Directly Observed Treatment Short Course Programme Research Articles

Factors Affecting the Success of the National Tuberculosis Control Program in Hospitals in Indonesia Based on the National Hospital Accreditation Standards (SNARS): A Scoping Review

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Tuberculosis (TB) is an infectious disease that is one of the leading causes of health problems worldwide and in developing countries. Hospitals have a very important role in the success of Tuberculosis control programs. Tuberculosis prevention and control encompass a range of health initiatives that are designed to safeguard public health, mitigate morbidity, disability, and death rates, disrupt the spread of the illness, combat medication resistance, and alleviate the adverse consequences associated with Tuberculosis. This scoping review aims to assess the factors that influence the success of the national tuberculosis control program in hospitals based on the National Hospital Accreditation Standards. A scoping review was conducted in this work, utilizing four databases: Google Scholar, Ebsco, Pro Quest, and Science Direct. The PRISMA Flowchart is a tool used to guide the process of selecting research publications. The inclusion exclusion criteria in the article search were limited to the last 10 years, starting from 2014 to 2023. The results of the scoping review showed that the factors influencing the success of the national tuberculosis program in hospitals based on the National Hospital Accreditation Standards are health promotion, early detection of tuberculosis or health screening, tuberculosis surveillance, risk factor control, surveillance of tuberculosis case finding and treatment, provision of immunity with vaccines and provision of tuberculosis preventive drugs. And in an effort to enhance the effectiveness of the Tuberculosis program, the government, hospitals, and communities should prioritize the implementation of the Directly Observed Treatment Shortcourse program in hospitals to ensure its smooth execution</em></p><p><em> </em></p></td></tr></tbody></table></div><strong><em>Keywords: Tuberculosis, Hospital, Program</em></strong>

Tuberculosis (TB) treatment challenges in TB-diabetes comorbid patients: a systematic review and meta-analysis

Background The Directly Observed Treatment-Short Course (DOTS) Programme was implemented by WHO and includes a combination of four anti-tuberculosis (TB) drugs (isoniazid, pyrazinamide, ethambutol and rifampicin) for a period of six months to eradicate the TB infection completely. Diabetes mellitus (DM) is recognized as one of a strong contributor of TB according to World Health Organization (WHO). The presence of diabetes mellitus type 2 (DM type 2) makes TB treatment complicated. Thus, the objective of the current meta-analysis was to identify and quantify the impact of type 2 DM on treatment outcomes of TB patients treated under the DOTS Programme. Methods This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Through a systematic review of relevant literature, we focused on studies investigating treatment outcomes including extended treatment duration and recurrence for individuals with both TB and DM undergoing DOTS therapy. The extracted information included study designs, sample sizes, patient characteristics and reported treatment results. Results In 44 studies from different parts of the world, the pooled HR for the impact of DM on extended treatment duration and reoccurrence were HR 0.72, 95% CI 0.56–0.83, p < .01 and HR 0.93, 95% CI 0.70–1.04, p = .08, respectively. The pooled HR for impact of DM on composite TB treatment outcomes was calculated as 0.76 (95% CI 0.60–0.87), p < .01 with an effect size of 41.18. The heterogeneity observed among the included studies was moderate (I 2 = 55.79%). Conclusions A negative impact of DM was found on recurrence and extended treatment duration in TB patients treated with DOTS therapy. DM type 2 is responsible for the TB treatment prolongation and TB recurrence rates. By implementing effective management strategies and advancing research, the challenges can be mitigated, arising due to the complex interaction between DM and TB.

