic management; Standard 2, the research questions addressed by TB trials should be relevant to affected communities, who should be included in all trial stages; Standard 3, trials should make every effort to be as inclusive as possible; Standard 4, the most efficient trial designs should be considered to improve the evidence base as quickly and cost effectively as possible, without compromising quality; Standard 5, trial governance should be in line with accepted good clinical practice; Standard 6, trials should investigate and report strategies that promote optimal engagement in care; Standard 7, where possible, TB trials should include pharmacokinetic and pharmacodynamic components; Standard 8, outcomes should include frequency of disease recurrence and post-treatment sequelae; Standard 9, TB trials should aim to harmonise key outcomes and data structures across studies; Standard 10, TB trials should include biobanking; Standard 11, treatment trials should invest in capacity strengthening of local trial and TB programme staff.CONCLUSION: These standards should improve the efficiency and effectiveness of evidence generation, as well as the translation of research into policy and practice.
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Affiliation(s)
- P du Cros
- Burnet Institute, Melbourne, VIC, Monash Infectious Diseases, Monash Health, Melbourne, VIC, Australia
| | - J Greig
- Burnet Institute, Melbourne, VIC, Médecins Sans Frontières (MSF), Manson Unit, London, UK
| | - J-W C Alffenaar
- Sydney Infectious Diseases Institute (Sydney ID), and, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Westmead Hospital, Sydney, NSW
| | - G B Cross
- Burnet Institute, Melbourne, VIC, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - C Cousins
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - C Berry
- Médecins Sans Frontières (MSF), Manson Unit, London, UK
| | - U Khan
- Interactive Research and Development Global, Singapore City, Singapore
| | - P P J Phillips
- UCSF Center for Tuberculosis, Division of Pulmonary and Critical Care Medicine, and
| | - G E Velásquez
- UCSF Center for Tuberculosis, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - J Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA
| | - M Spigelman
- Global Alliance for TB Drug Development, New York, NY, USA
| | - J T Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - S S Thi
- Eswatini National TB Control Program, Mbabane, Kingdom of Eswatini
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, GlaxoSmithKline, London, UK
| | - G K L Huang
- Burnet Institute, Melbourne, VIC, Northern Health Infectious Diseases, Northern Health, Melbourne, VIC
| | - G B Marks
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - A Turkova
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - L Guglielmetti
- Médecins Sans Frontières (MSF), Paris, Sorbonne Université, Institut national de la santé et de la recherche médicale, Unité 1135, Centre d'Immunologie et des Maladies Infectieuses, Paris, Assistance Publique Hôpitaux de Paris (APHP), Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries, Paris, France
| | - K L Chew
- Department of Laboratory Medicine, National University Hospital, Singapore City, Singapore
| | - H T Nguyen
- Research Department, Friends for International TB Relief, Ha Noi, Vietnam
| | - C W M Ong
- Infectious Diseases Translational Research Programme, Department of Medicine, National University of Singapore, Singapore City, Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore City, Institute of Healthcare Innovation & Technology, National University of Singapore, Singapore City, Singapore
| | - G Brigden
- The Global Fund, Geneva, Switzerland
| | - K P Singh
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia, Victorian Infectious Disease Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), TTU-TB, Borstel, Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - J A Seddon
- Department of Infectious Disease, Imperial College London, London, UK, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - B-T Nyang'wa
- Public Health Department, Operational Center Amsterdam (OCA), MSF, Amsterdam, The Netherlands
| | - A K J Maug
- Damien Foundation Bangladesh, Dhaka, Bangladesh
| | - M T Gler
- De La Salle Medical and Health Sciences Institute, Dasmariñas, the Philippines
| | - K E Dooley
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Quelapio
- Tropical Disease Foundation, Makati City, Manila, the Philippines, KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - B Tsogt
- Mongolian Anti-TB Coalition, Ulaanbaatar, Mongolia
| | - D Menzies
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute & McGill International TB Centre, Montreal, QC, Canada
| | - V Cox
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - C M Upton
- TASK Applied Science, Cape Town, South Africa
| | - A Skrahina
- The Republican Scientific and Practical Center for Pulmonology and TB, Minsk, Belarus
| | - L McKenna
- Treatment Action Group, New York, NY
| | - C R Horsburgh
- Departments of Global Health, Epidemiology, Biostatistics and Medicine, Schools of Public Health and Medicine, Boston University, Boston MA, USA
| | - K Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa, Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - B J Marais
- Sydney Infectious Diseases Institute (Sydney ID), and, The Children's Hospital at Westmead, Sydney, NSW, WHO Collaborating Centre in Tuberculosis, The University of Sydney, Sydney, NSW, Australia
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Main S, Dwihardiani B, Hidayat A, Khodijah S, Greig J, Chan G, Parry AE, Nababan B, Billy I, du Cros P, Triasih R. Knowledge and attitudes towards TB among healthcare workers in Yogyakarta, Indonesia. Public Health Action 2022; 12:133-140. [PMID: 36160721 PMCID: PMC9484592 DOI: 10.5588/pha.22.0017] [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] [Received: 04/03/2022] [Accepted: 07/06/2022] [Indexed: 11/12/2022] Open
Abstract
