Duration Of Tuberculosis Treatment Research Articles

Economic aspects of shortening the duration of tuberculosis treatment.

Economic aspects of shortening the duration of tuberculosis treatment.

A pairwise approach to revitalize β-lactams for the treatment of TB.

The dual β-lactam approach has been successfully applied to overcome target redundancy in nontuberculous mycobacteria. Surprisingly, this approach has not been leveraged for Mycobacterium tuberculosis, despite the high conservation of peptidoglycan synthesis. Through a comprehensive screen of oral β-lactam pairs, we have discovered that cefuroxime strongly potentiates the bactericidal activity of tebipenem and sulopenem-advanced clinical candidates-and amoxicillin, at concentrations achieved clinically. β-lactam pairs thus have the potential to reduce TB treatment duration.

Clinical outcomes in children living with HIV treated for non-severe tuberculosis in the SHINE Trial.

Children living with HIV(CLWH) are at high risk of tuberculosis(TB) and face poor outcomes, despite antiretroviral treatment(ART). We evaluated outcomes in CLWH and HIV-uninfected children treated for non-severe TB in the SHINE trial. SHINE was a randomized trial that enrolled children aged <16 years with smear-negative, non-severe TB who were randomized to receive 4 vs 6 months of TB treatment and followed for 72 weeks. We assessed TB relapse/recurrence, mortality, hospitalizations, grade ≥3 adverse events by HIV status, and HIV virological suppression in CLWH. Of 1204 enrolled, 127(11%) were CLWH, of similar age (median(IQR) 3.6(1.2, 10.3) vs. 3.5(1.5, 6.9)years, p= 0.07), but more underweight (WAZ; -2.3(-3.3, -0.8) vs -1.0(-1.8, -0.2), p<0.01) and anemic (hemoglobin 9.5(8.7, 10.9) vs 11.5(10.4, 12.3)g/dl, p<0.01) compared to HIV-uninfected children. 68(54%) CLWH were ART-naïve; baseline median CD4 count 719(241-1134) cells/mm3, CD4% 16(10-26)%). CLWH were more likely to be hospitalized (aOR=2.4(1.3-4.6)) and die (aHR(95%CI) 2.6(1.2,5.8)). HIV status, age <3 years (aHR 6.3(1.5,27.3)), malnutrition (aHR 6.2(2.4,15.9)) and hemoglobin <7g/dl(aHR 3.8(1.3,11.5) independently predicted mortality. Among children with available VL, 45% and 61% CLWH had VL<1000copies/ml at weeks 24 and 48, respectively. There was no difference in the effect of randomized treatment duration (4 vs 6 months) on TB treatment outcomes by HIV status (p for interaction=0.42). We found no evidence of a difference in TB outcomes between 4 and 6 months of treatment for CLWH treated for non-severe TB. Irrespective of TB treatment duration, CLWH had higher rates of mortality and hospitalization than HIV-uninfected counterparts.

Prevalence, treatment outcomes and determinants of TB/HIV coinfection: A 4-year retrospective review of national tuberculosis registry in a country in a MENA region

BackgroundThe co-occurrence of tuberculosis (TB) and AIDS (HIV) has emerged as a significant public health challenge. This study investigated the epidemiological factors and treatment outcomes of TB in individuals based on their HIV status in Iran. MethodsThe current study was a descriptive-analytical cross-sectional study that focused on new patients diagnosed with TB in Iran between 2018 and 2021. Patients’ data were sourced from the National Tuberculosis Registry database of Iran. A multiple logistic regression model was used to investigate the relationship between the most important influencing factors and TB/HIV coinfection. ResultsOver a 4-year period, a study was conducted on 25,011 new TB patients out of 30,762 registered in the national database. TB and HIV were coinfected in 672 cases (2.68%). The highest number of coinfection cases were found in patients with smear-negative pulmonary tuberculosis (249 patients, 37.05%) and extrapulmonary tuberculosis (123 patients, 18.19%). TB patients with coinfection had a median TB treatment duration of three months longer than others. The success rate of TB treatment was lower in patients with coinfection (437 patients, 65.02%) than in non-coinfection patients (20,302 patients, 83.41%). Treatment success probability in smear-positive pulmonary tuberculosis patients with and without coinfection was lower than other types of TB. Logistic regression analysis showed that having a TB risk factor was the strongest predictor of coinfection, with an odds ratio of 29.73 (95% CI: 22.05–40.07), followed by having an HIV risk factor with an odds ratio of 17.52 (95% CI: 13.68–22.45). ConclusionsThe findings of this research offer significant insights into the potential causes of HIV coinfection in individuals with TB, which could be used to inform the development of policies and strategies aimed at enhancing the identification and treatment of TB patients who are at risk of TB/HIV coinfection and to promote optimal health status for patients with TB.

