Duration Of Tuberculosis Treatment Research Articles

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.

Effects of Vitamin D supplementation on resolution of fever and cough in children with pulmonary tuberculosis: A randomized double-blind controlled trial in Indonesia.

BackgroundVarious studies in adults have shown a strong association between vitamin D and tuberculosis (TB), both in terms of vitamin D status and the benefits of vitamin D in managing TB. Studies on vitamin D and its relationship with childhood TB still lack in Indonesia as a country with the second-highest TB incidence globally. This study evaluated the effect of vitamin D supplementation on resolution of cough and fever in Indonesian children with pulmonary TB.MethodsWe conducted a randomized controlled trial of vitamin D supplementation in children with pulmonary TB and vitamin D insufficiency. Patients were randomly allocated with 1:1 ratio to receive either 1000 IU vitamin D or placebo daily after starting standard TB treatment. The primary outcome in this study was the resolution of fever and cough symptoms reviewed weekly after starting the treatment until the symptoms are resolved. The secondary outcome in this study was 25-hydroxyvitamin D serum level and nutritional status which was reviewed at the end of the trial. Intention to treat analyses were applied. Differences in clinical outcomes between two groups were calculated using Mann-Whitney U test or χ2 test, where appropriate.FindingsA total of 84 patients met the inclusion criteria, aged 6 to 18 years old, newly diagnosed with pulmonary TB and vitamin D insufficiency. Eighty patients (95,2%) completed the six months follow-up. Faster resolution of fever, cough, improved malnutrition status, and higher vitamin D level were found in the intervention group compared to the placebo group (all P < 0.001).ConclusionsVitamin D is beneficial in improving fever and cough resolution, and improving nutritional status in children with pulmonary TB and vitamin D insufficiency. Determination of adequate supplementation levels of more than 1000 IU requires further research to achieve normal vitamin D levels during the duration of treatment for pulmonary TB in children.Trial registrationClinicalTrials.gov (NCT05073965).

Relationship between Sex and Length of Treatment on Stress in Pulmonary Tuberculosis Patients at Oesapa Health Center, Kupang City

Background: Pulmonary tuberculosis (TB) is an infectious disease that is still a major health problem in Indonesia. The duration of TB treatment is 6-8 months, the long treatment period for TB disease causes many TB sufferers to be lazy to do routine treatment because they feel bored, tired, saturated, and depressed, causing stress and ultimately treatment is not optimal. Stress that is not handled properly can have a negative impact. There are several things that affect stress in individuals. One that affects stress is gender. Objective: To analyze the relationship between sex and length of treatment on stress in pulmonary tuberculosis patients at Oesapa Health Center, Kupang City. Methods: This study was an observational analytic study with a cross sectional study design conducted on pulmonary tuberculosis patients at Oesapa Health Center, Kupang City by filling in the Kessler Psychological Distress Scale (K-10) questionnaire. The sample in this study was 30 people. This research was analyzed by univariate, bivariate using the Chi-Square test. Results: The results of the Chi-Square Tests showed a significant value between sex and stress of pulmonary TB patients at Oesapa Health Center with a value of p = 0.548 or p&gt; 0.05, a significant level between length of treatment and stress of pulmonary TB patients at Oesapa puskesmas = 0.681 or p&gt; 0.05, which means that there is no relationship between length of treatment and stress in pulmonary TB patients at Oesapa puskesmas. Conclusion: There is no relationship between gender and length of treatment with stress in pulmonary tuberculosis patients at Oesapa Health Center.

Comparative Efficacy of the Novel Diarylquinoline TBAJ-876 and Bedaquiline against a Resistant Rv0678 Mutant in a Mouse Model of Tuberculosis.

