84 results on '"Philipp du Cros"'
Search Results
2. Community-Wide Active Case Finding for Tuberculosis: Time to Use the Evidence We Have
- Author
-
Mikaela Coleman, Chris Lowbridge, Philipp du Cros, and Ben J. Marais
- Subjects
tuberculosis ,active case finding ,systematic screening ,elimination ,population-wide ,community-wide ,Medicine - Abstract
Tuberculosis, caused by the Mycobacterium tuberculosis (Mtb) bacteria, is one of the world’s deadliest infectious diseases. Despite being the world’s oldest pandemic, tuberculosis is very much a challenge of the modern era. In high-incidence settings, all people are at risk, irrespective of whether they have common vulnerabilities to the disease warranting the current WHO recommendations for community-wide tuberculosis active case finding in these settings. Despite good evidence of effectiveness in reducing tuberculosis transmission, uptake of this strategy has been lacking in the communities that would derive greatest benefit. We consider the various complexities in eliminating tuberculosis from the first principles of the disease, including diagnostic and other challenges that must be navigated under an elimination agenda. We make the case that community-wide tuberculosis active case finding is the best strategy currently available to drive elimination forward in high-incidence settings and that no time should be lost in its implementation. Recognizing that high-incidence communities vary in their epidemiology and spatiosocial characteristics, tuberculosis research and funding must now shift towards radically supporting local implementation and operational research in communities. This “preparing of the ground” for scaling up to community-wide intervention centers the local knowledge and local experience of community epidemiology to optimize implementation practices and accelerate reductions in community-level tuberculosis transmission.
- Published
- 2024
- Full Text
- View/download PDF
3. Tuberculosis Case Finding in Kulon Progo District, Yogyakarta, Indonesia: Passive versus Active Case Finding Using Mobile Chest X-ray
- Author
-
John Silwanus Kaku, Riris Andono Ahmad, Stephanie Main, Dwi Oktofiana, Bintari Dwihardiani, Rina Triasih, Philipp du Cros, and Geoffrey Chan
- Subjects
Tuberculosis ,active-case finding ,mobile chest X-ray ,Medicine - Abstract
Active-case finding (ACF) using chest X-ray is an essential method of finding and diagnosing Tuberculosis (TB) cases that may be missed in Indonesia’s routine TB case finding. This study compares active and passive TB case-finding strategies. A retrospective study of TB case notification was conducted. Data between 1 January and 31 December 2021, was used. The population in this study were TB cases notified from Kulon Progo District health facilities, including those found through routine activities or active-case findings. A total of 249 TB cases were diagnosed in Kulon Progo in 2021, and 102 (41%) were bacteriologically confirmed. The TB patients’ ages ranged from 0 to 85 years (median 52, IQR 31–61). The majority of cases were male (59%, 147/249) and mostly among people aged 15–59 (61.4%, 153/249). The proportion of clinical TB diagnoses among cases found from active-case findings was 74.7% (68/91) while the proportion among passive-case findings was 50% (79/158). Active-case finding contributed 91 (36.5%) TB cases to the total cases detected in Kulon Progo in 2021. The use of chest X-rays in active-case findings likely contributed to the detection of a higher proportion of clinical TB than in passive-case findings.
- Published
- 2024
- Full Text
- View/download PDF
4. The Yield of Active Tuberculosis Disease and Latent Tuberculosis Infection in Tuberculosis Household Contacts Investigated Using Chest X-ray in Yogyakarta Province, Indonesia
- Author
-
Betty Nababan, Rina Triasih, Geoffrey Chan, Bintari Dwihardiani, Arif Hidayat, Setyogati C. Dewi, Lana Unwanah, Arif Mustofa, and Philipp du Cros
- Subjects
household contact ,contact investigation ,active TB ,latent TB infection ,factors ,Medicine - Abstract
In Indonesia, the implementation of tuberculosis (TB) contact investigation is limited, with low detection rates. We report the yield of and risk factors for TB disease and infection for household contacts (HHCs) investigated using chest X-ray (CXR) screening. We identified HHCs aged five years and above of bacteriologically confirmed index cases from 2018 to 2022 in Yogyakarta City and Kulon Progo. All HHCs were offered screening for TB symptoms; TB infection testing with either tuberculin skin testing or interferon gamma release assay; and referral for CXR. Sputum from those with symptoms or CXR suggestive of TB was tested with Xpert MTB/RIF. Risk factors for active TB disease and latent TB infection (LTBI) were identified by logistic regression models. We screened 2857 HHCs for TB between June 2020 and December 2022, with 68 (2.4%) diagnosed with active TB. Of 2621 HHCs eligible for LTBI investigation, 1083 (45.7%) were diagnosed with LTBI. The factors associated with active TB were age, being underweight, diabetes mellitus, urban living, and sleeping in the same house as an index case. Factors associated with LTBI were increasing age and male gender. Conclusions: Screening for HHC including CXR and TST/IGRA yielded a moderate prevalence of TB disease and infection.
- Published
- 2024
- Full Text
- View/download PDF
5. High Tuberculosis Preventive Treatment Uptake and Completion Rates Using a Person-Centered Approach among Tuberculosis Household Contact in Yogyakarta
- Author
-
Felisia Felisia, Rina Triasih, Betty Weri Yolanda Nababan, Guardian Yoki Sanjaya, Setyogati Candra Dewi, Endang Sri Rahayu, Lana Unwanah, Philipp du Cros, and Geoffrey Chan
- Subjects
tuberculosis preventive treatment (TPT) ,short regimen ,person-centered care ,Medicine - Abstract
Coverage of tuberculosis preventive treatment (TPT) in Indonesia is inadequate, and persons who start TPT often do not complete treatment. In 2020, Zero TB Yogyakarta implemented person-centered contact investigation and shorter TPT regimen provision in collaboration with primary health care centers. Between 1 January 2020 and 31 August 2022, we assessed eligibility for TPT among household contacts of persons with bacteriologically confirmed TB (index cases) and offered them a 3-month TPT regimen (3RH or 3HP). A dedicated nurse monitored contacts on TPT for treatment adherence and side effects every week in the first month and every two weeks in the next months. Contacts were also able to contact a nurse by phone or ask for home visits at any point if they had any concerns. A total of 1016 contacts were eligible for TPT: 772 (78.8%) started short regimen TPT with 706 (91.5%) completing their TPT. Side effects were reported in 26 (39%) of the non-completion group. We conclude that high rates of TPT uptake and completion among contacts assessed as eligible for TPT can be achieved through person-centered care and the use of shorter regimens. Side-effect monitoring and management while on TPT is vital for improving TPT completion.
- Published
- 2023
- Full Text
- View/download PDF
6. TB-PRACTECAL: study protocol for a randomised, controlled, open-label, phase II–III trial to evaluate the safety and efficacy of regimens containing bedaquiline and pretomanid for the treatment of adult patients with pulmonary multidrug-resistant tuberculosis
- Author
-
Catherine Berry, Philipp du Cros, Katherine Fielding, Suzanne Gajewski, Emil Kazounis, Timothy D. McHugh, Corinne Merle, Ilaria Motta, David A. J. Moore, and Bern-Thomas Nyang’wa
- Subjects
Multidrug-resistant tuberculosis ,Bedaquiline ,Linezolid ,Clofazimine ,Pretomanid ,Moxifloxacin ,Medicine (General) ,R5-920 - Abstract
Abstract Background Globally rifampicin-resistant tuberculosis disease affects around 460,000 people each year. Currently recommended regimens are 9–24 months duration, have poor efficacy and carry significant toxicity. A shorter, less toxic and more efficacious regimen would improve outcomes for people with rifampicin-resistant tuberculosis. Methods TB-PRACTECAL is an open-label, randomised, controlled, phase II/III non-inferiority trial evaluating the safety and efficacy of 24-week regimens containing bedaquiline and pretomanid to treat rifampicin-resistant tuberculosis. Conducted in Uzbekistan, South Africa and Belarus, patients aged 15 and above with rifampicin-resistant pulmonary tuberculosis and requiring a new course of therapy were eligible for inclusion irrespective of HIV status. In the first stage, equivalent to a phase IIB trial, patients were randomly assigned one of four regimens, stratified by site. Investigational regimens include oral bedaquiline, pretomanid and linezolid. Additionally, two of the regimens also included moxifloxacin (arm 1) and clofazimine (arm 2) respectively. Treatment was administered under direct observation for 24 weeks in investigational arms and 36 to 96 weeks in the standard of care arm. The second stage of the study was equivalent to a phase III trial, investigating the safety and efficacy of the most promising regimen/s. The primary outcome was the percentage of unfavourable outcomes at 72 weeks post-randomisation. This was a composite of early treatment discontinuation, treatment failure, recurrence, lost-to-follow-up and death. The study is being conducted in accordance with ICH-GCP and full ethical approval was obtained from Médecins sans Frontières ethical review board, London School of Hygiene and Tropical Medicine ethical review board as well as ERBs and regulatory authorities at each site. Discussion TB-PRACTECAL is an ambitious trial using adaptive design to accelerate regimen assessment and bring novel treatments that are effective and safe to patients quicker. The trial took a patient-centred approach, adapting to best practice guidelines throughout recruitment. The implementation faced significant challenges from the COVID-19 pandemic. The trial was terminated early for efficacy on the advice of the DSMB and will report on data collected up to the end of recruitment and, additionally, the planned final analysis at 72 weeks after the end of recruitment. Trial registration Clinicaltrials.gov NCT02589782. Registered on 28 October 2015.
