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Operational Research to Inform Programmatic Approaches to Management of Tuberculosis in Uzbekistan (Closed)

A project collection of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Papers displayed on this page all arise from the same project. Editorial decisions were made independently of project staff and handled by the Editor-in-Chief or qualified Editorial Board members.

Viewed by 32590

Editors

Dr. Masoud Dara

E-Mail Website
Project Leader
Honorary Senior Lecturer, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
Interests: emerging infectious diseases; infection prevention and control; climate change and vector borne diseases; HIV; viral Hepatitis; sexually transmitted diseases; tuberculosis
Dr. Nargiza Parpieva

E-Mail Website
Project Leader
Director of Republican Specialized Scientific-Practical Medical Center Phthisiology and Pulmonology, 1 Alimov street, Tashkent city 100086, Uzbekistan
Interests: tuberculosis; pulmonary diseases, research area; heath care managemnet
Dr. Askar Yedilbayev

E-Mail Website
Project Leader
Unit Lead, Joint Tuberculosis, HIV and viral Hepatitis Programme, Division of Country Health Programmes, WHO Regional Office for Europe, UN City, Marmorvej 51, 2100 Copenhagen Ø, Denmark
Interests: drug-resistant tuberculosis; tuberculosis prevention and treatment; tuberculosis and viral Hepatitis co-infection; tuberculosis and HIV co-infection; operational research
Dr. Lianne Kuppens

E-Mail Website
Project Leader
WHO Representative in Uzbekistan, 16, Torobiy street, 100100 Tashkent City, Uzbekistan
Interests: public health; health system strenghtening; governance; coordination and partnerships; universal health coverage; emergency preparedness and response and healthy life styles and behavior
Dr. Jamshid Gadoev

E-Mail Website
Project Leader
National Professional Officer, WHO country office in Uzbekistan, 16, Torobiy street, 100100 Tashkent City, Uzbekistan
Interests: tuberculosis, HIV/AIDS, viral hepatitis, operational research, public health

Project Overview

Dear Colleagues,

The European Tuberculosis Research Initiative (ERI-TB) was launched by the WHO Regional Office for Europe in 2017 in order to advance TB research in the region, and is one of the platforms that supports the implementation of the TB Action Plan of 2016–2020. Responsible officers within the Joint Tuberculosis, HIV, and Viral Hepatitis Program serve as ERI-TB secretariats. One of the ERI-TB objectives was to define a regional TB research agenda. The ERI-TB secretariats have facilitated the process and a European TB Research Agenda (ERA-TB) was developed using the core Regional (i) technical expertise, (ii) engagement of the civil society, as well as (iii) consultation with national and (iv) regional counterparts.

In June 2018, the WHO Regional Office for Europe launched the first Structured Operational Research Training of ERI-TB (SORT-TB) to facilitate the implementation of ERA-TB. The aim of SORT-TB is to build the capacity of TB researchers in East Europe and Central Asia in partnership with UNICEF/UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR). The first cohort of SORT-TB took the concept of the TDR’s SORT IT course (https://www.who.int/tdr/capacity/strengthening/sort/en/) to the next level by (i) supporting the implementation of ERA-TB, (ii) acting within the framework of the bilateral collaborative agreements (BCA) with member states, and (iii) supporting national counterparts to adapt country TB policies by turning research into action. The SORT-TB course consists of three workshops, taking the principal investigators (PIs) through the process of preparing an OR protocol, analyzing data, and preparing publishable manuscripts. In 2019–2020, the WHO Country Office in Uzbekistan, together with the WHO Regional Office for Europe, implemented the first country-specific SORT-TB course.

Thirteen research projects were carried out within the first country-specific SORT-TB cohort. Principal investigators from Uzbekistan, selected on a competitive basis, were enrolled into the course. Priority was given to those research projects that answer research questions defined in ERA-TB and that serve the purpose of improving the programmatic management of TB in Uzbekistan. Principal investigators were assigned into working groups, each consisting of two principal investigators, one senior mentor, one junior mentor, and one/two WHO co-mentors. Senior and junior mentors were selected from the pool of regional experts with experience in research and TB. Manuscripts prepared by research groups will serve the purpose of tailoring programs addressing the diagnostics, treatment, and care of TB in Uzbekistan.

The project collaborators are contributing work exclusively this Special Issue.