ABSTRACTBedaquiline (BDQ, B) is the first-in-class diarylquinoline to be approved for treatment of tuberculosis (TB). Recent guidelines recommend its use in treatment of multidrug- and extensively drug-resistant tuberculosis (MDR/XDR-TB). The newly approved regimen combining BDQ with pretomanid and linezolid is the first 6-month oral regimen proven to be effective against MDR/XDR-TB. However, the emergence of BDQ resistance, primarily due to inactivating mutations in the Rv0678 gene encoding a repressor of the MmpS5-MmpL5 transporter, threatens to undermine the efficacy of new BDQ-containing regimens. Since the shift in MIC due to these mutations is relatively small (2–8×), safer, and more potent, diarylquinoline analogues may be more effective than BDQ. TBAJ-876, which is in phase 1 trials, has more potent in vitro activity and a superior pre-clinical safety profile than BDQ. Using a murine model of TB, we evaluated the dose-dependent activity of TBAJ-876 compared to BDQ against the wild-type H37Rv strain and an isogenic Rv0678 loss-of-function mutant. Although the mutation affected the MIC of both drugs, the MIC of TBAJ-876 against the mutant was 10-fold lower than that of BDQ. TBAJ-876 at doses ≥6.25 mg/kg had greater efficacy against both strains compared to BDQ at 25 mg/kg, when administered alone or in combination with pretomanid and linezolid. Likewise, no selective amplification of BDQ-resistant bacteria was observed at TBAJ-876 doses ≥6.25 mg/kg. These results indicate that replacing BDQ with TBAJ-876 may shorten the duration of TB treatment and be more effective in treating and preventing infections caused by Rv0678 mutants.

Socio-Demographic Profile and Prevalence of Tuberculosis (TB) Treatment Outcomes among Tuberculosis/Human Immunodeficiency Virus (TB/HIV) Co-Infected Patients in Kelantan

In Kelantan, the prevalence of Tuberculosis (TB) treatment success rate among TB/HIV co-infection is still below the success target of the World Health Organisation (WHO). Our objective was to assess the socio-demographic profile and determine the prevalence of TB treatment outcomes among TB/HIV co-infected patients in Kelantan. The cross-sectional study involved secondary data from the MyTB online system from January 2014 to December 2018, carried out at TB/Leprosy Sector, State Health Department of Kelantan. The data were analysed using SPSS version 25.0 and STATA version 14. The ethics approval was obtained from the UniSZA Human Research Ethics Committee (UHREC) and Medical Research Ethics Committee (MREC) of Ministry of Health (MOH). There were 6,313 TB cases in Kelantan. Of these, 703 (11.1%) cases were TB/HIV co-infection. However, 36 cases were excluded, and 667 cases were evaluated based on inclusion and exclusion criteria. The mean (SD) age was 38.7 (7.9) years, and the mean duration of TB treatment was 202.8 (131.27) days. The prevalence of successful treatment was 57.1%, with 19.8% cases were cured, and another 37.3% cases were completed treatment. While the unsuccessful were 42.9%, with 10.1% cases were defaulted, and 32.8% cases died. The successful outcomes were significantly associated with the educational level, the anatomy of TB location, smoking status, DOTS by health care providers, source of notification, the place of treatment and method of detection. This study provides the basic data of patient’s socio-demographic profiles, and the prevalence of TB treatment success in Kelantan is under international target by WHO of ≥ 90.0%.

Economic Burden of Tuberculosis Diabetes Co-Morbidity in Tuberculosis Patients Attending Two Chest Clinics in Lagos State

Background: Diabetes mellitus (DM) increases the risk of developing tuberculosis (TB) three-fold. The cost of accessing care for TB-DM co-morbidity poses a significant burden on patients, as they bear both direct and indirect costs of treatment, mostly of out-of-pocket.Objective: To estimate the direct medical cost of illness in patients with TB-DM co-morbidity in two chest clinics in Lagos State.Materials and Methods: An observational study, carried out in two chest clinics in Lagos State to evaluate direct medical costs associated with TBDM co-morbidity during TB treatment. A semi structured questionnaire, pharmacy price list of drugs and an online transportation service lara.ng was employed to document and quantify prescribed medications, laboratory investigations, number of clinic attendance and attendant transportation costs.Results: Among the participants, 53.8% were females. The mean age was 50.7±9.7 years. The total direct medical and non-medical costs for TBDM management was NGN8,604,819 (USD24,585.20) for the duration of TB treatment. Average cost per patient (CPP) was NGN179,384.85 (USD512.53). This was equivalent to 49.8% of the current national minimum wage. Male patients incurred more mean direct medical cost than female patients (NGN26, 647.90 vs NGN24, 020.40), while female patients incurred more mean direct non-medical costs than the males (NGN22, 314.30 versus NGN13, 041.70). Patients aged 60 years and above incurred the highest mean direct costs compared to other age groups.Conclusion: Direct medical costs are substantial in TBDM co-morbidity and increase with age.