- Published
- 2022
- Full Text
- View/download PDF
7. Evolution and spread of a highly drug resistant strain of Mycobacterium tuberculosis in Papua New Guinea
- Author
-
Arnold Bainomugisa, Evelyn Lavu, Sushil Pandey, Suman Majumdar, Jennifer Banamu, Chris Coulter, Ben Marais, Lachlan Coin, Stephen M. Graham, and Philipp du Cros
- Subjects
Drug resistance ,Mycobacterium tuberculosis ,RR-TB ,Whole genome sequencing ,Papua New Guinea ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Molecular mechanisms determining the transmission and prevalence of drug resistant tuberculosis (DR-TB) in Papua New Guinea (PNG) are poorly understood. We used genomic and drug susceptibility data to explore the evolutionary history, temporal acquisition of resistance and transmission dynamics of DR-TB across PNG. Methods We performed whole genome sequencing on isolates from Central Public Health Laboratory, PNG, collected 2017–2019. Data analysis was done on a composite dataset that also included 100 genomes previously sequenced from Daru, PNG (2012–2015). Results Sampled isolates represented 14 of the 22 PNG provinces, the majority (66/94; 70%) came from the National Capital District (NCD). In the composite dataset, 91% of strains were Beijing 2.2.1.1, identified in 13 provinces. Phylogenetic tree of Beijing strains revealed two clades, Daru dominant clade (A) and NCD dominant clade (B). Multi-drug resistance (MDR) was repeatedly and independently acquired, with the first MDR cases in both clades noted to have emerged in the early 1990s, while fluoroquinolone resistance emerged in 2009 (95% highest posterior density 2000–2016). We identified the presence of a frameshift mutation within Rv0678 (p.Asp47fs) which has been suggested to confer resistance to bedaquiline, despite no known exposure to the drug. Overall genomic clustering was significantly associated with rpoC compensatory and inhA promoter mutations (p
- Published
- 2022
- Full Text
- View/download PDF
8. Detection of Mycobacterium tuberculosis Complex Using the Xpert MTB/RIF Ultra Assay on the Stool of Pediatric Patients in Dushanbe, Tajikistan
- Author
-
Michael L. Rekart, Lidiya Mun, Aung Aung, Diana Gomez, Winston Mulanda, Jarmila Kliescikova, Norman Sitali, Asliddin Rajabov, Shahnoza Azamova, Bobojon Pirmahmadzoda, Jay Achar, Jose Luis Alvarez, Jane Greig, Philipp du Cros, and Animesh Sinha
- Subjects
Mycobacterium tuberculosis ,Xpert MTB/Rif Ultra ,pediatric infectious disease ,stool ,Microbiology ,QR1-502 - Abstract
ABSTRACT We report the findings of a prospective laboratory diagnostic accuracy study to evaluate the sensitivity, specificity, and predictive values of the Xpert MTB/RIF Ultra assay for Mycobacterium tuberculosis detection in fresh stool specimens from children under 15 years of age with confirmed tuberculosis (TB) disease from Dushanbe, Tajikistan. Six hundred eighty-eight (688) participants were enrolled from April 2019 to October 2021. We identified 16 participants (2.3%) with confirmed TB disease, defined as ≥1 TB sign/symptom plus microbiologic confirmation. With the Xpert MTB/RIF Ultra assay for stool, we found a sensitivity of 68.8% (95% CI, 46.0 to 91.5) and a specificity of 98.7% (95% CI, 97.8 to 99.5) in confirmed TB disease. Our results are comparable to other published studies; however, our cohort was larger and our confirmed TB disease rate lower than most. We also demonstrated that this assay was feasible to implement in a centralized hospital laboratory in a low-middle-income Central Asian country. However, we encountered obstacles such as lack of staffing, material ruptures, outdated government protocols, and decreased case presentation due to COVID-19. We found eight patients whose only positive test was an Xpert Ultra stool assay. None needed treatment during the study; however, three were treated later, suggesting such cases require close observation. Our report is the first from Central Asia and one of a few from a low-middle-income country. We believe our study demonstrates the generalizability of the Xpert MTB/RIF Ultra assay on fresh stool specimens from children and provides further evidence supporting WHO’s approval of this diagnostic strategy. IMPORTANCE The importance of this report is that it provides further support for WHO’s recent recommendation that fresh stool is an acceptable sample for GeneXpert TB testing in children, especially small children who often cannot produce an adequate sputum sample. Diagnosing TB in this age group is difficult, and many cases are missed, leading to unacceptable rates of TB illness and death. In our large cohort of children from Dushanbe, Tajikistan, the GeneXpert stool test was positive in 69% of proven cases of TB, and there were very few false-positive tests. We also showed that this diagnostic strategy was feasible to implement in a low-middle-income country with an inefficient health care delivery system. We hope that many more programs will adopt this form of diagnosing TB in children.
- Published
- 2023
- Full Text
- View/download PDF
9. Spectrum of TB Disease and Treatment Outcomes in a Mobile Community Based Active Case Finding Program in Yogyakarta Province, Indonesia
- Author
-
Nur Rahmi Ananda, Rina Triasih, Bintari Dwihardiani, Betty Nababan, Arif Hidayat, Geoff Chan, and Philipp du Cros
- Subjects
active case finding ,subclinical TB disease ,spectrum TB disease ,treatment outcome ,Medicine - Abstract
The World Health Organization recommends using chest X-ray (CXR) in active case finding (ACF) to improve case detection. This study aimed to describe the spectrum and outcomes of TB disease diagnosed through a mobile community based ACF program in Yogyakarta. This prospective cohort study included people attending a TB ACF program in Yogyakarta between 1 January 2021 to 30 June 2022. Participants ≥10 years old underwent CXR, symptom screening, and Xpert MTB/RIF testing of sputum. Subclinical TB was defined as asymptomatic active TB, whether bacteriologically confirmed or not. Treatment outcome data were obtained from the national program TB database. 47,735 people attended the ACF program; the yield of TB disease was 0.86% (393/45,938). There were 217 symptomatic cases, of whom 72 (33.2%) were bacteriologically confirmed, and 176 asymptomatic cases, with 52 (29.5%) bacteriologically confirmed. Treatment success was 70.7% with high loss to follow up (9%) and not evaluated (17.1%). Multivariate analysis demonstrated weak evidence for lower unsuccessful outcomes in symptomatic versus subclinical TB (aOR 0.6, 95% CI 0.36–0.998). TB ACF programs utilizing CXR may diagnose a high proportion of subclinical TB. Linkage to care in ACF program is important to increase successful treatment outcomes.
- Published
- 2023
- Full Text
- View/download PDF
10. The prevalence and risk factors for tuberculosis among healthcare workers in Yogyakarta, Indonesia.
- Author
-
Stephanie Main, Rina Triasih, Jane Greig, Arif Hidayat, Immanuel Billy Brilliandi, Syarifah Khodijah, Geoff Chan, Nova Wilks, Amy Elizabeth Parry, Betty Nababan, Philipp du Cros, and Bintari Dwihardiani
- Subjects
Medicine ,Science - Abstract
Healthcare workers (HCWs) are at risk of contracting TB, particularly when in high tuberculosis (TB) burden settings. Routine surveillance data and evidence are limited on the burden of TB amongst HCWs in Indonesia. We aimed to measure the prevalence of TB infection (TBI) and disease among HCWs in four healthcare facilities in Yogyakarta province in Indonesia, and explore risk factors for TBI. A cross-sectional TB screening study targeted all HCWs from four pre-selected facilities (1 hospital, 3 primary care) in Yogyakarta, Indonesia. Voluntary screening included symptom assessment, Chest X-ray (CXR), Xpert MTB/RIF (if indicated) and tuberculin skin test (TST). Analyses were descriptive and included multivariable logistic regression. Of 792 HCWs, 681 consented (86%) to the screening; 59% (n = 401) were female, 62% were medical staff (n = 421), 77% worked in the one participating hospital (n = 524), and the median time working in the health sector was 13 years (IQR: 6-25 years). Nearly half had provided services for people with TB (46%, n = 316) and 9% reported ever having TB (n = 60). Among participants with presumptive TB (15%, n = 99/662), none were diagnosed microbiologically or clinically with active TB disease. TBI was detected in 25% (95% CI: 22-30; n = 112/441) of eligible HCWs with a TST result. A significant association was found between TB infection and being male (adjusted Odds Ratio (aOR) 2.02 (95%CI: 1.29-3.17)), currently working in the participating hospital compared to primary care (aOR 3.15 (95%CI: 1.75-5.66)), and older age (1.05 OR increase per year of life between 19-73 years (95%CI: 1.02-1.06)). This study supports prioritisation of HCWs as a high-risk group for TB infection and disease, and the need for comprehensive prevention and control programs in Indonesia. Further, it identifies characteristics of HCWs in Yogyakarta at higher risk of TBI, who could be prioritised in screening programs if universal coverage of prevention and control measures cannot be achieved.
- Published
- 2023
- Full Text
- View/download PDF
11. Evaluation of an Online Training Program on COVID-19 for Health Workers in Papua New Guinea
- Author
-
Yasmin Mohamed, Priscah Hezeri, Hinabokiole Kama, Kate Mills, Shelley Walker, Norah Hau’ofa, Carmellina Amol, Madi Jones, Philipp du Cros, and Yi Dan Lin
- Subjects
virtual training ,online training ,training evaluation ,COVID-19 ,Papua New Guinea ,Medicine - Abstract
Background: Health worker training is an important component of a holistic outbreak response, and travel restrictions resulting from the COVID-19 pandemic have highlighted the potential of virtual training. Evaluation of training activities is essential for understanding the effectiveness of a training program on knowledge and clinical practice. We conducted an evaluation of the online COVID-19 Healthcare E-Learning Platform (CoHELP) in Papua New Guinea (PNG) to assess its effectiveness, measure engagement and completion rates, and determine barriers and enablers to implementation, in order to inform policy and practice for future training in resource-limited settings. Methods: The evaluation team conducted a mixed methods evaluation consisting of pre- and post-knowledge quizzes; quantification of engagement with the online platform; post-training surveys; qualitative interviews with training participants, non-participants, and key informants; and audits of six health facilities. Results: A total of 364 participants from PNG signed up to participate in the CoHELP online training platform, with 41% (147/360) completing at least one module. Of the 24 participants who completed the post-training survey, 92% (22/24) would recommend the program to others and 79% (19/24) had used the knowledge or skills gained through CoHELP in their clinical practice. Qualitative interviews found that a lack of time and infrastructural challenges were common barriers to accessing online training, and participants appreciated the flexibility of online, self-paced learning. Conclusions: Initially high registration numbers did not translate to ongoing engagement with the CoHELP online platform, particularly for completion of evaluation activities. Overall, the CoHELP program received positive feedback from participants involved in the evaluation, highlighting the potential for further online training courses in PNG.
- Published
- 2023
- Full Text
- View/download PDF
12. A case report of a child with probable drug resistant tuberculous pericarditis with a review of challenges involved in diagnosis, treatment and follow up of children with DR-TB pericarditis
- Author
-
Aravind Swaminathan, Philipp du Cros, Jay Achar, Jarmila Kliescikova, Shamsiya Mirgayosieva, and Bobojon Pirmahmadzoda
- Subjects
Case report ,Multi drug resistant tuberculosis ,Pericarditis ,paediatric ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background There are unique challenges in the diagnosis and management of multi drug resistant tuberculosis (MDR-TB) in children. It is difficult to obtain confirmatory microbiological diagnosis in TB pericarditis. It is essential to differentiate between drug sensitive and drug resistant forms of TB as it has a major bearing on the regimen used, and inappropriate TB treatment combined with steroid use for pericarditis can lead to deterioration. With lack of samples, the treatment decision relies on the drug resistance pattern of the close contact if available. Therapeutic challenges of MDR-TB management in a child involve use of toxic drugs that need to be judiciously handled. We report a 2 years 4 months old male child who was diagnosed with TB pericarditis and treated based on the resistance pattern of his mother who was on treatment for pulmonary MDR-TB. Case presentation This 2 years 4 months old male child was diagnosed with TB involving his pericardium. Getting him started on an appropriate regimen was delayed due to the difficulty in establishing microbiological confirmation and drug susceptibility. He was commenced on a regimen based on his mother’s drug resistance pattern and required surgery due to cardiac failure during the course of his treatment. He successfully completed 2 years of therapy. Conclusions This child’s case demonstrates that despite unique challenges in diagnosis and management of drug resistant extra pulmonary tuberculosis in children, treatment of even complex forms can be successful. The need for high suspicion of MDR-TB, especially when there is close contact with pulmonary TB, careful design of an effective regimen that is tolerated by the child, indications for invasive surgical management of pericarditis, appropriate follow-up and management of adverse effects are emphasised.
