Directly Observed Therapy Research Articles

Effectiveness of Mobile Application to Improve Adherence to Tuberculosis Treatment: A Study Protocol

Introduction: Tuberculosis (TB) is a leading cause of death due to a single infectious agent. The disease is treatable by a minimum of six months of anti-TB drugs. However, prolonged duration of treatment using directly observed therapy (DOT) causes significant inconvenience to patients and is ineffective in improving treatment outcomes. Therefore, incorporating the Health Belief Model into the development of digital technology could help change behaviour and improve adherence. This study aimed to determine the effectiveness of mobile applications in improving TB medication adherence. Methods: This study proposed to conduct a randomized trial among TB patients in the Kota Kinabalu, Penampang, and Putatan districts of Sabah, Malaysia. The eligible sample will be randomly assigned to the mobile application DOT arm and standard DOT arm. The primary outcome is the adherence level calculated by the percentage of medication observed divided by the intended dose taken in two months, with 80% and more successfully observed treatment considered highly adherent. The secondary outcomes are health-related quality of life, satisfaction, and monthly household income. Multiple logistic regression and repeated measures ANCOVA will be used to determine the effectiveness of interventions to achieve primary and secondary outcomes. Discussion: The findings from this study could hopefully provide insight into rethinking TB care delivery to achieve better TB treatment outcomes. Trial Registration: This study protocol has been approved by the Medical Research Ethics Committee (MREC), Ministry of Health Malaysia (NMRR ID-21-01949-73X) and registered with ClinicalTrials.gov (NCT05259254).

Treatment seeking dilemma for tuberculosis as timed strategic prisoner’s dilemma game

Treatment seeking choices of individuals is one of the biggest hindrance in the global strategy to eliminate Tuberculosis (TB) by 2030. The individuals have a choice to take treatment under Directly Observed Treatment, short course (DOTS) which is the preferred strategy for curing and reducing the risk of TB cases. However, undergoing treatment under DOTS requires some changes in the routine behaviour of the infected individual which results in a ‘treatment seeking dilemma’. In this work, we explore the consequences of human choice of treatment on TB incidence by developing a compartmental model conjoined with timed strategic prisoner’s dilemma game. We classify the infected individuals into two categories, the individuals who cooperate (go directly to the DOTS for the treatment) and the individuals who defect (do not go directly to the DOTS for the treatment). We analyse the repercussion of this treatment seeking dilemma on the success of the ‘end TB strategy’. We also analyse the effectiveness of WHO strategy of public–private mixing (PPM) on TB incidence.

A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge Regarding Pulmonary Tuberculosis and DOTs Therapy among Tuberculosis Patients Attending Tuberculosis O.P.D at Selected Hospitals in Bhiwani, Haryana

Background of the Study: Tuberculosis is a global public health issue despite the discovery of the causal bacterium over 100 years ago and availability of effective medications and vaccines for prevention and cure. Tuberculosis has a global incidence rate of 119 per lakh, with low-income nations bearing the major burden at 197 per lakh. High-income countries have nine per lakh people, while middle-income countries have 85. Eight out of ten tuberculosis patients are economically productive aged 15-49. It kills more adults than any other infectious disease. India has roughly one-third of the global tuberculosis load. Aim of the Study: The goal of this study is to evaluate the efficacy of a planned education program on students' understanding of pulmonary tuberculosis and the DOTS treatment method. Methodology: This study examined how a comprehensive teaching program improved patients' understanding of pulmonary tuberculosis and DOTS therapy in the outpatient department (OPD) of selected hospitals in Bhiwani, Haryana. To attain the purpose, the researcher used pre-experimental study design. The study included 60 patients at the Directly Observed Therapy Short-course (DOTS) clinic in Bhiwani, Haryana. The researchers selected samples using convenience sampling. A structured knowledge questionnaire was used to collect data in this study. A group of tuberculosis patients provided data for ten days. The pre-test was given on May 17, 2021, before formal education began. Ten days later, the post-test was given. Data was processed and analyzed using descriptive and inferential statistics. Results: The mean pre-test knowledge score was 9.45, with a 2.65 standard deviation. In the post-test, the mean score was 19.40 with a standard deviation of 1.86. The computed mean difference was 9.95. The paired 't' test yielded 24.60 with 59 degrees of freedom. A p-value of 0.01 indicated statistical significance.

