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[post_author] => 15
[post_date] => 2021-09-01 20:28:44
[post_date_gmt] => 2021-09-02 00:28:44
[post_content] =>
BACKGROUND: Half of India´s three million TB patients are treated in the largely unregulated private sector, where quality of care is often poor. Private provider interface agencies (PPIAs) seek to improve private sector quality of care, which can be measured in terms of case fatality and recurrence rates.
METHODS: We conducted a retrospective cohort survey of 4,000 private sector patients managed by the PATH PPIA between 2014 and 2017. We estimated treatment and post-treatment case-fatality ratios (CFRs) and recurrence rates. We used Cox proportional hazards models to identify predictors of fatality and recurrence. Patient loss to follow-up was adjusted for using selection weighting.
RESULTS: The treatment CFR was 7.1% (95% CI 6.0–8.2). At 24 months post-treatment, the CFR was 2.4% (95% CI 1.7–3.0) and the recurrence rate was 1.9% (95% CI 1.3–2.5). Treatment fatality was associated with age (HR 1.02, 95% CI 1.02–1.03), clinical diagnosis (HR 0.61, 95% CI 0.45–0.84), treatment duration (HR 0.09, 95% CI 0.06–0.10) and adherence. Post-treatment fatality was associated with treatment duration (HR 0.87, 95% CI 0.79–0.91) and adherence.
CONCLUSIONS: We found a moderate treatment phase CFR among PPIA-managed private sector patient with low rates of post-treatment fatality and recurrence. Routine monitoring of patient outcomes after treatment would strengthen PPIAs and inform future post TB interventions.
Huddart, S., Ingawale, P., Edwin, J., Jondhale, V., Pai, M., Benedetti, A., Shah, D., & Vijayan, S. (2021). TB case fatality and recurrence in a private sector cohort in Mumbai, India.
The International Journal of Tuberculosis and Lung Disease, 25(9), 738-746. https://doi.org/10.5588/ijtld.21.0266
[post_title] => TB case fatality and recurrence in a private sector cohort in Mumbai, India
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[1] => WP_Post Object
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[post_date] => 2021-08-25 14:45:58
[post_date_gmt] => 2021-08-25 18:45:58
[post_content] => Bigio, J., van Gemert, W., Kaiser, B., Waning, B., & Pai, M. (2021). Asia emerges as a hotbed of diagnostic innovations for tuberculosis.
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, Volume 25, 100267, ISSN 2405-5794, https://doi.org/10.1016/j.jctube.2021.100267.
[post_title] => Asia emerges as a hotbed of diagnostic innovations for tuberculosis
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[post_date] => 2021-07-01 14:25:23
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[post_content] =>
Background
We assessed the impact of the coronavirus disease 2019 (COVID-19) epidemic in India on the consumption of antibiotics and hydroxychloroquine (HCQ) in the private sector in 2020 compared to the expected level of use had the epidemic not occurred.
Methods and findings
We performed interrupted time series (ITS) analyses of sales volumes reported in standard units (i.e., doses), collected at regular monthly intervals from January 2018 to December 2020 and obtained from IQVIA, India. As children are less prone to develop symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we hypothesized a predominant increase in non-child-appropriate formulation (non-CAF) sales. COVID-19-attributable changes in the level and trend of monthly sales of total antibiotics, azithromycin, and HCQ were estimated, accounting for seasonality and lockdown period where appropriate. A total of 16,290 million doses of antibiotics were sold in India in 2020, which is slightly less than the amount in 2018 and 2019. However, the proportion of non-CAF antibiotics increased from 72.5% (95% CI: 71.8% to 73.1%) in 2019 to 76.8% (95% CI: 76.2% to 77.5%) in 2020. Our ITS analyses estimated that COVID-19 likely contributed to 216.4 million (95% CI: 68.0 to 364.8 million; P = 0.008) excess doses of non-CAF antibiotics and 38.0 million (95% CI: 26.4 to 49.2 million; P < 0.001) excess doses of non-CAF azithromycin (equivalent to a minimum of 6.2 million azithromycin treatment courses) between June and September 2020, i.e., until the peak of the first epidemic wave, after which a negative change in trend was identified. In March 2020, we estimated a COVID-19-attributable change in level of +11.1 million doses (95% CI: 9.2 to 13.0 million; P < 0.001) for HCQ sales, whereas a weak negative change in monthly trend was found for this drug. Study limitations include the lack of coverage of the public healthcare sector, the inability to distinguish antibiotic and HCQ sales in inpatient versus outpatient care, and the suboptimal number of pre- and post-epidemic data points, which could have prevented an accurate adjustment for seasonal trends despite the robustness of our statistical approaches.
