DOTS Program Research Articles

Trends of Mycobacterium tuberculosis and Rifampicin resistance in Northwest Ethiopia: Xpert® MTB/RIF assay results from 2015 to 2021

BackgroundTuberculosis (TB) remains one of the leading causes of morbidity and mortality worldwide, particularly in countries with limited resources. The emergence of drug resistance in mycobacterium tuberculosis (MTB), particularly rifampicin (RIF) resistance, hindered TB control efforts. Continuous surveillance and regular monitoring of drug-resistant TB, including rifampicin resistance (RR), are required for effective TB intervention strategies and prevention and control measures.ObjectiveDetermine the trend of TB and RR-TB among presumptive TB patients in Northwest Ethiopia.MethodA retrospective study was conducted at the University of Gondar Comprehensive Specialized Hospital (UoG-CSH). The study included TB registration logbook data from all patients who visited the hospital and were tested for MTB using the Xpert® MTB/RIF assay between 2015 and 2021. The SPSS version 26 software was used to enter, clean, and analyze the laboratory-based data.ResultsA total of 18,787 patient results were included, with 93.8% (17,615/18787) of them being successful, meaning they were not invalid, error, or aborted. About 10.5% (1846/17615) of the 17,615 results were MTB-positive, with 7.42% (137/1846) RIF resistant. Age, anti-TB treatment history, and diagnosis year were associated with the presence of MTB and RR-MTB. Tuberculosis (TB) prevalence was higher in productive age groups, whereas RR-TB prevalence was higher in the elderly. Regarding diagnosis year, the prevalence of TB and RR-TB showed a declining trend as the year progressed. While MTB was detected in 12.8% (471/3669) of new and 22.2% (151/679) of re-treatment presumptive TB patients, RR-MTB was detected in 8.5% (40/471) of new and 18.5% (28/151) of re-treatment TB cases.ConclusionThe prevalence of TB and RR-TB in the study area showed a declining trend over the years. While TB was more prevalent in productive age groups (15 to 45 years), RR-TB was more prevalent in older populations (over 45 years), than others. Moreover, patients with a history of anti-TB drug exposure were more likely to be positive for DR-TB, highlighting the need to strengthen DOT programs for proper management of TB treatment.

Innovative Integrated Motivational Interviewing for Dual Management in Tuberculosis Patients with Diabetes (MID-DOT) in Malaysia

(1) Background: Achieving successful tuberculosis (TB) treatment outcomes among diabetic patients is a real challenge as TB complicates control of diabetes. This study aimed to evaluate the effectiveness of an integrated dual management educational module, MID-DOTS, which uses the mmotivational interviewing (MI) technique implemented within directly observed treatment as part of a short course (DOTS) program in TB patients with diabetes (TB/DM). A randomized controlled trial was conducted in the northeastern state of Malaysia. (2) Methods: One hundred and twenty-four TB patients with diabetes received educational intervention using a MID-DOT module that used the MI technique, which was repetitively applied by TB nurses throughout a 6-month DOTS program while another 122 patients were given standard health education. Study outcomes include the proportion of patients with successful TB treatment, and changes in HbA1c and diabetic self-care scores at 6 months. (3) Results: The successful TB treatment outcome was 88% in the intervention group versus 72% in the control group (RR = 1.24; 95%CI 1.16, 1.58). A significant reduction of HbA1c (mean difference 0.82%; 95%CI 0.66, 0.98) and significantly higher diabetes self-care score (mean difference 8.49; 95%CI 7.38, 9.59) were also shown in the intervention group. (4) Conclusions: A dual TB/DM educational strategy which integrates the MI technique applied repetitively within the DOTS program is effective in increasing successful TB treatment as well as improving diabetic outcomes.

Effect of Health Education on Family Independence Level Caring for Tuberculosis Sufferers DOTS Program

Pulmonary tuberculosis is an infectious disease that is still a public health problem in the world. The study aims to determine the level of independence of tuberculosis patients and families before and after the provision of health education. The research design used in this study is a pre-experimental method with one group pretest-postest design. The population of this study was all families who had family members suffering from Pulmonary Tuberculosis and were undergoing treatment ≤ 2 months, the sampling method used was purposive sampling. The results showed the effect of health education on family independence in caring for patients with Pulmonary Tuberculosis DOTS program, with a value of p = 0.005 which means p < α (0.05). It can be concluded that there is an influence of health education on the level of family independence in caring for tuberculosis patients. The results of this study, it is expected that the public health center will socialize the implementation of home care nursing, for tuberculosis patients to always take medication regularly, and future researchers are expected to use different research methods, tests, and variables as well as large samples