Dr. Masoud Dara
Dr. Nargiza Parpieva
Dr. Askar Yedilbayev
Dr. Lianne Kuppens
Dr. Jamshid Gadoev
Project Leaders

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the collection website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • tuberculosis
  • multidrug- and rifampicin-resistance (MDR/RR-TB)
  • extensively drug-resistant TB (XDR TB)
  • Central Asia
  • treatment success
  • adverse events
  • mycosis
  • Xpert MTB/Rif Ultra
  • Line probe
  • assay (HAIN)
  • sputum culture
  • TB pleurisy
  • urine from genital TB
  • TB/HIV
  • childhood TB

Published Papers (14 papers)

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2021

19 pages, 1651 KiB  
Article
Factors Associated with Unfavourable Treatment Outcomes in Patients with Tuberculosis: A 16-Year Cohort Study (2005–2020), Republic of Karakalpakstan, Uzbekistan
by Jamshid Gadoev, Damin Asadov, Anthony D. Harries, Ajay M. V. Kumar, Martin Johan Boeree, Araksya Hovhannesyan, Lianne Kuppens, Askar Yedilbayev, Oleksandr Korotych, Atadjan Hamraev, Kallibek Kudaybergenov, Barno Abdusamatova, Bakhtinur Khudanov and Masoud Dara
Int. J. Environ. Res. Public Health 2021, 18(23), 12827; https://doi.org/10.3390/ijerph182312827 - 05 Dec 2021
Cited by 2 | Viewed by 2121
Abstract
Tuberculosis (TB) remains a public health burden in the Republic of Karakalpakstan, Uzbekistan. This region-wide retrospective cohort study reports the treatment outcomes of patients registered in the TB electronic register and treated with first-line drugs in the TB Programme of the Republic of [...] Read more.
Tuberculosis (TB) remains a public health burden in the Republic of Karakalpakstan, Uzbekistan. This region-wide retrospective cohort study reports the treatment outcomes of patients registered in the TB electronic register and treated with first-line drugs in the TB Programme of the Republic of Karakalpakstan from 2005–2020 and factors associated with unfavourable outcomes. Among 35,122 registered patients, 24,394 (69%) patients were adults, 2339 (7%) were children, 18,032 (51%) were male and 19,774 (68%) lived in rural areas. Of these patients, 29,130 (83%) had pulmonary TB and 7497 (>22%) had been previously treated. There were 7440 (21%) patients who had unfavourable treatment outcomes. Factors associated with unfavourable treatment outcomes included: increasing age, living in certain parts of the republic, disability, pensioner status, unemployment, being HIV-positive, having pulmonary TB, and receiving category II treatment. Factors associated with death included: being adult and elderly, living in certain parts of the republic, having a disability, pensioner status, being HIV-positive, and receiving category II treatment. Factors associated with failure included: being adolescent, female, having pulmonary TB. Factors associated with loss to follow-up included: being male, disability, pensioner status, unemployment, receiving category II treatment. In summary, there are sub-groups of patients who need special attention in order to decrease unfavourable treatment outcomes. Full article
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6 pages, 262 KiB  
Editorial
Operational Research to Inform Programmatic Approaches to the Management of Tuberculosis in Uzbekistan
by Jamshid Gadoev, Anthony D. Harries, Oleksandr Korotych, Ajay M. V. Kumar, Andrei Dadu, Lianne Kuppens, Nargiza Parpieva, Barno Abdusamatova, Askar Yedilbayev and Masoud Dara
Int. J. Environ. Res. Public Health 2021, 18(23), 12308; https://doi.org/10.3390/ijerph182312308 - 23 Nov 2021
Viewed by 1444
Abstract
Globally, an estimated 10 million people fell ill with tuberculosis (TB) in 2019, a number that has been declining very slowly in recent years [...] Full article
11 pages, 298 KiB  
Article
Adverse Drug Reactions among Children with Tuberculosis in Tashkent, Uzbekistan, 2019
by Makhliyo Abdusalomova, Olga Denisiuk, Hayk Davtyan, Jamshid Gadoev, Barno Abdusamatova, Nargiza Parpieva and Abduvohid Sodikov
Int. J. Environ. Res. Public Health 2021, 18(14), 7574; https://doi.org/10.3390/ijerph18147574 - 16 Jul 2021
Cited by 4 | Viewed by 2005
Abstract
The treatment of childhood tuberculosis can be challenging due to the lack of pediatric drug formulations and monitoring of drug-toxicity in routine settings. There are no published studies from Uzbekistan on the adverse drug reactions (ADR) associated with anti-tuberculosis treatment in children. In [...] Read more.