SETTING: Healthcare workers (HCWs) are at an increased risk of TB worldwide. Individual knowledge and attitudes may influence HCW behaviour, and subsequently, TB risk. Indonesia has the second highest case-load globally. OBJECTIVE: To measure TB knowledge and attitudes among a subsection of HCWs in Yogyakarta, Indonesia, and to explore factors associated with knowledge. DESIGN: A cross-sectional study using an online survey targeting all HCW staff was conducted among HCWs from four pre-selected healthcare facilities in Yogyakarta. Descriptive analysis and a multivariable linear regression were undertaken. RESULTS: Of 792 HCWs, 290 (37%) completed the survey; 64% (n = 185) were medical staff, 33% (n = 95) reported previously being tested for active TB and 8% (n = 24) for latent TB. The mean knowledge score was 7.2/11 (SD 1.5): this was higher among medical staff and those with university education (average score increase: 0.53, 95% CI 0.15 to 0.90; and 0.38, 95% CI 0.01 to 0.74, respectively). Participants agreed that free access to TB screening (93%) and treatment (93%) should be available, and 57% of medical and 77% of non-medical staff would take preventive therapy if eligible. CONCLUSION: Participants had practical understanding of TB; however, gaps were identified in knowledge about TB disease progression and prevention. Prevention programmes were viewed positively. We suggest further TB education and engagement programmes for HCWs.
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Affiliation(s)
- S. Main
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC, Australia, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - B. Dwihardiani
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - A. Hidayat
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - S. Khodijah
- Department of Paediatric, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - J. Greig
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC, Australia
| | - G. Chan
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC, Australia
| | - A. E. Parry
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - B. Nababan
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - I. Billy
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - P. du Cros
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC, Australia
| | - R. Triasih
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia, Department of Paediatric, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital,
Yogyakarta, Indonesia
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Horter S, Daftary A, Keam T, Bernays S, Bhanushali K, Chavan D, Denholm J, Furin J, Jaramillo E, Khan A, Lin YD, Lobo R, Loveday M, Majumdar SS, Mistry N, Patel H, Rane S, Swaminathan A, Triasih R, Venkatesan N, Viney K, du Cros P. Person-centred care in TB. Int J Tuberc Lung Dis 2021; 25:784-787. [PMID: 34615573 DOI: 10.5588/ijtld.21.0327] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- S Horter
- Burnet Institute, Melbourne, VIC, Australia
| | - A Daftary
- Dahdaleh Institute of Global Health Research, York University, Toronto, ON, Canada, Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - T Keam
- Burnet Institute, Melbourne, VIC, Australia
| | - S Bernays
- School of Public Health, University of Sydney, Sydney, NSW, Australia, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - D Chavan
- Survivors Against TB, Mumbai, India
| | - J Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Australia, Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - E Jaramillo
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - A Khan
- Stop TB Partnership, Geneva, Switzerland
| | - Y D Lin
- Burnet Institute, Melbourne, VIC, Australia
| | | | - M Loveday
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - S S Majumdar
- Burnet Institute, Melbourne, VIC, Australia, Department of Paediatrics, University of Melbourne and Murdoch Children´s Research Institute, Melbourne, VIC, Australia
| | - N Mistry
- Foundation for Medical Research, Mumbai, India
| | - H Patel
- Survivors Against TB, Mumbai, India
| | - S Rane
- Survivors Against TB, Mumbai, India
| | | | - R Triasih
- Centre for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Department of Paediatric, Dr Sardjito Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - N Venkatesan
- Blavatnik School of Government, Oxford University, Oxford, UK
| | - K Viney
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - P du Cros
- Burnet Institute, Melbourne, VIC, Australia
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Chan G, Triasih R, Nababan B, du Cros P, Wilks N, Main S, Huang GKL, Lin D, Graham SM, Majumdar SS, Bakker M, Khan A, Khan FA, Dwihardiani B. Adapting active case-finding for TB during the COVID-19 pandemic in Yogyakarta, Indonesia. Public Health Action 2021; 11:41-49. [PMID: 34159059 PMCID: PMC8202624 DOI: 10.5588/pha.20.0071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
The COVID-19 pandemic and response measures, including lockdowns and the reorientation of health services, have disrupted essential health services for other diseases, including TB, HIV and malaria. For TB, reductions in case detection due to the COVID-19 pandemic are projected to result in increased TB transmission, morbidity and mortality. Active case-finding (ACF) for TB using community-based approaches is a potential strategy to offset reductions in TB detection by obviating the need for patients to seek care at a health facility. A number of approaches can be used to conduct TB ACF safely and screen designated target populations while managing the risks of SARS-CoV-2 transmission for staff, individuals and the community. We present a framework of options for and experience of adapting TB ACF services in response to the challenges of COVID-19 in our programme in Yogyakarta, Indonesia. Key changes have included revised prioritisation of target populations focusing on household contacts, reducing case-finding throughput, implementation of additional infection control measures and precautions, and integration of COVID-19 screening among those being screened for TB. Our approach could inform other programmes seeking to adapt TB ACF services to mitigate the negative impact of COVID-19 on TB case detection.
