Sputum Smear-positive TB Patients Research Articles

Experience on the first national anti-TB drug resistance survey (DRS) in Timor-Leste

BackgroundA national drug resistance survey (DRS) was implemented for the first time in Timor-Leste (TL) in 2019. The primary objective of the survey was to assess the prevalence of drug resistance among new and previously treated pulmonary TB patients in the country.MethodsThis nation-wide cross-sectional survey was conducted in 2019 targeting all new and previously treated sputum smear-positive pulmonary TB patients. Sputum samples were submitted to the National TB Reference Laboratory for confirmation of TB and to determine resistance to rifampicin by Xpert MTB/RIF. Culture was performed on solid media, and culture isolates of confirmed TB cases were shipped to the WHO Supranational TB Reference Laboratory in Chennai, India for whole genome sequencing (WGS). Survey summary statistics, data cross-tabulations and analysis of potential risk factors of rifampicin-resistant TB (RR-TB) were conducted using R statistical software (version 3.5.2).ResultsA total of 953 sputum-smear positive patients were enrolled, of which 917 were confirmed as positive for TB by either Xpert MTB/RIF or culture. An electronic web-based system was used for entry and storage of the data. Rifampicin resistance was detected among 0.6% (95% CI 0.2–1.3) of new cases and 2.7% (95% CI 0.5- 8.2) of previously treated cases. WGS was conducted for validation purposes on 65 randomly selected isolates (29% of RR-TB (2/7) and 7% of RS-TB (63/910) by Xpert MTB/RIF or pDST). The original test results agreed with the WGS validation results for 62/64 isolates (97%).ConclusionThe prevalence of RR-TB in Timor-Leste is relatively low compared to the estimated proportions of RR-TB in the WHO South-East Asia Region (2.5% [95% CI 1.9–3.3] among new cases and 14% [95% CI 7.7–21] among previously treated cases). The rapid sputum collection and transportation mechanism implemented in the survey demonstrates its feasibility in low resource settings and should be replicated for routinely transporting TB specimens from microscopy labs to GeneXpert sites. Establishment of in-country capacity for rapid molecular diagnostics for both first- and second-line DST is an immediate need for achieving universal drug susceptibility testing (DST) to guide appropriate patient management.

Diagnostic Performance of GeneChip for the Rapid Detection of Drug-Resistant Tuberculosis in Different Subgroups of Patients.

ObjectiveDrug-resistant tuberculosis (DR-TB) is a growing problem worldwide. The rapid drug susceptibility test (DST) of DR-TB enables the timely administration of a chemotherapy regimen that effectively treats DR-TB. GeneChip has been reported as a novel molecular diagnostic tool for rapid diagnosis but has limited data on the performance of subgroup patients with DR-TB. This study aims to assess the diagnostic value of GeneChip in patients with different sexes, ages, treatment histories, treatment outcomes, and places of residence.MethodsWe recruited newly registered sputum smear-positive pulmonary TB patients from January 2011 to September 2020 in Lianyungang City, Jiangsu Province, China. We applied both GeneChip and DST to measure drug resistance to rifampin (RIF) and isoniazid (INH). The kappa value, sensitivity, specificity, and agreement rate (AR) were calculated. We also applied a Classification and Regression Tree to explore factors related to the performance of GeneChip.ResultsWe observed that sex, age, treatment history, treatment outcomes, and drug resistance type were significantly associated with the performance of GeneChip. For RIF resistance, there was significant accordance in young patients (kappa: 0.79) and cases with the treatment failure outcome (kappa: 0.92). For multidrug resistance (MDR), there was significant accordance in young cases (kappa: 0.77). Compared with previously treated patients, the newly treated patients had a significantly higher AR in detecting RIF resistance (0.97 vs 0.92), INH resistance (0.95 vs 0.89), and MDR (0.98 vs 0.92). The overall sensitivity, specificity, AR and kappa value for the diagnosis of MDR-TB were 0.70 (95% CI: 0.63–0.70), 0.99 (95% CI: 0.98–0.99), 0.98 (95% CI: 0.97–0.98), and 0.72 (95% CI: 0.67–0.78), respectively.ConclusionWe observed a high concordance between GeneChip and DST among TB patients with different characteristics, indicating that GeneChip can be a potential alternative tool for rapid MDR-TB detection.