The treatment of childhood tuberculosis can be challenging due to the lack of pediatric drug formulations and monitoring of drug-toxicity in routine settings. There are no published studies from Uzbekistan on the adverse drug reactions (ADR) associated with anti-tuberculosis treatment in children. In this study, we aimed to investigate the ADR associated with anti-tuberculosis treatment in children. This was a cohort study using secondary program data of children treated at the city and regional tuberculosis clinics in Tashkent, Uzbekistan. Of the 302 patients evaluated, 135 (44.7%) reported ADR. New tuberculosis was registered in 277 (92%) patients and 262 (87%) had extrapulmonary tuberculosis. Factors associated with ADR included treatment at a regional hospital (adjusted odds ratio, aOR = 1.75; p = 0.026), female sex (aOR = 2.2; p = 0.004), and treatment with second-line drugs (aOR = 8.82; p < 0.001). The most common ADRs were gastrointestinal disorders (28.5%) followed by hepatitis (8.9%) and dermatologic reactions (8.6%). Most of the ADRs were mild (55.6%) or moderate (43.7%), only one child had severe ADR. Patients with the identified risk factors should be closely monitored during the treatment. We also recommend expansion of ADR surveillance throughout the country for more representative data in the future. Full article
12 pages, 820 KiB  
Article
Characteristics and Treatment Outcomes of Patients with Tuberculosis Receiving Adjunctive Surgery in Uzbekistan
by Anvar Riskiyev, Ana Ciobanu, Arax Hovhannesyan, Kristina Akopyan, Jamshid Gadoev and Nargiza Parpieva
Int. J. Environ. Res. Public Health 2021, 18(12), 6541; https://doi.org/10.3390/ijerph18126541 - 17 Jun 2021
Cited by 2 | Viewed by 1950
Abstract
Surgical interventions are performed as an adjunct to pharmacological treatment in Uzbekistan in 10–12% of diagnosed tuberculosis (TB) patients. In this study among patients with respiratory TB who had surgical interventions in Republican Specialized Scientific-Practical Medical Centre of Phthisiology and Pulmonology of Uzbekistan [...] Read more.
Surgical interventions are performed as an adjunct to pharmacological treatment in Uzbekistan in 10–12% of diagnosed tuberculosis (TB) patients. In this study among patients with respiratory TB who had surgical interventions in Republican Specialized Scientific-Practical Medical Centre of Phthisiology and Pulmonology of Uzbekistan (RSSPMCPP) from January to May 2017, we describe (i) reasons and types of surgical intervention, (ii) post-surgical complications, (iii) histological diagnosis before and after surgery, and (iv) treatment outcomes. There were 101 patients included in the analysis (mean age 36 years; 51% male; 71% lived in rural areas). The main indications for surgical intervention included pulmonary tuberculoma (40%), fibrocavitary, or cavernous pulmonary TB (23%) and massive hemoptysis (20%). Pulmonary resections were the most frequent surgical procedures: segmentectomy (41%), lobectomy or bilobectomy (19%), and combined resection (17%). Ten patients (9%) suffered post-surgery complications. According to histological examination after surgery, TB was confirmed in 81 (80%) patients. For the other 20 patients, the confirmed diagnoses were: lung cancer (n = 6), echinococcosis (n = 5), post-TB fibrosis (n = 5), non-tuberculous pleurisy (n = 2), hamartoma (n = 1), and pneumonia (n = 1). The majority of patients (94%), who underwent surgery, were considered successfully treated. In conclusion, adjunctive surgical therapy can be an option for TB treatment, especially in cases of complicated TB. Full article
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8 pages, 1973 KiB  
Article
Diagnostic Procedures, Diagnoses, and Treatment Outcomes of Patients with Presumptive Tuberculosis Pleural Effusion in Uzbekistan
by Fazlkhan Abdugapparov, Ruzanna Grigoryan, Nargiza Parpieva, Sherali Massavirov, Anvar Riskiyev, Jamshid Gadoev, Mariana Buziashvili, Nestani Tukvadze, Arax Hovhannesyan and Andrei Dadu
Int. J. Environ. Res. Public Health 2021, 18(11), 5769; https://doi.org/10.3390/ijerph18115769 - 27 May 2021
Cited by 1 | Viewed by 2569
Abstract
