Pub Date : 2024-06-01DOI: 10.5588/ijtldopen.23.0608
A. Ciobanu, V. Plesca, S. Doltu, M. Manea, L. Domente, A. Dadu
SETTINGThe Republic of Moldova is a lower-middle-income country. Patients with TB face some barriers to accessing TB services. Welfare benefits are available during TB treatment.OBJECTIVESWe aimed to determine the proportion of rifampicin-resistant TB (RR-TB) households that experienced catastrophic costs due to TB at a threshold of ≥20% of household income and investigate the associated risk factors.DESIGNA cross-sectional countrywide study comprised 430 patients with RR-TB who had received TB treatment as an inpatient or outpatient for at least 2 months.RESULTSRR-TB patients lost 30% of their household income in inpatient and 70% in outpatient TB care. TB-related costs were associated with being unofficially employed or unemployed (aOR 1.9, 95% CI 1.1–3.3), having fewer household members (aOR 2.1, 95% CI 1.3–3.5), having an income that accounted for over 50% of household income (aOR 2.4, 95% CI 1.5–3.8), and being a poor household (aOR 2.2, 95% CI 1.2–3.9).CONCLUSIONAlthough TB health services are provided to patients free of charge, 26% of RR-TB households experienced catastrophic TB costs. The associated factors should be considered to improve patient-centred TB care, especially in vulnerable groups. Welfare payments mitigate TB costs.
背景摩尔多瓦共和国是一个中低收入国家。结核病患者在获得结核病服务方面面临一些障碍。DESIGNA横断面全国性研究包括430名接受过至少2个月住院或门诊结核病治疗的耐利福平结核病（RR-TB）患者。结果RR-TB患者在住院期间和门诊结核病治疗期间分别损失了30%和70%的家庭收入。与结核病相关的费用与以下因素有关：非官方就业或失业（aOR 1.9，95% CI 1.1-3.3）、家庭成员较少（aOR 2.1，95% CI 1.3-3.5）、收入占家庭收入的 50%以上（aOR 2.结论虽然肺结核医疗服务是免费提供给患者的，但 26% 的 RR-TB 家庭经历了灾难性的肺结核费用。应考虑相关因素，以改善以患者为中心的结核病医疗服务，尤其是在弱势群体中。福利支付可减轻结核病费用。
{"title":"Determinant of catastrophic costs associated with treatment for rifampicin-resistant TB in households in the Republic of Moldova","authors":"A. Ciobanu, V. Plesca, S. Doltu, M. Manea, L. Domente, A. Dadu","doi":"10.5588/ijtldopen.23.0608","DOIUrl":"https://doi.org/10.5588/ijtldopen.23.0608","url":null,"abstract":"SETTINGThe Republic of Moldova is a lower-middle-income country. Patients with TB face some barriers to accessing TB services. Welfare benefits are available during TB treatment.OBJECTIVESWe\u0000 aimed to determine the proportion of rifampicin-resistant TB (RR-TB) households that experienced catastrophic costs due to TB at a threshold of ≥20% of household income and investigate the associated risk factors.DESIGNA cross-sectional\u0000 countrywide study comprised 430 patients with RR-TB who had received TB treatment as an inpatient or outpatient for at least 2 months.RESULTSRR-TB patients lost 30% of their household income in inpatient and 70% in outpatient TB care. TB-related\u0000 costs were associated with being unofficially employed or unemployed (aOR 1.9, 95% CI 1.1–3.3), having fewer household members (aOR 2.1, 95% CI 1.3–3.5), having an income that accounted for over 50% of household income (aOR 2.4, 95% CI 1.5–3.8), and being a poor household\u0000 (aOR 2.2, 95% CI 1.2–3.9).CONCLUSIONAlthough TB health services are provided to patients free of charge, 26% of RR-TB households experienced catastrophic TB costs. The associated factors should be considered to improve patient-centred\u0000 TB care, especially in vulnerable groups. Welfare payments mitigate TB costs.","PeriodicalId":516613,"journal":{"name":"IJTLD OPEN","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141408107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.5588/ijtldopen.24.0094
D. Evans, K. Hirasen, D.J. Casalme, M.T. Gler, A. Gupta, S. Juneja
