MDR-TB Patients Research Articles

Time to Cure and Predictive Factors Among Patients with Multi-Drug Resistance Tuberculosis in Puntland, Somalia: A Retrospective Cohort Study

Background: Multi-drug-resistant tuberculosis, also known as MDR-TB, is caused by bacteria that are resistant to the most effective first-line anti-tuberculosis medications, which are rifampicin and isoniazid. MDR-TB is an increasing global concern, and its spread has varying cure times for patients affected. Thus, this study was intended to investigate the median time to cure and identify predictive factors for patients with MDR-TB in Puntland, Somalia. Methods: A retrospective cohort study was carried out at the MDR-TB center in Galkayo, Puntland, Somalia between the years of July 2017 and August 2023. The study utilized data that were collected from the inquiry form and monitoring cards of a randomly selected sample of 130 patients over a 6-year period. The data were entered into Epi-Data version 4.3 and analyzed using R Programming version 4.4.0. Non-parametric methods were used to estimate the median time to cure for patients with MDR-TB. Semi-parametric and parametric models were employed to determine predictive factors that influence the time to cure for MDR-TB patients. The Akaike Information Criteria (AIC) and Bayesian Information Criteria (BIC) of different survival models were compared to select the model that offers the best fit. Results: Out of the total of MDR-TB patients, 109(83.85%) were cured and 21(16.15%) were censored during the follow-up period. The median time to cure from MDR-TB was found to be 619 days which is approximately 20 months. In accordance with the AIC and BIC, the Log-logistic accelerated failure time model was the best fit for the data as compared to the other AFT models. The result of the Log-logistic AFT model revealed that age, sex, disease site, and comorbidities significantly affect the time to cure for MDR-TB. According to this study, older age with MDR-TB patients, male MDR-TB patients, MDR-TB patients with comorbid conditions, and extrapulmonary MDR-TB patients had a longer time to cure than their reference categories. Conclusion: Based on the findings of the study, the median time to cure for patients with MDR-TB in Puntland was found to be 20 months. Sex, disease site, comorbidities and age were predictive factors of time to cure from MDR-TB.

Experience of Using Delamanid in the Treatment of Multiple Drug Resistant Tuberculosis

The objective: to evaluate treatment results in MDR TB patients when delamanid is added to the treatment regimen.Subjects and Methods. 91 patients with multiple drug resistant pulmonary tuberculosis were included in the study, of which 36 people (39.6%) were HIV positive. Patients were divided into four comparison groups depending on HIV status and inclusion of delamanid in the treatment regimen. Groups receiving delamanid included only patients in whom bedaquiline or linezolid had been discontinued due to adverse reactions.Results. The results of treatment of MDR TB when delamanid is added to the chemotherapy regimen during the intensive phase, indicate its high effectiveness and safety including HIV positive patients.

To investigate the impact of revised diagnostic algorithm on presentation of multidrug-resistant tuberculosis cases at a referral centre in India

ABSTRACT Introduction: A shift in policy has occurred with the introduction of molecular diagnostic tools for the upfront diagnosis of all cases of tuberculosis, including drug-resistant tuberculosis. The impact of this shift in policy on severity of disease was studied, and comparisons were drawn between the year 2015 and 2020. Study Type and Design: This was an observational study conducted between 2020 and 2021. Seventy patients of MDR-TB with or without additional drug resistance, hospitalized in the year 2015 and 2020, were studied. Results: The study reveals a substantial reduction in the median time from the onset of symptoms to diagnosis between 2015 and 2020. Specifically, the median duration decreased from 12 weeks in 2015 to 8 weeks in 2020. Moreover, we found that in 2015, all cases under study had a history of tuberculosis in comparison to 2020. Additionally, there was a higher incidence of anemia in 2015 compared to 2020. In the radiological examination, it was observed that in 2015, a higher frequency of cases exhibited cavitations, bronchiectasis, and fibrosis on chest X-rays compared to the findings in 2020. The mean cavity size in 2015 measured 6.73 cm, while in 2020, it averaged 4.06 cm. Additionally, we noticed a higher occurrence of significantly advanced cases in 2015 in contrast to 2020. Conclusion: The implementation of the new policy of upfront DST was noted to decrease the time required for diagnosis and bacterial load as ascertained from degree of sputum smear positivity, radiological lesions, and severity of anemia.