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Affiliation(s)
- G Chan
- Burnet Institute, Melbourne, VIC, Australia
| | - R Triasih
- Department of Paediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - B Nababan
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - P du Cros
- Burnet Institute, Melbourne, VIC, Australia
| | - N Wilks
- Burnet Institute, Melbourne, VIC, Australia
| | - S Main
- Burnet Institute, Melbourne, VIC, Australia
| | | | - D Lin
- Burnet Institute, Melbourne, VIC, Australia
| | - S M Graham
- Burnet Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Melbourne, VIC, Australia
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - S S Majumdar
- Burnet Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - M Bakker
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - A Khan
- STOP TB Partnership, Geneva, Switzerland
| | - F A Khan
- STOP TB Partnership, Geneva, Switzerland
| | - B Dwihardiani
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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5
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Maha A, Majumdar SS, Main S, Phillip W, Witari K, Schulz J, du Cros P. The effects of decentralisation of tuberculosis services in the East New Britain Province, Papua New Guinea. Public Health Action 2019; 9:S43-S49. [DOI: 10.5588/pha.18.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/13/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- A. Maha
- National Department of Health, Port Moresby, Papua New Guinea
| | | | - S. Main
- The Burnet Institute, Melbourne, Victoria, Australia
| | - W. Phillip
- The Burnet Institute, Melbourne, Victoria, Australia
| | - K. Witari
- Nonga General Hospital, Rabaul, Papua New Guinea
| | - J. Schulz
- Nonga General Hospital, Rabaul, Papua New Guinea
| | - P. du Cros
- The Burnet Institute, Melbourne, Victoria, Australia
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Sodeng K, Botu A, Semmie M, Yoannes M, Shewade HD, Commons R, Graham SM, du Cros P. Challenges in TB diagnosis and treatment: the Kavieng Provincial Hospital experience, Papua New Guinea. Public Health Action 2019; 9:S57-S61. [PMID: 31579651 DOI: 10.5588/pha.18.0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/18/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
Setting The Tuberculosis (TB) Basic Management Unit at Kavieng Provincial Hospital, New Ireland Province, Papua New Guinea. Objective To assess the linkage between laboratory diagnosis and treatment initiation and describe the characteristics and treatment outcomes of TB patients. Design This was a retrospective cohort study of 1) sputum smear-positive TB patients recorded in the laboratory register, and 2) TB patients recorded in the treatment register in 2015 and 2016. Results Of the 221 patients registered for TB treatment, 173 (78%) were clinically diagnosed; extrapulmonary TB was common (36% of all patients). Unfavourable treatment outcomes were seen in more than 40% of patients, including death (10%) and loss to follow-up (26%), and were significantly more common in smear-negative vs. smear-positive pulmonary TB patients (RR 1.69 [95%CI 1.02-2.80]). Only 4 (<2%) TB patients had undergone testing for HIV. Twelve (21%) of 58 sputum smear-positive TB patients were not registered as undergoing treatment for TB. Conclusion This study identifies diagnostic and treatment gaps in the TB treatment cascade at the Kavieng Basic Management Unit. The TB programme requires strengthening to address the high proportions of clinically diagnosed TB, of patients not tested for HIV and of loss to follow-up.