- Published
- 2020
- Full Text
- View/download PDF
13. Outcomes with a shorter multidrug-resistant tuberculosis regimen from Karakalpakstan, Uzbekistan
- Author
-
Philipp du Cros, Atadjan Khamraev, Zinaida Tigay, Tleubergen Abdrasuliev, Jane Greig, Graham Cooke, Krzysztof Herboczek, Tanya Pylypenko, Catherine Berry, Amrita Ronnachit, David Lister, Sebastian Dietrich, Cono Ariti, Khasan Safaev, Bern-Thomas Nyang'wa, Nargiza Parpieva, Mirzagalib Tillashaikhov, and Jay Achar
- Subjects
Medicine - Abstract
Background In 2016, World Health Organization guidelines conditionally recommended standardised shorter 9–12-month regimens for multidrug-resistant (MDR) tuberculosis (TB) treatment. We conducted a prospective study of a shorter standardised MDR-TB regimen in Karakalpakstan, Uzbekistan. Methods Consecutive adults and children with confirmed rifampicin-resistant pulmonary TB were enrolled between September 1, 2013 and March 31, 2015; exclusions included prior treatment with second-line anti-TB drugs, and documented resistance to ofloxacin or to two second-line injectable agents. The primary outcome was recurrence-free cure at 1 year following treatment completion. Results Of 146 enrolled patients, 128 were included: 67 female (52.3%), median age 30.1 (interquartile range 23.8–44.4) years. At the end of treatment, 71.9% (92 out of 128) of patients achieved treatment success, with 68% (87 out of 128) achieving recurrence-free cure at 1 year following completion. Unsuccessful outcomes during treatment included 22 (17.2%) treatment failures with fluoroquinolone-resistance amplification in 8 patients (8 out of 22, 36.4%); 12 (9.4%) lost to follow-up; and 2 (1.5%) deaths. Recurrence occurred in one patient. Fourteen patients (10.9%) experienced serious adverse events. Baseline resistance to both pyrazinamide and ethambutol (adjusted OR 6.13, 95% CI 2.01; 18.63) and adherence
- Published
- 2021
- Full Text
- View/download PDF
14. Bedaquiline overdose: A case report
- Author
-
Oleksandr Telnov, Veronica Alvarez, Elena Graglia, Lucas Molfino, Philipp du Cros, and Michael Rich
- Subjects
Infectious and parasitic diseases ,RC109-216 - Abstract
We present a case report describing outcomes in a 21 year old HIV-negative man who received treatment with bedaquiline. Due to error, dosage received comprised 4 pills of 100 mg every second day in the 60 days following the first two weeks of 4 pills of 100 mg every day. On detection, treatment was continued as per standard dosing of 200 mg given three times per week, with enhanced monitoring of ECG and liver function. The man was asymptomatic, with no signs of jaundice, abdominal pain, or abnormal heart rhythm. Toxic effects at this dosage were therefore not observed. Keywords: Tuberculosis, Bedaquiline, Adverse events, Therapeutic index, Tolerability
- Published
- 2019
- Full Text
- View/download PDF
15. Special Issue 'Innovation and Evidence for Achieving TB Elimination in the Asia-Pacific Region'
- Author
-
Philipp du Cros, Hamidah Hussain, and Kerri Viney
- Subjects
n/a ,Medicine - Abstract
The World Health Organization’s (WHO) END-TB strategy has set the world on course to climb the highest of medical mountains by 2035, with a targeted peak of reductions in TB deaths by 95%, TB cases by 90%, and no burden of catastrophic expenses on families due to TB [...]
- Published
- 2021
- Full Text
- View/download PDF
16. Peripheral neuropathy in a diabetic child treated with linezolid for multidrug-resistant tuberculosis: a case report and review of the literature
- Author
-
Aravind Swaminathan, Philipp du Cros, James A. Seddon, Shamsiya Mirgayosieva, Rajabov Asladdin, and Zulfiya Dusmatova
- Subjects
Case report ,Multi drug resistant tuberculosis ,Linezolid ,Neuropathy ,Diabetes mellitus ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Extensively drug-resistant (XDR) tuberculosis (TB) and multidrug resistant (MDR)-TB with additional resistance to injectable agents or fluoroquinolones are challenging to treat due to lack of available, effective drugs. Linezolid is one of the few drugs that has shown promise in treating these conditions. Long-term linezolid use is associated with toxicities such as peripheral and optic neuropathies. Diabetes mellitus (DM), especially when uncontrolled, can also result in peripheral neuropathy. The global burden of DM is increasing, and DM has been associated with a three-fold increased risk of developing TB disease. TB and DM can be a challenging combination to treat. DM can inhibit the host immune response to tuberculosis infection; and TB and some anti-TB drugs can worsen glycaemic control. A child experiencing neuropathy that is a possible complication of both DM and linezolid used to treat TB has not been reported previously. We report peripheral neuropathy in a 15-year-old boy with type 1 DM, diagnosed with MDR-TB and additional resistance to injectable TB medications. Case presentation The boy was treated with a linezolid-based regimen, but after 8 months developed peripheral neuropathy. It was unclear whether the neuropathy was caused by the DM or the linezolid therapy. He had clinical improvement following cessation of linezolid and was declared cured following 21 months of treatment. Following completion of treatment, nerve conduction studies demonstrated significant improvement in neuropathy. Conclusions To the best of our knowledge, this is the first case of peripheral neuropathy reported in a diabetic child on long-term linezolid therapy for tuberculosis. This case study underlines the importance of stringent follow-up for side effects of linezolid, especially when associated with co-morbidity such as DM that increases the chances of adverse effects. The presence of both DM and TB should alert a physician to strive for optimal glycaemic control to minimize the risk of complications as well as optimizing the chances of recovery from TB. Our case report shows the need for close and frequent monitoring for neuropathy to enable early intervention and thereby a favourable outcome in children who may otherwise suffer a long-lasting, debilitating, and painful neuropathy.
- Published
- 2017
- Full Text
- View/download PDF
17. Telemedicine in Resource-Limited Settings to Optimize Care for Multidrug-Resistant Tuberculosis
- Author
-
G. Khai Lin Huang, Gibson Pawape, Magdalene Taune, Stenard Hiasihri, Pilar Ustero, Daniel P. O'Brien, Philipp du Cros, Steve Graham, Richard Wootton, and Suman S. Majumdar
- Subjects
tuberculosis ,telemedicine ,multidrug-resistant ,resource-limited ,clinical expert group ,consilium ,Public aspects of medicine ,RA1-1270 - Abstract
The emergence and spread of multidrug-resistant tuberculosis (MDR-TB) poses a major threat to the global targets for TB control. In recent years, an evolving science and evidence base for MDR-TB has led to much needed changes in international guidelines promoting the use of newer TB drugs and regimens for MDR-TB, however, there remains a significant implementation gap. Due to the complexity of treating MDR-TB, management of cases is often supported by an expert multidisciplinary team, or clinical expert group. This service is often centralized, and may be delivered through a telemedicine platform. We have implemented a Web-based “store-and-forward” telemedicine service to optimize MDR-TB patient care in Daru, a remote and resource limited setting in Papua New Guinea (PNG). From April 2016 to February 2019, 237 cases were discussed using the service. This encompassed diagnostic (presumptive) and treatment cases, and more recently, support to the scale up of preventative therapy for latent TB infection. There were 75 cases in which the use of Bedaquiline was discussed or mentioned, with a high frequency of discussions occurring in the initial period (26 cases in the first 12 months), which has appeared to decrease as clinicians gained familiarity with use of the drug (15 cases in the last 12 months). This service has supported high quality clinical care and fostered collaboration between clinicians and technical experts in a shared learning environment.
- Published
- 2019
- Full Text
- View/download PDF
18. Off-Label Use of Bedaquiline in Children and Adolescents with Multidrug-Resistant Tuberculosis
- Author
-
Jay Achar, Cathy Hewison, Ana P. Cavalheiro, Alena Skrahina, Junia Cajazeiro, Parpieva Nargiza, Krzysztof Herboczek, Assliddin S. Rajabov, Jennifer Hughes, Gabriella Ferlazzo, James A. Seddon, and Philipp du Cros
- Subjects
MDR TB ,XDR TB ,pediatric ,treatment ,bedaquiline ,tuberculosis ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
We describe 27 children and adolescents
- Published
- 2017
- Full Text
- View/download PDF
19. Outcomes of HIV-infected versus HIV-non-infected patients treated for drug-resistance tuberculosis: Multicenter cohort study.
- Author
-
Mathieu Bastard, Elisabeth Sanchez-Padilla, Philipp du Cros, Atadjan Karimovich Khamraev, Nargiza Parpieva, Mirzagaleg Tillyashaykov, Armen Hayrapetyan, Kamene Kimenye, Shazina Khurkhumal, Themba Dlamini, Santiago Fadul Perez, Alex Telnov, Cathy Hewison, Francis Varaine, and Maryline Bonnet
- Subjects
Medicine ,Science - Abstract
The emergence of resistance to anti-tuberculosis (DR-TB) drugs and the HIV epidemic represent a serious threat for reducing the global burden of TB. Although data on HIV-negative DR-TB treatment outcomes are well published, few data on DR-TB outcomes among HIV co-infected people is available despite the great public health importance.We retrospectively reported and compared the DR-TB treatment outcomes of HIV-positive and HIV-negative patients treated with an individualized regimen based on WHO guidelines in seven countries: Abkhazia, Armenia, Colombia, Kenya, Kyrgyzstan, Swaziland and Uzbekistan.Of the 1,369 patients started DRTB treatment, 809 (59.1%) were multi-drug resistant (MDR-TB) and 418 (30.5%) were HIV-positive. HIV-positive patients were mainly from African countries (90.1%) while HIV-negative originated from Former Soviet Union (FSU) countries. Despite a higher case fatality rate (19.0% vs 9.4%), HIV-positive MDR-TB patients had a 10% higher success rate than HIV-negative patients (64.0% vs 53.2%, p = 0.007). No difference in treatment success was found among polydrug-resistant (PDR-TB) patients. Overall, lost to follow-up rate was much higher among HIV-negative (22.0% vs. 8.4%). Older age and not receiving ART were the only factors associated with unfavorable treatment outcome among HIV-positive patients.As already known for HIV-negative patients, success rate of DR-TB HIV-positive patients remains low and requires more effective DR-TB regimen using new drugs also suitable to HIV-infected patients on ART. The study also confirms the need of ART introduction in HIV co-infected patients.
- Published
- 2018
- Full Text
- View/download PDF
20. Principles for designing future regimens for multidrug-resistant tuberculosis
- Author
-
Grania Brigden, Bern-Thomas Nyang'wa, Philipp du Cros, Francis Varaine, Jennifer Hughes, Michael Rich, C Robert Horsburgh Jr, Carole D Mitnick, Eric Nuermberger, Helen McIlleron, Patrick PJ Phillips, and Manica Balasegaram
- Subjects
Public aspects of medicine ,RA1-1270 - Abstract
Fewer than 20% of patients with multidrug-resistant (MDR) tuberculosis are receiving treatment and there is an urgent need to scale up treatment programmes. One of the biggest barriers to scale-up is the treatment regimen, which is lengthy, complex, ineffective, poorly tolerated and expensive. For the first time in over 50 years, new drugs have been developed specifically to treat tuberculosis, with bedaquiline and potentially delamanid expected to be available soon for treatment of MDR cases. However, if the new drugs are merely added to the current treatment regimen, the new regimen will be at least as lengthy, cumbersome and toxic as the existing one. There is an urgent need for strategy and evidence on how to maximize the potential of the new drugs to improve outcomes and shorten treatment. We devised eight key principles for designing future treatment regimens to ensure that, once they are proven safe in clinical trials, they will be clinically effective and programmatically practicable. Regimens should contain at least one new class of drug; be broadly applicable for use against MDR and extensively drug-resistant Mycobacterium tuberculosis complex strains; contain three to five effective drugs, each from a different drug class; be delivered orally; have a simple dosing schedule; have a good side-effect profile that allows limited monitoring; last a maximum of 6 months; and have minimal interaction with antiretrovirals. Following these principles will maximize the potential of new compounds and help to overcome the clinical and programmatic disadvantages and scale-up constraints that plague the current regimen.