DIAGNOSTIC ROLE OF GASTRIC ASPIRATION IN SMEAR NEGATIVE PULMONARY TUBERCULOSIS IN ADULT

To study the diagnostic utility of gastric aspiration in sputum negative pulmonary tuberculosis by identifying gastric smear for AFB and culture.To compare the outcome among HIV positive and negative individuals. To study how many were false negative due to improper techniques in sputum sample submission. To compare the radiological patterns with yield in gastric aspiration.To investigate the role of bronchoscopy in smears negative pulmonary tuberculosis.From this study, gastric aspirate for smear positivity among sputum smear negative pulmonary tuberculosis was 24% and gastric culture positivity was 22%. Gastric aspirate for AFB smear and culture can be used as a tool in diagnosis of pulmonary tuberculosis in patients who cannot submit sputum and patients who are smear negative as suggested by the study.Gastric aspirate performed on 2 consecutive days may improve the diagnostic yield.Gastric aspirate performed among HIV positive patients was only 10%.Gastric aspirate positivity in culture had a high yield among chest xray with suspected pulmonary tuberculosis with consolidation pattern(38%).There is practice of prescribing fluoroquinolone for community acquired pneumonia in private. The patients seeking treatment in a tertiary care centre are not naïve population .Many of them would have had treatment and exposed to fluoroqunilones before presenting to us and hence these patients are at the risk of developing fluroquinolone resistant pulmonary tuberculosis. DOTS program in India is functioning at the level of primary health centre where sophisticated techniques like bronchoscopy are not available, patient presenting with no sputum under suspicion of tuberculosis, gastric aspirate can be performed as a diagnostic technique which is a simple outpatient procedure.

Assessment of Co-Infection in Tuberculosis Patients Prior to their Enrollment to the Direct Observed Treatment (Dot) Program in Buea, Limbe, and Douala Tuberculosis Treatment Centers

Introduction: Co-infections during Tuberculosis infection are among the leading causes of morbidity and mortality worldwide. These infections are a major public health problem among patients in most developing countries, including Cameroon. One of the important public problems in coendemic areas is co-infection with TB in humans. Moreover, there is no adequate research hitherto that provides information on the level of co-infection in Tuberculosis patients. Therefore, this study aimed to assess the prevalence and intensity of co-infections in newly diagnosed Tuberculosis patients prior to their enrollment to the Direct Observed Treatment (DOT) program in Buea, Limbe and Douala Tuberculosis treatment centers. Methods: This cross-sectional study was conducted from March to November 2020 using a purposive sampling technique. A fresh sputum sample was collected, processed, and examined through a smear microscopy and culturing technique. Blood samples were collected through finger pricking for the detection of blood parasites using thin and thick blood smears. Stool samples were also collected and processed using a direct wet mount, and Kato-Katz and Modified Ziehl Neelsen staining methods. The data was analyzed using SPSS version 20.0. A Chi-square test was done to assess the prevalence of co-infection among all TB patients recruited for this study. Results: A total of 200 newly diagnosed TB-positive patients were recruited from the three study sites. Out of the total participants recruited, 29.0% were diagnosed positive for blood parasites, 2.0% for intestinal parasites and 15.0% for viral infections, bringing the overall prevalence of co-infection to 46.0%. When specific infections were considered, malaria, filaria, intestinal parasites, HIV and HBV constituted 28.0%, 1.0%, 2.0%, 14.5% and 0.5% respectively. When dual-infection was considered, the results were 0.5% malaria/filaria, 1.5% malaria/intestinal parasites and 2.0% malaria/HIV. The mean parasite densities for all samples diagnosed positive for malaria, filarial and intestinal parasites were 107.0 ± 338.8 parasites/uL, 25.7 ± 356.4 mf/mL and 85.0 ± 85.4 EPG, respectively. Conclusion: The results indicate that there is an overlap of co-infections in TB patients with their interactions expected to lead to complications and difficulty when managing the TB patients, calling for more research and recommending more assessment for co-infection in TB patients before starting treatment.