BACKGROUNDIn 2022, the WHO announced that the 6-month BPaL/M regimen should be used for drug-resistant TB (DR-TB). We estimate the patient and provider costs of BPaL compared to current standard-of-care treatment in the Philippines.METHODSPatients on BPaL under operational research, or 9–11-month standard short oral regimen (SSOR) and 18–21-month standard long oral regimen (SLOR) under programmatic conditions were interviewed using the WHO cross-sectional TB patient cost tool. Provider costs were assessed through a bottom-up and top-down costing analysis.RESULTSTotal patient costs per treatment episode were lowest with BPaL (USD518.0) and increased with use of SSOR (USD825.8) and SLOR (USD1,023.0). Total provider costs per successful treatment were lowest with BPaL (USD1,994.5) and increased with SSOR (USD3,121.5) and SLOR (USD10,032.4). Compared to SSOR, BPaL treatment was cost-effective at even the lowest willingness to pay threshold. As expected, SLOR was the costliest and least effective regimen.CONCLUSIONSCosts incurred by patients on BPaL were 37% (95% CI 22–56) less than SSOR and 50% (95% CI 32–68) less than SLOR, while providers could save 36% (95% CI 21–56) to 80% (95% CI 64–93) per successful treatment, respectively. The study shows that treatment of DR-TB with BPaL was cost-saving for patients and cost-effective for the health system.
{"title":"Cost and cost-effectiveness of BPaL regimen used in drug-resistant TB treatment in the Philippines","authors":"D. Evans, K. Hirasen, D.J. Casalme, M.T. Gler, A. Gupta, S. Juneja","doi":"10.5588/ijtldopen.24.0094","DOIUrl":"https://doi.org/10.5588/ijtldopen.24.0094","url":null,"abstract":"BACKGROUNDIn 2022, the WHO announced that the 6-month BPaL/M regimen should be used for drug-resistant TB (DR-TB). We estimate the patient and provider costs of BPaL compared to current standard-of-care treatment in the Philippines.METHODSPatients\u0000 on BPaL under operational research, or 9–11-month standard short oral regimen (SSOR) and 18–21-month standard long oral regimen (SLOR) under programmatic conditions were interviewed using the WHO cross-sectional TB patient cost tool. Provider costs were assessed through a bottom-up\u0000 and top-down costing analysis.RESULTSTotal patient costs per treatment episode were lowest with BPaL (USD518.0) and increased with use of SSOR (USD825.8) and SLOR (USD1,023.0). Total provider costs per successful treatment were lowest with\u0000 BPaL (USD1,994.5) and increased with SSOR (USD3,121.5) and SLOR (USD10,032.4). Compared to SSOR, BPaL treatment was cost-effective at even the lowest willingness to pay threshold. As expected, SLOR was the costliest and least effective regimen.CONCLUSIONSCosts\u0000 incurred by patients on BPaL were 37% (95% CI 22–56) less than SSOR and 50% (95% CI 32–68) less than SLOR, while providers could save 36% (95% CI 21–56) to 80% (95% CI 64–93) per successful treatment, respectively. The study shows that treatment of DR-TB with BPaL was\u0000 cost-saving for patients and cost-effective for the health system.","PeriodicalId":516613,"journal":{"name":"IJTLD OPEN","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141390848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.5588/ijtldopen.24.0194
A.N. Shapiro, M. Dolynska, S. S. Chiang, N. Rybak, V. Petrenko, C.R. Horsburgh, J. Kobe, I. Terleieva, O. Sakalska, H. E. Jenkins
BACKGROUNDWe assessed the impact of the COVID-19 pandemic on TB notifications in Ukraine, stratified by multiple subgroups.DESIGN/METHODSWe analyzed data from Ukraine’s National TB Program from January 2015 to December 2020 using interrupted time series models. We compared observed cases to counterfactual estimated cases had the pandemic not occurred and estimated trends through December 2020 nationally and by various demographics. We compared the proportions of individuals who underwent drug susceptibility testing (DST) in February 2020 and April 2020 to assess the pandemic impact on drug resistance testing.RESULTSIn April 2020, there were 39% (95% CI 36–42) fewer TB notifications than the estimated counterfactual (3,060 estimated; 95% CI 2,918–3,202; 1,872 observed). We observed a greater decrease in notifications among refugees/migrants compared with non-refugees/migrants (64%, 95% CI 60–67 vs. 39%, 95% CI 36–42), and individuals aged <15 years compared with those aged ≥15 years (60%, 95% CI 57–64 vs. 38%, 95% CI 36–41). We also observed a decrease in the proportion of individuals receiving DST for several drugs.CONCLUSIONSThese findings underscore the challenges to TB prevention and care during disruption and may be generalizable to the current wartime situation, especially considering the substantial increase in refugees within and leaving Ukraine.
