Treatment Outcomes Of Tuberculosis Patients Research Articles

The Treatment Outcomes of Tuberculosis Patients at Adare General Hospital, Southern Ethiopia (A Five-Year Retrospective Study)

Ethiopia is among the countries most heavily affected by tuberculosis, where it is the leading cause of morbidity, the third cause of hospital admission and the second cause of death. To improve tuberculosis management and control, the early detection of cases, effective treatment and the persistent evaluation of treatment outcomes are vital issues that should be taken into consideration. This study was designed to determine the treatment outcomes and associated risk factors among TB patients registered at Adare General Hospital in Southern Ethiopia. A five-year retrospective study was conducted by reviewing the files of the TB patients registered from September 2013 to August 2017. The data were coded, cleaned, entered and analyzed using SPSS version 20 statistical software. Bivariate and multivariable logistic regression with odds ratios (OR) along with a 95% confidence interval was computed and interpreted. A p-value < 0.05 was declared as statistically significant. Among the 1122 cases, 620 (55.3%) were male, 748 (66.7%) were from urban areas, 319 (28.4%) were smear positive, 352 (31.4%) were smear negative and 451 (40.2%) were extra-pulmonary patients. Among the treated patients, 284 were declared cured, 753 completed their treatment, 29 were defaulters, 3 failed to follow up, and 53 died. The overall treatment success rate was 92.4%. The TB patients from urban areas (AOR = 1.44, 95% CI: 0.28, 0.67), and the HIV-negative TB patients (AOR = 5.48, 95% CI; 3.474, 8.64) were significantly associated with successful treatment outcomes. The treatment success rates of tuberculosis at Adare General Hospital were comparable to the national health facility-level coverage, but they should be maintained and strengthened further to attain tuberculosis-related national and millennium goals.

Identifying Predictors of Unfavorable Treatment Outcomes in Tuberculosis Patients

Objectives: In South Korea, there has been a continuous decrease in the incidence of tuberculosis (TB) attributable to a national TB elimination program; however, TB still poses a significant socioeconomic burden. This study aimed to analyze factors associated with successful TB treatment and to identify refractory patient groups with unfavorable outcomes. Methods: We analyzed anonymized data on 89,150 patients with TB provided by the Korea Disease Control and Prevention Agency. Specifically, we collected independent variables, which were categorized as individual, regional, and medical facility factors. Individual factors included age, sex, nationality, TB type, drug-resistant status, category of TB, housing type, underlying disease status, number of referrals, and smoking status. Regional factors referred to the region where the TB case was reported. Medical facility factors included the first visit to a medical facility, categorized by hospital type and the distinction between private–public mix (PPM) and non-PPM depending on the presence or absence of dedicated TB nurses. These factors were analyzed in relation to treatment success to identify refractory patient groups with unfavorable outcomes. Results: Multivariable logistic regression analysis revealed the following significant factors associated with successful TB treatment: sex, nationality, status of drug-resistant TB, category of TB, number of referrals, region of TB registry, underlying diseases, and smoking status. Specifically, compared with their relevant counterparts, male patients had a lower rate of successful treatment (adjusted odds ratio [aOR]: 0.66, reference [Ref.]: women); Korean nationals had a higher rate of treatment success (aOR: 7.20, Ref. foreign residents in Korea); resistant TB was associated with a lower rate of treatment success (aOR: 0.35, Ref.: non-resistant TB status); newly treated patients had a higher rate of treatment success (aOR: 1.75, Ref.: retreatment patient); switching hospitals once (aOR: 1.78), never (aOR: 1.41), or twice (aOR: 1.37) was associated with increased treatment success (Ref.: three or more times); having zero (aOR: 1.45), one (aOR: 1.31), or two (aOR: 1.24) underlying diseases was associated with a higher rate of treatment success (Ref. three or more underlying diseases); and past smokers (aOR: 1.40) and non-smokers (aOR: 1.35) had a higher rate of treatment success (Ref.: current smokers). Conclusions: Our study identified several factors contributing to unfavorable treatment outcomes in tuberculosis patients, including male patients, foreign residents in Korea, drug-resistant TB, retreatment patients, frequent hospital switching, multiple underlying diseases, and current smoking status. These research findings could inform the development of efficient management strategies and policies for improving the treatment success rate among patients with TB.