Outcome and determinants of Directly Observed Short-course treatment for tuberculosis patients

Background: The Directly Observed Treatment Short Course (DOTS) is a well-established and cost-effective strategy for treating Tuberculosis. It efficiently transforms infectious cases into non infectious ones, effectively interrupting the transmission cycle of the disease. Objectives: Measure the treatment outcomes in TB patients during 2016-2020, describe the socio-demographic and clinical profile of TB patients and evaluate the performance of the National TB program in Babil governorate based on WHO indicators. Methods: A descriptive cross-sectional study was done. All TB patients in the NTP Center of Babil governorate under the DOTS program from 2016 to 2020 were included. A form was developed to compile socio-demographic data, clinical presentation, and treatment outcomes. Results: A total number of cases was 1723. The mean age was 40.0 (± 21.0) years. The female constituted 53.8% of cases. The patients aged ≥ 65 years had the highest percentage of total cases 279 (16.2%). Pulmonary tuberculosis (PTB) constituted 56.1% of the cases 50.5% of them had smear-positive. The most common site for extrapulmonary tuberculosis (EPTB) was lymph nodes 41.1%. Treatment success was attained in 93.7%, while 3.3% of patients dead. The patients aged ≥ 65 years have the lowest success rate and highest treatment unsuccess rate opposite to young age groups (p 0.002). Conclusion: The treatment outcome target planned by WHO was achieved. The case detection rate of all form was low. The age and the site of TB significantly affected the outcome of treatment.

Unregulated medication use and complications: a case study of prolonged self-treated tuberculosis in Nepal

BackgroundTuberculosis (TB) is a global public health issue, particularly in resource-constrained countries like Nepal. This case report highlights the consequences of prolonged self-treatment and non-compliance with TB management protocols, emphasizing the need for increased awareness and intervention.Case PresentationA 50-year-old male from Nepal self-medicated with anti-tubercular drugs for 13 years after completing the recommended course of treatment. He experienced worsening symptoms, including respiratory distress and visual impairment. Upon evaluation, he was diagnosed with chronic cavitary pulmonary aspergillosis. The patient received comprehensive treatment, including antifungal therapy, steroids, antibiotics, and respiratory support, resulting in significant improvement.ConclusionsThis case highlights the dangers of self-treatment and non-compliance with TB management protocols. It emphasizes the importance of patient education, awareness programs, and regular follow-up to ensure treatment adherence and detect complications. The case also reveals gaps in the DOTS (Directly Observed Treatment, Short Course) program, including the need for improved surveillance, and a multidisciplinary approach. The ease of over-the-counter purchase of anti-tubercular drugs in Nepal contributed to the patient’s prolonged self-medication, highlighting a concerning. The complications arising from prolonged self-medication underscore the need for increased awareness, intervention, and patient education in TB management. Improving patient education, raising awareness about the risks of self-medication, and integrating ophthalmologic evaluations into standard management are essential for better TB control in Nepal.

Treatment Outcome Monitoring by Using Sputum Conversion Rate of Tuberculosis Patients in Pkd Kinta, Malaysia

Introduction: A control programme termed Directly Observed Treatment Short-Course (DOTS) is adopted to promote early TB detection and effective TB treatment. An indicator of a successful DOTS programme is the Sputum Conversion Rate (SCR) which is obtained at the end of the two-month intensive treatment to measure the treatment outcome by SCR. The present study determined the association between several factors and the SCR among TB patients attending the DOTS clinic at the Kinta District Health Office (PKD Kinta) in 2017. Methods: The factors included are sociodemographic factors, physical factors, knowledge, attitude, and practice of TB patients. All groups of 150 sputum smear positive pulmonary TB patients enrolled for treatment at PKD Kinta between January and September 2017 were recruited for this study by the cross-sectional questionnaire method. A statistical analysis was performed to determine the association between the variables and the SCR of the TB patients in the DOTS programme. Results: At the end of the two-month intensive period, an SCR of 96.0% was obtained. According to the statistical analysis of the association among sociodemographic factors and SCR, there are no statistical differences between the variables. Similarly, no association was found between the physical characteristics and SCR in the current study. Conclusion: SCR methods are perfect methods used in regular medicine to monitor TB cases’ treatment. The identification of factors influencing the DOTS programme is critical to ensuring the program’s success in eradicating TB in society.

