• 10-year assessment of treatment outcome among Cambodian refugees with sputum smear-positive tuberculosis in Khao-I-Dang, Thailand.

      Sukrakanchana-Trikham, P; Puéchal, X; Rigal, J; Rieder, H L; Médecins sans Frontières Tuberculosis Programme, Khao-I-Dang, Prachinburi, Thailand. (International Union Against Tuberculosis and Lung Disease, 1992-12)
      Tuberculosis control among displaced persons is fraught with difficulties to ensure adherence of patients to treatment for a prolonged period of time. In the Khao-I-Dang camp for Cambodian refugees an approach with daily, directly observed treatment throughout the course of 6 months duration was chosen to address the problem. Of a total 929 patients with sputum smear-positive tuberculosis who were enrolled from 1981 to 1990, 5.0% died, 75.5% completed treatment and were bacteriologically cured with a day-to-day adherence of more than 98%, none failed bacteriologically, 19.2% were transferred to another camp where continuation of treatment was guaranteed, and only 0.4% absconded from treatment. These data suggest that the approach to tuberculosis control in this refugee camp was very effective in cutting the chain of transmission of tuberculosis in a highly mobile population and in reducing substantially unnecessary morbidity and mortality.
    • Adapting the DOTS framework for tuberculosis control to the management of non-communicable diseases in sub-Saharan Africa

      Harries, A D; Jahn, A; Zachariah, R; Enarson, D; Clinical HIV Unit, Ministry of Health, Lilongwe, Malawi; Family Health International, Malawi Country Office, Lilongwe, Malawi; London School of Hygiene and Tropical Medicine, London, United Kingdom; Lighthouse Trust, Lilongwe, Malawi; International Training and Education Center on HIV, University of Washington, Seattle, WA; Médecins Sans Frontières, Operational Research Medical Department, Luxembourg; International Union against Tuberculosis and Lung Disease, Paris, France (Public Library of Science (PLoS), 2008-06-10)
    • Added value of bleach sedimentation microscopy for diagnosis of tuberculosis: a cost-effectiveness study.

      Bonnet, M; Tajahmady, A; Hepple, P; Ramsay, A; Githui, W; Gagdnidze, L; Guérin, P J; Varaine, F; Epicentre, Paris, France; Mission Nationale d’Expertise et d’Audit Hospitaliers, Paris, France; Manson Unit, Médecins Sans Frontières, London, UK; Liverpool School of Tropical Medicine, Liverpool, UK; United Nation’s Children’s Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training for Tropical Diseases, Geneva, Switzerland; Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya; Médecins Sans Frontières, Paris, France (2010-04-09)
      SETTING: Bleach sedimentation is a method used to increase the diagnostic yield of sputum microscopy for countries with a high prevalence of human immunodeficiency virus (HIV) infection and limited resources. OBJECTIVES: To compare the relative cost-effectiveness of different microscopy approaches in diagnosing tuberculosis (TB) in Kenya. METHODS: An analytical decision tree model including cost and effectiveness measures of 10 combinations of direct (D) and overnight bleach (B) sedimentation microscopy was constructed. Data were drawn from the evaluation of the bleach sedimentation method on two specimens (first on the spot [1] and second morning [2]) from 644 TB suspects in a peripheral health clinic. Incremental cost per smear-positive detected case was measured. Costs included human resources and materials using a micro-costing evaluation. RESULTS: All bleach-based microscopy approaches detected significantly more cases (between 23.3% for B1 and 25.9% for B1+B2) than the conventional D1+D2 approach (21.0%). Cost per tested case ranged between respectively euro 2.7 and euro 4.5 for B1 and B1+D2+B2. B1 and B1+B2 were the most cost-effective approaches. D1+B2 and D1+B1 were good alternatives to avoid using approaches exclusively based on bleach sedimentation microscopy. CONCLUSIONS: Among several effective microscopy approaches used, including sodium hypochlorite sedimentation, only some resulted in a limited increase in the laboratory workload and would be most suitable for programmatic implementation.
    • Addressing Diabetes Mellitus as Part of the Strategy for Ending TB

