Tuberculosis Medication Research Articles

Digital Adherence Technologies Linked to Mobile Money Incentives for Medication Adherence Among People Living With Tuberculosis: Mixed Methods Feasibility and Acceptability Study.

Complementing digital adherence technologies (DATs) with mobile money incentives may improve their utility in supporting tuberculosis medication adherence, yet the feasibility and acceptability of this integrated approach remain unclear. This study aims to describe the feasibility and acceptability of a novel DAT intervention called My Mobile Wallet composed of real-time adherence monitoring, SMS text message reminders, and mobile money incentives for tuberculosis medication adherence in a low-income setting. We purposively recruited people living with tuberculosis from the Mbarara Regional Referral Hospital in Mbarara, Uganda, who (1) were starting tuberculosis treatment at enrollment or within the past 4 weeks, (2) owned a mobile phone, (3) were able to use SMS test messaging, (4) were aged ≥18 years, and (5) were living in Mbarara district. At study exit (month 6), we used interviews and questionnaires informed by the unified theory of acceptance and use of technology (UTAUT) to collect feasibility and acceptability data, reflecting patients' experiences of using each component of My Mobile Wallet. Feasibility also included tracking the functionality of the adherence monitor (ie, an electronic pillbox) as well as SMS text message and mobile money delivery. We used a content analytical approach to inductively analyze qualitative data and Stata (version 13; StataCorp LLC) to analyze quantitative data. All 39 participants reported that the intervention was feasible because it was easy for them to use (eg, access and read SMS text messages) and worked as expected. Almost all SMS text messages (6880/7064, 97.4%) were sent as planned. The transmission of adherence data from the monitor worked well, with 98.37% (5682/5776) of the data transmitted as planned. All participants additionally reported that the intervention was acceptable because it helped them take their tuberculosis medication as prescribed; the mobile money incentives relieved them of tuberculosis-related financial burdens; SMS text message reminders and electronic pillbox-based alarms reminded them to take their medication on time; and participants perceived real-time adherence monitoring as "being watched" while taking their medication, which encouraged them to take their medication on time to demonstrate their commitment. The intervention was perceived as a sign of care, which eventually created emotional support and a sense of connectedness to health care. Participants preferred daily SMS text message reminders (32/39, 82%) to reminders linked to missed doses (7/39, 18%), citing the fact that tuberculosis medication is taken daily. The use of real-time adherence monitoring linked to SMS text message reminders and mobile money incentives for tuberculosis medication adherence was feasible and acceptable in a low-resource setting where poverty-based structural barriers heavily constrain tuberculosis treatment and care.

Design of molecular inhibitors against the NuoC protein of Mycobacterium tuberculosis.

Tuberculosis (TB) is one of the main health issues for the international scientific community. The NADH- quinone oxidoreductase subunit C (NuoC) protein belongs to the NADH dehydrogenase family, which plays a critical role in the electron transport chain and ATP synthesis and energy production in Mycobacterium tuberculosis (Mtb). In the present study, Nuoc protein is considered a potential drug target for identifying inhibitors for the protein. The Nuoc protein’s 3D structural features are determined using computational techniques, including active site identification, ADME properties and virtual screening. The NuoC theoretical model was developed using homology modeling techniques and its structure was verified by various validation methods. They provide insight into the conformational changes occurring in the NuoC protein. To identify drug-like compounds virtual screening studies were conducted around the active site using several ligand databases. According to the research residues the amino acid residues ARG98, ARG75 (basic), ASP99, ASP189, ASP98 (acidic), LEU101, LEU194 (nonpolar neutral), THR180 (polar neutral), GLU177(polar neutral), TYR181(polar neutral), PRO102, PRO192 (nonpolar neutral), and HIS191(basic) are important in drug-target interactions. Additionally, docking experiments of TB medications against NuoC were carried out. The study found that the ADME parameters of the selected ligand molecules are more favourable compared to existing TB drugs. This highlights the drug-like activity of the ligand molecules in inhibiting NuoC proteins. The structural data, along with the information about the active site and the selected ligand molecules, can help in identifying new therapeutic scaffolds for the treatment of Tuberculosis.

