Objective: To compare the incidence and severity of pregnancy-induced hypertensive disorders in twin pregnancy and in singleton gestation. Study design: Case-control study in the setting of a University HOspital. Each pregnancy of a consecutive series of 187 twin pregnancies attending the antenatal clinic and booked before a gestational age of 24 weeks was matched for maternal age, parity, and gestational age at delivery with a singleton pregnancy delivered in the same year. Primary end points of the analysis of the course and outcome of pregnancy were pregnancy-induced hypertension and proteinuric pre-eclampsia. Results: In the twin pregnancy group, 21% of patients met the criteria for the diagnosis of a pregnancy-induced hypertensive disorder, compared with 13% in the singleton pregnancy group (P < 0.05). The difference was due to a significantly higher incidence of pregnancy-induced hypertension in twin (15%) than in singleton (6%) pregnancy (P < 0.05), in particular in nulliparous women. The incidence of preeclampsia was similar in twin (6%) and singleton pregnancies (6.5%), without a difference in severity and in the occurrence of the HELLP syndrome. Conclusion: The incidence of non-proteinuric pregnancy-induced hypertension, but not of proteinuric preeclampsia, is increased in twin pregnancy.

Introduction Drug-resistant TB (DR-TB) care shifted from centralized to decentralized care in Tanzania in 2015. This study explored whether DR-TB training and mentoring supported healthcare workers’ (HCWs) DR-TB care performance. Methods This mixed study assessed HCWs’ DR-TB care knowledge, the training quality, and the mentoring around 454 HCWs who were trained across 55 DR-TB sites between January 2016 and December 2017. Pre- and post-training tests, end-of-training evaluation, supervisor’s interviews, DR-TB team self-assessment and team focus group discussion were conducted among trained HCWs. Interim and final treatment results of the national central site and the decentralized sites were compared. Results HCW’s knowledge increased for 15–20% between pre-training and post-training. HCWs and supervisors perceived mentoring as most appropriate to further develop their DR-TB competencies. Culture negativity after 6 months of treatment was similar for the decentralized sites compared to the national central site, 81% vs 79%, respectively, whereas decentralized sites had less loss to follow-up (0% versus 3%) and fewer deaths (3% versus 12%). Delays in laboratory results, stigma, and HCWs shortage were reported the main challenges of decentralized care. Conclusions Training and mentoring to provide DR-TB care at decentralized sites in Tanzania improved HCWs’ knowledge and skills in DR-TB care and supported observed good interim and final patient treatment outcomes despite health system challenges.

Background BPaL, a 6 month oral regimen composed of bedaquiline, pretomanid, and linezolid for treating extensively drug-resistant tuberculosis (XDR-TB) is a potential alternative for at least 20 months of individualized treatment regimens (ITR). The ITR has low tolerability, treatment adherence, and success rates, and hence to limit patient burden, loss to follow-up and the emergence of resistance it is essential to implement new DR-TB regimens. The objective of this study was to assess the acceptability, feasibility, and likelihood of implementing BPaL in Indonesia, Kyrgyzstan, and Nigeria. Methods We conducted a concurrent mixed-methods study among a cross-section of health care workers, programmatic and laboratory stakeholders between May 2018 and May 2019. We conducted semi-structured interviews and focus group discussions to assess perceptions on acceptability and feasibility of implementing BPaL. We determined the proportions of a recoded 3-point Likert scale (acceptable; neutral; unacceptable), as well as the overall likelihood of implementing BPaL (likely; neutral; unlikely) that participants graded per regimen, pre-defined aspect and country. We analysed the qualitative results using a deductive framework analysis. Results In total 188 stakeholders participated in this study: 63 from Kyrgyzstan, 51 from Indonesia, and 74 from Nigeria The majority were health care workers (110). Overall, 88% (146/166) of the stakeholders would likely implement BPaL once available. Overall acceptability for BPaL was high, especially patient friendliness was often rated as acceptable (93%, 124/133). In contrast, patient friendliness of the ITR was rated as acceptable by 45%. Stakeholders appreciated that BPaL would reduce workload and financial burden on the health care system. However, several stakeholders expressed concerns regarding BPaL safety (monitoring), long-term efficacy, and national regulatory requirements regarding introduction of the regimen. Stakeholders stressed the importance of addressing current health systems constraints as well, especially in treatment and safety monitoring systems. Conclusions Acceptability and feasibility of the BPaL regimen is high among TB stakeholders in Indonesia, Kyrgyzstan, and Nigeria. The majority is willing to start using BPaL as the standard of care for eligible patients despite country-specific health system constraints.

Objective In 2018, shorter treatment regimens (STR) for people with drug‐resistant tuberculosis (DR‐TB) were introduced in Tanzania and included kanamycin, high‐dose moxifloxacin, prothionamide, high‐dose isoniazid, clofazimine, ethambutol and pyrazinamide. We describe treatment outcomes of people diagnosed with DR‐TB in a cohort initiating treatment in 2018 in Tanzania. Methods This was a retrospective cohort study conducted at the National Centre of Excellence and decentralised DR‐TB treatment sites for the 2018 cohort followed from January 2018 to August 2020. We reviewed data from the National Tuberculosis and Leprosy Program DR‐TB database to assess clinical and demographic information. The association between different DR‐TB regimens and treatment outcome was assessed using logistic regression analysis. Treatment outcomes were described as treatment complete, cure, death, failure or lost to follow‐up. A successful treatment outcome was assigned when the patient achieved treatment completion or cure. Results A total of 449 people were diagnosed with DR‐TB of whom 382 had final treatment outcomes: 268 (70%) cured; 36 (9%) treatment completed; 16 (4%) lost to follow‐up; 62 (16%) died. There was no treatment failure. The treatment success rate was 79% (304 patients). The 2018 DR‐TB treatment cohort was initiated on the following regimens: 140 (46%) received STR, 90 (30%) received the standard longer regimen (SLR), 74 (24%) received a new drug regimen. Normal nutritional status at baseline [adjusted odds ratio (aOR) = 6.57, 95% CI (3.33–12.94), p < 0.001] and the STR [aOR = 2.67, 95% CI (1.38–5.18), p = 0.004] were independently associated with successful DR‐TB treatment outcome. Conclusion The majority of DR‐TB patients on STR in Tanzania achieved a better treatment outcome than on SLR. The acceptance and implementation of STR at decentralised sites promises greater treatment success. Assessing and improving nutritional status at baseline and introducing new shorter DR‐TB treatment regimens may strengthen favourable treatment outcomes.