• "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.
    • 'I cry every day': experiences of patients co-infected with HIV and multidrug-resistant tuberculosis.

      Isaakidis, P; Rangan, S; Pradhan, A; Ladomirska, J; Reid, T; Kielmann, K; Médecins Sans Frontières, Mumbai, India. (2013-09-15)
      To understand patients' challenges in adhering to treatment for MDR-TB/HIV co-infection within the context of their life circumstances and access to care and support.
    • 'I didn't know so many people cared about me': support for patients who interrupt drug-resistant TB treatment.

      Snyman, L; Venables, E; Trivino Duran, L; Mohr, E; Harmans, X; Isaakidis, P; Azevedo, VD (International Union Against Tuberculosis and Lung Disease, 2018-09-01)
      SETTING: Early interventions for patients who interrupt their treatment for drug-resistant tuberculosis (DR-TB) are rarely reported and assessed. A novel, patient-centred intervention for patients at risk of loss to follow-up (LTFU) from DR-TB treatment was implemented in Khayelitsha, South Africa, in September 2013. OBJECTIVE: To explore the experiences and perceptions of patients, key support persons, health care workers (HCWs) and programme managers of a patient-centred model. DESIGN: This was a qualitative study consisting of 18 in-depth interviews with patients, key support persons, HCWs, key informants and one focus group discussion with HCWs, between July and September 2017. Data were coded and thematically analysed. RESULTS: The model was well perceived and viewed positively by patients, care providers and programme managers. 'Normalisation' and tolerance of occasional treatment interruptions, tracing, tailored management plans and peer support were perceived to be beneficial for retaining patients in care. Although the model was resource-demanding, health workers were convinced that it 'needs to be sustained,' and proposed solutions for its standardisation. CONCLUSION: An intervention based on early tracing of patients who interrupt treatment, peer-delivered counselling and individualised management plans by a multidisciplinary team was considered a beneficial and acceptable model to support patients at risk of LTFU from DR-TB treatment.
    • 'I'm fed up': experiences of prior anti-tuberculosis treatment in patients with drug-resistant tuberculosis and HIV

      Furin, J; Isaakidis, P; Reid, A J; Kielmann, K (International Union Against Tuberculosis and Lung Disease, 2014-10-03)
      To understand the impact of past experiences of anti-tuberculosis treatment among patients co-infected with the human immunodeficiency virus and multidrug-resistant tuberculosis (MDR-TB) on perceptions and attitudes towards treatment.
    • Identification of Patients Who Could Benefit from Bedaquiline or Delamanid: a Multisite MDR-TB Cohort Study

      Bonnet, M; Bastard, M; du Cros, P; Khamraev, A; Kimenye, K; Khurkhumal, S; Hayrapetyan, A; Themba, D; Telnov, A; Sanchez-Padilla, E; et al. (International Union Against TB and Lung Disease, 2016-02-01)
      The World Health Organization recommends adding bedaquiline or delamanid to multidrug-resistant tuberculosis (MDR-TB) regimens for which four effective drugs are not available, and delamanid for patients at high risk of poor outcome.
    • Impact of Decentralized Care and the Xpert MTB/RIF Test on Rifampicin-Resistant Tuberculosis Treatment Initiation in Khayelitsha, South Africa

      Cox, H; Daniels, J F; Muller, O; Nicol, M P; Cox, V; Van Cutsem, G; Moyo, S; De Azevedo, V; Hughes, J (Oxford University Press, 2015-06-04)
    • Impact of introducing human immunodeficiency virus testing, treatment and care in a tuberculosis clinic in rural Kenya

      Huerga, H; Spillane, H; Guerrero, W; Odongo, A; Varaine, F; Médecins Sans Frontières, Nairobi, Kenya; National Tuberculosis Programme, Homa Bay, Kenya; Médecins Sans Frontières, Paris, France (2010-04-09)
      SETTING: In July 2005, Médecins Sans Frontières and the Ministry of Health, Kenya, implemented an integrated tuberculosis-human immunodeficiency virus (TB-HIV) programme in western Kenya. OBJECTIVE: To evaluate the impact of an integrated TB-HIV programme on patient care and TB programme outcomes. DESIGN: Retrospective evaluation of three time periods: before (January-June 2005), shortly after (January-June 2006) and medium term after (January-December 2007) the implementation of the integrated programme. RESULTS: Respectively 79% and 91% of TB patients were HIV tested shortly and at medium term after service integration. The HIV-positive rate varied from 96% before the intervention to respectively 88% (305/347) and 74% (301/405) after. The estimated number of HIV-positive cases was respectively 303, 323 and 331 in the three periods. The proportion of patients receiving cotrimoxazole prophylaxis increased significantly from 47% (142/303) to 94% (303/323) and 86% (285/331, P < 0.05). Before the intervention, 87% (171/197) of the TB-HIV patients would have been missed when initiating antiretroviral treatment, compared to respectively 29% (60/210) and 36% (78/215) after the integration. The TB programme success rate increased from 56% (230/409) to 71% (319/447) in the third period (P < 0.05); however, there was no significant decrease in the default rate: 20% to 22% (P = 0.66) and 18% (P = 0.37). CONCLUSION: Integrated TB-HIV care has a very positive impact on the management of TB-HIV patients and on TB treatment outcomes.
    • 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.
    • Impact of pyrazinamide resistance on multidrug-resistant tuberculosis in Karakalpakstan, Uzbekistan

