Patients with MDR-TB on domiciliary care in programmatic settings in Myanmar: Effect of a support package on preventing early deaths

Wai, Pyae Phyo; Shewade, Hemant Deepak; Kyaw, Nang Thu Thu; Kyaw, Khine Wut Yee; Thein, Soe; Thu, Aung; Oo, Myo Minn; Htwe, Pyae Sone; Tun, Moe Myint Theingi; Maung, Htet Myet Win; Soe, Kyaw; Aung, Si Thu

doi:10.1371/journal.pone.0187223

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…To address this issue all patients in Amhara region received food packages obtained from the global fund but they are not very adequate. Economical support and early nutritional intervention has been shown to reduce the mortality of MDR-TB patients [28, 39], and in resource-limited settings, profound undernutrition and gastrointestinal toxicities have been noted during MDR-TB treatment [37]. Malnutrition is also a predisposing factor for impaired host immunity to TB.…”

Section: Discussionmentioning

confidence: 99%

Predictors of mortality among multidrug-resistant tuberculosis patients in central Ethiopia: a retrospective follow-up study

et al. 2020

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The burden of multidrug-resistant tuberculosis (MDR-TB) related to mortality in resource-poor countries remains high. This study aimed to estimate the incidence and predictors of death among MDR-TB patients in central Ethiopia. A retrospective follow-up study was conducted at three hospitals in the Amhara region on 451 patients receiving treatment for MDR-TB from September 2010 to January 2017. Data were collected from patient registration books, charts and computer databases. Data were fitted to a parametric frailty model and survival was expressed as an adjusted hazard ratio (AHR) with a 95% confidence interval (CI). The median follow-up time of participants was 20 months (interquartile range: 12, 22) and 46 (10.20%) of patients died during this period. The incidence rate of mortality was 7.42 (95% CI 5.56–9.91)/100 person-years. Older age (AHR = 1.04, 95% CI 1.01–1.08), inability to self-care (AHR = 13.71, 95% CI 5.46–34.40), co-morbidity (AHR = 5.74, 95% CI 2.19–15.08), low body mass index (AHR = 4.13, 95% CI 1.02–16.64), acute lung complications (AHR = 4.22, 95% CI 1.66–10.70) and lung consolidation at baseline (AHR = 5.27, 95% CI 1.06–26.18) were independent predictors of mortality. Most of the identified predictor factors of death in this study were considered to be avoidable if the TB programme had provided nutritional support for malnourished patients and ensured a close follow-up of the elderly, and patients with co-morbidities.

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Section: Discussionmentioning

confidence: 99%

Predictors of mortality among multidrug-resistant tuberculosis patients in central Ethiopia: a retrospective follow-up study

et al. 2020

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“…Five studies that provided socioeconomic or psychosocial support during treatment reported treatment success among at least 71% of children and adolescents with tuberculosis. 55 – 58 , 62 …”

Section: Resultsmentioning

confidence: 99%

Tuberculosis care models for children and adolescents: a scoping review

Yuen¹,

Szkwarko²,

Dubois³

et al. 2022

Bull World Health Org

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Objective To map which tuberculosis care models are best suited for children and adolescents. Methods We conducted a scoping review to assess the impact of decentralized, integrated and family-centred care on child and adolescent tuberculosis-related outcomes, describe approaches for these care models and identify key knowledge gaps. We searched seven literature databases on 5 February 2021 (updated 16 February 2022), searched the references of 18 published reviews and requested data from ongoing studies. We included studies from countries with a high tuberculosis burden that used a care model of interest and reported tuberculosis diagnostic, treatment or prevention outcomes for an age group < 20 years old. Findings We identified 28 studies with a comparator group for the impact assessment and added 19 non-comparative studies to a qualitative analysis of care delivery approaches. Approaches included strengthening capacity in primary-level facilities, providing services in communities, screening for tuberculosis in other health services, co-locating tuberculosis and human immunodeficiency virus treatment, offering a choice of treatment location and providing social or economic support. Strengthening both decentralized diagnostic services and community linkages led to one-to-sevenfold increases in case detection across nine studies and improved prevention outcomes. We identified only five comparative studies on integrated or family-centred care, but 11 non-comparative studies reported successful treatment outcomes for at least 71% of children and adolescents. Conclusion Strengthening decentralized services in facilities and communities can improve tuberculosis outcomes for children and adolescents. Further research is needed to identify optimal integrated and family-centred care approaches.

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“…Therefore, as a first ever study, we aimed to assess whether the Union’s CBMDR-TBC project improved treatment initiation in patients diagnosed with MDR-TB. The effect of CBMDR-TBC project on unfavourable outcomes and death among registered patients during initial 8 months of treatment is published elsewhere [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Community-based MDR-TB care project improves treatment initiation in patients diagnosed with MDR-TB in Myanmar

Wai¹,

Shewade²,

Kyaw³

et al. 2018

PLoS ONE

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BackgroundThe Union in collaboration with national TB programme (NTP) started the community-based MDR-TB care (CBMDR-TBC) project in 33 townships of upper Myanmar to improve treatment initiation and treatment adherence. Patients with MDR-TB diagnosed/registered under NTP received support through the project staff, in addition to the routine domiciliary care provided by NTP staff. Each township had a project nurse exclusively for MDR-TB and 30 USD per month (max. for 4 months) were provided to the patient as a pre-treatment support.ObjectivesTo assess whether CBMDR-TBC project’s support improved treatment initiation.MethodsIn this cohort study (involving record review) of all diagnosed MDR-TB between January 2015 and June 2016 in project townships, CBMDR-TBC status was categorized as “receiving support” if date of project initiation in patient’s township was before the date of diagnosis and “not receiving support”, if otherwise. Cox proportional hazards regression (censored on 31 Dec 2016) was done to identify predictors of treatment initiation.ResultsOf 456 patients, 57% initiated treatment: 64% and 56% among patients “receiving support (n = 208)” and “not receiving support (n = 228)” respectively (CBMDR-TBC status was not known in 20 (4%) patients due to missing diagnosis dates). Among those initiated on treatment (n = 261), median (IQR) time to initiate treatment was 38 (20, 76) days: 31 (18, 50) among patients “receiving support” and 50 (26,101) among patients “not receiving support”. After adjusting other potential confounders (age, sex, region, HIV, past history of TB treatment), patients “receiving support” had 80% higher chance of initiating treatment [aHR (0.95 CI): 1.8 (1.3, 2.3)] when compared to patients “not receiving support”. In addition, age 15–54 years, previous history of TB and being HIV negative were independent predictors of treatment initiation.ConclusionReceiving support under CBMDR-TBC project improved treatment initiation: it not only improved the proportion initiated but also reduced time to treatment initiation. We also recommend improved tracking of all diagnosed patients as early as possible.

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Patients with MDR-TB on domiciliary care in programmatic settings in Myanmar: Effect of a support package on preventing early deaths

Cited by 5 publications

References 8 publications

Predictors of mortality among multidrug-resistant tuberculosis patients in central Ethiopia: a retrospective follow-up study

Predictors of mortality among multidrug-resistant tuberculosis patients in central Ethiopia: a retrospective follow-up study

Tuberculosis care models for children and adolescents: a scoping review

Community-based MDR-TB care project improves treatment initiation in patients diagnosed with MDR-TB in Myanmar

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