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Affiliation(s)
- K Sodeng
- Kavieng Provincial Hospital, New Ireland Province, Papua New Guinea
| | - A Botu
- Kavieng Provincial Hospital, New Ireland Province, Papua New Guinea
| | - M Semmie
- Kavieng Provincial Hospital, New Ireland Province, Papua New Guinea
| | - M Yoannes
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - H D Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India.,The Union, Paris, France
| | - R Commons
- Burnet Institute, Melbourne, Victoria, Australia.,Global Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - S M Graham
- Burnet Institute, Melbourne, Victoria, Australia.,Global Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - P du Cros
- Burnet Institute, Melbourne, Victoria, Australia
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7
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Taune M, Ustero P, Hiashiri S, Huang K, Aia P, Morris L, Main S, Chan G, du Cros P, Majumdar SS. Successful implementation of bedaquiline for multidrug-resistant TB treatment in remote Papua New Guinea. Public Health Action 2019; 9:S73-S79. [PMID: 31579654 PMCID: PMC6735455 DOI: 10.5588/pha.18.0071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 09/12/2018] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
SETTING Bedaquiline (BDQ) was introduced in the multi-drug-resistant tuberculosis (MDR-TB) programme in Daru in remote Papua New Guinea in 2015, along with a core package of active drug-safety monitoring (aDSM). OBJECTIVE To assess interim results and safety of BDQ for the treatment of MDR-TB from 1 July 2015 to 31 December 2017. DESIGN A retrospective cohort analysis of routine programme data. RESULTS Of 277 MDR-TB patients, 77 (39%) received BDQ with a total of 8 serious adverse events including 5 (6.5%) deaths, of which 1 (1.3% QTcF prolongation, grade 3) was attributable to BDQ. Of 200 (61%) patients who did not receive BDQ, there were 17 (9%) deaths. Completeness of monitoring for the BDQ group was 90% for >5 electrocardiograms and 79% for ⩾2 cultures. In the interim result indicator analysis at month 6 in the BDQ and non-BDQ groups, there were respectively 0% and 1% lost to follow-up; 6.5% and 8.5% who died; 94% and 91% in care; and 92% and 96% with negative culture among those monitored. CONCLUSION Early experience in Daru shows BDQ is safe and feasible to implement with aDSM with good interim effectiveness supporting the rapid adoption and scale-up of the 2019 WHO MDR-TB treatment guidelines in the programme and in similar remote settings.
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Affiliation(s)
- M Taune
- Daru General Hospital, Daru, Western Province, Papua New Guinea
| | - P Ustero
- Burnet Institute, Melbourne, Victoria, Australia
| | - S Hiashiri
- Burnet Institute, Melbourne, Victoria, Australia
| | - K Huang
- Burnet Institute, Melbourne, Victoria, Australia
| | - P Aia
- National TB Program, Port Moresby, Papua New Guinea
| | - L Morris
- Provincial Health Office, Daru, Western Province, Papua New Guinea
| | - S Main
- Burnet Institute, Melbourne, Victoria, Australia
| | - G Chan
- Burnet Institute, Melbourne, Victoria, Australia
| | - P du Cros
- Burnet Institute, Melbourne, Victoria, Australia
| | - S S Majumdar
- Burnet Institute, Melbourne, Victoria, Australia
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8
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Hapolo E, Ilai J, Francis T, du Cros P, Taune M, Chan G. TB treatment delay associated with drug resistance and admission at Daru General Hospital in Papua New Guinea. Public Health Action 2019; 9:S50-S56. [PMID: 31579650 DOI: 10.5588/pha.18.0075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/13/2018] [Accepted: 12/11/2018] [Indexed: 11/10/2022] Open
Abstract
SETTING Daru General Hospital, Daru Island, Papua New Guinea, where high rates of tuberculosis (TB) have been reported. Prompt diagnosis and effective treatment are needed for improving TB outcomes and to prevent nosocomial transmission. OBJECTIVE To assess the time to treatment initiation and the risk factors associated with delayed treatment for patients started on TB treatment at Daru General Hospital from January to September 2017. DESIGN This was a retrospective cohort study that entailed reviewing the records from treatment, admission, discharge and presumptive TB registers. RESULTS The study included 360 patients on TB treatment. The median time from presentation to treatment initiation was 7 days [IQR 3-11]. Treatment was started <7 days for 215 patients (60%); however, only 16.2% commenced treatment <2 days. Risk factors for delayed treatment were diagnosis of TB as an inpatient (OR 2.67, 95% CI 1.35-5.28, P = 0.005) and having drug-resistant TB (OR 2.65, 95% CI 1.5-4.68. P = 0.001). CONCLUSION A high proportion of TB patients commenced treatment <7 days. Inpatient status, DR-TB and lack of microbiological confirmation were associated with delays in treatment initiation. We recommend that programmes monitor the time from presentation to treatment initiation, and propose that a period of >3 days from presentation to treatment initiation be considered as delayed treatment initiation.