EVALUATION OF TUBERCULOSIS RECORDING AND REPORTING CASE SYSTEM AT SYARIF HIDAYATULLAH HOSPITAL IN 2020

The national TB control program target is TB elimination at 2035 and TB eradication at 2050. Hospitals must establish a DOTS Team who have responsibility to implementing the TB control program and must be record and report any disease cases. TB case reporting uses the Integrated Tuberculosis Information System (SITT) since 2020. Integrated Tuberculosis Information System has become the Tuberculosis Information System (SITB). Syarif Hidayatullah Hospital is one of the 3 hospitals that have not completed the report. This research is a descriptive analytic study with a qualitative approach. The data collecting data include documents review, observation, and in-depth interviews with key informants. The results showed that recording and reporting did not run optimally because 1) the lack of human resources such as nurses as the spearhead of manual record, 2) there was no funding for the TB DOTS program including for recording and reporting, 3) Hospital Information System was not integrated into all service units causing difficulties in data collection TB patients, 4) the internal network did not working properly because there is no socialize about TB recording and reporting flowchart. Increased management commitment in implementing the TB DOTS program so that recording and reporting can working properly.

Evaluation of Community Health Volunteers Training on Early Detection Skills of Pulmonary Tuberculosis

Background: achievement of coverage numbers of cases of pulmonary TB cases that meet the target impact on the prevention of disease transmission, complications, and even death due to pulmonary TB. Increasing the capacity of community health volunteers as partners of health workers in the early detection of pulmonary TB becomes a program that needs to be considered.Purpose: this study aims to identify the effect of community health volunteer training on the early detection of pulmonary tuberculosis.Methods: the study design used quasi-experimental pre-test and post-test types with a control group. The study was conducted in February-March 2020 in the working area of the Kutowinangun Primary Health Care Facilities. The total sample of 32 community health volunteers for each intervention and control group was selected by purposive sampling based on inclusion and exclusion criteria. The instruments used were observation sheets and modules developed by researchers. The training was conducted in 5 sessions over 5 days with a duration of 60 minutes per session. Data analysis using paired t-test and independent t-test. This research has passed the ethical test from the Ethics Committee of the Faculty of Public Health, University of Muhammadiyah Semarang.Results: there was an effect of community health volunteers' training on improving early TB pulmonary detection skills significantly with a p-value = 0,000 (p 0.05).Conclusion: refreshments of community health volunteers must be planned in the annual work plan program design. Increased skills have a positive impact on the increasing findings of new cases of pulmonary TB. Community health volunteer training can be integrated with the DOTS program in primary health care facilities.

Pedestrian Safety and Transit Corridors

This research examines the relationship between pedestrian accident locations on state-owned facilities (highways and urban arterials) and the presence of riders loading and alighting from bus transit. Many state facilities are important metropolitan transit corridors with large numbers of bus stops users, resulting in increased exposure of pedestrians to traffic and in increased numbers of collisions. The research also examines the association between pedestrian collisions and other travel generators (concentrations of retail activity and housing) as well as environmental conditions (wide roadways, high traffic volumes, and high speed limits).Based on a retrospective sampling approach and logistic regression models, the study shows that bus stop usage is associated with pedestrian collisions along state facilities. Less strong, but significant associations exist between retail location and size, traffic volume, and number of traffic lanes, and locations with high levels of pedestrian-vehicle collisions. The findings suggest that facilities with high numbers of bus riders need to accommodate people walking safely along and across the roadway. They support the development of state DOT programs for multimodal facilities, which integrate travel modes in major regional facilities within local suburban communities and pay specific attention to the role of transit in shaping the demand for nonmotorized travel on the facilities.

Analisis Motivasi Kader Kesehatan dalam Penemuan Kasus Tuberkulosis di Wilayah Kerja UPTD Puskesmas Pengaringan Oku Tahun 2021

Tuberculosis is an infectious infectious disease caused by the Mycobacterium tuberculosis which mainly attacks the lungs. The purpose of this study was to determine what factors were associated with the motivation of health cadres in finding cases of tuberculosis in the working area of ??UPTD Puskesmas Pengaringan Kab. OKU 2021. The design of this research is Cross Sectional. The population in this study were health cadres in the work area of ??Pengaringan Health Center, Ogan Komering Ulu Regency in 2021. The sampling method in this study used a total sampling technique. The number of samples in this study were 70 respondents. Data collection by using a questionnaire. The results of the statistical analysis of respondents using the Chi-Square test showed that there was a significant relationship (p < 0.05) for age (0.001), cadre tenure (0.013), education (0.007), knowledge (P Value 0.009), attitude (P Value 0.004 ), training (P Value 0.000) and supervision (0.000). From the results of the multivariate analysis, the dominant factor on the motivation of cadres in finding Tuberculosis cases in the work area of ??the Pengaringan Health Center, Ogan Komering Ulu Regency in 2021, is Supervision (P Value 0.000) (OR 28.967). From this research, it is hoped that the Puskesmas will carry out periodic supervision and guidance to health cadres, forming special cadres who run DOTS programs, especially in finding Tuberculosis cases.