Pharmacokinetics-pharmacodynamics of first-line antitubercular drugs: a comparative study in tuberculosis patients with and without concomitant diabetes mellitus.

To observe the variability in the plasma concentrations and pharmacokinetic-pharmacodynamic (PK-PD) profiles of first-line antitubercular drugs in pulmonary tuberculosis (TB) patients with and without diabetes mellitus (DM). Newly diagnosed pulmonary TB patients aged 18-60years with or without DM were included in the study. Group I (n = 20) included patients with TB, whereas group II (n = 20) included patients withboth TB and DM. After 2 weeks of therapy, plasma concentrations and other PK-PD parameters were determined. Improvements in clinical features, X-ray findings, sputum conversion, and adverse drug reactions (ADRs) were assessed after 2 months of therapy. Isoniazid displayed non-significantly higher plasma concentrations in diabetic patients, along with a significantly (P < 0.05) longer elimination half-life (t1/2). Rifampicin plasma concentrations at 4, 8, and 12 h were significantly (P < 0.05) lower, and it displayed significantly (P < 0.05) lower area underthe curve (AUC0-12 and AUC0-∞), shorter t1/2, higher clearance (Cl), and a lower AUC0-∞/MIC ratio in diabetic patients. Pyrazinamide and ethambutol showed non-significantly higher plasma concentrations, AUC0-12, AUC0-∞, and t1/2 in diabetic patients. The improvements in clinical features, X-ray findings, sputum conversion, and ADRs were comparable in both groups. The presence of DM in TB patients affects the PK-PD parameters of isoniazid, rifampicin, pyrazinamide, and ethambutol variably in the Indian population. Studies with a larger number of patients are required to further elucidate the role of DM on the PK-PD profile of first-line antitubercular drugs and treatment outcomes in TB patients with concomitant DM. CTRI/2021/08/035578 dated 11/08/2021.

Factors Affecting Treatment Outcomes for Tuberculosis Patients: A Retrospective Cohort Study

Background: Tuberculosis (TB) is one of the ten leading causes of death globally. The present study aims to examine the treatment outcomes in TB patients and to determine the factors associated with unsuccessful treatment outcomes. Materials and Methods: This study was a retrospective registry-based cohort study conducted in Ordu pro-vince of Turkey between 2017-2021. Logistic regression analysis was used to explore the risk factors asso-ciated with unsuccessful outcomes. Results: A total of 400 TB patients were included in the analysis. The observed overall treatment success rate (TSR) (cured or treatment completed) was 87.7% (351). 49 patients (12.3%) had unsuccessful treatment results (death, failure or loss to follow-up). Age&amp;gt;65 years (odds ratio [OR] =12.2, 95% confidence intervals [CI] =4.03-36.85), male gender (OR = 2.2, 95% CI = 1.05-4.45) and being foreign-born (OR = 9.2, 95% CI = 1.16-73.72) were identified as risk factors associated with unsuccessful outcomes in patients (p&amp;lt;0.05). Conclusions: Age&amp;gt;65 years, male gender and foreign-born patients tend to have unsuccessful treatment outcomes. Careful monitoring of patients with any of these characteristics and taking special precautions for them may help to decrease unsuccessful treatment outcomes.

Treatment outcome of tuberculosis patients in the directly observed treatment short course centres of Dibrugarh, Assam

Treatment outcome of tuberculosis patients in the directly observed treatment short course centres of Dibrugarh, Assam

Tuberculosis Treatment Outcomes and Associated Factors in Benadir Somalia. A Multicenter Cohort Study.

