Impact of connecting tuberculosis directly observed therapy short-course with smoking cessation on health-related quality of life

<p>Abstract</p> <p>Background</p> <p>With evolving evidence of association between tuberculosis (TB) and tobacco smoking, recommendations for the inclusion of tobacco cessation interventions in TB care are becoming increasingly important and more widely disseminated. Connecting TB and tobacco cessation interventions has been strongly advocated as this may yield better outcomes. However, no study has documented the impact of such connection on health-related quality of life (HRQoL). The objective of this study was to document the impact of an integrated TB directly observed therapy short-course (DOTS) plus smoking cessation intervention (SCI) on HRQoL.</p> <p>Methods</p> <p>This was a multi-centered non-randomized controlled study involving 120 TB patients who were current smokers at the time of TB diagnosis in Malaysia. Patients were assigned to either of two groups: the usual TB-DOTS plus SCI (SCIDOTS group) or the usual TB-DOTS only (DOTS group). The effect of the novel strategy on HRQoL was measured using EQ-5D questionnaire. Two-way repeated measure ANOVA was used to examine the effects.</p> <p>Results</p> <p>When compared, participants who received the integrated intervention had a better HRQoL than those who received the usual TB care. The SCIDOTS group had a significantly greater increase in EQ-5D utility score than the DOTS group during 6 months follow-up (mean ± SD = 0.98 ± 0.08 vs. 0.91 ± 0.14, <it>p </it>= 0.006). Similarly, the mean scores for EQ-VAS showed a consistently similar trend as the EQ-5D indices, with the scores increasing over the course of TB treatment. Furthermore, for the EQ-VAS, there were significant main effects for group [F (1, 84) = 4.91, <it>p </it>= 0.029, η²= 0.06], time [F (2, 168) = 139.50, <it>p </it>= < 0.001, η²= 0.62] and group x time interaction [F (2, 168) = 13.89, <it>p </it>= < 0.001, η²= 0.14].</p> <p>Conclusions</p> <p>This study supports the evidence that an integrated TB-tobacco treatment strategy could potentially improve overall quality of life outcomes among TB patients who are smokers.</p

Tobacco use prevalence, knowledge, and attitudes among newly diagnosed tuberculosis patients in Penang State and Wilayah Persekutuan Kuala Lumpur, Malaysia

<p>Abstract</p> <p>Background</p> <p>There is sufficient evidence to conclude that tobacco smoking is strongly linked to tuberculosis (TB) and a large proportion of TB patients may be active smokers. In addition, a previous analysis has suggested that a considerable proportion of the global burden of TB may be attributable to smoking. However, there is paucity of information on the prevalence of tobacco smoking among TB patients in Malaysia. Moreover, the tobacco-related knowledge, attitudes, and behaviors of TB patients who are smokers have not been previously explored. This study aimed to document the prevalence of smoking among newly diagnosed TB patients and to learn about the tobacco use knowledge and attitudes of those who are smokers among this population.</p> <p>Methods</p> <p>Data were generated on prevalence rates of smoking among newly diagnosed TB patients in the State of Penang from January 2008 to December 2008. The data were obtained based on a review of routinely collated data from the quarterly report on TB case registration. The study setting comprised of five healthcare facilities (TB clinics) located within Penang and Wilayah Persekutuan, Kuala Lumpur health districts in Malaysia, which were involved in a larger project, known as SCIDOTS Project. A 58-item questionnaire was used to assess the tobacco use knowledge, attitudes and behaviors of those TB patients who were smokers.</p> <p>Results</p> <p>Smoking status was determinant in 817 of 943 new cases of TB from January to December 2008. Of this, it was estimated that the prevalence rates of current- and ex-smoking among the TB patients were 40.27% (329/817) and 13.95% (114/817), respectively. The prevalence of ever-smoking among patients with TB was estimated to be 54,220 per 100,000 population. Of 120 eligible participants for the SCIDOTS Project, 88 responded to the survey (73.3% response rate) and 80 surveys were analyzed (66.7% usable rate). The mean (± SD) total score of tobacco use knowledge items was 4.23 ± 2.66 (maximum possible score=11). More than half of the participants (51.3%) were moderately dependent to nicotine. A moderately large proportion of the respondents (41.2%) reported that they have ever attempted to quit smoking, while more than half (56.3%) have not. Less than half (47.5%) of the study participants had knowledge about the body system on which cigarette smoking has the greatest negative effect. The majority wrongly believed that smokeless tobacco can increase athletic performance (60%) and that it is a safe and harmless product (46.2%). An overwhelming proportion (>80%) of the patients believed that: smoking is a waste of money, tobacco use is very dangerous to health, and that smokers are more likely to die from heart disease when compared with non-smokers. The use of smokeless tobacco was moderately prevalent among the participants with 28.8% reporting ever snuffed, but the use of cigar and pipe was uncommon.</p> <p>Conclusion</p> <p>Smoking prevalence rate is high among patients with TB in Malaysia. These patients generally had deficiencies in knowledge of tobacco use and its health dangers, but had positive attitudes against tobacco use. Efforts should be geared towards reducing tobacco use among this population due to its negative impact on TB treatment outcomes.</p

The SCIDOTS Project: Evidence of benefits of an integrated tobacco cessation intervention in tuberculosis care on treatment outcomes