- Published
- 2014
- Full Text
- View/download PDF
21. Training for Tuberculosis Elimination in Indonesia: Achievements, Reflections, and Potential for Impact
- Author
-
Stephanie Main, Trisasi Lestari, Rina Triasih, Geoff Chan, Lisa Davidson, Suman Majumdar, Devy Santoso, Sieyin Phung, Janne Laukkala, Steve Graham, Philipp du Cros, and Anna Ralph
- Subjects
tuberculosis ,elimination ,health workforce ,capacity building ,training ,impact ,Medicine - Abstract
Indonesia has the third highest tuberculosis (TB) caseload internationally. A cornerstone for strengthening health systems to respond to TB is a well-trained workforce. In a partnership between Indonesian and Australian institutions, TB training was run during 2018 to strengthen the local capacity to meet End TB strategy targets. This paper aims to report on course design, delivery, training outcomes, and reflections. Seventy-six Indonesian healthcare workers, program staff, researchers, and policy-makers were selected from over 800 applicants. The structure comprised three trainings, each with a pre-course workshop (in Indonesia) to identify learning needs, a two-week block (Australia), and a post-course workshop (Indonesia). The training content delivered was a combination of TB technical knowledge and program/project theory, design, and logic, and the training utilised multiple teaching and learning methods. An innovative element of the training was participant-designed TB workplace projects focusing on context-specific priorities. Evaluation was undertaken using participant surveys and appraisal of the projects. Participants rated the course highly, while success in project implementation varied. Reflections include the importance of involving Indonesian experts in delivery of training, the need to understand participant learning requirements and adapt the training content accordingly, and the challenge of measuring tangible training outputs.
- Published
- 2019
- Full Text
- View/download PDF
22. Progress in Medicine: Experts Take Stock.
- Author
-
PLOS Medicine Editors, Andrew Beck, Ewan Birney, Manuel Graeber, James Tumwine, Phillipa Hay, Hyeong Sik Ahn, Anushka Patel, Philipp du Cros, Lorenz von Seidlein, Nick Wareham, and Nicola Low
- Subjects
Medicine - Abstract
In the year-end editorial, the PLOS Medicine editors ask 11 researchers and clinicians about the most relevant challenges, promising research, and important initiatives in their fields as we head into 2016.
- Published
- 2015
- Full Text
- View/download PDF
23. Generating Evidence to Improve the Response to Neglected Diseases: How Operational Research in a Médecins Sans Frontières Buruli Ulcer Treatment Programme Informed International Management Guidance.
- Author
-
Daniel P O'Brien, Nathan Ford, Marco Vitoria, Kingsley Asiedu, Alexandra Calmy, Philipp Du Cros, Eric Comte, and Vanessa Christinet
- Subjects
Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Published
- 2015
- Full Text
- View/download PDF
24. Multidrug-Resistant Tuberculosis in Child Successfully Treated with 9-Month Drug Regimen
- Author
-
Jay Achar, Catherine Berry, Krzysztof Herboczek, Nargiza Parpieva, Mirzagaleb N. Tillyashaykhov, Zinaida N. Tigay, Atadjan Khamraev, Kalyan Velivela, James A. Seddon, and Philipp du Cros
- Subjects
multidrug-resistant ,pediatric ,treatment ,bacteria ,TB ,tuberculosis ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Published
- 2015
- Full Text
- View/download PDF
25. 'I can also serve as an inspiration': a qualitative study of the TB&Me blogging experience and its role in MDR-TB treatment.
- Author
-
Shona Horter, Beverley Stringer, Sarah Venis, and Philipp du Cros
- Subjects
Medicine ,Science - Abstract
In 2011, Médecins Sans Frontières (MSF) established a blogging project, "TB&Me," to enable patients with multidrug-resistant tuberculosis (MDR-TB) to share their experiences. By September 2012, 13 MDR-TB patients had blogged, either directly or with assistance, from the UK, Australia, Philippines, Swaziland, Central African Republic, Uganda, South Africa, India, and Armenia. Due to the lack of research on the potential for social media to support MDR-TB treatment and the innovative nature of the blog, we decided to conduct a qualitative study to examine patient and staff experiences. Our aim was to identify potential risks and benefits associated with blogging to enable us to determine whether social media had a role to play in supporting patients with MDR-TB.Participants were identified and selected purposively. TB&Me bloggers, project staff, MSF headquarters staff involved with TB and WHO European Region TB policy advisors were invited to participate in a semi-structured interview. Twenty interviews were conducted (five with bloggers). Data analysis drew upon principles of grounded theory, with constant comparison of data, cases and categories, and attention to deviant cases. We found that the TB&Me blog was associated with identified health benefits, with no reported instances of harm. There were three main findings: blogging was reported as useful for adherence to DR-TB treatment and supportive of the treatment-taking process by all bloggers and project staff; blogging provided support to patients (peer support, shared experience and reduction in isolation); and the blog was perceived as giving patients strength and voice.The TB&Me blog was seen to be associated with positive identified health and emotional benefits. Component 5 of the Stop TB Global Plan highlights the importance of empowering TB patients and communities. Blogging could be a useful tool to help achieve that ambition.
- Published
- 2014
- Full Text
- View/download PDF
26. Impact of HIV-associated conditions on mortality in people commencing anti-retroviral therapy in resource limited settings.
- Author
-
Catherine S Marshall, Andrea J Curtis, Tim Spelman, Daniel P O'Brien, Jane Greig, Leslie Shanks, Philipp du Cros, Esther C Casas, Marcio Silveira da Fonseca, Eugene Athan, and Julian H Elliott
- Subjects
Medicine ,Science - Abstract
OBJECTIVES: To identify associations between specific WHO stage 3 and 4 conditions diagnosed after ART initiation and all cause mortality for patients in resource-limited settings (RLS). DESIGN, SETTING: Analysis of routine program data collected prospectively from 25 programs in eight countries between 2002 and 2010. SUBJECTS, PARTICIPANTS: 36,664 study participants with median ART follow-up of 1.26 years (IQR 0.55-2.27). OUTCOME MEASURES: Using a proportional hazards model we identified factors associated with mortality, including the occurrence of specific WHO clinical stage 3 and 4 conditions during the 6-months following ART initiation. RESULTS: There were 2922 deaths during follow-up (8.0%). The crude mortality rate was 5.41 deaths per 100 person-years (95% CI: 5.21-5.61). The diagnosis of any WHO stage 3 or 4 condition during the first 6 months of ART was associated with increased mortality (HR: 2.21; 95% CI: 1.97-2.47). After adjustment for age, sex, region and pre-ART CD4 count, a diagnosis of extrapulmonary cryptococcosis (aHR: 3.54; 95% CI: 2.74-4.56), HIV wasting syndrome (aHR: 2.92; 95%CI: 2.21 -3.85), non-tuberculous mycobacterial infection (aHR: 2.43; 95% CI: 1.80-3.28) and Pneumocystis pneumonia (aHR: 2.17; 95% CI 1.80-3.28) were associated with the greatest increased mortality. Cerebral toxoplasmosis, pulmonary and extra-pulmonary tuberculosis, Kaposi's sarcoma and oral and oesophageal candidiasis were associated with increased mortality, though at lower rates. CONCLUSIONS: A diagnosis of certain WHO stage 3 and 4 conditions is associated with an increased risk of mortality in those initiating ART in RLS. This information will assist initiatives to reduce excess mortality, including prioritization of resources for diagnostics, therapeutic interventions and research.
- Published
- 2013
- Full Text
- View/download PDF
27. Risk factors associated with default from multi- and extensively drug-resistant tuberculosis treatment, Uzbekistan: a retrospective cohort analysis.
- Author
-
Maeve K Lalor, Jane Greig, Sholpan Allamuratova, Sandy Althomsons, Zinaida Tigay, Atadjan Khaemraev, Kai Braker, Oleksander Telnov, and Philipp du Cros
- Subjects
Medicine ,Science - Abstract
BACKGROUND: The Médecins Sans Frontières project of Uzbekistan has provided multidrug-resistant tuberculosis treatment in the Karakalpakstan region since 2003. Rates of default from treatment have been high, despite psychosocial support, increasing particularly since programme scale-up in 2007. We aimed to determine factors associated with default in multi- and extensively drug-resistant tuberculosis patients who started treatment between 2003 and 2008 and thus had finished approximately 2 years of treatment by the end of 2010. METHODS: A retrospective cohort analysis of multi- and extensively drug-resistant tuberculosis patients enrolled in treatment between 2003 and 2008 compared baseline demographic characteristics and possible risk factors for default. Default was defined as missing ≥60 consecutive days of treatment (all drugs). Data were routinely collected during treatment and entered in a database. Potential risk factors for default were assessed in univariate analysis using chi-square test and in multivariate analysis with logistic regression. RESULTS: 20% (142/710) of patients defaulted after a median of 6 months treatment (IQR 2.6-9.9). Factors associated with default included severity of resistance patterns (pre-extensively drug-resistant/extensively drug-resistant tuberculosis adjusted odds ratio 0.52, 95%CI: 0.31-0.86), previous default (2.38, 1.09-5.24) and age >45 years (1.77, 1.10-2.87). The default rate was 14% (42/294) for patients enrolled 2003-2006 and 24% (100/416) for 2007-2008 enrolments (p = 0.001). CONCLUSIONS: Default from treatment was high and increased with programme scale-up. It is essential to ensure scale-up of treatment is accompanied with scale-up of staff and patient support. A successful first course of tuberculosis treatment is important; patients who had previously defaulted were at increased risk of default and death. The protective effect of severe resistance profiles suggests that understanding disease severity or fear may motivate against default. Targeted health education and support for at-risk patients after 5 months of treatment when many begin to feel better may decrease default.
- Published
- 2013
- Full Text
- View/download PDF
28. Association of BMI category change with TB treatment mortality in HIV-positive smear-negative and extrapulmonary TB patients in Myanmar and Zimbabwe.
- Author
-
Lenka Benova, Katherine Fielding, Jane Greig, Bern-Thomas Nyang'wa, Esther Carrillo Casas, Marcio Silveira da Fonseca, and Philipp du Cros
- Subjects
Medicine ,Science - Abstract
The HIV epidemic has increased the proportion of patients with smear-negative and extrapulmonary tuberculosis (TB) diagnoses, with related higher rates of poor TB treatment outcomes. Unlike in smear-positive pulmonary TB, no interim markers of TB treatment progress are systematically used to identify individuals most at risk of mortality. The objective of this study was to assess the association of body mass index (BMI) change at 1 month (±15 days) from TB treatment start with mortality among HIV-positive individuals with smear-negative and extrapulmonary TB.A retrospective cohort study of adult HIV-positive new TB patients in Médecins Sans Frontières (MSF) treatment programmes in Myanmar and Zimbabwe was conducted using Cox proportional hazards regression to estimate the association between BMI category change and mortality. A cohort of 1090 TB patients (605 smear-negative and 485 extrapulmonary) was followed during TB treatment with mortality rate of 28.9 per 100 person-years. In multivariable analyses, remaining severely underweight or moving to a lower BMI category increased mortality (adjusted hazard ratio 4.05, 95% confidence interval 2.77-5.91, p
- Published
- 2012
- Full Text
- View/download PDF
29. Incidence of WHO stage 3 and 4 conditions following initiation of anti-retroviral therapy in resource limited settings.