      Harries, A D; Kumar, A M; Satyanarayana, S; Lin, Y; Zachariah, R; Lönnroth, K; Kapur, A (Oxford University Press, 2016-03-01)
      As we enter the new era of Sustainable Development Goals, the international community has committed to ending the TB epidemic by 2030 through implementation of an ambitious strategy to reduce TB-incidence and TB-related mortality and avoiding catastrophic costs for TB-affected families. Diabetes mellitus (DM) triples the risk of TB and increases the probability of adverse TB treatment outcomes such as failure, death and recurrent TB. The rapidly escalating global epidemic of DM means that DM needs to be addressed if TB-related milestones and targets are to be achieved. WHO and the International Union Against Tuberculosis and Lung Disease's Collaborative Framework for Care and Control of Tuberculosis and Diabetes, launched in 2011, provides a template to guide policy makers and implementers to combat the epidemics of both diseases. However, more evidence is required to answer important questions about bi-directional screening, optimal ways of delivering treatment, integration of DM and TB services, and infection control. This should in turn contribute to better and earlier TB case detection, and improved TB treatment outcomes and prevention. DM and TB collaborative care can also help guide the development of a more effective and integrated public health approach for managing non-communicable diseases.
    • 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; Epicentre, Paris, France. Fabienne.Nackers@msf.brussels.org (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.
    • Adherence, Tolerability, and Outcome After 36 Months of Isoniazid-Preventive Therapy in 2 Rural Clinics of Swaziland: A Prospective Observational Feasibility Study

      Mueller, Y; Mpala, Q; Kerschberger, B; Rusch, B; Mchunu, G; Mazibuko, S; Bonnet, M (Wolters Kluwer Health | Lippincott Williams & Wilkins, 2017-09)
      Although efficacy of 36 months isoniazid preventive therapy (IPT) among HIV-positive individuals has been proven in trial settings, outcome, tolerance, and adherence have rarely been evaluated in real-life settings.This is a prospective observational cohort study conducted in 2 primary care rural clinics in Swaziland.After negative tuberculosis symptom screening, patients either with the positive tuberculin skin test (TST) or after tuberculosis treatment were initiated on IPT for 144 weeks. In addition to routine clinic visits, adherence was assessed every semester.Of 288 eligible patients, 2 patients never started IPT (1 refusal, 1 contraindication), and 253 (87.8%), 234 (81.3%), and 228 (79.2%) were still on IPT after 48, 96, and 144 weeks, respectively (chiP = .01). Of 41 patients who interrupted IPT before 144 weeks, 21 defaulted (of which 17 also defaulted HIV care); 16 stopped because of adverse drug reactions; 2 were discontinued by clinicians' mistake and 1 because of TB symptoms. Five patients (1.7%) died of causes not related to IPT, 5 (1.7%) developed TB of which 2 were isoniazid-resistant, and 9 (3.1%) were transferred to another clinic. As an indicator of adherence, isoniazid could be detected in the urine during 86.3% (302/350) and 73.6% (248/337) of patient visits in the 2 clinics, respectively (chiP < .001).The routine implementation of IPT 36 months was feasible and good patient outcomes were achieved, with low TB incidence, good tolerance, and sustained adherence.
    • Advances in imaging chest tuberculosis: blurring of differences between children and adults

