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In 2009, the World Health Organization (WHO) estimated that [less than or equal to] 5% of patients with multidrug-resistant tuberculosis (MDR TB) were receiving appropriate diagnostic and therapeutic services. This [...]

Multidrug-resistant tuberculosis (MDR TB) is defined as infection with Mycobacterium tuberculosis with in vitro resistance to at least isoniazid and rifampin. The incidence of MDR TB disease was estimated to [...]

The purpose of this study is to validate a Spanish-speaking version of the internal corporate social responsibility questionnaire (ICSR Q), a questionnaire that is based on the social exchange theory and assess the perception of employees related to seven internal practices that reflect how responsible are organizations toward its workforce The questionnaire was applied to two samples of Colombian employees (N = 433). Confirmatory factor analysis revealed that the original structure of seven factors was maintained in the Spanish—speaking version, with appropriate levels of convergent and discriminant validity. Positive and significant relationships were found between internal corporate social responsibility and organizational commitment, both at affective and normative levels. Finally, type of employment contract (permanent or fixed term) implied significant differences in employee perceptions of internal corporate social responsibility. Our results provide evidence for the validity of the Spanish—speaking version of the internal corporate responsibility scale, suggesting its future application in investigations of internal aspects of corporate social responsibility in Spanish-speaking organizational contexts. [ABSTRACT FROM AUTHOR]

A study was conducted to evaluate the comprehensive treatment outcomes for patients with extensively drug-resistant tuberculosis. Results indicated that extensively drug-resistant tuberculosis in HIV-negative patients can be cured through outpatient treatment.

Many countries with financial support for HIV treatment experience delays in scale-up because of bureaucratic, operational, and technical obstacles. The authors describe the Peruvian National HIV Program's response to such [...]

Evidence of successful management of multidrug-resistant tuberculosis (MDRTB) is mainly generated from referral hospitals in high-income countries. We evaluate the management of MDRTB in 5 resource-limited countries: Estonia, Latvia, Peru, [...]

Programs implementing community-based directly observed therapy (DOT) have demonstrated success in the treatment of patients with tuberculosis. However, given complexities in the management and treatment of patients infected with multidrug-resistant tuberculosis (MDR-TB), the utilization of community-based DOT to treat MDR-TB patients has only recently been successfully attempted. We describe the first such program and highlight the crucial components and most critical challenges to creating a successful community-based MDR-TB treatment program. Keywords: Tuberculosis; Community-based treatment; Non-governmental organizations; Directly observed therapy; Multidrug-resistance; Peru

It may be possible to treat patients with multi-drug resistant tuberculosis in a community setting in poor countries, according to a study from Lima, Peru. Of 66 patients who were treated in a medical clinic, five died during the six-month treatment, but most of the rest were cured. Pyrazinamide and ethambutol were especially effective provided the bacterium was not resistant.

Background For treating multidrug-resistant tuberculosis (MDR TB), the World Health Organization (WHO) recommends a regimen of at least four second-line drugs that are likely to be effective as well as pyrazinamide. WHO guidelines indicate only marginal benefit for regimens based directly on drug susceptibility testing (DST) results. Recent evidence from isolated cohorts suggests that regimens containing more drugs may be beneficial, and that DST results are predictive of regimen effectiveness. The objective of our study was to gain insight into how regimen design affects treatment response by analyzing the association between time to sputum culture conversion and both the number of potentially effective drugs included in a regimen and the DST results of the drugs in the regimen. Methods and Findings We analyzed data from the Preserving Effective Tuberculosis Treatment Study (PETTS), a prospective observational study of 1,659 adults treated for MDR TB during 2005-2010 in nine countries: Estonia, Latvia, Peru, Philippines, Russian Federation, South Africa, South Korea, Thailand, and Taiwan. For all patients, monthly sputum samples were collected, and DST was performed on baseline isolates at the US Centers for Disease Control and Prevention. We included 1,137 patients in our analysis based on their having known baseline DST results for at least fluoroquinolones and second-line injectable drugs, and not having extensively drug-resistant TB. These patients were followed for a median of 20 mo (interquartile range 16-23 mo) after MDR TB treatment initiation. The primary outcome of interest was initial sputum culture conversion. We used Cox proportional hazards regression, stratifying by country to control for setting-associated confounders, and adjusting for the number of drugs to which patients' baseline isolates were resistant, baseline resistance pattern, previous treatment history, sputum smear result, and extent of disease on chest radiograph. In multivariable analysis, receiving an average of at least six potentially effective drugs (defined as drugs without a DST result indicating resistance) per day was associated with a 36% greater likelihood of sputum culture conversion than receiving an average of at least five but fewer than six potentially effective drugs per day (adjusted hazard ratio [aHR] 1.36, 95% CI 1.09-1.69). Inclusion of pyrazinamide (aHR 2.00, 95% C11.65-2.41) or more drugs to which baseline DST indicated susceptibility (aHR 1.65, 95% CI 1.48-1.84, per drug) in regimens was associated with greater increases in the likelihood of sputum culture conversion than including more drugs to which baseline DST indicated resistance (aHR 1.33, 95% C11.18-1.51, per drug). Including in the regimen more drugs for which DST was not performed was beneficial only if a minimum of three effective drugs was present in the regimen (aHR 1.39, 95% C11.09-1.76, per drug when three effective drugs present in regimen). The main limitation of this analysis is that it is based on observational data, not a randomized trial, and drug regimens varied across sites. However, PETTS was a uniquely large and rigorous observational study in terms of both the number of patients enrolled and the standardization of laboratory testing. Other limitations include the assumption of equivalent efficacy across drugs in a category, incomplete data on adherence, and the fact that the analysis considers only initial sputum culture conversion, not reversion or long-term relapse. Conclusions MDR TB regimens including more potentially effective drugs than the minimum of five currently recommended by WHO may encourage improved response to treatment in patients with MDR TB. Rapid access to high-quality DST results could facilitate the design of more effective individualized regimens. Randomized controlled trials are necessary to confirm whether individualized regimens with more than five drugs can indeed achieve better cure rates than current recommended regimens., Introduction World Health Organization (WHO) guidelines for the treatment of multidrug-resistant tuberculosis (MDR TB) recommend a regimen consisting of at least four second-line drugs that are likely to be effective [...]