背景我们评估了 COVID-19 大流行对乌克兰结核病通报的影响，并按多个亚群进行了分层。设计/方法我们使用间断时间序列模型分析了乌克兰国家结核病计划 2015 年 1 月至 2020 年 12 月的数据。我们将观察到的病例与未发生大流行时的反事实估计病例进行了比较，并按全国和不同人口统计学特征估计了到 2020 年 12 月的趋势。我们比较了 2020 年 2 月和 2020 年 4 月接受药物敏感性检测 (DST) 的人数比例，以评估大流行对耐药性检测的影响。结果 2020 年 4 月，结核病通报数比估计的反事实少 39% (95% CI 36-42)（估计为 3,060 例；95% CI 2,918-3,202 例；观察到 1,872 例）。我们发现，难民/移民与非难民/移民相比（64%，95% CI 60-67 vs. 39%，95% CI 36-42），年龄小于 15 岁的人与年龄大于 15 岁的人相比（60%，95% CI 57-64 vs. 38%，95% CI 36-41），通知率下降幅度更大。我们还观察到，接受多种药物 DST 检测的人数比例有所下降。结论：这些发现强调了混乱时期结核病预防和护理所面临的挑战，并可能适用于当前的战时局势，特别是考虑到乌克兰境内和离开乌克兰的难民人数大幅增加。
{"title":"The impact of the COVID-19 pandemic on TB notifications in Ukraine in 2020","authors":"A.N. Shapiro, M. Dolynska, S. S. Chiang, N. Rybak, V. Petrenko, C.R. Horsburgh, J. Kobe, I. Terleieva, O. Sakalska, H. E. Jenkins","doi":"10.5588/ijtldopen.24.0194","DOIUrl":"https://doi.org/10.5588/ijtldopen.24.0194","url":null,"abstract":"BACKGROUNDWe assessed the impact of the COVID-19 pandemic on TB notifications in Ukraine, stratified by multiple subgroups.DESIGN/METHODSWe analyzed data from Ukraine’s National TB\u0000 Program from January 2015 to December 2020 using interrupted time series models. We compared observed cases to counterfactual estimated cases had the pandemic not occurred and estimated trends through December 2020 nationally and by various demographics. We compared the proportions of individuals\u0000 who underwent drug susceptibility testing (DST) in February 2020 and April 2020 to assess the pandemic impact on drug resistance testing.RESULTSIn April 2020, there were 39% (95% CI 36–42) fewer TB notifications than the estimated\u0000 counterfactual (3,060 estimated; 95% CI 2,918–3,202; 1,872 observed). We observed a greater decrease in notifications among refugees/migrants compared with non-refugees/migrants (64%, 95% CI 60–67 vs. 39%, 95% CI 36–42), and individuals aged <15 years compared with those\u0000 aged ≥15 years (60%, 95% CI 57–64 vs. 38%, 95% CI 36–41). We also observed a decrease in the proportion of individuals receiving DST for several drugs.CONCLUSIONSThese findings underscore the challenges to TB prevention and\u0000 care during disruption and may be generalizable to the current wartime situation, especially considering the substantial increase in refugees within and leaving Ukraine.","PeriodicalId":516613,"journal":{"name":"IJTLD OPEN","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141413101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.5588/ijtldopen.24.0198
H. van der Westhuizen, J.-A. Nice, C. Tudor, Y. Liu, S. Ahmedov, A.R. Kansal, P.A. Jensen, R.L. Vincent, G. Mustapha, V. Vauhkonen, I.M. Ochoa Delgado, M. van der Walt, G. Volchenkov
{"title":"Embracing novel thinking to safeguard against airborne pathogens in indoor spaces","authors":"H. van der Westhuizen, J.-A. Nice, C. Tudor, Y. Liu, S. Ahmedov, A.R. Kansal, P.A. Jensen, R.L. Vincent, G. Mustapha, V. Vauhkonen, I.M. Ochoa Delgado, M. van der Walt, G. Volchenkov","doi":"10.5588/ijtldopen.24.0198","DOIUrl":"https://doi.org/10.5588/ijtldopen.24.0198","url":null,"abstract":"","PeriodicalId":516613,"journal":{"name":"IJTLD OPEN","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141407953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.5588/ijtldopen.24.0162
M. A. Yassin, L. Kimbo, E. Wandwalo, A. Rashid, A. Dzokoto, U. Weber, G. Stallworthy
BACKGROUNDTB remains a significant global health threat, claiming 1.3 million lives annually. The COVID-19 pandemic disrupted progress in the global TB response. Most patients with TB initially seek care from private providers, whereas only a small proportion are engaged by national programmes. The Global Fund is the major international source of funding for TB responses and supports the scale-up of innovative private-public mix (PPM) models in TB.METHODSWe collected programmatic and financial data on TB from 11 priority countries implementing PPM activities. Country examples and trends in the budget of Global Fund grants were analysed.RESULTSThese