      Kuhlin, J; Smith, C; Khaemraev, A; Tigay, Z; Parpieva, N; Tillyashaykhov, M; Achar, J; Hajek, J; Greig, J; du Cros, P; et al. (International Union Against Tuberculosis and Lung Disease, 2018-05-01)
      The World Health Organization (WHO) recommends the inclusion of pyrazinamide (PZA) in treatment regimens for multidrug-resistant tuberculosis (MDR-TB) unless resistance has been confirmed.
    • Impact of reduced hospitalisation on the cost of treatment for drug-resistant tuberculosis in South Africa

      Sinanovic, E; Ramma, L; Vassall, A; Azevedo, V; Wilkinson, L; Ndjeka, N; McCarthy, K; Churchyard, G; Cox, H (International Union Against Tuberculosis and Lung Disease, 2015-02-01)
      The cost of multidrug-resistant tuberculosis (MDR-TB) treatment is a major barrier to treatment scale-up in South Africa.
    • Impact of Xpert MTB/RIF for TB Diagnosis in a Primary Care Clinic with High TB and HIV Prevalence in South Africa: A Pragmatic Randomised Trial

      Cox, H; Mbhele, S; Mohess, N; Whitelaw, A; Muller, O; Zemanay, W; Little, F; Azevedo, V; Simpson, J; Boehme, C C; et al. (Public Library of Science, 2014-11-25)
      Xpert MTB/RIF is approved for use in tuberculosis (TB) and rifampicin-resistance diagnosis. However, data are limited on the impact of Xpert under routine conditions in settings with high TB burden.
    • Implementation of liquid culture for tuberculosis diagnosis in a remote setting: lessons learned.

      Hepple, P; Novoa-Cain, J; Cheruiyot, C; Richter, E; Ritmeijer, K; Médecins Sans Frontières, Manson Unit, London, UK. (2011-03)
      Although sputum smear microscopy is the primary method for tuberculosis (TB) diagnosis in low-resource settings, it has low sensitivity. The World Health Organization recommends the use of liquid culture techniques for TB diagnosis and drug susceptibility testing in low- and middle-income countries. An evaluation of samples from southern Sudan found that culture was able to detect cases of active pulmonary TB and extra-pulmonary TB missed by conventional smear microscopy. However, the long delays involved in obtaining culture results meant that they were usually not clinically useful, and high rates of non-tuberculous mycobacteria isolation made interpretation of results difficult. Improvements in diagnostic capacity and rapid speciation facilities, either on-site or through a local reference laboratory, are crucial.
    • Implementation of the thin layer agar for the diagnosis of smear-negative pulmonary tuberculosis in a high HIV prevalence setting in Homa Bay, Kenya.

      Martin, A; Munga Waweru, P; Babu Okatch, F; Amondi Ouma, N; Bonte, L; Varaine, F; Portaels, F; Institute of Tropical Medicine, Antwerp, Belgium; Médecins Sans Frontières, Paris, France; Homa Bay District Hospital, Kenya. (2009-06-03)
      The objective of this study was to evaluate the performance of a low-cost method, the Thin Layer Agar (TLA), for the diagnosis of smear-negative patients. This prospective study was performed in Homa Bay district Hospital in Kenya. Out of 1584 smear-negative sputum samples, 212 were positive by Löwenstein-Jensen (LJ) (13.5%) and 220 positive by TLA (14%). The sensitivity of LJ and TLA was 71% and 74 % respectively. TLA could become an affordable method for the diagnosis of smear-negative tuberculosis in resource-limited settings with results available within 2 weeks.
    • Implementing Joint TB and HIV Interventions in a Rural District of Malawi: Is There a Role for an International Non-Governmental Organisation?