СОСТОЯНИЕ КИШЕЧНОЙ МИКРОБИОТЫ У ДЕТЕЙ С ТУБЕРКУЛЕЗОМ ОРГАНОВ ДЫХАНИЯ

Aim: to study the structure and species composition, incidence of gut microbiota dysbiotic disorders using a new technique based on real-time polymerase chain reaction (PCR) – enteroflor®Kiddy – in children with pulmonary TB on TB treatment. Materials and methods. The study enrolled 63 children aged 2–12 years. We carried out a one-step cross-sectional study of gut microbiota in 49 patients (the median age was 5 years [3; 8]) with newly diagnosed active pulmonary TB: 13 children were examined before, and 36 children – at various time points of TB treatment; 14 children without focal TB did not receive TB treatment (the median age was 7.5 years [5,5; 10]). A specialized study of gut microbiota was performed using the enteroflor®Kiddy test system. Results. There was no difference in gut microbiota composition and incidence of dysbiotic disorders between children without focal TB and children with TB before TB treatment. We determined differences in gut microbiota in children with TB before TB treatment and during treatment monitoring: lower frequency of detection of Bifidobacterium spp. (100 and 61.1%, p &lt; 0.05); Butyricimonas spp. (92.3 and 58.3%, p &lt; 0.05); Desulfovibrio spp. (100 and 50.0%, p &lt; 0.05); Clostridium perfringens gr. (92.3 and 22.2%, p &lt; 0.001), higher frequency of detection of markers for pathogenicity and resistance of Clostridioides difficile (7.7 and 38.9%, p &lt; 0.05), and lower frequency of detection of Staphylococcus aureus (23.1 and 0%, p &lt; 0.05), respectively. We established that increased duration of TB treatment (more than 3 months vs. 2-3 months) led to higher frequency of gut microbiota dysbiotic disorders: complete absence of normobiota species Bifidobacterium spp. and Coriobacteriia was established in 52.4% and 14.3% of cases, respectively; pathogenic microbiota species Clostridioides difficile were detected 2.4 times more frequently (47.6%), Candida spp. fungi were detected 1.7 times more frequently (р &gt; 0.05). In children on TB treatment containing second-line drugs as compared to children only receiving first-line drugs dysbiotic disorders associated with Bifidobacterium spp. were significantly more frequent (69.2 and 30% respectively) (χ2 = 4.573, р = 0.05), up to complete absence in 50% of children receiving second-line drugs; and pathogenic microbiota species Clostridioides difficile were detected 4.6 times more frequently (46.2 and 10%, р = 0.059); cdtA, cdtB were detected twice as often (46.2 and 20.0%, р &gt; 0.05). The Candida genus fungi Candida spp. (р &gt; 0.05) were detected twice as often in the microbiota of children only receiving first-line drugs. Conclusion. TB treatment produces pronounced negative effect on gut microbiota. The increase in chemotherapy duration and inclusion of second-line drugs leads to increasing incidence of dysbiotic changes of specific representatives of normobiota, their decreasing amount, and significant increase in detection of markers for pathogenicity and resistance.