Facile green synthesis of silver nanoparticles derived from the medicinal plant Clerodendrum serratum and its biological activity against Mycobacterium species

The emergence of multidrug-resistant mycobacterial strains is a significant crisis that has led to higher treatment failure rates and more toxic and expensive medications for tuberculosis (TB). The urgent need to develop novel therapeutics has galvanized research interest towards developing alternative antimicrobials such as silver nanoparticles (AgNPs). The current study focused on the anti-mycobacterial activity of green-synthesized AgNPs and its polyethylene glycol encapsulated derivative (PEG-AgNPs) with improved stability using the leaves extract of Clerodendrum serratum. Different characterization methods were used to analyze them. DLS analysis revealed a lower polydispersity index of PEG-AgNPs, suggesting a more uniform size distribution than that of AgNPs. The HR-TEM results revealed that the AgNPs and PEG-AgNPs have predominantly spherical shapes in the size range of 9–35 nm and 15–60 nm, respectively, while positive values of Zeta potential indicate their stability. FTIR-ATR analysis confirmed the presence of functional groups responsible for reducing and capping the bio-reduced AgNPs, whereas the XRD data established its crystalline nature. Impressively, the PEG-AgNPs exhibited maximum inhibitory activity against different Tubercular and Non-Tuberculous Mycobacterium species i.e., Mycobacterium smegmatis, Mycobacterium fortuitum and Mycobacterium marinum, relative to those of AgNPs and Linezolid. The flow cytometry assay showed that the anti-mycobacterial action was mediated by an increase in cell wall permeability. Notably, the results of AFM confirm their ability to inhibit mycobacterial biofilm significantly. We demonstrated the nontoxic nature of these AgNPs, explicated by the absence of hemolytic activity against human RBCs. Overall, the results suggest that PEG-AgNPs could offer a novel therapeutic approach with potential anti-mycobacterial activity and can overcome the limitations of existing TB therapies.

Exploring opportunities to strengthen rural tuberculosis health service delivery: a qualitative study with health workers in Tibet autonomous region, China

ObjectivesThis qualitative study aimed to explore opportunities to strengthen tuberculosis (TB) health service delivery from the perspectives of health workers providing TB care in Shigatse prefecture of Tibet Autonomous Region,...

Anti-TB treatment non-adherence predictors: A multi-center cross-sectional study in Kandahar, Afghanistan

BackgroundAdherence to anti-TB treatment in low- and middle-income countries (LMICs), including Afghanistan, is critical for global TB control. ObjectivesWe aimed to determine anti-TB treatment non-adherence prevalence and its predictors in Kandahar, Afghanistan. MethodsWe conducted a multi-center cross-sectional study of 579 TB patients in Kandahar, using a systematic random sampling method, and collected their data on sociodemographic attributes, clinical factors, and mental health. The eight-item Tuberculosis Medication Adherence Questionnaire (TBMAQ) was used for labeling TB patients as adherent or non-adherent. We assigned a score of ≤4 (the cut-off) as non-adherence. We performed the multivariable logistic regression to probe significant predictors of non-adherence. ResultsThe non-adherence rate in this study was 66.8% (95% CI: 62.9–70.5). Being uneducated (AOR = 1.66, 95 % CI: 1.09–2.53), having a comorbid medical condition (AOR = 2.57, 95 % CI: 1.39–4.74), feeling stigmatized for having TB (AOR = 9.25, 95 % CI: 4.72–18.1), and having a comorbid depression (AOR = 1.77, 95 % CI: 1.16–2.71) were associated with non-adherence. ConclusionAnti-TB treatment adherence needs to be prioritized among TB patients overall, particularly in those with a low level of education, comorbidity, perceived TB-related stigma, and comorbid depression with consistent evidence of increased non-adherence.

Management of Isoniazid Monoresistant Tuberculosis

lsoniazid (INH) is one of the main first-line drugs used for the treatment of active tuberculosis (TB) and latent TB infection because it has bactericidal capabilities and a good level of safety. The presence of TB germs that are resistant to INH will reduce the effectiveness of TB treatment. The treatment mix for INH monoresistant TB patients is a combination of rifampicin (R), isoniazid (H), pyrazinamide (Z), ethambutol (E), and levofloxacin (Lfx) or R-H-Z-E-Lfx given for 6 months. If a health facility provides loose TB medication, the patient can be given a combination of treatment without INH (R-Z-E-Lfx). In conditions where the Lfx drug cannot be used because there is severe intolerance (serious adverse events) or there are contra indications, the treatment given is the R-H-Z-E combination for 6 months. Clinical monitoring for patients with INH monoresistant TB follows the same principles as treatment of drug-sensitive TB. In conclusion, the treatment guide for INH monoresistant TB patients is a combination of rifampicin (R), isoniazid (H), pyrazinamide (Z), ethambutol (E), and levofloxacin (Lfx) or R-H-Z-E-Lfx for 6 months.