Conclusions
A significant increase in non-CAF antibiotic sales, and particularly azithromycin, occurred during the peak phase of the first COVID-19 epidemic wave in India, indicating the need for urgent antibiotic stewardship measures.
Author summary
Why was this study done?
- There are concerns that the widespread and often inappropriate use of antibiotics has been aggravated by the COVID-19 pandemic, but little is known regarding the true impact of the pandemic on antibiotic use, particularly in low- and middle-income countries (LMICs).
- India is the largest antibiotic user in the world and is among the countries that are most severely affected by the pandemic.
- About 75% of healthcare in India is private, and this unregulated and fragmented private sector accounts for 90% of antibiotic consumption, raising major concerns about the potential effects of COVID-19 on prescribing and dispensing practices.
What did the researchers do and find?
- Using an interrupted time series (ITS) design, we examined sales volumes of total antibiotics, azithromycin alone, and hydroxychloroquine (HCQ) in India’s private sector from January 2018 to December 2020.
- Focusing on non-pediatric formulations and adjusting for underlying seasonal and non-seasonal trends and accounting for the effect of lockdown, we estimated the impact of the first epidemic wave on monthly sales.
- Based on our models, COVID-19 likely contributed to about 216 million excess doses (95% CI: 68.0 to 364.8 million; P = 0.008) of total antibiotics and 38.0 million excess doses (95% CI: 26.4 to 49.2 million; P < 0.001) of azithromycin between June and September 2020 (i.e., after the lockdown and until the epidemic peak).
- HCQ sales peaked in March 2020, reflecting the widespread use of this drug for both prophylaxis and treatment of COVID-19 (+11.1 million doses [95% CI: 9.2 to 13.0 million]; P < 0.001), followed by a slow decline afterwards.
What do these findings mean?
- Our findings indicate a significant increase in antibiotic sales, particularly of azithromycin, during the peak phase of the first COVID-19 epidemic wave in India.
- Similar trends are likely to have occurred in other LMICs, where antibiotics are often overused.
- The medium- and long-term consequences for bacterial resistance patterns are highly concerning, highlighting the need for urgent antibiotic stewardship measures.
Sulis G, Batomen B, Kotwani A, Pai M, Gandra S (2021) Sales of antibiotics and hydroxychloroquine in India during the COVID-19 epidemic: An interrupted time series analysis. PLoS Med 18(7): e1003682. https://doi.org/10.1371/journal.pmed.1003682
[post_title] => Sales of antibiotics and hydroxychloroquine in India during the COVID-19 epidemic: An interrupted time series analysis
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[ID] => 1796
[post_author] => 19
[post_date] => 2021-05-12 17:38:02
[post_date_gmt] => 2021-05-12 21:38:02
[post_content] =>
Background
The radical cure of
Plasmodium vivax requires treatment with an 8-aminoquinoline drug, such as primaquine and tafenoquine, to eradicate liver hypnozoite stages, which can reactivate to cause relapsing infections. Safe treatment regimens require prior screening of patients for glucose-6-phosphate dehydrogenase (G6PD) deficiency to avoid potential life-threatening drug induced haemolysis. Testing is rarely available in malaria endemic countries, but will be needed to support routine use of radical cure. This study investigates end-user perspectives in Bangladesh on the introduction of a quantitative G6PD test (SD Biosensor STANDARD™ G6PD analyser) to support malaria elimination.
