Increasing directly observed therapy related to improved tuberculosis treatment outcomes in Taiwan

Bloss, Emily; Pc, Chan; Nw, Cheng; Wang, K-F.; Sl, Yang; Cegielski, Peter

doi:10.5588/ijtld.11.0121

Cited by 26 publications

(14 citation statements)

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“…In this study, smear positive PTB was found to be associated with poor treatment outcome as previously reported [23]. In contrast to our finding, however, some studies [8,19] reported that having smear positive PTB is associated with favorable treatment outcomes.…”

Section: Discussionsupporting

confidence: 62%

Childhood tuberculosis and its treatment outcomes in Addis Ababa: a 5-years retrospective study

Hailu¹,

Abegaz

Belay

2014

BMC Pediatr

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BackgroundTuberculosis (TB) remains a significant public health problem leading to high morbidity and mortality both in adults and children. Reports on childhood TB and its treatment outcome are limited. In this retrospective study, we analyzed the epidemiology and treatment outcomes of TB among children in Addis Ababa.MethodsChildren registered for TB treatment over 5 years (2007 to 2011) were included in the analysis. Demographic and clinical data including treatment outcomes were extracted from TB unit registers of 23 health centers in Addis Ababa. Multivariate logistic regression was used to identify predictors of poor treatment outcomes.ResultsAmong 41,254 TB patients registered for treatment at the 23 health centers, 2708 (6.6%) were children. Among children with TB, the proportions of smear positive PTB, smear negative PTB and EPTB were 9.6%, 43.0% and 47.4%, respectively. Treatment outcomes were documented for 95.2% of children of whom 85.5% were successfully treated while rates of mortality and defaulting from treatment were 3.3% and 3.8%, respectively. The proportion of children with TB tested for HIV reached 88.3% during the final year of the study period compared to only 3.9% at the beginning of the study period. Mortality was significantly higher among under-five children (p < 0.001) and those with HIV co-infection (p < 0.001). On multivariate logistic regression, children 5–9 years [AOR = 2.50 (95% CI 1.67-3.74)] and 10–14 years [AOR = 2.70 (95% CI 1.86-3.91)] had a significantly higher successful treatment outcomes. On the other hand, smear positive PTB [AOR = 0.44 (95% CI 0.27-0.73), HIV co-infection (AOR = 0.49(95% CI 0.30-0.80)] and unknown HIV sero-status [AOR = 0.60 (95% CI 0.42-0.86)] were predictors of poor treatment outcomes.ConclusionThe proportion of childhood TB in this study is lower than the national estimate. The overall treatment success rate has met the WHO target. Nonetheless, younger children (< 5 years), children with smear positive PTB and those with HIV co-infection need special attention to reduce poor treatment outcomes among children in the study area.

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Section: Discussionsupporting

confidence: 62%

Childhood tuberculosis and its treatment outcomes in Addis Ababa: a 5-years retrospective study

Hailu¹,

Abegaz

Belay

2014

BMC Pediatr

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“…The default rate (4.9%) encompassed the foremost part of the unsuccessful outcome and was higher than that (0.6-3.8%) reported from other regions (Hailu, Abegaz & Belay, 2014;Satyanarayana et al, 2010;Tilahun & Gebre-Selassie, 2016) but lower (7%) than that informed by Aketi et al, 2016. In multivariate analysis, rural areas, sputum smear positivity, underweight, and retreatment were significantly associated with poor treatment outcomes. These findings are in line with previous studies (Bloss et al, 2012;Jaganath & Mupere, 2012;Sharma et al, 2008). The most important reason for all these risk factors could be non-adherence due to lack of education among the caregivers.…”

Section: Discussionsupporting

confidence: 94%

Peer Review #2 of "Epidemiology of tuberculosis and treatment outcomes among children in Pakistan: a 5 year retrospective study (v0.2)"