countries account for 60% of the global TB burden and Global Fund TB portfolio. PPM contributed 29% of national TB notifications in 2022 (range: 8% to 49%). During 2021–2023, US$1.4 billion was allocated for TB and US$155 million (11%) for PPM, while PPM contributed to 35% of national TB notification targets. PPM budgets increased over time from US$43 million (2002 to 2014) to US$129 million (2024 to 2026).CONCLUSIONThe Global Fund’s investments facilitated the expansion of innovative PPM models, improved access, and enhanced TB responses. Our indicative analysis underscores the need for evidence-based planning, collaboration, and increased domestic investment to accelerate the end of TB.
{"title":"Leveraging Global Fund’s investments to expand innovative public-private provider engagement in TB","authors":"M. A. Yassin, L. Kimbo, E. Wandwalo, A. Rashid, A. Dzokoto, U. Weber, G. Stallworthy","doi":"10.5588/ijtldopen.24.0162","DOIUrl":"https://doi.org/10.5588/ijtldopen.24.0162","url":null,"abstract":"BACKGROUNDTB remains a significant global health threat, claiming 1.3 million lives annually. The COVID-19 pandemic disrupted progress in the global TB response. Most patients with TB initially seek care from private providers, whereas only\u0000 a small proportion are engaged by national programmes. The Global Fund is the major international source of funding for TB responses and supports the scale-up of innovative private-public mix (PPM) models in TB.METHODSWe collected programmatic\u0000 and financial data on TB from 11 priority countries implementing PPM activities. Country examples and trends in the budget of Global Fund grants were analysed.RESULTSThese countries account for 60% of the global TB burden and Global\u0000 Fund TB portfolio. PPM contributed 29% of national TB notifications in 2022 (range: 8% to 49%). During 2021–2023, US$1.4 billion was allocated for TB and US$155 million (11%) for PPM, while PPM contributed to 35% of national TB notification targets. PPM budgets increased\u0000 over time from US$43 million (2002 to 2014) to US$129 million (2024 to 2026).CONCLUSIONThe Global Fund’s investments facilitated the expansion of innovative PPM models, improved access, and enhanced TB responses. Our\u0000 indicative analysis underscores the need for evidence-based planning, collaboration, and increased domestic investment to accelerate the end of TB.","PeriodicalId":516613,"journal":{"name":"IJTLD OPEN","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141398943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.5588/ijtldopen.24.0044
A. Lemson, T.A. Koster, N. Carpaij, C. Magis-Escurra, M. Boeree, R. Stemkens, R.E. Aarnoutse, A. van Laarhoven, R. van Crevel, J. van Ingen, W. Hoefsloot
{"title":"Evaluation of a national multidisciplinary meeting for non-tuberculous mycobacterial disease","authors":"A. Lemson, T.A. Koster, N. Carpaij, C. Magis-Escurra, M. Boeree, R. Stemkens, R.E. Aarnoutse, A. van Laarhoven, R. van Crevel, J. van Ingen, W. Hoefsloot","doi":"10.5588/ijtldopen.24.0044","DOIUrl":"https://doi.org/10.5588/ijtldopen.24.0044","url":null,"abstract":"","PeriodicalId":516613,"journal":{"name":"IJTLD OPEN","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141394293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.5588/ijtldopen.24.0113
N. Schönfeld, L. Barkane, I. Davoliene, M. Danilovitš, S. Miliauskas, F. Ader, O.M. Kon, C. Lange, A. Duvignaud, M. Heiss-Neumann, N. Hittel, N. Lazarević, I. Knebel, A. Martin, B. Eschenbach, E. van Heumen, V. George