Hambatan Pelaksanaan Program Directly Observed Treatment Short-Course (DOTS) Di Negara Berkembang: Sebuah Tinjauan Sistematik

Tuberculosis is a global burden with most cases occurring in developing countries. After the implementation of Directly Observed Treatment Short-course (DOTS), the incidence of tuberculosis decreased. Despite, studies reported constraints in implementing this program. This study aims to describe the challenges of DOTS implementation in developing countries narratively. Methods: a search strategy through PUBMED was used to identify relevant articles. 10 relevant articles were included from 349 records. The studies were conducted in 8 developing countries namely South Africa, Sub-Saharan Africa, Brazil, Ethiopia, Indonesia, Angola and Nigeria. All articles included was extracted and categorized in ten main points regarding the challenges of the implementation of DOTS program. Results: There were 10 main points of challenges in implementing the DOTS strategy in developing countries : lack of access to health centres, managerial and organizational service problems, lack of health education-related tuberculosis, lack of supervision, TB co-infection, lack of trained health workers, smoking, alcohol, and drug abuse during treatment, patient-health professional relationship, lack of food availability and interruption during treatment. Conclusion: The implementation of the DOTS strategy encounters many challenges in developing countries where lack of health facilities, managerial and organizational service problems and lack of education-related TB are the main challenges to implement the program

Hambatan Pelaksanaan Program Directly Observed Treatment Short - Course (DOTS) di Negara Berkembang : Sebuah Tinjauan Sistematik

Tuberculosis is a global burden with most cases occurring in developing countries. After the implementation of Directly Observed Treatment Short-course (DOTS), the incidence of tuberculosis decreased. Despite, studies reported constraints in implementing this program. This study aims to describe the challenges of DOTS implementation in developing countries narratively. Methods a search strategy through PUBMED was used to identify relevant articles. 10 relevant articles were included from 349 records. The studies were conducted in 8 developing countries namely South Africa, Sub-Saharan Africa, Brazil, Ethiopia, Indonesia, Angola and Nigeria. All articles included was extracted and categorized in ten main points regarding the challenges of the implementation of DOTS program. Results: There were 10 main points of challenges in implementing the DOTS strategy in developing countries : lack of access to health centres, managerial and organizational service problems, lack of health education-related tuberculosis, lack of supervision, TB co-infection, lack of trained health workers, smoking, alcohol, and drug abuse during treatment, patient-health professional relationship, lack of food availability and interruption during treatment. The Conclusion is the implementation of the DOTS strategy encounters many challenges in developing countries where lack of health facilities, managerial and organizational service problems and lack of education-related TB are the main challenges to implement the program.

Treatment outcomes of tuberculosis patients in a Directly Observed Treatment Short course (DOTS) Referral Centre in Delta State, Nigeria: a five-year review (2012 - 2016).

The objective of this study is to observe the trend in treatment outcomes and identify determinants of treatment success among patients recruited into care through the DOTS strategy. A retrospective record review of tuberculosis patients (2012-2016) was carried out at the Tuberculosis and Leprosy Referral Centre, Eku, Delta State, Nigeria. Records of four hundred and twenty five (425) tuberculosis patients under DOTS were reviewed over five years. The highest number of cases under treatment, 102 (24.0%), was recorded in 2013. The mean age (SD) of patients was 37.3 (±16.5) years, majority of the patients were male (62.4%) and 18% had TB/HIV co-infection. Treatment outcomes of patients were cured (53.4%), completed (27.8%), died (6.8%), failed (2.4%), lost to follow up (4.9%), transferred out (1.2%) and not evaluated (3.5%). Over all, treatment success rate was 81.2% with a trend of 88.7% (2012), 87.3% (2013), 85.9% (2014), 65.0% (2015) and 65.8% (2016) respectively. Patient characteristics were not associated with treatment success. The treatment success rate was high and in line with the national recommendation of 80% and above. The trend showed a reduction in number of new cases enrolled into the DOTS programme, reduction in success rate with a concomitant increase in loss to follow up. There was no association between patient characteristics and TB treatment success. System strengthening on patient follow up, community health education and treatment adherence is recommended.

