Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-11 (of 11 Records) |
Query Trace: Moore BK[original query] |
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Pediatric tuberculosis: A review of evidence-based best practices for clinicians and health care providers
Moore BK , Graham SM , Nandakumar S , Doyle J , Maloney SA . Pathogens 2024 13 (6) Advances in pediatric TB care are promising, the result of decades of advocacy, operational and clinical trials research, and political will by national and local TB programs in high-burden countries. However, implementation challenges remain in linking policy to practice and scaling up innovations for prevention, diagnosis, and treatment of TB in children, especially in resource-limited settings. There is both need and opportunity to strengthen clinician confidence in making a TB diagnosis and managing the various manifestations of TB in children, which can facilitate the translation of evidence to action and expand access to new tools and strategies to address TB in this population. This review aims to summarize existing guidance and best practices for clinicians and health care providers in low-resource, TB-endemic settings and identify resources with more detailed and actionable information for decision-making along the clinical cascade to prevent, find, and cure TB in children. |
Evidence to action: Translating innovations in management of child and adolescent TB into routine practice in high-burden countries
Moore BK , Dlodlo RA , Dongo JP , Verkuijl S , Sekadde MP , Sandy C , Maloney SA . Pathogens 2022 11 (4) Child and adolescent tuberculosis (TB) has been long neglected by TB programs but there have been substantive strides in prioritizing TB among these populations in the past two decades. Yet, gaps remain in translating evidence and policy to action at the primary care level, ensuring access to novel tools and approaches to diagnosis, treatment, and prevention for children and adolescents at risk of TB disease. This article describes the progress that has been made and the gaps that remain in addressing TB among children and adolescents while also highlighting pragmatic approaches and the role of multisectoral partnerships in facilitating integration of innovations into routine program practice. © 2022 by the authors. Licensee MDPI, Basel, Switzerland. |
Tuberculosis treatment within differentiated service delivery models in global HIV/TB programming.
Tran CH , Moore BK , Pathmanathan I , Lungu P , Shah NS , Oboho I , Al-Samarrai T , Maloney SA , Date A , Boyd AT . J Int AIDS Soc 2021 24 Suppl 6 e25809 INTRODUCTION: Providing more convenient and patient-centred options for service delivery is a priority within global HIV programmes. These efforts improve patient satisfaction and retention and free up time for providers to focus on new HIV diagnoses or severe illness. Recently, the coronavirus disease 2019 (COVID-19) pandemic precipitated expanded eligibility criteria for these differentiated service delivery (DSD) models to decongest clinics and protect patients and healthcare workers. This has resulted in dramatic scale-up of DSD for antiretroviral therapy, cotrimoxazole and tuberculosis (TB) preventive treatment. While TB treatment among people living with HIV (PLHIV) has traditionally involved frequent, facility-based management, TB treatment can also be adapted within DSD models. Such adaptations could include electronic tools to ensure appropriate clinical management, treatment support, adherence counselling and adverse event (AE) monitoring. In this commentary, we outline considerations for DSD of TB treatment among PLHIV, building on best practices from global DSD model implementation for HIV service delivery. DISCUSSION: In operationalizing TB treatment in DSD models, we consider the following: what activity is being done, when or how often it takes place, where it takes place, by whom and for whom. We discuss considerations for various programme elements including TB screening and diagnosis; medication dispensing; patient education, counselling and support; clinical management and monitoring; and reporting and recording. General approaches include multi-month dispensing for TB medications during intensive and continuation phases of treatment and standardized virtual adherence and AE monitoring. Lastly, we provide operational examples of TB treatment delivery through DSD models, including a conceptual model and an early implementation experience from Zambia. CONCLUSIONS: COVID-19 has catalysed the rapid expansion of differentiated patient-centred service delivery for PLHIV. Expanding DSD models to include TB treatment can capitalize on existing platforms, while providing high-quality, routine treatment, follow-up and patient education and empowerment. |
Pre-treatment loss to follow-up among children with multidrug-resistant tuberculosis in South Africa, 2008-2010
