11 research outputs found
Patients with MDR-TB on domiciliary care in programmatic settings in Myanmar: Effect of a support package on preventing early deaths
<div><p>Background</p><p>The community-based MDR-TB care (CBMDR-TBC) project was implemented in 2015 by The Union in collaboration with national TB programme (NTP) in 33 townships of upper Myanmar to improve treatment outcomes among patients with MDR-TB registered under NTP. They received community-based support through the project staff, in addition to the routine domiciliary care provided by NTP staff. Each project township had a project nurse exclusively for MDR-TB and a community volunteer who provided evening directly observed therapy (in addition to morning directly observed therapy by NTP).</p><p>Objectives</p><p>To determine the effect of CBMDR-TBC project on death and unfavourable outcomes during the intensive phase of MDR-TB treatment.</p><p>Methods</p><p>In this cohort study involving record review, all patients diagnosed with MDR-TB between January 2015 and June 2016 in project townships and initiated on treatment till 31 Dec 2016 were included. CBMDR-TBC status was categorized as “receiving support” if project initiation in patient’s township was before treatment initiation, “receiving partial support” if project initiation was after treatment initiation, and “not receiving support” if project initiation was after intensive phase treatment outcome declaration. Time to event analysis (censored on 10 April 2017) and cox regression was done.</p><p>Results</p><p>Of 261 patients initiated on treatment, death and unfavourable outcomes were accounted for 13% and 21% among “receiving support (n = 163)”, 3% and 24% among “receiving partial support (n = 75)” and 13% and 26% among “not receiving support (n = 23)” respectively. After adjusting for other potential confounders, the association between CBMDR-TBC and unfavourable outcomes was not statistically significant. However, when compared to “not receiving support”, those “receiving support” and “receiving partial support” had 20% [aHR (0.95 CI: 0.8 (0.2–3.1)] and 90% lower hazard [aHR (0.95 CI: 0.1 (0.02–0.9)] of death, respectively. This was intriguing. Implementation of CBMDR-TBC coincided with implementation of decentralized MDR-TB centers at district level. Hence, patients that would have generally not accessed MDR-TB treatment before decentralization also started receiving treatment and were also included under CBMDR-TBC “received support” group. These patients could possibly be expected to sicker at treatment initiation than patients in other CBMDR-TBC groups. This could be the possible reason for nullifying the effect of CBMDR-TBC in “receiving support” group and therefore similar survival was found when compared to “not receiving support”.</p><p>Conclusion</p><p>CBMDR-TBC may prevent early deaths and has a scope for expansion to other townships of Myanmar and implications for NTPs globally. However, future studies should consider including data on extent of sickness at treatment initiation and patient level support received under CBMDR-TBC.</p></div
Criteria to identify presumptive MDR-TB under programme setting who were referred to X-pert MTB/RIF testing facilities, Myanmar, 2015–16.
<p>Criteria to identify presumptive MDR-TB under programme setting who were referred to X-pert MTB/RIF testing facilities, Myanmar, 2015–16.</p
Demographic characteristics of patients with MDRTB registered for treatment between January 2015 and June 2016 in 33 community-based MDR-TB care (CBMDR-TBC) project supported townships in Myanmar.
<p>Demographic characteristics of patients with MDRTB registered for treatment between January 2015 and June 2016 in 33 community-based MDR-TB care (CBMDR-TBC) project supported townships in Myanmar.</p
Operational definition of MDR-TB treatment outcomes at end of intensive phase, Myanmar (2015–16) [11].
<p>Operational definition of MDR-TB treatment outcomes at end of intensive phase, Myanmar (2015–16) [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0187223#pone.0187223.ref011" target="_blank">11</a>].</p
Risk factors for unfavorable treatment outcomes among patients with MDR-TB registered for treatment between January 2015 and June 2016 in 33 community-based MDR-TB care (CBMDR-TBC) project supported townships in Myanmar.
<p>Risk factors for unfavorable treatment outcomes among patients with MDR-TB registered for treatment between January 2015 and June 2016 in 33 community-based MDR-TB care (CBMDR-TBC) project supported townships in Myanmar.</p
Map of Myanmar showing 33 community-based MDR-TB care project (CBMDR-TBC) supported townships across four states/regions of Upper Myanmar, 2015–16.
<p>Map of Myanmar showing 33 community-based MDR-TB care project (CBMDR-TBC) supported townships across four states/regions of Upper Myanmar, 2015–16.</p
Care under community-based MDR-TB (CBMDR-TBC) project and end intensive phase treatment outcomes among patient with MDR-TB registered for treatment between January 2015 and June 2016 in 33 CBMDR-TBC project supported townships in Myanmar.
<p>Care under community-based MDR-TB (CBMDR-TBC) project and end intensive phase treatment outcomes among patient with MDR-TB registered for treatment between January 2015 and June 2016 in 33 CBMDR-TBC project supported townships in Myanmar.</p
Risk factors for death among patients with MDRTB registered for treatment initiation between January 2015 and June 2016 in 33 community-based MDR-TB care (CBMDR-TBC) project supported townships in Myanmar.
<p>Risk factors for death among patients with MDRTB registered for treatment initiation between January 2015 and June 2016 in 33 community-based MDR-TB care (CBMDR-TBC) project supported townships in Myanmar.</p
Death in intensive phase among patients with MDRTB registered for treatment between January 2015 and June 2016 in 33 community-based MDR-TB care (CBMDR-TBC) project supported townships in Myanmar (all patients and by CBMDR-TBC status).
<p>*under CBMDR_TBC after treatment initiation (“receiving partial support”); under CBMDR-TBC before treatment initiation (“receiving support”); Log rank test p value = 0.03 (unadjusted).</p
Support package by the community-based MDR-TB care (CBMDR-TBC) project in Myanmar, 2015–16.
<p>Support package by the community-based MDR-TB care (CBMDR-TBC) project in Myanmar, 2015–16.</p