• Language in tuberculosis services: can we change to patient-centred terminology and stop the paradigm of blaming the patients?

      Zachariah, R; Harries, A D; Srinath, S; Ram, S; Viney, K; Singogo, E; Lal, P; Mendoza-Ticona, A; Sreenivas, A; Aung, N W; et al. (2012-06)
      The words 'defaulter', 'suspect' and 'control' have been part of the language of tuberculosis (TB) services for many decades, and they continue to be used in international guidelines and in published literature. From a patient perspective, it is our opinion that these terms are at best inappropriate, coercive and disempowering, and at worst they could be perceived as judgmental and criminalising, tending to place the blame of the disease or responsibility for adverse treatment outcomes on one side-that of the patients. In this article, which brings together a wide range of authors and institutions from Africa, Asia, Latin America, Europe and the Pacific, we discuss the use of the words 'defaulter', 'suspect' and 'control' and argue why it is detrimental to continue using them in the context of TB. We propose that 'defaulter' be replaced with 'person lost to follow-up'; that 'TB suspect' be replaced by 'person with presumptive TB' or 'person to be evaluated for TB'; and that the term 'control' be replaced with 'prevention and care' or simply deleted. These terms are non-judgmental and patient-centred. We appeal to the global Stop TB Partnership to lead discussions on this issue and to make concrete steps towards changing the current paradigm.
    • Lessons Learnt from TB Screening in Closed Immigration Centres in Italy

      Crepet, A; Repetto, E; Al Rousan, A; Sané Schepisi, M; Girardi, E; Prestileo, T; Codecasa, L; Garelli, S; Corrao, S; Ippolito, G; et al. (Oxford University Press, 2016-05-20)
      Between June 2012 and December 2013 Médecins Sans Frontières launched a pilot project with the aim of testing a strategy for improving timely diagnosis of active pulmonary TB among migrants hosted in four centres of identification and expulsion (CIE) in Italy.
    • "Life continues": Patient, health care and community care workers perspectives on self-administered treatment for rifampicin-resistant tuberculosis in Khayelitsha, South Africa

      Mohr, E; Snyman, L; Mbakaz, Z; Caldwell, J; DeAzevedo, V; Kock, Y; Trivino Duran, L; Venables, E (Public Library of Science, 2018-09-14)
      Self-administered treatment (SAT), a differentiated model of care for rifampicin-resistant tuberculosis (RR-TB), might address adherence challenges faced by patients and health care systems. This study explored patient, health-care worker (HCW) and community care worker (CCW) perspectives on a SAT pilot programme in South Africa, in which patients were given medication to take at home with the optional support of a CCW.
    • Linezolid for multidrug-resistant tuberculosis in HIV-infected and -uninfected patients.

      Hughes, J; Isaakidis, P; Andries, A; Mansoor, H; Cox, V; Meintjes, G; Cox, H (2015-07)
    • Linezolid for multidrug-resistant tuberculosis.

      Cox, H; Ford, N; Hughes, J; Goemaere, E (2013-01)
    • Linezolid for the treatment of complicated drug-resistant tuberculosis: a systematic review and meta-analysis [Review article].