Multidrug Resistant Tuberculosis (MDR-TB) Factors: Literature Review

Background: Multidrug-resistant tuberculosis (MDRTB) is the biggest problem in preventing and eradicating TB in the world. MDR-TB occurs if the tuberculosis germs are resistant to various first-line OAT, at least two drugs, namely isoniazid and rifampicin. The emergence of MDR-TB cases presents new obstacles and challenges to the effectiveness of TB control programs due to difficult diagnosis, high rates of therapy failure, and death. This literature review aims to determine the factors that cause multidrug-resistant tuberculosis (MDR-TB). Methods: The method used in this article is a literature review using journal databases from Pubmed and Google Scholar in the 2020-2023 time period with the keywords "drug MDR TB," "multi-drug TB MDR factors," "TB MDR," and " resistant TB medicine" found in 1,990 articles, 304 from Pubmed, and 1,960 from Google Scholar). Articles were selected according to the criteria, and the result was 20 articles ready to be reviewed Results: The results of this study show that risk factors have been proven to show that there is a significant relationship between history of diabetes mellitus, history of TB treatment, patient motivation, adherence to taking medication, duration of TB treatment, status of drug side effects, employment, marital status, economic level, history of contact with patients. MDR TB, stress level, and family support are related to the incidence of MDR TB Conclusion: The conclusion of the 20 articles reviewed shows that age, gender, compliance with taking medication, diabetes mellitus, and a history of contact with MDR TB patients are the factors that most influence the occurrence of MDR TB

Inhibition of host PARP1 contributes to the anti-inflammatory and antitubercular activity of pyrazinamide

The antibiotic pyrazinamide (PZA) is a cornerstone of tuberculosis (TB) therapy that shortens treatment durations by several months despite being only weakly bactericidal. Intriguingly, PZA is also an anti-inflammatory molecule shown to specifically reduce inflammatory cytokine signaling and lesion activity in TB patients. However, the target and clinical importance of PZA’s host-directed activity during TB therapy remain unclear. Here, we identify the host enzyme Poly(ADP-ribose) Polymerase 1 (PARP1), a pro-inflammatory master regulator strongly activated in TB, as a functionally relevant host target of PZA. We show that PZA inhibits PARP1 enzymatic activity in macrophages and in mice where it reverses TB-induced PARP1 activity in lungs to uninfected levels. Utilizing a PZA-resistant mutant, we demonstrate that PZA’s immune-modulatory effects are PARP1-dependent but independent of its bactericidal activity. Importantly, PZA’s bactericidal efficacy is impaired in PARP1-deficient mice, suggesting that immune modulation may be an integral component of PZA’s antitubercular activity. In addition, adjunctive PARP1 inhibition dramatically reduces inflammation and lesion size in mice and may be a means to reduce lung damage and shorten TB treatment duration. Together, these findings provide insight into PZA’s mechanism of action and the therapeutic potential of PARP1 inhibition in the treatment of TB.

Hubungan Jumlah Monosit Dan Nilai Laju Endap Darah (LED) Terhadap Lama Pengobatan Pasien Tuberculosis

Tuberculosis (TBC) is a bacterial infection caused by Mycobacterium tuberculosis. The duration of TBC treatment is routinely 6 months; otherwise, resistance will develop. TBC can increase leukocytes, including monocytosis as an inflammatory response and an elevated ESR. The aim of this study was to determine the relationship between the number of monocytes and the ESR value on the duration of tuberculosis treatment in patients at the Respira Lung Hospital, Yogyakarta City. The study was conducted in June and July 2023 at the Respira Pulmonary Hospital in Yogyakarta City. The study sample was 32 tuberculosis patients and blood was drawn to determine the monocyte number and ESR value. The results showed that the average number of monocytes was 7% (normal), the ESR value was 41.59 mm/hour (high) with the average duration of tuberculosis treatment for respondents was 3 months. Spearman test obtained Sig p&lt;0.05. This study concluded that there is a correlation between the number of monocytes and the ESR value on the duration of TB treatment in patients at the Respira Lung Hospital in Yogyakarta City, with the direction of the relationship reversed.

Shorter TB treatment regimens should be safer as well.

Most ongoing and planned TB therapeutic trials are focused on shortening the duration of treatment while giving less consideration to other aspects of TB care that are important to people with TB. Here we argue that other variables besides duration of TB treatment should also be considered when developing new TB treatment regimens, including drug toxicity, time spent in monitoring and overall quality of life while on therapy. We examine the specific use of linezolid in treatment-shortening trials for drug-susceptible TB and propose additional endpoints that should be prioritised in TB treatment studies.