Assessment of Quality of Life and Social Correlates among Drug Sensitive and Multidrug-resistant Tuberculosis Patients

Abstract Background: Tuberculosis (TB) has significant health, social, psychological, and economic impacts on patients. This study aimed to assess and compare quality of life (QOL) among multidrug-resistant (MDR) TB patients and drug-sensitive TB patients. Materials and Methods: A comparative study was conducted among 40 MDR-TB patients and 80 age- and gender-matched drug-sensitive TB patients in Chitradurga district, South India. Sociodemographic data were collected and QOL was assessed using the WHO BREF scale. Data were analyzed using SPSS v20. Results: The study population was predominantly male (65%) and aged 27–35 years. Education level and socioeconomic status differed significantly between MDR and sensitive TB groups (P < 0.05). MDR-TB patients had significantly lower self-rated QOL and health satisfaction compared to sensitive TB patients (P < 0.001). MDR-TB patients scored lower on all four QOL domains (physical, psychological, social relationships, and environmental), with the psychological domain most affected. The majority of both MDR and sensitive TB patients had “fair” QOL across domains. Conclusion: QOL was impaired in both MDR and sensitive TB patients, but more severely in MDR-TB. The psychological domain was most affected. Factors such as poor accessibility to health services, low socioeconomic status, and poor mental health may contribute to reduce QOL in TB patients.

A Mixed-Method Study of Medication-Related Burden Among Multi-Drug Resistant Tuberculosis Patients in West Java, Indonesia.

Multidrug-resistant tuberculosis presents a challenging obstacle in global TB control. It necessitates complex and long-term therapy, which can potentially lead to medication-related burdens that may ultimately reduce therapy adherence and quality of life. This study aimed to gain a deep understanding of the medication-related burdens experienced by multidrug-resistant tuberculosis patients. The study was conducted using a convergent mixed-method approach involving MDR-TB patients and their caregivers. Qualitative data were collected through semi-structured in-depth interviews, while quantitative data were gathered using the validated Living with Medicine Questionnaire 3. In the quantitative part, associations between patients' characteristics and burden levels were analysed using bivariate and multivariate analyses. Seventy-four participants were involved in the study, with 71 of them completing the questionnaire and 36 participating in interviews. The qualitative results revealed the subjectivity of medication-related burden perception, which could not be fully captured by the quantitative method. Four themes of medication-related burdens emerged: personal beliefs, regimen burdens, socioeconomic burdens, and healthcare burdens. The quantitative results provided a generalized representation of the population. Age and side effects were found to be significantly associated with higher burden levels, with those aged 18-30having an odds ratio (OR) of 7.303 (95% CI: 1.045-51.034), and those aged 31-40having an OR of 6.53 (95% CI: 1.077-39.607). Additionally, experiencing side effects had a substantial impact, with an OR of 46.602 (95% CI: 2.825-768.894). Both sets of results are valuable for designing patient-centered care. MDR-TB therapy imposes a significant burden, particularly regarding the characteristics of regimen. By understanding this burden, healthcare professionals can help improve the quality of life for these patients.

Predictors of mortality among multidrug-resistant tuberculosis patients after decentralization of services in Tanzania from 2017 to 2019: retrospective cohort study