Tuberculosis (TB) pleural effusion (TPE) is the second most common manifestation of extrapulmonary TB (EPTB), which remains a great diagnostic challenge worldwide. In Uzbekistan, there has been no formal evaluation of the actual practices of diagnosing and treating TPE. Our cohort study therefore [...] Read more.
Tuberculosis (TB) pleural effusion (TPE) is the second most common manifestation of extrapulmonary TB (EPTB), which remains a great diagnostic challenge worldwide. In Uzbekistan, there has been no formal evaluation of the actual practices of diagnosing and treating TPE. Our cohort study therefore aimed to describe the frequency and types of different diagnostic procedures of TPE during 2017–2018 and assess the association of baseline characteristics and establish diagnostic methods with TB treatment outcomes. In total, 187 patients with presumptive TPE were assessed, and 149 had a confirmed diagnosis of TPE (other diagnoses included cancer n = 8, pneumonia n = 17, and 13 cases were unspecified). TB was bacteriologically confirmed in 22 (14.8%), cytologically confirmed in 64 (43.0%), and histologically confirmed in 16 (10.7%) patients. Hepatitis was the only co-morbidity significantly associated with unsuccessful treatment outcomes (RR 4.8; 95%CI: 1.44–15.98, p value 0.011). Multivariable regression analysis showed that drug-resistant TB was independently associated with unsuccessful TB treatment outcome. (RR 3.83; 95%CI: 1.05–14.02, p value 0.04). Multidisciplinary approaches are required to maximize the diagnostic accuracy of TPE and minimize the chances of misdiagnosis. TPE patients with co-infections and those with drug resistance should be more closely monitored to try and ensure successful TB treatment outcomes. Full article
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10 pages, 1925 KiB  
Article
Incidence Rate and Risk Factors for Tuberculosis among People Living with HIV: A 2015–2017 Cohort from Tashkent, Uzbekistan
by Dilbar Sadirova, Ruzanna Grigoryan, Nargiza Parpieva, Venera Barotova, Aleksandr Trubnikov, Lola Kalandarova, Jamshid Gadoev, Davron Mukhtarov, Mariana Buziashvili, Nestani Tukvadze, Arax Hovhannesyan and Andrei Dadu
Int. J. Environ. Res. Public Health 2021, 18(11), 5746; https://doi.org/10.3390/ijerph18115746 - 27 May 2021
Cited by 2 | Viewed by 2096
Abstract
People living with the human immunodeficiency virus (PLHIV) have a higher risk of developing active tuberculosis (TB) disease, and TB remains a major cause of death in PLHIV. Uzbekistan is facing a substantial TB epidemic, which increases the risk of PLHIV developing active [...] Read more.
People living with the human immunodeficiency virus (PLHIV) have a higher risk of developing active tuberculosis (TB) disease, and TB remains a major cause of death in PLHIV. Uzbekistan is facing a substantial TB epidemic, which increases the risk of PLHIV developing active TB. Our retrospective cohort study aimed to evaluate the incidence rate and assess the risk factors for developing active TB among PLHIV. We collected secondary data extracted from medical charts of all patients, newly diagnosed at the AIDS Center in Tashkent, during the period of 2015–2017. The incidence rate of TB among PLHIV was 5.1 (95% CI: 4.5–6.0) per 1000 person/month. Adjusted regression analysis showed three major risk factors for TB, namely, being less than 15 years old (hazard ratio (HR) 5.83; 95% CI: 3.24–10.50, p value = 0.001),low CD4 count (adjusted hazard ratio(aHR) 21.0; 95% CI: 9.25–47.7, p value < 0.001), and antiretroviral therapy (ART) interruption/not receiving ART (aHR 5.57; 95% CI: 3.46–8.97 and aHR 6.2; 95% CI: 3.75–10.24, p value < 0.001, respectively) were significantly associated with developing active TB among PLHIV. Our findings indicate that taking prescribed ART without interruptions and maintaining CD4cell counts higher than 320 cells/μL are essential to prevent the development of active TB among PLHIV. Full article
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13 pages, 703 KiB  
Article
Hospitalizations and Treatment Outcomes in Patients with Urogenital Tuberculosis in Tashkent, Uzbekistan, 2016–2018
by Bakhtiyor Ismatov, Yuliia Sereda, Serine Sahakyan, Jamshid Gadoev and Nargiza Parpieva
Int. J. Environ. Res. Public Health 2021, 18(9), 4817; https://doi.org/10.3390/ijerph18094817 - 30 Apr 2021