Default in Tuberculosis Treatment among Women Registered in DOTS Center of Taplejung District, Nepal: A Descriptive Study

INTRODUCTION: Default is one of the unfavourable outcomes for patients on DOTS and represents an important challenge for the control program. Therefore, this study was designed to assess default in tuberculosis (TB) treatment among women registered in DOTS center at Taplejung District of Nepal. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted at Taplejung district of Nepal in thethe year 2016. Records of TB patients from all DOTS centre for one year were obtained and treatment default cases for women were identified. Face to face interview was conducted by using semi-structured questionnaire to collect data from the patients. The data were entered and analyzed in MS Excel software. RESULTS: Out of total 30 female TB patients, 72.0% of respondents belonged to the age group of 15-49 years where as 73.3% of the respondents were Kirat and from Dalit caste ethnicity. Less than half of the respondents (48.0%) thought, feeling better after medication, was the reason for default TB. A second major cause for default in tuberculosis treatment was distance to reach DOTS center (12.0%) and lack of food at home (10.0%). Likewise, few respondents said lack of family support (6.7%), thinking about side effects (6.7%), medicine not working (3.3%) and stigma (6.7%) were the reasons for the default in tuberculosis treatment. CONCLUSIONS: Majority of the respondents left treatment because they felt better after medication. A second major reason for default in TB treatment was distance to reach DOTS center. The findings may be helpful in planning modifications in DOTS program of Nepal.

An Analysis on the Effect of Psychosocial and Any Other Risk Factors towards the Incident of TB MDR Service Work Area of Public Health Office in Ciamis Regency in 2019

Tuberculosis disease remains the main community health problem in Indonesia, both in its prevalence aspects and other problems. Attempts in handling the tuberculosis disease are still being carried out. However, obstacles are found in the attempt to handle it, one of the obstacles is the impact of the unsuccessful medication for the tuberculosis patients. This research is aimed at investigating the effect of the psychosocial and any other risk factors towards the incident of TB-MDR. The research employed cross sectional method by using a total sample of 62 respondents. The study showed that to support the implementation of the DOTS Program, the patients suffering TB-MDR should be monitored simultaneously for their progress during medication, especially in the aspect of psychosocial.

Prevalence and Associated Factors of Human Immune Deficiency Virus and Tuberculosis Co-Infection in Patients Attending Kolla Diba Health Center, Dembia District, Northwest Ethiopia.

BackgroundTB-HIV co-infection is the most common problem of African countries, especially, Sub-Saharan countries including Ethiopia. So this study aimed to assess TB-HIV co-infection with its associated factors in patients with Tuberculosis in Northwest Ethiopia. Although the prevalence of TB-HIV was low, the need for strengthening the health extension program especially in urban dwellers also needed to include TB-HIV testing.ObjectiveThis study aimed to assess TB-HIV co-infection with its associated factors in patients with Tuberculosis in Northwest Ethiopia.MethodologyInstitutional based cross-sectional study has been done and a total of 638 subjects participated in the study. The data of the study subjects were collected from the tuberculosis logbook using two trained data collectors who were work in the TB DOTS program and by using a well-prepared checklist and SPSS was used for analyzing data.Results9.7% (62/638) of TB patients were found to be co-infected with HIV. Among these 32 (11.4%) were females and 30 (8.4%) were males. More infected individuals were found in urban residents 44 (20%) than rural residents and age groups 30–40 years 31 (22.5%) are more infected than the other age group. TBforms, age, and residence were associated with HIV/TB co-infection significantly.Conclusions and RecommendationsAlthough the prevalence of TB-HIV was low, the need for strengthening the health extension program especially in urban dwellers is needed to include TB-HIV testing. Further surveys involving HIV infected TB patients to strengthen and scale-up for TB and HIV is needed.

