Tuberculosis Medication Research Articles

Assessing the key factors contributing to non-adherence to pulmonary tuberculosis treatment: a descriptive study.

Tuberculosis (TB) remains a significant public health challenge, particularly in developing nations like India, where it imposes a considerable burden. This descriptive cross-sectional study aimed to assess the factors affecting noncompliance with TB medications among pulmonary TB patients in an Indian community. A total of 215 participants were selected through non-probability purposive sampling. Data on factors contributing to non-adherence were collected using a structured self-administered questionnaire. Demographic characteristics, including age, gender, education, marital status, occupation, habitat, income, diagnosis, and duration since diagnosis, were recorded and analyzed. Key factors contributing to non-adherence were categorized into personal, economic, social, psychological, health facility, and technological factors. The results demonstrated that the non-adherence rate was 48.3%, while 51.7% of participants exhibited adherence to TB treatment. Discontinuing medication to feel better significantly increased noncompliance risk, especially for those who stopped "most of the time" vs. those who never stopped (odds ratio = 8.693, 95% confidence interval: 3.179-23.77). This study reveals that non-adherence to pulmonary TB treatment is influenced by a range of factors, including personal, economic, social, psychological, health facility, and technological factors, highlighting the need for multifaceted interventions to improve adherence.

Effects of positive deviance nutrition intervention on sputum smear conversion among patients on tuberculosis medication in Kericho County, Kenya

Effects of positive deviance nutrition intervention on sputum smear conversion among patients on tuberculosis medication in Kericho County, Kenya

P-448. Contextual assessment and potential barriers and facilitators of a mobile health program to support treatment of tuberculosis and HIV in Kilimanjaro, Tanzania: opportunities for care integration

Abstract Background Despite increasing smartphone penetration globally, personalized mobile health (mHealth) care interventions remain largely untapped for people with tuberculosis (TB) in many settings. A smartphone platform adopted to support treatment of human immunodeficiency virus (HIV) in the US was adapted and piloted for HIV/TB care in a distinct urban population, with high usage and improved clinical outcomes. Systematic evaluation of potential contextual influences on mHealth implementation is needed to ensure appropriateness, feasibility, and acceptability of the intervention for HIV/TB care within Kilimanjaro.Table 1:Perspectives on existing HIV and TB care delivery experiences and integration of services Methods We conducted semi-structured in-depth interviews at Kilimanjaro Christian Medical Centre and Kibong’oto Hospital with patients (18 y/o+ with drug-susceptible/drug-resistant-TB, with/without HIV, > 1 month on treatment) and providers (e.g. physicians, nurses). Guides were designed using Bury’s Framework for Chronic Illness and the Consolidated Framework for Implementation Research (CFIR). Analysis was performed using a priori open coding/constant comparisons methodology. A preliminary codebook built deductively from frameworks was iterated with inductive codes based on emergent themes. Results To date, 12 patient and 12 provider interviews have been conducted; analysis is underway. Specific perspectives demonstrated opportunities for enhancement of HIV/TB care integration (Table 1). Preliminary analysis suggests feature phone access is more common among patients. Additional themes relate to perceptions of an external intervention source (CFIR domain: Intervention Characteristics), compatibility with current provider smartphone access/workload, existing directive nature of patient-provider relationships, and current level of system digitization at sites (workplace internet stability/data access) (Inner Setting). Conclusion Analysis to date reveals several prominent themes to consider for adaptation of the intervention: 1) daily life/experiences with TB/HIV 2) determinants of and 3) experiences with TB/HIV care 4) mobile phone ownership, usage 5) perceptions of the intervention within the context and to support 6) home urine testing for personalized dosing of TB medications. Disclosures Jacqueline Hodges, MD MPH, Gilead Sciences: Grant/Research Support

Enhancing tuberculosis case notifications through mapping sales of medicine in the private sector: a quasi-experimental study in Punjab province, Pakistan