      Zachariah, R; Teck, R; Harries, A D; Humblet, P; Operational Research (HIV-TB), Médecins Sans Frontières, Medical Department, Brussels Operational Centre, Brussels, Belgium. zachariah@internet.lu (International Union Against TB and Lung Disease, 2004-09)
      In a rural district in Malawi, poorly motivated health personnel, shortages of human and financial resources, weak dialogue between existing tuberculosis (TB) and human immunodeficiency virus (HIV) programmes and poor community involvement are constraints to establishing joint TB-HIV interventions. The presence of a non-governmental organisation (NGO), Médecins Sans Frontières (MSF), in the health care delivery system provided an opportunity to bridge some of these gaps. The main inputs provided by MSF included additional staff, supplementary drugs including antiretroviral drugs, technical assistance and infrastructure development. The introduction of a scheme of monthly performance-linked incentives for health personnel proved successful in improving their performance, as judged by attendance rates as well as the quality and quantity of activities. This initiative also provided the district management with a tool for exerting pressure on health staff to improve their performance. The availability of independent NGO funds and a logistics team for construction of new infrastructure allowed the rapid initiation of new interventions at the district level without having to wait for disbursements of funds from the central level. This introduced a new dynamic of decentralised operational flexibility at the district level which improved access to care and support for people with TB-HIV.
    • In Reply

      Zachariah R; Gomani P; Massaquoi M; Harries A D (The TB Union, 2011-11)
    • In reply to ‘Language in tuberculosis services’ [Correspondence]

      Zachariah, R; Srinath, S; Edginton, M E (2012-06)
    • Incidence of Tuberculosis in HIV-Infected Patients Before and After Starting Combined Antiretroviral Therapy in 8 Sub-Saharan African HIV Programs.

      Nicholas, S; Sabapathy, K; Ferreyra, C; Varaine, F; Pujades-Rodríguez, M; From the *Epicentre, Paris, France; †MSF AIDS Working Group, Amsterdam, The Netherlands; ‖MSF AIDS Working Group, Barcelona, Spain; and ‡MSF Tuberculosis Working Group, Paris, France. (2011-08-01)
    • 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).
    • Infection Control for Drug-Resistant Tuberculosis: Early Diagnosis and Treatment Is the Key

      van Cutsem, G; Isaakidis, P; Farley, J; Nardell, E; Volchenkov, G; Cox, H (Oxford University Press -- We regret that this article is behind a paywall., 2016-05-15)
      Multidrug-resistant (MDR) tuberculosis, "Ebola with wings," is a significant threat to tuberculosis control efforts. Previous prevailing views that resistance was mainly acquired through poor treatment led to decades of focus on drug-sensitive rather than drug-resistant (DR) tuberculosis, driven by the World Health Organization's directly observed therapy, short course strategy. The paradigm has shifted toward recognition that most DR tuberculosis is transmitted and that there is a need for increased efforts to control DR tuberculosis. Yet most people with DR tuberculosis are untested and untreated, driving transmission in the community and in health systems in high-burden settings. The risk of nosocomial transmission is high for patients and staff alike. Lowering transmission risk for MDR tuberculosis requires a combination approach centered on rapid identification of active tuberculosis disease and tuberculosis drug resistance, followed by rapid initiation of appropriate treatment and adherence support, complemented by universal tuberculosis infection control measures in healthcare facilities. It also requires a second paradigm shift, from the classic infection control hierarchy to a novel, decentralized approach across the continuum from early diagnosis and treatment to community awareness and support. A massive scale-up of rapid diagnosis and treatment is necessary to control the MDR tuberculosis epidemic. This will not be possible without intense efforts toward the implementation of decentralized, ambulatory models of care. Increasing political will and resources need to be accompanied by a paradigm shift. Instead of focusing on diagnosed cases, recognition that transmission is driven largely by undiagnosed, untreated cases, both in the community and in healthcare settings, is necessary. This article discusses this comprehensive approach, strategies available, and associated challenges.
    • Infection control in households of drug-resistant tuberculosis patients co-infected with HIV in Mumbai, India

      Albuquerque, T; Isaakidis, P; Das, M; Saranchuk, P; Andries, A; Misquita, D P; Khan, S; Dubois, S; Peskett, C; Browne, M (International Union Against Tuberculosis and Lung Disease, 2014-03)
      Background: Mumbai has a population of 21 million, and an increasingly recognised epidemic of drug-resistant tuberculosis (DR-TB). Objective: To describe TB infection control (IC) measures implemented in households of DR-TB patients co-infected with the human immunodeficiency virus(HIV) under a Médecins Sans Frontières programme. Methods: IC assessments were carried out in patient households between May 2012 and March 2013. A simplified,standardised assessment tool was utilised to assess the risk of TB transmission and guide interventions. Administrative, environmental and personal protective measures were tailored to patient needs. Results: IC assessments were carried out in 29 houses.Measures included health education, segregating sleeping areas of patients, improving natural ventilation by opening windows, removing curtains and obstacles to air flow, installing fans and air extractors and providing surgical masks to patients for limited periods. Environmental interventions were carried out in 22 houses. Conclusions: TB IC could be a beneficial component of a comprehensive TB and HIV care programme in households and communities. Although particularly challenging in slum settings, IC measures that are feasible, affordable and acceptable can be implemented in such settings using simplified and standardised tools. Appropriate IC interventions at household level may prevent new cases of DR-TB, especially in households of patients with a lower chance of cure.