- Author
-
Andrea J Curtis, Catherine S Marshall, Tim Spelman, Jane Greig, Julian H Elliot, Leslie Shanks, Philipp Du Cros, Esther C Casas, Marcio Silveria Da Fonseca, and Daniel P O'Brien
- Subjects
Medicine ,Science - Abstract
OBJECTIVES: To determine the incidence of WHO clinical stage 3 and 4 conditions during early anti-retroviral therapy (ART) in resource limited settings (RLS). DESIGN/SETTING: A descriptive analysis of routine program data collected prospectively from 25 Médecins Sans Frontières supported HIV treatment programs in eight countries between 2002 and 2010. SUBJECTS/PARTICIPANTS: 35,349 study participants with median follow-up on ART of 1.33 years (IQR 0.51-2.41). OUTCOME MEASURES: Incidence in 100 person-years of WHO stage 3 or 4 conditions during 5 periods after ART initiation. Diagnoses of conditions were made according to WHO criteria and relied upon clinical assessments supported by basic laboratory investigations. RESULTS: The incidence of any WHO clinical stage 3 or 4 condition over 3 years was 40.02 per 100 person-years (31.77 for stage 3 and 8.25 for stage 4). The incidence of stage 3 and 4 conditions fell by over 97% between months 0-3 and months 25-36 (77.81 to 2.40 for stage 3 and 28.70 to 0.64 for stage 4). During months 0-3 pulmonary tuberculosis was the most common condition diagnosed in adults (incidence 22.24 per 100 person-years) and children aged 5-14 years (25.76) and oral candidiasis was the most common in children
- Published
- 2012
- Full Text
- View/download PDF
30. Counting children: comparing reporting for paediatric HIV and tuberculosis
- Author
-
Philipp du Cros, Bern-Thomas Nyang'wa, Marianne Gale, Sarah Venis, and Nathan Ford
- Subjects
Public aspects of medicine ,RA1-1270 - Published
- 2011
31. Evaluation of an Online Training Program on COVID-19 for Health Workers in Papua New Guinea
- Author
-
Lin, Yasmin Mohamed, Priscah Hezeri, Hinabokiole Kama, Kate Mills, Shelley Walker, Norah Hau’ofa, Carmellina Amol, Madi Jones, Philipp du Cros, and Yi Dan
- Subjects
virtual training ,online training ,training evaluation ,COVID-19 ,Papua New Guinea - Abstract
Background: Health worker training is an important component of a holistic outbreak response, and travel restrictions resulting from the COVID-19 pandemic have highlighted the potential of virtual training. Evaluation of training activities is essential for understanding the effectiveness of a training program on knowledge and clinical practice. We conducted an evaluation of the online COVID-19 Healthcare E-Learning Platform (CoHELP) in Papua New Guinea (PNG) to assess its effectiveness, measure engagement and completion rates, and determine barriers and enablers to implementation, in order to inform policy and practice for future training in resource-limited settings. Methods: The evaluation team conducted a mixed methods evaluation consisting of pre- and post-knowledge quizzes; quantification of engagement with the online platform; post-training surveys; qualitative interviews with training participants, non-participants, and key informants; and audits of six health facilities. Results: A total of 364 participants from PNG signed up to participate in the CoHELP online training platform, with 41% (147/360) completing at least one module. Of the 24 participants who completed the post-training survey, 92% (22/24) would recommend the program to others and 79% (19/24) had used the knowledge or skills gained through CoHELP in their clinical practice. Qualitative interviews found that a lack of time and infrastructural challenges were common barriers to accessing online training, and participants appreciated the flexibility of online, self-paced learning. Conclusions: Initially high registration numbers did not translate to ongoing engagement with the CoHELP online platform, particularly for completion of evaluation activities. Overall, the CoHELP program received positive feedback from participants involved in the evaluation, highlighting the potential for further online training courses in PNG.
- Published
- 2023
- Full Text
- View/download PDF
32. Counting children: comparing reporting for paediatric HIV and tuberculosis
- Author
-
Philipp du Cros, Bern-Thomas Nyang'wa, Marianne Gale, Sarah Venis, and Nathan Ford
- Subjects
Public aspects of medicine ,RA1-1270 - Full Text
- View/download PDF
33. A 24-Week, All-Oral Regimen for Rifampin-Resistant Tuberculosis
- Author
-
Bern-Thomas, Nyang'wa, Catherine, Berry, Emil, Kazounis, Ilaria, Motta, Nargiza, Parpieva, Zinaida, Tigay, Varvara, Solodovnikova, Irina, Liverko, Ronelle, Moodliar, Matthew, Dodd, Nosipho, Ngubane, Mohammed, Rassool, Timothy D, McHugh, Melvin, Spigelman, David A J, Moore, Koert, Ritmeijer, Philipp, du Cros, Katherine, Fielding, and Emma, Veitch
- Subjects
Moxifloxacin ,Tuberculosis, Multidrug-Resistant ,Antitubercular Agents ,Humans ,Drug Therapy, Combination ,General Medicine ,Rifampin ,Tuberculosis, Pulmonary - Abstract
In patients with rifampin-resistant tuberculosis, all-oral treatment regimens that are more effective, shorter, and have a more acceptable side-effect profile than current regimens are needed.We conducted an open-label, phase 2-3, multicenter, randomized, controlled, noninferiority trial to evaluate the efficacy and safety of three 24-week, all-oral regimens for the treatment of rifampin-resistant tuberculosis. Patients in Belarus, South Africa, and Uzbekistan who were 15 years of age or older and had rifampin-resistant pulmonary tuberculosis were enrolled. In stage 2 of the trial, a 24-week regimen of bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) was compared with a 9-to-20-month standard-care regimen. The primary outcome was an unfavorable status (a composite of death, treatment failure, treatment discontinuation, loss to follow-up, or recurrence of tuberculosis) at 72 weeks after randomization. The noninferiority margin was 12 percentage points.Recruitment was terminated early. Of 301 patients in stage 2 of the trial, 145, 128, and 90 patients were evaluable in the intention-to-treat, modified intention-to-treat, and per-protocol populations, respectively. In the modified intention-to-treat analysis, 11% of the patients in the BPaLM group and 48% of those in the standard-care group had a primary-outcome event (risk difference, -37 percentage points; 96.6% confidence interval [CI], -53 to -22). In the per-protocol analysis, 4% of the patients in the BPaLM group and 12% of those in the standard-care group had a primary-outcome event (risk difference, -9 percentage points; 96.6% CI, -22 to 4). In the as-treated population, the incidence of adverse events of grade 3 or higher or serious adverse events was lower in the BPaLM group than in the standard-care group (19% vs. 59%).In patients with rifampin-resistant pulmonary tuberculosis, a 24-week, all-oral regimen was noninferior to the accepted standard-care treatment, and it had a better safety profile. (Funded by Médecins sans Frontières; TB-PRACTECAL ClinicalTrials.gov number, NCT02589782.).
- Published
- 2022
34. Prevalence of and risk factors for Tuberculosis among health care workers in Yogyakarta, Indonesia
- Author
-
Stephanie Main, Rina Triasih, Jane Greig, Arif Hidayat, Immanuel Billy Brilliandi, Syarifah Khodijah, Geoff Chan, Nova Wilks, Amy Elizabeth Parry, Betty Nababan, Philipp du Cros, and Bintari Dwihardiani
- Abstract
BackgroundHealthcare workers (HCWs) are at risk of contracting TB, particularly when in high tuberculosis (TB) burden settings. Routine surveillance data and evidence are limited on the burden of TB amongst HCWs in Indonesia.ObjectiveTo measure the prevalence of TB infection (TBI) and disease among HCWs in four healthcare facilities in Yogyakarta and explore risk factors for TBI.MethodsA cross-sectional TB screening study targeted all HCWs from four pre-selected facilities (1 hospital, 3 primary care) in Yogyakarta, Indonesia. Voluntary screening included symptom assessment, Chest X-ray (CXR), Xpert MTB/RIF (if indicated) and tuberculin skin test (TST). Analyses were descriptive and included multivariable logistic regression.ResultsOf 792 HCWs, 681 consented (86%) to the screening; 59% (n=401) were female, 62% were medical staff (n=421), 77% worked in the one participating hospital (n=524), and the median time working in the health sector was 13 years (IQR: 6-25 years). Nearly half had provided services for people with TB (46%, n=316) and 9% reported ever having TB (n=60).Among participants with presumptive TB (15%, n=99/662), none were diagnosed microbiologically or clinically with active TB disease. TBI was detected in 25% (95% CI: 22-30; n=112/441) of eligible HCWs with a TST result. A significant association was found between TB infection and being male (adjusted Odds Ratio (aOR) 2.02 (95%CI: 1.29-3.17)), currently working in the participating hospital compared to primary care (aOR 3.15 (95%CI: 1.75-5.66)), and older age (1.05 OR increase per year of life between 19-73 years (95%CI: 1.02-1.06)).ConclusionThis study supports prioritisation of HCWs as a high-risk group for TB infection and disease, and the need for comprehensive prevention and control programs in Indonesia. Further, it identifies characteristics of HCWs in Yogyakarta at higher risk of TBI, who could be prioritised in screening programs if universal coverage of prevention and control measures cannot be achieved.
- Published
- 2022
35. Evolution and spread of a highly drug resistant strain of Mycobacterium tuberculosis in Papua New Guinea
- Author
-
Arnold Bainomugisa, Evelyn Lavu, Sushil Pandey, Suman Majumdar, Jennifer Banamu, Chris Coulter, Ben Marais, Lachlan Coin, Stephen M. Graham, and Philipp du Cros
- Subjects
Papua New Guinea ,Infectious Diseases ,Drug Resistance, Multiple, Bacterial ,Mutation ,Tuberculosis, Multidrug-Resistant ,Antitubercular Agents ,Humans ,Microbial Sensitivity Tests ,Mycobacterium tuberculosis ,Tuberculosis, Lymph Node ,Noncommunicable Diseases ,Phylogeny - Abstract
Background Molecular mechanisms determining the transmission and prevalence of drug resistant tuberculosis (DR-TB) in Papua New Guinea (PNG) are poorly understood. We used genomic and drug susceptibility data to explore the evolutionary history, temporal acquisition of resistance and transmission dynamics of DR-TB across PNG. Methods We performed whole genome sequencing on isolates from Central Public Health Laboratory, PNG, collected 2017–2019. Data analysis was done on a composite dataset that also included 100 genomes previously sequenced from Daru, PNG (2012–2015). Results Sampled isolates represented 14 of the 22 PNG provinces, the majority (66/94; 70%) came from the National Capital District (NCD). In the composite dataset, 91% of strains were Beijing 2.2.1.1, identified in 13 provinces. Phylogenetic tree of Beijing strains revealed two clades, Daru dominant clade (A) and NCD dominant clade (B). Multi-drug resistance (MDR) was repeatedly and independently acquired, with the first MDR cases in both clades noted to have emerged in the early 1990s, while fluoroquinolone resistance emerged in 2009 (95% highest posterior density 2000–2016). We identified the presence of a frameshift mutation within Rv0678 (p.Asp47fs) which has been suggested to confer resistance to bedaquiline, despite no known exposure to the drug. Overall genomic clustering was significantly associated with rpoC compensatory and inhA promoter mutations (p Conclusions The acquisition and evolution of drug resistance among the major clades of Beijing strain threaten the success of DR-TB treatment in PNG. With continued transmission of this strain in PNG, genotypic drug resistance surveillance using whole genome sequencing is essential for improved public health response to outbreaks. With occurrence of resistance to newer drugs such as bedaquiline, knowledge of full drug resistance profiles will be important for optimal treatment selection.