IntroductionIn Pakistan, almost one-third of people who develop tuberculosis (TB) are missed by the National TB Program (NTP). A considerable number of people with TB receive treatment in the private sector but remain unnotified. This study documents the outcomes of an intervention to identify people with TB through private pharmacy engagement, building on mapping TB medicine sales in Punjab Province.MethodsA comprehensive intervention was carried out in four districts of Punjab with high anti-TB drug sales, comprising a policy change requiring mandatory notification of TB medication sales, mapping and engaging pharmacies selling anti-TB drugs, reporting through a novel ‘eTB’ mobile application and providing support via a call center. We collected both historical and prospective TB notification data from the intervention and control districts. The primary outcome was the change in TB notifications during the intervention period compared with historical and control notifications.ResultsOver the 12-month intervention period, 15,669 people with TB were reported from 2,943 pharmacies in four districts. Among the people identified, 88% were male (n = 13,673), 95% had pulmonary disease (n = 14,969), and 4,256 (27%) were bacteriologically confirmed. Chain pharmacies (n = 14) contributed to 39% of the yield. TB notifications increased by 17,462 (+ 34%) over the baseline period compared with an 8% increase in the control districts. The number of bacteriologically confirmed notifications increased by 32% compared with 16% in the control districts. The proportion of bacteriological confirmation was similar before and during the intervention.ConclusionThe results of the largest TB intervention with pharmacies globally showed incredible potential to link people with TB who are receiving care in the private sector. Mapping TB medicine sales in the private sector with tailored interventions can contribute to closing the gap in notifications where anti-TB drug sales in the private sector are prevalent.

Patients perception related to pulmonary tuberculosis and adherence medication

Patients perception related to pulmonary tuberculosis and adherence medication

Adherence to Pulmonary Tuberculosis Medication and Associated Factors Among Adults: A Cross-Sectional Study in the Metinaro and Becora Sub-Districts, Dili, Timor-Leste.

Timor Leste is one of the top countries in Asia with a high incidence rate of pulmonary tuberculosis (TB). The success of TB treatment necessitated a more profound comprehension of adherence as a multifaceted behavioral issue, along with identifying the barriers that hinder and the factors that promote patient adherence. This study aimed to assess the rate of pulmonary TB medication adherence and identify its predictors among adults in Metinaro and Becora, Dili, Timor-Leste. A descriptive analytical cross-sectional study was conducted, and new patients with pulmonary TB aged 18 years and above were selected using a proportional sampling method. Quantitative data were collected from 398 patients with pulmonary tuberculosis. The medication adherence results were as follows: 73.6% low adherence, 18.3% moderate adherence, and only 8.1% high adherence. The study identified significant predictors of medication adherence, such as health service factors (OR = 14.024, 95% CI: 5.42-35.54, p = 0.001). Patients who perceived a high quality in the health service were 14 times more likely to exhibit higher medication adherence. Regarding individual behaviors, patients who consumed alcohol or occasionally engaged in physical exercise were significantly less likely to exhibit higher medication adherence (OR = 0.17, 95% CI: 0.091-0.312, p = 0.001). Similarly, patients experiencing high levels of stigma were less likely to achieve strong adherence (OR = 0.146, 95% CI: 0.058-0.326, p = 0.001).Both health service quality and individual factors, such as lifestyle behaviors and social stigma, were statistically significant predictors ofTB medication adherence. Enhancing the healthcare infrastructure, implementing multisectoral strategies for behavior change, and reducing stigma are crucial. Additionally, mobile health technologies, like SMS reminders and telehealth, might support real-time adherence improvements.

Diagnostic and Treatment Challenges of Recurrent Tuberculosis in Patient with Drug-Induced Hepatotoxicity: A Case Report

Introduction: Pulmonary tuberculosis (TB) remains one of the most significant global health challenges, especially complicated by cases with incomplete treatment histories. The recurrence of TB poses diagnostic and therapeutic dilemmas that significantly impact patient outcomes. Case Presentation: We report a case of a 57-year-old female patient presenting with recurrent pulmonary TB after an incomplete treatment course. The patient's history revealed gaps in adherence to the prescribed TB regimen, leading to multiple relapses. In this study, we found that patients undergoing TB treatment may experience liver damage as a result of the TB medication, also known as DIH. Comprehensive diagnostic procedures, including chest radiography, sputum culture, and molecular testing, confirmed recurrent TB. The patient's clinical manifestations, treatment plan, and response to therapy are detailed. Conclusion: Recurrent TB is common, particularly in older adults, and is influenced more by environmental factors than occupation. Additionally, ATT poses risks of hepatotoxicity, especially in malnourished patients, underscoring the importance of managing side effects and addressing factors like malnutrition to prevent complications and improve outcomes. This case underscores the importance of complete adherence to TB treatment regimens and highlights the challenges in managing recurrent TB. It emphasizes the need for robust follow-up, patient education strategies, early diagnosis, and prompt intervention to prevent recurrence and enhance patient outcomes.