The Effect of Assertive Commitment Therapy on Medication Adherence and Quality of Life of Pulmonary Tuberculosis (TB) Patients in the Buhit Health Center Area, Samosir Regency, Indonesia

Medication adherence is the extent to which a person's behavior in taking medication is in accordance with agreed recommendations from a health care provider. The long duration of TB treatment causes many sufferers to be disobedient because they feel they are healthy and feel bored and fed up. Assertive commitment therapy is a therapy that aims to improve flexible psychological aspects or the ability to better undergo current changes. This study aimed to determine the effect of assertive commitment therapy on medication adherence and quality of life of pulmonary TB patients in the Buhit Health Center area, Samosir Regency, in 2023. Type of quantitative research with research design quasi-experimental two group pre-test posttest design. Research in Buhit Health Center, Samosir Regency, in December 2022 – June 2023. The study population was 60 pulmonary TB patients, sampling technique used consecutive sampling. The sample was divided into 2 groups, namely 30 people in the intervention group and 30 people in the control group. Data collection using MMAS-8 and WHOQOL-BREF questionnaires. Data analysis with independent t-tests. The results of the study showed that the average value of medication adherence in the intervention group was higher after participating in the ACT program (Mean=20.54, SD=4.13) compared to the value before receiving treatment ((Mean=47.37, SD=3.68). These results indicate a difference between the mean value of medication adherence in the intervention group before and after treatment (t = -193, 09; p = 0.00). The mean value of quality of life in the intervention group was higher after participating in the ACT program (Mean=78.20, SD=11.17) compared to the value before receiving treatment (Mean=42.86, SD=7.61). These results show a difference between the mean value of quality of life in the intervention group before and after treatment (t = -55,42; p = 0,00).

Reasons of TB Treatment Non Compliance

Objective: To assess the prevalence and reasons of non compliance to treatment of tuberculosis among the patients of Sharif medical city Hospital Lahore. Material and Methods: 150 patients of tuberculosis were taken as a sample based upon non-probability convenient sampling. The data was collected by the investigators themselves with the use of semi-structured questionnaire that was finalized after pre-testing. Results: The data was analysed by putting into IBM statistics SPSS software. All the respondents(100%) have already heard about tuberculosis. The pooled prevalence of non compliance to TB is 44.4%. Conclusion: Overall level of knowledge about tuberculosis and its practices among the patients of tuberculosis attending Sharif medical city hospital Lahore was found satisfactory (40%). The majority of respondents are not taking medicine because of side effects of drugs (41.3%), fear of drugs (40%), long duration of TB treatment (62.7%) and TB clinic is far from home (66.7%).

ResR/McdR-regulated protein translation machinery contributes to drug resilience in Mycobacterium tuberculosis

Survival response of the human tuberculosis pathogen, Mycobacterium tuberculosis (Mtb) to a diverse environmental cues is governed through its versatile transcription regulatory mechanisms with the help of a large pool of transcription regulators (TRs). Rv1830 is one such conserved TR, which remains uncharacterized in Mtb. It was named as McdR based on an effect on cell division upon its overexpression in Mycobacterium smegmatis. Recently, it has been implicated in antibiotic resilience in Mtb and reannotated as ResR. While Rv1830 affects cell division by modulating the expression of M. smegmatis whiB2, the underlying cause of its essentiality and regulation of drug resilience in Mtb is yet to be deciphered. Here we show that ResR/McdR, encoded by ERDMAN_2020 in virulent Mtb Erdman, is pivotal for bacterial proliferation and crucial metabolic activities. Importantly, ResR/McdR directly regulates ribosomal gene expression and protein synthesis, requiring distinct disordered N-terminal sequence. Compared to control, bacteria depleted with resR/mcdR exhibit delayed recovery post-antibiotic treatment. A similar effect upon knockdown of rplN operon genes further implicates ResR/McdR-regulated protein translation machinery in attributing drug resilience in Mtb. Overall, findings from this study suggest that chemical inhibitors of ResR/McdR may be proven effective as adjunctive therapy for shortening the duration of TB treatment.