BARRIERS TO THE IMPLEMENTATION OF ISONIAZID PREVENTIVE THERAPY AMONG CHILDREN UNDER FIVE YEARS OLD IN CLOSE CONTACT WITH SPUTUM SMEAR-POSITIVE TB PATIENTS

Background: The implementation of isoniazid preventive therapy (IPT) among children under five years old in close contact with sputum smear-positive TB patients is still low. Only 21,7% of children implemented the IPT in Central Java in 2017. Assessment of the barriers to IPT implementation needs to be carried out in the control of child TB cases.Objective: To analyze the barriers to IPT implementation among children under five years old in close contact with sputum smear-positive TB patients.Methods: A cross-sectional study was conducted among children (age <5 years) in close contact with sputum smear-positive TB patients. Data were collected from KRMT Wongsonegoro Hospital, Dr. Adhyatma, MPH Hospital, Puskesmas Kedungmundu, and Puskesmas Bandarharjo. Structured questionnaires were used to obtain sociodemographic information and to identify associated barriers to IPT implementation. The data were analyzed using Fisher’s exact test.Results: The majority (93,3%) of the total subject (75) of this study did not implement the IPT. The results of the bivariate analysis showed that distance to health facilities (p=0.024), perceived barriers (p=0.016), and cues to action (p=0.001) had a significant association as barriers to IPT implementation. Meanwhile age (p=0.622), gender (p=2.121), education level (p=0.073), economic level (p=0.521), knowledge level (p=0.166), and perceived threats (p=0.316) had no significant association as barriers to IPT implementation.Conclusion: IPT implementation rate is low. The barriers were distance to health facilities, perceived barriers, and cues to action.

First molecular-based anti-TB drug resistance survey in Eritrea.

BACKGROUND: In the absence of reliable data on drug-resistant TB in Eritrea, a national survey was conducted in 2018 using molecular-based methods, bypassing the need for culture.METHODS: A cross-sectional study was conducted in all 77 TB microscopy centres in the country. All 629 newly registered sputum smear-positive pulmonary TB patients were enrolled over 12 months. Sputum samples were tested using the Xpert® MTB/RIF assay and targeted next-generation sequencing (Deeplex Myc-TB) to identify resistance and explore the phylogenetics of Mycobacterium tuberculosis complex strains.RESULTS: Drug resistance profiles were obtained for 555 patients (502 new, 53 previously treated). The prevalence of rifampicin-resistant TB (RR-TB) was respectively 2.0% and 7.6% among new and previously treated cases. All RR-TB isolates that were susceptible to isoniazid displayed a phylogenetic marker conferring capreomycin resistance, confirming circulation of a previously described resistant TB sub-lineage in the Horn of Africa. Only one case of fluoroquinolone resistance was detected.CONCLUSION: The prevalence of rifampicin resistance among TB patients is encouragingly low. The scarcity of fluoroquinolone resistance bodes well for the success of the recommended all-oral treatment regimen. Surveillance based on molecular approaches enables a reliable estimation of the burden of resistance and can be used to guide appropriate treatment and care.