HIV-TB Coinfection: A Systemic Review and Meta-analysis Insights

HIV and Tuberculosis (TB) are the leading global causes of death among patients with infectious diseases. They contribute significantly to morbidity around the world because of their impact on shared immune defense mechanisms. Tuberculosis is an infection that exploits the vulnerability of compromised immune systems. Opportunistic infections are illnesses that are more frequent or severe in individuals with compromised immune systems. HIV weakens the immune system, making people more susceptible to tuberculosis. When someone is infected with both HIV and tuberculosis, this is known as HIV/TB coinfection. HIV and tuberculosis represent the primary infectious disease challenges in countries with limited resources. In affected individuals, the interaction between Mycobacterium tuberculosis and HIV exacerbates the effects of each other, hastening the decline of immune function and leading to premature mortality if left untreated. Individuals with HIV are more likely than those without HIV to develop active tuberculosis as a result of untreated latent tuberculosis. Antiretroviral therapy (ART) is the use of HIV medications to protect the immune system and prevent the progression of HIV to acquired immunodeficiency syndrome (AIDS). In people with HIV and latent tuberculosis, combined treatment with HIV and TB medications reduces the likelihood of latent tuberculosis progressing to active tuberculosis. The purpose of this research is to understand better the pathogenesis and pathways of HIV/TB co-infection, as well as to investigate drug-drug interactions in multi-drug therapies.

Tuberculosis treatment interruption: a qualitative exploration of barriers, challenges, coping strategies and facilitators in Malaysia.

Tuberculosis (TB) treatment interruption undermines the effectiveness of TB medications and jeopardizes treatment outcomes. This study aimed to explore barriers, challenges, coping strategies and facilitators of TB treatment interruption to understand the treatment pathway in achieving successful outcomes. In-depth interviews were conducted at public health clinics in Sarawak, Malaysia, utilizing a phenomenological approach. Thirty patients who experienced TB treatment interruption with eventual successful treatment were purposively selected based on various reasons for treatment interruption to obtain diverse viewpoints. The audio-recorded transcriptions underwent thematic and content analysis. Five major themes emerged under barriers and challenges: socioeconomic, patient, therapy, healthcare and condition-related factors. Notably, financial burdens led individuals to prioritize work over health. Adverse drug reactions resulted in inappropriate self-medication and healthcare dissatisfaction. Medication error with suboptimal dosing was another facet leading to treatment forfeiture. Lack of knowledge about treatment duration and medication adherence, along with negative personal factors such as laziness, dishonesty and forgetfulness were reported. Participants employed coping strategies to confront barriers and challenges, including acceptance and commitment to disease and treatment, self-adaptation in mental, physical and social aspects, and self-management of minor adverse events. Fear of disease worsening, previous experiences, social and financial supports, along with intrinsic motivators, were essential facilitators that prevented interruptions. Interconnectivity across the explored dimensions contextualized the understanding of TB treatment interruption and offered valuable information for designing patient-centered intervention strategies. Improving patient education coupled with tailored interventions addressing psychosocial and economic barriers is crucial for ensuring TB treatment completion.

Perceived Social Support and Medication Dose Interruption Among Pulmonary Tuberculosis Patients in Western India: A Cross-Sectional Study.

Introduction Despite efforts, tuberculosis (TB) remains a major public health problem in developing countries, and India alone accounts for most of the global TB cases. Although the treatment for TB is highly successful, a significant number of TB patients in India do not complete their assigned treatment.Social support has a key influence on medication adherence for chronic illnesses like diabetes, asthma, HIV, hypertension, cardiovascular diseases, and TB. However, limited research in India focuses on patients' perceived social support and its association with medication dose interruption among pulmonary TB patients. Thisstudy aims to fill this gap and examine the association between perceived social support and medication dose interruption among pulmonary TB patients in Western India. Methods A cross-sectional study was conducted at three directly observed treatment, short-course (DOTS) centers in Bhiwandi City, Maharashtra state, in Western India. A total of 477 participants were recruited, and data on participants' medication dose interruptions in the last month, their clinical characteristics, and their perceived social support were collected. Descriptive and inferential statistics were applied. Results Perceived social support presented a significant association with TB medication dose interruption. Participants who reported low social support were significantly 2.6 times more likely to miss their doses in the last month (adjusted odds ratio (aOR) = 2.6 (95% confidence interval (CI): 1.556-4.403), P < 0.001). Participants who reported low family support were significantly 4.1 times more likely to miss their doses when compared with the participants who reported high family support (aOR = 4.1 (95% CI: 2.482-7.070), P < 0.001).Among the participants who missed their doses one to five times in the last month, those who reported low social support were significantly 2.5 times more likely to miss their doses, when compared with the participants who reported high social support (aOR = 2.5 (95% CI: 1.318-4.810), P = 0.005). Likewise, among the group of participants who missed their doses six or more times in the last month, those who reported low social support were significantly 3.1 times more likely to miss their doses, when compared with the participants who reported high social support (aOR = 3.1 (95% CI: 1.452-6.744), P = 0.004). Conclusion The study results underscore the importance of integrating patient-centered strategies into healthcare systems, ensuring that they not only offer social protectionbut also recognize social support as a critical component of TB treatment. This study could potentially inform various healthcare policymakers in formulating such patient-centric and focused intervention strategies by involving social networks and family dynamics.

