Improve Tuberculosis Treatment Outcomes Research Articles

Fecal microbiota transplantation: A potential novel treatment strategy for extensively drug-resistant tuberculosis

Tuberculosis (TB) is one of the infectious diseases with the highest mortality and morbidity. The evolution of drug-resistant TB, particularly extensively drug-resistant TB (XDR-TB) is a global concern. The current anti-TB treatment regimens for XDR-TB are long and associated with adverse events, low patient adherence, and low success rates. Fecal microbiota transplantation (FMT) was approved for the treatment of recurrent or refractory Clostridium difficile infection in 2019 and has been shown to be a safe and well-tolerated treatment strategy. Given the bidirectional movement and interaction of metabolites, hormones, and cytokines between the gut and the lungs, FMT may be able to enhance overall XDR-TB treatment by facilitating immune cell activation. Here, we hypothesize that FMT, in conjunction with standard TB treatment, may improve TB treatment outcomes for those with XDR-TB. We discuss the efficacy, safety, and ethical issues associated with the use of FMT.

The Impact of Optimal Glycemic Control on Tuberculosis Treatment Outcomes in Patients With Diabetes Mellitus: Systematic Review and Meta-Analysis.

Diabetes mellitus (DM) increases the risk of developing tuberculosis (TB), and optimal glycemic control has been shown to reduce the risk of complications and improve the TB treatment outcomes in patients with DM. This study aims to investigate the role of glycemic control in improving TB treatment outcomes among patients with DM. MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) assessing the impact of oral glycemic control in patients with TB who have DM. Outcomes of interest were radiological findings, treatment success, sputum positivity, and mortality. Evaluations were reported as risk ratios (RRs) with 95% CIs using weighted random-effects models. The analysis included 6919 patients from 7 observational studies. Our meta-analysis showed significant differences between patients with optimal glycemic control and those with poor glycemic control with regard to improved treatment outcomes (RR 1.13, 95% CI 1.02-1.25; P=.02; I²=65%), reduced sputum positivity (RR 0.23, 95% CI 0.09-0.61; P=.003; I²=66%), and fewer cavitary lesions (RR 0.59, 95% CI 0.51-0.68; P<.001; I²=0%) in radiological findings. There was no significant difference between the 2 groups in terms of mortality (RR 0.57, 95% CI 0.22-1.49; P=.25; I²=0%), multilobar involvement (RR 0.57, 95% CI 0.22-1.49; P=.25; I²=0%) on radiologic examination, and upper lobe (RR 0.94, 95% CI 0.76-1.17; P=.58; I²=0%) and lower lobe (RR 1.05, 95% CI 0.48-2.30; P=.91; I²=75%) involvement on radiologic examination. We concluded that optimal glycemic control is crucial for reducing susceptibility, minimizing complications, and improving treatment outcomes in patients with TB with DM. Emphasizing effective health management and health care strategies are essential in achieving this control. Integrating comprehensive care among patients with TB with DM will enhance patient outcomes and alleviate the burden of disease in this population. PROSPERO CRD42023427362; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=427362.

Non-adherence to anti-tuberculosis treatment and associated factors among TB patients in public health facilities of Hossana town, Southern Ethiopia, 2022.

Non-adherence to anti-tuberculosis treatment is one of the crucial challenges to improving TB treatment outcomes and reducing healthcare costs. The prevalence of non-adherence to anti-tuberculosis treatment is not well documented in the study context. Therefore, this study was aimed at estimating the prevalence of non-adherence to anti-tuberculosis treatment and associated factors among TB patients attending TB clinics in Hosanna town, Southern Ethiopia, in 2022. An institution-based cross-sectional study was conducted from April to May 2022. A systematic random sampling technique was employed to select a sample of 233 study subjects from all four public health facilities. According to the order of arrival, every second person was interviewed. Data were collected using a structured questionnaire that was created using several works of literature. A multivariable binary logistic regression analysis was used to identify factors associated with non-adherence to anti-TB drugs. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was estimated. The study included 233 tuberculosis (TB) patients with a response rate of 100%. The prevalence of non-adherence was 18% (95% CI: 15.39, 21.82). Being in the continuation phase (AOR = 3.09, 95% CI: 1.16, 8.23), not attending formal education (AOR = 2.47, 95% CI: 1.12, 5.42), not disclosing TB status to their family (AOR = 2.36, 95% CI: 0.11, 5.04) and having poor TB knowledge (AOR = 3.09, 95% CI: 1.48, 6.48) were significantly associated with non-adherence to TB treatment. Among TB patients, there was a significant prevalence of non-adherence to anti-TB medications. Interventions that target patients with low education status, are in the continuation phase, and do not disclose their TB status to their families are required to improve TB treatment adherence. In addition, improving health education is important to enhance TB knowledge, which has an impact on TB treatment adherence. The need for good drug adherence should be emphasized while counseling TB patients.