COVID-19 and Tuberculosis: A perspective of Bangladesh

Tuberculosis is our old enemy while COVID-19 (Coronavirus disease 2019) is a novel one. Both diseases have many similarities in terms of target organ affected, transmission, clinical presentations. COVID-19 is a fast-track novel pandemic while tuberculosis is a slow-moving pandemic. As control measures, countries all over the globe have enforced lockdown to halt the spread of the SARS-CoV-2 virus, but this stringent method has a negative impact on access to the health care delivery system. It seems that there is a dropping of new case findings, but modeling projection by WHO estimates that the total number of tuberculosis cases will rise by 2025. Bangladesh is a high Tuberculosis burden country in the south Asia region. Worldwide COVID-19 has a negative impact on tuberculosis diagnosis and management strategy. Bangladesh has impending threat to rise in tuberculosis case in future because of lockdown process, densely populated nation, poverty, reallocation of tuberculosis diagnostic facility and trained staff to diagnose COVID-19 and collapse of DOTS (directly observed treatment, short-course) program of NTP (national tuberculosis control program), rampant use of immunosuppressant’s including steroid, biologics. Prompt tuberculosis case detection, digital supervised drug delivery, avoidance of injudicious use of steroids, biologics to treat COVID-19, and testing for both COVID-19 and tuberculosis should be simultaneously undertaken to tackle this overwhelming situation. Eradication of psycho-social stigma about these two diseases is essential for preventing a perfect storm. BSMMU J 2022; 15(1): 54-56

Successful tuberculosis treatment outcome in East Gojjam zone, Ethiopia: cross-sectional study design

ABSTRACT Introduction: Ill health is one of the natural phenomena that can happen to human beings at any time due to either communicable or non-communicable diseases. Tuberculosis (TB) is one of those communicable diseases caused by the bacillus Mycobacterium tuberculosis which can be transmitted through droplet nuclei while coughing, sneezing, shouting, or singing. Infection with tuberculosis negatively affects the productive segment of the economy, resulting in a reduction in national productivity. The World Health Organization (WHO) recommended early case detection, accurate diagnosis, and standardized treatment as a means to prevent new infections. In Ethiopia, detecting TB cases early, diagnosing, and treating these cases as per the guideline has been practiced for years through the Directly Observed Treatment Short-course (DOTS) program which was started in 1997. Various researches on TB treatment outcomes and their predictors have been done in Ethiopia. However, almost all of the findings vary from each other even though the country has a standardized definition of the outcomes and data aggregation tools. Moreover, none of the findings and reports showed the magnitude of successful TB treatment outcomes in the study area. Objective: This research was intended to assess the prevalence of successful TB treatment outcomes among patients enrolled in a DOTS program in the east Gojjam zone, northwest Ethiopia. Result: Eighty six percent (86%) of all cases enrolled in the DOTS program were successfully treated in the East Gojjam zone, and sex, place of residence, educational status, smear result during entry to the DOTS program, and HIV test result were factors significantly affecting successful TB treatment outcomes in the study area. Conclusion and Recommendation: The magnitude of successful TB treatment outcome of this study is low compared to the national strategic plan. It is advisable to work on the identified factors to positively affect successful TB treatment outcomes in the study area.