BACKGROUNDA post-authorisation safety study (PASS) on delamanid (DLM) was conducted as part of a post-approval commitment to the European Medicines Agency. The aim of this study was to evaluate the use of DLM in a real-life setting, its safety, and treatment outcomes in patients with multidrug-resistant TB (MDR-TB).METHODSThis was a prospective, multicentric, non-interventional study conducted in the European Union. MDR-TB Regimen selection and patient monitoring were conducted in accordance with existing medical practices. Data on the use of DLM, related adverse events, and treatment outcomes were collected for up to 30 months after the first DLM dose. Descriptive summary statistics were used for continuous and categorical variables.RESULTSOut of 86 patients, one had extrapulmonary TB. Two-thirds of the patients were treated with DLM for more than 24 weeks. The most frequent adverse drug reaction to DLM was QT interval prolongation. Resistance to DLM was detected in one patient during treatment. The treatment success rate was 77%.CONCLUSIONNo new safety concerns were revealed, including in patients treated with DLM for more than 24 weeks. QT interval prolongations were well managed and did not lead to any clinically significant cardiac effects. The treatment outcomes were in line with the WHO target for Europe.
{"title":"Real-life use of delamanid: results from the European post-authorisation safety study","authors":"N. Schönfeld, L. Barkane, I. Davoliene, M. Danilovitš, S. Miliauskas, F. Ader, O.M. Kon, C. Lange, A. Duvignaud, M. Heiss-Neumann, N. Hittel, N. Lazarević, I. Knebel, A. Martin, B. Eschenbach, E. van Heumen, V. George","doi":"10.5588/ijtldopen.24.0113","DOIUrl":"https://doi.org/10.5588/ijtldopen.24.0113","url":null,"abstract":"BACKGROUNDA post-authorisation safety study (PASS) on delamanid (DLM) was conducted as part of a post-approval commitment to the European Medicines Agency. The aim of this study was to evaluate the use of DLM in a real-life setting, its safety,\u0000 and treatment outcomes in patients with multidrug-resistant TB (MDR-TB).METHODSThis was a prospective, multicentric, non-interventional study conducted in the European Union. MDR-TB Regimen selection and patient monitoring were conducted\u0000 in accordance with existing medical practices. Data on the use of DLM, related adverse events, and treatment outcomes were collected for up to 30 months after the first DLM dose. Descriptive summary statistics were used for continuous and categorical variables.RESULTSOut\u0000 of 86 patients, one had extrapulmonary TB. Two-thirds of the patients were treated with DLM for more than 24 weeks. The most frequent adverse drug reaction to DLM was QT interval prolongation. Resistance to DLM was detected in one patient during treatment. The treatment success rate was 77%.CONCLUSIONNo\u0000 new safety concerns were revealed, including in patients treated with DLM for more than 24 weeks. QT interval prolongations were well managed and did not lead to any clinically significant cardiac effects. The treatment outcomes were in line with the WHO target for Europe.","PeriodicalId":516613,"journal":{"name":"IJTLD OPEN","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141405602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.5588/ijtldopen.24.0006
F. Saluzzo, F. Masood, V. Batignani, F. Di Marco, U. Majeed, A. Ghazal, D.M. Cirillo, S. Tahseen
BACKGROUNDThe insurgence of resistance to key drugs of the BPaLM (bedaquiline + pretomanid + moxifloxacin) regimen is a major concern. In settings with widespread resistance to fluoroquinolones (FQs), like Pakistan, new technologies, such as Xpert® MTB/XDR, may ensure drug resistance upfront screening. This study aims to assess MTB/XDR's performance in detecting FQs and isoniazid resistance, proposing a renewed diagnostic algorithm for drug-resistant TB (DR-TB).METHODSThis cross-sectional prospective study, approved by the local ethical committee, collected samples from people newly and previously diagnosed with TB over 6 months. Xpert® MTB/RIF Ultra, MTB/XDR, Genotype® MTBDRplus, Genotype® MTBDRsl, culture, and phenotypic drug susceptibility testing (pDST) for relevant drugs (including bedaquiline and levofloxacin) were performed. Next-generation sequencing (NGS) resolved discordances between MTB/XDR and pDST results.RESULTSThe analysis showed that MTB/XDR has 91.5% and 88.2% sensitivity and 99.5% and 97.7% specificity in detecting respectively isoniazid (INH) and resistance to FQs, demonstrating that MTB/XDR meets the WHO targets for INH resistance detection at the peripheral level. NGS effectively resolved discordances between MTB/XDR and pDST results.CONCLUSIONSThe obtained results allowed designing the proposed diagnostic algorithm for rapid identification of DR-TB, ensuring rapid and equitable access to drug susceptibility testing for TB, ultimately improving TB care and control.