Interventions for promoting patients’ adherence to 14-day primaquine treatment in a highly malaria-endemic township in Myanmar: a qualitative study among key stakeholders

BackgroundPlasmodium vivax malaria is considered a major threat to malaria eradication. The radical cure for P. vivax malaria normally requires a 14-day administration of primaquine (PQ) to clear hypnozoites. However, maintaining adherence to PQ treatment is a significant challenge, particularly in malaria-endemic rural areas. Hence, this study aimed to formulate interventions for promoting patients’ commitment to PQ treatment in a highly malaria-endemic township in Myanmar.MethodsA qualitative study was conducted in Waingmaw Township in northern Myanmar, where P. vivax malaria is highly endemic. Key stakeholders including public health officers and community members participated in focus group discussions (FGDs) and in-depth interviews (IDIs) in September 2022. Data were collected using validated guidelines, translated into English, and visualized through thematic analysis.ResultsResponsible individuals from different levels of the Myanmar National Malaria Control Programme participated in the IDIs. Most of them reported being aware of the markedly increasing trend of P. vivax and the possibility of relapse cases, especially among migrants who are lost to follow-up. Workload was a key concern surrounding intervention implementation. The respondents discussed possible interventions, such as implementing directly observed treatment (DOT) by family members, piloting a shorter PQ regimen, expanding the community’s malaria volunteer network, and strengthening health education activities using local languages to promote reasonable drug adherence. FGDs among community members revealed that although people were knowledgeable about malaria symptoms, places to seek treatment, and the use of bed nets to prevent mosquito bites, most of them still preferred to be treated by quack doctors and rarely used insecticide-treated nets at worksites. Many often stopped taking the prescribed drugs once the symptoms disappeared. Nevertheless, some respondents requested more bed nets to be distributed and health promotion activities to be conducted.ConclusionIn rural areas where human resources are limited, interventions such as implementing family member DOT or shortening PQ regimens should be introduced to enhance the radical cure for the P. vivax infection. Disseminating information about the importance of taking the entire treatment course and emphasizing the burden of relapse is also essential.

Community-supported self-administered tuberculosis treatment combined with active tuberculosis screening: a pilot experience in Conakry, Guinea

ABSTRACT Directly observed treatment (DOT) for tuberculosis (TB) is recommended by the World Health Organization. However, DOT does not always meet patients’ preferences, burdens health facilities, and is hard to implement in settings where access to healthcare services is regularly interrupted. A model addressing these limitations of DOT is community-supported self-administered treatment (CS-SAT), in which patients who self-administer TB treatment receive regular visits from community members. Guinea is a country with a high TB burden, recurrent epidemics, and periodic socio-political unrest. We piloted a CS-SAT model for drug-susceptible TB patients in Conakry, led by community volunteers, who also conducted active TB case finding among household contacts and referrals for isoniazid preventive treatment (IPT) in children below 5 years old. We aimed to assess TB treatment outcomes of patients on CS-SAT and describe the number of patients identified with TB case finding and IPT provision. Prospectively enrolled bacteriologically confirmed TB patients, presenting to two facilities, received monthly TB medication. Community volunteers performed bi-weekly (initiation phase) and later monthly (continuation phase) home visits to verify treatment adherence, screen household contacts for TB, and assess IPT uptake in children under five. Among 359 enrolled TB patients, 237 (66.0%) were male, and 37 (10.3%) were HIV-positive. Three hundred forty (94.7%) participants had treatment success, seven (1.9%) died, seven (1.9%) experienced treatment failure, and five (1.4%) were lost-to-follow-up. Among 1585 household contacts screened for TB, 26 (1.6%) had TB symptoms, of whom five (19.2%) were diagnosed with pulmonary TB. IPT referral was done for 376 children from 198 households. In a challenging setting, where DOT is often not feasible, CS-SAT led to successful TB treatment outcomes and created an opportunity for active TB case finding and IPT referral. We recommend the Guinean CS-SAT model for implementation in similar settings.