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Affiliation(s)
- E Hapolo
- Daru General Hospital, Daru, Western Province, Papua New Guinea
| | - J Ilai
- Daru General Hospital, Daru, Western Province, Papua New Guinea
| | - T Francis
- Daru General Hospital, Daru, Western Province, Papua New Guinea
| | - P du Cros
- Burnet Institute, Melbourne, Victoria, Australia
| | - M Taune
- Daru General Hospital, Daru, Western Province, Papua New Guinea
| | - G Chan
- Burnet Institute, Melbourne, Victoria, Australia
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Apis V, Landi M, Graham SM, Islam T, Amini J, Sabumi G, Mandalakas AM, Meae T, du Cros P, Shewade HD, Welch H. Outcomes in children treated for tuberculosis with the new dispersible fixed-dose combinations in Port Moresby. Public Health Action 2019; 9:S32-S37. [PMID: 31579647 DOI: 10.5588/pha.18.0062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/12/2018] [Accepted: 01/13/2019] [Indexed: 12/30/2022] Open
Abstract
Setting The new child-friendly fixed dose combinations (FDCs) were introduced at Port Moresby General Hospital, Papua New Guinea, in 2016 for the first-line treatment of children (aged <15 years) with tuberculosis (TB) who weighed <25 kg. Objective To describe the characteristics and outcomes for children treated with the new FDCs, and to identify risk factors for unfavourable treatment outcomes. Design This was a retrospective cohort study of all children treated for TB with the FDCs from August 2016 to August 2017. Results Of 713 children included, 488 (68%) were diagnosed with pulmonary TB. Only 6 (0.8%) TB cases were bacteriologically confirmed and human immunodeficiency virus (HIV) status was known in 50%. Treatment outcomes were favourable in 425 (60%) children. Of 288 children with unfavourable outcomes, there were 242 (84%) with loss to follow-up (LTFU) and 25 (8.4%) were known to have died. Children who were severely underweight (weight-for-age Z score <-3) on presentation were at greater risk of LTFU compared to children of normal weight on multivariable analysis (aRR 1.3, 95%CI 1.0-1.6, P < 0.05). Conclusion Alternative models of care to decrease LTFU during treatment are needed, including integration with nutritional support. Improving diagnosis through microbiological confirmation of TB and HIV are major challenges to be addressed.
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Affiliation(s)
- V Apis
- Port Moresby General Hospital, Port Moresby, Papua New Guinea (PNG)
| | - M Landi
- Port Moresby General Hospital, Port Moresby, Papua New Guinea (PNG).,School of Medicine and Health Science, University of Papua New Guinea, Port Moresby, PNG
| | - S M Graham
- The Burnet Institute, Melbourne, Victoria, Australia.,Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - T Islam
- World Health Organization, Representative Office for PNG, Port Moresby, PNG
| | - J Amini
- National Department of Health, Port Moresby, PNG
| | - G Sabumi
- Health & HIV Implementation Services Provider, Abt JTA, Port Moresby, PNG
| | - A M Mandalakas
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - T Meae
- Port Moresby General Hospital, Port Moresby, Papua New Guinea (PNG)
| | - P du Cros
- The Burnet Institute, Melbourne, Victoria, Australia
| | - H D Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union, South-East Asia Office, New Delhi, India
| | - H Welch
- Port Moresby General Hospital, Port Moresby, Papua New Guinea (PNG).,School of Medicine and Health Science, University of Papua New Guinea, Port Moresby, PNG.,Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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10
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Kuhlin J, Smith C, Khaemraev A, Tigay Z, Parpieva N, Tillyashaykhov M, Achar J, Hajek J, Greig J, du Cros P, Moore D. Impact of pyrazinamide resistance on multidrug-resistant tuberculosis in Karakalpakstan, Uzbekistan. Int J Tuberc Lung Dis 2018; 22:544-550. [DOI: 10.5588/ijtld.17.0483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- J. Kuhlin
- London School of Hygiene & Tropical Medicine, London, UK
| | - C. Smith
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Z. Tigay
- Ministry of Health, Nukus, Uzbekistan
| | | | | | - J. Achar
- Medécins Sans Frontières, Manson Unit, London, UK
| | - J. Hajek
- University of British Columbia, Vancouver, British Columbia, Canada
| | - J. Greig
- Medécins Sans Frontières, Manson Unit, London, UK
| | - P. du Cros
- Medécins Sans Frontières, Manson Unit, London, UK
| | - D. Moore
- London School of Hygiene & Tropical Medicine, London, UK
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11
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Stringer B, Lowton K, Tillashaikhov M, Parpieva N, Ulmasova D, du Cros P, Hasker E, Sergeeva N. 'They prefer hidden treatment': anti-tuberculosis drug-taking practices and drug regulation in Karakalpakstan. Int J Tuberc Lung Dis 2018; 20:1084-90. [PMID: 27393544 DOI: 10.5588/ijtld.15.0815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING The joint Médecins Sans Frontières/Ministry of Health Multidrug-Resistant Tuberculosis (MDR-TB) Programme, Karakalpakstan, Uzbekistan. OBJECTIVE Uzbekistan has high rates of MDR-TB. We aimed to understand patients' and prescribers' attitudes to anti-tuberculosis drug prescription, regulation and drug-taking behaviour. METHODS Participants (12 patients, 12 practitioners) were recruited purposively. Data were gathered qualitatively using field notes and in-depth interviews and analysed thematically. FINDINGS Our analysis highlighted two main themes. First, shame and stigma were reported to increase the likelihood of self-treatment and incorrect use of anti-tuberculosis drugs, most commonly at the initial stages of illness. A health system failure to promote health information was perceived, leading to wrong diagnoses and inappropriate therapies. Motivated by shame, patients hid their condition by resorting to drug treatment options outside the programme, compounding the risk of chaotic management and dissemination of erroneous information through lay networks. Second, positive influences on treatment were reported through patients, practitioners and peers working effectively together to deliver the correct information and support, which acted to normalise TB, reduce stigma and prevent misuse of anti-tuberculosis drugs. CONCLUSION Effective case finding, patient support and community education strategies are essential. Patients, practitioners and peers working together can help reduce stigma and prevent misuse of anti-tuberculosis drugs.