Tuberculosis Treatment Outcome and Associated Factors Among Tuberculosis Patients Under Directly Observed Treatment Short-Course at Arba Minch General Hospital, Southern Ethiopia: A Five-Year Retrospective Study

Background: Although directly observed treatment short course has been implemented among different countries, tuberculosis (TB) remains a major public health issue in the 21 st century and Ethiopia is the eighth highest-burden country in the world. Thus, assessment of TB treatment outcomes and its associated factors in DOTS are among the major indicators of the performance of a national TB control program. Objective: The aim of this study was to assess tuberculosis treatment outcome and associated factors among TB patients under directly observed treatment short-course at Arba Minch General Hospital TB clinic, Southern Ethiopia from September 2015 to August 2020.MethodsAn Institutional based retrospective study was conducted by reviewing the five years (1 st September 2015 to 30 th August 2020) TB treatment registries at the TB clinic of Arba Minch General Hospital. A total of 498 TB patients from the registration with complete information were enrolled. Patients’ data like age, sex, residence, type of TB, the status of TB case, smear result of PTB, HIV co-infection, year of TB diagnosis, and treatment outcomes were extracted from the TB treatment registration with a data collection checklist. SPSS version 25 statistical software was used for final data analysis. Results: From the overall enrolled TB patients, 312 (62.7%) were males and about 286 (57.4%) were from rural areas. In terms of TB type 94% were pulmonary TB, of which 66% were smear negative (PTB-) and 86.3% were new TB cases. The proportion of TB/HIV co-infection was 17.7%. Overall, 440 (88.4%) TB patients had successful treatment outcomes (28.5% cured and 59.9% completed treatment), while 11.6% patients had unsuccessful treatment outcomes (7.8% defaulted, 2.2 died, and 1.6% treatment failure). The unsuccessful TB treatment outcome was significantly associated with re-treatment TB cases [AOR=3.345, 95% CI: (1.739-6.436)], smear-negative PTB cases, [AOR = 2.558, 95% CI: (1.229-5.323)] and with EPTB [AOR = 4.817, 95% CI: (2.101-11.044)]. Conclusion: The high TB treatment success rate in our setting is in line the target set by the WHO. However, successful treatment outcome was very law in EPTB, re-treatment, and smear negative PTB cases. Therefore, targeted measures should be considered to decrease poor tuberculosis treatment outcomes among high-risk patients through; careful monitoring, making the DOTS program more accessible and counselling. Funding: This research was supported by Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Southern Ethiopia. Declaration of Interest: The authors declare that they have no conflicts of interest for this work. Ethical Approval: This study was approved by the Arba Minch University, College of Medicine and Health Sciences, Department of Medical Laboratory Sciences

ANALISIS FAKTOR YANG BERPENGARUH TERHADAP KONVERSI SPUTUM BASIL TAHAN ASAM PADA PENDERITA TUBERKULOSIS

Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. The incidence of tuberculosis in Indonesia is high because the success rate of tuberculosis treatment has decreased which causes the chain of transmission continues to occur. The main government programs to decrese the incidence and increasing the success treatment with the Directly Observed Treatment (DOTS) program. One important indicator of the DOTS program to assessing the success of tuberculosis treatment is the conversion of positive AFB sputum to negative at the end of the intensive phase of treatment. AFB sputum conversion to negative at the end of the intensive phase of treatment is influenced by several internal factors such as level of education and income, gender, adherence, patient's nutritional status, and comorbidities. Then external factors can also influence the AFB sputum conversion in anti-tuberculosis treatment such as environmental conditions, smear positivity, drug taking supervisors (PMO), and availability of drugs in health facilities.

Tuberculosis Treatment Outcomes and Associated Factors Among Patients Treated at Woldia General Hospital in Northeast Ethiopia: An Institution-Based Cross-Sectional Study.