Russo¹

2018

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Background: Regardless of the advancement in medical technologies, the diagnosis of tuberculosis (TB) in children has remained a challenge. Childhood TB is rampant and an important cause of morbidity and mortality. The objective of this study was to determine the trend of TB and treatment outcomes in children aged ≤ 14 years registered for TB treatment under DOTS course in 3 districts of Sindh, Pakistan. Methods: For this retrospective study, records of TB children (≤ 14 years) registered for the treatment of TB from January 2011 to December 2015 in 3 districts of Pakistan, were collected. Demographic data, baseline weight, clinical manifestations, radiography, histopathology results and treatment outcomes were collected from TB unit registers. Results: A total of 2,167 children were treated for TB during the study period. Of these, 1,199 (55.3%) were females and 1,242 (57.3%) were from urban areas. Over three-quarter of patients (76.9%) had pulmonary TB with 13.3% of sputum smear positive cases. The overall treatment success rate was 92.4%. In multivariate analysis, rural residents (OR: 2.146, p < 0.001), sputum smear positive cases (OR: 3.409, p < 0.001) and retreated patients (OR: 5.919, p < 0.001), were significantly associated with unsuccessful treatment outcomes. However, age group ≤ 2 years, male and those who were underweight were found to have the highest risk of pulmonary tuberculosis (OR: 1.953, p < 0.001; OR: 1.262, p = 0.028; OR: 1.342, p = 0.008), respectively. Conclusion: Patients at risk of treatment failure must be given particular attention. Moreover, strategies are needed to further improve the diagnosis and treatment of TB among children and improve the recording system.

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“…One of the possible reasons for this is the high percentage (129/134, 96.3%) of directly observed therapy (DOT). The CDC of Taiwan has enforced the DOT program since 2006, and the implementation rate of DOT for TB case now exceeds 90% [16]. In Taiwan, once a TB case is verified, the patient is invited to participate in the DOT program.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Treatment Outcomes of Patients with Low- and High-Concentration Isoniazid-Monoresistant Tuberculosis

et al. 2014

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BackgroundIsoniazid (INH) resistance is now the most common type of tuberculosis (TB) infection resistance worldwide. The aim of this study was to evaluate the clinical characteristics and treatment outcomes of patients with low- and high-concentration INH-monoresistant TB.MethodsOne hundred and thirty-four patients with culture-confirmed INH-monoresistant TB during 2006 January to 2007 December were retrospectively enrolled. INH resistance was classified as either low-concentration or high-concentration resistance according to the critical concentrations of 0.2 µg/mL or 1 µg/mL of INH, respectively. The patients’ clinical outcomes, treatment regimens, and treatment duration were analyzed.ResultsThe treatment success rates between low- and high-concentration INH-resistant TB were similar (81.8% vs. 86.7%). The treatment regimens and treatment duration were similar between both groups. Only a minor percentage of the patients in both groups received 6-month treatment regimens (low vs. high concentration resistance, 9.1% vs. 13.3%; respectively, p = 0.447) The most common reason for treatment duration longer than 6 months was pyrazinamide given for less than 6 months, followed by a delay in clinical response to treatment. Multivariable analysis showed that prior tuberculosis treatment (Odds ratio, 2.82, 95% C.I., 1.02–7.77, p = 0.045) was the only independent risk factor for unsuccessful treatment outcome.ConclusionDifferent levels of INH resistance did not affect the treatment outcomes of patients with INH-monoresistant tuberculosis. Prolonged Rifampin-containing regimens may achieve those good outcomes in patients with low- and high-concentration INH-monoresistant TB.

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Increasing directly observed therapy related to improved tuberculosis treatment outcomes in Taiwan

Abstract: These findings highlight the importance of ensuring universal DOT in improving treatment outcomes among new pulmonary TB patients.

Cited by 26 publications

References 0 publications

Childhood tuberculosis and its treatment outcomes in Addis Ababa: a 5-years retrospective study

Childhood tuberculosis and its treatment outcomes in Addis Ababa: a 5-years retrospective study

Peer Review #2 of "Epidemiology of tuberculosis and treatment outcomes among children in Pakistan: a 5 year retrospective study (v0.2)"

Clinical Characteristics and Treatment Outcomes of Patients with Low- and High-Concentration Isoniazid-Monoresistant Tuberculosis

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