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Atre S, Barthwal M, Gaikwad S, Sawant T, Sahasrabudhe T, Kakrani A, Lokhande R, Deshmukh S, Raskar S, Hodgar B, Jadhav V, Gupte N, Gupta A, Golub J, Mave V. Cascade of care for people with TB and diabetes in India. Int J Tuberc Lung Dis 2022; 26:787-788. [PMID: 35898132 DOI: 10.5588/ijtld.22.0180] [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] [Indexed: 11/10/2022] Open
Affiliation(s)
- S Atre
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - M Barthwal
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - S Gaikwad
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - T Sawant
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - T Sahasrabudhe
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - A Kakrani
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - R Lokhande
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - S Deshmukh
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - S Raskar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | | | | | - N Gupte
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - A Gupta
- Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J Golub
- Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - V Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Cox SR, Gupte AN, Thomas B, Gaikwad S, Mave V, Padmapriyadarsini C, Sahasrabudhe TR, Kadam D, Gupte N, Hanna LE, Kagal A, Paradkar M, Thiruvengadam K, Jain D, Atre S, Sekar K, Raskar S, Shivakumar SVBY, Santhappan R, Deshmukh S, Pradhan N, Kulkarni V, Kakrani A, Barthwal MS, Sawant T, DeLuca A, Suryavanshi N, Chander G, Bollinger R, Golub JE, Gupta A. Unhealthy alcohol use independently associated with unfavorable TB treatment outcomes among Indian men. Int J Tuberc Lung Dis 2021; 25:182-190. [PMID: 33688806 DOI: 10.5588/ijtld.20.0778] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Approximately 10% of incident TB cases worldwide are attributable to alcohol. However, evidence associating alcohol with unfavorable TB treatment outcomes is weak.METHODS: We prospectively evaluated men (≥18 years) with pulmonary TB in India for up to 24 months to investigate the association between alcohol use and treatment outcomes. Unhealthy alcohol use was defined as a score of ≥4 on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) scale at entry. Unfavorable TB treatment outcomes included failure, recurrence, and all-cause mortality, analyzed as composite and independent endpoints.RESULTS: Among 751 men, we identified unhealthy alcohol use in 302 (40%). Median age was 39 years (IQR 28-50); 415 (55%) were underweight (defined as a body mass index [BMI] <18.5 kg/m²); and 198 (26%) experienced an unfavorable outcome. Unhealthy alcohol use was an independent risk factor for the composite unfavorable outcome (adjusted incidence rate ratio [aIRR] 1.47, 95% CI 1.05-2.06; P = 0.03) and death (aIRR 1.90, 95% CI 1.08-3.34; P = 0.03), specifically. We found significant interaction between AUDIT-C and BMI; underweight men with unhealthy alcohol use had increased risk of unfavorable outcomes (aIRR 2.22, 95% CI 1.44-3.44; P < 0.001) compared to men with BMI ≥18.5 kg/m² and AUDIT-C <4.CONCLUSION: Unhealthy alcohol use was independently associated with unfavorable TB treatment outcomes, highlighting the need for integrating effective alcohol interventions into TB care.
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Affiliation(s)
- S R Cox
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - A N Gupte
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - B Thomas
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - S Gaikwad
- Byramjee Jeejeebhoy Government Medical College (BJGMC) and Sassoon General Hospital, Pune
| | - V Mave
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune
| | | | - T R Sahasrabudhe
- Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune
| | - D Kadam
- Byramjee Jeejeebhoy Government Medical College (BJGMC) and Sassoon General Hospital, Pune
| | - N Gupte
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune
| | - L E Hanna
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - A Kagal
- Byramjee Jeejeebhoy Government Medical College (BJGMC) and Sassoon General Hospital, Pune
| | - M Paradkar
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - K Thiruvengadam
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - D Jain
- BJGMC Clinical Research Site, Pune
| | - S Atre
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune, Johns Hopkins India Private Limited, Pune, India
| | - K Sekar
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - S Raskar
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - S V B Y Shivakumar
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, Johns Hopkins India Private Limited, Pune, India
| | - R Santhappan
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - S Deshmukh
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - N Pradhan
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - V Kulkarni
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - A Kakrani
- Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune
| | - M S Barthwal
- Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune
| | - T Sawant
- Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune
| | - A DeLuca
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - N Suryavanshi
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - G Chander
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - R Bollinger
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - J E Golub
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - A Gupta
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
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Deshmukh S, Atre S, Chavan A, Raskar S, Sawant T, Mave V, Gupte N, Gaikwad S, Sahasrabudhe T, Barthwal M, Kakrani A, Kagal A, Gupta A, Bharadwaj R, Pradhan N, Dharmshale S, Golub J. Assessment of the Xpert assay among adult pulmonary tuberculosis suspects with and without diabetes mellitus. Int J Tuberc Lung Dis 2020; 24:113-117. [DOI: 10.5588/ijtld.19.0239] [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
SETTING: Pune and Pimpri-Chinchwad Municipal Corporation area, Maharashtra State, India.OBJECTIVE: To assess the sensitivity and specificity of the Xpert® MTB/RIF assay among adults with suspected pulmonary tuberculosis (PTB) and with or without diabetes
(DM).DESIGN: As part of a prospective cohort study, we screened 2359 adults presumed to have PTB with no history of TB. All individuals underwent testing for two sputum smears, culture, Xpert, glycated haemoglobin and fasting blood sugar. We calculated sensitivity and specificity
of Xpert by comparing it with TB sputum culture result as a gold standard.RESULTS: Among screened individuals, 483 (20%) were diagnosed with DM and 1153 (49%) with pre-DM; 723 (31%) had no DM. Overall sensitivity of Xpert was 96% (95%CI 95–97) and specificity was 91% (95%CI
89–93). Xpert sensitivity was significantly higher among DM group (98%) than in the ‘No DM' (95%; P < 0.01) and pre-DM (96%; P < 0.05) groups. Among sputum smear-negative individuals, Xpert sensitivity was higher in the DM group than in the No DM (92% vs. 82%;
P = 0.054) and pre-DM group (92% vs. 82%; P = 0.037).CONCLUSION: High sensitivity and specificity of Xpert underscores the need for its rapid scale up for the early detection of TB in settings with a high dual burden of TB and DM.
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Affiliation(s)
- S. Deshmukh
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India, Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, USA
| | - S. Atre
- Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, USA, Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - A. Chavan
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India
| | - S. Raskar
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India
| | - T. Sawant
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - V. Mave
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - N. Gupte
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - S. Gaikwad
- Byramjee-Jeejeebhoy Government Medical College, Pune India
| | - T. Sahasrabudhe
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - M. Barthwal
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - A. Kakrani
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - A. Kagal
- Byramjee-Jeejeebhoy Government Medical College, Pune India
| | - A. Gupta
- Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, USA, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - R. Bharadwaj
- Byramjee-Jeejeebhoy Government Medical College, Pune India
| | - N. Pradhan
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India
| | - S. Dharmshale
- Byramjee-Jeejeebhoy Government Medical College, Pune India
| | - J. Golub
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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