BackgroundTuberculosis remains a major global health problem. It causes ill-health among millions of people each year and ranks alongside the human immunodeficiency virus (HIV) as a leading cause of death worldwide. For effective tuberculosis control, it is a prerequisite to detect the cases as early as possible and to ensure that the tuberculosis patients complete their treatment and get cured. However, the burden of the problem is still a national issue, and there is a scarcity of research to show treatment outcomes and associated factors of tuberculosis at the North Wollo Zone, specifically Woldia.MethodsInstitution-based, retrospective register-based data were collected from medical records of tuberculosis patients from 2015 up to 2018 at Woldia General Hospital. The data were analyzed using SPSS version 24, and multiple logistic regression methods were used to investigate the association between independent and dependent variables. A P-value of less than 5% was considered statistically significant in the final model.ResultsThe prevalence of successful tuberculosis treatment outcomes was 80.7%. Among all patients, 73% were pulmonary tuberculosis cases. This study results show that age less than 24 years old [AOR: 4.7; 95% CI (1.3–10.1)], male sex [AOR: 2.8; 95% CI (2.1–4.8)], year of registration in 2018 [AOR: 4.8; 95% CI (3.9–7.4)], and HIV negative status [AOR: 3.9; 95% CI (1.4–10.7)] were found to be significantly associated factors with the treatment outcomes of tuberculosis.ConclusionThe study showed that nearly 20% of tuberculosis patients had an unsuccessful treatment outcome. Older age, female sex, year of registration in 2015, and being HIV positive were found significantly associated with poor tuberculosis treatment outcomes. Therefore, targeted measures should be considered to decrease poor TB treatment outcomes among high-risk patients through careful monitoring, making the DOTs program more accessible, counseling, and linking HIV patients.

Patient factors related to pre-treatment delay of pulmonary tuberculosis: A retrospective cohort study in Bangladesh

BackgroundBurden of tuberculosis (TB) is still high in Bangladesh. Pre-treatment delay is a hindrance in reducing this burden by early diagnosis and prompt treatment of TB. The study was conducted to identify the patient factors related to pre-treatment delay of pulmonary TB. MethodsThis retrospective cohort study was performed during January to June 2018 in a cohort of 240 consecutively enrolled; newly detected adult pulmonary TB (PTB) patients initiated anti-TB therapy during the study period. Two DOTS were selected randomly using cluster sampling and all the PTB patients enrolled in the DOTS centres formed the study population. Informed written consent was obtained from the patients, prior to data collection. Data were collected by face-to-face interview and reviewing medical records using a semi-structured questionnaire and checklist respectively. ResultsAge of the patients was associated with pre-treatment delay of TB (p < 0.05) with predominance in elderly (75.0%). Delay in care seeking was associated with inability to make decision (RR = 1.84; AR: 35.84%) and awareness of patients (RR = 0.33; AR = −40.0%). Delay in diagnosis was associated with economic problem (RR: 1.63; AR: 28.85%); work barrier (RR: 1.75; AR: 35.03%); inability to make decision (RR: 1.93; AR: 40.65%); delayed investigation (RR: 2.88; AR: 56.17%); others’ assistance (RR: 1.77; AR: 28.53%); and symptomatic treatment (RR: 6.43; AR: 65.14%). Delay in treatment initiation was associated with repeated investigations (RR = 1.52; AR: 23.29%) and smear positivity (RR: 0.64; AR: 23.11%). Awareness of patients regarding symptoms and smear positivity were revealed as protective factors for pre-treatment delay of TB. ConclusionDelay in care seeking, diagnosis, and treatment initiation contribute substantially to pre-treatment delay of PTB. Considerable reduction in pre-treatment delay may be achieved through changes in awareness of patients and ensuring early diagnosis and prompt treatment of PTB under DOTS programme.

Fungsi – Fungsi Keluarga dengan Hasil Pengobatan Tuberculosis Program DOTS

This study aimed to determine the function of the family with TB treatment in the DOTS program in the Sumenep District Health Center. This type of research is a survey using a cross-sectional design. The results showed that variables with a P-value &lt;0.05 were affective function, socialization functions, and family care functions, and there were no variables with a P value&gt; 0.05. In conclusion, the three dominant independent variables are the affective function in the success of TB treatment.&#x0D; &#x0D; Keywords: Jean Watson's Theory, Family Tuberculosis

Advantage in privacy protection by using synchronous video observed treatment enhances treatment adherence among patients with latent tuberculosis infection