      Cox, H; Ford, N; Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa; Monash University, Melbourne, Victoria, Australia; ‡ Médecins Sans Frontières, London, UK; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa (Publisher International Union Against Tuberculosis and Lung Disease, 2012-02-08)
      BACKGROUND: Current treatment for drug-resistant tuberculosis (DR-TB) is inadequate, and outcomes are significantly poorer than for drug-susceptible TB, particularly for patients previously treated with second-line drugs, treatment failures or extensively drug-resistant (XDR-) TB patients (complicated DR-TB). Linezolid is not recommended for routine DR-TB treatment due to the lack of efficacy data, but is suggested for patients where adequate second-line regimens are difficult to design.OBJECTIVE: To conduct a systematic review and metaanalysis to assess existing evidence of efficacy and safety of linezolid for DR-TB treatment.METHODS: We searched PubMed, Embase and abstracts from World Conferences of The Union for studies published through February 2011. We included all studies in which linezolid was given systematically to DR-TB patients and where treatment outcomes were reported.RESULTS: A total of 11 studies were included in our review, representing 148 patients. The pooled proportion for treatment success was 67.99% (95%CI 58.00-78.99, τ2 129.42). There were no significant differences in success comparing daily linezolid dose (≤600 vs. >600 mg) and mean linezolid duration (≤7 vs. >7 months). The pooled estimate for the frequency of any adverse events was 61.48% (95%CI 40.15-82.80), with 36.23% (95%CI 20.67-51.79) discontinuing linezolid due to adverse events.CONCLUSION: Treatment success with linezolid was equal to or better than that commonly achieved for uncomplicated DR-TB, and better than previous reports for previously treated patients and those with XDR-TB. While data are limited, linezolid appears be a useful drug, albeit associated with significant adverse events, and should be considered in the treatment of complicated DR-TB.
    • 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.
    • The looming epidemic of diabetes-associated tuberculosis: learning lessons from HIV-associated tuberculosis

      Harries, A D; Lin, Y; Satyanarayana, S; Lönnroth, K; Li, L; Wilson, N; Chauhan, L S; Zachariah, R; Baker, M A; Jeon, C Y; et al. (International Union Against Tuberculosis and Lung Disease, 2011-11-01)
      The prevalence of diabetes mellitus is increasing at a dramatic rate, and countries in Asia, particularly India and China, will bear the brunt of this epidemic. Persons with diabetes have a significantly increased risk of active tuberculosis (TB), which is two to three times higher than in persons without diabetes. In this article, we argue that the epidemiological interactions and the effects on clinical presentation and treatment resulting from the interaction between diabetes and TB are similar to those observed for human immunodeficiency virus (HIV) and TB. The lessons learned from approaches to reduce the dual burden of HIV and TB, and especially the modes of screening for the two diseases, can be adapted and applied to the screening, diagnosis, treatment and prevention of diabetes and TB. The new World Health Organization (WHO) and The Union Collaborative Framework for care and control of TB and diabetes has many similarities to the WHO Policy on Collaborative Activities to reduce the dual burden of TB and HIV, and aims to guide policy makers and implementers on how to move forward and combat this looming dual epidemic. The response to the growing HIV-associated TB epidemic in the 1980s and 1990s was slow and uncoordinated, despite clearly articulated warnings about the scale of the forthcoming problem. We must not make the same mistake with diabetes and TB. The Framework provides a template for action, and it is now up to donors, policy makers and implementers to apply the recommendations in the field and to 'learn by doing'.
    • Loss from treatment for drug resistant tuberculosis: risk factors and patient outcomes in a community-based program in Khayelitsha, South Africa

      Moyo, S; Cox, H S; Hughes, J; Daniels, J; Synman, L; De Azevedo, V; Shroufi, A; Cox, V; van Cutsem, G (Public Library of Science, 2015-03-18)
      A community based drug resistant tuberculosis (DR-TB) program has been incrementally implemented in Khayelitsha, a high HIV and TB burden community in South Africa. We investigated loss from treatment (LFT), and post treatment outcomes of DR-TB patients in this setting.
    • 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.
    • Lost to follow up from tuberculosis treatment in an urban informal settlement (Kibera), Nairobi, Kenya: what are the rates and determinants?