{"title":"TB drug susceptibility testing in high fluoroquinolone resistance settings","authors":"F. Saluzzo, F. Masood, V. Batignani, F. Di Marco, U. Majeed, A. Ghazal, D.M. Cirillo, S. Tahseen","doi":"10.5588/ijtldopen.24.0006","DOIUrl":"https://doi.org/10.5588/ijtldopen.24.0006","url":null,"abstract":"BACKGROUNDThe insurgence of resistance to key drugs of the BPaLM (bedaquiline + pretomanid + moxifloxacin) regimen is a major concern. In settings with widespread resistance to fluoroquinolones (FQs), like Pakistan, new technologies, such as\u0000 Xpert® MTB/XDR, may ensure drug resistance upfront screening. This study aims to assess MTB/XDR's performance in detecting FQs and isoniazid resistance, proposing a renewed diagnostic algorithm for drug-resistant TB (DR-TB).METHODSThis\u0000 cross-sectional prospective study, approved by the local ethical committee, collected samples from people newly and previously diagnosed with TB over 6 months. Xpert® MTB/RIF Ultra, MTB/XDR, Genotype® MTBDRplus, Genotype® MTBDRsl,\u0000 culture, and phenotypic drug susceptibility testing (pDST) for relevant drugs (including bedaquiline and levofloxacin) were performed. Next-generation sequencing (NGS) resolved discordances between MTB/XDR and pDST results.RESULTSThe\u0000 analysis showed that MTB/XDR has 91.5% and 88.2% sensitivity and 99.5% and 97.7% specificity in detecting respectively isoniazid (INH) and resistance to FQs, demonstrating that MTB/XDR meets the WHO targets for INH resistance detection at the peripheral level. NGS effectively resolved discordances\u0000 between MTB/XDR and pDST results.CONCLUSIONSThe obtained results allowed designing the proposed diagnostic algorithm for rapid identification of DR-TB, ensuring rapid and equitable access to drug susceptibility testing for TB, ultimately\u0000 improving TB care and control.","PeriodicalId":516613,"journal":{"name":"IJTLD OPEN","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141056233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.5588/ijtldopen.23.0501
N. Cassim, S.V. Omar, S. D. Masuku, H. Moultrie, W.S. Stevens, F. Ismail, P. da Silva
INTRODUCTIONIn South Africa, Xpert® MTB/RIF Ultra (Ultra) is the recommended diagnostic assay for TB with line-probe assays for first- (LPAfl) and second-line drugs (LPAsl) providing additional drug susceptibility testing (DST) for samples that were rifampicin-resistant (RR-TB). To guide implementation of the recently launched Xpert® MTB/XDR (MTB/XDR) assay, a cost-outcomes analysis was conducted comparing total costs for genotypic DST (gDST) for persons diagnosed with RR-TB considering three strategies: replacing LPAfl/LPAsl (centralised level) with MTB/XDR vs. Ultra reflex testing (decentralised level). Further, DST was performed using residual specimen following RR-TB diagnosis.METHODSThe total cost of gDST was determined for three strategies, considering loss to follow-up (LTFU), unsuccessful test rates, and specimen volume.RESULTSFor 2019, 9,415 persons were diagnosed with RR-TB. A 35% LTFU rate between RR-TB diagnosis and LPAfl/LPAsl-DST was estimated. Unsuccessful test rates of 37% and 23.3% were reported for LPAfl and LPAsl, respectively. The estimated total costs were $191,472 for the conventional strategy, $122,352 for the centralised strategy, and $126,838 for the decentralised strategy. However, it was found that sufficient residual volume for reflex MTB/XDR testing is a limiting factor at the decentralised level.CONCLUSIONCentralising the implementation of XDR testing, as compared to LPAfl/LPAsl, leads to significant cost savings.