BackgroundMultidrug-resistant tuberculosis (MDR-TB) presents persistent global health challenges, characterized by low treatment success rates among patients enrolled for treatment. The World Health Organization recommends decentralization to improve outcomes. This study aims to assess predictors of mortality among MDR-TB patients after decentralization of services in Tanzania. This was a retrospective cohort study involving all MDR-TB patients enrolled in treatment in all 31 regions in Tanzania from 2017 to 2019. The overall mortality rate among MDR-TB patients was calculated using the incidence rate. Additionally, independent factors of MDR-TB mortality were determined using multivariable cox proportional hazards models.ResultsThe study followed 985 patients for a total of 12,929 months. During this time, it found that approximately 12 out of every 1000 patients died each month. Specifically, the death rates were about 18 out of 1000 patients at 6 months, 8 out of 1000 at 12 months, and 7 out of 1000 at 24 months. Patients who had both MDR-TB and HIV, as well as those who were malnourished, had a lower chance of surviving at 6, 12, and 24 months. Malnourished patients had almost three times the risk of dying [adjusted hazard ratio (aHR) 2.96, with a 95% confidence interval (CI) of 2.10–4.19], while those with HIV had nearly double the risk [aHR 1.91, with a 95% CI of 1.37–2.65].ConclusionIn summary, our study on MDR-TB patient outcomes in Tanzania between 2017 and 2019 reveals a pattern of high mortality rates within the first 6 months of treatment. Furthermore, malnutrition and HIV co-infection were found to be significant predictors of mortality. To decrease mortality, it is crucial to closely monitor patients during the initial 6 months of treatment, especially those who are malnourished or co-infected with HIV, and ensure they receive appropriate and timely care. Additionally, further investigation is needed to find out what may be contributing to possible rise in mortality rate.

The Association of Chronic Pulmonary Aspergillosis and Chronic Pulmonary Histoplasmosis with MDR-TB Patients in Indonesia.

In Indonesia, 2.4% of all new tuberculosis patients had multi-drug resistant disease (MDR-TB); an estimated 24,000 incidences. Historical case series of MDR-TB described a high frequency of cavitation and poor prognosis. The diagnosis of chronic pulmonary aspergillosis (CPA) relies on raised levels of Aspergillus IgG antibodies, and detectable Histoplasma IgG antibodies are suspicious for chronic pulmonary histoplasmosis (CPH). We investigated whether MDR-TB patients might have concurrent CPH or CPA. This was a cross-sectional study with 50 MDR-TB patients. ELISA was used to detect Histoplasma IgG antibodies and lateral flow assay was used to detect Aspergillus IgG/IgM antibodies. Several other possible disease determinants were assessed by multivariate analysis. Of the 50 MDR-TB patients, 14 (28%) and 16 (32%) had positive Histoplasma or Aspergillus serology; six patients (12%) had dual antibody reactivity. Radiological abnormalities in positive patients included diffuse or local infiltrates, nodules, consolidation, and apical cavities, consistent with CPH and CPA. Patients with detectable fungal antibodies tended to have worse disease, and 4 of 26 (15.3%) died in the first 5 months of dual infection (p = 0.11 compared with no deaths in those with only MDR-TB). The criteria for the diagnosis of CPH and CPA were fulfilled in those with moderately and far advanced disease (13 of 14 or 93%) and 12 of 16 (75%), respectively. Damp housing was the only determinant associated with Histoplasma antibodies (PR 2.01; 95%CI 0.56-7.19), while pets were associated with the Aspergillus antibody (PR 18.024; 95%CI 1.594-203.744). CPA or CPH are probably frequent in MDR-TB patients in Indonesia and may carry a worse prognosis.

Results of Treatment of Patients with Multiple Drug Resistant Tuberculosis among Key Populations during the COVID-19 Pandemic in Dushanbe, Tajikistan

The objective: to identify changes in effectiveness of treatment of multiple drug resistant tuberculosis among key populations in Dushanbe, including the period of the COVID-19 pandemic.Subjects and Methods. Retrospective study of medical records of 431 MDR TB patients registered for treatment in Dushanbe was conducted (2017-2019 - Group 1 and 2020-2021 - Group 2 (the COVID-19 pandemic period)).Results. The duration of treatment was 15.4±6.9 months in Group 1, and 10.8±4.3 months in Group 2, which was due to the introduction of short-course regimens in that group. At the same time, in Group 2 there was an increase in effectiveness of MDR TB treatment to 85% versus 80% in Group 1, which was due to the use of new drugs and regimens containing them. In Group 1, a statistically significant association was found between MDR TB treatment failure and the following parameters: male gender (RR=2.3 (1.36-4.04), p=0.002), positive HIV status (RR=2.35 (1.37-4.05), p=0.011), hepatitis C infection (RR=3.0 (1.87-4.8), p <0.001), alcohol (RR=3.2 (1.96-5.2), p<0.001) and substances abuse (RR=3.99 (2.5-6.2), p<0.001), previous imprisonment (RR=2.6 (1.48-4.6), p<0.001), unemployment (RR=3.5 (1.8-6.7), p <0.001), and homelessness (RR=5.0 (3.9-6.5), p=0.0011). In Group 2, failure of MDR TB treatment was statistically significantly associated with hepatitis C (RR=3.3 (1.5-7.2), p=0.02), alcohol and drug abuse (RR= 4.4 ( 1.95-10.1). p =0.026), as well as (unlike Group 1) labor migration (RR=3.0 (1.45-6.2), p=0.0068), in-patient treatment (RR=3.8 (1.36-10.64), p=0.0056), while there was no association with HIV status.