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.

Factors Influencing Adherence to Pulmonary Tuberculosis Treatment among Adult Patients at St Francis’ Hospital-Katete, Zambia

Background: Pulmonary tuberculosis (PTB) is a contagious bacterial infection of the lungs caused by mycobacterium tuberculosis, also known as tubercle bacilli. The symptoms of PTB can appear gradually and vary in severity. Malnutrition, Human Immunodeficiency Virus (HIV) infection/Acquired Immunodeficiency Syndrome (AIDs), age (young and old), diabetes mellitus, substance abuse, low socioeconomic status, malignancies, and or overcrowding are some of the common risk factors for PTB. According to the Zambia Demographic Health Survey (ZDHS, 2021), Zambia’s prevalence rate of PTB stood at 455 cases per 100,000 population. The World Health Organization (WHO) has recommended Direct Observation of Treatment (DOT) by a trained supervisor (WHO, 2019). However, implementing DOT in Zambia is challenging for both the patient and healthcare provider as it has been observed that a daily visit to a health facility for the first two months by PTB patients was very difficult for a range of reasons which included severe illness at the initiation of treatment, distance too far for walking, and high transportation costs. Objective: The study aimed at determining Factors Influencing Adherence to Pulmonary Tuberculosis Treatment among Adult PTB Patients at St Francis’ Hospital-Katete, Zambia. Methods and materials: Data was collected using a questionnaire and the study sample was one hundred (100) Adult PTB patients, who were selected by simple random sampling method. A quantitative descriptive cross-sectional study design was used. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 21. Chi-square test was used to determine the relationship between independent and dependent variables. Conclusion: The study revealed a significant association between ‘level of information and knowledge, individual motivational support, behavioural skill’ and ‘Adult PTB patients’ adherence to PTB treatment’. Level of Information and knowledge (p-value 0.001), Individual .........

Coverage evaluation of mass drug administration with triple drug regimen in an evaluation unit in Nagpur district of Maharashtra, India.

Triple drug regimen (IDA; Ivermectin, Diethylcarbamazine, Albendazole) recommended for accelerating elimination of lymphatic filariasis was launched in India in December 2018. Nagpur district in Maharashtra was one of the first five districts where this strategy was introduced. The National Vector Borne Disease Control Programme (NVBDCP) at the district reported ~85.0% treatment coverage in the first round of mass drug administration (MDA) with IDA implemented in EU-2 in Nagpur district in January 2019. As per the national guideline, a coverage evaluation survey was carried out and both quantitative and qualitative data were collected to assess the treatment coverage, the level of community preparation and identify the gaps, if any, for improvement. A Coverage Evaluation Survey (CES) following the WHO recommended protocol was conducted in one of the two evaluation units (EU-2) in Nagpur district in March 2019. Coverage Sample Builder (CSB) V2.9 tool was used to calculate the sample size, select sites and estimate drug coverage. The CSB tool followed a two-stage cluster sampling procedure to select 30 primary sampling units (ward/village as a cluster) and a list of random numbers for selecting households (HHs) in each cluster. The results were analyzed for operational indicators. Stata ver. 14.0 software was used to construct the 95% confidence limits accounting for clustering. A total of 1601 individuals aged 5-85 years of both gender from 328 HHs were surveyed from the 30 randomly selected clusters in EU-2. The mean age was 33.8±17.6 years. Among the surveyed population, 78.0% received the drugs (programme reach) and 66.1% consumed the drugs (survey coverage). Survey coverage was significantly higher in rural (82.6%) than in urban (59.4%) and peri-urban (58.6%) areas (P<0.001). Directly observed treatment (DOT) among the surveyed population was 51.6%. Adverse events were reported among 6.9% respondents who reported to have consumed the drugs. The IDA based MDA strategy could achieve just the required level of treatment coverage (~65%) in EU-2, Nagpur district, which had previously undergone several rounds of DA-MDAs (Diethylcarbamazine, Albendazole). Having achieved an effective treatment coverage of >80% in rural areas, the coverage in urban and peri-urban areas need to be improved in order to attain the impact of IDA-MDA. It is imperative to strengthen drug delivery and community preparation activities along with improved DOT especially in urban and peri-urban areas to achieve the required level of treatment coverage. Addition of ivermectin did not have any additional perceived adverse events.