Discontinuation of tuberculosis treatment among children in the Kampala Capital City Authority health facilities: a mixed-methods study

IntroductionDiscontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death. DTT in children is understudied in Uganda. We examined the level and factors associated with DTT among children at four large health facilities in Kampala Capital City Authority and documented the reasons for DTT from treatment supporters and healthcare provider perspectives.MethodsWe conducted a retrospective analysis of records for children < 15 years diagnosed and treated for TB between January 2018 and December 2019. We held focus group discussions with treatment supporters and key informant interviews with healthcare providers. We defined DTT as the stoppage of TB treatment for 30 or more consecutive days. We used a stepwise generalized linear model to assess factors independently associated with DTT and content analysis for the qualitative data reported using sub-themes.ResultsOf 312 participants enrolled, 35 (11.2%) had discontinued TB treatment. The reasons for DTT included lack of privacy at healthcare facilities for children with TB and their treatment supporters, the disappearance of TB symptoms following treatment initiation, poor implementation of the community-based directly observed therapy short-course (CB-DOTS) strategy, insufficient funding to the TB program, and frequent stock-outs of TB drugs. DTT was more likely during the continuation phase of TB treatment compared to the intensive phase (Adjusted odds ratio (aOR), 5.22; 95% Confidence Interval (CI), 1.76–17.52) and when the treatment supporter was employed compared to when the treatment supporter was unemployed (aOR, 3.60; 95% CI, 1.34–11.38).ConclusionMany children with TB discontinue TB treatment and this might exacerbate TB morbidity and mortality. To mitigate DTT, healthcare providers should ensure children with TB and their treatment supporters are accorded privacy during service provision and provide more information about TB symptom resolution and treatment duration versus the need to complete treatment. The district and national TB control programs should address gaps in funding to TB care, the supply of TB drugs, and the implementation of the CB-DOTS strategy.

Chemical Classes Presenting Novel Antituberculosis Agents Currently in Different Phases of Drug Development: A 2010-2020 Review.

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), is a curable airborne disease currently treated using a drug regimen consisting of four drugs. Global TB control has been a persistent challenge for many decades due to the emergence of drug-resistant Mtb strains. The duration and complexity of TB treatment are the main issues leading to treatment failures. Other challenges faced by currently deployed TB regimens include drug-drug interactions, miss-matched pharmacokinetics parameters of drugs in a regimen, and lack of activity against slow replicating sub-population. These challenges underpin the continuous search for novel TB drugs and treatment regimens. This review summarizes new TB drugs/drug candidates under development with emphasis on their chemical classes, biological targets, mode of resistance generation, and pharmacokinetic properties. As effective TB treatment requires a combination of drugs, the issue of drug-drug interaction is, therefore, of great concern; herein, we have compiled drug-drug interaction reports, as well as efficacy reports for drug combinations studies involving antitubercular agents in clinical development.

Host-Directed Therapies: Modulating Inflammation to Treat Tuberculosis.

Following infection with Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), most human hosts are able to contain the infection and avoid progression to active TB disease through expression of a balanced, homeostatic immune response. Proinflammatory mechanisms aiming to kill, slow and sequester the pathogen are key to a successful host response. However, an excessive or inappropriate pro-inflammatory response may lead to granuloma enlargement and tissue damage, which may prolong the TB treatment duration and permanently diminish the lung function of TB survivors. The host also expresses certain anti-inflammatory mediators which may play either beneficial or detrimental roles depending on the timing of their deployment. The balance between the timing and expression levels of pro- and anti-inflammatory responses plays an important role in the fate of infection. Interestingly, M. tuberculosis appears to manipulate both sides of the human immune response to remodel the host environment for its own benefit. Consequently, therapies which modulate either end of this spectrum of immune responses at the appropriate time may have the potential to improve the treatment of TB or to reduce the formation of permanent lung damage after microbiological cure. Here, we highlight host-directed TB therapies targeting pro- or anti-inflammatory processes that have been evaluated in pre-clinical models. The repurposing of already available drugs known to modulate these responses may improve the future of TB therapy.