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Affiliation(s)
- B Stringer
- Médecins Sans Frontières (MSF), London, UK
| | - K Lowton
- Department of Sociology, University of Sussex, London, UK
| | - M Tillashaikhov
- Republican Specialised Scientific and Practical Medical Centre of Phthisiology and Pulmonology, Ministry of Health Uzbekistan, Tashkent, Uzbekistan
| | - N Parpieva
- Republican Specialised Scientific and Practical Medical Centre of Phthisiology and Pulmonology, Ministry of Health Uzbekistan, Tashkent, Uzbekistan
| | - D Ulmasova
- Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
| | - P du Cros
- Médecins Sans Frontières (MSF), London, UK
| | - E Hasker
- Institute of Tropical Medicine, Antwerp, Belgium
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12
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Furin J, Alirol E, Allen E, Fielding K, Merle C, Abubakar I, Andersen J, Davies G, Dheda K, Diacon A, Dooley KE, Dravnice G, Eisenach K, Everitt D, Ferstenberg D, Goolam-Mahomed A, Grobusch MP, Gupta R, Harausz E, Harrington M, Horsburgh CR, Lienhardt C, McNeeley D, Mitnick CD, Nachman S, Nahid P, Nunn AJ, Phillips P, Rodriguez C, Shah S, Wells C, Thomas-Nyang'wa B, du Cros P. Drug-resistant tuberculosis clinical trials: proposed core research definitions in adults. Int J Tuberc Lung Dis 2017; 20:290-4. [PMID: 27046707 DOI: 10.5588/ijtld.15.0490] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Drug-resistant tuberculosis (DR-TB) is a growing public health problem, and for the first time in decades, new drugs for the treatment of this disease have been developed. These new drugs have prompted strengthened efforts in DR-TB clinical trials research, and there are now multiple ongoing and planned DR-TB clinical trials. To facilitate comparability and maximise policy impact, a common set of core research definitions is needed, and this paper presents a core set of efficacy and safety definitions as well as other important considerations in DR-TB clinical trials work. To elaborate these definitions, a search of clinical trials registries, published manuscripts and conference proceedings was undertaken to identify groups conducting trials of new regimens for the treatment of DR-TB. Individuals from these groups developed the core set of definitions presented here. Further work is needed to validate and assess the utility of these definitions but they represent an important first step to ensure there is comparability in clinical trials on multidrug-resistant TB.
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Affiliation(s)
- J Furin
- TB Research Unit, Case Western Reserve University School of Medicine, Room E-202, 2210 Circle Dr, Cleveland, OH 44149, USA.
| | - E Alirol
- Manson Unit Médicins Sans Frontières, London, UK
| | - E Allen
- Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - K Fielding
- Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - C Merle
- Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - I Abubakar
- Department of Infection and Population Health, University College of London, London, UK
| | - J Andersen
- Statistical and Data Analysis Center, Harvard School of Public Health, Boston, Massachusetts, USA
| | - G Davies
- Institutes of Infection and Global Health and of Translational Medicine, University of Liverpool, Liverpool, UK
| | - K Dheda
- Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - A Diacon
- Biomedical Sciences, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa
| | - K E Dooley
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - G Dravnice
- Tuberculosis Foundation, KNCV, Amsterdam, The Netherlands
| | - K Eisenach
- Pathology and Microbiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - D Everitt
- Global Alliance for TB Drug Development, New York, New York, USA
| | | | | | - M P Grobusch
- Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R Gupta
- Otsuka USA, Rockville, Maryland, USA
| | - E Harausz
- TB Research Unit, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - M Harrington
- Treatment Action Group, New York City, New York, USA
| | - C R Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - C Lienhardt
- Stop TB Partnership & Stop TB Department, World Health Organization, Geneva, Switzerland
| | - D McNeeley
- Medical Service Corp International, Arlington, Virginia, USA
| | - C D Mitnick
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - S Nachman
- Department of Pediatrics, Stony Brook School of Medicine, Stony Brook, New York, USA
| | - P Nahid
- Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
| | - A J Nunn
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
| | - P Phillips
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
| | - C Rodriguez
- Department of Respiratory Medicine, P D Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - S Shah
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - C Wells
- Otsuka USA, Rockville, Maryland, USA
| | | | - P du Cros
- Manson Unit Médicins Sans Frontières, London, UK
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13
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Furin J, Mafukidze A, Brigden G, du Cros P, Golin R, Harausz E, Seddon JA, Ustero P, Garcia-Prats AJ. A bitter pill to swallow: the need for better medications for drug-resistant tuberculosis in children. Int J Tuberc Lung Dis 2016; 19 Suppl 1:55-60. [PMID: 26564544 DOI: 10.5588/ijtld.15.0380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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
The large and growing access gap between the number of children who become sick with drug-resistant tuberculosis (DR-TB) and those who are treated for the disease each year represents a significant health systems failure. While there are multiple reasons why children with DR-TB are not diagnosed and treated, a serious challenge is the medications used to treat the disease. This paper presents three child DR-TB cases who were treated incorrectly; the cases are used to illustrate some of the problems with existing second-line medications. Challenges, including the perception that the drugs are more dangerous than the disease, lack of proper dosing recommendations and formulations, and the high cost of current treatment, all contribute to a perverse situation in which the most vulnerable pediatric patients are provided with a lower standard of care. This situation can be reversed with novel partnerships and training models, pharmacokinetic studies of the relevant drugs, increased collaboration, and dedicated funding, grounded in a rights-based approach to DR-TB in children.