Study of Relationship between the Knowledge and Attitude of Tuberculosis (TB) Patients about Drug Compliance at the Health Centre

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis, which most often attacks various organs, especially the lungs. This study aimed to determine the relationship between knowledge and TB patients' attitudes toward compliance with tuberculosis drugs at the Helvetia Medan Health Center. This type of research used an analytical observational method with the cross-sectional approach. The sampling technique used was quota sampling, with 75 respondents. Data collection in this study used to form sheets in questionnaires given to respondents directly and data analysis using the chi-square test. The results showed that respondents with good knowledge were 29 respondents (38.7%), good enough 33 respondents (44%), not good enough 12 respondents (16%), and not good one respondent (1.3%). A good attitude was 23 respondents (30.7%), good enough 37 respondents (49.3%), not good enough 14 respondents (18.7%), and not good one respondent (1.3%). Obedient compliance to TB medication was 25 respondents (33.3%), quite obedient 33 respondents (44%), and less obedient 17 respondents (22.7%). This study concluded that knowledge and attitude had a significant relationship with adherence to tuberculosis medication, with a knowledge p-value of 0.003 <0.05 and an attitude p-value of 0.037 <0.05. Healthcare professionals must employ innovative strategies to enhance knowledge and attitudes, raise public awareness, and ensure full compliance with the TB treatment program. It is crucial to implement this measure to mitigate the future prevalence of antibiotic resistance in treating tuberculosis.

Successful Treatment of Cerebral Tuberculoma in Acquired Immune Deficiency Syndrome Patient a Case Report

Introduction: Tuberculosis (TB) remains a leading problem in developing and endemic countries. Cerebral tuberculosis is a rare but dangerous complication of tuberculosis infection in the central nervous system. The immunosuppressive condition in human immunodeficiency virus infection is a risk factor for severe tuberculosis. Case Report: An Indonesian man, 32 years old, married, came with complaints of headaches, dizziness, delirium, nausea and vomiting since 1 month before the examination. He had a history of TB treatment 1 year before the examination. The results of the neurological examination were within normal limits, the HIV test was reactive and there was a decrease in CD4. Head MRI examination with contrast showed multiple solid nodules in the thalamus with the largest size 2.3×2.7 cm, indicating cerebral tuberculoma. Chest x-ray was normal, GeneXpert MTB sputum was not detected. Next, primary treatment is given with anti-tuberculosis drugs, Highly Active Antiretroviral Therapy (HAART), co-trimoxazole, and dexamethasone. There was clinical, laboratory and radiological improvement after 12 months of treatment. Viral load is undetectable, CD4 is elevated. A head CT scan did not show tuberculoma. He became healthy and was able to return to work Discussion: Cerebral tuberculoma is a condition characterized by the presence of intracranial tuberculoma. The clinical manifestations are non-specific, such as headaches or seizures. This is caused by space occupying lesions and increase intracranial pressure. In this case, the diagnosis of cerebral tuberculoma was made through head MRI with contrast. TB therapy and co-trimoxazole are given as soon as the diagnosis is made, while antiretrovirals are given 2 weeks after he has tolerated the TB medication. The minimum duration of therapy for cerebral tuberculosis is 12 months. He require lifelong antiretroviral medication. Conclusion: Tuberculoma should be considered as differential diagnosis of space-occupying lesions in patients HIV/AIDS. Early diagnosis, adequate therapy, patient adherence and family support can cure severe tuberculosis.