Correlation between Gene polymorphism levels of serum matrix metalloproteinases with cavitary features and pulmonary fibrosis of the Patient tuberculosis multi-drug resistance using high-resolution computerized tomography of the Thorax

Matrix metalloproteinases (MMPs) are proteins that play a role in the inflammatory and remodeling processes caused by infections, including pulmonary tuberculosis (TB), especially multidrug resistance. This study aims to investigate the relationship between variations in MMP-1 and MMP-9 blood levels, cavity features such as number, diameter, and wall thickness, and the location of fibrosis in multidrug-resistant (MDR) and drug-sensitive (DS) tuberculosis patients. This study used a comparative cross-sectional study design. The subjects, who were outpatients at Abdoel Moelok Hospital, Lampung, Indonesia, had passed the ethical test. We divided the subjects into two groups: 34 in the MDR-TB group and 36 in the DS-TB group. An ELISA test determined the levels of MMP-1 and MMP-9, while the PCR-sequencing method determined the genotypes of MMP-1 and MMP-9. Additionally, we measured cavities and fibrosis using thoracic high-resolution computerized tomography (HRCT) imaging. In MDR-TB patients, there was a significant difference in the number of cavities larger than 6.6 mm in diameter, as well as cavity thickness, compared to DS-TB patients. The distribution of fibrosis in lung segments was also significantly different in MDR-TB compared to DS-TB. Although MMP-9 levels in the MDR-TB group were higher than in the DS-TB group, there was no statistically significant difference. Based on HRCT measurements, this study found a link between MDR-TB and DS-TB in terms of the number of cavities, the diameter of the cavities, the thickness of the cavity walls, and the location of fibrosis in the affected lung segments. There was no link between the MMP-1 (−1607G) and MMP-9 (C1562T) genotypes and the levels of MMP-1 and MMP-9 in the blood. The MMP-1 genotype in the two study groups was very different and was linked to twice as many cases of MDR-TB. In addition, there was a substantial difference in cavity wall thickness between the G/G MMP-1 1607 genotype and the T/T MMP-9 genotype in the two study groups.

Comparison of Anxiety Levels in MDR-TB Patients with Individual and Short-term Regimens at Dr. Soebandi Regional General Hospital, Jember, Indonesia

Comparison of Anxiety Levels in MDR-TB Patients with Individual and Short-term Regimens at Dr. Soebandi Regional General Hospital, Jember, Indonesia

Mycobacterium tuberculosis and human immunodeficiency virus co-infection and associated variables among presumptive pulmonary tuberculosis patients in Ethiopia; a health institution based cross-sectional study

