• Adherence to self-administered tuberculosis treatment in a high HIV-prevalence setting: a cross-sectional survey in Homa Bay, Kenya.

      Nackers, F; Huerga, H; Espié, E; Aloo, A O; Bastard, M; Etard, J-F; Sitienei, J; Varaine, F; Chakaya, J; Bonnet, M; et al. (2012-03-12)
      Good adherence to treatment is crucial to control tuberculosis (TB). Efficiency and feasibility of directly observed therapy (DOT) under routine program conditions have been questioned. As an alternative, Médecins sans Frontières introduced self-administered therapy (SAT) in several TB programs. We aimed to measure adherence to TB treatment among patients receiving TB chemotherapy with fixed dose combination (FDC) under SAT at the Homa Bay district hospital (Kenya). A second objective was to compare the adherence agreement between different assessment tools.
    • Adverse Events among HIV/MDR-TB Co-Infected Patients Receiving Antiretroviral and Second Line Anti-TB Treatment in Mumbai, India.

      Isaakidis, P; Varghese, B; Mansoor, H; Cox, H S; Ladomirska, J; Saranchuk, P; Da Silva, E; Khan, S; Paryani, R; Udwadia, Z; et al. (PLoS, 2012-07)
      Significant adverse events (AE) have been reported in patients receiving medications for multidrug- and extensively-drug-resistant tuberculosis (MDR-TB & XDR-TB). However, there is little prospective data on AE in MDR- or XDR-TB/HIV co-infected patients on antituberculosis and antiretroviral therapy (ART) in programmatic settings.
    • Alarming Levels of Drug-Resistant Tuberculosis in HIV-Infected Patients in Metropolitan Mumbai, India

      Isaakidis, P; Das, M; Kumar, A M V; Peskett, C; Khetarpal, M; Bamne, A; Adsul, B; Manglani, M; Sachdeva, K S; Parmar, M; et al. (Public Library of Science, 2014-10-21)
      Drug-resistant tuberculosis (DR-TB) is a looming threat to tuberculosis control in India. However, no countrywide prevalence data are available. The burden of DR-TB in HIV-co-infected patients is likewise unknown. Undiagnosed and untreated DR-TB among HIV-infected patients is a major cause of mortality and morbidity. We aimed to assess the prevalence of DR-TB (defined as resistance to any anti-TB drug) in patients attending public antiretroviral treatment (ART) centers in greater metropolitan Mumbai, India.
    • Ambulatory Multi-Drug Resistant Tuberculosis Treatment Outcomes in a Cohort of HIV-Infected Patients in a Slum Setting in Mumbai, India.

      Isaakidis, P; Cox, H S; Varghese, B; Montaldo, C; Da Silva, E; Mansoor, H; Ladomirska, J; Sotgiu, G; Migliori, G B; Pontali, E; et al. (2011-12)
      India carries one quarter of the global burden of multi-drug resistant TB (MDR-TB) and has an estimated 2.5 million people living with HIV. Despite this reality, provision of treatment for MDR-TB is extremely limited, particularly for HIV-infected individuals. Médecins Sans Frontières (MSF) has been treating HIV-infected MDR-TB patients in Mumbai since May 2007. This is the first report of treatment outcomes among HIV-infected MDR-TB patients in India.
    • Breast tuberculosis in men: A systematic review

      Quaglio, G; Pizzol, D; Bortolani, A; Manenti, F; Isaakidis, P; Putoto, G; Olliaro, PL (Public Library of Science, 2018-04-03)
      Breast tuberculosis in male is a rarely reported and poorly described condition.
    • Can follow-up examination of tuberculosis patients be simplified? A study in Chhattisgarh, India

      Kundu, D; M V Kumar, A; Satyanarayana, S; Dewan, P K; Achuthan Nair, S; Khaparde, K; Nayak, P; Van den Bergh, R; Manzi, M; Enarson, D A; et al. (Public Library of Science, 2012-12-05)
      Each follow-up during the course of tuberculosis treatment currently requires two sputum examinations. However, the incremental yield of the second sputum sample during follow-up of different types of tuberculosis patients has never been determined precisely.
    • Challenging drug-resistant TB treatment journey for children, adolescents and their care-givers: A qualitative study.