Tuberculosis the Lernaean Hydra of 21st Century - A Post Covid Update on the Indian Scenario

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Tuberculosis usually affects the lungs, but it can also affect other parts of the body, such as the brain, kidneys, and spine. In most cases, tuberculosis is preventable. However, tuberculosis patients can die if not treated properly. According to the World Health Organization (WHO), tuberculosis (TB) is a worldwide pandemic. It is the primary cause of mortality among HIV-infected individuals. Poor adherence to Tuberculosis treatment can lead to prolonged infection and poor treatment outcomes. Prevention plays a very important role in the fight against TB. Directly Observed Treatment aims to improve adherence to TB treatment by observing patients while they take TB medications. India's DOTS (directly observed treatment short course) program is the world's fastest-growing and biggest in terms of patients beginning on treatment, as well as the second-largest in terms of population coverage. Its purpose is to reduce TB mortality and morbidity while also reducing infection transmission until TB is no longer a serious public health concern in India. Multidrug-resistant tuberculosis (MDR-TB) is caused by organisms that are resistant to at least two of the most potent tuberculosis drugs, isoniazid and rifampicin. Multidrug-resistant tuberculosis (MDR-TB) is an increasing danger to tuberculosis eradication, and it is the outcome of a failing tuberculosis control program. Community-based programs can improve patient outcomes by allowing patients to receive treatment at home and addressing socioeconomic barriers to adherence to treatment. This article discusses about Tuberculosis and the ways to manage tuberculosis.

Study about Tuberculosis in Thailand: An approach to Treatment, GIS and Sichon Model

In this study, we seek to identify geographical areas where ongoing tuberculosis epidemiological characteristics is occurring by linking Geographic Information Systems (GIS) technology in Thailand. In addition, we seek to assess how the directly observed treatment short-course (DOTS) program improved new tuberculosis diagnosis and treatment successes in Sichon District, Nakhon Si Thammarat province, Thailand from 2014 to 2016. The assessment program included seven indicators, and the results revealed that 73 new cases of tuberculosis were admitted for treatment on average every year, with rates of risk group screening findings of 4.28, 5.23, and 6.04 %, respectively. Patients who come to the hospital for diagnosis make up most of the demographic. However, only a minor proportion of patients are identified through community-based primary screening. In the years 2013-2016, the mortality rate of TB cases is expected to rise by 10.25 %, 4.25 %, and 5.56 %, respectively. The elderly and HIV-positive patients comprise most of the TB mortality population. When completing the DOTS program at a hospital, however, the rate of success has fallen short of the targets. Furthermore, the screening technique excludes the target group. As a result, people suffering tuberculosis are reported to be slower and more susceptible to symptoms. As a result, researchers advise that the DOTS program be supported by enhancing treatment follow-up to improve the effectiveness of TB treatment and collaboration with health care worker (HCW).

Process and outcome evaluation of directly observed treatment short course (DOTs) in Kerman city, Southeast of Iran

BackgroundUnderstanding tuberculosis (TB) treatment programs' process and the outcome is one of the critical strategies to prevent the disease's occurrence and accelerate achieving sustainable development goals to reduce TB cases. The present study aimed to evaluate directly observed treatment short-course (DOTs) for tuberculosis. MethodsThe present cross-sectional, descriptive-analytical study extracted information from the tuberculosis surveillance system's recorded data by a researcher-made checklist with questions from patients and health system staff. We analyzed the data by SPSS version 20. ResultsThe outcome of patients' treatment was 85.39% improved, and the rest were death and failure of treatment and absence from treatment. The mean and standard deviation of the onset of the first symptom and diagnosis and detection of the disease was 117 and 126 days, respectively. The mean and standard deviation of the interval between diagnosis and treatment was 5.53 and 8.03 days, respectively. Regarding the treatment length, 95.5% of the cases followed the treatment length, and the rest were not observed. The history of hospitalization was 45.3% among patients, and the rest had no history of hospitalization, and the mean and standard deviation of the day of hospitalization were 6.68 ± 9.50 days. ConclusionsThe existence of an appropriate program for early diagnosis of tuberculosis, observing the length of treatment, training private and public centers to strengthen the care system, and strengthening the DOTs program to control tuberculosis seems to be necessary.

Survival Analysis of Risk Factors for Mortality in a Cohort of Patients with Tuberculosis.