- Published
- 2021
36. Tb-practecal: Study Protocol for a Randomised, Controlled, Open-label, Phase II-III Trial to Evaluate the Safety and Efficacy of Regimens Containing Bedaquiline and Pretomanid for the Treatment of Adult Patients With Pulmonary Multidrug Resistant Tuberculosis
- Author
-
Catherine Berry, Philipp du Cros, Katherine Fielding, Suzanne Gajewski, Emil Kazounis, Timothy D McHugh, Corinne Merle, Ilaria Motta, David AJ Moore, and Bern-Thomas Nyang'wa
- Abstract
BackgroundGlobally rifampicin-resistant tuberculosis disease affects around 460 000 people each year. Current recommended regimens are 9-24 months duration, have poor efficacy and carry significant toxicity. A shorter, less toxic and more efficacious regimen would improve outcomes for people with rifampicin-resistant tuberculosis. MethodsTB-PRACTECAL is an open-label, randomised, controlled, phase II/III non-inferiority trial evaluating the safety and efficacy of 24 week regimens containing bedaquiline and pretomanid to treat rifampicin resistant tuberculosis. Conducted in Uzbekistan, South Africa and Belarus, patients aged 15 and above with rifampicin resistant pulmonary tuberculosis and requiring a new course of therapy are eligible for inclusion irrespective of HIV status. In the first stage, equivalent to a phase IIB trial, patients are randomly assigned one of four regimens, stratified by site. Investigational regimens include oral bedaquiline, pretomanid and linezolid. Additionally, two of the regimens also include moxifloxacin (arm 1) and clofazimine (arm 2) respectively. Treatment is administered under direct observation for 24 weeks in investigational arms and 36 to 96 weeks in the standard of care arm. The second stage of the study is equivalent to a phase III trial, investigating the safety and efficacy of the most promising regimen/s. The primary outcome is the percentage of unfavourable outcomes at 72 weeks post randomisation. This is a composite of early treatment discontinuation, treatment failure, recurrence, lost to follow up and death. The study is conducted in accordance with ICH-GCP and full ethical approval was obtained from Médecins sans Frontières ethical review board, London School of Hygiene and Tropical Medicine ethical review board as well as ERBs and regulatory authorities at each site. DiscussionTB-PRACTECAL is an ambitious trial using adaptive design to accelerate regimen assessment and bring novel regimens that are effective and safe to patients quicker. The trial took a patient-centred approach, adapting to best practice guidelines throughout recruitment. The implementation faced significant challenges from the COVID-19 pandemic. The trial was terminated early for efficacy on the advice of the DSMB and will report on data collected up to end of recruitment and additionally, the planned final analysis at 72 weeks after end of recruitment. Trial registrationClinicaltrials.gov registration number NCT02589782
- Published
- 2021
37. Estimating the Burden of SARS-CoV-2 among the Rohingya Refugees
- Author
-
Andrew S. Azman, Paul Spiegel, Lori Niehaus, Shaun A. Truelove, Natalya Kostandova, Chiara Altare, V. Bhargavi Rao, Julianna Smith, Sonia A Hegde, and Philipp du Cros
- Subjects
education.field_of_study ,business.industry ,Refugee ,Incidence (epidemiology) ,Population ,Outbreak ,law.invention ,Transmission (mechanics) ,law ,Community health ,Pandemic ,Medicine ,Infection control ,education ,business ,Demography - Abstract
BackgroundSince the emergence of the COVID-19 pandemic, substantial concern has surrounded its impact among the Rohingya refugees living in the Kutupalong-Balukhali refugee camps in Bangladesh. Early modeling work projected a massive outbreak was likely after an introduction of the SARS-CoV-2 virus into the camps. Despite this, only 317 laboratory-confirmed cases and 10 deaths were reported through October 2020. While these official numbers portray a situation where the virus has been largely controlled, other sources contradict this, suggesting the low reported numbers to be a result of limited care seeking and testing, highlighting a population not willing to seek care or be tested. SARS-CoV-2 seroprevalence estimates from similar a timeframe in India (57%) and Bangladesh (74%) further sow doubt that transmission had been controlled. Here we explore multiple data sources to understand the plausibility of a much larger SARS-CoV-2 outbreak among the Rohingya refugees.MethodsWe used a mixed approach to analyze SARS-CoV-2 transmission using multiple available datasets. Using data from reported testing, cases, and deaths from the World Health Organization (WHO) and from WHO’s Emergency Warning, Alert, and Response System, we characterized the probabilities of care seeking, testing, and being positive if tested. Unofficial death data, including reported pre-death symptoms, come from a community-based mortality survey conducted by the International Organization for Migration (IOM),) in addition to community health worker reported deaths. We developed a probabilistic inference framework, drawing on these data sources, to explore three scenarios of what might have happened among the Rohingya refugees.ResultsAmong the 144 survey-identified deaths, 48 were consistent with suspected COVID-19. These deaths were consistent with viral exposures during Ramadan, a period of increased social contacts, and coincided with a spike in reported cases and testing positivity in June 2020. The age profile of suspected COVID-19 deaths mirrored that expected. Through the probability framework, we find that under each scenario, a substantial outbreak likely occurred, though the cumulative size and timing vary considerably. In conjunction with the reported and suspected deaths, the data suggest a large outbreak could have occurred early during spring 2020. Furthermore, while many mild and asymptomatic infections likely occurred, death data analyzed suggest there may have been significant unreported mortality.ConclusionsWith the high population density, inability to home isolate adequately, and limited personal protective equipment, infection prevention and control in the Rohingya population is extremely challenging. Despite the low reported numbers of cases and deaths, our results suggest an early large-scale outbreak is consistent with multiple sources of data, particularly when accounting for limited care seeking behavior and low infection severity among this young population. While the currently available data do not allow us to estimate the precise incidence, these results indicate substantial unrecognized SARS-CoV-2 transmission may have occurred in these camps. However, until serological testing provides more conclusive evidence, we are only able to speculate about the extent of transmission among the Rohingya.
- Published
- 2021
38. Beyond the bubble: neighbours helping neighbours
- Author
-
Yi Dan Lin, Jane Greig, Stenard Hiasihri, Philipp du Cros, and Evelyn Lavu
- Subjects
2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Bubble ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Internal Medicine ,Medicine ,business ,Virology - Published
- 2021
39. Outcomes with a shorter multidrug-resistant tuberculosis regimen from Karakalpakstan, Uzbekistan
- Author
-
Graham S Cooke, Philipp du Cros, Cono Ariti, Krzysztof Herboczek, Tanya Pylypenko, Amrita Ronnachit, Atadjan Khamraev, Jay Achar, Zinaida Tigay, Sebastian Dietrich, David Lister, Nargiza Parpieva, Khasan Safaev, Catherine C. Berry, Bern-Thomas Nyang'wa, Tleubergen Abdrasuliev, Mirzagalib Tillashaikhov, Jane Greig, Medicins sans Frontiers (UK), and National Institute for Health Research
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Tuberculosis ,business.industry ,lcsh:R ,lcsh:Medicine ,Original Articles ,Pyrazinamide ,medicine.disease ,Regimen ,Internal medicine ,medicine ,Ethionamide ,Ofloxacin ,Adverse effect ,Prospective cohort study ,business ,Ethambutol ,medicine.drug - Abstract
Background In 2016, World Health Organization guidelines conditionally recommended standardised shorter 9–12-month regimens for multidrug-resistant (MDR) tuberculosis (TB) treatment. We conducted a prospective study of a shorter standardised MDR-TB regimen in Karakalpakstan, Uzbekistan. Methods Consecutive adults and children with confirmed rifampicin-resistant pulmonary TB were enrolled between September 1, 2013 and March 31, 2015; exclusions included prior treatment with second-line anti-TB drugs, and documented resistance to ofloxacin or to two second-line injectable agents. The primary outcome was recurrence-free cure at 1 year following treatment completion. Results Of 146 enrolled patients, 128 were included: 67 female (52.3%), median age 30.1 (interquartile range 23.8–44.4) years. At the end of treatment, 71.9% (92 out of 128) of patients achieved treatment success, with 68% (87 out of 128) achieving recurrence-free cure at 1 year following completion. Unsuccessful outcomes during treatment included 22 (17.2%) treatment failures with fluoroquinolone-resistance amplification in 8 patients (8 out of 22, 36.4%); 12 (9.4%) lost to follow-up; and 2 (1.5%) deaths. Recurrence occurred in one patient. Fourteen patients (10.9%) experienced serious adverse events. Baseline resistance to both pyrazinamide and ethambutol (adjusted OR 6.13, 95% CI 2.01; 18.63) and adherence, A standardised shorter MDR-TB regimen observational study in Uzbekistan showed moderate success, but high treatment failure with significant risk of amplification of fluoroquinolone resistance https://bit.ly/3o8vfJz
- Published
- 2020
40. A case report of a child with probable drug resistant tuberculous pericarditis with a review of challenges involved in diagnosis, treatment and follow up of children with DR-TB pericarditis
- Author
-
Jarmila Kliescikova, Philipp du Cros, Aravind Swaminathan, Bobojon Pirmahmadzoda, Jay Achar, and Shamsiya Mirgayosieva
- Subjects
Male ,Drug ,medicine.medical_specialty ,Pericarditis ,paediatric ,media_common.quotation_subject ,Antitubercular Agents ,Case Report ,Drug resistance ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,0302 clinical medicine ,Medical microbiology ,Tuberculosis, Multidrug-Resistant ,medicine ,Humans ,lcsh:RC109-216 ,Multi drug resistant tuberculosis ,030212 general & internal medicine ,Intensive care medicine ,Adverse effect ,media_common ,business.industry ,Tuberculous pericarditis ,Multi-drug-resistant tuberculosis ,Mycobacterium tuberculosis ,Pericarditis, Tuberculous ,medicine.disease ,Regimen ,Infectious Diseases ,030228 respiratory system ,Child, Preschool ,business ,Follow-Up Studies - Abstract
Background There are unique challenges in the diagnosis and management of multi drug resistant tuberculosis (MDR-TB) in children. It is difficult to obtain confirmatory microbiological diagnosis in TB pericarditis. It is essential to differentiate between drug sensitive and drug resistant forms of TB as it has a major bearing on the regimen used, and inappropriate TB treatment combined with steroid use for pericarditis can lead to deterioration. With lack of samples, the treatment decision relies on the drug resistance pattern of the close contact if available. Therapeutic challenges of MDR-TB management in a child involve use of toxic drugs that need to be judiciously handled. We report a 2 years 4 months old male child who was diagnosed with TB pericarditis and treated based on the resistance pattern of his mother who was on treatment for pulmonary MDR-TB. Case presentation This 2 years 4 months old male child was diagnosed with TB involving his pericardium. Getting him started on an appropriate regimen was delayed due to the difficulty in establishing microbiological confirmation and drug susceptibility. He was commenced on a regimen based on his mother’s drug resistance pattern and required surgery due to cardiac failure during the course of his treatment. He successfully completed 2 years of therapy. Conclusions This child’s case demonstrates that despite unique challenges in diagnosis and management of drug resistant extra pulmonary tuberculosis in children, treatment of even complex forms can be successful. The need for high suspicion of MDR-TB, especially when there is close contact with pulmonary TB, careful design of an effective regimen that is tolerated by the child, indications for invasive surgical management of pericarditis, appropriate follow-up and management of adverse effects are emphasised.