Determining the minimum duration of treatment in tuberculosis: An order restricted non-inferiority trial design.

Tuberculosis (TB) is one of the biggest killers among infectious diseases worldwide. Together with the identification of drugs that can provide benefits to patients, the challenge in TB is also the optimisation of the duration of these treatments. While conventional duration of treatment in TB is 6 months, there is evidence that shorter durations might be as effective but could be associated with fewer side effects and may be associated with better adherence. Based on a recent proposal of an adaptive order-restricted superiority design that employs the ordering assumptions within various duration of the same drug, we propose a non-inferiority (typically used in TB trials) adaptive design that effectively uses the order assumption. Together with the general construction of the hypothesis testing and expression for type I and type II errors, we focus on how the novel design was proposed for a TB trial concept. We consider a number of practical aspects such as choice of the design parameters, randomisation ratios, and timings of the interim analyses, and how these were discussed with the clinical team.

T-BACCO SCORE: A predictive scoring tool for tuberculosis (TB) loss to follow-up among TB smokers.

Loss to follow-up (LTFU) and smoking during TB treatment are major challenges for TB control programs. Smoking increases the severity and prolongs TB treatment duration, which lead to a higher rate of LTFU. We aim to develop a prognostic scoring tool to predict LTFU among TB patients who smoke to improve successful TB treatment outcomes. The development of the prognostic model utilized prospectively collected longitudinal data of adult TB patients who smoked in the state of Selangor between 2013 until 2017, which were obtained from the Malaysian Tuberculosis Information System (MyTB) database. Data were randomly split into development and internal validation cohorts. A simple prognostic score (T-BACCO SCORE) was constructed based on the regression coefficients of predictors in the final logistic model of the development cohort. Estimated missing data was 2.8% from the development cohort and was completely at random. Model discrimination was determined using c-statistics (AUCs), and calibration was based on the Hosmer and Lemeshow goodness of fit test and calibration plot. The model highlights several variables with different T-BACCO SCORE values as predictors for LTFU among TB patients who smoke (e.g., age group, ethnicity, locality, nationality, educational level, monthly income level, employment status, TB case category, TB detection methods, X-ray categories, HIV status, and sputum status). The prognostic scores were categorized into three groups that predict the risk for LTFU: low-risk (<15 points), medium-risk (15 to 25 points) and high-risk (> 25 points). The model exhibited fair discrimination with a c-statistic of 0.681 (95% CI 0.627-0.710) and good calibration with a nonsignificant chi-square Hosmer‒Lemeshow's goodness of fit test χ2 = 4.893 and accompanying p value of 0.769. Predicting LTFU among TB patients who smoke in the early phase of TB treatment is achievable using this simple T-BACCO SCORE. The applicability of the tool in clinical settings helps health care professionals manage TB smokers based on their risk scores. Further external validation should be carried out prior to use.

Treatment of tuberculosis: what is new?

Never before have so many people around the world been simultaneously affected by tuberculosis. Tuberculosis is the leading cause of death from abacterial infectious disease worldwide. The World Health Organization's ambitious goal from 2014 of achieving global elimination of tuberculosis does not seem realistic, but on current trends, tuberculosis could be eliminated in the European Union by 2040. Since the beginning of 2022, there have been more innovations for the treatment of tuberculosis than in no other comparable time period before. One month of rifapentine and isoniazid is effective in treating latent tuberculosis infection. However, rifapentine is licensed in the USA but not in the EU and must be imported for individual cases. The duration of the standard treatment for tuberculosis can be shortened to four months but this treatment regimen is also based on rifapentine, in addition to isoniazid, pyrazinamide, and moxifloxacin. The approval of rifapentine in Europe is a much-needed step towards shortening the treatment of tuberculosis. With new drugs an even shorter standard treatment of only 2months is possible. The treatment of multidrug-resistant/rifampicin-resistant tuberculosis (MDR-/RR-TB) has been shortened to six months, the same length as the standard treatment available in Germany. The combination of bedaquiline, pretomanid, linezolid ± moxifloxacin, cured around 90% of affected patients were cured in studies with atreatment duration of six months. With 19drugs in clinical trials, the treatment of tuberculosis is expected to continue to improve rapidly in the coming years.