Identification of Anti-Tuberculosis Drugs Targeting DNA Gyrase A and Serine/Threonine Protein Kinase PknB: A Machine Learning-Assisted Drug-Repurposing Approach.

Tuberculosis (TB) is a global health challenge associated with considerable levels of illness and mortality worldwide. The development of innovative therapeutic strategies is crucial to combat the rise of drug-resistant TB strains. DNA Gyrase A (GyrA) and serine/threonine protein kinase (PknB) are promising targets for new TB medications. This study employed techniques such as similarity searches, molecular docking analyses, machine learning (ML)-driven absolute binding-free energy calculations, and molecular dynamics (MD) simulations to find potential drug candidates. By combining ligand- and structure-based methods with ML principles and MD simulations, a novel strategy was proposed for identifying small molecules. Drugs with structural similarities to existing TB therapies were assessed for their binding affinity to GyrA and PknB through various docking approaches and ML-based predictions. A detailed analysis identified six promising compounds for each target, such as DB00199, DB01220, DB06827, DB11753, DB14631, and DB14703 for GyrA; and DB00547, DB00615, DB06827, DB14644, DB11753, and DB14703 for PknB. Notably, DB11753 and DB14703 show significant potential for both targets. Furthermore, MD simulations' statistical metrics confirm the drug-target complexes' stability, with MM-GBSA analyses underscoring their strong binding affinity, indicating their promise for TB treatment even though they were not initially designed for this disease.

An Evaluation of Medication Adherence in New Tuberculosis Cases in Ankara: A Prospective Cohort Study.

The objective of this study was to investigate the factors influencing adherence with tuberculosis medication therapy. Non-adherence can result in treatment failure, ongoing infectiousness, and the development of drug resistance. Therefore, understanding the reasons behind non-adherence is crucial for achieving the World Health Organization's target of 90% treatment success. Data were collected prospectively from a cohort at three different tuberculosis dispensaries (TBDs), with participants being followed up with at face-to-face visits every two months for a total of three visits. In this study, the adherence rates among participants were the highest during the intensive treatment phase (81.0% at the first follow-up) but declined during the continuation phase, reaching 69.4% at the second follow-up (at the end of the fourth month of treatment) and 71.1% at the third follow-up (at the end of the sixth month of treatment) according to self-reports for the past 30 days. According to the generalised estimating equations method, factors significantly associated with better adherence included knowledge of infectiousness, daily access to medication, workplace permissions, high household income, regular sleep patterns, extrapulmonary TB, secondary education, and no alcohol consumption. Non-adherence with anti-TB medication has been observed in patients with TB, particularly during the continuation phase of treatment. Interventions targeting patients who experience frequent forgetfulness, adverse drug reactions, or a lack of workplace flexibility may help to improve adherence. In addition, providing personalised health education that highlights the risks of non-adherence and emphasises the infectious nature of TB could improve understanding and commitment to treatment. Ensuring regular follow-ups and support, particularly for those with lower socioeconomic status or limited social support, can further reinforce the importance of adherence in TB treatment outcomes.

Therapeutic Potential of Silver Nanoparticles (AgNPs) as an Antimycobacterial Agent: A Comprehensive Review.