What matters most? A qualitative study exploring priorities for supportive interventions for people with tuberculosis in urban Viet Nam

IntroductionThe health and economic burden of tuberculosis (TB) in urban Viet Nam is high. Social protection and support interventions can improve treatment outcomes and reduce costs. However, evidence regarding optimal...

Barriers and Facilitators to Implementing a Digital Adherence Technology for Tuberculosis Treatment Supervision in Uganda: Qualitative Study.

Ensuring the completion of treatment for tuberculosis (TB) remains a key challenge in many high-burden countries. 99DOTS is a low-cost digital adherence technology that has emerged as a promising tool for monitoring and supporting TB treatment completion. We aimed to understand the feasibility and acceptability of 99DOTS, a mobile phone-based TB treatment support method, and characterize barriers and facilitators to its implementation during a pragmatic trial in Uganda. Between April 1 and August 31, 2021, we conducted in-depth interviews with people with TB and key informant interviews with health workers and district and regional TB officers involved in the implementation of 99DOTS at 18 health facilities in Uganda. Semistructured interview guides were informed by the capability, opportunity, motivation, and behavior (COM-B) model and explored perceptions of, and experiences with, 99DOTS, including barriers and facilitators to its use. Qualitative analysis was conducted using the framework approach. Interviews were conducted with 30 people with TB, 12 health workers, and 7 TB officers. All people with TB, health workers, and TB officers noted that 99DOTS supported and encouraged people with TB to take their anti-TB medication, facilitated treatment monitoring, and improved relationships between people with TB and health workers. Participants also liked that the platform was free, easy to use, and improved TB treatment outcomes. Barriers to 99DOTS implementation for some people with TB were related to limited literacy, including technology literacy; limited access to electricity to charge their mobile phone to make dosing confirmation calls; and poor network connection. Gender differences in 99DOTS uptake also emerged. Specifically, women with TB were described to be more concerned that 99DOTS use would expose them to TB stigma and to be more likely to have mobile phone-access issues than men with TB. By contrast, men with TB not only had access to mobile phones but also received substantial support from their female partners to take their anti-TB medication and make 99DOTS dosing confirmation calls. Finally, although women with TB were described to face more barriers to 99DOTS use than men with TB, the women's narratives centered on the ways the platform facilitated and improved their adherence, whereas the men's narratives did not. Overall, 99DOTS seems to be a feasible and acceptable strategy to support anti-TB medication adherence in Uganda. However, access to mobile phones, inability to charge mobile phones, and concerns about stigma should be considered and addressed as part of programmatic implementation to maximize uptake among all people with TB, particularly women and those with fewer financial resources.

Practical Models of Pharmaceutical Care for Improving Tuberculosis Patient Detection and Treatment Outcomes: A Systematic Scoping Review.

Decreasing global tuberculosis (TB) notifications indicate problems related to TB patient detection and treatment outcomes. Pharmaceutical care (PC) has potential roles in managing these issues. However, PC practices have not yet become widespread in the real world. This systematic scoping review aimed to identify and analyze the current literature on practical models of pharmaceutical care for improving tuberculosis patient detection and treatment outcomes. We then discussed the present challenges and future considerations for the successful implementation of PC services in TB. A systematic scoping review was performed to identify the practice models of PC in TB. Systematic searches and screening were used to identify relevant articles in the PubMed and Cochrane databases. We then discussed the challenges and recommendations for successful implementation using a framework to improve professional healthcare practice. Our analysis included 14 of 201 eligible articles. We identified that the focuses in the PC of TB are on increasing patient detection (four articles) and improving TB treatment outcomes (ten articles). Practices cover services in the community and hospital settings, such as screening and referring people with presumptive TB, tuberculin test services, collaborative practices for treatment completion, directly observed treatment, the solution of drug-related problems, reporting and managing adverse drug reactions, and medication adherence programs. Although PC services positively increase TB patient detection and treatment outcomes, hidden challenges in the actual practice are analyzed. Several factors should be comprehensively considered in successful implementation, such as guidelines, individual pharmacy personnel, patient, professional interaction, organizational capacity, regulation, incentive, and resource factors. Hence, a collaborative PC program that involves all related stakeholders should be considered to create successful and sustainable PC services in TB.

