Factors affecting outcomes of individualised treatment for drug resistant tuberculosis in an endemic region

Saha, Avinandan; Vaidya, Preyas J; Chavhan, Vinod B; Pandey, Kanti Bhooshan; Kate, Arvind; Leüppi, Jörg D.; Tamm, Michael; Chhajed, Prashant N.

doi:10.1016/j.ijtb.2017.04.001

Cited by 4 publications

(6 citation statements)

References 17 publications

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“…For RR or MDR TB, men had higher unfavorable outcomes in 4 studies [ 128 – 131 ] ( Fig 9 ). Sex had nonsignificant associations in 4 studies [ 132 – 135 ]. Older age—more than 35 or 45 years or per each year increase—was associated with unfavorable outcomes in 4 studies [ 129 , 131 , 132 , 136 ].…”

Section: Resultsmentioning

confidence: 99%

“…Sex had nonsignificant associations in 4 studies [ 132 – 135 ]. Older age—more than 35 or 45 years or per each year increase—was associated with unfavorable outcomes in 4 studies [ 129 , 131 , 132 , 136 ]. Age had nonsignificant associations in 7 studies [ 128 , 130 , 133 – 135 , 137 , 138 ].…”

Section: Resultsmentioning

confidence: 99%

“…Only statistically significant findings are presented. Some studies in the review with adjusted analyses reported nonsignificant findings for sex [ 132 – 135 ], age [ 128 , 130 , 133 – 135 , 137 , 138 ], previous TB history [ 135 , 137 ], cavitary disease [ 135 ], HIV status [ 128 , 134 ], BMI/weight [ 134 , 135 , 140 ], and tobacco use [ 139 ]. BMI, body mass index; CI, confidence interval; DOT, directly observed therapy; HIV, human immunodeficiency virus; kg, kilogram; LPA, line probe assay; MDR, multidrug-resistant; RR, rifampin-resistant; TB, tuberculosis.…”

Section: Resultsmentioning

confidence: 99%

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Barriers to engagement in the care cascade for tuberculosis disease in India: A systematic review of quantitative studies

Jhaveri,

Galivanche

et al. 2024

PLoS Med

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Background India accounts for about one-quarter of people contracting tuberculosis (TB) disease annually and nearly one-third of TB deaths globally. Many Indians do not navigate all care cascade stages to receive TB treatment and achieve recurrence-free survival. Guided by a population/exposure/comparison/outcomes (PECO) framework, we report findings of a systematic review to identify factors contributing to unfavorable outcomes across each care cascade gap for TB disease in India. Methods and findings We defined care cascade gaps as comprising people with confirmed or presumptive TB who did not: start the TB diagnostic workup (Gap 1), complete the workup (Gap 2), start treatment (Gap 3), achieve treatment success (Gap 4), or achieve TB recurrence-free survival (Gap 5). Three systematic searches of PubMed, Embase, and Web of Science from January 1, 2000 to August 14, 2023 were conducted. We identified articles evaluating factors associated with unfavorable outcomes for each gap (reported as adjusted odds, relative risk, or hazard ratios) and, among people experiencing unfavorable outcomes, reasons for these outcomes (reported as proportions), with specific quality or risk of bias criteria for each gap. Findings were organized into person-, family-, and society-, or health system-related factors, using a social-ecological framework. Factors associated with unfavorable outcomes across multiple cascade stages included: male sex, older age, poverty-related factors, lower symptom severity or duration, undernutrition, alcohol use, smoking, and distrust of (or dissatisfaction with) health services. People previously treated for TB were more likely to seek care and engage in the diagnostic workup (Gaps 1 and 2) but more likely to suffer pretreatment loss to follow-up (Gap 3) and unfavorable treatment outcomes (Gap 4), especially those who were lost to follow-up during their prior treatment. For individual care cascade gaps, multiple studies highlighted lack of TB knowledge and structural barriers (e.g., transportation challenges) as contributing to lack of care-seeking for TB symptoms (Gap 1, 14 studies); lack of access to diagnostics (e.g., X-ray), non-identification of eligible people for testing, and failure of providers to communicate concern for TB as contributing to non-completion of the diagnostic workup (Gap 2, 17 studies); stigma, poor recording of patient contact information by providers, and early death from diagnostic delays as contributing to pretreatment loss to follow-up (Gap 3, 15 studies); and lack of TB knowledge, stigma, depression, and medication adverse effects as contributing to unfavorable treatment outcomes (Gap 4, 86 studies). Medication nonadherence contributed to unfavorable treatment outcomes (Gap 4) and TB recurrence (Gap 5, 14 studies). Limitations include lack of meta-analyses due to the heterogeneity of findings and limited generalizability to some Indian regions, given the country’s diverse population. Conclusions This systematic review illuminates common patterns of risk that shape outcomes for Indians with TB, while highlighting knowledge gaps—particularly regarding TB care for children or in the private sector—to guide future research. Findings may inform targeting of support services to people with TB who have higher risk of poor outcomes and inform multicomponent interventions to close gaps in the care cascade.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Barriers to engagement in the care cascade for tuberculosis disease in India: A systematic review of quantitative studies