      Das, M; Mathur, T; Ravi, S; Meneguim, AC; Iyer, A; Mansoor, H; Kalon, S; Hossain, FN; Acharya, S; Ferlazzo, G; et al. (Public Library of Science, 2021-03-10)
      Background: Childhood multidrug-resistant TB (MDR-TB) still affects around 25000 children every year across the globe. Though the treatment success rates for drug-resistant TB (DR-TB) in children are better than adults, children and adolescents face unique hurdles during DR-TB (MDR-TB, Pre-XDR TB and XDR-TB) treatment. This study aimed to understand the patients, guardians and healthcare providers' perspectives about DR-TB treatment journey of patients and caregivers. Methods: This is a qualitative study involving in depth-interviews of purposively selected adolescents (n = 6), patients guardians (for children and adolescents, n = 5) and health care providers (n = 8) of Médecins Sans Frontières (MSF) clinic, Mumbai, India. In-depth face to face interviews were conducted in English or Hindi language using interview guides during September-November 2019. The interviews were audio-recorded after consent. Thematic network analysis was used to summarize textual data. ATLAS.ti (version 7) was used for analysis. Result: The age of adolescent patients ranged from 15-19 years and four were female. Five guardians (of three child and two adolescent patients) and eight healthcare providers (including clinicians- 2, DOT providers-2, counselors-2 and programme managers-2) were interviewed. The overarching theme of the analysis was: Challenging DR-TB treatment journey which consisted of four sub-themes: 1) physical-trauma, 2) emotional-trauma, 3) unavailable social-support and 4) non-adapted healthcare services. Difficulties in compounding of drugs were noted for children while adolescents shared experiences around disruption in social life due to disease and treatment. Most of the patients and caregivers experienced treatment fatigue and burnout during the DR-TB treatment. Participants during interviews gave recommendations to improve care. Discussion: The TB programmes must consider the patient and family as one unit when designing the package of care for paediatric DR-TB. Child and adolescent friendly services (paediatric-formulations, age-specific counselling tools and regular interaction with patients and caregivers) will help minimizing burnout in patients and caregivers.
    • Coadministration of lopinavir/ritonavir and rifampicin in HIV and tuberculosis co-infected adults in South Africa

      Murphy, R A; Marconi, V C; Gandhi, R T; Kuritzkes, D R; Sunpath, H; Medical Unit, Médecins Sans Frontières/Doctors Without Borders, New York, New York, United States of America (Public Library of Science, 2012-09-28)
      In HIV-infected patients receiving rifampicin-based treatment for tuberculosis (TB), the dosage of lopinavir/ritonavir (LPV/r) is adjusted to prevent sub-therapeutic lopinavir concentrations. In this setting, South African clinicians were advised to administer super-boosted LPV/r (400 mg/400 mg) twice daily, instead of standard dosed LPV/r (400 mg/100 mg) twice daily. We sought to determine--in routine practice--the tolerability and HIV treatment outcomes associated with super-boosted LPV/r compared to unadjusted LPV/r in combination with rifampicin-based TB treatment.
    • Detection and Quantification of Mycobacterium Tuberculosis in the Sputum of Culture-Negative HIV-infected Pulmonary Tuberculosis Suspects: A Proof-of-Concept Study

      Madico, G; Mpeirwe, M; White, L; Vinhas, S; Orr, B; Orikiriza, P; Miller, N S; Gaeddert, M; Mwanga-Amumpaire, J; Palaci, M; et al. (Public Library of Science, 2016-07-08)
      Rapid diagnosis of pulmonary tuberculosis (TB) is critical for timely initiation of treatment and interruption of transmission. Yet, despite recent advances, many patients remain undiagnosed. Culture, usually considered the most sensitive diagnostic method, is sub-optimal for paucibacillary disease.
    • Direct Observation (DO) for Drug-Resistant Tuberculosis: Do We Really DO?