Moore BK , Erasmus L , Ershova J , Smith SE , Ndjeka N , Podewils LJ . PLoS One 2020 15 (4) e0230504 Multidrug-resistant (MDR) TB is more difficult to diagnose and treat compared with drug-susceptible TB. Young children are at greater risk of severe TB disease and death when treatment is delayed compared to adults. We sought to describe characteristics of children (<13 years) diagnosed with MDR TB between 2008-2010 in three South African provinces and assess factors associated with pre-treatment loss to follow-up. We matched laboratory and medical records at treatment facilities to identify pre-treatment loss and examined demographic and clinical characteristics for association with loss. Categorical variables were examined for association using Pearson's x2 or Fisher's exact test, employing Bonferroni correction for multiple pairwise comparisons. Between 2008-2010, 156 children were diagnosed with laboratory-confirmed MDR TB. Only 44% (n = 69) were documented as having received treatment. Young children (<2 years) (47/59, 80%), children with extrapulmonary (EP) TB (27/34, 79%), and children diagnosed at general hospitals (60/97, 62%) were most likely to be lost before treatment. Children most vulnerable to death from TB are most likely to be lost before treatment, possibly leading to underestimates of disease burden, case notifications, and poor outcomes among this population. Point-of-care diagnosis and robust follow-up may reduce pre-treatment loss in this population. |
Treatment outcomes in global systematic review and patient meta-analysis of children with extensively drug-resistant tuberculosis
Osman M , Harausz EP , Garcia-Prats AJ , Schaaf HS , Moore BK , Hicks RM , Achar J , Amanullah F , Barry P , Becerra M , Chiotan DI , Drobac PC , Flood J , Furin J , Gegia M , Isaakidis P , Mariandyshev A , Ozere I , Shah NS , Skrahina A , Yablokova E , Seddon JA , Hesseling AC . Emerg Infect Dis 2019 25 (3) 441-450 Extensively drug-resistant tuberculosis (XDR TB) has extremely poor treatment outcomes in adults. Limited data are available for children. We report on clinical manifestations, treatment, and outcomes for 37 children (<15 years of age) with bacteriologically confirmed XDR TB in 11 countries. These patients were managed during 1999-2013. For the 37 children, median age was 11 years, 32 (87%) had pulmonary TB, and 29 had a recorded HIV status; 7 (24%) were infected with HIV. Median treatment duration was 7.0 months for the intensive phase and 12.2 months for the continuation phase. Thirty (81%) children had favorable treatment outcomes. Four (11%) died, 1 (3%) failed treatment, and 2 (5%) did not complete treatment. We found a high proportion of favorable treatment outcomes among children, with mortality rates markedly lower than for adults. Regimens and duration of treatment varied considerably. Evaluation of new regimens in children is required. |
Treatment and outcomes in children with multidrug-resistant tuberculosis: A systematic review and individual patient data meta-analysis
Harausz EP , Garcia-Prats AJ , Law S , Schaaf HS , Kredo T , Seddon JA , Menzies D , Turkova A , Achar J , Amanullah F , Barry P , Becerra M , Chan ED , Chan PC , Ioana Chiotan D , Crossa A , Drobac PC , Fairlie L , Falzon D , Flood J , Gegia M , Hicks RM , Isaakidis P , Kadri SM , Kampmann B , Madhi SA , Marais E , Mariandyshev A , Mendez-Echevarria A , Moore BK , Nargiza P , Ozere I , Padayatchi N , Ur-Rehman S , Rybak N , Santiago-Garcia B , Shah NS , Sharma S , Shim TS , Skrahina A , Soriano-Arandes A , van den Boom M , van der Werf MJ , van der Werf TS , Williams B , Yablokova E , Yim JJ , Furin J , Hesseling AC . PLoS Med 2018 15 (7) e1002591 BACKGROUND: An estimated 32,000 children develop multidrug-resistant tuberculosis (MDR-TB; Mycobacterium tuberculosis resistant to isoniazid and rifampin) each year. Little is known about the optimal treatment for these children. METHODS AND FINDINGS: To inform the pediatric aspects of the revised World Health Organization (WHO) MDR-TB treatment guidelines, we performed a systematic review and individual patient data (IPD) meta-analysis, describing treatment outcomes in children treated for MDR-TB. To identify eligible reports we searched PubMed, LILACS, Embase, The Cochrane Library, PsychINFO, and BioMedCentral databases through 1 October 2014. To identify unpublished data, we reviewed conference abstracts, contacted experts in the field, and requested data through other routes, including at national and international conferences and through organizations working in pediatric MDR-TB. A cohort was eligible for inclusion if it included a minimum of three children (aged <15 years) who were treated for bacteriologically confirmed or clinically diagnosed MDR-TB, and if treatment outcomes were reported. The search yielded 2,772 reports; after review, 33 studies were eligible for inclusion, with IPD provided for 28 of these. All data were from published or unpublished observational cohorts. We analyzed demographic, clinical, and treatment factors as predictors of treatment outcome. In order to obtain adjusted estimates, we used a random-effects multivariable logistic regression (random intercept and random