Knowledge about tuberculosis, treatment adherence and outcome among ambulatory patients with drug-sensitive tuberculosis in two directly-observed treatment centres in Southwest Nigeria

BackgroundTuberculosis (TB) remains one of the most common infectious diseases worldwide. Although TB is curable provided the treatment commenced quickly, appropriately and uninterrupted throughout TB treatment duration. However, high default rate, treatment interruption and therapy non-adherence coupled with inadequate disease knowledge significantly contribute to poor TB treatment outcome, especially in developing countries. This study therefore assessed knowledge about TB and possible reasons for treatment non-adherence among drug-sensitive TB (DS-TB) patients, as well as evaluated treatment outcomes for the DS-TB managed within a 5-year period.MethodsA mixed-method design comprising a cross-sectional questionnaire-guided survey among 140-ambulatory DS-TB patients from January–March 2019, and a retrospective review of medical-records of DS-TB managed from 2013 to 2017 in two WHO-certified TB directly-observed-treatment centres. Data were summarized using descriptive statistics, while categorical variables were evaluated with Chi-square at p < 0.05.ResultsAmong the prospective DS-TB patients, males were 77(55.0%) and females were 63(45.0%). Most (63;45.0%) belonged to ages 18-34 years. A substantial proportion knew that TB is curable (137;97.9%) and transmittable (128;91.4%), while 107(46.1%) accurately cited coughing without covering the mouth as a principal mode of transmission. Only 10(4.0%) mentioned adherence to TB medications as a measure to prevent transmission. Inaccessibility to healthcare facility (33;55.0%) and pill-burden (10,16.7%) were topmost reasons for TB treatment non-adherence. Of the 2262-DS-TB patients whose treatment outcomes were evaluated, 1211(53.5%) were cured, 580(25.6%) had treatment completed, 240(10.6%) defaulted, 54(2.3%) failed treatment and 177(7.8%) died. Overall, the treatment success rate within the 5-year period ranged from 77.4 to 81.9%.ConclusionsKnowledge about TB among the prospective DS-TB patients is relatively high, especially with respect to modes of TB transmission and preventive measures, but a sizeable number lacks the understanding of ensuring optimal TB medication-adherence to prevent TB transmission. Inaccessibility to healthcare facility largely accounts for treatment non-adherence. Outcomes of treatment within the 5-year period show that nearly half were cured, while almost one-tenth died. Overall treatment success rate is about 12% below the WHO-defined target. There is generally a need for concerned stakeholders to step-up efforts in ensuring consistent TB enlightenment, while improving access to TB care is essential for better treatment outcome.

Higher Dosing of Rifamycins Does Not Increase Activity against Mycobacterium tuberculosis in the Hollow-Fiber Infection Model.

Improvements in the translational value of preclinical models can allow more-successful and more-focused research on shortening the duration of tuberculosis treatment. Although the hollow-fiber infection model (HFIM) is considered a valuable addition to the drug development pipeline, its exact role has not been fully determined yet. Since the strategy of increasing the dose of rifamycins is being evaluated for its treatment-shortening potential, additional in vitro modeling is important. Therefore, we assessed increased dosing of rifampin and rifapentine in our HFIM in order to gain more insight into the place of the HFIM in the drug development pipeline. Total and free-fraction concentrations corresponding to daily dosing of 2.7, 10, and 50 mg of rifampin/kg of body weight, as well as 600 mg and 1,500 mg rifapentine, were assessed in our HFIM using the Mycobacterium tuberculosis H37Rv strain. Drug activity and the emergence of drug resistance were assessed by CFU counting and subsequent mathematical modeling over 14 days, and pharmacokinetic exposures were checked. We found that increasing rifampin exposure above what is expected with the standard dose did not result in higher antimycobacterial activity. For rifapentine, only the highest concentration showed increased activity, but the clinical relevance of this observation is questionable. Moreover, for both drugs, the emergence of resistance was unrelated to exposure. In conclusion, in the simplest experimental setup, the results of the HFIM did not fully correspond to preexisting clinical data. The inclusion of additional parameters and readouts in this preclinical model could be of interest for proper assessment of the translational value of the HFIM.

Korelasi Antara Lama Menjalani Pengobatan Tuberkulosis Paru Dengan Skor Depresi Pada Pasien Tuberkulosis Paru Yang Menjalani Pengobatan di Poliklinik Paru RSUD Dr. Pirngadi Medan

Background : Pulmonary tuberculosis is an infectious disease caused by mycobacterium tuberculosis. This bactery can be transmitted through airbone particles and droplets. The treatment is a long term therapy and can be a stressor which effect patient’s physical and psychologycal, that leads to depression.&#x0D; Objective : The objective of this study was to determine the correlation between pulmonary tuberculosis treatment duration and depression score. &#x0D; Methods : This study was a correlative analysis with cross sectional design. The sample were 52 respondents whom currently endured the treatment of pulmonary tuberculosis in pulmonary unit in RSUD Pirngadi Medan, selected by consecutive sampling. Beck’s inventory depression II questionnaires were used to measure depression score. The data were analyzed with pearson correlation test. &#x0D; Result : There was a low negative correlation between duration of pulmonary tuberculosis treatment and depression score (p = 0,027 ; r = -0,309)&#x0D; Conclusion : The longer duration of pulmonary tuberculosis treatment, the lower the depression score.