BackgroundCo-infection of Mycobacterium tuberculosis (MTB) and the Human Immunodeficiency Virus (HIV) is a major global public health issue, particularly in border areas of resource-limited nations, including Ethiopia. ObjectiveTo explore the prevalence and associated variables of MTB/HIV co-infection among PTB presumptive patients in Northwest Ethiopia. MethodsFrom February to August 2021, a cross-sectional institutional investigation was conducted at the Metema and Abrehajira hospitals. Semi-structured questionnaires were used to collect socio-demographic and clinical data. The MTB/RIF Xpert assay was used to process sputum, and 3 ml of veins blood was collected for HIV rapid test (STAT-PAK, ABON, and SD BIOLINE HIV test algorithm) following the Ethiopian National HIV test algorithm. The Gene Xpert assay's sample processing control was checked to ensure data quality. Data entered into Epi-Data were exported to SPSS version 20 for analysis. Statistically significant variables (p-value ≤0.2) from bivariable analysis were included in multivariable analysis. A p-value ≤ 0.05 was judged statistically significant. ResultsThis study included 314 PTB presumptive patients with a median age of 35.0 years, of which 178 (56.69 %) were males. Among all patients, 40(12.7 %) and 51(16.2 %) were PTB, and HIV seropositivity, respectively. Of the PTB patients, 14/40 (35 %) (95 % CI: 24.4–45.6) were co-infected with HIV/AIDS. Married patients were 70 % less likely than unmarried individuals (AOR = 0.3 CI; 0.07–0.98) to have MTB/HIV co-infection. Patients who had contact history with MDR-TB patients (AOR = 5 CI; 1.37–18.00), and those who had a history of alcohol use (AOR = 12.2 CI; 2.56–57.8) were more likely to have MTB-HIV co-infection than their peers. ConclusionOur findings showed that MTB-HIV co-infection is one of the most important community health concerns in the study area. Therefore, MTB/HIV cooperation activities should be fully in place to prevent co-infection and its impact on the population.

A pragmatic randomized controlled trial to evaluate the efficacy and safety of an oral short-course regimen including bedaquiline for the treatment of patients with multidrug-resistant tuberculosis in China: study protocol for PROSPECT

IntroductionThe lack of safe, effective, and simple short-course regimens (SCRs) for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) treatment has significantly impeded TB control efforts in China.MethodsThis phase 4, randomized, open-label, controlled, non-inferiority trial aims to assess the efficacy and safety of a 9-month all-oral SCR containing bedaquiline (BDQ) versus an all-oral SCR without BDQ for adult MDR-TB patients (18–65 years) in China. The trial design mainly mirrors that of the “Evaluation of a Standardized Treatment Regimen of Anti-Tuberculosis Drugs for Patients with MDR-TB” (STREAM) stage 2 study, while also incorporating programmatic data from South Africa and the 2019 consensus recommendations of Chinese MDR/RR-TB treatment experts. Experimental arm participants will receive a modified STREAM regimen C that replaces three group C drugs, ethambutol (EMB), pyrazinamide (PZA), and prothionamide (PTO), with two group B drugs, linezolid (LZD) and cycloserine (CS), while omitting high-dose isoniazid (INH) for confirmed INH-resistant cases. BDQ duration will be extended from 6 to 9 months for participants with Mycobacterium tuberculosis-positive sputum cultures at week 16. The control arm will receive a modified STREAM regimen B without high-dose INH and injectable kanamycin (KM) that incorporates experimental arm LZD and CS dosages, treatment durations, and administration methods. LZD (600 mg) will be given daily for ≥ 24 weeks as guided by observed benefits and harm. The primary outcome measures the proportion of participants with favorable treatment outcomes at treatment completion (week 40), while the same measurement taken at 48 weeks post-treatment completion is the secondary outcome. Assuming an α = 0.025 significance level (one-sided test), 80% power, 15% non-inferiority margin, and 10% lost to follow-up rate, each arm requires 106 participants (212 total) to demonstrate non-inferiority.DiscussionPROSPECT aims to assess the safety and efficacy of a BDQ-containing SCR MDR-TB treatment at seventeen sites across China, while also providing high-quality data to guide SCRs administration under the direction of the China National Tuberculosis Program for MDR-TB. Additionally, PROSPECT will explore the potential benefits of extending the administration of the 9-month BDQ-containing SCR for participants without sputum conversion by week 16.Trial registrationClinicalTrials.gov NCT05306223. Prospectively registered on 16 March 2022 at https://clinicaltrials.gov/ct2/show/NCT05306223?term=NCT05306223&draw=1&rank=1 {2}.