Identify the treatment effects and risk factors for mortality in patients with pulmonary tuberculosis receiving antituberculosis treatment under the Directly Observed Treatment Short-Course (DOTS) program to reduce the mortality rate of tuberculosis. A retrospective cohort analysis was conducted on the outcomes of antituberculosis treatment of 7,032 patients with tuberculosis in the DOTS program, in the Tuberculosis Management Information System from 2014 to 2017 in Tianjin, China. The Kaplan–Meier method and multifactor Cox proportional risk regression model were used to analyze the risk factors for mortality during antituberculosis treatment under DOTS. The success rate of antituberculosis treatment was 90.24% and the mortality rate was 4.56% among 7,032 cases of tuberculosis in Tianjin. Cox regression analysis showed that advanced age, male sex, human immunodeficiency virus (HIV) positivity, first sputum positivity, retreated tuberculosis, and a delayed visit (≥14 days) were risk factors for mortality in patients with pulmonary tuberculosis receiving antituberculosis treatment under DOTS. The treatment effects in patients with pulmonary tuberculosis during antituberculosis treatment under DOTS were positive in Tianjin. Advanced age, male sex, HIV positivity, first sputum positivity, retreated tuberculosis, and a delayed visit (≥14 days) increased the risk for mortality during antituberculosis treatment.

Predictors of loss to follow-up of tuberculosis cases under the DOTS programme in Namibia.

BackgroundIn Namibia, one out of every 25 cases of tuberculosis (TB) is “lost to follow-up” (LTFU). This has impacted negatively on national efforts to end the disease by 2035. The aim of this study was to determine the trends and predictors of LTFU under the directly observed treatment short-course (DOTS) programme in Namibia.MethodsThe study involved a retrospective longitudinal analysis of a nationwide cohort of TB cases registered under the DOTS programme in Namibia from 2006 to 2015. The trends and predictors of LTFU among cases in the National Electronic TB Register of the National TB and Leprosy Program were respectively determined by interrupted time series and multivariate logistic regression analyses using R-Studio software.ResultsOut of 104 203 TB cases, 3775 (3.6%) were LTFU. A quarter (26%) of cases with poor outcomes were due to LTFU. The annual decline in cases of LTFU was significant between the first (2005–2010) and second (2010–2015) medium-term plan period for TB programme implementation (p=0.002). The independent predictors of LTFU were male sex (p=0.004), 15–24 years age group (p=0.03), provider of treatment (p<0.001), intensive phase (p=0.047) and living in border/transit regions (p<0.001). HIV co-infection and TB regimen were not significant predictors of LTFU.ConclusionsThere were declining trends in LTFU in Namibia. DOTS programmes should integrate socioeconomic interventions for young and middle-aged adult male TB cases to reduce LTFU.

Psychological changes and associated factors among patients with tuberculosis who received directly observed treatment short-course in metropolitan areas of Japan: quantitative and qualitative perspectives