      Kizito, K W; Dunkley, S; Kingori, M; Reid, T; Médecins Sans Frontières - Operational Centre Belgium, Kenya Mission, Kileleshwa, Nairobi, Kenya. kwalta@gmail.com (2011-01)
      Patients lost to follow up (LTFU) from treatment are a major concern for tuberculosis (TB) programmes. It is even more challenging in programmes in urban informal settlements (slums) with large, highly mobile, impoverished populations. Kibera, on the outskirts of Nairobi, Kenya is such a community with an estimated population of 500,000 to 700,000. Médecins Sans Frontières (MSF), in collaboration with the Kenyan Ministry of Public Health and Sanitation (MPHS), operate three clinics providing integrated TB, HIV and primary health care. We undertook a retrospective study between July 2006 and December 2008 to determine the rate of LTFU from the TB programme in Kibera and to assess associated clinical and socio-demographic factors. Thanks to an innovative 'Defaulter Tracing Programme', patients who missed their appointments were routinely traced and encouraged to return for treatment. Where possible, reasons for missed appointments were recorded. LTFU occurred in 146 (13%) of the 1094 patients registered, with male gender, no salaried employment, lack of family support and positive TB smear at diagnosis found to be significant associations (P value ≤ 0.05). The most commonly cited reasons for LTFU were relocation from Kibera to 'up-country' rural homes and work commitments.
    • 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.
    • Low uptake of antiretroviral therapy after admission with human immunodeficiency virus and tuberculosis in KwaZulu-Natal, South Africa.

      Murphy, R A; Sunpath, H; Taha, B; Kappagoda, S; Maphasa, K T M; Kuritzkes, D R; Smeaton, L; Doctors Without Borders USA, New York, USA; McCord Hospital, South Africa; Harvard Medical School, Massachusetts, USA; Division of Infectious Disease and Geographic Medicine, California, USA; Zoe-Life, South Africa; Section of Retroviral Therapeutics, Massachusetts, USA; Centre for Biostatistics in AIDS Research, Massachusetts, USA (2010-07-01)
      A prospective cohort study was conducted among human immunodeficiency virus (HIV) infected in-patients with tuberculosis (TB) or other opportunistic infections (OIs) in South Africa to estimate subsequent antiretroviral therapy (ART) uptake and survival.
    • Lowenstein-Jensen Selective Medium for Reducing Contamination in Mycobacterium tuberculosis Culture

      Kassaza, K; Orikiriza, P; Llosa, A; Bazira, J; Nyehangane, D; Page, A-L; Boum, Y (2014-07)
      We compared Mycobacterium tuberculosis sputum culture recovery and contamination rates between Lowenstein-Jensen medium (LJ) containing the following decontaminants and LJ alone: (i) PANTA (n = 299), (ii) Selectatab-MB (n = 299), and (iii) penicillin G (n = 234). The contamination rate for LJ alone was approximately 31%, versus 5.0% for PANTA-containing, 2% for Selectatab-containing, and 9% for penicillin-containing media (P < 0.001). M. tuberculosis isolation rates were 9.8%, 17%, 18%, and 12% for standard LJ, PANTA, Selectatab, and penicillin cultures, respectively.
    • Male Gender is independently associated with pulmonary tuberculosis among sputum and non-sputum producers people with presumptive tuberculosis in Southwestern Uganda

      Boum, Y; Atwine, D; Orikiriza, P; Assimwe, J; Page, A-L; Mwanga-Amumpaire, J; Bonnet, M (BioMed Central, 2014-12-10)
      BackgroundLittle is known about the association between gender and risk of TB infection. We sought to assess the impact of gender on TB prevalence among people with presumptive tuberculosis at a regional referral hospital in a high TB and HIV prevalence setting.MethodsWe analyzed data from two diagnostic TB studies conducted in rural, southwestern Uganda. People with presumptive tuberculosis were evaluated by chest X-ray, fluorescence microscopy, TB culture, and HIV testing. Our primary outcome of interest was TB infection, as defined by a positive TB culture. Our primary explanatory variable of interest was gender. We fit univariable and multivariable logistic regression models to investigate associations between TB infection and gender, before and after adjusting or possible confounding factors, including ability to produce sputum, age and residence.ResultsBetween April 2010 and September 2012, 863 people with presumptive tuberculosis (PWPTB) were enrolled in the two studies at Mbarara Regional Referral Hospital (MRRH) in Uganda. Among them 664 (76.9%) were able to produce sputum. X-ray was suggestive of TB for 258 (66.5%) of males and 175 (44.8%) of female (p¿<¿0.001). using microscopy 84 (20%) of males and 48 (10.9%) of females were diagnosed with TB (p¿<¿0.001) while 122 (30.3%) of males and 76 (18.4%) of females were diagnosed with TB (p¿<¿0.001) using TB culture.In multivariable logistic regression models, the odds of having TB was higher in males than females (AOR 2.2 (1.56-3.18 95%CI°, P¿<¿0.001), after adjustment for age, HIV status, ability to produce sputum, and residence.ConclusionIn Southwestern Uganda, TB prevalence is higher among male than female people with presumptive TB. The increased risk of TB among males is independent of other TB risk factors. These findings emphasize the need for gender-focused interventions aimed at reducing TB transmission.
    • MDR tuberculosis and non-compliance with therapy (correspondence)

