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Quality of tuberculosis care in India: A systematic review
indian journal of tuberculosis 62 (2015) 188–192
Conclusion: The estimated prevalence rates in the two different sample survey areas were comparable, indicating that the repeated prevalence surveys in the study area did not influence the observed decline in TB disease prevalence. http://dx.doi.org/10.1016/j.ijtb.2015.09.022 Cost-utility analysis of LED fluorescence microscopy in the diagnosis of pulmonary tuberculosis in Indian settings
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of those standards. Eleven studies with both public and private providers found higher levels of appropriate knowledge/practice in the public sector. Conclusions: Available evidence suggests suboptimal quality of TB care, particularly in the private sector. Improvement of quality of care should be a priority for India. http://dx.doi.org/10.1016/j.ijtb.2015.09.024 RMP exposure is lower in HIV-infected TB patients receiving intermittent than daily anti-tuberculosis treatment
V. Kelly; K.D. Sagili; S. Satyanarayana; L.W. Reza; S.S. Chadha; N.C. Wilson. The International Journal of Tuberculosis and Lung Disease 2015; 19(6): 696–701. Background: With support from the Stop TB Partnership's TB REACH Wave 2 Grant, diagnostic microscopy services for tuberculosis (TB) were upgraded from conventional ZiehlNeelsen (ZN) based sputum microscopy to light emitting diode technology-based fluorescence microscopy (LED FM) in 200 high-workload microscopy centres in India as a pilot intervention. Objective: To evaluate the cost-effectiveness of LED-FM over conventional ZN microscopy to inform further scale-up. Methods: A decision-tree model was constructed to assess the cost utility of LED FM over ZN microscopy. The results were summarised using incremental cost-effectiveness ratio (ICER); one-way and probabilistic sensitivity analyses were also conducted to address uncertainty within the model. Data were analysed from 200 medical colleges in 2011 and 2012, before and after the introduction of LED microscopes. A full costing analysis was carried out from the perspective of a national TB programme. Results: The ICER was calculated at US$14.64 per disabilityadjusted life-year, with an 82% probability of being cost-effective at a willingness-to-pay threshold equivalent to Indian gross domestic product per capita. Conclusions: LED FM is a cost-effective intervention for detecting TB cases in India at high-workload medical college settings. http://dx.doi.org/10.1016/j.ijtb.2015.09.023 Quality of tuberculosis care in India: A systematic review
S. Satyanarayana; R. Subbaraman; P. Shete; G. Gore; J. Das; A. Cattamanchi; K. Mayer; D. Menzies; A.D. Harries; P. Hopewell; M. Pai. The International Journal of Tuberculosis and Lung Disease 2015; 19(7):751–63. Background: While Indian studies have assessed care providers' knowledge and practices, there is no systematic review on the quality of tuberculosis (TB) care. Methods: We searched multiple sources to identify studies (2000–2014) on providers' knowledge and practices. We used the International Standards for TB Care to benchmark quality of care. Results: Of the 47 studies included, 35 were questionnaire surveys and 12 used chart abstraction. None assessed actual practice using standardised patients. Heterogeneity in the findings precluded meta-analysis. Of 22 studies evaluating provider knowledge about using sputum smears for diagnosis, 10 found that less than half of providers had correct knowledge; 3 of 4 studies assessing self-reported practices by providers found that less than a quarter reported ordering smears for patients with chest symptoms. In 11 of 14 studies that assessed treatment, less than one third of providers knew the standard regimen for drug-susceptible TB. Adherence to standards in practice was generally lower than correct knowledge
A.K. Hemanth Kumar; G. Narendran; R.S. Kumar; G. Ramachandran; L. Sekar; K. Raja; S. Swaminathan. The International Journal of Tuberculosis and Lung Disease 2015; 19(7): 805–7. We compared the pharmacokinetics of rifampicin (RMP) during daily and intermittent (thrice weekly) anti-tuberculosis treatment in human immunodeficiency virus infected tuberculosis patients. Patients treated with a thrice-weekly regimen had significantly lower plasma peak concentration, area under the time concentration curve from 0 to 24 h and higher oral clearance of RMP than those treated with the daily regimen. The median values were respectively 3.7 and 6.4 mg/ml (P < 0.001), 20.7 and 29.4 mg/ml h (P = 0.03) and 21.7 and 15.3 ml/min (P = 0.03). http://dx.doi.org/10.1016/j.ijtb.2015.09.025 Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children: A systematic review and metaanalysis