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Affiliation(s)
- J Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - A Mafukidze
- University Research Corporation, Mbabne, Swaziland
| | - G Brigden
- Access Campaign, Médecins Sans Frontières (MSF), Geneva, Switzerland
| | | | - R Golin
- Baylor International Paediatric AIDS Initiative, Mbabane, Swaziland
| | - E Harausz
- TB Research Unit, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - P Ustero
- Global TB Childhood Programme, Baylor College of Medicine, Swaziland
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
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14
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Swaminathan A, du Cros P, Seddon JA, Quinnell S, Bobokhojaev OI, Dusmatova Z, Achar J. Treating children for drug-resistant tuberculosis in Tajikistan with Group 5 medications. Int J Tuberc Lung Dis 2016; 20:474-8. [DOI: 10.5588/ijtld.15.0666] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | - J. A. Seddon
- † Manson Unit, MSF, London, ‡ Imperial College London, London, UK
| | - S. Quinnell
- * Médecins Sans Frontières (MSF), Dushanbe, Tajikistan
| | - O. I. Bobokhojaev
- § National Tuberculosis Programme, Ministry of Health and Social Protection of the Republic of Tajikistan, Dushanbe, Tajikistan
| | - Z. Dusmatova
- * Médecins Sans Frontières (MSF), Dushanbe, Tajikistan
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15
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Bonnet M, Bastard M, du Cros P, Khamraev A, Kimenye K, Khurkhumal S, Hayrapetyan A, Themba D, Telnov A, Sanchez-Padilla E, Hewison C, Varaine F. Identification of patients who could benefit from bedaquiline or delamanid: a multisite MDR-TB cohort study. Int J Tuberc Lung Dis 2016; 20:177-86. [DOI: 10.5588/ijtld.15.0962] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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16
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du Cros P, Swaminathan A, Bobokhojaev OI, Sharifovna ZD, Martin C, Herboczek K, Höhn C, Seddon JA. Challenges and solutions to implementing drug-resistant tuberculosis programmes for children in Central Asia. Public Health Action 2015; 5:99-102. [PMID: 26400377 DOI: 10.5588/pha.15.0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/26/2015] [Accepted: 04/07/2015] [Indexed: 11/10/2022] Open
Abstract
Guidelines for children with drug-resistant tuberculosis (DR-TB) tend to focus on individual patient care; there is little guidance for national tuberculosis programmes (NTPs) on how to plan, implement and integrate DR-TB services for children. In 2013, through the paediatric tuberculosis (TB) programme started by the Tajikistan Ministry of Health and Médecins Sans Frontières in 2011, 21 children became the first to be treated for multidrug-resistant tuberculosis (MDR-TB) in Tajikistan. We describe the challenges encountered in establishing the programme and the solutions to these challenges, and propose a framework to guide the implementation of paediatric DR-TB care. This framework could prove useful for other NTPs in resource-limited settings.