This study aims to test the theoretical model of career adaptability of refugees to investigate the dynamics of successful resettlement. The theoretical model is grounded on career construction and social network theory. We employ quantitative and qualitative methodologies to test the model in a sample of Venezuelans living and working in Colombia. The quantitative results provide partial support for Campion's model. However, we test an alternative model and find that career adaptability has a direct relationship with subjective resettlement (i.e., life satisfaction and psychological health). In addition, cultural identification plays a buffering role on the harmful effects of discrimination on subjective resettlement. Qualitative results from eight in-depth interviews shed light on the process of refugee resettlement, thus revealing the role of social networks. Our study contributes to previous research on refugees by testing, adapting, and expanding a novel model of work resettlement and focusing on a group of refugees transitioning from one emerging country to another emerging country. [ABSTRACT FROM AUTHOR]

Patients treated in Peru for multidrug-resistant tuberculosis (MDR-TB) were followed-up for a median of 67 months. Among 86 patients considered cured after completion of treatment, 97% remain healthy; 1 patient [...]

Pablos-Mendez, Gowda, and Frieden aim to establish a "rational" base for the control of multidrug-resistant tuberculosis (MDR-TB) in resource-poor settings (see pp. 489-494). To assess the rationality of their framework, [...]

Background. Resistance to second-line drugs develops during treatment of multidrug-resistant (MDR) tuberculosis, but the impact on treatment outcome has not been determined. Methods. Patients with MDR tuberculosis starting second-line drug treatment were enrolled in a prospective cohort study. Sputum cultures were analyzed at a central reference laboratory.We compared subjects with successful and poor treatment outcomes in terms of (1) initial and acquired resistance to fluoroquinolones and second-line injectable drugs (SLIs) and (2) treatment regimens. Results. Of 1244 patients with MDR tuberculosis, 973 (78.2%) had known outcomes and 232 (18.6%) were lost to follow-up. Among those with known outcomes, treatment succeeded in 85.8% with plain MDR tuberculosis, 69.7% with initial resistance to either a fluoroquinolone or an SLI, 37.5% with acquired resistance to a fluoroquinolone or SLI, 29.3% with initial and 13.0% with acquired extensively drug-resistant tuberculosis (P < .001 for trend). In contrast, among those with known outcomes, treatment success increased stepwise from 41.6% to 92.3% as the number of drugs proven effective increased from ≤1 to ≥5 (P < .001 for trend), while acquired drug resistance decreased from 12% to 16% range, depending on the drug, down to 0%-2% (P < .001 for trend). In multivariable analysis, the adjusted odds of treatment success decreased 0.62-fold (95% confidence interval, .56-.69) for each increment in drug resistance and increased 2.1-fold (1.40-3.18) for each additional effective drug, controlling for differences between programs and patients. Specific treatment, patient, and program variables were also associated with treatment outcome. Conclusions. Increasing drug resistance was associated in a logical stepwise manner with poor treatment outcomes. Acquired resistance was worse than initial resistance to the same drugs. Increasing numbers of effective drugs, specific drugs, and specific program characteristics were associated with better outcomes and less acquired resistance. [ABSTRACT FROM AUTHOR]