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6 result(s)
Journal Article > EditorialFull Text

Urgent request for pretomanid label expansion to align with WHO guidelines and improve treatment accessibility and efficacy

IJTLD OPEN. 1 March 2025; Volume 2 (Issue 3); 117-119.; DOI:10.5588/ijtldopen.25.0152
Kuksa L, Andrejak C, Haecker B, Bothamley G, Calcagno A,  et al.
IJTLD OPEN. 1 March 2025; Volume 2 (Issue 3); 117-119.; DOI:10.5588/ijtldopen.25.0152

Pretomanid is a key anti-TB drug included in the WHO list of essential medications. The current EMA-approved label for pretomanid restricts its use to the regimen comprising bedaquiline, pretomanid and linezolid (BPaL) and only for extensively drug-resistant-TB or multidrug-resistant TB, "when antibiotics used for the latter form of TB do not work or cause unacceptable side effects." This restricted use implies that the older, prolonged and poorly tolerated regimens remain the recommended treatment for most cases of drug-resistant TB. The authors, representing many respiratory groups and societies, call for the label expansion of pretomanid to align with global guidelines, allowing for broader use.


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Journal Article > LetterFull Text

Sustained treatment success at 12 months for drug-resistant TB patients on concomitant bedaquiline-delamanid

IJTLD OPEN. 1 February 2025; Volume 2 (Issue 2); 107-109.; DOI:10.5588/ijtldopen.24.0600
Chavan V, Silsarma A, Mahajan R, Khan S, Singh P,  et al.
IJTLD OPEN. 1 February 2025; Volume 2 (Issue 2); 107-109.; DOI:10.5588/ijtldopen.24.0600
Journal Article > ResearchFull Text

Second-line drug-resistant TB and associated risk factors in Karakalpakstan, Uzbekistan

IJTLD OPEN. 1 September 2024; Volume 1 (Issue 9); 391-397.; DOI:10.5588/ijtldopen.24.0351
Moe S, Azamat I, Allamuratova S, Oluya M, Khristusev A,  et al.
IJTLD OPEN. 1 September 2024; Volume 1 (Issue 9); 391-397.; DOI:10.5588/ijtldopen.24.0351

BACKGROUND

Drug-resistant TB (DR-TB) remains a major public health threat. In 2022, Uzbekistan reported 2,117 cases of DR-TB, with 69% tested for fluoroquinolone resistance. Limited information is available on the prevalence of resistance to bedaquiline, linezolid, and fluoroquinolone, which are key components of the all-oral treatment regimen for rifampicin-resistant TB in Uzbekistan.


METHODS

A retrospective study was conducted using extensive programmatic data from 2019 to 2023 in Uzbekistan. We assessed second-line drug-resistant TB (SLDR-TB) rates using phenotypic drug susceptibility testing (pDST). Demographic and clinical characteristics associated with SLDR-TB were analysed using multivariable logistic regression models based on the Allen-Cady approach.


RESULTS 

In total, 2,405 patients with TB who had undergone pDST were included (median age 40 years, 47% female). The overall SLDR-TB resistance rate was 24% (95% CI 22-26). Prevalence of resistance to bedaquiline, linezolid, moxifloxacin, levofloxacin, and amikacin were respectively 3.1%, 0.8%, 15%, 13%, and 12%. Risk factors for SLDR-TB were resistance to rifampicin and/or isoniazid, exposure to clofazimine, retreatment status, contact with drug-susceptible TB case or DR-TB case, and diabetes.


CONCLUSIONS

The high prevalence of SLDR-TB is of major concern, emphasising the need for baseline pDST in RR-TB treatment. Identified risk factors can aid early detection of at-risk individuals and inform clinical practice.

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Journal Article > ResearchFull Text

Yield of TB screening in prisons in Tajikistan

IJTLD OPEN. 1 August 2024; Volume 1 (Issue 8); 344-348.; DOI:10.5588/ijtldopen.24.0272
Moe S, Asozoda M, Aung A, Dusmatova Z, Akintore F,  et al.
IJTLD OPEN. 1 August 2024; Volume 1 (Issue 8); 344-348.; DOI:10.5588/ijtldopen.24.0272

BACKGROUND

The rate of TB in prison institutions is estimated to be 23 times higher than in the general population. Limited documentation exists regarding TB screening in Tajikistan's prisons. This study aims to report findings from a TB screening conducted in prison facilities in Tajikistan.


METHODS

A systematic TB screening was conducted between July 2022 and September 2023, following a locally adapted algorithm based on WHO recommendations. The screening yield was calculated as the proportion of confirmed TB cases, with categorical variables compared using a χ2 test.