Methods
The perspectives of users on the SD Biosensor test were analysed using semi-structured interviews and focus group discussions with health care providers and malaria programme officers in Bangladesh. Key emerging themes regarding the feasibility of introducing this test into routine practice, including perceived barriers, were analysed.
Results
In total 63 participants were interviewed. Participants emphasized the life-saving potential of the biosensor, but raised concerns including the impact of limited staff time, high workload and some technical aspects of the device. Participants highlighted that there are both too few and too many
P. vivax patients to implement G6PD testing owing to challenges of funding, workload and complex testing infrastructure. Implementing the biosensor would require flexibility and improvisation to deal with remote sites, overcoming a low index of suspicion and mutual interplay of declining patient numbers and reluctance to test. This approach would generate new forms of evidence to justify introduction in policy and carefully consider questions of deployment given declining patient numbers.
Conclusions
The results of the study show that, in an elimination context, the importance of malaria needs to be maintained for both policy makers and the affected communities, in this case by ensuring
P. vivax, PQ treatment, and G6PD deficiency remain visible. Availability of new technologies, such as the biosensor, will fuel ongoing debates about priorities for allocating resources that must be adapted to a constantly evolving target. Technical and logistical concerns regarding the biosensor should be addressed by future product designs, adequate training, strengthened supply chains, and careful planning of communication, advocacy and staff interactions at all health system levels.
Engel, N., Ghergu, C., Matin, M.A.
et al. (2021). Implementing radical cure diagnostics for malaria: user perspectives on G6PD testing in Bangladesh.
Malaria Journal, 20
, 217.
[post_title] => Implementing radical cure diagnostics for malaria: user perspectives on G6PD testing in Bangladesh
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[post_modified] => 2021-11-15 17:38:20
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[4] => WP_Post Object
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[ID] => 1472
[post_author] => 17
[post_date] => 2021-01-13 00:00:09
[post_date_gmt] => 2021-01-13 05:00:09
[post_content] => Public health experts often describe care in India’s private sector as ‘chaotic,’ ‘substandard,’ ‘profit-driven,’ and ‘arbitrary.’ Discourse tends to focus on the ‘predatory behavior' of doctors who demand consultation fees and kickbacks for everything from medicine, to laboratory tests, to specialist referrals, and even hospital stays. These practices are ethnographically observable. However, this discourse does not take into account the multiple uncertainties, ethical complexity, and personal relationships involved in providing care in exchange for money in a setting of scarce personal and public resources. Situated at the very end of a value chain designed to make money from health, or the lack thereof, private physicians find themselves embroiled in moral peril. In this article, I engage what it means to make a livelihood in a context such as this by considering the economic, moral, and epistemic practices that physicians and their patients use to create and evaluate the value of pharmaceuticals in Mumbai’s slums. Based on over a year of clinic ethnography and interviews with family physicians, specialists, pharmacists, and pharmaceutical wholesalers, I trace how physicians manage the effects of a pharmaceutical value chain that produces profit by fulfilling patient’s health needs and desires.
McDowell, A. (2021). Dr. Zahir’s dilemma: money and morals in India’s private medical networks.
BioSocieties, 1-24.
[post_title] => Dr. Zahir’s dilemma: money and morals in India’s private medical networks
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[post_modified] => 2021-07-08 19:10:40
[post_modified_gmt] => 2021-07-08 23:10:40
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[5] => WP_Post Object
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[ID] => 1449
[post_author] => 23
[post_date] => 2020-03-01 00:00:11
[post_date_gmt] => 2020-03-01 05:00:11
[post_content] => Abstract
Problem: Despite implementation of universal health coverage in Thailand, gaps remain in the system for screening contacts of tuberculosis patients.
Approach: We designed broader criteria for contact investigation and new screening practices and assessed the approach in a programme-based operational research study in 2017-2018. Clinic staff interviewed 100 index patients and asked them to give household and non-household contacts an invitation for a free screening and chest X-ray. Contact persons who attended received 250 Thai baht (about 8 United States dollars) allowance for transport.