The uncontrolled emergence of multidrug-resistant mycobacterial strains presents as the primary determinant of the present crisis in antimycobacterial therapeutics and underscores tuberculosis (TB) as a daunting global health concern. There is an urgent requirement for drug development for the treatment of TB. Numerous novel molecules are presently undergoing clinical investigation as part of TB drug development. However, the complex cell wall and the lifecycle of M. tuberculosis within the host pose a significant challenge to the development of new drugs and, therefore, led to a shift in research focus towards alternative antibacterial compounds, notably nanotechnology. A novel approach to TB therapy utilizing silver nanoparticles (AgNPs) holds the potential to address the medical limitations imposed by drug resistance commonly associated with currently available antibiotics. Their broad-spectrum antimicrobial activity presents the utilization of AgNPs as a promising avenue for the development of therapeutics targeting mycobacterial-induced diseases, which can effectively target Mycobacterium tuberculosis, including drug-resistant strains. AgNPs can enhance the effectiveness of traditional antibiotics, potentially leading to better treatment outcomes and a shorter duration of therapy. However, the successful implementation of this complementary strategy is contingent upon addressing several pivotal therapeutic challenges, including suboptimal delivery, variability in intra-macrophagic antimycobacterial effect, and potential toxicity. Future perspectives may involve developing targeted delivery systems that maximize therapeutic effects and minimize side effects, as well as exploring combinations with existing TB medications to enhance treatment outcomes. We have attempted to provide a comprehensive overview of the antimycobacterial activity of AgNPs, and critically analyze the advantages and limitations of employing silver nanoparticles in the treatment of TB.

Integrated virtual screening and MD simulation study to discover potential inhibitors of mycobacterial electron transfer flavoprotein oxidoreductase.

Tuberculosis (TB) continues to be a major global health burden, with high incidence and mortality rates, compounded by the emergence and spread of drug-resistant strains. The limitations of current TB medications and the urgent need for new drugs targeting drug-resistant strains, particularly multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB, underscore the pressing demand for innovative anti-TB drugs that can shorten treatment duration. This has led to a focus on targeting energy metabolism of Mycobacterium tuberculosis (Mtb) as a promising approach for drug discovery. This study focused on repurposing drugs against the crucial mycobacterial protein, electron transfer flavoprotein oxidoreductase (EtfD), integral to utilizing fatty acids and cholesterol as a carbon source during infection. The research adopted an integrative approach, starting with virtual screening of approved drugs from the ZINC20 database against EtfD, followed by molecular docking, and concluding with molecular dynamics (MD) simulations. Diacerein, levonadifloxacin, and gatifloxacin were identified as promising candidates for repurposing against TB based on their strong binding affinity, stability, and interactions with EtfD. ADMET analysis and anti-TB sensitivity predictions assessed their pharmacokinetic and therapeutic potential. Diacerein and levonadifloxacin, previously unexplored in anti-tuberculous therapy, along with gatifloxacin, known for its efficacy in drug-resistant TB, have broad-spectrum antimicrobial properties and favorable pharmacokinetic profiles, suggesting potential as alternatives to current TB treatments, especially against resistant strains. This study underscores the efficacy of computational drug repurposing, highlighting bacterial energy metabolism and lipid catabolism as fruitful targets. Further research is necessary to validate the clinical suitability and efficacy of diacerein, levonadifloxacin, and gatifloxacin, potentially enhancing the arsenal against global TB.

Enhancing HIV/AIDS and TB medication logistics: A comprehensive approach to global healthcare distribution

The distribution of HIV/AIDS and tuberculosis (TB) medications is critical to the success of global healthcare initiatives, particularly in regions with limited infrastructure and resources. This review examines the logistical challenges hindering the efficient delivery of these life-saving medications, including supply chain inefficiencies, poor infrastructure, and geographical barriers. It also explores innovative approaches to optimizing logistics, such as the use of blockchain, drones, and artificial intelligence (AI), alongside public-private partnerships (PPPs) and supportive policy frameworks. These emerging technologies have the potential to enhance the availability and effectiveness of HIV/AIDS and TB treatments by improving supply chain transparency, reducing stockouts, and overcoming transportation challenges in remote areas. The paper further assesses the impact of these logistical improvements on healthcare outcomes, demonstrating how they contribute to improved patient adherence, reduced disease transmission, and cost savings. Finally, recommendations are provided for policymakers, healthcare organizations, and stakeholders to adopt these innovations, and future research directions are proposed to expand these models to other medications and diseases.