Determinants of Unsuccessful TB Treatment Outcomes Among Patients on Directly Observed Treatment Short Course in Jimma Town Health Facilities, Southwest Ethiopia: A Case-Control Study.

Even though Ethiopia's Federal Ministry of Health has been implementing several programs aimed at reducing the burden of tuberculosis (TB), It does not demonstrate adequate progress. As a result, identifying the determinants of unsuccessful outcomes of directly observed treatment, short-course (DOTS) is critical. This study aimed to assess the determinants of unsuccessful TB treatment outcomes among patients with DOTS in Jimma town, southwest Ethiopia. An unmatched case-control study using secondary data was conducted among 118 cases and 472 controls from April 1 to June 1, 2021. Cases were TB cases with unsuccessful treatment courses whereas controls were those of successful treatment. Data were collected using a standardized tool. Statistical analysis was done using SPSS version 23 software. A binary logistic regression model was used to identify the determinants. We found that the determinants including age > 35 years (AOR=1.9, 95% CI: 1.14-3.2), lack of contact person (AOR= 27, 95% CI: 15.8-46.3), being HIV positive (AOR=7.3, 95% CI: 3.7-14.2)), and being malnourished (AOR=4.5, 95% CI: 1.5-12.9) were significantly associated with unsuccessful tuberculosis treatment outcome. In this study, advanced age, being HIV positive, lack of contact person, and being malnourished were determinant factors for unsuccessful TB treatment outcomes. Hence, careful monitoring, screening, and management of risk factors are recommended.

Coverage and utilization of Nikshay Poshan Yojana among patients with tuberculosis: Exploring patterns and influencing factors

BackgroundIndia bears a burden of tuberculosis (TB) and undernutrition, both of which are interconnected, as undernutrition increases the susceptibility and affects the outcome of TB infection. To address this, government of India introduced Nikshay Poshan Yojana in 2018 to provide nutritional support to patients with TB. However, the end-usage and barriers of the monetary benefit under this scheme have not been extensively studied. ObjectiveTo address these gaps, our study aimed to estimate Nikshay Poshan Yojana coverage among patients with tuberculosis in the Ballabgarh tuberculosis unit, explore end-usage patterns, and identify facilitators and barriers for availing the monetary benefit. MethodsWe conducted a mixed-methods study in Ballabgarh tuberculosis unit (TU) in Faridabad district of Haryana state, India. To assess the coverage, we randomly selected patients treated under the Ballabgarh TU between January 2019 and December 2021. We conducted telephonic interviews using a semi-structured questionnaire and collected data on the coverage and end usage of the Nikshay Poshan Yojana scheme. Descriptive analysis was conducted using R software. We conducted in-depth interviews with a senior treatment supervisor and a district tuberculosis officer and two focus group discussions with tuberculosis patients. Thematic analysis was used to identify the factors of end usage, facilitators, and barriers of the use of monetary benefits under the scheme. ResultsAmong the 251 patients with TB enrolled in the study, 60.6% received at least one and 22.3% received all instalments. The median amount received was INR 2500 (USD 31.2), with 90.9% of the funds being spent on purchasing food items. Fruits and milk were the main food items purchased. Factors influencing the end usage included personal or family needs, awareness of the nutritional benefits in addressing the disease, advice from parents and Directly Observed Treatment Short-course (DOTS) providers, and the need for diagnostic tests or medications. Facilitators for utilization included assistance in creating bank accounts, centralized monitoring, and the flexibility of receiving the monetary benefit through parents' or family members' accounts. The barriers for utilization of Nikshay Poshan Yojana were non-availability of bank account, dormant bank account, delay due to bank related issues or administrative procedures. ConclusionThe findings revealed a substantial partial coverage and poor full coverage of Nikshay Poshan Yojana. The monetary benefit received was primarily utilized for purchasing food items, indicating adherence to the intended purpose.