In low-resource countries like Somalia, tuberculosis (TB) is still a serious global health concern. Understanding the treatment outcomes of TB patients in specific regions is crucial for developing effective strategies to combat the disease. This study aimed to assess the treatment outcomes of TB patients in Benadir, Somalia. A retrospective cohort study was conducted using data from TB treatment centers in Benadir, Somalia. The study included all TB patients who initiated treatment between July 1, 2019 and June 30, 2020. Treatment outcomes, including treatment success, treatment failure, lost, death, and transfer out, were analyzed. Factors associated with treatment outcomes were also examined using chi-square test. The study comprised 3165 TB patients in total. The mean age of the observations was 29.9 years, with males making up the majority (64.58%). The overall success rate of TB treatment was 80.6%, with 5.3% lost, 4.6% died, 0.5% failed, 4.6% transferred out, and 4.4% not evaluated. Factors associated with unfavorable treatment outcomes included older age and HIV co-infection. The treatment success rate for TB patients in Benadir, Somalia, is below the global target of 90%. Enhancing access to quality TB diagnostic and treatment services, as well as addressing social and economic barriers to treatment adherence, are essential for improving TB control in Benadir, Somalia.

The Practice and Modalities of African Traditional Medicine in Tuberculosis Treatment - A Traditional Medical Practitioners’ Perspective

Aims: This study sought to explore the role of the traditional medical practitioner (TMP) and document the modalities of tuberculosis (TB) treatment in traditional medicine (TM) in Harare, Zimbabwe. Study design: An ethnographic research survey of TMPs in Harare urban. Place and Duration of Study: Harare’s southern suburbs of Warren Park, Mufakose, Budiriro, Belvedere, Mbare (Mupedzanhamo) and Harare central business district, between April and June 2021. Methodology: Fourteen (14) experienced TB practitioners, registered with the Zimbabwe National Traditional Healers Association (ZINATHA) were recruited for the study. These included exclusive herbalists (36%), spiritualists (14%) and those who used a combination of spiritualism and herbalism (50%) in their practice. Data was collected through semi-structured in-person interviews. The practices and treatment modalities in the traditional treatment of TB were documented; and any linkages with the conventional medical system were identified. Results: Forty-six (46) plant species from 28 families were prescribed in various polyherbal combinations for a maximum of 6 months in difficult cases. TMPs were found to be relevant and knowledgeable in the treatment of TB. In addition to offering alternative or complementary treatment options to patients, TMPs were also agents of health education promotion, and collaborated to some extent with allopathic healthcare providers across the service delivery system from diagnosis to treatment of patients. Conclusion: If formalized, TMPs have the potential to make considerable contributions to TB treatment strategies and help improve treatment outcome in TB patients.

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

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

The Convention of Regular Treatment with Sphetic Conversion During Intensive Tuberculosis Treatment

Purpose: The primary objective of this research is to investigate the relationship between medication regularity and sputum conversion following the intensive treatment phase of pulmonary tuberculosis (TB) at Banyu Urip Public Health Center in Surabaya. Recognizing the importance of sputum conversion as a key determinant of treatment success in pulmonary TB, this study aims to assess the impact of medication regularity on the achievement of sputum conversion among TB patients. Methods: This study adopts an analytic correlation approach with a cross-sectional design. The study population comprises tuberculosis patients receiving treatment at the Public Health Center. Data collection involves simple random sampling of 51 respondents, focusing on variables related to medication regularity and sputum conversion. Questionnaires based on the Morisky Medication Adherence Scale-8 (MMAS-8) and observation sheets are utilized as instruments. Data analysis is conducted using logistic binary regression to examine the relationship between medication regularity and sputum conversion. Results and Discussion: Among the 51 respondents, 70.6% demonstrated regularity in treatment, with 76.5% achieving sputum conversion. The Spearman rank test analysis indicates a significant relationship between medication regularity and sputum conversion (p = 0.011; p &lt; α = 0.05; r = 0.352). These findings suggest that adherence to medication is positively associated with successful sputum conversion following the intensive treatment phase of tuberculosis. Such results underscore the critical role of medication regularity in achieving positive treatment outcomes in TB patients. Implications of the Research: The research outcomes hold important implications for healthcare providers and policymakers involved in tuberculosis management and control. The findings highlight the significance of promoting medication regularity among TB patients to enhance treatment efficacy and increase the likelihood of sputum conversion. It underscores the importance of providing comprehensive counseling and support services to TB patients and their families, along with engaging other relevant stakeholders, to ensure adherence to treatment protocols throughout the course of therapy. Originality/Value: This study contributes to the existing literature by focusing on the relationship between medication regularity and sputum conversion specifically within the context of tuberculosis treatment. By employing logistic binary regression analysis and incorporating the MMAS-8 questionnaire, the research offers valuable insights into the factors influencing treatment outcomes in TB patients. The findings provide a basis for targeted interventions aimed at improving medication adherence and enhancing treatment success rates in pulmonary tuberculosis, thereby contributing to more effective tuberculosis management strategies.