Serum biomarkers for monitoring response to tuberculosis treatment: an assessment of the effect of different covariates among slow and fast treatment responders

Introduction The long duration of tuberculosis treatment, as well as the 2-year post-treatment follow-up period often required for predicting relapse, present a hindrance to drug development and treatment monitoring efforts. Therefore, there is need for treatment response biomarkers to inform treatment time shortening, clinical decision-making, and inform clinical trials. Objectives To assess the abilities of serum host biomarkers to predict treatment response among active PTB patients. Methods Active pulmonary TB patients (n = 53) as confirmed by sputum MGIT culture were enrolled at a TB treatment centre in Kampala, Uganda. We evaluated concentrations of 27 serum host biomarkers at baseline, month 2, and month 6 following the initiation of anti-tuberculosis treatment using the luminex platform for their ability to predict sputum culture status at month-2 post treatment initiation. Results There were significant differences in concentrations of IL1ra, IL1β, IL6, IP10, MCP-1, and IFNγ during treatment. A bio-signature comprising TTP, TNFα, PDGF-BB, IL9, and GCSF best predicted month 2 culture conversion with sensitivity and specificity of 82% (95% CI; 66 -92% and 57 -96% respectively). Slow anti-TB treatment responders had higher pro-inflammatory marker levels during treatment. The strongest correlation was observed between VEGF and IL12p70 (0.94), IL17A and basic FGF (0.92), basic FGF, and IL2 (0.88), and IL10 with IL17A (0.87). Conclusion We identified host biomarkers that predicted early response to PTB treatment, which may be valuable in future clinical trials and treatment monitoring. Similarly, strong correlations between biomarkers provide options for biomarkers substitutions during the development of treatment response monitoring tools or point of care tests.

Hepatotoxicity and tuberculosis treatment outcomes in chronic liver disease.

The treatment of tuberculosis (TB) is known to cause liver injury, however, there is limited data to guide optimal treatment for patients with chronic liver disease. We undertook a retrospective case series of patients with chronic liver disease and TB disease. The primary objective was to determine if there was a difference in the incidence of drug-induced liver injury (DILI) in patients with cirrhosis versus those with chronic hepatitis. Additionally, we sought to compare TB treatment outcomes, type and duration of therapy, and incidence of adverse events. We included 56 patients (chronic hepatitis 40; cirrhosis 16). There were 33 patients (58.9%) who experienced DILI requiring treatment modification, with no significant difference between groups (65% versus 43.8%, p = 0.23). Patients with chronic hepatitis were more likely to receive treatment with standard first-line intensive phase therapy that included a combination of rifampin (RIF), isoniazid, and pyrazinamide (80.8% versus 19.2%, p = 0.03) and any regimen than included isoniazid (92.5% versus 68.8%, p = 0.04). The risk of DILI was higher when more hepatotoxic TB medications were used. Overall treatment success in this cohort was low (55.4%), with no significant difference between groups (62.5% versus 37.5%, p = 0.14). Most patients with treatment success (97%) were able to tolerate a rifamycin. The risk of DILI is high, especially with the use of isoniazid, in patients with TB and chronic liver disease. This risk can be effectively mitigated with no difference in treatment outcomes in the presence of cirrhosis.

ЭТИОЛОГИЧЕСКАЯ ВЕРИФИКАЦИЯ МИКОБАКТЕРИОЗА ЛЕГКИХ ПРИ ИССЛЕДОВАНИИ ОПЕРАЦИОННОГО МАТЕРИАЛА У ПАЦИЕНТОВ С ДИАГНОЗОМ А16.0 – РЕАЛЬНАЯ ПРАКТИКА