Pre-Post Assessment of Serum Zinc and Copper Status in Uncomplicated Pulmonary Tuberculosis Patients Receiving Directly Observed Treatment Short Course

Mycobacterium tuberculosis causing the infectious disease tuberculosis has a predilection for the lungs although it is common to see other organs involved. India has adopted the TB-DOTS program for the treatment of the same. Undernutrition and tuberculosis are mutually inclusive. Micronutrients like zinc and copper play a key role in cytokine kinetics and immunity and thus are important in an individual’s response to infectious disease. Serum copper and zinc levels in patients with pulmonary tuberculosis (pTB) before and after two months of directly observed treatment short course (DOTS) were assessed in this study. The serum samples of 39 pTB patients were collected before the commencement of anti-tubercular therapy (ATT) and tested for copper and zinc levels. At the end of the intensive phase of treatment, blood samples of 31 out of the 39 pTB patients were again collected and tested for the same trace elements. In the pre-post comparison of 31 patients who could be followed up, an increase in serum zinc levels [101 (74.9) μg/ dl vs 112(155.5) μg/dl)] after the treatment was not statistically significant (p=0.15). The serum copper levels [184(105.7) μg/dl vs 247(80.8) μg/dl)] were significantly (p&lt;0.01) increased after two months of DOTS therapy. Sputum negativity was close to 81%.Serum copper, as well as zinc levels, were increased after DOTS therapy for two months. Since the response to therapy was 69%, supplementation of copper and zinc may benefit the pTB patients in achieving sputum negativity sooner and completely.

Impact of socio-demographic factors on prevalence of rifampicin resistance among patients attending some hospitals in Yobe state of Nigeria

Rifampicin resistance in Mycobacterium tuberculosis is a public health concern in many countries including Nigeria. There is an increase of multidrug resistant tuberculosis which results to morbidity and mortality among presumptive tuberculosis patients. Data regarding Rifampicin resistant tuberculosis in the study area are lacking. A one year prospective, cross-sectional, laboratory based study was carried out among patients attending Direct Observed Treatment Short course in Damaturu, Gashua and potiskum specialist hospitals, Yobe State, Nigeria; from January, 2020 to December, 2020. Sputum samples were collected from consented / assented participants and analyzed using MTB/RIF assay (Cepheid, GeneXpert USA). The data were analyzed using Person Chi-Square and p≤0.05 considered the presence of significant relationship and results were presented in tables and charts. Out of 400 studied participants, males had a prevalence of 2.5% (10/400) while females had 0.8% (3/400). Age group 30-39 years had the highest prevalence of 1.5%. The results show significant relationship between age, gender, and marital status, in the study area. This study confirmed the presence of Rifampicin resistant tuberculosis in the study area. Therefore, there’s need to have a public health awareness and strengthen the laboratory capacity for diagnosis and make the services available and accessible to the patients who need them.