Anne K. Detjen; Andrew R. DiNardo; Jacinta Leyden; Karen R. Steingart; Dick Menzies; Ian Schiller; Nandini Dendukuri; Anna M. Mandalakas. The Lancet Respiratory Medicine 2015; 3(6): 415– 96. Background: Microbiological confirmation of childhood tuberculosis is rare because of the difficulty of collection of specimens, low sensitivity of smear microscopy, and poor access to culture. We aimed to establish summary estimates for sensitivity and specificity of the Xpert MTB/RIF assay compared with microscopy in the diagnosis of pulmonary tuberculosis in children. Methods: We searched for studies published up to January 6, 2015, that used Xpert in any setting in children with and without HIV infection. We systematically reviewed studies that compared the diagnostic accuracy of Xpert MTB/RIF (Xpert) with microscopy for detection of pulmonary tuberculosis and rifampicin resistance in children younger than 16 years against two reference standards—culture results and culture-negative children who were started on anti-tuberculosis therapy. We did meta-analyses using a bivariate randomeffects model. Findings: We identified 15 studies including 4768 respiratory specimens in 3640 children investigated for pulmonary tuberculosis. Culture tests were positive for tuberculosis in 12% (420 of 3640) of all children assessed and Xpert was positive in 11% (406 of 3640). Compared with culture, the pooled sensitivities and specificities of Xpert for tuberculosis detection were 62% (95% credible interval 51–73) and 98% (97–99), respectively, with use of expectorated or induced sputum samples and 66% (51–81) and 98% (96–99), respectively, with use of samples from gastric lavage. Xpert sensitivity was 36– 44% higher than was sensitivity for microscopy. Xpert sensitivity in culture-negative children started on antituberculosis therapy was 2% (1–3) for expectorated or induced sputum.
Conclusion: The estimated prevalence rates in the two different sample survey areas were comparable, indicating that the repeated prevalence surveys in the study area did not influence the observed decline in TB disease prevalence. http://dx.doi.org/10.1016/j.ijtb.2015.09.022 Cost-utility analysis of LED fluorescence microscopy in the diagnosis of pulmonary tuberculosis in Indian settings
191
of those standards. Eleven studies with both public and private providers found higher levels of appropriate knowledge/practice in the public sector. Conclusions: Available evidence suggests suboptimal quality of TB care, particularly in the private sector. Improvement of quality of care should be a priority for India. http://dx.doi.org/10.1016/j.ijtb.2015.09.024 RMP exposure is lower in HIV-infected TB patients receiving intermittent than daily anti-tuberculosis treatment
V. Kelly; K.D. Sagili; S. Satyanarayana; L.W. Reza; S.S. Chadha; N.C. Wilson. The International Journal of Tuberculosis and Lung Disease 2015; 19(6): 696–701. Background: With support from the Stop TB Partnership's TB REACH Wave 2 Grant, diagnostic microscopy services for tuberculosis (TB) were upgraded from conventional ZiehlNeelsen (ZN) based sputum microscopy to light emitting diode technology-based fluorescence microscopy (LED FM) in 200 high-workload microscopy centres in India as a pilot intervention. Objective: To evaluate the cost-effectiveness of LED-FM over conventional ZN microscopy to inform further scale-up. Methods: A decision-tree model was constructed to assess the cost utility of LED FM over ZN microscopy. The results were summarised using incremental cost-effectiveness ratio (ICER); one-way and probabilistic sensitivity analyses were also conducted to address uncertainty within the model. Data were analysed from 200 medical colleges in 2011 and 2012, before and after the introduction of LED microscopes. A full costing analysis was carried out from the perspective of a national TB programme. Results: The ICER was calculated at US$14.64 per disabilityadjusted life-year, with an 82% probability of being cost-effective at a willingness-to-pay threshold equivalent to Indian gross domestic product per capita. Conclusions: LED FM is a cost-effective intervention for detecting TB cases in India at high-workload medical college settings. http://dx.doi.org/10.1016/j.ijtb.2015.09.023 Quality of tuberculosis care in India: A systematic review