The relationship between the length of treatment for pulmonary tuberculosis patients in the intensive phase and hemoglobin levels

Background: Tuberculosis (TB) medication can alter hematological parameters, including hemoglobin levels. Hemoglobin levels due to anti-TB drugs have the potential to cause anemia. Therefore, it is important to know the risk of anemia during intensive phase TB treatment therapy. Objectives: This study aims to determine the relationship between the length of treatment for TB patients in the intensive phase and hemoglobin levels. Materials and Methods: The sample was selected using the accidental sampling method. The number of samples obtained was 31 consisting of 17 respondents from the Kedungmundu Community Health Center, 14 respondents from the Bangetayu Community Health Center. EDTA blood was analyzed using a KX21-N hematology analyzer. The relationship between the duration of treatment and hemoglobin levels in TB patients was statistically tested using Pearson correlation test. Results: Most of the intensive phase TB patients are in the 15-24 years age group. The percentage of female patients is 54.8%, and 45.2% male. TB patients with a treatment duration of 5-8 weeks are 34.1% and a treatment duration of 1-4 weeks is 65.9%. Normal hemoglobin levels are 51.6%, and low hemoglobin levels are 48.4%. The results of the Pearson correlation test have a significance level of 0.862. Conclusion: There is no correlation between the duration of treatment of intensive phase TB patients and hemoglobin levels. The importance of monitoring hemoglobin levels during intensive phase treatment, in order to monitor the effectiveness of treatment or the presence of complications such as anemia.

Molecular Indicator for Distinguishing Multi-drug-Resistant Tuberculosis from Drug Sensitivity Tuberculosis and Potential Medications for Treatment.

The issue of multi-drug-resistant tuberculosis (MDR-TB) presents a substantial challenge to global public health. Regrettably, the diagnosis of drug-resistant tuberculosis (DR-TB) frequently necessitates an extended period or more extensive laboratory resources. The swift identification of MDR-TB poses a particularly challenging endeavor. To identify the biomarkers indicative of multi-drug resistance, we conducted a screening of the GSE147689 dataset for differentially expressed genes (DEGs) and subsequently conducted a gene enrichment analysis. Our analysis identified a total of 117 DEGs, concentrated in pathways related to the immune response. Three machine learning methods, namely random forest, decision tree, and support vector machine recursive feature elimination (SVM-RFE), were implemented to identify the top 10 genes according to their feature importance scores. A4GALT and S1PR1, which were identified as common genes among the three methods, were selected as potential molecular markers for distinguishing between MDR-TB and drug-susceptible tuberculosis (DS-TB). These markers were subsequently validated using the GSE147690 dataset. The findings suggested that A4GALT exhibited area under the curve (AUC) values of 0.8571 and 0.7121 in the training and test datasets, respectively, for distinguishing between MDR-TB and DS-TB. S1PR1 demonstrated AUC values of 0.8163 and 0.5404 in the training and test datasets, respectively. When A4GALT and S1PR1 were combined, the AUC values in the training and test datasets were 0.881 and 0.7551, respectively. The relationship between hub genes and 28 immune cells infiltrating MDR-TB was investigated using single sample gene enrichment analysis (ssGSEA). The findings indicated that MDR-TB samples exhibited a higher proportion of type 1T helper cells and a lower proportion of activated dendritic cells in contrast to DS-TB samples. A negative correlation was observed between A4GALT and type 1T helper cells, whereas a positive correlation was found with activated dendritic cells. S1PR1 exhibited a positive correlation with type 1T helper cells and a negative correlation with activated dendritic cells. Furthermore, our study utilized connectivity map analysis to identify nine potential medications, including verapamil, for treating MDR-TB. In conclusion, our research identified two molecular indicators for the differentiation between MDR-TB and DS-TB and identified a total of nine potential medications for MDR-TB.

A Study to Assess Anti-TB Treatment Compliance, Factors Predictive for Poor Adherence and Perpetual Defaulting among Patient Living with TB in Namuseche Chipata Eastern Province–Zambia