Impact of diabetes mellitus on tuberculosis treatment outcomes: a cohort study in Bengaluru, India

Background: Tuberculosis (TB) remains a significant global health challenge, particularly in regions with a high prevalence of diabetes mellitus (DM). This study aims to evaluate the impact of DM on the treatment outcomes of TB patients in Bengaluru, India. Methods: In this cohort study, we examined 592 patients with smear-positive pulmonary TB, half of whom had a comorbid diagnosis of DM. Conducted in the Bruhat Bengaluru Mahanagara Palike area, the study included patients registered under the national TB elimination programme (NTEP). Data were collected on demographic characteristics, treatment adherence, sputum positivity, and treatment outcomes over six months. Results: The study revealed a high prevalence of DM among TB patients. Significant associations were observed between DM and various challenges, including higher rates of sputum positivity, poor adherence to anti-TB and anti-diabetic medications, increased adverse drug reactions (ADRs), and a higher default rate. TB patients with DM had a 1.5 times higher risk of unsuccessful treatment outcomes compared to non-diabetics. Furthermore, the risk of poor outcomes, particularly relapse, increased substantially in the TB-DM group during the six-month follow-up. Conclusions: Our findings highlight the crucial need for integrated TB and DM management strategies. This includes routine DM screening for TB patients, personalized treatment regimens, and enhanced patient education and support. These measures are essential for improving treatment outcomes in TB patients with comorbid DM.

Assessing the Degree of Determinant Impact on the Management Outcomes of Drug Sensitive Pulmonary Tuberculosis in Sierra Leone-A Case Study of Rural Bo District.

Purpose: Treatment outcomes of tuberculosis are strongly influenced by the level of socioeconomic status of a population. Predisposing factors of tuberculosis such as undernutrition, diabetes, and AIDS are hinged on the socioeconomic status of a population.&#x0D; Alcohol, smoking and illicit drug use disorders can predispose to TB especially in hyperendemic setting. Sierra Leone still grapples with socio-economic challenges including all the factors that predispose people to the disease and as well precipitates TB transmission.&#x0D; Methodology: The study was a retrospective cohort study to assess the degree of impact on the determinants of drug sensitive pulmonary tuberculosis treatment outcomes in patients managed in catchment areas in the rural Bo district of Southern Sierra Leone. Data were collected from 2176 participants with even ID numbers enrolled from January 2018 to January 2022 out of the population of 533,900. Sample was calculated at a 99% confidence level and 3% margin of error.&#x0D; Findings: A Chi2 test was performed between age: α= &lt;15 yrs β= ≥15yrs and exit which showed a statistically significant relationship between the two, χ² (4) = 188.32, p = &lt;0.001, Cramér’s V = 0.29 with the calculated p-value of &lt;0.001 that is lower than the defined significance level of 5%. There was also a statistically significant relationship between source of income and exit, χ² (12) = 94.57, p = &lt;0.001, There was a statistically significant relationship between food security and exit, χ² (4) = 15.32, p = 0.004, Cramér’s V = 0.08. The calculated p-value of 0.004 is lower than the defined significance level of 5%.&#x0D; Unique contribution to theory, practice and policy: Shows that favorable treatment outcomes are a combination of use of chemotherapy, psychosocial care, social, economic and economic moderation strategies especially in the global South where the majority of the patients live in poverty.