Determining Mycobacterium tuberculosis Drug Resistance and Risk Factors for Multidrug-Resistant Tuberculosis in Sputum Smear-Positive Tuberculosis Outpatients in Anhui Province, China, 2015-2016.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is currently a major problem in China. The prevention and treatment work for MDR-TB patients started late in Anhui province. To determine the prevalence of MDR-TB in sputum smear-positive TB patients (SSPTBPs) and analyze the risk factors for MDR-TB in Anhui province, we conducted an investigation of drug resistance among SSPTB outpatients from September 2015 to August 2016.MethodsA stratified cluster-randomized sampling method was used to obtain a representative sample. It was estimated that 2290 new cases and 440 previously treated cases of SSPTBPs needed to be recruited from 40 survey sites. Isolates were tested for resistance to six first-line and second-line anti-TB drugs. Information from patient questionnaire survey was used to identify factors linked to MDR-TB.ResultsFinally, a total of 3047 SSPTBPs were recruited from 40 survey sites; of these, 2530 specimens were successfully cultured and had drug susceptibility testing done. The proportions of rifampin resistant (RR)-TB were 11.42% (289/2530, 95% CI: 10.18–12.66%), 7.64% (163/2133, 95% CI: 6.38–8.62%) and 31.74% (126/397, 95% CI: 27.38–36.60%) in all cases, new cases and previously treated cases, respectively, and the proportions of confirmed MDR-TB were 7.63% (193/2530, 95% CI: 6.59–8.66%), 4.97% (106/2133, 95% CI: 4.05–5.89%) and 21.91% (87/397, 95% CI: 17.83–26.00%), respectively. The ofloxacin resistance rate in previously treated SSPTBPs reached 21.66% (95% CI: 17.33–26.75%). Patients who had received two or more anti-TB treatment courses were significantly associated with MDR-TB compared to patients who have received one anti-TB course.ConclusionMDR-TB prevalence was high among SSPTBPs in Anhui province, and past anti-TB treatment course was associated with MDR-TB.

Alarming levels of multidrug-resistant tuberculosis in Ukraine: results from the first national survey.

The true prevalence of multidrug-resistant tuberculosis (MDR-TB) in Ukraine is not known. Available data are a decade old and limited to only one province. To determine the prevalence of MDR-TB among new and previously treated TB cases in Ukraine and explore the risk factors associated with drug resistance. A total of 1550 sputum smear-positive pulmonary TB patients were recruited from 40 clusters throughout Ukraine. Sputum specimens were examined using culture, drug susceptibility testing and pncA gene sequencing. The proportion of MDR-TB among new and previously treated TB cases was respectively 24.1% (95%CI 20.7-27.6) and 58.1% (95%CI 52.1-64.1). More than one third (38.0%) of MDR-TB or rifampicin (RMP) resistant cases showed resistance to either a fluoroquinolone (FQ) or a second-line injectable agent or both. Resistance to pyrazinamide and FQs was low in patients with RMP-susceptible TB. Among new TB cases, the odds of MDR-TB were higher among patients who were younger, female and living in south-eastern provinces, as well as among human immunodeficiency virus-positive patients who belonged to a low socio-economic group. Our study showed that the burden of MDR-TB in Ukraine was much greater than previously assumed. Urgent actions are needed to prevent further spread of drug-resistant TB in Ukraine.

High-risk screening and detection of multidrug-resistant tuberculosis in two prefectures of China: a drug susceptibility surveillance-based secondary data analysis

ABSTRACTBackground: In China, less than one-fifth of multidrug-resistant tuberculosis (MDR-TB) cases are detected. MDR-TB screening is conducted amongst the following five high-risk groups of TB patients: chronic cases, close contacts of MDR-TB patients, patients with treatment failure, relapsed and returned patients, and smear-positive patients at the end of the third month of initial treatment.Objective: To estimate the possibility of detecting MDR-TB cases if only the high-risk screening strategy is applied in China.Methods: A secondary analysis was applied to the surveillance-based longitudinal data of all sputum smear-positive TB patients in Prefecture E and Prefecture W of China from 2013 to 2015. The population attributable risk (PAR) was estimated using odds ratios for five risk factors/predictors and exposure proportions amongst all MDR-TB cases.Results: A total of 3513 TB patients (2807 from Prefecture E and 706 from Prefecture W) were included. Males accounted for 77.91% (2737/3513) of the patients. The average age was 52.5 ± 20.0 years old. Overall, 40.34% (71/176) of MDR-TB patients were from the five high-risk groups during the three-year study period. The detected proportion of MDR-TB cases using the high-risk screening strategy was significantly higher in Prefecture E than in Prefecture W. The PAR% for all five risk factors/predictors was 43.4% (95% CI: 24.6–61.7%), 49.9% (95% CI: 31.3–67.0%), and 30.3% (95% CI: 12.9–50.1%) in Prefecture E and 36.6% (95% CI: 10.4–64.5%), 13.3% (95% CI: −1.7–39.7%), and −82.5% (95% CI: −117.5–−11.2%) in Prefecture W in 2013, 2014, and 2015, respectively. The PAR% for the five specific risk factors/predictors ranged from 0.4% (95% CI: −0.2–4.8%) to 21.0% (95% CI: 13.1–30.0%) in these two prefectures.Conclusion: In general, a high-risk screening strategy would miss more than half of the MDR-TB patients because they do not belong to the five high-risk groups.