Tuberculosis Burden in Bangladesh: Progressions and Challenges of Continuing Control Intervention

Tuberculosis (TB) has been a significant public health burden in Bangladesh, and to address this issue, the country has implemented the Directly Observed Treatment Short-Course (DOTS) intervention since 1993. The government has partnered with non-governmental organizations (NGOs) to implement community-based TB control programs. Research has shown that this approach has led to significant success in TB control, including a high case detection rate (&gt; 81%), successful TB treatment (95%), and reduced TB mortality (27/100,000 population) over the past two decades. However, there are still significant concerns regarding the control of people living with HIV-TB (PLHIV-TB), multidrug-resistant TB (MDR-TB), and latent TB infection (LTBI). Additionally, the COVID-19 pandemic has slowed down the progress of TB control efforts. Challenges such as inadequate linkages with local NGOs, social stigma, gender discrimination in TB diagnosis, inadequate human resources, and poverty factors further exacerbate the situation. This study calls for a paradigm shift in TB control intervention towards a rights-based and need-based approach, considering gender, ethnicity, elderly people, and children. By addressing these challenges and implementing a comprehensive approach to TB control, Bangladesh is expected to achieve its goal of ending TB by 2035.

Acceptability and feasibility of digital adherence technologies for drug-susceptible tuberculosis treatment supervision: A meta-analysis of implementation feedback.

Digital adherence technologies (DATs) have emerged as an alternative to directly observed therapy (DOT) for supervisions of tuberculosis (TB) treatment. We conducted a meta-analysis of implementation feedback obtained from people with TB and health care workers (HCWs) involved in TB REACH Wave 6-funded DAT evaluation projects. Projects administered standardized post-implementation surveys based on the Capability, Opportunity, Motivation, Behavior (COM-B) model to people with TB and their health care workers. The surveys included questions on demographics and technology use, Likert scale questions to assess capability, opportunity, and motivation to use DAT and open-ended feedback. We summarized demographic and technology use data descriptively, generated pooled estimates of responses to Likert scale questions within each COM-B category for people with TB and health care workers using random effects models, and performed qualitative analysis of open-ended feedback using a modified framework analysis approach. The analysis included surveys administered to 1290 people with TB and 90 HCWs across 6 TB REACH-funded projects. People with TB and HCWs had an overall positive impression of DATs with pooled estimates between 4·0 to 4·8 out of 5 across COM-B categories. However, 44% of people with TB reported taking TB medications without reporting dosing via DATs and 23% reported missing a dose of medication. Common reasons included problems with electricity, network coverage, and technical issues with the DAT platform. DATs were overall perceived to reduce visits to clinics, decrease cost, increase social support, and decrease workload of HCWs. DATs were acceptable in a wide variety of settings. However, there were challenges related to the feasibility of using current DAT platforms. Implementation efforts should concentrate on ensuring access, anticipating, and addressing technical challenges, and minimizing additional cost to people with TB.

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.

Tuberculosis medication adherence in a secondary care center in SouthEastern Nigeria

Adherence to a treatment strategy known as Directly Observed Treatment Short course (DOTS) by patients diagnosed of tuberculosis is essential in the effective treatment of the disease. This is in order to avoid recurrence, resistance and complications that results from non-adherence. This paper assessed the adherence to anti-tuberculosis medications among tuberculosis patients in a secondary healthcare facility in Anambra State, Nigeria. This was a descriptive crosssectional study and a semi-structured interviewer-administered questionnaire was used. The study population comprised of tuberculosis patients who has been on anti-TB medications for at least four weeks at the Tuberculosis clinic. A systematic random sampling technique was used to enrol the respondents into the study. The mean age of the respondents was 39.68±16.66 years. Majority of the respondents correctly alluded to tuberculosis as being caused by bacteria (91.7%); and that the duration of treatment was at least six months (100.0%). A great proportion of the respondents affirmed that a vaccine is available for prevention of tuberculosis infection (91.7%); also all the respondents agreed that covering mouth and nose while coughing/sneezing is a preventive measure of TB spread (100.0%). About 15.2% of the respondents sometimes stop taking their medications when they feel their health condition is under control, however, a great proportion of the respondents had good adherence to medications (76.0%). Major reasons for missing medication among the non-adherent were that they forgot (91.8%) and that there were too much medication to take at once (1.2%). Statistically significant associations existed between drug adherence and age, sex and educational qualification; as respondents within the age range of 60-69 years, female and those who had completed tertiary education had better adherence to anti-TB medications. TB medication non-adherence is a potential risk factor for poor health outcomes, hence more effort is needed to increase the rate of adherence.