Tuberculosis Co-infection among HIV/AIDS Cases Attending an Anti-retroviral Therapy Center: A Retrospective Cohort Study from Pakistan

Objective: The co-occurrence of tuberculosis (TB) and human immunodeficiency virus (HIV) results in heightened morbidity and mortality, placing an increased burden on healthcare systems. This study aims to assess the incidence and identify associated risk factors for TB/HIV co-infection, with the objective of enhancing the survival rates of co-infected patients in Pakistan. Methods: This retrospective cohort investigation took place at the Anti-Retroviral Treatment Center in Islamabad, Pakistan. Data spanning a decade (January 2006 to December 2016) were extracted from 2,542 people living with HIV using a pre-tested data extraction tool. Results: Following the exclusion of 156 ineligible participants, records of 2,386 individuals were analyzed over 4,433 person-years. The cumulative incidence and incidence rate of TB among HIV/AIDS patients were 446 (18.7%) and 0.001 cases/10,000 person-years, respectively. The majority (81%) of incident TB cases occurred within one year, predominantly manifesting as pulmonary TB. Of the TB-infected individuals, 98.6% received TB medication, with 0.7% prescribed Isoniazid prophylaxis. Significant associations with TB were identified in relation to work abroad history, patient age, and current HIV stage (P<0.05). Binary logistic regression indicated a 3.1 times higher likelihood of TB infection in the anemic group compared to the non-anemic group. HIV/AIDS infection emerged as a consistent TB risk factor irrespective of CD4 count and WHO HIV staging. Conclusion: This study highlights a substantial incidence of TB co-infection among HIV patients in Pakistan, emphasizing the need for comprehensive efforts by the National AIDS Control and National TB Control Programs to effectively manage co-infection.

Adjunctive administration of parabiotic Lactobacillus sakei CVL-001 ameliorates drug-induced toxicity and pulmonary inflammation during antibiotic treatment for tuberculosis

Tuberculosis (TB) treatment requires a long therapeutic duration and induces adverse effects such as hepatotoxicity, causing discontinuation of treatment. Reduced adherence to TB medications elevates the risk of recurrence and the development of drug resistance. Additionally, severe cavitary TB with a high burden of Mycobacterium tuberculosis (Mtb) and inflammation-mediated tissue damage may need an extended treatment duration, resulting in a higher tendency of drug-induced toxicity. We previously reported that the administration of Lactobacillus sakei CVL-001 (L. sakei CVL-001) regulates inflammation and improves mucosal barrier function in a murine colitis model. Since accumulating evidence has reported the functional roles of probiotics in drug-induced liver injury and pulmonary inflammation, we employed a parabiotic form of the L. sakei CVL-001 to investigate whether this supplement may provide beneficial effects on the reduction in drug-induced liver damage and pulmonary inflammation during chemotherapy. Intriguingly, L. sakei CVL-001 administration slightly reduced Mtb burden without affecting lung inflammation and weight loss in both Mtb-resistant and -susceptible mice. Moreover, L. sakei CVL-001 decreased T cell-mediated inflammatory responses and increased regulatory T cells along with an elevated antigen-specific IL-10 production, suggesting that this parabiotic may restrain excessive inflammation during antibiotic treatment. Furthermore, the parabiotic intervention significantly reduced levels of alanine aminotransferase, an indicator of hepatotoxicity, and cell death in liver tissues. Collectively, our data suggest that L. sakei CVL-001 administration has the potential to be an adjunctive therapy by reducing pulmonary inflammation and liver damage during anti-TB drug treatment and may benefit adherence to TB medication in lengthy treatment.