- Published
- 2020
41. Programmatic versus personalised approaches to managing the global epidemic of multidrug-resistant tuberculosis
- Author
-
Alimuddin Zumla, Seyed Ehtesham Hasnain, Jeremiah Chakaya, Philipp du Cros, Sayoki Mfinanga, Ruvandhi R. Nathavitharana, Ben J. Marais, Francine Ntoumi, and Nathan Kapata
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Tuberculosis ,biology ,National Health Programs ,business.industry ,Transmission (medicine) ,Public health ,Antitubercular Agents ,Drug resistance ,Mycobacterium tuberculosis ,biology.organism_classification ,medicine.disease ,Global Health ,Multiple drug resistance ,Tuberculosis, Multidrug-Resistant ,Global health ,Medicine ,Humans ,Rural area ,Precision Medicine ,business ,Intensive care medicine ,Epidemics - Abstract
The push to end tuberculosis as a global public health threat received a major boost from the first UN General Assembly high-level meeting on tuberculosis in 2018.1 To end tuberculosis by 2035, however, hurdles need to be overcome in detection, provision of care, and treatment of drug-resistant tuberculosis. In 2018, an estimated 500 000 people had rifampicin-resistant (RR) tuberculosis, of whom 78% had multidrug-resistant (MDR) tuberculosis.2 Prevalence of RR or MDR tuberculosis is higher in people who have previously been treated than in those who have never had tuberculosis treatment.3 Care cascade analyses show major gaps in the continuum of care from diagnosis to treatment completion for individuals with RR or MDR tuberculosis. The current global treatment success rate of RR or MDR tuberculosis is unacceptably low at 56%,3 and patients in rural areas are probably at an increased risk of poor outcomes.4 These constraints continue to fuel the ongoing transmission of RR and MDR tuberculosis as well as the emergence of additional drug resistance.
- Published
- 2020
42. Performance of The Truenat Tuberculosis and Rifampicin-Resistance Assays in the Microscopy Centre: A Prospective Multicentre Diagnostic Accuracy Study
- Author
-
Adam Penn-Nicholson, Sivaramakrishnan N. Gomathi, César Ugarte-Gil, Abyot Meaza, Evelyn Lavu, Pranav Patel, Bandana Choudhury, Camilla Rodrigues, Sarabjit Chadha, Mubin Kazi, Aurélien Macé, Pamela Nabeta, Catharina Boehme, Raman R. Gangakhedkar, Sanjay Sarin, Ephrem Tesfaye, Eduardo Gotuzzo, Philipp du Cros, Srikanth Tripathy, Morten Ruhwald, Manjula Singh, Claudia M. Denkinger, Samuel G. Schumacher, and Truenat Trial Consortium Group
- Subjects
medicine.medical_specialty ,Tuberculosis ,biology ,business.industry ,Diagnostic accuracy ,Rifampicin resistance ,biology.organism_classification ,medicine.disease ,Helsinki declaration ,Mycobacterium tuberculosis ,Clinical trial ,Informed consent ,Internal medicine ,medicine ,business ,Rifampicin ,medicine.drug - Abstract
Background: Bringing reliable and accurate tuberculosis (TB) diagnosis closer to patients is a key priority for global TB control. Molbio Diagnostics have developed the Truenat point-of-care molecular assays for detection of TB and rifampicin (RIF) resistance. Methods: We conducted a prospective multicentre study at 19 microscopy centres and seven reference laboratories in Peru, India, Ethiopia and Papua New Guinea to determine the diagnostic accuracy of the Truenat MTB, MTB Plus and MTB-RIF Dx assays in comparison with Xpert MTB/RIF (‘Xpert’) and Xpert MTB/RIF Ultra (‘Ultra’) using culture as the reference standard (NCT03712709). Findings: Of 1,807 enrolled participants with TB signs/symptoms, 24% were culture positive for Mycobacterium tuberculosis , of which 15% were RIF-resistant by phenotypic drug sensitivity testing. In microscopy centres, the pooled sensitivity of Truenat MTB and Truenat MTB Plus was 73% [95% CI: 67, 78] and 80% [95% CI: 75, 84], respectively. Among smear-negative specimens, sensitivities were 36% [95% CI: 27, 47] and 47% [95% CI: 37, 58], respectively. Specificity of Truenat MTB and MTB Plus was 98% [95% CI: 97, 99] and 96% [95% CI: 95, 97], respectively. Sensitivity of Truenat MTB-RIF was 84% [95% CI: 62, 95], and specificity was 95% [95% CI: 90, 97]. Interpretation: Truenat assays have comparable accuracy with Xpert and can be performed in microscopy centres and primary health centres. Funding Statement: Bill & Melinda Gates Foundation (OPP1208706), India TB Research Consortium, Indian Council for Medical Research, Australian Department of Foreign Affairs and Trade via the PNGAus Partnership, and German KfW. Declaration of Interests: APN, AMa, CMd, MR, PN and SGS are employed by the Foundation for Innovative New Diagnostics (FIND). FIND is a not-for-profit foundation that supports the evaluation of publicly prioritized tuberculosis assays and the implementation of WHO-approved (guidance and prequalification) assays using donor grants. FIND has product evaluation agreements with several private sector companies that design diagnostics for tuberculosis and other diseases. These agreements strictly define FIND's independence and neutrality with regard to these private sector companies. All other authors have nothing to declare. Ethics Approval Statement: The study was conducted in accordance with the 1964 Helsinki declaration and its subsequent amendments and approved by the relevant institutional review boards and independent ethics committees. All participants provided informed consent, either written, or if illiterate, as a thumbprint on the consent form signed and dated by an impartial witness.
- Published
- 2020
43. Bedaquiline overdose: A case report
- Author
-
Michael Rich, Philipp du Cros, Lucas Molfino, Veronica Alvarez, Oleksandr Telnov, and Elena Graglia
- Subjects
Male ,0301 basic medicine ,Microbiology (medical) ,Abdominal pain ,030106 microbiology ,Antitubercular Agents ,Asymptomatic ,lcsh:Infectious and parasitic diseases ,Young Adult ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine ,Humans ,lcsh:RC109-216 ,030212 general & internal medicine ,Dosing ,Diarylquinolines ,Adverse effect ,business.industry ,General Medicine ,Jaundice ,Infectious Diseases ,chemistry ,Tolerability ,Anesthesia ,Liver function ,Drug Overdose ,Bedaquiline ,medicine.symptom ,business - Abstract
We present a case report describing outcomes in a 21 year old HIV-negative man who received treatment with bedaquiline. Due to error, dosage received comprised 4 pills of 100 mg every second day in the 60 days following the first two weeks of 4 pills of 100 mg every day. On detection, treatment was continued as per standard dosing of 200 mg given three times per week, with enhanced monitoring of ECG and liver function. The man was asymptomatic, with no signs of jaundice, abdominal pain, or abnormal heart rhythm. Toxic effects at this dosage were therefore not observed. Keywords: Tuberculosis, Bedaquiline, Adverse events, Therapeutic index, Tolerability
- Published
- 2019
44. A prospective multicentre diagnostic accuracy study for the Truenat tuberculosis assays
- Author
-
Claudia M. Denkinger, Cesar Ugarte-Gil, Manjula Singh, B. U. Choudhury, Evelyn Lavu, Sanjay Sarin, Catharina Boehme, Morten Ruhwald, Adam Penn-Nicholson, Samuel G Schumacher, Sivaramakrishnan N. Gomathi, Ephrem Tesfaye, Mubin Kazi, Camilla Rodrigues, Eduardo Gotuzzo, Aurélien Macé, Pranav Patel, Srikanth Tripathy, Pamela Nabeta, Philipp du Cros, Sarabjit Chadha, Abyot Meaza, and Raman R. Gangakhedkar
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Tuberculosis ,Primary health care ,Diagnostic accuracy ,Microbial Sensitivity Tests ,Sensitivity and Specificity ,World health ,Mycobacterium tuberculosis ,Original Research Articles ,Internal medicine ,Drug Resistance, Bacterial ,Humans ,Medicine ,Prospective Studies ,Antibiotics, Antitubercular ,biology ,business.industry ,Sputum ,New guinea ,Drug susceptibility ,bacterial infections and mycoses ,biology.organism_classification ,medicine.disease ,tuberculosis ,purl.org/pe-repo/ocde/ford#3.02.07 [https] ,diagnostic accuracy ,Truenat tuberculosis assays ,business ,Rifampicin ,medicine.drug - Abstract
Background Bringing reliable and accurate tuberculosis (TB) diagnosis closer to patients is a key priority for global TB control. Molbio Diagnostics have developed the Truenat point-of-care molecular assays for detection of TB and rifampicin (RIF) resistance. Methods We conducted a prospective multicentre diagnostic accuracy study at 19 primary healthcare centres and seven reference laboratories in Peru, India, Ethiopia and Papua New Guinea to estimate the diagnostic accuracy of the point-of-care Truenat MTB, MTB Plus and MTB-RIF Dx assays for pulmonary TB using culture and phenotypic drug susceptibility testing as the reference standard, compared with Xpert MTB/RIF or Ultra. Results Of 1807 enrolled participants with TB signs/symptoms, 24% were culture-positive for Mycobacterium tuberculosis, of which 15% were RIF-resistant. In microscopy centres, the pooled sensitivity of Truenat MTB and Truenat MTB Plus was 73% (95% CI 67–78%) and 80% (95% CI 75–84%), respectively. Among smear-negative specimens, sensitivities were 36% (95% CI 27–47%) and 47% (95% CI 37–58%), respectively. Sensitivity of Truenat MTB-RIF was 84% (95% CI 62–95%). Truenat assays showed high specificity. Head-to-head comparison in the central reference laboratories suggested that the Truenat assays have similar performance to Xpert MTB/RIF. Conclusion We found the performance of Molbio's Truenat MTB, MTB Plus and MTB-RIF Dx assays to be comparable to that of the Xpert MTB/RIF assay. Performing the Truenat tests in primary healthcare centres with very limited infrastructure was feasible. These data supported the development of a World Health Organization policy recommendation of the Molbio assays., Diagnostic performance of point-of-care Truenat assays in primary healthcare centres is comparable to that of Xpert MTB/RIF placed in reference laboratories. The WHO now recommends Truenat as an initial test for detection of TB and RIF resistance. https://bit.ly/31Wj3S6
- Published
- 2021
45. Telemedicine in Resource-Limited Settings to Optimize Care for Multidrug-Resistant Tuberculosis
- Author
-
Suman S Majumdar, Stenard Hiasihri, Philipp du Cros, Gibson Pawape, Pilar Ustero, Richard Wootton, Steve Graham, Magdalene Taune, G Khai Lin Huang, and Daniel P O'Brien
- Subjects
Telemedicine ,Service (systems architecture) ,Tuberculosis ,clinical expert group ,media_common.quotation_subject ,multidrug-resistant ,digital health ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine ,Quality (business) ,030212 general & internal medicine ,media_common ,VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801 ,business.industry ,lcsh:Public aspects of medicine ,030503 health policy & services ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,medicine.disease ,Digital health ,chemistry ,tuberculosis ,resource-limited ,consilium ,Perspective ,Medical emergency ,Public Health ,telemedicine ,Bedaquiline ,VDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801 ,0305 other medical science ,business ,Limited resources - Abstract
The emergence and spread of multidrug-resistant tuberculosis (MDR-TB) poses a major threat to the global targets for TB control. In recent years, an evolving science and evidence base for MDR-TB has led to much needed changes in international guidelines promoting the use of newer TB drugs and regimens for MDR-TB, however, there remains a significant implementation gap. Due to the complexity of treating MDR-TB, management of cases is often supported by an expert multidisciplinary team, or clinical expert group. This service is often centralized, and may be delivered through a telemedicine platform. We have implemented a Web-based “store-and-forward” telemedicine service to optimize MDR-TB patient care in Daru, a remote and resource limited setting in Papua New Guinea (PNG). From April 2016 to February 2019, 237 cases were discussed using the service. This encompassed diagnostic (presumptive) and treatment cases, and more recently, support to the scale up of preventative therapy for latent TB infection. There were 75 cases in which the use of Bedaquiline was discussed or mentioned, with a high frequency of discussions occurring in the initial period (26 cases in the first 12 months), which has appeared to decrease as clinicians gained familiarity with use of the drug (15 cases in the last 12 months). This service has supported high quality clinical care and fostered collaboration between clinicians and technical experts in a shared learning environment.