{"title":"Xpert MTB/XDR implementation in South Africa: cost outcomes of centralised vs. decentralised approaches","authors":"N. Cassim, S.V. Omar, S. D. Masuku, H. Moultrie, W.S. Stevens, F. Ismail, P. da Silva","doi":"10.5588/ijtldopen.23.0501","DOIUrl":"https://doi.org/10.5588/ijtldopen.23.0501","url":null,"abstract":"INTRODUCTIONIn South Africa, Xpert® MTB/RIF Ultra (Ultra) is the recommended diagnostic assay for TB with line-probe assays for first- (LPAfl) and second-line drugs (LPAsl) providing additional drug susceptibility testing (DST)\u0000 for samples that were rifampicin-resistant (RR-TB). To guide implementation of the recently launched Xpert® MTB/XDR (MTB/XDR) assay, a cost-outcomes analysis was conducted comparing total costs for genotypic DST (gDST) for persons diagnosed with RR-TB considering three strategies:\u0000 replacing LPAfl/LPAsl (centralised level) with MTB/XDR vs. Ultra reflex testing (decentralised level). Further, DST was performed using residual specimen following RR-TB diagnosis.METHODSThe total cost of gDST was determined for three\u0000 strategies, considering loss to follow-up (LTFU), unsuccessful test rates, and specimen volume.RESULTSFor 2019, 9,415 persons were diagnosed with RR-TB. A 35% LTFU rate between RR-TB diagnosis and LPAfl/LPAsl-DST was estimated. Unsuccessful\u0000 test rates of 37% and 23.3% were reported for LPAfl and LPAsl, respectively. The estimated total costs were $191,472 for the conventional strategy, $122,352 for the centralised strategy, and $126,838 for the decentralised strategy. However, it was found that sufficient\u0000 residual volume for reflex MTB/XDR testing is a limiting factor at the decentralised level.CONCLUSIONCentralising the implementation of XDR testing, as compared to LPAfl/LPAsl, leads to significant cost savings.","PeriodicalId":516613,"journal":{"name":"IJTLD OPEN","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141032030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.5588/ijtldopen.24.0011
J. Zifodya, J.S. Kreniske, T. Temu, S. Masyuko, E.F. Attia, J. Mogaka, D. Onyango, S.T. Page, K. Crothers, J. Kinuthia, C. Farquhar, S. LaCourse
{"title":"HIV and diabetes impair M. tuberculosis-specific interferon-gamma responses on QuantiFERON-TB Gold Plus testing","authors":"J. Zifodya, J.S. Kreniske, T. Temu, S. Masyuko, E.F. Attia, J. Mogaka, D. Onyango, S.T. Page, K. Crothers, J. Kinuthia, C. Farquhar, S. LaCourse","doi":"10.5588/ijtldopen.24.0011","DOIUrl":"https://doi.org/10.5588/ijtldopen.24.0011","url":null,"abstract":"","PeriodicalId":516613,"journal":{"name":"IJTLD OPEN","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141049287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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