Knowledge, Attitudes and Health-seeking behaviour among Patients with Tuberculosis: A Cross-sectional Study

Background: South Africa is hugely overburdened with the cases of Tuberculosis (TB); individual’s lack of knowledge, attitude towards the disease and delays in health-seeking behaviour, are indirectly associated with death. This study assessed the knowledge, attitude and treatment of TB, and further examined the health-seeking behaviour of TB patients. Methods: This cross-sectional study involved 327 conveniently selected participants with TB from three community health centres in Nelson Mandela Bay Health District, Eastern Cape, South Africa. A close-ended questionnaire was used to collect demographic details, knowledge, attitude and health-seeking behaviour variables. Descriptive and multivariate logistic regression analyses were performed. Statistical significance was considered at alpha &lt;0.05 and a confidence interval of 95%. Results: The majority of these TB patients indicated that cold air (76.5%), a dusty environment (85.9%), TB bacteria in the air (88.4%), and smoking (84.7%) had caused the disease. About 87.2% of the respondents indicated that TB treatment duration took six months or longer. Participants thought that follow-up sputum tests are an important part of TB treatment (70.6%); non-adherence to TB treatment might lead to drug-resistant TB or death (80%); TB disease could turn into HIV if not properly treated (77.4%) and that individuals with TB disease have HIV (59.9%). About 56.9% participants felt that TB treatment is difficult, takes a long time, is unpleasant, interferes with work or marriage, and people who drink and smoke are to blame for its spread (60.6%). The majority of the participants (74.0%) disagreed with TB being an African disease and 53.5% did not associate TB with poverty. The majority of the participants (92%) indicated that follow-ups at clinics were avoided because of stigmatisation. In the multivariate logistic regression analysis, the informal housing scheme was a statistically significant (p&lt;0.05) factor determining the correct knowledge of TB (AOR=0.556; 95% CI: 0.316-0.977). There was a statistically significant association among TB knowledge, attitude and health-seeking behaviour. Conclusion: The participants generally had good knowledge about TB; however, there were misconceptions regarding its spread by cold air and dusty environments. The majority of participants did not attend follow-up TB treatment because of fear of stigmatisation. Formal settlements are associated with the correct knowledge of TB. Measures aimed at addressing the misconceptions about TB and its treatment are needed.

PENGARUH PMR DENGAN KARTU PENGINGAT TERHADAP KEPATUHAN DAN KESESUAIAN PENGOBATAN PASIEN TUBERKULOSIS

The duration of tuberculosis treatment affects patient adherence. The pharmacist monitors the patient's medication by providing an intervention in the form of a reminder card. The research objective was to use a reminder card to determine the compliance level of tuberculosis patients. The design of this study was a pre-experimental one group pretest-post test from December 2019 - January 2020. The study sample was 133 adult tuberculosis patients who received detached drugs and had undergone treatment &gt;1 month at the Pulmonary Poly Outpatient Waluyo Jati Kraksaan Hospital. The level of adherence with the reminder card intervention was calculated using the pill count method and analyzed using the Wilcoxon test. The result of tuberculosis patient adherence level increased significantly (p&lt;0.05) after giving the reminder card from 50.00% to 99.37%. Providing a reminder card is an effort that can improve adherence to treatment of tuberculosis patients.

Prevalence of human immunodeficiency virus among pulmonary tuberculosis patients: A cross-sectional study.