      Benbaba, S; Isaakidis, P; Das, M; Jadhav, S; Reid, T; Furin, J (2015-12-29)
      Directly-observed therapy (DOT) is recommended for drug-resistant tuberculosis (DR-TB) patients during their entire treatment duration. However, there is limited published evidence on implementation of direct observation (DO) in the field. This study aims to detail whether DO was followed with DR-TB patients in a Médecins Sans Frontières (MSF) tuberculosis program in Mumbai, India.
    • Directly-observed and self-administered tuberculosis treatment in a chronic, low-intensity conflict setting in India

      Das, M; Isaakidis, P; Armstrong, E; Gundipudi, N R; Babu, R B; Qureshi, I A; Claes, A; Mudimanchi, A K; Prasad, N; Mansoor, H; et al. (Public Library of Science, 2014)
      Limited data are available about tuberculosis treatment models of care for internally displaced populations in chronic, low-intensity conflict zones. This study aimed to detail experiences of a Médecins Sans Frontières tuberculosis programme in Andhra Pradesh-Chhattisgarh border area, India, from January to December 2012.
    • Epidemic Levels of Drug Resistant Tuberculosis (MDR and XDR-TB) in a High HIV Prevalence Setting in Khayelitsha, South Africa.

      Cox, H S; McDermid, C; Azevedo, V; Muller, O; Coetzee, D; Simpson, J; Barnard, M; Coetzee, G; van Cutsem, G; Goemaere, E; et al. (2010-11-15)
      BACKGROUND: Although multidrug-resistant tuberculosis (MDR-TB) is emerging as a significant threat to tuberculosis control in high HIV prevalence countries such as South Africa, limited data is available on the burden of drug resistant tuberculosis and any association with HIV in such settings. We conducted a community-based representative survey to assess the MDR-TB burden in Khayelitsha, an urban township in South Africa with high HIV and TB prevalence. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional survey was conducted among adult clinic attendees suspected for pulmonary tuberculosis in two large primary care clinics, together constituting 50% of the tuberculosis burden in Khayelitsha. Drug susceptibility testing (DST) for isoniazid and rifampicin was conducted using a line probe assay on positive sputum cultures, and with culture-based DST for first and second-line drugs. Between May and November 2008, culture positive pulmonary tuberculosis was diagnosed in 271 new and 264 previously treated tuberculosis suspects (sample enriched with previously treated cases). Among those with known HIV status, 55% and 71% were HIV infected respectively. MDR-TB was diagnosed in 3.3% and 7.7% of new and previously treated cases. These figures equate to an estimated case notification rate for MDR-TB of 51/100,000/year, with new cases constituting 55% of the estimated MDR-TB burden. HIV infection was not significantly associated with rifampicin resistance in multivariate analyses. CONCLUSIONS/SIGNIFICANCE: There is an extremely high burden of MDR-TB in this setting, most likely representing ongoing transmission. These data highlight the need to diagnose drug resistance among all TB cases, and for innovative models of case detection and treatment for MDR-TB, in order to interrupt transmission and control this emerging epidemic.
    • Evaluation of combined LED-fluorescence microscopy and bleach sedimentation for diagnosis of tuberculosis at peripheral health service level.

      Bonnet, M; Gagnidze, L; Guerin, P J; Bonte, L; Ramsay, A; Githui, W; Varaine, F; Epicentre, Paris, France. maryline.bonnet@geneva.msf.org (2011-05-31)
      Sputum microscopy is the only diagnostic for tuberculosis (TB) available at peripheral levels of health service in resource-poor countries. Its sensitivity is reduced in high HIV-prevalence settings. Sodium hypochlorite (NaOCl) specimen sedimentation prior microscopy and light-emitting diode (LED)-fluorescence microscopy (FM) can individually improve performance of microscopy. This study aimed to evaluate the performance of combined LED-FM and NaOCl sputum sedimentation for TB detection at peripheral level of health services.
    • High Rate of Hypothyroidism in Multidrug-Resistant Tuberculosis Patients Co-Infected with HIV in Mumbai, India.