slope, unless specified otherwise) adjusted for the following covariates: age, sex, HIV infection, malnutrition, severe extrapulmonary disease, or the presence of severe disease on chest radiograph. We analyzed data from 975 children from 18 countries; 731 (75%) had bacteriologically confirmed and 244 (25%) had clinically diagnosed MDR-TB. The median age was 7.1 years. Of 910 (93%) children with documented HIV status, 359 (39%) were infected with HIV. When compared to clinically diagnosed patients, children with confirmed MDR-TB were more likely to be older, to be infected with HIV, to be malnourished, and to have severe tuberculosis (TB) on chest radiograph (p < 0.001 for all characteristics). Overall, 764 of 975 (78%) had a successful treatment outcome at the conclusion of therapy: 548/731 (75%) of confirmed and 216/244 (89%) of clinically diagnosed children (absolute difference 14%, 95% confidence interval [CI] 8%-19%, p < 0.001). Treatment was successful in only 56% of children with bacteriologically confirmed TB who were infected with HIV who did not receive any antiretroviral treatment (ART) during MDR-TB therapy, compared to 82% in children infected with HIV who received ART during MDR-TB therapy (absolute difference 26%, 95% CI 5%-48%, p = 0.006). In children with confirmed MDR-TB, the use of second-line injectable agents and high-dose isoniazid (15-20 mg/kg/day) were associated with treatment success (adjusted odds ratio [aOR] 2.9, 95% CI 1.0-8.3, p = 0.041 and aOR 5.9, 95% CI 1.7-20.5, p = 0.007, respectively). These findings for high-dose isoniazid may have been affected by site effect, as the majority of patients came from Cape Town. Limitations of this study include the difficulty of estimating the treatment effects of individual drugs within multidrug regimens, only observational cohort studies were available for inclusion, and treatment decisions were based on the clinician's perception of illness, with resulting potential for bias. CONCLUSIONS: This study suggests that children respond favorably to MDR-TB treatment. The low success rate in children infected with HIV who did not receive ART during their MDR-TB treatment highlights the need for ART in these children. Our findings of individual drug effects on treatment outcome should be further evaluated. |
Treatment outcomes of children with HIV infection and drug-resistant TB in three provinces in South Africa, 2005-2008
Hall EW , Morris SB , Moore BK , Erasmus L , Odendaal R , Menzies H , van der Walt M , Smith SE . Pediatr Infect Dis J 2017 36 (12) e322-e327 OBJECTIVE: To describe outcomes of HIV-infected pediatric patients with drug-resistant tuberculosis (DR TB). METHODS: Demographic, clinical, and laboratory data from pediatric patient charts treated for DR TB during 2005-2008 were collected retrospectively from five MDR TB hospitals in South Africa. Data were summarized and Pearson's chi-squared test or Fisher's exact test were used to assess differences in variables of interest by HIV status. A time-to-event analysis was conducted using days from start of treatment to death. Variables of interest were first assessed using the Kaplan-Meier method. Cox proportional hazard models were fit to estimate crude and adjusted hazard ratios. RESULTS: Of 423 eligible participants, 398 (95%) had culture-confirmed DR-TB and 238 (56%) were HIV-infected. A total of 54% were underweight, 42% were male and median age was 10.7 years (IQR: 5.5-15.3). Of the 423 participants, 245 (58%) were successfully treated, 69 (16%) died, treatment failed in 3 (1%), 36 (9%) were lost to follow-up, and 70 (17%) were still on treatment, transferred or had unknown outcomes. Time to death differed by HIV status (p=0.008), sex (p<0.001), year of TB diagnosis (p=0.05) and weight status (p=0.002). Over the two-year risk period, the adjusted rate of death was 2-fold higher among participants with HIV compared to HIV-negative participants (aHR=2.28; 95% CI: 1.11, 4.68). CONCLUSIONS: Male, underweight, and HIV-infected children with DR TB were more likely to experience death when compared to other children with DR TB within this study population. |
Mixed impact of Xpert((R)) MTB/RIF on tuberculosis diagnosis in Cambodia
Auld SC , Moore BK , Kyle RP , Eng B , Nong K , Pevzner ES , Eam KK , Eang MT , Killam WP . Public Health Action 2016 6 (2) 129-35 SETTING: National Tuberculosis (TB) Program sites in northwest Cambodia. OBJECTIVE: To evaluate the impact of Xpert((R)) MTB/RIF at point of care (POC) as compared to non-POC sites on the diagnostic evaluation of people living with the human immunodeficiency virus (PLHIV) with TB symptoms and patients with possible multidrug-resistant (MDR) TB. DESIGN: Observational cohort of patients undergoing routine diagnostic evaluation for TB following the rollout of Xpert. RESULTS: Between October 2011 and June 2013, 431 of 822 (52%) PLHIV with TB symptoms and 240/493 (49%) patients with possible MDR-TB underwent Xpert. Xpert was more likely to be performed when available as POC. A smaller proportion of PLHIV at POC sites were diagnosed with TB than at non-POC sites; however, at POC sites, a higher proportion of those diagnosed with TB were bacteriologically positive. There was poor agreement between Xpert and other tests such as smear microscopy and culture. Overall, the evaluation of patients with possible MDR-TB increased following Xpert rollout, yet for patients confirmed as having drug resistance on drug susceptibility testing, only 46% had rifampin resistance that would be identified with Xpert. CONCLUSION: Although utilization of Xpert was low, it may have contributed to an increase in evaluations for possible MDR-TB and a decline in empiric treatment for PLHIV when available as POC. |