TB Treatment Delays in Odisha, India: Is It Expected Even after These Many Years of RNTCP Implementation?

BackgroundIn India, the Revised National TB Control Programme (RNTCP) envisages initiation of TB treatment within seven days of diagnosis among smear-positive patients. After nearly two decades of RNTCP implementation, treatment delays are usually not expected.ObjectivesTo determine the proportion of sputum smear-positive TB patients who were initiated on treatment after seven days and their associated risk factors.MethodsThe study was conducted in Cuttack and Rayagada districts of Odisha. It was a retrospective cohort study that involves review of TB treatment registers and laboratory registers for 2013.ResultsAmong 1,800 pulmonary TB (PTB) patients, 1,074 (60%) had been initiated on treatment within seven days of diagnosis, 721 (40%) had been initiated on treatment more than seven days, and 354 (20%) had delays of more than 15 days. The mean duration between TB diagnosis and treatment initiation was 21 days with a range of 8–207 days (median = 14 days). Odds of treatment delay of more than seven days were 4.9 times (95% confidence interval [CI] 3.3-6.6) among those who had been previously treated, 6.2 times (95% CI 1.3-29.7) among those infected with HIV, and 1.8 times (95% CI 1.1-2.9) among those diagnosed outside district DMC.ConclusionDelay in initiation of TB treatment occurred in majority of the smear-positive patients. The RNTCP should focus on core areas of providing quality TB services with time-tested strategies. To have real-time monitoring mechanisms for diagnosed smear-positive TB patients is expected to be the way forward.

Tuberculosis-HIV Co-infection Rate among Smear Positive Pulmonary Tuberculosis Patients and Associated Risk Factors in Southern Ethiopia

The objective of this study was to estimate HIV infection and associated risk factors among smear positive pulmonary TB patients in Southern Ethiopia. A cross-sectional study design was used to recruit 221 consecutive smear positive pulmonary TB patients visiting three hospitals in Gamo Goffa Zone from March, 2013 to February, 2014. A structured questionnaire was used to collect data on socio demographic, behavioral and economic factors from study units. Chi-square, fisher’s exact test and logistic regression were used to assess the association between the above factors and HIV infection among smear positive pulmonary TB. The rate of HIV-TB co-infection among sputum smear-positive pulmonary TB patients in southern Ethiopia was 6.8% with 95% confidence interval of 3.3 to 10.3%. Drinking alcohol was significantly associated with increased risk of HIV infection among smear positive pulmonary TB patients in univariable logistic regression but that association was not maintained after controlling for potential confounding variables. Other factors significantly associated with HIV infection among the study population were previous anti-TB treatment, being resident in urban area and participants who had monthly income of less than or equal to 1000 Ethiopian birr as compared to those who had no regular monthly income. The rate of TB-HIV infection among smear positive pulmonary TB patients in Southern Ethiopia was low. However, the government or other partner organizations should work on decreasing the burden of co-infection through designing strategy on preventing HIV transmission in the urban area; increase the monthly income of citizens while enhancing TB-HIV collaborative activity to prevent reactivation of TB.Keywords: TB-HIV co-infection Smear-positive pulmonary TB Risk factors South Ethiopia

Evaluation of genetic mutations associated with mycobacterium tuberculosis resistance to isoniazid, rifampicin (MTBDR plus), fluoroquinolone and injectable second-line drugs (MTBDRsl)