BackgroundTreatment of latent tuberculosis infection (LTBI) is an important strategy for active disease prevention. Conventional in-person DOT (CDOT) programs are challenged by patient dissatisfaction over problems of convenience and privacy. The present study assessed satisfaction to DOT program and treatment adherence of synchronous video observed treatment (SVOT) programs from patients’ perspectives. MethodsA two-part questionnaire was presented to 240 subjects with LTBI who received a 9-month isoniazid treatment regimen along with mandatory DOT monitoring during January 2014 to December 2017. ResultsSatisfactions with location arrangement (p<0.001), ensuring treatment adherence (p=0.027), and privacy issues (p=0.005) were superior in the SVOT group. The overall rate of LTBI treatment completion was 91.25%. One (1.25%) and 20 (12.50%) of the participants in the SVOT and CDOT groups, respectively, quit LTBI treatment (p=0.008). Development of adverse events [adjusted hazard ratio, aHR 8.01 (3.42–18.79)], and the concern of privacy infringement [aHR 5.86 (2.69–12.76)] by the DOT program independently increase the risk of withdrawal. SVOT program [aHR 0.21 (0.06–0.68)] and a belief in the importance of adherence on treatment efficacy [aHR 0.29 (0.08–0.98)] were independent predictors preventing patients from withdrawing from treatment. ConclusionsA comprehensive patient-centered DOT program enables high treatment adherence for the 9-month isoniazid LTBI treatment. Furthermore, SVOT was associated with superior patients’ satisfactions which translate into higher treatment completion rates. As treatment adherence is the key to the efficacy of LTBI treatment, SVOT should be a reasonable supplement for LTBI treatment.

Does time to loss to follow-up differ among adult tuberculosis patients initiated on tuberculosis treatment and care between general hospital and health centers? A retrospective cohort study

BackgroundPatients’ loss to follow-up (LTFU) from tuberculosis treatment and care is a growing worry in Ethiopia. But, available information is inadequate in assessing the time to tuberculosis patient loss to follow-up difference between health centers and a general hospital in Ethiopia. We aimed to assess time to LTFU difference between health centers and a general hospital in rural Ethiopia.MethodsWe conducted a retrospective cohort study from September 2008 to August 2015 and collected data from September 1 to October 02, 2016. A total of 1341 TB patients with known treatment outcomes were included into the study. Log rank test was used to compare the difference in time to TB patient loss to follow-up between health centers and a general hospital, whereas Cox proportional hazard model was used to assess factors associated with time to loss to follow-up in both settings.ResultsWe reviewed a total of 1341 patient records, and the overall follow-up time was 3074.7 and 3974 person months of observation (PMOs) for TB patients followed at health centers and a general hospital, respectively. The incidence of loss to follow-up rate was 27.3 per 1000 PMOs and 9.6 per 1000 PMOs, at health centers and a general hospital, respectively. From the overall loss to follow-ups that occurred, 55 (65.5%) and 33 (86.8%) of LTFUs occurred during the intensive phase and grew to 78 (92.9%) and 38 (100%) at health center and a general hospital, respectively, at the end of 6-month observation period. Older age (AOR = 1.7, 95%CI, 1.2–2.5, P < 0.001), being a rural resident (AHR = 2.7, 95%CI, 1.6–4.6), HIV reactive (AHR = 2.2, 95%CI, 1.5–3.2), following treatment and care in health center (AHR = 3.38, 95%CI, 2.06–5.53), and living at more than 10 km away from the health facility (AHR = 3.4, 95%CI, 2.1–5.7) were predictors for time to loss to follow-up among TB patients on treatment and care.ConclusionTime to TB patient loss to follow-up between health centers and a general hospital was significant. Loss to follow-up was high in patients with older age, rural residence, sero positive for HIV, living further from the health facilities, and following treatment and care at health centers. Strengthening the DOTs program with special emphasis on health centers is highly recommended.

Sputum Conversion is Faster with Vitamin D Suplementation in Pulmonary TB Patients

Pulmonary tuberculosis (TB) is still a problem that must be resolved in Indonesia, especially North Sumatra. The study aims to determine the effect of vitamin D supplementation on the speed of sputum conversion in pulmonary TB patients. Randomized controlled trial study was conducted on 41 pulmonary TB patients according to inclusion criteria. Research subjects were given TB drug (DOTS program) and vitamin D treatment for 2 months. Sputum examination based on smear was carried out microscopically at 2nd week, 4nd week, 6nd week, and 8nd week after treatment. The results showed that all pulmonary TB patients who were given the intervention experienced sputum conversion. Research subjects with AFB +1 occurred the fastest conversion compared to the others. Statistical analysis using chi square obtained significant results (p = 0.0001). Sputum conversion evaluation based on the initial AFB status, there was a significant relationship between the time of sputum conversion with the initial AFB status with a very strong correlation level (r = 0.767). Vitamin D has been shown to have a significant effect on the patient's sputum conversion.&#x0D; &#x0D; Keywords: pulmonary TB; vitamin D; sputum conversion