Conference Material > Video (talk)
Lightowler M
Epicentre Scientific Day Paris 2023. 2023 June 8
English
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Journal Article > ResearchFull Text
Public Health Action. 2019 September 21; Volume 9; DOI:10.5588/pha.18.0069
Moses I, Main S, Commons RJ, Robertson B, Mek A, et al.
Public Health Action. 2019 September 21; Volume 9; DOI:10.5588/pha.18.0069
Setting:
Gulf Province, a rural area of mainland Papua New Guinea, is known to have one of the highest burdens of tuberculosis (TB) in the country.
Objectives:
To describe the characteristics and outcomes of TB patients registered for first-line treatment in Kerema General Hospital in Gulf Province between January and December 2016.
Design:
This was a retrospective cohort study using routinely collected programme data.
Results:
Of 347 cases with a recorded TB site, 54% were male and 32% were aged <15 years. No human immunodeficiency virus (HIV) status was recorded for 51% of cases. TB was bacteriologically confirmed in 23% of cases. Among the cohort, there were 145 extrapulmonary TB cases (42%); the site of disease was unknown in 56% of these cases. Of the 297 cases with treatment outcome evaluated, 56% had a favourable outcome and 26% were lost to follow-up. On multivariable analysis, extrapulmonary TB (adjusted OR [aOR] 0.51, 95%CI 0.30–0.88, P = 0.02) and bacteriologically confirmed TB (aOR 0.40, 95%CI 0.21–0.77, P < 0.01) were associated with decreased odds of an unfavourable treatment outcome.
Conclusion:
The study findings highlight the need to improve TB diagnosis, access to HIV testing, treatment adherence, patient support and the quality of TB programme data in Gulf Province.
Gulf Province, a rural area of mainland Papua New Guinea, is known to have one of the highest burdens of tuberculosis (TB) in the country.
Objectives:
To describe the characteristics and outcomes of TB patients registered for first-line treatment in Kerema General Hospital in Gulf Province between January and December 2016.
Design:
This was a retrospective cohort study using routinely collected programme data.
Results:
Of 347 cases with a recorded TB site, 54% were male and 32% were aged <15 years. No human immunodeficiency virus (HIV) status was recorded for 51% of cases. TB was bacteriologically confirmed in 23% of cases. Among the cohort, there were 145 extrapulmonary TB cases (42%); the site of disease was unknown in 56% of these cases. Of the 297 cases with treatment outcome evaluated, 56% had a favourable outcome and 26% were lost to follow-up. On multivariable analysis, extrapulmonary TB (adjusted OR [aOR] 0.51, 95%CI 0.30–0.88, P = 0.02) and bacteriologically confirmed TB (aOR 0.40, 95%CI 0.21–0.77, P < 0.01) were associated with decreased odds of an unfavourable treatment outcome.
Conclusion:
The study findings highlight the need to improve TB diagnosis, access to HIV testing, treatment adherence, patient support and the quality of TB programme data in Gulf Province.
Journal Article > ReviewFull Text
BMC Med. 2018 October 29; Volume 16 (Issue 1); 186.; DOI:10.1186/s12916-018-1177-5
Das D, Grais RF, Okiro EA, Stepniewska K, Mansoor R, et al.
BMC Med. 2018 October 29; Volume 16 (Issue 1); 186.; DOI:10.1186/s12916-018-1177-5
Despite substantial improvement in the control of malaria and decreased prevalence of malnutrition over the past two decades, both conditions remain heavy burdens that cause hundreds of thousands of deaths in children in resource-poor countries every year. Better understanding of the complex interactions between malaria and malnutrition is crucial for optimally targeting interventions where both conditions co-exist. This systematic review aimed to assess the evidence of the interplay between malaria and malnutrition.
Journal Article > ResearchFull Text
Confl Health. 2013 September 16; Volume 7 (Issue 1); DOI:10.1186/1752-1505-7-19
de Jong K, Shanks L, Ariti C, Denault M, Siddiqui R, et al.
Confl Health. 2013 September 16; Volume 7 (Issue 1); DOI:10.1186/1752-1505-7-19
Medecins Sans Frontieres (MSF) provides individual counselling interventions in medical humanitarian programmes in contexts affected by conflict and violence. Although mental health and psychosocial interventions are a common part of the humanitarian response, little is known about how the profile and outcomes for individuals seeking care differs across contexts. We did a retrospective analysis of routine programme data to determine who accessed MSF counselling services and why, and the individual and programmatic risk factors for poor outcomes.
Journal Article > ResearchFull Text
Public Health Action. 2023 June 21; Volume 13 (Issue 2); 60-64.; DOI:10.5588/pha.22.0062
Kurbaniyazova G, Msibi F, Bogati H, Kal M, Sofa A, et al.
Public Health Action. 2023 June 21; Volume 13 (Issue 2); 60-64.; DOI:10.5588/pha.22.0062
English
Français
SETTING
Papua New Guinea (PNG) has one of the world’s highest TB incidence rates. It is difficult for patients to access TB care in remote provinces due to insufficient infrastructure and challenging terrain, making varied, targeted delivery models for treating TB necessary.