Aims and objectivesTuberculosis (TB) is one of the major public health problems in Armenia. In 2009, TB incidence in Armenia was reported to be as high as 45.5 per 100,000 population, and TB mortality was 3.9 per 100,000 population. Only 35% of estimated new sputum smear-positive pulmonary TB patients are notified annually. From 1729 TB cases notified in 2010, only 329 patients were sputum smear-positive. The treatment success rate of new sputum smear-positive pulmonary TB patients was 76%, which is below the WHO target of 85%. Poor treatment outcome is partially explained by the high prevalence of drug resistant forms of TB. According to the 2007 drug resistance survey, MDR-TB among never-treated patients was 9.4% and 43.2% among previously treated cases with 4% of XDR cases. This represents an enormous public health challenge for Armenia; early identification and effective treatment of patients with MDR-TB is crucial to prevent further spread of the disease. MethodsA total of 583 specimens are sent to the NRL Armenia being either acid-fast bacterium positive or negative, but culture positive. Rifampin and isoniazid resistance was performed on 77 out of the 583 specimens of DR TB clinical isolates to analyze resistance for FQL, AM/CP and EMB.The DNA preparation method used was as described and recommended by the manufacturer (MTBDR plus version 1.0 and MTBDR sl version 2.0 Hain Lifescience, Nehren).For 99 (88.4%) and 160 (76.2%) strains, the mutations causing rifampicin and isoniazid resistance were located in the codon of rpoB S531L and katG S315T 1, respectively. Regarding isoniazid, 14 (6.6%) strains have a mutation in the inhA regulatory region (C15T) and 31 (14.7%) in both katG and InhA.Mutations detected in the FQ, EMB and rrs-resistant respectively are: 13 (16.9%) strains with the majority of mutations (10 [13%]) in the codon of 94 of the gyrA gen; 20 (26%) strains, with the majority of mutations (7 [9.1%]) in the codon of 306 of the EMB gen; and 13 (16.8%) strains with the majority of mutations (9 [11.6%]) in the codon of 1401 of the rrs gen.Comparing with phenotypically DST sensitivity and specificity for RMP was 97.6% (69 strains) and 100%, respectively. False resistance was detected for 2 strains containing missed bands of rpoB (W6, 7, 8) and 1 strain W7. Sensitivity and specificity for INH was 98.33%, 87.5% (69 strains). From 2 strains, 1 was false resistant (missing of WT 1, 2 bands) and 1 false sensitive results for INH. The sensitivity and specificity for AM/CM was 80%, 100%, and for the FQL 85.7%, 96.72%, respectively (69 strains). ConclusionRapid and accurate detection of resistance to first- and second-line anti-TB drugs is the key to successful therapy and interruption of the transmission chain of MDRTB strains. In summary, this data represent an important addition to the rare epidemiological data concerning resistance patterns of MTB in Armenia and showed that the application of the GenoType MTBDRplus and GenoType MTBDRsl assays might be useful additional tools to allow for a rapid and safe diagnosis of MDR and XDR TB. In mutations associated with katG, high dosages of isoniazid in future will be considered for treatment.

Increase in anti-tuberculosis drug resistance in Botswana: results from the fourth National Drug Resistance Survey

Although approximately 0.5 million cases of multidrug-resistant tuberculosis (MDR-TB) occur globally each year, surveillance data are limited. Botswana is one of the few high TB burden countries to have carried out multiple anti-tuberculosis drug resistance surveys (in 1995-1996, 1999 and 2002). In 2007-2008, we conducted the fourth national survey of anti-tuberculosis drug resistance in Botswana to assess anti-tuberculosis drug resistance, including trends over time. In the previous survey, 0.8% (95%CI 0.4-1.5) of new patients and 10.4% (95%CI 5.6-17.3) of previously treated patients had MDR-TB. During the survey period, eligible specimens from all new sputum-smear positive TB patients and from all TB patients with history of previous anti-tuberculosis treatment underwent mycobacterial culture and anti-tuberculosis drug susceptibility testing (DST). Of 924 new TB patients and 137 with previous anti-tuberculosis treatment with DST results, respectively 23 (2.5%, 95%CI 1.6-3.7) and 9 (6.6%, 95%CI 3.3-11.7) had MDR-TB. The proportion of new TB patients with MDR-TB has tripled in Botswana since the previous survey. Combatting drug-resistant TB will require the scale-up of MDR-TB diagnosis and treatment to prevent the transmission of MDR-TB and strengthening of general TB control to prevent the emergence of resistance.