Viewed by 1741
Abstract
Despite the global shift to ambulatory tuberculosis (TB) care, hospitalizations remain common in Uzbekistan. This study examined the duration and determinants of hospitalizations among adult patients (≥18 years) with urogenital TB (UGTB) treated with first-line anti-TB drugs during 2016–2018 in Tashkent, Uzbekistan. This [...] Read more.
Despite the global shift to ambulatory tuberculosis (TB) care, hospitalizations remain common in Uzbekistan. This study examined the duration and determinants of hospitalizations among adult patients (≥18 years) with urogenital TB (UGTB) treated with first-line anti-TB drugs during 2016–2018 in Tashkent, Uzbekistan. This was a cohort study based on the analysis of health records. Of 142 included patients, 77 (54%) were males, the mean (±standard deviation) age was 40 ± 16 years, and 68 (48%) were laboratory-confirmed. A total of 136 (96%) patients were hospitalized during the intensive phase, and 12 (8%) had hospital admissions during the continuation phase of treatment. The median length of stay (LOS) during treatment was 56 days (Interquartile range: 56–58 days). LOS was associated with history of migration (adjusted incidence rate ratio (aIRR): 0.46, 95% confidence interval (CI): 0.32–0.69, p < 0.001); UGTB-related surgery (aIRR: 1.18, 95% CI: 1.01–1.38, p = 0.045); and hepatitis B comorbidity (aIRR: 3.18, 95% CI: 1.98–5.39, p < 0.001). The treatment success was 94% and it was not associated with the LOS. Hospitalization was almost universal among patients with UGTB in Uzbekistan. Future research should focus on finding out what proportion of hospitalizations were not clinically justified and could have been avoided. Full article
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14 pages, 1223 KiB  
Article
Scaling Up Molecular Diagnostic Tests for Drug-Resistant Tuberculosis in Uzbekistan from 2012–2019: Are We on the Right Track?
by Sharofiddin Yuldashev, Nargiza Parpieva, Salikhdjan Alimov, Laziz Turaev, Khasan Safaev, Kostyantyn Dumchev, Jamshid Gadoev, Oleksandr Korotych and Anthony D. Harries
Int. J. Environ. Res. Public Health 2021, 18(9), 4685; https://doi.org/10.3390/ijerph18094685 - 28 Apr 2021
Cited by 2 | Viewed by 2398
Abstract
Uzbekistan has a large burden of drug-resistant tuberculosis (TB). To deal with this public health threat, the National TB Program introduced rapid molecular diagnostic tests such as Xpert MTB/RIF (Xpert) and line probe assays (LPAs) for first-line and second-line drugs. We documented the [...] Read more.
Uzbekistan has a large burden of drug-resistant tuberculosis (TB). To deal with this public health threat, the National TB Program introduced rapid molecular diagnostic tests such as Xpert MTB/RIF (Xpert) and line probe assays (LPAs) for first-line and second-line drugs. We documented the scale-up of Xpert and LPAs from 2012–2019 and assessed whether this led to an increase in patients with laboratory-confirmed multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) and extensively drug-resistant TB (XDR-TB). This was a descriptive study using secondary program data. The numbers of GeneXpert instruments cumulatively increased from six to sixty-seven, resulting in annual assays increasing from 5574 to 107,330. A broader use of the technology resulted in a lower proportion of tests detecting Mycobacterium tuberculosis with half of the positive results showing rifampicin resistance. LPA instruments cumulatively increased from two to thirteen; the annual first-line assays for MDR-TB increased from 2582 to 6607 while second-line assays increased from 1435 in 2016 to 6815 in 2019 with about one quarter to one third of diagnosed patients showing second-line drug resistance. Patient numbers with laboratory-confirmed MDR-TB remained stable (from 1728 to 2060) but there was a large increase in patients with laboratory-confirmed XDR-TB (from 31 to 696). Programmatic implications and ways forward are discussed. Full article
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15 pages, 911 KiB  
Article
Trends, Characteristics and Treatment Outcomes of Patients with Drug-Resistant Tuberculosis in Uzbekistan: 2013–2018
by Khasan Safaev, Nargiza Parpieva, Irina Liverko, Sharofiddin Yuldashev, Kostyantyn Dumchev, Jamshid Gadoev, Oleksandr Korotych and Anthony D. Harries