      Andronikou, S; Vanhoenacker, F M; De Backer, A I; Medecins Sans Frontiers, Amsterdam, The Netherlands; Department of Radiology, University of Cape Town, Cape Town, South Africa; Department of Radiology, Sint-Maarten Hospital, Duffel-Mechelen, Belgium; University Hospital Antwerp, Edegem, Belgium; Department of Radiology, Sint-Lucas Hospital, Ghent, Belgium; (Elsevier, 2009-12-01)
      This article reviews the ongoing role of imaging in the diagnosis of tuberculosis (TB) and its complications. A modern imaging classification of TB, taking into account both adults and children and the blurring of differences in the presentation patterns, must be absorbed into daily practice. Clinicians must not only be familiar with imaging features of TB but also become expert at detecting these when radiologists are unavailable. Communication between radiologists and clinicians with regard to local constraints, patterns of disease, human immunodeficiency virus (HIV) coinfection rates, and imaging parameters relevant for management (especially in drug resistance programs) is paramount for making an impact with imaging, and preserving clinician confidence. Recognition of special imaging, anatomic and vulnerability differences between children and adults is more important than trying to define patterns of disease exclusive to children.
    • 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; Migliori, G B; Sotgiu, G; Reid, T; Médecins Sans Frontières, Mumbai, India. (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; Kanchar, A; Rewari, B B; Deshpande, A; Rodrigues, C; Shetty, A; Rebello, L; Saranchuk, P (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.
    • Alternative sputum collection methods for diagnosis of childhood intrathoracic tuberculosis: a systematic literature review

      Ioos, V; Cordel, H; Bonnet, M (BMJ Journals, 2018-08-20)
      Diagnosis of intrathoracic tuberculosis (ITB) is limited in children partly by their difficulty to produce sputum specimen.
    • 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; Saranchuk, P; Rodrigues, C; Reid, T; Médecins Sans Frontières, Mumbai, India. (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.
    • Ambulatory tuberculosis treatment in post-Semashko health care systems needs supportive financing mechanisms

      Kohler, S; Asadov, D A; Bründer, A; Healy, S; Khamraev, A K; Sergeeva, N; Tinnemann, P (International Union Against Tuberculosis and Lung Disease, 2014-12-01)
      The tuberculosis (TB) control strategy in the Republic of Karakalpakstan, Uzbekistan, is being changed to decentralised out-patient care for most TB patients by the Government of Uzbekistan, in collaboration with the international medical humanitarian organisation Médecins Sans Frontières. Ambulatory treatment of both drug-susceptible and drug-resistant TB from the first day of treatment has been recommended since 2011. Out-patient treatment of TB from the beginning of treatment was previously prohibited. However, the current Uzbek health financing system, which evolved from the Soviet Semashko model, offers incentives that work against the adoption of ambulatory TB treatment. Based on the 'Comprehensive TB Care for All' programme implemented in Karakalpakstan, we describe how existing policies for the allocation of health funds complicate the scale-up of ambulatory-based management of TB.
    • Are sputum samples of retreatment tuberculosis reaching the reference laboratories? A 9-year audit in Tanzania

      Kilale, A M; Ngowi, B J; Mfinanga, G S; Egwaga, S; Doulla, B; Kumar, A M V; Khogali, M; van Griensven, J; Harries, A D; Zachariah, R; Hinderaker, S G (2013-06-21)
    • Are tuberculosis patients in a tertiary care hospital in Hyderabad, India being managed according to national guidelines?

      Kondapaka, K K; Prasad, S V; Satyanarayana, S; Kandi, S; Zachariah, R; Harries, A D; Nagaraja, S B; Tetali, S; Anchala, R; Kannuri, N K; Murthy, K; Koppu, D; Vangari, L; Rao, S; Department of Pulmonary Medicine, Osmania Medical College, Hyderabad, India; International Union Against Tuberculosis and Lung Disease (The Union), South East Asia Regional Office, New Delhi, India; Medecins sans Frontieres, Medical Department (Operational Research), Brussels Operational Center, Brussels, Luxembourg; International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Office of the WHO Representative in India, New Delhi, India; Public Health Foundation of India (Indian Institute of Public Health-Hyderabad), Hyderabad, India; Department of Pulmonary Medicine, Gandhi Medical College, Hyderabad, India; Department of Pediatrics, Osmania Medical College, Hyderabad, India; State Tuberculosis Office, Andhra Pradesh, India (Public Library of Science (PLoS), 2012-01-17)
      A tertiary health care facility (Government General and Chest hospital) in Hyderabad, India.
    • Assessing and improving data quality from community health workers: a successful intervention in Neno, Malawi