Relationship between host Mycobacterium tuberculosis-specific CD4 T cell responses and sputum bacillary clearance during early anti-tuberculosis treatment

Event Abstract Back to Event Relationship between host Mycobacterium tuberculosis-specific CD4 T cell responses and sputum bacillary clearance during early anti-tuberculosis treatment David T. Mzinza1*, Derek Sloan1, 2, Katalin Wilkinson3, Robert Wilkinson3, Gerry Davies1, 2, Robert Heyderman1 and Henry Mwandumba1, 2 1 Malawi Liverpool Wellcome Trust Clinical Research Programme, Malawi 2 University of Liverpool, United Kingdom 3 University of Cape Town, South Africa Tuberculosis treatment is associated with changes in host Mycobacterium tuberculosis (Mtb) antigen-specific T cell responses. It is unclear how these changes relate to treatment outcomes. We investigated the relationship between Mtb-specific immune response, quantitative bacteriology and clinical outcomes of treatment in sputum smear-positive adult TB patients receiving anti-TB treatment at Queen Elizabeth Central Hospital, Malawi. Peripheral blood and sputum samples for PBMC isolation and serial mycobacterial culture respectively were collected from 45 patients irrespective of their HIV status before and after 56 days of treatment. Mtb-specific immune responses were assessed by quantification of IFN-γ secreting T cells in response to CFP-10 and ESAT-6 using an ELISPOT assay. Mtb clearance from sputum was evaluated by mycobacteria growth indicator tube culture system. Results are given as median and differences were considered statistically significant if P≤0.05. Preliminary results show a difference in the rate of bacillary clearance and host responses with respect to HIV. 71% of HIV-uninfected and 50% of HIV-infected patients were culture negative by 2 months of treatment. Similarly, the number of IFN- secreting T cells reduced during treatment in HIV-uninfected patients (median change -60 SFU/106 PBMC, IQR 4-204), while there was a smaller reduction in HIV-infected patients (median change -14 SFU/106 PBMC, IQR 0-51) (Mann-Whitney U-test p = 0.085). Preliminary findings suggest an association between magnitude of host Mtb-specific T cell responses and mycobacterial load. We plan to analyze the data further by doing regression modeling to investigate the relationship between immunological parameters, HIV status and bacillary clearance. Keywords: Tuberculosis, T cell, IFN- γ, CFP-10, ESAT-6 Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Host-pathogen interactions Citation: Mzinza DT, Sloan D, Wilkinson K, Wilkinson R, Davies G, Heyderman R and Mwandumba H (2013). Relationship between host Mycobacterium tuberculosis-specific CD4 T cell responses and sputum bacillary clearance during early anti-tuberculosis treatment. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.00095 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 09 Mar 2013; Published Online: 22 Aug 2013. * Correspondence: Mr. David T Mzinza, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi, dmzinza@mlw.mw Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers David T Mzinza Derek Sloan Katalin Wilkinson Robert Wilkinson Gerry Davies Robert Heyderman Henry Mwandumba Google David T Mzinza Derek Sloan Katalin Wilkinson Robert Wilkinson Gerry Davies Robert Heyderman Henry Mwandumba Google Scholar David T Mzinza Derek Sloan Katalin Wilkinson Robert Wilkinson Gerry Davies Robert Heyderman Henry Mwandumba PubMed David T Mzinza Derek Sloan Katalin Wilkinson Robert Wilkinson Gerry Davies Robert Heyderman Henry Mwandumba Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

High initial default in patients with smear-positive pulmonary tuberculosis at a regional hospital in Accra, Ghana

Sputum smear-positive TB patients, diagnosed in the laboratory, who never start anti-TB treatment are classified as ‘initial defaulters’. In Ridge Hospital, Accra, Ghana, there were 84 laboratory confirmed TB cases in 2009, of whom 32 (38%) were initial defaulters. Cure and default rates based on this cohort were 54% and 43% respectively, compared with rates of 87% and 8% when using the cohort based on 52 patients registered for treatment. This study highlights the problem of initial defaulters, and shows that programme performance may be poor when patients in laboratory registers are used as the cohort to evaluate treatment outcomes.