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Affiliation(s)
- P du Cros
- Manson Unit, Médecins Sans Frontières (MSF), London, UK
| | | | - O I Bobokhojaev
- Ministry of Health and Social Protection of Population, Dushanbe, Tajikistan
| | - Z D Sharifovna
- Ministry of Health and Social Protection of Population, Dushanbe, Tajikistan
| | | | - K Herboczek
- Manson Unit, Médecins Sans Frontières (MSF), London, UK
| | - C Höhn
- MSF, Dushanbe, Tajikistan
| | - J A Seddon
- Manson Unit, Médecins Sans Frontières (MSF), London, UK ; Department of Paediatrics, Imperial College, London, UK
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17
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Russell GK, Merle CS, Cooke GS, Casas EC, Silveira da Fonseca M, du Cros P. Towards the WHO target of zero childhood tuberculosis deaths: an analysis of mortality in 13 locations in Africa and Asia. Int J Tuberc Lung Dis 2014; 17:1518-23. [PMID: 24200262 DOI: 10.5588/ijtld.13.0238] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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 Achieving the World Health Organization (WHO) target of zero paediatric tuberculosis (TB) deaths will require an understanding of the underlying risk factors for mortality. OBJECTIVE To identify risk factors for mortality and assess the impact of human immunodeficiency virus (HIV) testing during anti-tuberculosis treatment in children in 13 TB-HIV programmes run by Médecins Sans Frontières. DESIGN In a retrospective cohort study, we recorded mortality and analysed risk factors using descriptive statistics and logistic regression. Diagnosis was based on WHO algorithm and smear microscopy. RESULTS A total of 2451 children (mean age 5.2 years, SD 3.9) were treated for TB. Half (51.0%) lived in Asia, the remainder in sub-Saharan Africa; 56.0% had pulmonary TB; 6.4% were diagnosed using smear microscopy; 211 (8.6%) died. Of 1513 children tested for HIV, 935 (61.8%) were positive; 120 (12.8%) died compared with 30/578 (5.2%) HIV-negative children. Risk factors included being HIV-positive (OR 2.6, 95%CI 1.6-4.2), age <5 years (1.7, 95%CI 1.2-2.5) and having tuberculous meningitis (2.6, 95%CI 1.0-6.8). Risk was higher in African children of unknown HIV status than in those who were confirmed HIV-negative (1.9, 95%CI 1.1-3.3). CONCLUSIONS Strategies to eliminate childhood TB deaths should include addressing the high-risk groups identified in this study, enhanced TB prevention, universal HIV testing and the development of a rapid diagnostic test.
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18
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Ulmasova DJ, Uzakova G, Tillyashayhov MN, Turaev L, van Gemert W, Hoffmann H, Zignol M, Kremer K, Gombogaram T, Gadoev J, du Cros P, Muslimova N, Jalolov A, Dadu A, de Colombani P, Telnov O, Slizkiy A, Kholikulov B, Dara M, Falzon D. Multidrug-resistant tuberculosis in Uzbekistan: results of a nationwide survey, 2010 to 2011. ACTA ACUST UNITED AC 2013; 18. [PMID: 24176581 DOI: 10.2807/1560-7917.es2013.18.42.20609] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multidrug-resistant tuberculosis (MDR-TB; resistance to at least rifampicin and isoniazid) is a global public health concern. In 2010–2011, Uzbekistan, in central Asia, conducted its first countrywide survey to determine the prevalence of MDR-TB among TB patients. The proportion of MDR-TB among new and previously treated TB patients throughout the country was measured and risk factors for MDR-TB explored. A total of 1,037 patients were included. MDR-TB was detected in 165 treatment-naïve (23.2%; 95% confidence interval (CI) 17.8%–29.5%) and 207 previously treated (62.0%; 95% CI: 52.5%–70.7%) patients. In 5.3% (95% CI: 3.1%–8.4%) of MDR-TB cases, resistance to fluoroquinolones and second-line injectable drugs (extensively drug resistant TB; XDR-TB) was detected. MDR-TB was significantly associated with age under 45 years (adjusted odds ratio: 2.24; 95% CI: 1.45–3.45), imprisonment (1.93; 95% CI: 1.01–3.70), previous treatment (4.45; 95% CI: 2.66–7.43), and not owning a home (1.79; 95% CI: 1.01–3.16). MDR-TB estimates for Uzbekistan are among the highest reported in former Soviet Union countries. Efforts to diagnose, treat and prevent spread of MDR-TB need scaling up.
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19
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Toczek A, Cox H, du Cros P, Cooke G, Ford N. Strategies for reducing treatment default in drug-resistant tuberculosis: systematic review and meta-analysis [Review article]. Int J Tuberc Lung Dis 2013; 17:299-307. [DOI: 10.5588/ijtld.12.0537] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A. Toczek
- Faculty of Medicine, Imperial College London, UK
| | - H. Cox
- Médecins Sans Frontières, Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
| | - P. du Cros
- Manson Unit, Médecins Sans Frontières, London, UK
| | - G. Cooke
- Faculty of Medicine, Imperial College London, UK; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, South Africa
| | - N. Ford
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa; Manson Unit, Médecins Sans Frontières, London, UK
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20
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Majumdar S, O'Brien D, Hurtado N, Hewison C, du Cros P. The ‘frozen state’ of drug-resistant tuberculosis: notes from the field in Abkhazia. Intern Med J 2011; 41:805-8. [DOI: 10.1111/j.1445-5994.2011.02617.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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