Background of the Study: Tuberculosis (TB) is the ninth leading cause of death worldwide. According to WHO at least 1.5 million people each year succumb to TB, thus making it the world's top infectious killer as well as the leading cause from a single infectious agent, ranking above HIV/AIDS. Zambia is one of the top 30 high TB burden countries. People with active TB can infect 5– 15 other people through close contact over the course of a year. TB patients with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a higher risk of falling ill. Without proper treatment, 45% of HIV-negative people with TB on average and nearly all HIV-positive people with TB will die. Defaulting on TB medication is a major barrier to both local and global TB control. Defaulting increases, the risk of drug resistance, treatment failure, relapse and death, and may prolong infectiousness. Poor adherence to treatment means that patients remain infectious for longer and are more likely to relapse or succumb to tuberculosis. The rate of anti-TB treatment compliance, adherence and perpetual defaulting TB treatment was and is still high during the intensive phase of treatment. Most people who are called “lost to follow up” don’t have adequate information as to why they should continue and finish their TB medication.  Methodology: A qualitative, phenomenological cross-sectional research design was used. Namuseche Prison Clinic and surrounding compounds of Chipata Township in Eastern Province Zambia. A total of 141 participants was recruited through purposive sampling. In-depth interviews were conducted. The SPSS package version 23 was applied to conduct quantitative analysis. The proposal was approved by the Chreso University Ethics Clearance Committee and National Health Research Authority. Researcher ensured confidentially and voluntary participation with informed consent.  Results: The age of the respondents in this study ranged from 18 years to 50 years. Knowledge on TB related questions was very high in this study and stood at 87.3%. TB treatment default was found in 34 (32.7%) respondents and was associated with distance to the facility and transport costs, feeling unwell and the drug side effects.  Conclusion: TB treatment default was found in 34 (32.7%) respondents and was associated with distance to the facility and transport costs, feeling unwell and the drug side effects.

Study of Molecular Docking, Molecular Dynamics, Pharmacokinetics and Toxicity Prediction: Compounds from Nigella sativa Linn, Andrographis paniculata Nees, and Propolis as Inhibitors of Mycobacterium tuberculosis Growth

Background: Tuberculosis (TB) is caused by *Mycobacterium tuberculosis*, and Multiple Drug-Resistant Tuberculosis (MDR-TB) arises from resistance to first-line treatments like Rifampicin and Isoniazid. Since current TB medications have been used for over four decades, discovering new drug candidates is critical. This research focuses on herbal compounds—Black cumin (*Nigella sativa*), Sambiloto (*Andrographis paniculata*), and propolis—as potential inhibitors of *M. tuberculosis* by targeting DHFR. The objective of the study is to predict the activity of these herbal compounds prior to in vitro and in vivo testing. Methods: This study employed computational tools, including Molegro Virtual Docking (MVD) and Molecular Dynamics (MD), to assess the interactions of the herbal compounds with DHFR (PDB ID: 2CIG). Pharmacokinetic predictions were also conducted to evaluate the absorption and toxicity of the compounds. Results: Molecular docking and MD simulations indicated that Andrographolide, Thymoquinone, and Caffeic Acid Phenethyl Ester effectively inhibited the growth of *M. tuberculosis*. The analysis revealed favorable binding interactions and conformational changes in DHFR, with significant activity observed for Thymoquinone. Conclusion: This study suggests that Andrographolide, Thymoquinone, and Caffeic Acid Phenethyl Ester may serve as promising candidates for further development as anti-tuberculosis drugs. Subsequent in vitro and in vivo studies are warranted to validate their therapeutic potential.

Chronic Pulmonary Aspergillosis with Tracheobronchial Involvement

Introduction: Aspergillosis is a fungal infection commonly found in human lungs and takes several forms. Chronic pulmonary aspergillosis (CPA) commonly affects individuals with underlying disease, most usually lung tuberculosis (TB). Aspergillosis can cause the formation of a fungus ball in the lung cavity and can also manifest in the tracheobronchial area, although this is rarely seen in immunocompetent patients. Case: A 23-year-old woman came with persistent cough, hemoptysis, and shortness of breath for 4 months. The patient also had a significant weight loss and a history of lung TB 3 years ago. She had completed her lung TB medication. Physical examination showed increased respiratory rate and rhonchi on the left lung. GeneXpert showed no Mycobacterium tuberculosis (MTB) detected. The chest X-ray showed a cavity on the left superior lobe of the lung. Bronchoscopy showed multiple plaques along the trachea, carina, and left main bronchus. A chest computed tomography (CT) scan with contrast enhancement was performed, and a fungus ball was found inside the cavity in the left upper lobe of the lung. The patient was given intravenous fluconazole as therapy and continued with oral fluconazole when discharged. A second bronchoscopy was performed, and improvement was shown. Conclusion: Early detection and treatment should be applied to CPA patients since some studies showed poor prognosis and low five-year survival rates.