Local setting: Chiang Rai province, Thailand, has high rates of tuberculosis notification and a high number of people living in poverty. The coverage of contact investigation in under 5-year-olds was only 33.2% (222 screened out of 668 contacts) over 2011-2015.
Relevant changes: Index patients identified 440 contacts in total and gave invitation cards to 227 of them. The contact investigation coverage was 81.1% (184/227) and tuberculosis detection among contacts screened was 6.0% (11/184). Of the 11 contacts with active tuberculosis, three did not have tuberculosis symptoms, three were non-household contacts and three were contacts of non-smear-positive tuberculosis patients. The contact investigation coverage of the contacts younger than 5 years was 100% (14/14) and the yield of tuberculosis detection in this age group was 21.4% (3/14).
Lessons learnt: High coverage of contact investigation with a high yield of tuberculosis detection among contacts can be achieved by applying broader criteria for contact investigation and providing financial support for transportation.
Imsanguan, W., Bupachat, S., Wanchaithanawong, V., Luangjina, S., Thawtheong, S., Nedsuwan, S., ... & Ngamvithayapong-Yanai, J. (2020). Contact tracing for tuberculosis, Thailand.
Bulletin of the World Health Organization,
98(3), 212.
[post_title] => Contact tracing for tuberculosis, Thailand
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[post_name] => contact-tracing-for-tuberculosis-thailand
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[post_modified] => 2021-07-08 19:37:12
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[post_date] => 2020-01-01 11:30:48
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[post_content] =>
SETTING: Pune and Pimpri-Chinchwad Municipal Corporation area, Maharashtra State, India.
OBJECTIVE: To assess the sensitivity and specificity of the Xpert
® MTB/RIF assay among adults with suspected pulmonary tuberculosis (PTB) and with or without diabetes (DM).
DESIGN: As part of a prospective cohort study, we screened 2359 adults presumed to have PTB with no history of TB. All individuals underwent testing for two sputum smears, culture, Xpert, glycated haemoglobin and fasting blood sugar. We calculated sensitivity and specificity of Xpert by comparing it with TB sputum culture result as a gold standard.
RESULTS: Among screened individuals, 483 (20%) were diagnosed with DM and 1153 (49%) with pre-DM; 723 (31%) had no DM. Overall sensitivity of Xpert was 96% (95%CI 95-97) and specificity was 91% (95%CI 89-93). Xpert sensitivity was significantly higher among DM group (98%) than in the 'No DM' (95%;
P < 0.01) and pre-DM (96%;
P < 0.05) groups. Among sputum smear-negative individuals, Xpert sensitivity was higher in the DM group than in the No DM (92% vs. 82%;
P = 0.054) and pre-DM group (92% vs. 82%;
P = 0.037).
CONCLUSION: High sensitivity and specificity of Xpert underscores the need for its rapid scale up for the early detection of TB in settings with a high dual burden of TB and DM.
Deshmukh, S., Atre, S., Chavan, A., Raskar, S., Sawant, T., Mave, V., Gupte, N., Gaikwad, S., Sahasrabudhe, T., Barthwal, M., Kakrani, A., Kagal, A., Gupta, A., Bharadwaj, R., Pradhan, N., Dharmshale, S., & Golub, J. Assessment of the Xpert assay among adult pulmonary tuberculosis suspects with and without diabetes mellitus.
The International Journal of Tuberculosis and Lung Disease, 24(1), 113-117.
[post_title] => Assessment of the Xpert assay among adult pulmonary tuberculosis suspects with and without diabetes mellitus
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[post_date] => 2019-10-31 18:00:51
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[post_content] => GCTA. (2019).
Capacity-building of affected communities for accelerated to drug-resistant tuberculosis in the South-East Asia Region.