NEW COHORT ANALYSIS SYSTEM IN NEW TUBERCULOSIS SURVEILLANCE SYSTEM IN JAPAN

To know factors to influence treatment outcome of new cohort analysis method in revised TB surveillance system and important points for quality improvement of the system using hospital based real data of TB patients. To analyze treatment outcome of new sputum smear positive TB patients hospitalized to Fukujuji Hospital during 2004 year by new cohort analysis method. One hundred and ninety-four TB patients were hospitalized. Out of them, 166 were new cases. Cohort analysis showed 104 treatment success cases (62.7%), 27 died cases (16.3%), 2 failure cases (1.2%), 9 defaulter cases (5.4 %), 15 transfer-out cases (9.0%), 7 cases with treatment longer than 1 year (4.2%), and 2 other cases (1.2%). Among 27 died cases, 18 cases were due to TB death. Out of other 9 cases, 4 were due to malignancy, 3 due to pneumonia, and 2 other causes. Out of 9 defaulter cases, 6 were self-interruption, 2 were due to medical doctor's decision to resolve side effects. Out of 7 cases with treatment longer than 1 year, half were due to drug resistance and another half were due to side effects. Twenty-eight retreatment cases showed 15 treatment success, 4 failure cases, 5 transferred-out, 2 cases with longer treatment than 1 year, and 2 other cases. To evaluate TB treatment outcome, died cases should be categorized into TB death and non-TB death. Defaulter cases and cases with treatment longer than 1 year should be categorized by causes into drug resistant cases and cases with interruption by side effects. At national level, data collection of drug sensitivity test results and development of cohort analysis method for drug resistant cases, especially multi-drug resistant cases, are needed to make new cohort analysis method more relevant to TB treatment outcome.

Adherence to anti-tuberculosis treatment among pulmonary tuberculosis patients: a qualitative and quantitative study

BackgroundTuberculosis (TB) patients have difficulty following a long-term treatment regimen. Efforts to improve treatment outcomes require better understanding of adherence as a complex behavioral issue and of the particular barriers to and facilitators of patient adherence.MethodsThis study was carried out in Jiangsu Province of China with both quantitative and qualitative approaches. For the quantitative study, 780 sputum-smear positive TB patients consecutively registered since 2006 in 13 counties (districts) were queried with a structured questionnaire. Patients who had missed 10% of their total prescribed doses of TB drugs were deemed as non-adherent. Risks for non-adherence were estimated by computing odds ratios (ORs) and their 95% confidence intervals (95% CIs) using a logistic regression model. We also invited 20 TB patients and 10 local health workers for in-depth interviews. We then used content analysis based on this qualitative study to explore factors associated with non-adherence.ResultsThe proportion of non-adherence among 670 patients was 12.2%. Univariate analysis showed that patients, who were illiterate, divorced/widowed, lacked health insurance and were migrants, were more likely to be non-adherent. The crude ORs(95%CIs) were 2.38(1.37-4.13), 2.42(1.30-4.52), 1.89(1.07-3.32) and 1.98(1.03-3.83), respectively. The risk of non-adherence was lower among patients whose treatment was given under direct observation by village doctors or regular home visits by health workers, with ORs (95% CIs) of 0.19(0.10-0.36) and 0.23(0.10-0.51), respectively. In multivariate analysis, factors associated with non-adherence included illiteracy (OR: 2.42; 95% CI: 1.25-4.67) and direct observation by village doctors (OR: 0.23; 95% CI: 0.11-0.45). The in-depth interviews indicated that financial burdens and extra medical expenditures, adverse drug reactions, and social stigma were additional potential factors accounted for non-adherence.ConclusionMore importance should be given to treatment adherence under the current TB control program. Heavy financial burdens, lack of social support, adverse drug reactions and personal factors are associated with non-adherence. Direct observation and regular home visits by health workers appear to reduce the risk of non-adherence. More patient-centered interventions and greater attention to structural barriers are needed to improve treatment adherence.