BackgroundThe directly observed treatment short-course (DOTS) is one of the most effective tuberculosis (TB) control measures worldwide. However, despite its aim of providing comprehensive and humanistic care, few studies have examined its psychological effects from the patient’s perspective. Thus, this study aimed to evaluate the psychological changes and identify associated factors among patients with TB undergoing the DOTS program in Japan.MethodsThis cross-sectional study recruited patients with TB receiving the DOTS program via 32 public health centers in four metropolitan cities in Japan. Surveys were administered to the patients and their attending public health or clinical nurses, who were responsible for their care and the DOTS program. Data were collected regarding the patients’ demographic and clinical characteristics, post-traumatic growth (using the Post-Traumatic Growth Inventory-Short Form [PTGI-SF]), and medication adherence, alongside open-ended questions, from 2014 to 2015. Additionally, the patients’ appraisal of the DOTS program’s efficacy and nurses’ assessment of the program’s practices were measured using two original questionnaires. Factors associated with post-traumatic growth were analyzed using variable estimation, correlation analysis, and logistic regression. Thematic analysis was conducted on the open-ended responses.ResultsQuestionnaires were returned by 127 patients (125 valid answers); 98 (78.4%) of the respondents were men. Their mean age was 63.3 (standard deviation: 15.8) years. The mean PTGI-SF score was 21.7 (standard deviation: 11.1). The logistic regression analysis found that post-traumatic growth was significantly associated with the patients’ appraisal of the program’s efficacy (odds ratio [OR] = 1.157, 95% confidence interval [CI] = 1.026–1.304) and nurses’ assessment of the practices (OR = 1.307, 95% CI = 1.065–1.603). In the qualitative analysis, “Non-acceptance,” “Frustration,” and “Anxiety” were extracted as barriers to treatment; “Fear,” “Acquiring a partner,” “Relief,” and “Belief” were extracted as treatment drivers; and “Life changes” and “Rebuilding oneself” were extracted as treatment outcomes.ConclusionsThe DOTS program in Japan improves patients’ treatment adherence and leads to recovery and psychological growth. Even in other regions, it may be effective to incorporate this program’s practices that place importance on partnerships with patients. It is also necessary to continue refined quantitative and qualitative evaluations.

Co-Management of Active Tuberculosis and Diabetes Mellitus Under Supervised DOTS Strategy—A Saudi Perspective

Tuberculosis (TB) is a global public health concern, specifically in countries which have high prevalence of HIV/AIDS, malnutrition, unhygienic conditions, etc. Some evidence has been presented that diabetes mellitus (DM) is a risk factor for TB. On the other hand, among those who have DM, TB infection enhances glucose intolerance and worsens glycemic control. The combination of TB and DM, due to immuno-compromised status of DM, can delay the healing process of TB. The focus of this paper is the World Health Organization directly observed treatment, short course (DOTS) program implemented in Gazan province, Saudi Arabia, to treat TB. The data included some patients with both TB and DM. The data has been analyzed to assess how effective the DOTS program was in managing TB. It was found that DM was not a significant factor in the outcome of TB treatment. We used the same data and observed that the non-significance of DM is due to heterogeneity of patient population, Saudis and Non-Saudis. The prevalence of DM was very high among Saudis. This is understandable in view of different lifestyles. Non-Saudis are predominantly Yemenis. For Saudis, DM was indeed found to play a role in the treatment outcome of TB, after an application of a classification tree methodology on the data. This is the main focus of the paper.

Treatment Outcomes of Tuberculosis at Asella Teaching Hospital, Ethiopia: Ten Years' Retrospective Aggregated Data.

Directly Observed Treatment Short-course (DOTS) has been one of the major strategies to combat the epidemic of tuberculosis (TB) globally. This study aimed to evaluate TB treatment outcomes between September 2004 and July 2014 under the DOTS program at one of the largest public hospitals in Ethiopia. A retrospective data of TB patients registered at Asella Teaching Hospital between September 2004 and July 2014 were obtained from hospital registry. Treatment outcomes and types of TB cases were categorized according to the national TB control program guideline. Binomial and multinomial logistic regression models were used to analyze the association between treatment outcomes and potential predictor variables. A total of 1,755 TB patients' records were included in the study. Of these, 945 (53.8%) were male, 480 (27.4%) smear-positive TB, 287 (16.4%) HIV positive, and 1,549 (88.3%) new cases. Among 480 smear-positive pulmonary TB cases, 377 (78.5%) patients were cured, 21 (4.40) completed the treatment, 35 (7.3%) transferred out, 19 (4.0%) died, 24 (5.0%) defaulted, and 4 (0.8%) failure. Overall, 398 (82.9%) smear-positive pulmonary TB patients were successfully treated. For smear-negative TB (n = 641) and extrapulmonary TB cases (n = 634), 1,036 (81.3%) completed the treatment and demonstrated favorable response. Taking all TB types into account, 1,434 (81.7%) were considered as successfully treated. In the multivariate binary logistic model, patients in older age group (AOR = 0.386, 95% CI: 0.250-0.596) and retreatment cases (AOR = 0.422, 95% CI: 0.226-0.790) were less likely to be successfully treated compared to younger and new cases, respectively. In multinomial logistic regression, age increment by 1 year increased the risk of death and default of TB patients by 0.05 (adjusted β = 0.05; 95% CI: 0.03, 0.06) and 0.02 (adjusted β = 0.02; 95% CI: 0.01, 0.04). The odds of TB patients who died during treatment were higher among HIV-infected TB patients (adjusted β = 2.65; 95% CI: 1.28, 5.50). The treatment success rate of TB patients was low as compared to the national target. TB control needs to be strengthened for the enhancement of treatment outcome.