S. Satyanarayana; R. Subbaraman; P. Shete; G. Gore; J. Das; A. Cattamanchi; K. Mayer; D. Menzies; A.D. Harries; P. Hopewell; M. Pai. The International Journal of Tuberculosis and Lung Disease 2015; 19(7):751–63. Background: While Indian studies have assessed care providers' knowledge and practices, there is no systematic review on the quality of tuberculosis (TB) care. Methods: We searched multiple sources to identify studies (2000–2014) on providers' knowledge and practices. We used the International Standards for TB Care to benchmark quality of care. Results: Of the 47 studies included, 35 were questionnaire surveys and 12 used chart abstraction. None assessed actual practice using standardised patients. Heterogeneity in the findings precluded meta-analysis. Of 22 studies evaluating provider knowledge about using sputum smears for diagnosis, 10 found that less than half of providers had correct knowledge; 3 of 4 studies assessing self-reported practices by providers found that less than a quarter reported ordering smears for patients with chest symptoms. In 11 of 14 studies that assessed treatment, less than one third of providers knew the standard regimen for drug-susceptible TB. Adherence to standards in practice was generally lower than correct knowledge
A.K. Hemanth Kumar; G. Narendran; R.S. Kumar; G. Ramachandran; L. Sekar; K. Raja; S. Swaminathan. The International Journal of Tuberculosis and Lung Disease 2015; 19(7): 805–7. We compared the pharmacokinetics of rifampicin (RMP) during daily and intermittent (thrice weekly) anti-tuberculosis treatment in human immunodeficiency virus infected tuberculosis patients. Patients treated with a thrice-weekly regimen had significantly lower plasma peak concentration, area under the time concentration curve from 0 to 24 h and higher oral clearance of RMP than those treated with the daily regimen. The median values were respectively 3.7 and 6.4 mg/ml (P < 0.001), 20.7 and 29.4 mg/ml h (P = 0.03) and 21.7 and 15.3 ml/min (P = 0.03). http://dx.doi.org/10.1016/j.ijtb.2015.09.025 Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children: A systematic review and metaanalysis
Anne K. Detjen; Andrew R. DiNardo; Jacinta Leyden; Karen R. Steingart; Dick Menzies; Ian Schiller; Nandini Dendukuri; Anna M. Mandalakas. The Lancet Respiratory Medicine 2015; 3(6): 415– 96. Background: Microbiological confirmation of childhood tuberculosis is rare because of the difficulty of collection of specimens, low sensitivity of smear microscopy, and poor access to culture. We aimed to establish summary estimates for sensitivity and specificity of the Xpert MTB/RIF assay compared with microscopy in the diagnosis of pulmonary tuberculosis in children. Methods: We searched for studies published up to January 6, 2015, that used Xpert in any setting in children with and without HIV infection. We systematically reviewed studies that compared the diagnostic accuracy of Xpert MTB/RIF (Xpert) with microscopy for detection of pulmonary tuberculosis and rifampicin resistance in children younger than 16 years against two reference standards—culture results and culture-negative children who were started on anti-tuberculosis therapy. We did meta-analyses using a bivariate randomeffects model. Findings: We identified 15 studies including 4768 respiratory specimens in 3640 children investigated for pulmonary tuberculosis. Culture tests were positive for tuberculosis in 12% (420 of 3640) of all children assessed and Xpert was positive in 11% (406 of 3640). Compared with culture, the pooled sensitivities and specificities of Xpert for tuberculosis detection were 62% (95% credible interval 51–73) and 98% (97–99), respectively, with use of expectorated or induced sputum samples and 66% (51–81) and 98% (96–99), respectively, with use of samples from gastric lavage. Xpert sensitivity was 36– 44% higher than was sensitivity for microscopy. Xpert sensitivity in culture-negative children started on antituberculosis therapy was 2% (1–3) for expectorated or induced sputum.