- Published
- 2019
46. Standardised shorter regimens
- Author
-
Syed, Abidi, Jay, Achar, Mourtala Mohamed, Assao Neino, Didi, Bang, Andrea, Benedetti, Sarah, Brode, Jonathon R, Campbell, Esther C, Casas, Francesca, Conradie, Gunta, Dravniece, Philipp, du Cros, Dennis, Falzon, Ernesto, Jaramillo, Christopher, Kuaban, Zhiyi, Lan, Christoph, Lange, Pei Zhi, Li, Mavluda, Makhmudova, Aung Kya Jai, Maug, Dick, Menzies, Giovanni Battista, Migliori, Ann, Miller, Bakyt, Myrzaliev, Norbert, Ndjeka, Jürgen, Noeske, Nargiza, Parpieva, Alberto, Piubello, Valérie, Schwoebel, Welile, Sikhondze, Rupak, Singla, Mahamadou Bassirou, Souleymane, Arnaud, Trébucq, Armand, Van Deun, Kerri, Viney, Karin, Weyer, Betty Jingxuan, Zhang, and Faiz, Ahmad Khan
- Subjects
Treatment Outcome ,Tuberculosis, Multidrug-Resistant ,Antitubercular Agents ,Humans ,Microbial Sensitivity Tests ,Mycobacterium tuberculosis ,Rifampin - Abstract
We sought to compare the effectiveness of two World Health Organization (WHO)-recommended regimens for the treatment of rifampin- or multidrug-resistant (RR/MDR) tuberculosis (TB): a standardised regimen of 9-12 months (the "shorter regimen") and individualised regimens of ≥20 months ("longer regimens").We collected individual patient data from observational studies identified through systematic reviews and a public call for data. We included patients meeting WHO eligibility criteria for the shorter regimen: not previously treated with second-line drugs, and with fluoroquinolone- and second-line injectable agent-susceptible RR/MDR-TB. We used propensity score matched, mixed effects meta-regression to calculate adjusted odds ratios and adjusted risk differences (aRDs) for failure or relapse, death within 12 months of treatment initiation and loss to follow-up.We included 2625 out of 3378 (77.7%) individuals from nine studies of shorter regimens and 2717 out of 13 104 (20.7%) individuals from 53 studies of longer regimens. Treatment success was higher with the shorter regimen than with longer regimens (pooled proportions 80.0%
- Published
- 2019
47. Training for Tuberculosis Elimination in Indonesia: Achievements, Reflections, and Potential for Impact
- Author
-
Steve Graham, Lisa Davidson, Anna P. Ralph, Geoff Chan, Trisasi Lestari, Suman S Majumdar, Philipp du Cros, Sieyin Phung, S. Main, Devy Santoso, Rina Triasih, and Janne Laukkala
- Subjects
Tuberculosis ,030231 tropical medicine ,lcsh:Medicine ,Training (civil) ,health workforce ,03 medical and health sciences ,0302 clinical medicine ,elimination ,Health care ,medicine ,030212 general & internal medicine ,Medical education ,training ,General Immunology and Microbiology ,business.industry ,Communication ,capacity building ,lcsh:R ,Public Health, Environmental and Occupational Health ,Cornerstone ,Capacity building ,medicine.disease ,language.human_language ,Indonesian ,Infectious Diseases ,tuberculosis ,General partnership ,Workforce ,language ,impact ,Business - Abstract
Indonesia has the third highest tuberculosis (TB) caseload internationally. A cornerstone for strengthening health systems to respond to TB is a well-trained workforce. In a partnership between Indonesian and Australian institutions, TB training was run during 2018 to strengthen the local capacity to meet End TB strategy targets. This paper aims to report on course design, delivery, training outcomes, and reflections. Seventy-six Indonesian healthcare workers, program staff, researchers, and policy-makers were selected from over 800 applicants. The structure comprised three trainings, each with a pre-course workshop (in Indonesia) to identify learning needs, a two-week block (Australia), and a post-course workshop (Indonesia). The training content delivered was a combination of TB technical knowledge and program/project theory, design, and logic, and the training utilised multiple teaching and learning methods. An innovative element of the training was participant-designed TB workplace projects focusing on context-specific priorities. Evaluation was undertaken using participant surveys and appraisal of the projects. Participants rated the course highly, while success in project implementation varied. Reflections include the importance of involving Indonesian experts in delivery of training, the need to understand participant learning requirements and adapt the training content accordingly, and the challenge of measuring tangible training outputs.
- Published
- 2019
48. Off-Label Use of Bedaquiline in Children and Adolescents with Multidrug-Resistant Tuberculosis
- Author
-
Jennifer Hughes, Ana P. Cavalheiro, Assliddin S. Rajabov, Jay Achar, Philipp du Cros, Cathy Hewison, Krzysztof Herboczek, Junia Cajazeiro, Gabriella Ferlazzo, James A Seddon, Parpieva Nargiza, and Alena Skrahina
- Subjects
Male ,Tajikistan ,Pediatrics ,Epidemiology ,Antitubercular Agents ,lcsh:Medicine ,Off-label use ,Cohort Studies ,chemistry.chemical_compound ,South Africa ,0302 clinical medicine ,1108 Medical Microbiology ,XDR TB ,Tuberculosis, Multidrug-Resistant ,Medicine ,off-label use ,030212 general & internal medicine ,adolescents ,Diarylquinolines ,bedaquiline ,Child ,bacteria ,Off-Label Use of Bedaquiline in Children and Adolescents with Multidrug-Resistant Tuberculosis ,biology ,treatment ,Dispatch ,Belarus ,Uzbekistan ,multidrug-resistant tuberculosis ,Infectious Diseases ,TB ,1117 Public Health And Health Services ,tuberculosis ,Female ,France ,Cohort study ,Microbiology (medical) ,medicine.medical_specialty ,Tuberculosis ,Adolescent ,Microbiology ,lcsh:Infectious and parasitic diseases ,Mycobacterium tuberculosis ,03 medical and health sciences ,respiratory infections ,Antibiotic resistance ,children ,multidrug resistance ,Humans ,lcsh:RC109-216 ,antimicrobial resistance ,Adverse effect ,business.industry ,lcsh:R ,1103 Clinical Sciences ,biology.organism_classification ,medicine.disease ,United Kingdom ,Multiple drug resistance ,pediatric ,030228 respiratory system ,chemistry ,Bedaquiline ,business ,MDR TB - Abstract
We describe 27 children and adolescents
- Published
- 2017
49. Standardised shorter regimens versus individualised longer regimens for rifampin- or multidrug-resistant tuberculosis
- Author
-
Mahamadou Bassirou Souleymane, Betty Jingxuan Zhang, Christopher Kuaban, Nargiza Parpieva, Sarah K. Brode, Karin Weyer, Dick Menzies, Syed Kumail Abidi, Arnaud Trébucq, Alberto Piubello, Ernesto Jaramillo, Norbert Ndjeka, W Sikhondze, Armand Van Deun, Esther C. Casas, Francesca Conradie, Pei Zhi Li, Ann C. Miller, Rupak Singla, V Schwoebel, Mavluda Makhmudova, Jay Achar, Christoph Lange, Mourtala Mohamed Assao Neino, Jonathon R. Campbell, Giovanni Battista Migliori, Philipp du Cros, Bakyt Myrzaliev, Dennis Falzon, Kerri Viney, Gunta Dravniece, Zhiyi Lan, Didi Bang, J Noeske, Faiz Ahmad Khan, Andrea Benedetti, and Aung Kya Jai Maug
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Absolute risk reduction ,Odds ratio ,Pyrazinamide ,03 medical and health sciences ,Regimen ,0302 clinical medicine ,030228 respiratory system ,Internal medicine ,Prothionamide ,Propensity score matching ,medicine ,Ethionamide ,030212 general & internal medicine ,business ,Ethambutol ,medicine.drug - Abstract
We sought to compare the effectiveness of two World Health Organization (WHO)-recommended regimens for the treatment of rifampin- or multidrug-resistant (RR/MDR) tuberculosis (TB): a standardised regimen of 9–12 months (the “shorter regimen”) and individualised regimens of ≥20 months (“longer regimens”).We collected individual patient data from observational studies identified through systematic reviews and a public call for data. We included patients meeting WHO eligibility criteria for the shorter regimen: not previously treated with second-line drugs, and with fluoroquinolone- and second-line injectable agent-susceptible RR/MDR-TB. We used propensity score matched, mixed effects meta-regression to calculate adjusted odds ratios and adjusted risk differences (aRDs) for failure or relapse, death within 12 months of treatment initiation and loss to follow-up.We included 2625 out of 3378 (77.7%) individuals from nine studies of shorter regimens and 2717 out of 13 104 (20.7%) individuals from 53 studies of longer regimens. Treatment success was higher with the shorter regimen than with longer regimens (pooled proportions 80.0% versus 75.3%), due to less loss to follow-up with the former (aRD −0.15, 95% CI −0.17– −0.12). The risk difference for failure or relapse was slightly higher with the shorter regimen overall (aRD 0.02, 95% CI 0–0.05) and greater in magnitude with baseline resistance to pyrazinamide (aRD 0.12, 95% CI 0.07–0.16), prothionamide/ethionamide (aRD 0.07, 95% CI −0.01–0.16) or ethambutol (aRD 0.09, 95% CI 0.04–0.13).In patients meeting WHO criteria for its use, the standardised shorter regimen was associated with substantially less loss to follow-up during treatment compared with individualised longer regimens and with more failure or relapse in the presence of resistance to component medications. Our findings support the need to improve access to reliable drug susceptibility testing.
- Published
- 2019
50. Revised Definitions of Multidrug-Resistant Tuberculosis Treatment Outcomes: Closer to the Reality?
- Author
-
Maryline Bonnet, Cathy Hewison, Shazina Khurkhumal, Elisabeth Sanchez-Padilla, Atadjan Khamraev, Philipp du Cros, Mathieu Bastard, Alex Telnov, Francis Varaine, Armen Hayrapetyan, Kamene Kimenye, and Themba Dlamini
- Subjects
Pulmonary and Respiratory Medicine ,Multiple drug resistance ,medicine.medical_specialty ,Tuberculosis ,business.industry ,Treatment outcome ,medicine ,Critical Care and Intensive Care Medicine ,Intensive care medicine ,medicine.disease ,Psychiatry ,business - Published
- 2015
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.