      Cox, H; Hughes, J; Ford, N; London, L; Medecins Sans Frontieres (Elsevier, 2012-03)
    • MDR tuberculosis and non-compliance with therapy.

      Cox, H; Hughes, J; Ford, N; London, L; Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa; and University of Cape Town, Cape Town, South Africa (Elservier, 2012-03)
    • MDR/XDR-TB management of patients and contacts: challenges facing the new decade. The 2020 clinical update by the Global Tuberculosis Network.

      Battista Migliori, G; Tiberi, S; Zumla, A; Petersen, E; Muhwa Chakaya, J; Wejse, C; Muñoz Torrico, M; Duarte, R; Alffenaar, JW; Schaaf, HS; et al. (Elsevier, 2020-02-04)
      The continuous flow of new research articles on MDR-TB diagnosis, treatment, prevention and rehabilitation requires frequent update of existing guidelines. This review is aimed at providing clinicians and public health staff with an updated and easy-to-consult document arising from consensus of Global Tuberculosis Network (GTN) experts. The core published documents and guidelines have been reviewed including the recently published MDR-TB WHO rapid advice and ATS/CDC/ERS/IDSA guidelines. After a rapid review of epidemiology and risk factors, the clinical priorities on MDR-TB diagnosis (including whole genome sequencing and drug-susceptibility testing interpretations) and treatment (treatment design and management, TB in children) are discussed. Furthermore, the review comprehensively describes the latest information on contact tracing and LTBI management in MDR-TB contacts, while providing guidance on post-treatment functional evaluation and rehabilitation of TB sequelae, infection control and other public health priorities.
    • A misleading appearance of a common disease: tuberculosis with generalized lymphadenopathy—a case report

      Bottineau, MC; Kouevi, KA; Chauvet, E; Garcia, DM; Galetto-Lacour, A; Wagner, N (Oxford University Press, 2019-09-28)
      Introduction: Tuberculosis is a common illness for vulnerable populations in resource-limited settings. Lymph nodes in tuberculosis represent the most frequent extra-pulmonary form of tuberculosis in children, but lymph nodes are rarely generalized and large. We report an atypical pediatric case of tuberculosis with lymphadenopathy. Patient concerns and findings: A two-year-old child with severe acute malnutrition presented with painless, generalized, and excessively large nodes which were not compressive and were without fistula. Main diagnoses, interventions, outcomes: Fine needle aspiration was performed and led to the detection of lymph node granulomatous lymphadenitis suggestive of tuberculosis. Conclusion: The child was immediately initiated on anti-tuberculosis therapy with a very successful outcome. Clinicians should be aware of atypical manifestations such as the one we describe in the interest of swift diagnosis and initiation of treatment.
    • Missed Opportunities for Earlier Diagnosis of rifampicin-resistant Tuberculosis despite access to Xpert(®) MTB/RIF

      Mohr, E; Daniels, J; Muller, O; Furin, J; Chabalala, B; Steele, S J; Cox, V; Dolby, T; Ferlazzo, G; Shroufi, A; et al. (International Union Against Tuberculosis and Lung Disease, 2017-10-01)
      To assess the proportion of rifampicin-resistant tuberculosis (RR-TB) patients with potential earlier RR-TB diagnoses in Khayelitsha, South Africa.