3 research outputs found
Herbal and traditional medicines pharmacovigilance for holistic treatment
13-21Compared to allopathic medicines or chemically synthesized drugs, there is a growing use of natural compounds and
supplements in herbal medicine to treat various diseases as they are safe and devoid of side effects. Though, this is not
completely true as many cases of the detrimental impact of herbal or traditional medicine have been reported. Herbal
medicines contain unpurified plant portions or extracts which may have these side effects. How effective are the drug
molecules derived from natural products, or how destructive are the undesirable compounds that must be investigated?
Natural extracts are mixtures of various components, and there is uncertainty about the mechanism of action of certain
herbal medicines. There may be a lot of factors involved like placebo effects, and other molecules without which medicine
may not work in isolation. In this study, we have reviewed the effects of herbal medicines, possible causes for their benefits
like epigenetic changes, adverse drug reactions, and the provision to control these issues. We have also explored the
measures being taken at the national and international levels. There have been efforts to minimize the issues related to side
effects based on reporting from the population using remedies monitored by pharmacovigilance
Data_Sheet_2_Comprehensive assessment of invalid and indeterminate results in Truenat MTB-RIF testing across sites under the national TB elimination program of India.docx
IntroductionTruenat MTB-RIF assay (Truenat), a nucleic acid amplification test (NAAT), is a real-time polymerase chain reaction (RT-PCR) chip-based assay that can detect Mycobacterium tuberculosis (Mtb) and rifampicin (RIF) drug resistance using portable, battery-operated devices. The National TB Elimination Program (NTEP) in India introduced this novel tool at the district and subdistrict level in 2020. This study aimed to assess the level and causes of inconclusive results (invalid results, errors, and indeterminate results) in MTB and RIF testing at NTEP sites and the root causes of these in the programmatic setting.MethodsTruenat testing data from 1,690 functional Truenat sites under the NTEP from April to June 2021 were analyzed to assess the rates of errors, invalid MTB results, and indeterminate RIF results. Following this analysis, 12 Truenat sites were selected based on site performance in Truenat testing, diversity of climatic conditions, and geographical terrain. These sites were visited to assess the root causes of their high and low rates of inconclusive results using a structured checklist.ResultsA total of 327,649 Truenat tests performed for MTB and RIF testing were analyzed. The rate of invalid MTB results was 5.2% [95% confidence interval (CI): 5.11β5.26; n =β16,998] and the rate of errors was 2.5% (95% CI: 2.46β2.57; n =β8,240) in Truenat MTB chip testing. For Mtb-positive samples tested using the Truenat RIF chip for detection of RIF resistance (n =β40,926), the rate of indeterminate results was 15.3% (95% CI: 14.97β15.67; n =β6,267) and the rate of errors was 1.6% (95% CI: 1.53β1.78; n =β675). There was a 40.1% retesting gap for Mtb testing and a 78.2% gap for inconclusive RR results. Among the inconclusive results retested, 27.9% (95% CI: 27.23β28.66; n =β4,222) were Mtb-positive, and 9.2% (95% CI: 7.84β10.76; n =β139) were detected as RR.ConclusionThe main causes affecting Truenat testing performance include suboptimal adherence to standard operating procedures (SOPs), inadequate training, improper storage of testing kits, inadequate sputum quality, lack of quality control, and delays in the rectification of machine issues. Root cause analysis identified that strengthening of training, external quality control, and supervision could improve the rate of inconclusive results. Ensuring hands-on training of technicians for Truenat testing and retesting of samples with inconclusive results are major recommendations while planning for Truenat scale-up. The recommendations from the study were consolidated into technical guidance documents and videos and disseminated to laboratory staff working at the tiered network of TB laboratories under the NTEP in order to improve Truenat MTB-RIF testing performance.</p
Data_Sheet_1_Comprehensive assessment of invalid and indeterminate results in Truenat MTB-RIF testing across sites under the national TB elimination program of India.docx
IntroductionTruenat MTB-RIF assay (Truenat), a nucleic acid amplification test (NAAT), is a real-time polymerase chain reaction (RT-PCR) chip-based assay that can detect Mycobacterium tuberculosis (Mtb) and rifampicin (RIF) drug resistance using portable, battery-operated devices. The National TB Elimination Program (NTEP) in India introduced this novel tool at the district and subdistrict level in 2020. This study aimed to assess the level and causes of inconclusive results (invalid results, errors, and indeterminate results) in MTB and RIF testing at NTEP sites and the root causes of these in the programmatic setting.MethodsTruenat testing data from 1,690 functional Truenat sites under the NTEP from April to June 2021 were analyzed to assess the rates of errors, invalid MTB results, and indeterminate RIF results. Following this analysis, 12 Truenat sites were selected based on site performance in Truenat testing, diversity of climatic conditions, and geographical terrain. These sites were visited to assess the root causes of their high and low rates of inconclusive results using a structured checklist.ResultsA total of 327,649 Truenat tests performed for MTB and RIF testing were analyzed. The rate of invalid MTB results was 5.2% [95% confidence interval (CI): 5.11β5.26; n =β16,998] and the rate of errors was 2.5% (95% CI: 2.46β2.57; n =β8,240) in Truenat MTB chip testing. For Mtb-positive samples tested using the Truenat RIF chip for detection of RIF resistance (n =β40,926), the rate of indeterminate results was 15.3% (95% CI: 14.97β15.67; n =β6,267) and the rate of errors was 1.6% (95% CI: 1.53β1.78; n =β675). There was a 40.1% retesting gap for Mtb testing and a 78.2% gap for inconclusive RR results. Among the inconclusive results retested, 27.9% (95% CI: 27.23β28.66; n =β4,222) were Mtb-positive, and 9.2% (95% CI: 7.84β10.76; n =β139) were detected as RR.ConclusionThe main causes affecting Truenat testing performance include suboptimal adherence to standard operating procedures (SOPs), inadequate training, improper storage of testing kits, inadequate sputum quality, lack of quality control, and delays in the rectification of machine issues. Root cause analysis identified that strengthening of training, external quality control, and supervision could improve the rate of inconclusive results. Ensuring hands-on training of technicians for Truenat testing and retesting of samples with inconclusive results are major recommendations while planning for Truenat scale-up. The recommendations from the study were consolidated into technical guidance documents and videos and disseminated to laboratory staff working at the tiered network of TB laboratories under the NTEP in order to improve Truenat MTB-RIF testing performance.</p