Digital adherence technologies to improve tuberculosis treatment outcomes in China: a cluster-randomised superiority trial

Drug-sensitive tuberculosis treatment requires 6 months of therapy, so adherence problems are common. Digital adherence technologies might improve tuberculosis treatment outcomes. We aimed to evaluate the effect of a daily reminder medication monitor, monthly review of adherence data by the health-care provider, and differentiated care for patients with adherence issues, on tuberculosis treatment adherence and outcomes. We did a cluster-randomised superiority trial across four prefectures in China. 24 counties or districts (clusters) were randomly assigned (1:1) to intervention or control groups. We enrolled patients aged 18 years or older with GeneXpert-positive, rifampicin-sensitive pulmonary tuberculosis, who were receiving daily fixed-dose combination treatment. Patients in the intervention group received a medication monitor for daily drug-dosing reminders, monthly review of adherence data by health-care provider, and management of poor adherence; and patients in the control group received routine care (silent-mode monitor-measured adherence). Only the independent endpoints review committee who assessed endpoint data for some participants were masked to study group assignment. Patients were followed up (with sputum solid culture) at 12 and 18 months. The primary outcome was a composite of death, loss to follow-up, treatment failure, switch to multidrug-resistant tuberculosis treatment, or tuberculosis recurrence by 18 months from treatment start, analysed in the intention-to-treat population. Analysis accounted for study design with multiple imputation for the primary outcome. This trial is now complete and is registered with ISRCTN, 35812455. Between Jan 26, 2017, and April 3, 2019, 15 257 patients were assessed for eligibility and 3074 were enrolled, 2686 (87%) of whom were included in the intention-to-treat population. 1909 (71%) of 2686 patients were male, 777 (29%) were female, and the median age was 44 years (IQR 29-58). By 18 months from treatment start, using multiple imputation for missing outcomes, 239 (16% [geometric mean of cluster-level proportion]) of 1388 patients in the control group and 224 (16%) of 1298 in the intervention group had a primary composite outcome event (289 [62%] of 463 events were loss to follow-up during treatment and 42 [9%] were tuberculosis recurrence). The intervention had no effect on risk of the primary composite outcome (adjusted risk ratio 1·01, 95% CI 0·73-1·40). Our digital medication monitor intervention had no effect on unfavourable outcomes, which included loss to follow-up during treatment, tuberculosis recurrence, death, and treatment failure. There was a failure to change patient management following identification of treatment non-adherence at monthly reviews. A better understanding of adherence patterns and how they relate to poor outcomes, coupled with a more timely review of adherence data and improved implementation of differentiated care, may be required. Bill & Melinda Gates Foundation.

The Effect of the Community-Based- Directly Observed Therapy on the Treatment Outcome of Tuberculosis Patients in Mitooma District, Western-Uganda