A comparative analysis of the profile and treatment outcomes of tuberculosis patients managed at the community and primary health care facilities in Botswana

BackgroundSuccessful treatment of Tuberculosis (TB) is necessary for mitigating and averting millions of deaths annually. This study compared the profiles and measured the association between patients, health system-related factors, and TB treatment outcomes of patients managed through the community tuberculosis care model with those managed in primary health care settings. MethodsA retrospective multicenter cross-sectional study was conducted in six districts in Botswana. Patient’s records were reviewed using a data extraction sheet, and data not captured on registers were obtained using a structured questionnaire. ResultsThree hundred and twenty-four TB patients were sampled. Most participants (84 %; n = 273) were receiving community-based DOT. Patients with moderate TB knowledge (OR 5.3,955 CI 1.01–27.7), good perception of TB care (OR 11, 95 % CI 1.29–94.0), were more likely to enroll for community DOT and achieve treatment cure. Those in businesses (OR 3.85 95 %CI 1.10–22.6), always had treatment available (OR 3.66, 95 % CI 1.12–11.4), never drank alcohol (OR 2.11, 95 %CI 1.06–4.19), used their vehicle (OR 2.11.95 %CI 0.99–4.48) were likely to enroll for community DOT. ConclusionA patient-specific education program and continuous improvement practices to increase patient TB knowledge and satisfaction should be implemented at all levels to improve treatment outcomes.

Delays in Treatment Initiation and Treatment Outcomes in Patients with Tuberculosis in the Kyrgyz Republic: Are There Differences between Migrants and Non-Migrants?

Migrants are at increased risk of developing tuberculosis (TB) and have poor treatment outcomes. The National TB program (NTP) of the Kyrgyz Republic recognizes two types of migrants: internal (intra-country) and external (inter-country) migrants. This cohort study compared the characteristics, timeliness of diagnosis and treatment initiation, and treatment outcomes of TB patients (internal migrant vs. external migrant vs. non-migrant) identified during treatment in the country in 2021. The TB treatment register and treatment cards of 5114 patients (156 internal, 430 external, and 4528 non-migrants) were reviewed. Risk factors (unemployment, smoking, alcohol use, and homelessness) were higher (p-value < 0.001) in internal (84%) than in external migrants (66%) and non-migrants (43%). The median delay in seeking care post-symptom onset was longer (p-value= 0.03) in external (30 days) than in internal migrants (21 days) and non-migrants (25 days). Successful treatment outcomes for drug-sensitive TB were higher in internal (89%, p-value = 0.012) and external migrants (86%, p-value = 0.001) than in non-migrants (78%). Internal and external migrants should be separately considered with respect to TB care and monitoring under the NTP. Success rates seem to be high in migrants, but our findings may be biased, as migrants with poor healthcare access may remain undetected and untreated and have undocumented poor outcomes.

Impact of Lifestyle Change Intervention on Tuberculosis Treatment Outcome in Tuberculosis Patients with Diabetes Mellitus Comorbidity in South West Nigeria