      Admon, A J; Bazile, J; Makungwa, H; Chingoli, M A; Hirschhorn, L R; Peckarsky, M; Rigodon, J; Herce, M; Chingoli, F; Malani, P N; Hedt-Gauthier, B L (International Union Against TB and Lung Disease, 2013-03)
    • A Bayesian Response-Adaptive Trial in Tuberculosis: The endTB Trial

      Cellamare, M; Ventz, S; Baudin, E; Mitnick, CD; Trippa, L (SAGE Publications, 2016-08-23)
      To evaluate the use of Bayesian adaptive randomization for clinical trials of new treatments for multidrug-resistant tuberculosis.
    • Bedaquiline and delamanid in combination for treatment of drug-resistant tuberculosis

      Mohr, E; Ferlazzo, G; Hewison, C; De Azevedo, V; Isaakidis, P (Elsevier, 2019-05-01)
      Here we report on the final outcomes for the cohort of 28 patients from Armenia, India, and South Africa who initiated regimens containing the combination of bedaquiline and delamanid from January to August, 2016, for the treatment of multidrug-resistant tuberculosis in our cohort study.1 The median duration on combination treatment was 12 months (interquartile range [IQR] 5·9–20·0); 17 (61%) of 28 patients received the combination for more than 6 months.
    • Bedaquiline overdose: A case report

      Telnov, O; Alvarez, V; Gragila, E; Molfino, L; du Cros, P; Rich, M (Elsevier, 2019-04-02)
      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.
    • The Beijing genotype and drug resistant tuberculosis in the Aral Sea region of Central Asia.

      Cox, H; Kubica, T; Doshetov, D; Kebede, Y; Rüsch-Gerdess, S; Niemann, S; Médecins Sans Frontières, Aral Sea Area Programme, Uzbekistan and Turkmenistan Tashkent, Uzbekistan. h.cox2@pgrad.unimelb.edu.au (2005)
      BACKGROUND: After the collapse of the Soviet Union, dramatically increasing rates of tuberculosis and multidrug-resistant tuberculosis (MDR-TB) have been reported from several countries. This development has been mainly attributed to the widespread breakdown of TB control systems and declining socio-economic status. However, recent studies have raised concern that the Beijing genotype of Mycobacterium tuberculosis might be contributing to the epidemic through its widespread presence and potentially enhanced ability to acquire resistance. METHODS: A total of 397 M. tuberculosis strains from a cross sectional survey performed in the Aral Sea region in Uzbekistan and Turkmenistan have been analysed by drug susceptibility testing, IS6110 fingerprinting, and spoligotyping. RESULTS: Fifteen isolates showed mixed banding patterns indicating simultaneous infection with 2 strains. Among the remaining 382 strains, 152 (40%) were grouped in 42 clusters with identical fingerprint and spoligotype patterns. Overall, 50% of all isolates were Beijing genotype, with 55% of these strains appearing in clusters compared to 25% of non-Beijing strains. The percentage of Beijing strains increased with increasing drug resistance among both new and previously treated patients; 38% of fully-susceptible isolates were Beijing genotype, while 75% of MDR-TB strains were of the Beijing type. CONCLUSION: The Beijing genotype is a major cause of tuberculosis in this region, it is strongly associated with drug resistance, independent of previous tuberculosis treatment and may be strongly contributing to the transmission of MDR-TB. Further investigation around the consequences of Beijing genotype infection for both tuberculosis transmission and outcomes of standard short course chemotherapy are urgently needed.
    • Better Treatment of XDR Tuberculosis Needed in South Africa

      Cox, H; van Cutsem, G; Cox, V (Elsevier, 2014-08-16)