Tuberculosis (TB) remains the ninth leading cause of death in the world and a leading cause of death among infectious diseases. Sub-Saharan Africa has nearly all high TB burden countries including Uganda which contributes to the highest Tuberculosis related mortality globally. Poor adherence to Tuberculosis treatment can lead to prolonged infection and poor treatment outcomes. Directly Observed Treatment (DOT) seeks to improve adherence to TB treatment by observing patients while they take their anti-TB medications. The aim of the study was to determine the effect of the Community Based- DOT on the Treatment Outcomes of Tuberculosis Patients in Mitooma District, Western Uganda. A cross-sectional survey research design was adopted and data were collected from the TB patients. Results revealed that TB patients who were not educated were 9.01 times more likely to get cured compared to the educated patients (AOR=9.01; 95% CI (1.6-5.9); p=0.013). Duration or time spent on TB medication was associated with TB treatment outcome because the patients who had spent 6 months on TB medication (AOR=2.9; 95% CI (1.14 – 7.9); p=0.004) were threefold more likely to get cured compared to those who had spent less than one month. Similarly, patients who had spent six months and above (AOR=4.1; 95%CI (0.07 – 0.87); p=0.026) were more than four times more likely to get cured compared to those who had spent less than one month. Results further showed that patients who were neutral in attributing their health state to the way they swallowed the TB medication (AOR = 0.33; 95%CI (0.12 – 0.9); p=0.001) were 67% less likely to get cured compared to patients who strongly agreed that their health status were attributed to the way they swallowed TB medication. Majority of the TB patients described the program as vital in treatment of TB disease as health caregivers would work closely with TB patients to adhere to treatment. Further, the study revealed that CB-DOT improved TB treatment outcomes. Monitoring the swallowing of TB drugs by health workers, health education and regular visits were highly recommended. Therefore, studies on policies for implementation of patient-centered and community-centered CB-DOT deserve further attention.

Effectiveness of digital adherence technologies in improving tuberculosis treatment outcomes in four countries: a pragmatic cluster randomised trial protocol

IntroductionSuccessful treatment of tuberculosis depends to a large extent on good adherence to treatment regimens, which relies on directly observed treatment (DOT). This in turn requires frequent visits to health...

Evaluating Social Protection Policies With an Implementation Science Framework: India's Direct Benefit Transfer for Tuberculosis Comment on "Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? - A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India".

Addressing the social and structural determinants of tuberculosis (TB) through social protection programs is a central feature of global public health policy and disease elimination strategies. However, how best to implement such programs remains unknown. India's direct benefit transfer (DBT) program is the largest cash transfer program in the world dedicated to supporting individuals affected by TB. Despite several studies aimed at evaluating the impact of DBT, many questions remain about its implementation, mechanisms of action, and effectiveness. Dave and Rupani's mixed-methods evaluation of this program previously published in this journal offers valuable insights into the strengths and limitations of the DBT program in improving TB treatment outcomes. Their results also provide an opportunity for demonstrating how systematically collected data may be further analyzed and presented using implementation science, a field of study using methods to promote the systematic uptake of evidence-based interventions to support sustainable program scale-up.

Tuberculosis treatment outcomes and patient support groups, southern India.

To assess treatment outcomes in tuberculosis patients participating in support group meetings in five districts of Karnataka and Telangana states in southern India. Tuberculosis patients from five selected districts who began treatment in 2019 were offered regular monthly support group meetings, with a focus on patients in urban slum areas with risk factors for adverse outcomes. We tracked the patients' participation in these meetings and extracted treatment outcomes from the Nikshay national tuberculosis database for the same patients in 2021. We compared treatment outcomes based on attendance of the support groups meetings. Of 30 706 tuberculosis patients who started treatment in 2019, 3651 (11.9%) attended support groups meetings. Of patients who attended at least one support meeting, 94.1% (3426/3639) had successful treatment outcomes versus 88.2% (23 745/26 922) of patients who did not attend meetings (adjusted odds ratio, aOR: 2.44; 95% confidence interval, CI: 2.10-2.82). The odds of successful treatment outcomes were higher in meeting participants than non-participants for all variables examined including: age ≥ 60 years (aOR: 3.19; 95% CI: 2.26-4.51); female sex (aOR: 3.33; 95% CI: 2.46-4.50); diabetes comorbidity (aOR: 3.03; 95% CI: 1.91-4.81); human immunodeficiency virus infection (aOR: 3.73; 95% CI: 1.76-7.93); tuberculosis retreatment (aOR: 1.69; 1.22-2.33); and drug-resistant tuberculosis (aOR: 1.93; 95% CI: 1.21-3.09). Participation in support groups for tuberculosis patients was significantly associated with successful tuberculosis treatment outcomes, especially among high-risk groups. Expanding access to support groups could improve tuberculosis treatment outcomes at the population level.

Closing the Evidence Gap of Cash Transfer for Tuberculosis-Affected Households Comment on "Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? - A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India".