Jhaveri,

Galivanche

et al. 2024

PLoS Med

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“…Clinical pharmacist applies the clinical knowledge on disease prevention and management, identification and solving drug related problems in the community. The drug resistant can be prevented through proper understanding of the mechanism of drug nature, early treatment initiation and good follow up patients for medication adherence, proper storage of drugs, effective infection control practices, early diagnosis and improving patient's health related quality of life will motivates the effective control of drug resistance problem [33,34]. Clinical pharmacist should positioned in the community care and initiation of awareness programmes on prevention and management meeting effective prescribing pattern of second line drugs can reduce the drug resistance problem in the community care.…”

Section: Resultsmentioning

confidence: 99%

A Review on Clinical Pharmacist Care Services on Prevention and Management of Tuberculosis associated Burden in Health Care Practice

Male¹

2019

Madridge J Intern Emerg Med

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Tuberculosis is caused by a highly transmissible microorganism, and Mycobacterium tuberculosis spreads infection through air due to coughing, sneezing, spiting and talking imposes major health problems in the community. Every year more than 2 million people die with tuberculosis from Africa, China, and South East Asia having higher incidences. Around 2,80,000 people get affected by tuberculosis in India, the second highest drug resistance tuberculosis affected country in the world. The tuberculosis patients suffer with weight loss, loss of appetite, fever, sticky blood in sputum, chest pain and fatigue. Drug resistant tuberculosis often encountered by bacteria that do not respond to anti-tubercular drugs like Isoniazid and Rifampicin. Drug resistance emerges due to premature treatment pattern, poor medication adherence, ineffective drug formulations and poor quality of medications, improper storage and act of self medications. Though effective treatments are provided by the physician, the prevention and management of tuberculosis is now called for intervention by health care team. Clinical pharmacist being one in health care team can be effectively positioned in the treatment care can initiate and implement health screening awareness programme, education on early diagnosis, infection control practices, drug resistance burden awareness and offering supportive care. Clinical pharmacist in all clinical setup and community health care centre can render meticulous services in the eradication of tuberculosis disease.

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“…A diagnosis of drug-resistant TB can only be made based on microbiological testing of tissue samples. Furthermore, treatment regimens that have been individualised following DST have shown better outcomes in the treatment of drug-resistant TB compared to protocol-based fixed regimens [9]. Therefore, tissue sampling for microbiological testing is necessary.…”

Section: Introductionmentioning

confidence: 99%

EBUS-TBNA in the rapid microbiological diagnosis of drug-resistant mediastinal tuberculous lymphadenopathy

et al. 2019

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This study aimed to examine the use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the rapid diagnosis of mediastinal tuberculous lymphadenitis and drug-resistant mediastinal tuberculous lymphadenitis.A diagnosis of TB was confirmed by a positive Xpert MTB/RIF test or Mycobacterium tuberculosis culture. Rifampicin-resistant TB (RR-TB) or multidrug-resistant TB (MDR-TB) was diagnosed upon the detection of rifampicin resistance by Xpert MTB/RIF or resistance to rifampicin and isoniazid by phenotypic drug susceptibility testing (DST).Xpert MTB/RIF was positive in 43 of 56 patients (77%) and TB culture was positive in 31 of 56 patients (55%). Of these 56 patients, 25 (45%) were Xpert MTB/RIF positive and TB culture negative, 13 (23%) were Xpert MTB/RIF negative and TB culture positive, and 18 (32%) were Xpert MTB/RIF positive and TB culture positive. 11 patients (20%) had drug-resistant TB: seven with RR/MDR-TB, one with pre-extensively drug-resistant (XDR) TB, two with XDR-TB and one with isoniazid mono-resistance.An Xpert MTB/RIF assay carried out on EBUS-TBNA specimens provides rapid diagnosis of TB. Xpert MTB/RIF testing appears to have additional and more rapid sensitivity compared with culture alone. Culture-based DST provides an additional exclusive yield and the full resistance profile in addition to or instead of rifampicin resistance.

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Factors affecting outcomes of individualised treatment for drug resistant tuberculosis in an endemic region

Cited by 4 publications

References 17 publications

Barriers to engagement in the care cascade for tuberculosis disease in India: A systematic review of quantitative studies

Barriers to engagement in the care cascade for tuberculosis disease in India: A systematic review of quantitative studies

A Review on Clinical Pharmacist Care Services on Prevention and Management of Tuberculosis associated Burden in Health Care Practice

EBUS-TBNA in the rapid microbiological diagnosis of drug-resistant mediastinal tuberculous lymphadenopathy

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