Objective: to evaluate effectiveness of etiological verification of pulmonary mycobacteriosis (PM) in patients with diagnosed “pulmonary TB without bacteriological or histological confirmation” (А16.0) as per ICD-10 and species diversity of nontuberculous mycobacteria (NTM) in resection samples from the studied cohort. Materials and methods.We analyzed test results from 28 patients with initially diagnosed “pulmonary TB without bacteriological or histological confirmation” (А16.0) as per ICD-10 and verified PM according to resection sample studies. The microbiological study (at least two sputum samples, one bronchobiopsy sample, and one resection sample) included luminescent microscopy (LUM), extraction of M. tuberculosis DNA or NTM DNA by polymerase chain reaction (PCR), culture growth on liquid media in the ВАСТЕС MGIT 960 system, identification of mycobacteria by molecular genetic methods: real-time PCR for M. tuberculosis DNA detection (Syntol, Russia) and DNA-strip technology (GenoType Mycobacterium CM/AS Hain Lifescience). Results. The analysis of referral diagnoses established that in more than half of patients with diagnosed “pulmonary TB without bacteriological or histological confirmation” (А16.0) changes in the lungs had been referred to tuberculoma (64.3%) or infiltrative TB (21.4%); 28.6% of patients had received TB treatment as per chemotherapy regimen no. 3, and 17.8% of patients – broad-spectrum antibiotics. TB treatment duration varied from 4 to 28 months. Atypical lung resections were performed in most cases (75%). NTM DNA detection in resection samples was the most informative method of etiological verification of PMB (100% of cases). NTM culture growth was observed in 17.9% of cases. Only slowly-growing NTM were represented in the studied cohort as etiologically significant. Conclusion. The diagnosis verification is based on data obtained by microbiological and/or histological, cytological studies. Studies of resection samples from TB suspects significantly improve diagnostic effectiveness.

Improving Tuberculosis Medication Adherence: The Potential of Integrating Digital Technology and Health Belief Model.

Tuberculosis (TB) is a significant public health concern. Globally, TB is among the top 10 and the leading cause of death due to a single infectious agent. Providing standard anti-TB therapy for at least 6 months is recommended as one of the crucial strategies to control the TB epidemic. However, the long duration of TB treatment raised the issue of non-adherence. Non-adherence to TB therapy could negatively affect clinical and public health outcomes. Thus, directly observed therapy (DOT) has been introduced as a standard strategy to improve anti-TB medication adherence. Nonetheless, the DOT approach has been criticized due to inconvenience, stigma, reduced economic productivity, and reduced quality of life, which ultimately could complicate adherence issues. Apart from that, its effectiveness in improving anti-TB adherence is debatable. Therefore, digital technology could be an essential tool to enhance the implementation of DOT. Incorporating the health belief model (HBM) into digital technology can further increase its effectiveness in changing behavior and improving medication adherence. This article aimed to review the latest evidence regarding TB medication non-adherence, its associated factors, DOT's efficacy and its alternatives, and the use of digital technology and HBM in improving medication adherence. This paper used the narrative review methodology to analyze related articles to address the study objectives. Conventional DOT has several disadvantages in TB management. Integrating HBM in digital technology development is potentially effective in improving medication adherence. Digital technology provides an opportunity to improve medication adherence to overcome various issues related to DOT implementation.

ANALYSIS OF TREATMENT COMPLIANCE WITH TUBERCULOSIS (TB) PATIENTS IN TB MANAGEMENT PROGRAM IN JOHAN PAHLAWAN PUSKESMAS, ACEH BARAT REGENCY

Tuberculosis is a chronic infectious disease caused by the bacterium Mycobacterium tuberculosis. Johan Pahlawan Puskesmas is the Puskesmas with the most TB cases compared to other Puskesmas based on the results of TB data reports from the West Aceh Health Office. There were 35 patients being treated based on 314 suspected cases reported from the Johan Pahlawan Health Center. The type of research used in this research is descriptive qualitative . In this study, the selection of informants was carried out using a purposive sampling method with a total of 5 informants. The data collection method in this research is by conducting in- depth interviews . The results of the study were determined based on several categories which were summarized from the results of in-depth interviews, some of these categories were formed into four themes, namely duration of TB treatment, knowledge about TB, presence of drug-taking supervisors and barriers to treatment. Researchers suggest to the health service unit to form a team of extension workers in providing education to the public, to health workers to be more proactive in monitoring the role of the Drug Swallowing Supervisor and patient regularity, and making agreements with patients to complete treatment.