Int. J. Environ. Res. Public Health 2021, 18(9), 4663; https://doi.org/10.3390/ijerph18094663 - 27 Apr 2021
Cited by 11 | Viewed by 2360
Abstract
Uzbekistan has a high burden of drug-resistant tuberculosis (TB). Although conventional treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) has been available since 2013, there has been no systematic documentation about its use and effectiveness. We therefore documented at national level [...] Read more.
Uzbekistan has a high burden of drug-resistant tuberculosis (TB). Although conventional treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) has been available since 2013, there has been no systematic documentation about its use and effectiveness. We therefore documented at national level the trends, characteristics, and outcomes of patients with drug-resistant TB enrolled for treatment from 2013–2018 and assessed risk factors for unfavorable treatment outcomes (death, failure, loss to follow-up, treatment continuation, change to XDR-TB regimen) in patients treated in Tashkent city from 2016–2017. This was a cohort study using secondary aggregate and individual patient data. Between 2013 and 2018, MDR-TB numbers were stable between 2347 and 2653 per annum, while XDR-TB numbers increased from 33 to 433 per annum. At national level, treatment success (cured and treatment completed) for MDR-TB decreased annually from 63% to 57%, while treatment success for XDR-TB increased annually from 24% to 57%. On multivariable analysis, risk factors for unfavorable outcomes, death, and loss to follow-up in drug-resistant TB patients treated in Tashkent city included XDR-TB, male sex, increasing age, previous TB treatment, alcohol abuse, and associated comorbidities (cardiovascular and liver disease, diabetes, and HIV/AIDS). Reasons for these findings and programmatic implications are discussed. Full article
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11 pages, 330 KiB  
Article
Risk Factors for Unfavorable Treatment Outcomes among the Human Immunodeficiency Virus-Associated Tuberculosis Population in Tashkent City, Uzbekistan: 2013–2017
by Sherali Massavirov, Kristina Akopyan, Fazlkhan Abdugapparov, Ana Ciobanu, Arax Hovhanessyan, Mavluda Khodjaeva, Jamshid Gadoev and Nargiza Parpieva
Int. J. Environ. Res. Public Health 2021, 18(9), 4623; https://doi.org/10.3390/ijerph18094623 - 27 Apr 2021
Cited by 4 | Viewed by 2299
Abstract
Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection poses a growing clinical challenge. People living with HIV have a higher chance of developing TB, and once the disease has progressed, are at greater risk of having unfavorable TB treatment outcomes. Data on TB [...] Read more.
Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection poses a growing clinical challenge. People living with HIV have a higher chance of developing TB, and once the disease has progressed, are at greater risk of having unfavorable TB treatment outcomes. Data on TB treatment outcomes among the HIV-associated TB population in Uzbekistan are limited. Thus, we conducted a cohort study among 808 adult patients with HIV-associated TB registered at the Tashkent TB referral hospital from 2013–2017 to document baseline characteristics and evaluate risk factors for unfavorable TB treatment outcomes. The data were collected from medical records and ambulatory cards. About 79.8% of the study population had favorable treatment outcomes. Antiretroviral therapy (ART) coverage at the admission was 26.9%. Information on CD4-cell counts and viral loads were largely missing. Having extrapulmonary TB (aOR 2.21, 95% CI: 1.38–3.53, p = 0.001), positive sputum smear laboratory results on admission (aOR 1.62, 95% CI: 1.07–2.40), diabetes (aOR 5.16, 95% CI: 1.77–14.98), and hepatitis C (aOR 1.68, 95% CI: 1.14–2.46) were independent risk factors for developing unfavorable TB treatment outcomes. The study findings provide evidence for targeted clinical management in co-infected patients with risk factors. Strengthening the integration of TB/HIV services may improve availability of key data to improve co-infection management. Full article
16 pages, 895 KiB  
Article
Effectiveness and Safety of a Shorter Treatment Regimen in a Setting with a High Burden of Multidrug-Resistant Tuberculosis