OBJECTIVE
To assess treatment outcomes using self-administered treatment (SAT), family-supported treatment and community-based directly observed therapy (DOT) via treatment supporter (TS) in the PNG context.
DESIGN
A retrospective, descriptive analysis of routinely collected data from 360 patients at two sites in 2019–2020. All patients were assigned a treatment model based on risk factors (adherence or default) and offered patient education and counselling (PEC), family counselling and transportation fees. End-of-treatment outcomes were assessed for each model.
RESULTS
Treatment success rates among drug-susceptible TB (DS-TB) were good overall: 91.1% for SAT, 81.4% for family-supported treatment and 77% for DOT patients. SAT was strongly associated with favourable outcomes (OR 5.7, 95% CI 1.7–19.3), as were PEC sessions (OR 4.3, 95% CI 2.5–7.2).
CONCLUSION
By considering risk factors when determining their treatment delivery model, strong outcomes were seen in all three groups. Multiple modes of treatment administration, tailored to individuals’ needs and risk factors, is a feasible, effective, patient-centred care model for hard-to-reach, resource-limited settings.
Papua New Guinea (PNG) has one of the world’s highest TB incidence rates. It is difficult for patients to access TB care in remote provinces due to insufficient infrastructure and challenging terrain, making varied, targeted delivery models for treating TB necessary.
OBJECTIVE
To assess treatment outcomes using self-administered treatment (SAT), family-supported treatment and community-based directly observed therapy (DOT) via treatment supporter (TS) in the PNG context.
DESIGN
A retrospective, descriptive analysis of routinely collected data from 360 patients at two sites in 2019–2020. All patients were assigned a treatment model based on risk factors (adherence or default) and offered patient education and counselling (PEC), family counselling and transportation fees. End-of-treatment outcomes were assessed for each model.
RESULTS
Treatment success rates among drug-susceptible TB (DS-TB) were good overall: 91.1% for SAT, 81.4% for family-supported treatment and 77% for DOT patients. SAT was strongly associated with favourable outcomes (OR 5.7, 95% CI 1.7–19.3), as were PEC sessions (OR 4.3, 95% CI 2.5–7.2).
CONCLUSION
By considering risk factors when determining their treatment delivery model, strong outcomes were seen in all three groups. Multiple modes of treatment administration, tailored to individuals’ needs and risk factors, is a feasible, effective, patient-centred care model for hard-to-reach, resource-limited settings.
Journal Article > ResearchFull Text
Int J Tuberc Lung Dis. 2018 April 1; Volume 22 (Issue 4); 407-412.; DOI:10.5588/ijtld.17.0706
Cox V, Brigden G, Crespo RH, Lessem E, Lynch S, et al.
Int J Tuberc Lung Dis. 2018 April 1; Volume 22 (Issue 4); 407-412.; DOI:10.5588/ijtld.17.0706
SETTING
The World Health Organization recommended two new drugs, bedaquiline (BDQ) and delamanid (DLM), for the treatment of multidrug-resistant tuberculosis (MDR-TB) in 2013 and 2014, respectively. An estimated one third of patients with MDR-TB would benefit from the inclusion of these drugs in their treatment regimens.
DESIGN
A convenience sample of 36 countries voluntarily reported monthly data on cumulative programmatic use of new drugs to the Drug-Resistant TB Scale-Up Treatment Action Team between 1 July 2015 and 31 June 2017. Programmatic use was defined as treatment for MDR-TB with newer drugs outside of clinical trials or compassionate use.
RESULTS
A total of 10 164 persons were started on BDQ and 688 started on DLM during the reporting period. Only 15.7% of the 69 213 persons estimated to need newer drugs over the study period were reported to have received them.
CONCLUSION
While there has been significant progress in some countries, uptake of the newer drugs has not kept pace with a conservative estimate of need; fewer than 20% of persons likely to benefit from either BDQ or DLM have received them. Concerted efforts are needed to ensure that the newer drugs are made available more widely for persons with MDR-TB in need of these therapeutic options.
The World Health Organization recommended two new drugs, bedaquiline (BDQ) and delamanid (DLM), for the treatment of multidrug-resistant tuberculosis (MDR-TB) in 2013 and 2014, respectively. An estimated one third of patients with MDR-TB would benefit from the inclusion of these drugs in their treatment regimens.
DESIGN
A convenience sample of 36 countries voluntarily reported monthly data on cumulative programmatic use of new drugs to the Drug-Resistant TB Scale-Up Treatment Action Team between 1 July 2015 and 31 June 2017. Programmatic use was defined as treatment for MDR-TB with newer drugs outside of clinical trials or compassionate use.
RESULTS
A total of 10 164 persons were started on BDQ and 688 started on DLM during the reporting period. Only 15.7% of the 69 213 persons estimated to need newer drugs over the study period were reported to have received them.