Mapping the effectiveness of the community tuberculosis care programs: a systematic review

BackgroundTuberculosis is a significant global public health threat, especially in countries with limited resources. To improve tuberculosis care, the World Health Organization emphasizes the importance of considering a TB patient’s journey across a variety of connected settings and facilities. A systematic review was conducted to map previously conducted studies to identify existing community TB implementation models, their effectiveness on cost, and treatment outcomes.MethodsSystematic search through various electronic databases MEDLINE, EBSCO (PsycINFO and CINAHL), Cochrane Library, EMBASE, WHO Regional Databases, gray literature, and hand-searched bibliographies was performed. Articles published in English between the years 2000 and 2022 with a substantial focus on community TB implementation models were considered for inclusion. Studies were excluded if the intervention was purely facility-based and those focusing exclusively on qualitative assessments. Two reviewers used standardized methods to screen titles, abstracts, and data charting. Included studies were assessed for quality using ROBINS-I and ROB 2. Analysis of study results uses a PRISMA flow diagram and quantitative approach.ResultsA total of 6982 articles were identified with 36 meeting the eligibility criteria for analysis. Electronic medication monitors showed an increased probability of treatment success rate (RR 1.0–4.33 and the 95% CI 0.98–95.4) in four cohort studies in low- and middle-income countries with the incremental cost-effectiveness of $434. Four cohort studies evaluating community health worker direct observation therapy in low- and middle-income countries showed a treatment success risk ratio of up to 3.09 with a 95% CI of 0.06–7.88. (32,41,43,48) and incremental cost-effectiveness up to USS$410. Moreover, four comparative studies in low- and middle-income countries showed family directly observed treatment success risk ratio up to 9.07, 95% CI of 0.92–89.9. Furthermore, four short message service trials revealed a treatment success risk ratio ranging from 1.0 to 1.45 (95% CI fell within these values) with a cost-effectiveness of up to 350I$ compared to standard of care.ConclusionsThis review illustrates that community-based TB interventions such as electronic medication monitors, community health worker direct observation therapy, family directly observed treatment, and short message service can substantially bolster efficiency and convenience for patients and providers while reducing health system costs and improving clinical outcomes.

CHIME - A tailored HCV microelimination project in Viennese people who inject drugs at drug centralized substitution centers

BackgroundHepatitis C remains highly prevalent among people who inject drugs (PWIDs). We propose an integrated approach for screening/diagnostic testing and treatment in 6,665 Viennese PWIDs registered to access opioid agonist therapy (OAT). MethodsOAT prescriptions were required monthly at one of nine approved authorities, making them ideal platforms for hepatitis C virus (HCV) screening. All PWIDs attending these authorities between January 2019 and March 2020 were offered on-site HCV screening, and consecutive HCV RNA PCR in case of positive HCV serology. In HCV viremic PWIDs, offsite referral to HCV care and treatment according to directly observed therapy (DOT) alongside OAT were performed. Results4,327/6,665 (64.9%) individuals were contacted before the COVID-19-related project discontinuation. There were 1,538/4,327 (35.5%) individuals who had participated in the study. HCV serology was available in 1,510/1,538 (98.2%): 795/1,519 (52.6%) had a positive serology, among whom 632 (79.5%) were followed-up with a PCR test. In 8/1,538 (0.5%) additional study participants HCV RNA PCR was assessed without prior serological screening. 239/640 (37.3%) individuals were HCV viremic with 51 (21.3%) having started on direct-acting antivirals (DAAs). 48/51 (94.1%) had completed treatment, among whom 42 (87.5% according to ITT) had achieved sustained virologic response at 12 weeks after completing treatment (SVR12) and 6 (12.5%) had been lost to follow-up after completion of therapy (SVR12 according to mITT: 42/42, 100%). No treatment failures had occurred. ConclusionProviding integrated point-of-care HCV screening/diagnostic testing at central OAT approved centers, followed by DOT with DAAs, represents an effective HCV microelimination strategy. While some PWIDs were lost in the cascade to cure and the absolute number of SVR was limited by the COVID-19 pandemic, our approach will allow linkage to care in a large proportion of Viennese PWIDs.