Achieving the targets of eliminating tuberculosis (TB) requires a combination of biomedical, epidemiological, and social approaches. Having hitted by the coronavirus disease 2019 (COVID-19) pandemic which diminishes the financial capacity of TB-affected households, the importance of delivering socioeconomic support to TB-affected household emerges. However, the evidence of TB-related socioeconomic support is still scarce, and some questions are left unanswered. A sequential explanatory mixed-methods study by Dave and Rupani shows that the direct benefit transfer (DBT), a form of cash transfer, to TB-affected households improves TB treatment outcomes in India despite the challenges. Some critical issues remain to be discussed: trading-off between the amount of cash and its sustainability, choosing the most appropriate support packages, detecting, and reaching the target population, and arranging the most effective delivery strategy. Knowledge gap remains to be answered, and a global research agenda and political commitment are critical to encourage more evidence in delivering socioeconomic support for TB control.

Expression analysis of efflux gene Rv1634 in drug resistance Mycobacterium tuberculosis isolates

Drug resistant tuberculosis (DR-TB) is a serious health issue worldwide and a number of mechanisms have been suggested which are involved in developing resistance in Mycobacterium tuberculosis to anti-tuberculosis drugs. In the Indian perspective, the pattern and prevalence of drug-resistant tuberculosis (DR-TB) are heterogeneous across regions and settings. Notably, isoniazid (INH), rifampicin (RIF) and ethambutol (EMB) are the most effective drugs in tuberculosis therapy. Understanding the pattern of resistance to these drugs in the Indian population is essential in quick diagnosis of multidrug-resistant (MDR) tuberculosis and extensive DR-TB (XDR-TB). A total of 36 Mycobacterium isolates from the North Indian population were exposed and tested for drug susceptibility with INH, RIF and EMB in vitro and results showed that 25, 24 and 24 isolates were resistant to INH, RIF and EMB respectively. Gene expression analysis revealed that approximately 50% of isolates under the stress of these three anti-tuberculosis drugs showed overexpression of efflux gene Rv1634. Moreover, overexpression of gene Rv1634 contributes to the emergence of drug resistance in M. tuberculosis and inhibition of Rv1634 along with other efflux pump genes and may provide a promising strategy for improving tuberculosis treatment outcomes in North India.

Impacts of tuberculosis services strengthening and the COVID-19 pandemic on case detection and treatment outcomes in Mimika District, Papua, Indonesia: 2014-2021.

Indonesia is a high-burden tuberculosis (TB) country with a wide case detection gap, exacerbated by the COVID-19 pandemic. We aimed to review the epidemiology of TB in a high-endemic setting of Indonesia before and during the implementation of health system strengthening activities for TB, including during the first two years of the COVID-19 pandemic. We analysed TB program data from Mimika District, Papua, Indonesia from 2014 to 2021. Health system strengthening activities to improve the programmatic management of TB were implemented from 2017 onwards. Activities included decentralization of TB services, training and mentoring of healthcare workers, improved screening for co-morbidities, and introduction and optimisation of Xpert testing in 2018. A total of 11,803 TB cases were notified to the Mimika District Health Office over eight years (2014-21). Between 2015 and 2019, there was a 67% increase in annual case notifications, an 89% increase in bacteriologically confirmed cases and the proportion of TB cases detected in primary care increased from 26% to 46%. In 2020, coinciding with the COVID-19 pandemic, investigation of people with presumptive TB fell by 38%, but the proportion of those tested with Xpert increased. TB case notifications decreased by 19% from 1,796 in 2019 to 1,461 in 2020, but then increased by 17% to 1,716 in 2021. Routine screening for co-morbidities (HIV, diabetes) among TB patients improved over time and was not affected by the pandemic. Treatment success overall was 71% and remained relatively unchanged. Loss to follow-up and death were 18% and 3.7% respectively. Improvements in TB case finding were observed over a period in which a range of health system strengthening activities were implemented. While COVID-19 had a negative impact on the TB program in Mimika District, there are encouraging signs of recovery. Further work is needed to improve TB treatment outcomes.

