• Are they there yet? Linkage of patients with tuberculosis to services for tobacco cessation and alcohol abuse - a mixed methods study from Karnataka, India

      Navya, N; Jeyashree, K; Madhukeshwar, AK; Anand, T; Nirgude, AS; Nayarmoole, BM; Isaakidis, P (BMC, 2019-02-01)
      Background: Tobacco use and alcohol abuse are associated with higher risk of tuberculosis (TB) infection, progression to active TB and adverse treatment outcomes among patients with TB. Revised National Tuberculosis Control Programme (RNTCP) treatment guidelines (2016) require the documentation of tobacco and alcohol use among patients with TB and their linkage to tobacco and alcohol abuse treatment services. This study aimed to assess the extent of documentation of tobacco and alcohol usage data in the TB treatment card and to explore in-depth, the operational issues involved in linkage. Methods: A convergent parallel mixed methods study was conducted. All new TB treatment cards of adult patients registered under RNTCP between January and June 2017 in Dakshina Kannada district were reviewed to assess documentation. Document review was done to understand the process of linkage (directing patients to tobacco and alcohol abuse treatment services). In-depth interview of health care providers (n = 7) and patients with TB (n = 5) explored into their perspectives on linkage. Results: Among 413 treatment cards reviewed, tobacco use was documented in 322 (78%), of whom 86 (21%) were documented as current tobacco users. Sixteen (19%) out of these 86 patients were linked to tobacco cessation services. Alcohol usage status was documented in 319 (77%) cards of whom 71(17%) were documented as alcohol users. Eleven (16%) out of these 71 patients were linked to alcohol abuse treatment services. The questions in the treatment card lacked clarity. Guidelines on eliciting history of substance abuse and criteria for linkage were not detailed. Perceived enablers for linkage included family support, will power of the patients and fear of complications. Challenges included patient's lack of motivation, financial and time constraints, inadequate guidelines and lack of co-ordination mechanisms between TB programme and tobacco/alcohol abuse treatment services. Conclusion: Documentation was good but not universally done. Clear operational guidelines on linkage and treatment guidelines for health care providers to appropriately manage the patients with comorbidities are lacking. Lack of coordination between the TB treatment programme and tobacco cessation as well as alcohol treatment services was considered a major challenge in effective implementation of the linkage services.
    • Does an Isoniazid Prophylaxis Register Improve Tuberculosis Contact Management in South African Children?

      van Soelen, N; du Preez, K; van Wyk, S S; Mandalakas, A M; Enarson, D A; Reid, A J; Hesseling, A C (Public Library of Science, 2013)
      We compared the change in child household contact management of pulmonary tuberculosis (TB) cases before and after the implementation of an isoniazid preventive therapy (IPT) register in an urban clinic setting in Cape Town, South Africa.
    • Intensified Tuberculosis Case Finding among Malnourished Children in Nutritional Rehabilitation Centres of Karnataka, India: Missed Opportunities

      Bhat, P G; Kumar, A M V; Naik, B; Satyanarayana, S; Kg, D; Nair, S A; MD, S; Heldal, E; Enarson, D A; Reid, A J (Public Library of Science, 2013)
      Severe acute malnutrition (SAM) is the most serious form of malnutrition affecting children under-five and is associated with many infectious diseases including Tuberculosis (TB). In India, nutritional rehabilitation centres (NRCs) have been recently established for the management of SAM including TB. The National TB Programme (NTP) in India has introduced a revised algorithm for diagnosing paediatric TB. We aimed to examine whether NRCs adhered to these guidelines in diagnosing TB among SAM children.
    • Intensive-Phase Treatment Outcomes among Hospitalized Multidrug-Resistant Tuberculosis Patients: Results from a Nationwide Cohort in Nigeria

      Oladimeji, O; Isaakidis, P; Obasanya, O J; Eltayeb, O; Khogali, M; Van den Bergh, R; Kumar, A M V; Hinderaker, S G; Abdurrahman, S T; Lawson, L; et al. (Public Library of Science, 2014-04)
      Nigeria is faced with a high burden of Human Immunodeficiency Virus (HIV) infection and multidrug-resistant tuberculosis (MDR-TB). Treatment outcomes among MDR-TB patients registered across the globe have been poor, partly due to high loss-to-follow-up. To address this challenge, MDR-TB patients in Nigeria are hospitalized during the intensive-phase(IP) of treatment (first 6-8 months) and are provided with a package of care including standardized MDR-TB treatment regimen, antiretroviral therapy (ART) and cotrimoxazole prophylaxis (CPT) for HIV-infected patients, nutritional and psychosocial support. In this study, we report the end-IP treatment outcomes among them.
    • Profile and treatment outcomes of elderly patients with tuberculosis in Delhi, India: implications for their management

      Patra, S; Lukhmana, S; Tayler Smith, K; Kannan, A T; Satyanarayana, S; Enarson, D A; Nagar, R K; Marcel, M; Reid, T; Department of Community Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India (Oxford University Press, 2013-11-04)
      Given India's high rate of TB, rising burden of non-communicable diseases (NCDs) and growing elderly population, elderly TB patients may be at higher risk of adverse outcomes including death, loss-to-follow-up (LTFU) and treatment failure. This may call for modifications in their management. This study thus aimed to compare the profile and treatment outcomes between elderly (≥60 years) and non-elderly (15-59 years) TB patients.
    • Provider-initiated HIV testing and counselling for TB in low HIV prevalence settings: is it worthwhile?

      Nagai, S; Robinson, R; Rahamefy, J R; Randriambeloson, S J; Ranaivomanana, D A; Razafindranaivo, T; Rakotobe, L; Ranaivo, A; Hinderaker, S G; Harries, A D; et al. (Oxford University Press, 2014-01-23)
      We assessed the HIV-positive yield of offering provider-initiated HIV testing and counselling (PITC) for TB and the costs, in Madagascar, which has a low HIV prevalence and a high TB burden.