Peran PMO dan Analisis Tingkat Kepatuhan Menelan Obat pada Pasien Tuberkulosis Paru di Puskesmas Palembang: Dampak terhadap Kesembuhan

Pulmonary tuberculosis (TB) is a chronic infection caused by Mycobacterium tuberculosis, which is one of the top 10 leading causes of death worldwide. Treating pulmonary TB using the DOTS strategy ensures the involvement of a Directly Observed Treatment (DOT) Supervisor, ensuring patient compliance and regular treatment for successful recovery. This study aims to analyze the role of the DOT Supervisor (PMO) in patient compliance and its impact on the recovery of pulmonary TB patients at Merdeka Community Health Center in Palembang. The research was designed as a cross-sectional observational quantitative study, with a sample size of 31 individuals who completed a 6-month treatment and provided complete data. The results of the study revealed that the PMO played a significant role and fulfilled their duties according to the DOTS strategy. The PMO's role was categorized as supportive in 61.3% of cases and non-supportive in 38.7% of cases. The level of compliance in taking medication among pulmonary TB patients was 74.2%, while non-compliance accounted for 25.8%. There was a significant relationship between the PMO's role and patient adherence to medication intake guidelines in pulmonary TB patients at Merdeka Community Health Center, with an R-value of 27.800. In conclusion, the research findings indicate a significant relationship between the PMO's role, medication compliance, and its impact on recovery.

Intersections of informal work status, gender and tuberculosis diagnosis: Insights from a qualitative study from an Indian setting.

There is evidence that more than one third of tuberculosis (TB) cases in India go undiagnosed each year and it is more pronounced among female patients. While there are studies available on the socioeconomic, cultural and gender-related dimensions of TB diagnosis delays among female patients in India, intersections of gender, informal work and diagnosis delays are not sufficiently studied. The present study aims to fill this gap by examining the TB diagnosis delay that are linked to the contingencies of working in informal arrangements for women from lower socio economic background. The study draws on 80 qualitative in-depth interviews conducted among female patients from lower socio-economic background, who were working or recently stopped working in informal arrangements and undergoing Directly Observed Therapy, Short-course (DOTS) treatment in Bengaluru (India) city and 60 willing significant others of the patients. The participants were identified through a scoping survey that covered 188 female patients from 18 DOTS centres in the city. Other than the already known reasons for the delay in TB diagnosis for women such as normalisation of symptoms, stigma and the gender-related discrimination leading to low prioritisation of women's illness, the present study identifies reasons related to work informality. These are normalisation of symptoms as workplace health problems; work related concerns that restricted formal help seeking; non TB specific narratives of symptoms, often incorrectly assumed to be work related health issues or comorbidities and thus confounding the early accurate diagnosis by the medical personnel and shifting between formal and informal systems of help-seeking. Further, the study found that mere knowledge of TB symptoms did not always translate to early diagnosis for patients from the lower socioeconomic groups working in informal arrangements due to the fear of losing work and wages owing to hospital visits. The workplace focus, especially the informal sector where a huge majority of India's workforce is employed, is notably absent in the TB elimination programme. The study indicates the need to adopt a comprehensive approach in the ongoing TB elimination programme in India in which family, living environment and workplace should be integral parts.