To study the profile of multi-drug resistant tuberculosis (MDR) TB patients on shorter regimen at a tertiary care Centre of North India

The effectiveness of shorter regimen for the treatment of MDR-TB patients was found in the study done by Damien Foundation in Bangladesh, therefore we planned to study the profile MDR-TB patients who were taking shorter regimen so that various factors can be explored related to this regimen in Indian scenario.This was a prospective longitudinal study done in respiratory medicine department between January 2020 to December 2021. There were 177 patients of MDR/ RR pulmonary TB were identified and as per inclusion criteria and based on exclusion criteria 84 patients were excluded therefore our study population comprised of 93 remaining patients those who filled the study protocol, their treatment (Injectable shorter regimen ) and follow up investigations done as per programmatic management of drug resistant TB guideline of National TB elimination programme. There were 55(59%) males and 38(41%) were females and mean age of patient was 31±15.11 years (range 4-82 years). Out of 93 patients 27(29%) were smokers and 25(27%) were alcoholics and the most common symptom was fever 92(98.9%). The most common comorbidity was diabetes mellitus 11(11.9%). The most common minor side effect seen was GI intolerance in 41(44.1%) patients.Out of 93 patients 76.3% (71) were cured and 23.7% (22) patients were failed to cure. The association between smoking and treatment outcome was statistically significant (p value=0.013). The association between treatment outcome and previous history of adequate treatment was found to be significant (p=0.016).

Contact investigation in multidrug-resistant tuberculosis:ethical challenges.

Contact investigation is an evidence-based intervention of multidrug-resistant tuberculosis (MDR-TB) to protect public health by interrupting the chain of transmission. In pursuit of contact investigation, patients' MDR-TB status has to be disclosed to third parties (to the minimum necessary) for tracing the contacts. Nevertheless, disclosure to third parties often unintentionally leads the MDR-TB patients suffered from social discrimination and stigma. For this reason, patients are less inclined to reveal their MDR-TB status and becomes a significant issue in contact investigation. This issue certainly turns into a negative impact on the public interest. Tension between keeping MDR-TB status confidential and safeguarding public health arises in relation to this issue. Regarding MDR-TB management, patient compliance with treatment and contact investigation are equally important. Patients might fail to comply with anti-TB therapy and be reluctant to seek healthcare due to disclosure concerns. In order to have treatment adherence, MDRTB patients should not live through social discrimination and stigma arising from disclosure and TB team has a duty to support them as a mean of reciprocity. However, implementation of contact investigation as a public health policy can still be challenging even with promising reciprocal support to the patients because MDR-TB patients are living in different contexts and situations. There can be no straight forward settlement but an appropriate justification for each distinct context is needed to strike a balance between individual confidentiality and public interest.

Satisfaction Level of Multi-Drug Resistant Tuberculosis Patient: A Hospital Based Study in Bangladesh

Background: Realizing the patients’ need and improving the quality of services, a satisfaction survey can effectively help management and the patient. The aim of this study was to investigate satisfaction level of multi-drug resistant tuberculosis (MDRTB) patients at tertiary level hospital in Bangladesh. Methods: A cross-sectional study conducted at Chest Disease Hospital (CDH), Rajshahi among 199 MDR-TB patients using random sampling technique. A semi-structured questionnaire was used to collect basic, socio-demographic, behavioral and satisfaction specific data with ensuring no any risk for providing right information. Five point “Likert Scale” was used to measure patients’ satisfaction level. The relevant data were carefully coded and recoded for statistical analysis, and independent samples t-test and multinomial logistic regression analysis were used to see the difference and association of influencing factors on satisfaction. Results: In this study, we observed that the mean age of MDR-TB patient admitted at CDH was 39.8 years with range from 16 to 62 years. About 90% patients were satisfied with behavior of care providers, and 50% and 29% patients were satisfied in hospital environment and supplied food respectively. We also found that old age group, male, less educated, smoker, diabetic, married, high income and less expenditure group, business or service holder and Muslim were more satisfied than their counterparts. The multinomial logistic regression analysis showed that young age group (≤40 years) was five times more dissatisfied than old age group (≥40 years) (OR=5.345; 95% CI: 1.123-25.448; p<0.05). Receiving monthly money from the program positively impacted on satisfaction. Similarly, drug toxicity, length of stay and loneliness was negatively impacted on satisfaction. Conclusion: Considering the mentioned influencing factors can strengthen the national control program effort at CDH in Rajshahi division, Bangladesh. Similar study in other chest disease hospitals located mostly in different divisions in the country can also help comparing the factors for nationwide improvement.