INTERVENTION APPROACHES OF STIGMA RELATED TO TUBERCULOSIS IN DEVELOPING COUNTRIES: A SYSTEMATIC REVIEW

Considerable efforts and concurrent studies have been made to substantiate the control of tuberculosis (TB). The control was not achieved significantly, as the stigma is one of the significant barriers to controlling tuberculosis. It hampers the TB treatment’s determined targeted completion. However, despite countless measures to improve therapy completion, non-adherence to therapy remains a global issue. This systematic review is aimed at evaluating tuberculosis-related measures to increase adherence to treatment among patients with tuberculosis in developing countries. A systematic search of electronic databases (PubMed, Google Scholar, Pro-Quest science Direct, Ovid, Spring, Global Health, and Cochrane) covering articles published between 2003 and 2019 was carried out using truncated search words such as “tuberculosis-related stigma,” TB Stigma,” “intervention,” “treatment adherence,” “treatment compliance" and "developing countries." We included information from developing countries addressing the stigma between TB patients and their anti-stigma intervention. Eight hundred sixty-seven articles have been retrieved, 346 have been excluded due to duplication, and 397 other non-relevant articles have been excluded at the title screening stage. Subsequently, after full-text articles were assessed for failing to meet inclusion criteria, 118 articles were excluded, and only six studies remained. The six articles have improved TB treatment outcomes with stigma intervention, including health education and counseling, TB club self-support, and psychological support interventions. Setting, resources and local TB epidemiology may vary in the optimal implementation of stigma interventions.

Drug-susceptible tuberculosis treatment outcomes and its associated factors among inmates in prison settings in Bauchi State, Nigeria, 2014-2018.

Tuberculosis (TB) is a contagious disease and its transmissibility is increased in congregate settings. TB incidence rates are five-to-fifty times higher among inmates in prison settings than the general population which has a direct impact on the outcome of TB treatment. There is paucity of information on TB treatment outcomes and its associated factors in Nigerian prison settings. We therefore assessed TB treatment outcomes among inmates in prison settings in Bauchi State, Nigeria. We conducted a retrospective data analysis of inmates with TB in the five-main prison settings in Bauchi State. We extracted socio-demographic, clinical and treatment outcome characteristics from TB treatment register of inmates treated for TB between January 2014 and December 2018, using a checklist. We calculated the TB treatment success rate (TSR) and explored the relationship between the TSR and socio-demographic and clinical characteristics. Related variables were modelled in multiple logistic regression to identify factors associated with TSR at 5% level of significance. All 216 inmates were male with mean (SD) age of 37.6±11.4 years. Seventy-six (35.2%) were cured, 61 (28.2%) completed treatment, 65 (30.1%) were transferred-out without evaluation and 14 (6.5%) died. Overall TSR was 72.9%. Factors associated with successful-treatment-outcome were age, weight, imprisonment duration and HIV status. The results indicate that inmates who are 20–29 years are at least ten times more likely to be successful (aOR = 10.5; 95%CI: 3.2–35.1) than inmates who are 55 years or older. Inmates who are 30–39 years are about four times more likely to be successful than inmates who are 55 years or older (aOR = 4.2; 95% CI: 1.3–13.1). In general, the younger an inmate, the more successful he is. Inmates with pretreatment-weight; 55kg or more are 13 times more likely to be successful (aOR = 13.3; 95%CI: 6.0–29.6) than inmates with weight below 55kg. Inmates who were imprisoned for 2 years or less are about three times more likely to be successful (aOR = 2.6; 95%CI: 1.3–5.4) than inmates who were imprisoned for more than 2 years and HIV negative inmates were three times more likely to succeed (aOR = 3.3; 95%CI:1.4–7.8) than inmates who were HIV positive. We recommended that to improve TB treatment outcome among inmates; age, duration-of-imprisonment, weight and TB/HIV co-infection should be the major consideration during pretreatment, psychological and nutritional counselling and a tracking-system be developed by the authority to follow-up inmates transferred-out to other health facilities to ensure they complete the treatment and outcomes evaluated.

Effect of a brief motivational interview and text message intervention targeting tobacco smoking, alcohol use and medication adherence to improve tuberculosis treatment outcomes in adult patients with tuberculosis: a multicentre, randomised controlled trial of the ProLife programme in South Africa

ObjectiveTo investigate the effectiveness of a complex behavioural intervention, ProLife, on tuberculosis (TB) treatment success, medication adherence, alcohol use and tobacco smoking.DesignMulticentre, individual, randomised controlled trial where participants were assigned...

The Effect of Diabetes and Prediabetes on Antituberculosis Treatment Outcomes: A Multicenter Prospective Cohort Study.