      Andries, A; Isaakidis, P; Das, M; Khan, S; Paryani, R; Desai, C; Dalal, A; Mansoor, H; Verma, R; Fernandes, D; et al. (PLoS, 2013-10-23)
      Adverse events (AEs) among HIV-infected patients with multidrug-resistant tuberculosis (MDR-TB) receiving anti-TB and antiretroviral treatments (ART) are under-researched and underreported. Hypothyroidism is a common AE associated with ethionamide, p-aminosalicylic acid (PAS), and stavudine. The aim of this study was to determine the frequency of and risk factors associated with hypothyroidism in HIV/MDR-TB co-infected patients.
    • "I Can Also Serve as an Inspiration": A Qualitative Study of the TB&Me Blogging Experience and Its Role in MDR-TB Treatment

      Horter, S; Stringer, B; Venis, S; du Cros, P (Public Library of Science, 2014-09-24)
      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.
    • Impact of Introducing the Line Probe Assay on Time to Treatment Initiation of MDR-TB in Delhi, India

      Singla, N; Satyanarayana, S; Sachdeva, K S; Van den Bergh, R; Reid, T; Tayler-Smith, K; Myneedu, V P; Ali, E; Enarson, D A; Behera, D; et al. (Public Library of Science, 2014-07-24)
      National Institute of Tuberculosis and Respiratory Diseases (erstwhile Lala Ram Sarup Institute) in Delhi, India.
    • Incremental Yield of Including Determine-TB LAM Assay in Diagnostic Algorithms for Hospitalized and Ambulatory HIV-Positive Patients in Kenya

      Huerga, H; Ferlazzo, G; Bevilacqua, P; Kirubi, B; Ardizzoni, E; Wanjala, S; Sitienei, J; Bonnet, M (Public Library of Science, 2017-01-26)
      Determine-TB LAM assay is a urine point-of-care test useful for TB diagnosis in HIV-positive patients. We assessed the incremental diagnostic yield of adding LAM to algorithms based on clinical signs, sputum smear-microscopy, chest X-ray and Xpert MTB/RIF in HIV-positive patients with symptoms of pulmonary TB (PTB).
    • Linezolid-Associated Optic Neuropathy in Drug-Resistant Tuberculosis Patients in Mumbai, India

      Mehta, S; Das, M; Laxmeshwar, C; Jonckheere, S; Thi, SS; Isaakidis, P (Public Library of Science, 2016-09-09)
      Patients on linezolid-containing drug-resistant TB (DR-TB) regimen often develop adverse-events, particularly peripheral and optic neuropathy. Programmatic data and experiences of linezolid-associated optic neuropathy from high DR-TB burden settings are lacking. The study aimed to determine the frequency of and risk-factors associated with linezolid-associated optic neuropathy and document the experiences related to treatment/care of DR-TB patients on linezolid-containing regimens.
    • Loss-To-Follow-Up on Multidrug Resistant Tuberculosis Treatment in Gujarat, India: The WHEN and WHO of It

      Shringarpure, K S; Isaakidis, P; Sagili, K D; Baxi, R K (Public Library of Science, 2015-07-13)
      Multidrug-resistant Tuberculosis (MDR-TB) is a rising global threat to public health and concerted efforts for its treatment are diluted if the outcomes are not successful, loss to follow up (LFU) being one of them. It is therefore necessary to know the proportion and the associated reasons for LFU and devise effective patient-centered strategies to improve retention in care.
    • Low Resistance to First and Second Line Anti-Tuberculosis Drugs among Treatment Naive Pulmonary Tuberculosis Patients in Southwestern Uganda

      Orikiriza, P; Tibenderana, B; Siedner, M J; Mueller, Y; Byarugaba, F; Moore, C C; Evans, E E; Bonnet, M; Page, A-L; Bazira, J; et al. (Public Library of Science, 2015-02-06)
      There are limited data on region-specific drug susceptibility of tuberculosis (TB) in Uganda. We performed resistance testing on specimens collected from treatment-naive patients with pulmonary TB in Southwestern Uganda for first and second line anti-TB drugs. We sought to provide data to guide regional recommendations for empiric TB therapy.