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      Tuberculosis Treatment Monitoring by Video Directly Observed Therapy in 5 Health Districts, California, USA

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          Abstract

          We assessed video directly observed therapy (VDOT) for monitoring tuberculosis treatment in 5 health districts in California, USA, to compare adherence between 174 patients using VDOT and 159 patients using in-person directly observed therapy (DOT). Multivariable linear regression analyses identified participant-reported sociodemographics, risk behaviors, and treatment experience associated with adherence. Median participant age was 44 (range 18–87) years; 61% of participants were male. Median fraction of expected doses observed (FEDO) among VDOT participants was higher (93.0% [interquartile range (IQR) 83.4%–97.1%]) than among patients receiving DOT (66.4% [IQR 55.1%–89.3%]). Most participants (96%) would recommend VDOT to others; 90% preferred VDOT over DOT. Lower FEDO was independently associated with US or Mexico birth, shorter VDOT duration, finding VDOT difficult, frequently taking medications while away from home, and having video-recording problems (p<0.05). VDOT cost 32% (range 6%–46%) less than DOT. VDOT was feasible, acceptable, and achieved high adherence at lower cost than DOT.

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          Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis.

          Payam Nahid, Susan Dorman, Narges Alipanah … (2016)
          The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.
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            Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis.

            Neel Gandhi, Paul Nunn, Keertan Dheda … (2010)
            Although progress has been made to reduce global incidence of drug-susceptible tuberculosis, the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis during the past decade threatens to undermine these advances. However, countries are responding far too slowly. Of the estimated 440,000 cases of MDR tuberculosis that occurred in 2008, only 7% were identified and reported to WHO. Of these cases, only a fifth were treated according to WHO standards. Although treatment of MDR and XDR tuberculosis is possible with currently available diagnostic techniques and drugs, the treatment course is substantially more costly and laborious than for drug-susceptible tuberculosis, with higher rates of treatment failure and mortality. Nonetheless, a few countries provide examples of how existing technologies can be used to reverse the epidemic of MDR tuberculosis within a decade. Major improvements in laboratory capacity, infection control, performance of tuberculosis control programmes, and treatment regimens for both drug-susceptible and drug-resistant disease will be needed, together with a massive scale-up in diagnosis and treatment of MDR and XDR tuberculosis to prevent drug-resistant strains from becoming the dominant form of tuberculosis. New diagnostic tests and drugs are likely to become available during the next few years and should accelerate control of MDR and XDR tuberculosis. Equally important, especially in the highest-burden countries of India, China, and Russia, will be a commitment to tuberculosis control including improvements in national policies and health systems that remove financial barriers to treatment, encourage rational drug use, and create the infrastructure necessary to manage MDR tuberculosis on a national scale. Copyright 2010 Elsevier Ltd. All rights reserved.
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              Resistance to fluoroquinolones and second-line injectable drugs: impact on multidrug-resistant TB outcomes.

              Rosella Centis, Kathryn DeRiemer, Dick Menzies … (2013)
              A meta-analysis for response to treatment was undertaken using individual data of multidrug-resistant tuberculosis (MDR-TB) (resistance to isoniazid and rifampicin) patients from 26 centres. The analysis assessed the impact of additional resistance to fluoroquinolones and/or second-line injectable drugs on treatment outcome. Compared with treatment failure, relapse and death, treatment success was higher in MDR-TB patients infected with strains without additional resistance (n=4763; 64%, 95% CI 57-72%) or with resistance to second-line injectable drugs only (n=1130; 56%, 95% CI 45-66%), than in those having resistance to fluoroquinolones alone (n=426; 48%, 95% CI 36-60%) or to fluoroquinolones plus second-line injectable drugs (extensively drug resistant (XDR)-TB) (n=405; 40%, 95% CI 27-53%). In XDR-TB patients, treatment success was highest if at least six drugs were used in the intensive phase (adjusted OR 4.9, 95% CI 1.4-16.6; reference fewer than three drugs) and four in the continuation phase (OR 6.1, 95% CI 1.4-26.3). The odds of success in XDR-TB patients was maximised when the intensive phase reached 6.6-9.0 months duration and the total duration of treatment 20.1-25.0 months. In XDR-TB patients, regimens containing more drugs than those recommended in MDR-TB but given for a similar duration were associated with the highest odds of success. All data were from observational studies and methodologies varied between centres, therefore, the bias may be substantial. Better quality evidence is needed to optimise regimens.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (iso-abbrev): Emerging Infect. Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): October 2018
                Volume: 24
                Issue: 10
                Pages: 1806-1815
                Affiliations
                [1]University of California San Diego, La Jolla, California, USA (R.S. Garfein, L. Liu, J. Cuevas-Mota, K. Collins, F. Muñoz, J. Cepeda, M.A. Bulterys, N.K. Martin, P. Rios, F. Raab);
                [2]University of Arkansas, Fayetteville, Arkansas, USA (D.G. Catanzaro); San Diego County Health and Human Services Agency, San Diego, California, USA (K. Moser);
                [3]San Francisco Department of Public Health, San Francisco, California, USA (J. Higashi);
                [4]Santa Clara County Public Health Department, San Jose, California, USA (T. Al-Samarrai);
                [5]Imperial County Public Health Department, El Centro, California, USA (P. Kriner);
                [6]San Joaquin Public Health Services, Stockton, California, USA (J. Vaishampayan)
                Author notes
                Address for correspondence: Richard S. Garfein, University of California, San Diego, 9500 Gilman Dr, MC-0725, La Jolla, CA 92093-0507, USA; email: rgarfein@ 123456ucsd.edu
                Article
                Publisher ID: 18-0459
                DOI: 10.3201/eid2410.180459
                PMC ID: 6154139
                PubMed ID: 30226154
                SO-VID: f7e62ce7-8e32-4384-8fba-61215e912d64
                History
                Categories
                Subject: Research
                Subject: Research
                Subject: Tuberculosis Treatment Monitoring by Video Directly Observed Therapy in 5 Health Districts, California, USA

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: mhealth,medication adherence monitoring,smartphone,video technology,antimicrobial resistance,patient-centered care,tuberculosis and other mycobacteria,bacteria,video directly observed therapy,vdot,california,united states
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: mhealth, medication adherence monitoring, smartphone, video technology, antimicrobial resistance, patient-centered care, tuberculosis and other mycobacteria, bacteria, video directly observed therapy, vdot, california, united states

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