Tuberculosis (TB) is caused by Mycobacterium tuberculosis and is an endemic disease in Sudan, where it has rapidly become the major complication of human immunodeficiency virus (HIV) infection. Thus, this study aimed to determine the prevalence of HIV among TB patients and evaluate the co-infection rate. The association of HIV prevalence with gender, age, and duration of treatment as risk factors was also determined. A descriptive cross-sectional study was performed in Omdurman Abu Anga Hospital, Khartoum, Sudan, from October 2018 to March 2019. A total of 281 blood samples were obtained randomly from pulmonary TB patients. The plasma was examined for the presence of HIV antibodies using sandwich ELISA. A structured questionnaire was used during data collection. A noticeable marker for HIV immunoglobulin M/immunoglobulin G was found in 12 patients (4.3%), of which five patients (41.7%) were diagnosed as new TB cases. Moreover, the relationship between age, sex, and duration of TB treatment and the prevalence of HIV was not significantly different (P > 0.05). In conclusion, the prevalence of HIV antibodies among TB pulmonary patients is high. Therefore, all TB patients should be examined for HIV risk factors and advised to undergo HIV testing. Further studies are essential to provide more insights into the epidemiology of the co-infection to better report the double burden of HIV and TB among TB patients in Sudan.

Prevalence and risk factors of depression in patients with drug-resistant tuberculosis in Nepal: A cross-sectional study

BackgroundPatients with drug-resistant tuberculosis (DR TB) have a protracted course of illness and the available treatment has a low success rate. These factors combined with the associated stigma and financial implications put the patients with DR TB at an increased risk of depression. The psychiatric side effects of anti-tuberculosis drugs further aggravate the problem. This study aimed to estimate the prevalence of depression among patients with DR TB in Nepal and identify risk factors. MethodsWe conducted this cross-sectional study in April 2018 at all the functioning 11 programmatic DR TB treatment centers across Nepal. We selected 129 patients aged ≥ 16 years receiving treatment for DR TB by non-probability quota sampling. Six trained data collectors conducted face-to-face interviews and administered the Nepali language version of Patient Health Questionnaire 9 (PHQ-9) to screen for depression. We summarized sociodemographic and treatment characteristics with median (Interquartile Range [IQR]) and proportions as appropriate. We performed univariate analysis for the variables hypothesized as risk factors for depression. We fitted a multivariable binary logistic regression model with depression as the outcome variable and the variables with a significance level of < 0.25 as explanatory variables. We regarded a p-value of < 0.05 as significant for individual variables in the logistic regression model. ResultsOf the 129 patients studied, 92 (71.3%) were male and the median age was 36 years (IQR 25–48). The majority (109, 84.4%) had multi-drug resistant tuberculosis (MDR TB). We identified 81 patients (62.7%, 95% Confidence Interval [CI] 53.7–71) with the PHQ-9 score of 10 or more signifying probable depressive disorder. In univariate analyses, age, treatment center location, DR TB treatment duration, and duration of current illness had a p-value lower than the pre-specified cut-off of 0.25. In the multivariable logistic regression model, we found a statistically significant association of depression with the duration of illness (adjusted Odds Ratio 1.15, 95% CI 1.07–1.26, p < 0.001). ConclusionThis study has found that a large proportion of the patients with DR TB screened have depression suggesting the need for screening and management of comorbid depression within the National TB Control Program.

Relevance of the Warburg Effect in Tuberculosis for Host-Directed Therapy.

Tuberculosis (TB) was responsible for more deaths in 2019 than any other infectious agent. This epidemic is exacerbated by the ongoing development of multi-drug resistance and HIV co-infection. Recent studies have therefore focused on identifying host-directed therapies (HDTs) that can be used in combination with anti-mycobacterial drugs to shorten the duration of TB treatment and improve TB outcomes. In searching for effective HDTs for TB, studies have looked toward immunometabolism, the study of the role of metabolism in host immunity and, in particular, the Warburg effect. Across a variety of experimental paradigms ranging from in vitro systems to the clinic, studies on the role of the Warburg effect in TB have produced seemingly conflicting results and contradictory conclusions. To reconcile this literature, we take a historical approach to revisit the definition of the Warburg effect, re-examine the foundational papers on the Warburg effect in the cancer field and explore its application to immunometabolism. With a firm context established, we assess the literature investigating metabolism and immunometabolism in TB for sufficient evidence to support the role of the Warburg effect in TB immunity. The effects of the differences between animal models, species of origin of the macrophages, duration of infection and Mycobacterium tuberculosis strains used for these studies are highlighted. In addition, the shortcomings of using 2-deoxyglucose as an inhibitor of glycolysis are discussed. We conclude by proposing experimental criteria that are essential for future studies on the Warburg effect in TB to assist with the research for HDTs to combat TB.