A systematic review of the prevalence of psychosis in people with tuberculosis

IntroductionTuberculosis is a bacterial infectious disease caused by Mycobacterium tuberculosis. This disease predominately affects the lungs but also affects other parts of the body, including the central nervous system. According to the the World Health Organization (2023), tuberculosis has an incidence of 6.4 million people in 2022, with 1.5 million deaths attributed to this disease. Psychosis describes a group of disorders that affects a person’s thought process and perception. It is a serious disorder that can have a profound impact on a person’s mental and physical health. As a result, psychosis symptoms and its treatment can complicate the management of tuberculosis.Objectives The aim of this systematic review is to explore the association between tuberculosis and psychosis. It has been shown that up to 70% of patients with tuberculosis also have comorbid mental illness, this is likely to include psychosis. There are also shared risk factors between tuberculosis and psychosis, including poverty and homelessness, substance abuse, HIV positive serology and isolation. Tuberculosis medication, including isoniazid and rifampicin have been shown to have adverse psychiatric effects and we will examine if this includes psychosis.MethodsA systematic review was pre-registered with PROSPRO and performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, OVID and PsychINFO databases were searched from beginning of records to September 2023. This included hand-search of relevant reference lists. Observational and epidemiological studies were included along with population based registries.ResultsOver one thousand (1,154) articles were identified and screened. There was significant heterogenity in results and over half of studies were from Asia and Africa. Many studies reported cases of drug-induced psychosis from anti-tubercular agents. Studies also discussed the increased risk of TB incidence among patients with psychosis and other psychiatric disorders.ConclusionsThis study identifies the importance of training healthcare workers in rapid detection of co-morbid psychosis in patients with tuberculosis, along with neuropsychiatric side effects of antitubercular agents. Integration of psychiatric and medical care of these patients would be of benefit to improve outcomes in this patient population. More research is needed on co-morbidity of tuberculosis and psychosis.Disclosure of InterestNone Declared

Giant Intrapulmonary Mature Teratoma with Thoracostomy Intervention: A Rare Case Report

Background: Teratoma usually found in mediastinum and rarely found in the lung. Mature teratomas are the most common histological type of germ cell tumours, followed by seminoma. First case reported by Mohr in 1839 and until now only few cases of intrapulmonary teratomas have been reported.
 Case: A man, 64-years old man, nonsmoker complains of shortness of breath since 6 months and worsened in a week. Patient had history medication for tuberculosis in 2019. Chest Contrast CT-Scan showed hypodense mass and suggestive for benign left lung tumor. TTNA were performed and suggestive for teratoma. Joint conference with several department agree to proceed with thoracostomy. Thoracostomy with wide excision been done to remove the mass and examined for anatomic pathology then confirmed for mature teratoma. During thoracostomy, we cannot removed 100% of the tumor because it adhesive with aorta and parietal pleura. Patient treated in ICU and worsens. Unfortunately, patient passed away four days later.
 Conclusion: Teratoma is rarely found inside of the lung. Early diagnosis and resection of intrapulmonary teratoma is critical to prevent complications and provide definitive treatment.

Acceptability of smart locker technology for dispensing chronic disease medication among patients and healthcare providers in Nigeria.

Smart lockers are automated delivery machines. They have been used in dispensing ARVs and Tuberculosis medication to chronically ill patients in South Africa, Kenya, and Eswatini. However, there is no evidence of smart lockers in dispensing chronic disease medication in Nigeria. This study aimed to assess the acceptability of smart lockers in dispensing chronic disease medication and to describe the barriers to accessing care among patients with chronic diseases medication in 5 states in Nigeria. We conducted a cross-sectional study among healthcare workers and patients living with chronic diseases in five Nigerian states of Adamawa, Akwa Ibom, Cross River, Benue, and Niger between November and December 2021. A total of 1,133 participants were recruited (728 patients and 405 healthcare workers). The results revealed that most patients and healthcare workers agreed that using smart lockers for drug dispensing will lead to reduced transportation costs, hospital waiting times, the workload of healthcare workers, and decongestion of health facilities. The majority of the patients living with chronic diseases (43%) and healthcare workers (51%) showed high acceptability for the use of smart lockers. The use of smart lockers in dispensing chronic disease medication in Nigeria is feasible, and patients and healthcare workers are willing to accept the smart lockers, provided that a patient-centred implementation strategy is developed.

Prevalence of alcohol and drug use and their impact on adherence among hospitalised TB patients in South Africa.

This cross-sectional study aimed to explore the use of alcohol and drugs and the potential impact on adherence to medication for tuberculosis. Adult patients admitted to specialised tuberculosis hospitals in South Africa were assessed for drug use, alcohol use and adherence to tuberculosis medication. A total of 175 patients participated in the study; 32% reported harmful alcohol use, and 44% reported problematic use of drugs. Participants who used drugs were four times as likely (OR = 4.11, 95% CI (1.89, 8.91)) and those using alcohol were twice as likely (OR = 2.06, 95% CI (1.02, 5.08)) to be nonadherent to medication for tuberculosis. Prevalence of harmful/hazardous use of alcohol and other drugs was high and significantly correlated with poorer medication adherence. Routine screening for and treatment of substance use in patients on treatment for tuberculosis and ongoing monitoring of adherence to medication is recommended.