<p>Abstract</p> <p>Background</p> <p>There is substantial evidence to support the association between tuberculosis (TB) and tobacco smoking and that the smoking-related immunological abnormalities in TB are reversible within six weeks of cessation. Therefore, connecting TB and tobacco cessation interventions may produce significant benefits and positively impact TB treatment outcomes. However, no study has extensively documented the evidence of benefits of such integration. SCIDOTS Project is a study from the context of a developing nation aimed to determine this.</p> <p>Methods</p> <p>An integrated TB-tobacco intervention was provided by trained TB directly observed therapy short-course (DOTS) providers at five chest clinics in Malaysia. The study was a prospective non-randomized controlled intervention using quasi-experimental design. Using Transtheoretical Model approach, 120 eligible participants who were current smokers at the time of TB diagnosis were assigned to either of two treatment groups: conventional TB DOTS plus smoking cessation intervention (integrated intervention or SCIDOTS group) or conventional TB DOTS alone (comparison or DOTS group). At baseline, newly diagnosed TB patients considering quitting smoking within the next 30 days were placed in the integrated intervention group, while those who were contemplating quitting were assigned to the comparison group. Eleven sessions of individualized cognitive behavioral therapy with or without nicotine replacement therapy were provided to each participant in the integrated intervention group. The impacts of the novel approach on biochemically validated smoking cessation and TB treatment outcomes were measured periodically as appropriate.</p> <p>Results</p> <p>A linear effect on both 7-day point prevalence abstinence and continuous abstinence was observed over time in the intervention group. At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting smoking when compared with those who received the conventional TB treatment alone (77.5% vs. 8.7%; p < 0.001). Furthermore, at the end of TB treatment (6 months or later), there were significantly higher rates of treatment default (15.2% vs. 2.5%; p = 0.019) and treatment failure (6.5% vs. 0%; p = 0.019) in the DOTS group than in the SCIDOTS group.</p> <p>Conclusion</p> <p>This study provides evidence that connecting TB-tobacco treatment strategy is significant among TB patients who are smokers. The findings suggest that the integrated approach may be beneficial and confer advantages on short-term outcomes and possibly on future lung health of TB patients who quit smoking. This study may have important implications on health policy and clinical practice related to TB management among tobacco users.</p

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

PHARMACOECONOMIC EVALUATION FOR DENGUE VACCINE PRICING FOR MALAYSIA: TOWARDS AFFORDABILITY, COST EFFECTIVENESS AND SUSTAINABILITY

Objective: Malaysian health ministry is currently evaluating the licensing of dengue vaccine Dengvaxia using a set of criteria including safety, efficacy and cost-effectiveness. The purpose of this research is to formulate a model framework to assist transparent decision-making.Methods: To quantify the cost-effective price of vaccine, pharmacoeconomic evaluation models are commonly used. We review in this paper dengue economic burdens and pharmacoeconomic models, with particular reference to cost-effectiveness.Results: A major weakness in current pharmacoeconomic models is the omission of cost of vaccine production, which is two orders of magnitude lower than the market price. This paper proposes an inclusive model that yields a highly cost-effective threshold price of dengue vaccine at USD 5 per dose for Malaysia.Conclusion: At USD 5 per dose, Dengue vaccine will be fair, Affordable and sustainable

Impact of latent tuberculosis infection on health and wellbeing:A systematic review and meta-analysis

The impact of latent tuberculosis infection (LTBI) on health and wellbeing is not well understood. This review aims to evaluate the health and wellbeing of individuals with LTBI. A systematic literature search was performed to assess studies reporting patient-reported outcomes in LTBI management including health-related quality of life (HRQoL), health utilities, disease burden and experience of individuals with LTBI. A pooled analysis was performed to estimate the effect of LTBI on HRQoL. A total of 4464 studies were screened, of which 13 eligible articles describing nine unique studies were included for review. The HRQoL of individuals with LTBI and without tuberculosis (TB) infection were comparable, and better than patients with active TB disease. However, individuals with LTBI reported poorer mental health compared with individuals without TB infection (mean difference −4.16, 95% CI −7.45– −0.87; p=0.01). Qualitative studies suggest the presence of fear, anxiety and stigma in individuals with LTBI. This review highlights potential psychosocial challenges in individuals with LTBI despite the absence of clinical symptoms. While their quality of life was marginally affected, this could be evidence to support LTBI management in preventing TB re-activation and the severe consequences of active TB disease that affect all domains of HRQoL

Newly diagnosed tuberculosis patients and tobacco use in North Malaysia: the prevalence of tobacco use, knowledge, and attitudes

Background: Sufficient evidence concludes that tobacco smoking is strongly linked to tuberculosis (TB). It was suggested that a considerable proportion of the global burden of TB may be attributable to smoking. This study aimed to document the prevalence of smoking among newly diagnosed TB patients and to learn about their tobacco use knowledge and attitudes

Potential impact of a pilot training program on smoking cessation intervention for tuberculosis DOTS providers in Malaysia

Background The association between tuberculosis (TB)and tobacco smoking is becoming increasingly important. Smoking cessation may yield substantial positive effects on TB treatment outcomes, relapse, and future lung disease. Thus, TB directly observed therapy, short-course (TB DOTS) providers are uniquely positioned to intervene with those TB patients who are smokers. Unfortunately, most health care professionals are inadequately trained to provide such service

Genomic diversity of SARS-CoV-2 in Malaysia

More than a year after its first appearance in December 2019, the COVID-19 pandemic is still on a rampage in many parts of the world. Although several vaccines have been approved for emergency use, the emergence and rapid spread of new SARS-CoV-2 variants have sparked fears of vaccine failure due to immune evasion. Massive viral genome sequencing has been recommended to track the genetic changes that could lead to adverse consequences. Methods We sequenced SARS-CoV-2 respiratory isolates from the National Public Health Laboratory, Malaysia and examined them together with viral genomes deposited in GISAID by other Malaysian researchers, to understand the evolutionary trend of the virus circulating in the country. We studied the distribution of virus lineages and site-wise mutations, analysed genetic clustering with the goeBURST full Minimum Spanning Tree algorithm, examined the trend of viral nucleotide diversity over time and performed nucleotide substitution association analyses