DIFFERENCES OF INTERLEUKIN-18 AND INTERLEUKIN-10 LEVELS IN RIFAMPICIN RESISTANT AND RIFAMPICIN SENSITIVE PULMONARY TUBERCULOSIS PATIENTS IN DR. SOETOMO HOSPITAL SURABAYA

Rifampicin is an anti-tuberculosis drug which has an efficient antimicrobial effect and the basis of a short-term treatment regimen for tuberculosis (TB) patients. Rifampicin plays an important role against the growth and slow metabolism of Bacilli M. tuberculosis. Resistance to rifampicin causes the duration of tuberculosis treatment to be longer. Interleukin-18 (IL-18) is a pro-inflammatory cytokine which plays a role in controlling the growth of M. tuberculosis through its ability to induce IFN-γ, while Interleukin-10 (IL-10) is an anti-inflammatory cytokine which plays a role in limiting tissue damage due to the inflammatory process and maintain tissue homeostasis. IL-18 and IL-10 has an important role in explaining the different degrees of inflammation in rifampicin resistant (RR) and rifampicin sensitive (RS) pulmonary tuberculosis patients. The purpose of this study is to determine different levels of IL-18 and IL-10 in new TB patients with RR and RS. This study was a retrospective cohort study with a cross-sectional design carried out from August-November 2018 in the TB-DOTS/MDR clinic at Dr. Soetomo Hospital, Surabaya. 50 research subjects were examined and grouped into two groups, namely pulmonary TB with RR (n = 25) and pulmonary TB with RS (n = 25) based on GeneXpert examination and anti-tuberculosis drug therapy ≤ 1 month. IL-18 and IL-10 were measured using the ELISA Method. Differences in IL-18 and IL-10 levels between groups were analyzed using the Mann-Whitney test. The mean level of IL-18 (pg/ml) in RR and RS pulmonary TB patients were 1273.53±749.86 and 787.96 ±589.28 respectively. The mean level of IL-10 (pg/ml) in RR and RS pulmonary TB patients were 125.25±118.32 and 128.81±135.77 repectively. The mean level of IL-18 in RR and RS pulmonary TB patients were found to have a significant difference, while the mean level of IL-10 did not have a significant difference. Keywords: Interleukin-18, Interleukin-10, Tuberculosis, Rifampicin Resistant, Rifampicin Sensitive

Adherence to Anti-Tuberculosis Treatment Among Pediatric Patients at Nekemte Specialized Hospital, Western Ethiopia.

BackgroundNon-adherence to tuberculosis treatment is the most challenging and hindering factor for successful tuberculosis therapy. The long duration of tuberculosis treatment and the undesirable effects of anti-tuberculosis drugs result in non-adherence to treatment among pediatric patients. Hence, this study was aimed to evaluate pediatrics adherence status among tuberculosis pediatric patients on anti-tuberculosis treatment at Nekemte Specialized Hospital.MethodsA health facility-based cross-sectional study design was used to recruit pediatric TB patients who were receiving their treatment between February 15 and March 15, 2019. Adherence to tuberculosis therapy was evaluated using data obtained from face-to-face interviews of their respective caregivers. The collected data were entered into EPI-manager 4.0.2 software and analyzed using SPSS version 24. Logistic regression was used to analyze the variables and variables with p-value <0.05 had a statistically significant association with the adherence to anti TB treatment.ResultsAmong 202 participants involved in the study, 120 (59.4%) of them were males and 119 (58.9%) were in the age category of 11–15 years. A total of 166 (82.2%) of the patients had extra-pulmonary tuberculosis and 174 (86.1%) of them were in the intensive phase. Of the pediatric tuberculosis patients, 48 (73.3%) of them have adhered to the treatment regimen. Female gender [AOR: 3.3, 95% CI: 1.52–7.2], younger age (0–5 years) [AOR: 5.96 95% CI: 1.81–19.6], living in urban area [AOR: 3.73, 95% CI: 1.67–8.36], and patients who did not experience side effect [AOR: 2.87, 95% CI: 1.41–5.81] were predictors of good adherence to tuberculosis treatment up on multivariable logistic regression analysis.ConclusionThe level of adherence observed in our study area was low. Age, sex, residence, and side effect experience showed an association with tuberculosis treatment adherence. Therefore, health care providers should educate all patients with tuberculosis before the initiation of anti-tuberculosis treatment.