It is unclear whether diabetes or prediabetes affects unfavorable treatment outcomes and death in people with tuberculosis (PWTB). Culture-confirmed, drug-susceptible PWTB, enrolled in the Regional Prospective Observational Research in Tuberculosis (RePORT)-Brazil cohort between 2015 and 2019 (N = 643) were stratified based on glycemic status according to baseline glycated hemoglobin. Unfavorable tuberculosis (TB) outcome was defined as treatment failure or modification, recurrence, or death; favorable outcome was cure or treatment completion. We corroborated the findings using data from PWTB reported to the Brazilian National System of Diseases Notification (SINAN) during 2015-2019 (N = 20 989). Logistic regression models evaluated associations between glycemic status and outcomes. In both cohorts, in univariate analysis, unfavorable outcomes were more frequently associated with smoking, illicit drug use, and human immunodeficiency virus infection. Diabetes, but not prediabetes, was associated with unfavorable outcomes in the RePORT-Brazil (adjusted relative risk [aRR], 2.45; P < .001) and SINAN (aRR, 1.76; P < .001) cohorts. Furthermore, diabetes was associated with high risk of death (during TB treatment) in both RePORT-Brazil (aRR, 2.16; P = .040) and SINAN (aRR, 1.93; P = .001). Diabetes was associated with an increased risk of unfavorable outcomes and mortality in Brazilian PWTB. Interventions to improve TB treatment outcomes in persons with diabetes are needed.

One dollar incentive improves tuberculosis treatment outcomes in programmatic settings in rural Uganda

The study aim was to determine the association of a one United States dollar (USD) dollar incentive and tuberculosis (TB) treatment outcomes among people with TB receiving treatment at a rural hospital in Uganda under programmatic settings. We conducted a quasi-experiment in which people with TB were randomised (1:1 ratio) to receive either a one USD incentive at months 0, 2, 5 and 6 (Dollar arm) or routine care (Routine arm). A second control group (Retrospective controls) consisted of participants who had a treatment outcome in the preceding 6 months. Treatment outcomes were compared between the intervention and control groups using Pearson’s chi-square and Fisher’s exact tests. The association between the incentive and treatment outcomes was determined using Poisson regression analysis with robust variances. Between November 2018 and October 2019, we enrolled 180 participants (60 in the Dollar arm and 120 in the Control group). TB cure (33.3% vs. 20.8%, p = 0.068) and treatment success (70.0% vs. 59.2% p = 0.156) were higher in the Dollar arm than the Control group, while loss-to-follow-up was lower in the Dollar arm (10.0% vs. 20.8% p = 0.070). Participants in the Dollar arm were more likely to be cured (adjusted incidence rate ratio (aIRR): 1.59, 95% CI 1.04–2.44, p = 0.032) and less likely to be lost to follow-up (aIRR: 0.44, 95% CI 0.20–0.96, p = 0.040). A one-dollar incentive was associated with higher TB cure and lower loss-to-follow-up among people with TB in rural Uganda.

Tuberculosis and associated risk factors among children and adolescent population in Serbia: 12 year's retrospective study.

Recognition and epidemiological control of childhood and adolescent tuberculosis (TB) is essential to achieve effective control of TB in general as it presents high risk for transmission in the community. The aim of the study is to provide a descriptive and analytic overview of the trends in childhood and adolescent TB notifications and treatment outcomes and to identify factors associated with treatment success in a twelve-year period in Serbia. We performed a retrospective trend analysis and analysis of treatment outcomes of 596 child and adolescent TB cases notified in Serbia in the period 2005-2016 from all health facilities, as well as logistic regression analysis to identify predictors of treatment success. Factors independently associated with treatment success were: new TB (OR=2.60; 95% CI: 1.45-3.74), male sex (OR=2.55; 95% CI: 2.09-3.00), pulmonary TB (OR=3.34; 95% CI: 2.34-4.34), comorbidities (OR=2.58; 95% CI: 2.24-2.91), age below 5 years (OR=0.37; 95% CI: 0.32-0.43), and social vulnerability (OR=0.40; 95% CI: 0.34-0.46). In order to improve TB treatment outcomes among children and adolescent population in Serbia, it is important to focus on female, age group 5-18, EPTB, retreatment cases and socially vulnerable groups.