El Diario de Pontevedra : periódico liberal: Ano XXIII Número 6687 - 1906 agosto 6

Additional file 7. Graphs depicting the sixteen peptides in which several active TB patients displayed TPAs above the healthy threshold; the overall nTPA mean (solids line) between the two groups was not statistically significant

MOESM8 of Second generation multiple reaction monitoring assays for enhanced detection of ultra-low abundance Mycobacterium tuberculosis peptides in human serum

Additional file 8. Summary of seventeen peptides which failed to discriminate between active TB and healthy controls; panel 1 and 2 are the peptides from MRM assay 1 and 2, respectively

Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies

<div><p>Background</p><p>Incomplete adherence to tuberculosis (TB) treatment increases the risk of delayed culture conversion with continued transmission in the community, as well as treatment failure, relapse, and development or amplification of drug resistance. We conducted a systematic review and meta-analysis of adherence interventions, including directly observed therapy (DOT), to determine which approaches lead to improved TB treatment outcomes.</p><p>Methods and findings</p><p>We systematically reviewed Medline as well as the references of published review articles for relevant studies of adherence to multidrug treatment of both drug-susceptible and drug-resistant TB through February 3, 2018. We included randomized controlled trials (RCTs) as well as prospective and retrospective cohort studies (CSs) with an internal or external control group that evaluated any adherence intervention and conducted a meta-analysis of their impact on TB treatment outcomes. Our search identified 7,729 articles, of which 129 met the inclusion criteria for quantitative analysis. Seven adherence categories were identified, including DOT offered by different providers and at various locations, reminders and tracers, incentives and enablers, patient education, digital technologies (short message services [SMSs] via mobile phones and video-observed therapy [VOT]), staff education, and combinations of these interventions. When compared with DOT alone, self-administered therapy (SAT) was associated with lower rates of treatment success (CS: risk ratio [RR] 0.81, 95% CI 0.73–0.89; RCT: RR 0.94, 95% CI 0.89–0.98), adherence (CS: RR 0.83, 95% CI 0.75–0.93), and sputum smear conversion (RCT: RR 0.92, 95% CI 0.87–0.98) as well as higher rates of development of drug resistance (CS: RR 4.19, 95% CI 2.34–7.49). When compared to DOT provided by healthcare providers, DOT provided by family members was associated with a lower rate of adherence (CS: RR 0.86, 95% CI 0.79–0.94). DOT delivery in the community versus at the clinic was associated with a higher rate of treatment success (CS: RR 1.08, 95% CI 1.01–1.15) and sputum conversion at the end of two months (CS: RR 1.05, 95% CI 1.02–1.08) as well as lower rates of treatment failure (CS: RR 0.56, 95% CI 0.33–0.95) and loss to follow-up (CS: RR 0.63, 95% CI 0.40–0.98). Medication monitors improved adherence and treatment success and VOT was comparable with DOT. SMS reminders led to a higher treatment completion rate in one RCT and were associated with higher rates of cure and sputum conversion when used in combination with medication monitors. TB treatment outcomes improved when patient education, healthcare provider education, incentives and enablers, psychological interventions, reminders and tracers, or mobile digital technologies were employed. Our findings are limited by the heterogeneity of the included studies and lack of standardized research methodology on adherence interventions.</p><p>Conclusion</p><p>TB treatment outcomes are improved with the use of adherence interventions, such as patient education and counseling, incentives and enablers, psychological interventions, reminders and tracers, and digital health technologies. Trained healthcare providers as well as community delivery provides patient-centered DOT options that both enhance adherence and improve treatment outcomes as compared to unsupervised, SAT alone.</p></div

Meta-analysis of the impact of staff education on treatment success rates.

<p>M-H, Mantel-Haenszel; RCT, randomized controlled trial.</p

Comparison of adherence rates in patients receiving DOT by a family member versus HCW.

<p>DOT, directly observed therapy; HCW, healthcare worker; M-H, Mantel-Haenszel.</p

Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies - Fig 2

<p>(A) SAT compared with DOT on TB treatment outcomes. (B) Impact of any DOT provided by lay providers, family members, or healthcare workers on TB treatment outcomes. * = significant heterogeneity in the meta-analysis as determined by I² statistic. 1 = depicted is the rate of adherence in one study defined as completing >90% of treatment doses by pill counting in one CS and based on six positive INH urine tests done at random in one RCT. Conversion = sputum conversion to negative at the end of two months (CS) and three months (RCT). <i>N</i> = number of studies included within the meta-analysis. Resistance = development of drug resistance. CS, cohort study; DOT, directly observed therapy; HCW, healthcare worker; INH, isoniazid; LTFU, loss to follow-up; RCT, randomized controlled trial; RR, risk ratio; SAT, self-administered therapy; TB, tuberculosis.</p

Rates of sputum conversion at two months in patients receiving phone reminders in addition to standard care versus standard care alone.

<p>M-H, Mantel-Haenszel; RCT, randomized controlled trial.</p

Meta-analysis of rates of sputum conversion at two months in patients receiving reminders/tracers in addition to standard care versus standard care alone.

<p>M-H, Mantel-Haenszel; RCT, randomized controlled trial.</p

Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies - Fig 23

<p>(A) Impact of digital technologies on TB treatment outcomes. (B) Impact of combining different types of adherence interventions on TB treatment outcomes. * = significant heterogeneity in the meta-analysis, as determined by I² statistic. 1 = defined as proportion of patients taking >90% of pills. Conversion = sputum conversion at the end of two months. <i>N</i> = number of studies included within the meta-analysis. Poor adherence = percentage of patient-months in which >20% of doses were missed. CS, cohort study; DOT, directly observed therapy; LTFU, loss to follow-up; RCT, randomized controlled trial; RR, risk ratio; TB, tuberculosis; VOT, video-observed therapy.</p

Meta-analysis of treatment success rates in patients receiving DOT by different types of providers.

<p>DOT, directly observed therapy; HCW, healthcare worker; M-H, Mantel-Haenszel.</p