Patients’ Perception of a Community Pharmacist-Managed Multidrug-Resistant Tuberculosis Program in Peru: A Public Health Perspective

Objectives: The primary objective is to investigate the public’s perception about the role of the community pharmacist in Peru’s directly observed treatment, short course (DOTS) program. The secondary objective is to assess perceived barriers that would prevent the public from utilizing community pharmacists in order to identify future opportunities for community pharmacists to increase adherence to multidrug-resistant tuberculosis (MDR-TB) therapy. Design: Qualitative study comprised of an 8 close-ended survey questionnaire.&#x0D; Setting: Healthcare clinics established by a medical mission group in Lima and surrounding communities, Peru, from July 13 to July 27, 2015. Participants: Patients 15 years of age and over who sought healthcare at the clinics. Main outcome measures: Public’s perception about the role of the community pharmacist in Peru and barriers that would prevent the public from seeking a community pharmacist. Results: Out of the 445 patients approached, 438 patients completed the survey, resulting in a 98% response rate. More than half (52%) of the respondents were likely to seek a community pharmacist to assist them in completing a MDR-TB medication regimen. Almost half (48%) of the respondents felt comfortable with assistance of a community pharmacist in completing an MDR-TB regimen. The physician was the first health care professional that was contacted for all medical situations, including drug-related questions (61%). Lack of privacy in the pharmacy (53%) and busyness of the pharmacists (52%) were the top perceived barriers for asking community pharmacists questions. Conclusion: This study highlights the need for pharmacist participation in Peru’s DOTS program. Furthermore, this investigation has identified several issues of concern related to current community pharmacy practice in Peru. Therefore, future efforts may be necessary to address these identified areas of opportunity to promote the community pharmacist’s role in health screening, drug therapy monitoring, and counseling to decrease the public health burden of MDR-TB.&#x0D; Conflict of Interest&#x0D; We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents or royalties.&#x0D; &#x0D; Type: Original Research

Objective measurement of isoniazid levels: practical approach for monitoring tuberculosis drug treatment adherence

Drug treatment adherence is one of the biggest issues in tuberculosis (TB) treatment. Including DOTS (Directly Observed Treatment, Short-course) program, many programs for TB cases have yielded marginal success and the new drug resistance varieties of TB persist. During the 1960s, researchers have projected naphthoquinone–mercuric chloride (N-M) test as the single most way to objectively track the presence of isoniazid (INH) in urine and hence treatment adherence. INH is metabolised by cytochrome P450s and usually cleared from body within 8 h. Hence, the typical INH levels in biological fluids are within 1–5 μg/ml. The N-M test practically works at 10–50 μg/ml and the authors developed the sodium polyacrylate (SPA) as a solid surface to improve detection limit of INH by 6–10 fold. The modification involves absorbing the reagents of N-M test on the SPA surface and lyophilised material is directly used for diagnosis. The dry beads can detect 1–2 μg/ml of INH in saliva. The test performed with spiked as well as clinical samples and the results have good correlation. This new test has a realistic chance of tracking the TB treatment adherence remotely and in that direction a system was projected for implementation.