by Aleksandr Trubnikov, Arax Hovhannesyan, Kristina Akopyan, Ana Ciobanu, Dilbar Sadirova, Lola Kalandarova, Nargiza Parpieva and Jamshid Gadoev
Int. J. Environ. Res. Public Health 2021, 18(8), 4121; https://doi.org/10.3390/ijerph18084121 - 13 Apr 2021
Cited by 11 | Viewed by 2606
Abstract
Treatment of drug-resistant tuberculosis is lengthy, insufficiently effective, and toxic. Since 2016, the World Health Organization has recommended shorter treatment regimens (STR). We assessed effectiveness and predictors of drug adverse events (DAE) among patients treated with STR. There were 95 consecutive rifampicin-resistant patients [...] Read more.
Treatment of drug-resistant tuberculosis is lengthy, insufficiently effective, and toxic. Since 2016, the World Health Organization has recommended shorter treatment regimens (STR). We assessed effectiveness and predictors of drug adverse events (DAE) among patients treated with STR. There were 95 consecutive rifampicin-resistant patients enrolled in STR in Tashkent between June 2018 and September 2019. Of these, 66.3% were successfully treated, 17.9% suffered failed treatment, 7.4% died, 5.3% were lost to follow-up and 3.2% were not evaluated. No recurrence was identified in 54 patients after 12 months of successful treatment completion. There were 47 reported DAE: the incidence rate was 6.15 DAE per 100 person-months-of-treatment. Any DAE was reported in 38 (40%) patients and grade 3/4 DAE were recorded in 21 (22.1%) patients. Median time to DAE was 101 (interquartile range 64–139) days. The most frequently encountered DAE were gastro-intestinal disorders, followed by hepatotoxicity and ototoxicity. The most commonly offending drug inducing DAE was protionamide. The dose was temporarily interrupted in 55.3% of DAE, reduced in 8.5% of DAE and permanently withdrawn in another 8.5% of DAE. HIV status was the only predictor associated with increased hazard of DAE. In Uzbekistan STR showed moderate effectiveness and safety, although treatment failure was high. Full article
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11 pages, 2121 KiB  
Article
Treatment Compliance of Multidrug Resistant Tuberculosis in Uzbekistan: Does Practice Follow Policy?
by Ruzilya Usmanova, Nargiza Parpieva, Hayk Davtyan, Olga Denisiuk, Jamshid Gadoev, Sevak Alaverdyan, Kostyantyn Dumchev, Irina Liverko and Barno Abdusamatova
Int. J. Environ. Res. Public Health 2021, 18(8), 4071; https://doi.org/10.3390/ijerph18084071 - 12 Apr 2021
Cited by 5 | Viewed by 2188
Abstract
Compliance with treatment guidelines is essential to achieve successful outcomes in tuberculosis patients. Thus, we assessed if multidrug-resistant tuberculosis treatment practices from 2012–2018 in Uzbekistan were compliant with national guidelines in terms of regimens prescribed, weight-based drug dosages used, and documentation of treatment [...] Read more.
Compliance with treatment guidelines is essential to achieve successful outcomes in tuberculosis patients. Thus, we assessed if multidrug-resistant tuberculosis treatment practices from 2012–2018 in Uzbekistan were compliant with national guidelines in terms of regimens prescribed, weight-based drug dosages used, and documentation of treatment changes (such as prolongation of intensive phase, change of drugs, and their reasons) in the treatment card and Consilium form. A total of 1481 patients were included. Of them, only 25% received standardized regimens as per guidelines and the remaining received individualized regimens. There was an increasing trend in using standardized regimens from 2% in 2012 to 44% in 2018. Compliance to recommended weight-based drug dosages was observed in 85% of the patients during the intensive phase and 84% in the continuation phase—ranged 71–91% over the years. Prolongation of the intensive phase was done in 42% of patients. The treatment was changed in 44% of patients during the intensive phase and 34% of patients during the continuation phase. The documentation of treatment changes was suboptimal (42–75%) during the initial years (2012–2014); however, it improved significantly during later years (86–100%). Future research should explore reasons for non-compliance so that the quality of patient care can be improved. Full article