CONCLUSION
While there has been significant progress in some countries, uptake of the newer drugs has not kept pace with a conservative estimate of need; fewer than 20% of persons likely to benefit from either BDQ or DLM have received them. Concerted efforts are needed to ensure that the newer drugs are made available more widely for persons with MDR-TB in need of these therapeutic options.
Conference Material > Abstract
Lightowler M
Epicentre Scientific Day Paris 2023. 2023 June 8
BACKGROUND
Papua New Guinea (PNG) is a high tuberculosis (TB) burden country. Early diagnosis is crucial for TB control and access to chest X-ray is lacking in many peripheral settings. Médecins Sans Frontières (MSF) provides diagnosis and treatment to TB patients in Port Moresby, the capital city in collaboration with the Ministry of Health.
OBJECTIVES
The primary objective of this study is to assess the performance of lung ultrasound for TB diagnosis in patients with presumptive pulmonary TB. We compared lung ultrasound findings associated with TB to radiological findings on chest X-ray.
METHODS
Prospective diagnostic study which included patients above 10 years attending MSF TB clinic between May 2022 to May 2023. Those reporting cough for at least two weeks were considered as presumptive pulmonary TB. All patients enrolled underwent a clinical consultation, GeneXpert in sputum, chest X-ray and lung ultrasound. Patients were categorised as confirmed TB, unconfirmed TB or not TB. For the estimation of the sensitivity and specificity of the imaging tools, confirmed TB and not TB were used as reference standard.
RESULTS
Among 496 patients included, 55% were male, median age was 30 [Interquartile range 23-42] years, 42% were initiated on TB treatment, in total, 152 (31%) had confirmed TB, 55 (11%) unconfirmed TB and 289 (58%) not TB. Among 208 patients with both chest Xray and lung ultrasound, reviewed by an expert, the ultrasound had a sensitivity of 92% (95%CI: 87-96), and a specificity of 40% (95%CI: 34-47). The sensitivity and specificity of the chest x ray were 92% (95%CI: 88- 96) and 67% (95%CI: 60-73), respectively. The kappa coefficient for the agreement between the two imaging methods was 0.37 (95%CI: 0.25-0.49). Of 112 patients with suggestive TB by chest X-ray, 100 (89%) had findings of TB in the ultrasound.
CONCLUSION
Lung ultrasound for pulmonary TB diagnosis had a comparable sensitivity to chest X-ray, however specificity was very limited and lower than chest X-ray. Agreement between the two imaging tools was low. However, lung ultrasound detected TB in most of the chest X-rays suggestive of TB.
KEY MESSAGE
Lung ultrasound can be a potential tool for TB diagnosis when chest X-ray is not available. Next steps in the study are to look at possible combination of findings with better specificity and maintained sensitivity.
This abstract is not to be quoted for publication.
Papua New Guinea (PNG) is a high tuberculosis (TB) burden country. Early diagnosis is crucial for TB control and access to chest X-ray is lacking in many peripheral settings. Médecins Sans Frontières (MSF) provides diagnosis and treatment to TB patients in Port Moresby, the capital city in collaboration with the Ministry of Health.
OBJECTIVES
The primary objective of this study is to assess the performance of lung ultrasound for TB diagnosis in patients with presumptive pulmonary TB. We compared lung ultrasound findings associated with TB to radiological findings on chest X-ray.
METHODS
Prospective diagnostic study which included patients above 10 years attending MSF TB clinic between May 2022 to May 2023. Those reporting cough for at least two weeks were considered as presumptive pulmonary TB. All patients enrolled underwent a clinical consultation, GeneXpert in sputum, chest X-ray and lung ultrasound. Patients were categorised as confirmed TB, unconfirmed TB or not TB. For the estimation of the sensitivity and specificity of the imaging tools, confirmed TB and not TB were used as reference standard.
RESULTS
Among 496 patients included, 55% were male, median age was 30 [Interquartile range 23-42] years, 42% were initiated on TB treatment, in total, 152 (31%) had confirmed TB, 55 (11%) unconfirmed TB and 289 (58%) not TB. Among 208 patients with both chest Xray and lung ultrasound, reviewed by an expert, the ultrasound had a sensitivity of 92% (95%CI: 87-96), and a specificity of 40% (95%CI: 34-47). The sensitivity and specificity of the chest x ray were 92% (95%CI: 88- 96) and 67% (95%CI: 60-73), respectively. The kappa coefficient for the agreement between the two imaging methods was 0.37 (95%CI: 0.25-0.49). Of 112 patients with suggestive TB by chest X-ray, 100 (89%) had findings of TB in the ultrasound.
CONCLUSION
Lung ultrasound for pulmonary TB diagnosis had a comparable sensitivity to chest X-ray, however specificity was very limited and lower than chest X-ray. Agreement between the two imaging tools was low. However, lung ultrasound detected TB in most of the chest X-rays suggestive of TB.
KEY MESSAGE
Lung ultrasound can be a potential tool for TB diagnosis when chest X-ray is not available. Next steps in the study are to look at possible combination of findings with better specificity and maintained sensitivity.
This abstract is not to be quoted for publication.