RESULTS

A total of 7,223 screenings were conducted, identifying 31 TB cases, including 17 drug-susceptible TB cases, eight drug-resistant TB cases, and six clinically diagnosed cases. The overall screening yield was 0.43%. Notably, the screening yield was 3.4% among individuals with at least one TB symptom and 0.03% among those without TB symptoms (P < 0.001).


CONCLUSION

The identified rate of TB in these prisons is five times higher than in the general population. Symptomatic individuals had a higher likelihood of TB diagnosis, and using chest X-rays significantly improved screening yield. We recommend increasing the capacity for chest X-ray testing to enhance TB prevention and control within prison settings.

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Journal Article > ResearchFull Text

A 10-year review of isoniazid-resistant TB management in Uzbekistan 2009-2020

IJTLD OPEN. 1 July 2024; Volume 1 (Issue 7); 285-291.; DOI:10.5588/ijtldopen.23.0533
Rekart M, Thit P, Oluya M, Moe S, Hasan T,  et al.
IJTLD OPEN. 1 July 2024; Volume 1 (Issue 7); 285-291.; DOI:10.5588/ijtldopen.23.0533

Background

Isoniazid (INH, H) resistance is the most common drug-resistant TB pattern, with treatment success rates lower than those in drug-susceptible TB. The WHO recommends a 6-month regimen of rifampicin (RIF, R), ethambutol (EMB, E), pyrazinamide (PZA, Z), and levofloxacin (Lfx) (6REZLfx) for INH-resistant, RIF-susceptible TB (HRRS-TB). Uzbekistan has a high burden of TB (62/100,000 population) and multidrug-resistant TB (12/100,000 population).


Methods

We conducted a retrospective, descriptive study of microbiologically confirmed HRRS-TB using routinely collected programmatic data from 2009 to 2020.


Results

We included 854 HRRS-TB cases. Treatment success was 80.2% overall. For REZLfx, the treatment success rate was 92.0% over a short treatment duration, with no amplifications to RIF or second-line anti-TB drug resistance. We documented 46 regimens with REZLfx plus linezolid (success 87.0%) and 539 regimens using kanamycin or capreomycin (success 76.6%). We identified 37 treatment failures (4.3%), 30 deaths (3.5%), 25 resistance amplifications (2.9%), including eight to RIF (0.9%), and 99 lost to follow-up (LTFU) cases (11.6%). Unsuccessful outcomes were more common with older age, diabetes, chest X-ray cavities, smear positivity, smear-positive persistence, and male sex. LTFU was more common with injection-containing regimens.


Conclusions

REZLfx is a safe and effective first-line treatment for INH-resistant, RIF-susceptible TB. Treatment success was lower and LTFU was higher for injection-containing regimens.

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Journal Article > ResearchFull Text

Evaluation of a short training course of chest X-ray interpretation for the diagnosis of paediatric TB

IJTLD OPEN. 1 February 2024; Volume 1 (Issue 2); 76-82.; DOI:10.5588/ijtldopen.23.0484
Melingui BF, Leroy-Terquem E, Palmer M, Taguebue JV, Wachinou AP,  et al.
IJTLD OPEN. 1 February 2024; Volume 1 (Issue 2); 76-82.; DOI:10.5588/ijtldopen.23.0484
BACKGROUND
Chest X-ray (CXR) interpretation is challenging for the diagnosis of paediatric TB. We assessed the performance of a three half-day CXR training module for healthcare workers (HCWs) at low healthcare levels in six high TB incidence countries.

METHODS
Within the TB-Speed Decentralization Study, we developed a three half-day training course to identify normal CXR, CXR of good quality and identify six TB-suggestive features. We performed a pre–post training assessment on a pre-defined set of 20 CXR readings. We compared the proportion of correctly interpreted CXRs and the median reading score before and after the training using the McNemar test and a linear mixed model.

RESULTS
Of 191 HCWs, 43 (23%) were physicians, 103 (54%) nurses, 18 (9.4%) radiology technicians and 12 (6.3%) other professionals. Of 2,840 CXRs with both assessment, respectively 1,843 (64.9%) and 2,277 (80.2%) were correctly interpreted during pre-training and post-training (P < 0.001). The median reading score improved significantly from 13/20 to 16/20 after the training, after adjusting by country, facility and profession (adjusted β = 3.31, 95% CI 2.44–4.47).

CONCLUSION
Despite some limitations of the course assessment that did not include abnormal non-TB suggestive CXR, study findings suggest that a short CXR training course could improve HCWs’ interpretation skills in diagnosing paediatric TB.
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