Telenursing Intervention for Pulmonary Tuberculosis Patients - A Scoping Review.

Management of care for people with Pulmonary TB at home using Information and Communication Technology (ICT) tools and innovative approaches, such as tools for telecommunications online education. In the nursing sector, the use of telecommunications is called telenursing. The purpose of this study is to determine the types of telecommunications-based interventions, especially telenursing, in monitoring the level of treatment adherence in patients with pulmonary TB. This study used a scoping review method approach to determine the type of telecommunications-based interventions, especially telenursing, in monitoring the level of treatment adherence in patients with pulmonary TB. Literature distribution using several sources, namely EBSCOhost, Scopus (Elsevier), and PubMed. To facilitate obtaining appropriate literature, PICO techniques are used in conducting literature searches, P (population/problem/patient), I (intervention, prognostic factor, exposure), C (comparison, control), and O (outcome). Keywords used in English "Tuberculosis OR Pulmonary Tuberculosis AND Telehealth OR Telehealth Nursing AND Medication Adherence OR Medication Compliance OR Behavior". In total from the 13 articles obtained, the articles used several telehealth to pulmonary TB patients with various implementations, such as the Directly Observed Therapy, Short Course (DOTS) (n = 7). These four implementations have the same goal and support adherence to taking medication and daily recovery in pulmonary TB patients. Overall characteristics of pulmonary TB patients in the reviewed articles are pediatric TB patients (0-14 years), adult TB (18-30 years). A total of 9 studies used a sample population of adult TB patients (18-30 years), TB undergoing Directly Observed Treatment Short-course (DOTS), TB receiving medical care and TB patients actively receiving treatment. The most influential effectiveness of telehealth in helping the treatment process of Pulmonary TB patients is Directly Observed Treatment Short-course (DOTS) because the main focus of the DOTS strategy is patient discovery and cure, priority is given to infectious TB patients without ruling out other types of TB.

Tuberculosis in the elderly population

ABSTRACT Tuberculosis (TB) is a significant public health challenge, with the elderly population being particularly affected in certain regions. Around 17.5% of TB cases in France, in 2019, occurred in individuals over 65 years old. Aging leads to decreased lung function and structural changes that predispose the elderly to TB infection. Immunosenescence, comorbidities, malnutrition, and communal living situations increase TB risk in the elderly. TB symptoms in the elderly are often nonspecific and overlap with other conditions, complicating diagnosis. Radiological presentations may differ from younger patients, and the elderly may struggle to produce sputum for testing. Elderly patients may experience varying tolerances to TB medications, and age-related physiological changes and comorbidities influence treatment tolerance and outcomes. Careful management of drug interactions is crucial. Elderly TB patients, especially those who are frail or dependent, are at higher risk for infection and complications. Adherence to treatment is critical, often necessitating directly observed therapy and nutritional support.

Pharmaceutical cost dynamics for the treatment of rifampicin-resistant tuberculosis in children and adolescents in South Africa, India, and the Philippines.

Rifampicin-resistant (RR) tuberculosis (TB) in children is a major global health concern but is often neglected in economics research. Accurate cost estimations across the spectrum of paediatric RR-TB treatment regimens are critical inputs for prioritisation and budgeting decisions, and an existing knowledge gap at local and international levels. This normative cost analysis was nested in a Phase I/II pharmacokinetics, safety, tolerability, and acceptability trial of TB medications in children in South Africa, the Philippines and India. It assessed the pharmaceutical costs of 36 childhood RR-TB regimens using combinations from 16 different medicines in 34 oral formulations (adult and child-friendly) in 11 weight bands in children <15 years of age. The analysis used local and Global Drug Facility pricing, and local and international guideline recommendations, including adaptions of BPaL and BPaLM regimens in adults. Costs varied significantly between regimen length, age/weight banding, severity of disease, presence of fluroquinolone resistance, and different country guideline recommendations. WHO recommended regimen costs ranged 12-fold: from US$232 per course (short regimen in non-severe disease) to US$2,761 (long regimen in severe, fluroquinolone-resistant disease). Regimen treating fluoroquinolone-resistant infection cost US$1,090 more than comparable WHO-recommended regimen. Providing child-friendly medicine formulations in <5-year-olds across all WHO-recommended regimens is expected to cost an additional $380 (range $212-$563) per child but is expected to have wider benefits including palatability, acceptability, adherence, tolerability, and dose accuracy. There were substantial differences in regimen affordability between countries when adjusted for purchasing power and domestic spending on health. Appropriate, effective, and affordable treatment options are an important component of the fight against childhood RR-TB. A comprehensive understanding of the cost and affordability dynamics of treatment options will enable national TB programs and global collaborations to make the best use of limited healthcare resources for the care of children with RR-TB.

