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Lew W.-J.,World Health Organization | Harrington K.,World Health Organization | Garfin C.,National TB Programme | Islam T.,Stop TB | And 2 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2016

SETTING: National Tuberculosis Programme, the Philippines. OBJECTIVE: To compare treatment outcomes of Category I and Category II regimens among mono-and/or polyresistant tuberculosis (TB) cases under programme conditions. DESIGN: Retrospective cohort analysis of pulmonary TB patients from two data sets from the National Drug Resistance Survey and the Programmatic Management of Drug-resistant Tuberculosis by linking drug resistance patterns with treatment outcomes. RESULTS: Of 288 Category I patients, 193 were isoniazid (INH) resistant, 42 were either ethambutol (EMB) or streptomycin (SM) resistant, and 53 were resistant to a combination of two or all three TB drugs. Of 138 Category II patients, 92 were INH-resistant, 9 were either EMB-or SM-resistant, and 37 were polyresistant. Respectively 206 (87.7%) and 41 (77.4%) mono-and poly-resistant patients treated with the Category I regimen achieved significantly higher successful treatment outcomes, in comparison to respectively 60 (59.4%) and 15 (40.5%) mono-and polyresistant patients treated with the Category II regimen. CONCLUSION: The Category II regimen produced poor outcomes, whereas the Category I regimen achieved a treatment success rate of more than 85% among new patients with the same drug resistance patterns. The poor outcomes of the Category II regimen could be attributed to other factors such as patient behaviour and comorbidities, rather than drug resistance. © 2016 The Union.

Floyd K.,World Health Organization | Hutubessy R.,World Health Organization | Kliiman K.,University of Tartu | Centis R.,Care and Research Institute | And 6 more authors.
European Respiratory Journal | Year: 2012

Evidence on the cost and cost-effectiveness of treatment of multidrug-resistant tuberculosis (MDR-TB) is limited, and no published data are available from former Soviet Union countries, where rates of MDR-TB are highest globally. We evaluated the cost and cost-effectiveness of MDR-TB treatment in Estonia and Russia (Tomsk Oblast), comparing cohorts enrolled on treatment according to World Health Organization (WHO) guidelines in 2001 and 2002 with cohorts treated in previous years. Costs were assessed from a health system perspective in 2003 US$; effects were measured as cures, deaths averted and disability-adjusted life-years (DALYs) averted. Cure rates when WHO guidelines were followed were 61% (90 out of 149) in Estonia and 76% (76 out of 100) in Tomsk Oblast, with a cost per patient treated of US$8,974 and US$10,088, respectively. Before WHO guidelines were followed, cure rates were 52% in Estonia and 15% in Tomsk Oblast; the cost per patient treated was US$4,729 and US$2,282, respectively. Drugs and hospitalisation accounted for 69-90% of total costs. The cost per DALY averted by treatment following WHO guidelines was US$579 (range US$297-US$902) in Estonia and US$429 (range US$302-US$546) in Tomsk Oblast. Treatment of patients with MDR-TB can be cost-effective, but requires substantial additional investment in tuberculosis control in priority countries.

Safdar N.,A+ Network | Zahid R.,A+ Network | Shah S.,University of York | Fatima R.,National TB Programme | And 2 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2015

BACKGROUND: Passive smoking is associated with tuberculosis (TB). Measures are required to protect non-smoking TB patients from second-hand smoke (SHS). SETTING: We developed a behavioural intervention to encourage TB patients to implement smoking restrictions at home in Pakistan. OBJECTIVES: To assess the likelihood of such an intervention being successful and to inform a definitive trial in future. DESIGN: This was a pilot randomised controlled trial in which non-smoking TB patients were randomised to receive either individual-based support or individual-based support combined with family reminders. We recruited patients living with at least one smoker in their homes. Our primary outcome was urinary cotinine level as a measure of SHS exposure 2 months post-randomisation. RESULTS: Of 273 patients assessed for eligibility, 150 (56%) patients were recruited and all but one were retained throughout the trial. A statistically significant absolute reduction was observed in non-smoking participants' exposure to SHS based on urinary cotinine levels in both Arm 1 (71%, 95%CI 61-79) and Arm 2 (76%, 95%CI 67-83) between baseline and follow-up at 2 months. CONCLUSIONS: The recruitment and retention rates for trial participants make it feasible to conduct a definitive trial in future. The observed effect size makes it worthwhile to conduct such a trial. © 2015 The Union.

Maama-Maime L.B.,National TB Programme | Mareka M.,Laboratory Services | Ershova J.V.,Centers for Disease Control and Prevention | Tlali T.E.,Laboratory Services | And 6 more authors.
PLoS ONE | Year: 2015

Setting Drug resistance is an increasing threat to tuberculosis (TB) control worldwide. The World Health Organization advises monitoring for drug resistance, with either ongoing surveillance or periodic surveys. Methods The antituberculosis drug resistance survey was conducted in Lesotho in 2008-2009. Basic demographic and TB history information was collected from individuals with positive sputum smear results at 17 diagnostic facilities. Additional sputum sample was sent to the national TB reference laboratory for culture and drug susceptibility testing. Results Among 3441 eligible smear-positive persons, 1121 (32.6%) were not requested to submit sputum for culture. Among 2320 persons submitted sputum, 1164 (50.2%) were not asked for clinical information or did not have valid sputum samples for testing. In addition, 445/ 2320 (19.2%) were excluded from analysis because of other laboratory or data management reasons. Among 984/3441 (28.6%) persons who had data available for analysis, MDR-TB was present in 24/773 (3.1%) of new and 25/195 (12.8%) of retreatment TB cases. Logistical, operational and data management challenges affected survey results. Conclusion MDR-TB is prevalent in Lesotho, but limitations reduced the reliability of our findings. Multiple lessons learned during this survey can be applied to improve the next drug resistance survey in Lesotho and other resource constrained countries may learn how to avoid these bottlenecks. ©This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Kamal S.M.M.,National Institute of Diseases of the Chest and Hospital NIDCH | Hossain Md.A.,National TB Programme | Sultana S.,World Health Organization | Begum V.,NPO WHO | And 11 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2015

OBJECTIVE: To determine the prevalence of tuberculosis (TB) drug resistance in Bangladesh. DESIGN: Weighted cluster sampling among smearpositive cases, and standard culture and drug susceptibility testing on solid medium were used. RESULTS: Of 1480 patients enrolled during 2011, 12 falsified multidrug-resistant TB (MDR-TB) patients were excluded. Analysis included 1340 cases (90.5% of those enrolled) with valid results and known treatment antecedents. Of 1049 new cases, 12.3% (95%CI 9.3-16.1) had strains resistant to any of the first-line drugs tested, and 1.4% (95%CI 0.7-2.5) were MDR-TB. Among the 291 previously treated cases, this was respectively 43.2% (95%CI 37.1-49.5) and 28.5% (95%CI 23.5-34.1). History of previous anti-tuberculosis treatment was the only predictive factor for firstline drug resistance (OR 34.9). Among the MDR-TB patients, 19.2% (95%CI 11.3-30.5; exclusively previously treated) also showed resistance to ofloxacin. Resistance to kanamycin was not detected. CONCLUSION: Although MDR-TB prevalence was relatively low, transmission of MDR-TB may be increasing in Bangladesh. MDR-TB with fluoroquinolone resistance is rapidly rising. Integrating the private sector should be made high priority given the excessive proportion of MDR-TB retreatment cases in large cities. TB control programmes and donors should avoid applying undue pressure towards meeting global targets, which can lead to corruption of data even in national surveys. © 2015 The Union.

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