Comparison of short term and long term multidrug resistant tuberculosis treatment outcomes in tertiary care settings

IntroductionTuberculosis is a contagious and communicable disease while drug resistant tuberculosis is difficult to treat and requires long duration. Various strategies are focused to treat the drug resistant tuberculosis focusing lesser side effects and shorter duration of treatment. ObjectiveTo compare treatment outcomes between short-term and long-term regimens among patients registered at a tertiary care hospital's Programmatic Management of Drug-Resistant TB (PMDT) site in Pakistan. MethodsA comparative prospective cohort study was conducted at IMBB, The University of Lahore, in collaboration with the Health Research Institute (HRI) TB Research Centre at King Edward Medical University/Mayo Hospital, Lahore. The study included a sample size of 136 patients, with 68 patients in each treatment regimen (long-term and short-term). Adult pulmonary MDR TB patients seeking treatment from the facility were included based on predefined criteria. Data was collected using a pre-designed questionnaire after obtaining ethical approval and informed consent. The rates of patients' cure, treatment completed, treatment failure and death were calculated. ResultsA total of 131 patients were successfully followed up and included in the final analysis. Of these, 66 patients were in the long-term treatment group and 65 patients were in the short-term treatment group. The cure rate was 74.8 %, with 98 patients successfully cured, and 13.8 % of patients completed their treatment successfully. In the long-term treatment group, the cure rate was 75.6 %, with a treatment failure rate of 6.2 %. In the short-term treatment group, the cure rate was 73.8 %, with a treatment failure rate of 6.1 %. The death rate was 4.5 % in the short-term treatment group and 6.2 % in the long-term treatment group. However, these differences in treatment outcomes were statistically insignificant (p-values > 0.05). The newer drugs, bedaquiline and delamanid, did not show significant improvements in the treatment of multidrug-resistant TB patients. Side effects at completion of treatment remained to be significantly lesser (p < 0.05) among short term treatment group as compared to long term treatment group. ConclusionThe findings suggest that short-term treatment regimens are equally effective as long-term treatment regimens, with the added benefit of presenting fewer side effects.

The Overview Side Effects of MDR TB Short Term Regimen for Heart and Kidney Function in MDR TB Patients at H. Adam Malik General Hospital Medan, North Sumatra

The Overview Side Effects of MDR TB Short Term Regimen for Heart and Kidney Function in MDR TB Patients at H. Adam Malik General Hospital Medan, North Sumatra

Adverse Drug Reactions in Multi-Drug Resistant Tuberculosis Patients, in India, who had received DOTS Plus Treatment along with Home Care and Counselling

Background: Adverse drug reactions are common in MDR-TB patients on treatment. An adverse drug reaction (ADR) is defined as an appreciably harmful or unpleasant reaction resulting from an intervention related to the use of a medicinal product. Revised National Tuberculosis Control Programme used 24-months long Category IV/DOTS Plus regimen for treatment of MDR-TB. The Community Health Department of St. Stephen’s Hospital started an innovative project in 2009, in the form of Home Care for MDR Patients and it concluded with Long-term Follow-up of patients, who had received DOTS Plus Treatment along with Home Care and Counselling (2015). Aims: To study the spectrum, severity and the risk factors for ADRs in MDR-TB patients. Methods: In this retrospective study files of 109 MDR-TB patients who had received treatment along with home care and counselling support, were reviewed. The study was conducted between January to May 2024. Results: Out of 109 MDR TB patients there were 68 (62%) developed one or more ADR. Joint pains 44(40.36%), was the most commonly observed ADR, followed by nausea 29(26.6%) and vomiting 25(22.93%), weakness 23(21.1%), anxiety and depression 16(14.67%), difficulty in breathing 14(12.84%), tremors 13(11.9%), giddiness 11(10.1%), skin rashes 10(9.2%). According to Hartwig Scale mild ADRs were 58.8%, moderate 5.9% and severe 35.3%. Patients who had BMI &lt;18.5 experienced less ADRs with an Odds Ratio =0.22; 95% CI=0.06 to 0.72, p=0.0124. Unemployment was associated with higher number of ADRs OR=3.5; 95% CI=0.99 to 12.29, p=0.05. Sixty-two % MDR TB patients had ADRs. Our treatment outcomes showed 41(60.3) as cured, 24(35.3) died, 2(2.9) defaulted and 1(1.5) failed treatment. This was possible because healthcare teams counselled and provided all possible support to patients 24x7 thus improving adherence to therapy. Conclusion: ADRs occurred in more than half of the cases, with joint pain being the most common. Interventions such as counselling of patients and their family on importance of adherence to drugs at the initiation of treatment, provision of nutritional support, psychological counselling and motivation, instant referral for ADRs and care of patients at referred facilities, help patients not becoming defaulters.