Use of Smartphone-Based Video Directly Observed Therapy to Increase Tuberculosis Medication Adherence: An Interventional Study.

Tuberculosis (TB) treatment through Directly Observed Therapy (DOT) has an alternative form of video surveillance therapy (VOT) that utilizes the technological capabilities of smartphones to provide patients with low-cost access to doctors without impacting their work and personal life. We aimed to assess TB patients' drug compliance, perceptions, and feasibility towards smartphone-based video direct observed therapy (VDOT) in Jeddah, KSA. We conducted a prospective non-randomized interventional study. We delivered smartphone-based VDOT among previously unstudied patients to monitor adherence to the treatment regimen. The expected total number of VDOT sessions was1200. We conducted post-intervention interviews to assess acceptability and satisfaction. In this study, we included 20 participants, 16 of whom were males, with a mean age of 34.3 (±12.5) years. No side effects to the treatments were identified in all participants. The adherence rate for the total period was 93% and 99.5%, measured by the first and second methods, respectively. Most participants were satisfied with the VDOT experience, the time spent on sessions, and the approach's privacy. This study provides promising results for the feasibility and effectiveness of smartphone-based VDOT for TB treatment to increase adherence which was indicated by a high compliance rate, acceptability, and high satisfaction level.

Adverse event reporting practices in drug-resistant tuberculosis facilities across South Africa.

The reporting of adverse drug reactions associated with drug-resistant tuberculosis (DR-TB) medication is important for pharmacovigilance, especially in high-burden countries such as South Africa. With DR-TB treatment being so dynamic, it is important to understand adverse event reporting practices at specialised facilities. The study aimed to understand the adverse drug reaction (ADR) reporting practices at DR-TB treatment facilities in South Africa. Interviews were conducted with healthcare workers at specialised DR-TB facilities. This was to collect data on demographics, pharmacovigilance training, and determine attitudes and practices towards reporting adverse events. A checklist was developed to review the most recent adverse event forms captured at the facility. Most participants did not have adverse event reporting training since their initial training but were confident that they could complete a form themselves. Most participants could correctly identify the major adverse events associated with DR-TB medication, but some deemed non-adverse events as plausible. Adverse event report forms were not standardised with most participants deeming further training and regular feedback as reasons to report ADRs. Standardisation of adverse event report forms used and the establishment of regular reporting will increase adverse event reporting at DR-TB facilities. Continuous training, empowerment and expansion of staff categories eligible to report adverse events will enhance and sustain such practice. The study highlights challenges faced by healthcare professionals in reporting adverse events.

Pengaruh homecare Terhadap Pengetahuan dan Kepatuhan Pasien Tuberkulosis di Puskesmas Kota Barat Gorontalo

Patients knowledge and adherence in attending medication is one of the most important factors in determining the succes of therapy, including tuberculosis medication. One of the effort to improve knoeledge and adherence is by providing information about the disease and current medication. This research aimed to determine the effect of homecare on the level of knowledge and aherence of tuberculosis patients in the working area of Puskesmas (Public Health Center) Kota Barat. The method used was quasi-experimental with the form of one group pretest-posttest. This research was conducted for one month with a total sample of 24 respondents. The research data were analyzed using the Paired Sample T-Test. The research findings indicated that the knowledge of patients before and after being provided homecare was at a good level, patient adherence before and after being provided homecare was categorized as obedient. Additionally, there was a significant effect of providing information through homecare media on the level of knowledge with a sig. value= 0.000 (0.01). However, there was no significant effect on therapy adherence with a sig. value= 0.010 (0.01) in tuberculosis patients in the working area of Puskesmas Kota Barat, Gorontalo