It is well documented in the literature that there is poor treatment outcome in patients with Tuberculosis and Diabetes (TBDM) comorbidity due to the observed interference of drugs for Tuberculosis (TB) treatment on anti-diabetic drugs and elevated glucose level reduces the efficacy of anti- tuberculosis drugs leading to poor TB treatment outcome, and that insulin therapy is not affected by this drug interaction. Importantly, access to Insulin is a challenge due to its prohibitive out-of-pocket cost. The only alternative sustainable treatment for TBDM patients in resource-limited communities is lifestyle-based intervention. This study evaluated the impact of lifestyle intervention on TB treatment outcomes in patients with TBDM comorbidity. This study is a quasi-experimental intervention involving two cohorts of 25 TBDM patients each, as control and experimental cohorts. Their enrolment was from Tuberculosis patients from health facilities in Lagos and Oyo states. The questionnaires were administered before the commencement of the Intervention and at 8 weeks. The sputum Acid Fast Bacillus (AFB) was checked, and chest x-ray (CXR) done before Intervention and Sputum AFB at 8 weeks. The Control group showed no difference in the means of the sputum AFB 95%CI: 0.12(- 0.12 – 0.36; p&gt;0.05), which was an indication of poor treatment outcome. The difference in the means of the sputum AFB in the intervention group was statistically significant 95%CI: -0.8(-0.9 - -0.6; p&lt;0.05). The intervention with educational and behavioral lifestyle modifications significantly improved the outcome of treatment of TB in TBDM comorbidity. Keywords: Behavioral change, Tuberculosis, Diabetes, comorbidity, Treatment outcome.

Effect of Lifestyle Modification Intervention on Diabetes Mellitus Treatment Outcomes in Tuberculosis Patients with Diabetes Mellitus in Southwest Nigeria

There is an observed poor treatment outcome of Diabetes mellitus (DM) in patients with Tuberculosis and Diabetes (TBDM) comorbidity due to interference of drugs used in the treatment of Tuberculosis (TB) with first- line drugs used in the treatment of DM. Insulin does not interact with TB drugs, but it is not accessible and affordable to low–resource communities due to high cost. Hence a lifestyle-based intervention, which this study evaluated to determine its effect on Diabetes control in these individuals. It is a quasi-experimental intervention with two groups of 25 participants each as experimental and control cohorts, enrolled from Tuberculosis Healthcare centers in Lagos and Oyo states. The questionnaires were administered after the baseline Glycated hemoglobin (HBA1c) has been measured, repeated after 12 weeks, and analyzed with SPSS software. In the control cohort, the difference in the means of HBA1c was statistically significant at 95%CI: 1.1(0.2 – 2.1; p&lt;0.05), indicating a worsening of blood glucose control. The difference in the means of educational scores was not significant 95%CI: -0.04(-2.8 – 2.7; p&lt;0.05), showing no uptake. In the intervention group, the difference in the means of the HBA1c was statistically significant 95%CI: -2.4(-3.1 – 1.6: p&lt;0.05), indicating improvement in glucose control. The difference in the means of the educational and behavioral score was significant statistically 95%CI: 40.6(37.7 – 43.6; p&lt;0.05) indicating uptake of behavioral changes. The intervention with educational and behavioral lifestyle modifications improved the blood glucose control as an adjunct to the conventional treatment with drugs compared to the control group. Keywords: Behavioral change, Lifestyle, Treatment, Tuberculosis-Diabetes comorbidity.

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

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

Tuberculosis treatment outcomes and patient support groups, southern India.

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

Identification of potential inhibitors of Mycobacterium tuberculosis shikimate kinase: molecular docking, in silico toxicity and in vitro experiments.

Tuberculosis (TB) is one of the main causes of death from a single pathological agent, Mycobacterium tuberculosis (Mtb). In addition, the emergence of drug-resistant TB strains has exacerbated even further the treatment outcome of TB patients. It is thus needed the search for new therapeutic strategies to improve the current treatment and to circumvent the resistance mechanisms of Mtb. The shikimate kinase (SK) is the fifth enzyme of the shikimate pathway, which is essential for the survival of Mtb. The shikimate pathway is absent in humans, thereby indicating SK as an attractive target for the development of anti-TB drugs. In this work, a combination of in silico and in vitro techniques was used to identify potential inhibitors for SK from Mtb (MtSK). All compounds of our in-house database (Centro de Pesquisas em Biologia Molecular e Funcional, CPBMF) were submitted to in silico toxicity analysis to evaluate the risk of hepatotoxicity. Docking experiments were performed to identify the potential inhibitors of MtSK according to the predicted binding energy. In vitro inhibitory activity of MtSK-catalyzed chemical reaction at a single compound concentration was assessed. Minimum inhibitory concentration values for in vitro growth of pan-sensitive Mtb H37Rv strain were also determined. The mixed approach implemented in this work was able to identify five compounds that inhibit both MtSK and the in vitro growth of Mtb.