Effect of Cost-Exemption Policy on Treatment Interruption in Patients With Newly Diagnosed Pulmonary Tuberculosis in South Korea.

In 2021, South Korea had the highest incidence rate (49 per 100 000 population) and the third highest mortality rate (3.8 per 100 000 population) due to pulmonary tuberculosis (TB) among Organization for Economic Co-operation and Development countries. Notably, premature interruption of TB treatment interferes with TB control efforts. Therefore, we examined the effect of the co-payment waiver on treatment interruption and mortality among patients with pulmonary TB in South Korea. Patients who had newly treated TB in South Korea from 2013 to 2019 were selected from the nationwide data of the entire Korean National Health Insurance Service (NHIS) population. The effects of policy implementation on treatment adherence and mortality rates depending on treatment interruption history were evaluated. In total, 73 116 and 1673 patients with drug-susceptible (DS) and multidrug-resistant (MDR) pulmonary TB, respectively, were included in the final study population. After implementing the cost-exemption policy, the treatment interruption rate tended to decrease in the continuation phase in the DS-TB group (slope change: -0.097, P=.011). However, it increased in the intensive phase in the MDR-TB group (slope change: 0.733, P=.001). MDR-TB patients were likely to experience an interruption of TB treatment (adjusted odds ratio [aOR], 6.04; 95% CI, 5.43-6.71), and treatment interruption history was a significant risk factor for 1-year and overall mortality rates (adjusted hazard ratios [aHRs]: 2.01, 95% CI, 1.86-2.18 and 1.77, 95% CI, 1.70-1.84, respectively) in the DS-TB group. Implementing the cost-exemption policy effectively reduced the treatment interruption rate among patients with DS pulmonary TB.

Epidemiology of multi-drug resistant Tuberculosis in the western region of Kenya.

Multidrug-resistant tuberculosis (TB) (MDR-TB), or TB that is simultaneously resistant to both isoniazid (INH) and rifampicin (RIF), is a barrier to successful TB control and treatment. Stratified data on MDR-TB, particularly in the high-burden western Kenya region, remain unknown. This data is important to monitor the efficacy of TB control and treatment efforts. Herein, we determined the molecular epidemiology of drug-resistant TB and associated risk factors in western Kenya. This was a non-experimental, population-based, cross-sectional study conducted between January and August 2018. Morning sputum samples of individuals suspected of pulmonary TB were collected, processed, and screened for Mycobacterium tuberculosis (Mtb) and drug resistance using line probe assay (LPA) and Mycobacterium growth indicator tubes (MGIT) culture. MGIT-positive samples were cultured on brain heart infusion (BHII) agar media, and the presence of Mtb was validated using Immunochromatographic assay (ICA). Drug sensitivity was performed on MGIT and ICA-positive but BHI-negative samples. Statistical significance was set at P < 0.05. Of the 622 Mtb isolates, 536 (86.2%) were susceptible to RIF and INH. The rest, 86 (13.83%), were resistant to either drugs or both. A two-sample proportional equality test revealed that the MDR-TB prevalence in western Kenya (5%) did not vary significantly from the global MDR-TB estimate (3.9%) (P = 0.196). Men comprised the majority of susceptible and resistant TB (75.9% and 77.4%%, respectively). Also, compared with healthy individuals, the prevalence of HIV was significantly higher in MDR-TB patients (35.9% vs 5.6%). Finally, TB prevalence was highest in individuals aged 25-44 years, who accounted for 58.4% of the total TB cases. Evidently, the prevalence of MDRTB in western Kenya is high. Particular attention should be paid to men, young adults, and those with HIV, who bear the greatest burden of resistant TB. Overall, there is a need to refine TB control and treatment programs in the region to yield better outcomes.