[post_title] => Capacity-building of affected communities for accelerated to drug-resistant tuberculosis in the South-East Asia Region
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[post_date] => 2019-09-12 14:52:31
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[post_content] => Understanding Tuberculosis and its Control: Anthropological and ethnographic Approaches
Over the last two decades, attempts to control the problem of tuberculosis have become increasingly more complex, as countries adopt and adapt to evolving global TB strategies. Significant funding has also increased apace, diagnostic possibilities have evolved, and greater attention is being paid to developing broader health systems. Against this background, this book examines tuberculosis control through an anthropological lens. Drawing on ethnographic case studies from China, India, Nepal, South Africa, Romania, Brazil, Ghana and France, the volume considers: the relationship between global and national policies and their unintended effects; the emergence and impact of introducing new diagnostics; the reliance on and use of statistical numbers for representing tuberculosis, and the politics of this; the impact of the disease on health workers, as well as patients; the rise of drug-resistant forms; and issues of attempted control. Together, the examples showcase the value of an anthropological understanding to demonstrate the broader bio-political and social dimensions of tuberculosis and attempts to deal with it.
MacDonald, H., & Harper, I. (Eds.). (2019).
Understanding Tuberculosis and Its Control: Anthropological and Ethnographic Approaches. Routledge.
[post_title] => Between representing and intervening: Diagnosing childhood tuberculosis during a vaccine trial in South Africa
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[post_date] => 2019-08-01 00:00:36
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[post_content] => This paper outlines insights qualitative research brings to the study of quality of care. It advocates understanding care as sequential, interpersonal action aimed at improving health and documenting the networks in which care occurs. It assesses the strengths and weakness of contemporary quantitative and qualitative approaches to examining quality of care for tuberculosis (TB) before outlining three qualitative research programs aimed at understanding quality of TB in India.
McDowell, A., Engel, N., & Daftary, A. (2019). In the eye of the multiple beholders: Qualitative research perspectives on studying and encouraging quality of TB care in India.
Journal of clinical tuberculosis and other mycobacterial diseases,
16, 100111.
[post_title] => In the eye of the multiple beholders: Qualitative research perspectives on studying and encouraging quality of TB care in India
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[ID] => 1752
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[post_date] => 2021-09-01 20:28:44
[post_date_gmt] => 2021-09-02 00:28:44
[post_content] =>
BACKGROUND: Half of India´s three million TB patients are treated in the largely unregulated private sector, where quality of care is often poor. Private provider interface agencies (PPIAs) seek to improve private sector quality of care, which can be measured in terms of case fatality and recurrence rates.
METHODS: We conducted a retrospective cohort survey of 4,000 private sector patients managed by the PATH PPIA between 2014 and 2017. We estimated treatment and post-treatment case-fatality ratios (CFRs) and recurrence rates. We used Cox proportional hazards models to identify predictors of fatality and recurrence. Patient loss to follow-up was adjusted for using selection weighting.
RESULTS: The treatment CFR was 7.1% (95% CI 6.0–8.2). At 24 months post-treatment, the CFR was 2.4% (95% CI 1.7–3.0) and the recurrence rate was 1.9% (95% CI 1.3–2.5). Treatment fatality was associated with age (HR 1.02, 95% CI 1.02–1.03), clinical diagnosis (HR 0.61, 95% CI 0.45–0.84), treatment duration (HR 0.09, 95% CI 0.06–0.10) and adherence. Post-treatment fatality was associated with treatment duration (HR 0.87, 95% CI 0.79–0.91) and adherence.
CONCLUSIONS: We found a moderate treatment phase CFR among PPIA-managed private sector patient with low rates of post-treatment fatality and recurrence. Routine monitoring of patient outcomes after treatment would strengthen PPIAs and inform future post TB interventions.
Huddart, S., Ingawale, P., Edwin, J., Jondhale, V., Pai, M., Benedetti, A., Shah, D., & Vijayan, S. (2021). TB case fatality and recurrence in a private sector cohort in Mumbai, India.
The International Journal of Tuberculosis and Lung Disease, 25(9), 738-746. https://doi.org/10.5588/ijtld.21.0266
[post_title] => TB case fatality and recurrence in a private sector cohort in Mumbai, India
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