Effect of HIV status and antiretroviral treatment on treatment outcomes of tuberculosis patients in a rural primary healthcare clinic in South Africa.

Tuberculosis (TB) remains the leading cause of death among human immunodeficiency virus (HIV) infected individuals in South Africa. Despite the implementation of HIV/TB integration services at primary healthcare facility level, the effect of HIV on TB treatment outcomes has not been well investigated. To provide evidence base for TB treatment outcome improvement to meet End TB Strategy goal, we assessed the effect of HIV status on treatment outcomes of TB patients at a rural clinic in the Ugu Health District, South Africa. We reviewed medical records involving a cohort of 508 TB patients registered for treatment between 1 January 2013 and 31 December 2015 at rural public sector clinic in KwaZulu-Natal province, South Africa. Data were extracted from National TB Programme clinic cards and the TB case registers routinely maintained at study sites. The effect of HIV status on TB treatment outcomes was determined by using multinomial logistic regression. Estimates used were relative risk ratio (RRR) at 95% confidence intervals (95%CI). A total of 506 patients were included in the analysis. Majority of the patients (88%) were new TB cases, 70% had pulmonary TB and 59% were co-infected with HIV. Most of HIV positive patients were on antiretroviral therapy (ART) (90% (n = 268)). About 82% had successful treatment outcome (cured 39.1% (n = 198) and completed treatment (42.9% (n = 217)), 7% (n = 39) died 0.6% (n = 3) failed treatment, 3.9% (n = 20) defaulted treatment and the rest (6.6% (n = 33)) were transferred out of the facility. Furthermore, HIV positive patients had a higher mortality rate (9.67%) than HIV negative patients (2.91%)". Using completed treatment as reference, HIV positive patients not on ART relative to negative patients were more likely to have unsuccessful outcomes [RRR, 5.41; 95%CI, 2.11-13.86]. When compared between HIV status, HIV positive TB patients were more likely to have unsuccessful treatment outcome in rural primary care. Antiretroviral treatment seems to have had no effect on the likelihood of TB treatment success in rural primary care. The TB mortality rate in HIV positive patients, on the other hand, was higher than in HIV negative patients emphasizing the need for enhanced integrated management of HIV/TB in rural South Africa through active screening of TB among HIV positive individuals and early access to ART among HIV positive TB cases.

Treatment outcomes of tuberculosis patients in a Directly Observed Treatment Short course (DOTS) Referral Centre in Delta State, Nigeria: a five-year review (2012 - 2016).

The objective of this study is to observe the trend in treatment outcomes and identify determinants of treatment success among patients recruited into care through the DOTS strategy. A retrospective record review of tuberculosis patients (2012-2016) was carried out at the Tuberculosis and Leprosy Referral Centre, Eku, Delta State, Nigeria. Records of four hundred and twenty five (425) tuberculosis patients under DOTS were reviewed over five years. The highest number of cases under treatment, 102 (24.0%), was recorded in 2013. The mean age (SD) of patients was 37.3 (±16.5) years, majority of the patients were male (62.4%) and 18% had TB/HIV co-infection. Treatment outcomes of patients were cured (53.4%), completed (27.8%), died (6.8%), failed (2.4%), lost to follow up (4.9%), transferred out (1.2%) and not evaluated (3.5%). Over all, treatment success rate was 81.2% with a trend of 88.7% (2012), 87.3% (2013), 85.9% (2014), 65.0% (2015) and 65.8% (2016) respectively. Patient characteristics were not associated with treatment success. The treatment success rate was high and in line with the national recommendation of 80% and above. The trend showed a reduction in number of new cases enrolled into the DOTS programme, reduction in success rate with a concomitant increase in loss to follow up. There was no association between patient characteristics and TB treatment success. System strengthening on patient follow up, community health education and treatment adherence is recommended.