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8 pages, 277 KiB  
Article
Treatment Outcomes of Isoniazid-Resistant (Rifampicin Susceptible) Tuberculosis Patients in Uzbekistan, 2017–2018
by Zayniddin Sayfutdinov, Ajay Kumar, Dilyara Nabirova, Jamshid Gadoev, Laziz Turaev, Sanjar Sultanov, Sevak Alaverdyan and Nargiza Parpieva
Int. J. Environ. Res. Public Health 2021, 18(6), 2965; https://doi.org/10.3390/ijerph18062965 - 14 Mar 2021
Cited by 3 | Viewed by 2371
Abstract
Tuberculosis patients “resistant to isoniazid and susceptible to rifampicin (Hr-TB)” remain neglected, despite a high burden and poor outcomes. The World Health Organization (WHO) recommends a 6 month regimen consisting of levofloxacin, rifampicin, ethambutol, and pyrazinamide (LRZE) to treat Hr-TB. In contrast, Uzbekistan [...] Read more.
Tuberculosis patients “resistant to isoniazid and susceptible to rifampicin (Hr-TB)” remain neglected, despite a high burden and poor outcomes. The World Health Organization (WHO) recommends a 6 month regimen consisting of levofloxacin, rifampicin, ethambutol, and pyrazinamide (LRZE) to treat Hr-TB. In contrast, Uzbekistan uses a 9 month regimen (LRZE plus a second-line injectable in the first 3 months). We aimed to assess the treatment outcomes of this novel regimen among Hr-TB patients treated in two regions of Uzbekistan (Fergana and Bukhara) in 2017–2018. We conducted a cohort study involving secondary analysis of routine surveillance data. Of 132 Hr-TB patients, 105 (80%) were successfully treated. Death was the predominant unsuccessful outcome (13, 10%) followed by “treatment failure” (10, 8%) and “lost to follow-up” (4, 2%). High treatment success is an indicator of the potential effectiveness of the novel regimen and adds to the limited global evidence on this issue. However, the sample size was small and there was no comparison group. Since the study was conducted in two regions of Uzbekistan only, the findings have limited generalizability. We recommend future research using an adequate sample size and an appropriate study design (randomized controlled trial or prospective cohort with a control group receiving the WHO-recommended regimen). Full article
13 pages, 1065 KiB  
Article
Universal Access to Xpert MTB/RIF Testing for Diagnosis of Tuberculosis in Uzbekistan: How Well Are We Doing?
by Laziz Turaev, Ajay Kumar, Dilyara Nabirova, Sevak Alaverdyan, Nargiza Parpieva and Barno Abdusamatova
Int. J. Environ. Res. Public Health 2021, 18(6), 2915; https://doi.org/10.3390/ijerph18062915 - 12 Mar 2021
Cited by 3 | Viewed by 2060
Abstract
As per national guidelines in Uzbekistan, all presumptive tuberculosis patients should be tested using the Xpert MTB/RIF assay for diagnosing tuberculosis. There is no published evidence how well this is being implemented. In this paper, we report on the Xpert coverage among presumptive [...] Read more.
As per national guidelines in Uzbekistan, all presumptive tuberculosis patients should be tested using the Xpert MTB/RIF assay for diagnosing tuberculosis. There is no published evidence how well this is being implemented. In this paper, we report on the Xpert coverage among presumptive tuberculosis patients in 2018 and 2019, factors associated with non-testing and delays involved. Analysis of national aggregate data indicated that Xpert testing increased from 24% in 2018 to 46% in 2019, with variation among the regions: 21% in Tashkent region to 100% in Karakalpakstan. In a cohort (January–March 2019) constituted of 40 randomly selected health facilities in Tashkent city and Bukhara region, there were 1940 patients of whom 832 (43%, 95% confidence interval (CI): 41–45%) were not Xpert-tested. Non-testing was significantly higher in Bukhara region (73%) compared to Tashkent city (28%). In multivariable analysis, patient’s age, distance between primary health centre (PHC) and Xpert laboratory, diagnostic capacity and site of PHC were associated with non-testing. The median (interquartile range) duration from date of initial visit to PHC to receiving results was 1 (1–2) day in Tashkent city compared to 3 (1–6) days in Bukhara region (p-value < 0.001). While there is commendable progress, universal access to Xpert testing is not a reality yet. Full article
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