Epidemiology of drug-resistant tuberculosis among children and adolescents in South Africa, 2005-2010
Moore BK , Anyalechi E , van der Walt M , Smith S , Erasmus L , Lancaster J , Morris S , Ndjeka N , Ershova J , Ismail N , Burton D , Menzies H . Int J Tuberc Lung Dis 2015 19 (6) 663-9 OBJECTIVE: To describe the demographic and clinical characteristics of children and adolescents diagnosed with resistance to any anti-tuberculosis drug (drug-resistant tuberculosis; DR-TB) in South Africa. DESIGN: We retrospectively reviewed medical records of all children (<13 years) and adolescents (13 to <18 years) with DR-TB at specialty hospitals in four South African provinces from 2005 to 2010. RESULTS: During the review period, 774 children and adolescents (median age 11.3 years) were diagnosed with DR-TB at selected facilities. A high proportion of patients had a history of previous TB treatment (285/631; 45.2%), human immunodeficiency virus (HIV) infection (375/685; 54.7%), contact with a TB case (347/454; 76.4%), and smear-positive (443/729; 60.8%), cavitary (253/680, 38.7%) disease. Eighty-two per cent of patients with HIV infection received antiretroviral therapy. Of 626 patients diagnosed with multidrug-resistant TB (MDR-TB), 561 (89.6%) received a regimen consistent with national guidelines; the median length of treatment was 22 months (IQR 16-25). Among 400 patients with any DR-TB and a known outcome, 20.3% died during treatment. CONCLUSION: Pediatric DR-TB in these provinces is characterized by complex clinical features at diagnosis, with one in five children dying during treatment. History of previous treatment and contact with a TB patient indicate opportunities for earlier diagnosis and treatment to improve outcomes. |
Rollout of Xpert MTB/RIF in northwest Cambodia for the diagnosis of tuberculosis among PLHA
Auld SC , Moore BK , Killam WP , Eng B , Nong K , Pevzner EC , Eam KK , Eang MT , Warren D , Whitehead SJ . Public Health Action 2014 4 (4) 216-221 OBJECTIVE: To describe the implementation and utilization of the Xpert MTB/RIF (Xpert) assay to diagnose tuberculosis (TB) among people living with the human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS, PLHA) in Cambodia. DESIGN: Following the rollout of Xpert, an evaluation was conducted in four provinces of Cambodia from March to December 2012 to determine the utilization, performance, and turnaround time (TAT) of Xpert among PLHA. Data were collected from paper-based patient registers. RESULTS: Of 497 PLHA with a positive TB symptom screen, 357 (72%) were tested with smear microscopy, and 250 (50%) with Xpert; 25 (10%) PLHA tested with Xpert were positive for TB and none were rifampicin-resistant. The utilization of Xpert increased from 23% to 75%, with a median TAT of 1 day. Across districts, utilization ranged from zero to 85%, while the TAT ranged from zero to 22 days. CONCLUSION: While early data show increasing utilization of Xpert for PLHA with a positive symptom screen, most patients underwent smear microscopy as an initial diagnostic test. Training delays and challenges associated with specimen referral may have contributed to variability in Xpert uptake and TAT, particularly for sites without onsite Xpert testing. Enhanced programmatic support, particularly for specimen referral and results reporting, may facilitate appropriate utilization. |
The disconnect between a national tuberculosis drug resistance survey and treatment outcomes: a lost opportunity
Click ES , Chirenda J , Kibias S , Menzies HJ , Oeltmann JE , Sentle C , Muribe T , Lere TD , Makombe R , Bamrah S , Moore BK , Cain KP . Int J Tuberc Lung Dis 2014 18 (11) 1319-22 We linked results from the Fourth Botswana National Drug Resistance Survey (DRS), 2007-2008, to patient records from the national Electronic Tuberculosis Registry to determine treatment outcomes. Of 915 new patients, 651 (71%) had treatment data available. Completion or cure was achieved for 10/15 (67%, 95%CI 42-85) with isoniazid monoresistance, (6/16, 38%, 95%CI 18-61) with multidrug resistance, while 73% (391/537, 95%CI 69-76) were susceptible to first-line drugs. The analysis was limited because of unavailable treatment records and undocumented outcomes. Prospective analyses following DRSs should be considered to ensure adequate outcome data. |
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