V Apis1, M Landi1,2, S M Graham3,4,5, T Islam6, J Amini7, G Sabumi8, A M Mandalakas9, T Meae1, P du Cros3, H D Shewade5,10, H Welch1,2,9. 1. Port Moresby General Hospital, Port Moresby, Papua New Guinea (PNG). 2. School of Medicine and Health Science, University of Papua New Guinea, Port Moresby, PNG. 3. The Burnet Institute, Melbourne, Victoria, Australia. 4. Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia. 5. International Union Against Tuberculosis and Lung Disease (The Union), Paris, France. 6. World Health Organization, Representative Office for PNG, Port Moresby, PNG. 7. National Department of Health, Port Moresby, PNG. 8. Health & HIV Implementation Services Provider, Abt JTA, Port Moresby, PNG. 9. Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA. 10. The Union, South-East Asia Office, New Delhi, India.
Abstract
SETTING: The new child-friendly fixed dose combinations (FDCs) were introduced at Port Moresby General Hospital, Papua New Guinea, in 2016 for the first-line treatment of children (aged <15 years) with tuberculosis (TB) who weighed <25 kg. OBJECTIVE: To describe the characteristics and outcomes for children treated with the new FDCs, and to identify risk factors for unfavourable treatment outcomes. DESIGN: This was a retrospective cohort study of all children treated for TB with the FDCs from August 2016 to August 2017. RESULTS: Of 713 children included, 488 (68%) were diagnosed with pulmonary TB. Only 6 (0.8%) TB cases were bacteriologically confirmed and human immunodeficiency virus (HIV) status was known in 50%. Treatment outcomes were favourable in 425 (60%) children. Of 288 children with unfavourable outcomes, there were 242 (84%) with loss to follow-up (LTFU) and 25 (8.4%) were known to have died. Children who were severely underweight (weight-for-age Z score <-3) on presentation were at greater risk of LTFU compared to children of normal weight on multivariable analysis (aRR 1.3, 95%CI 1.0-1.6, P < 0.05). CONCLUSION: Alternative models of care to decrease LTFU during treatment are needed, including integration with nutritional support. Improving diagnosis through microbiological confirmation of TB and HIV are major challenges to be addressed.
SETTING: The new child-friendly fixed dose combinations (FDCs) were introduced at Port Moresby General Hospital, Papua New Guinea, in 2016 for the first-line treatment of children (aged <15 years) with tuberculosis (TB) who weighed <25 kg. OBJECTIVE: To describe the characteristics and outcomes for children treated with the new FDCs, and to identify risk factors for unfavourable treatment outcomes. DESIGN: This was a retrospective cohort study of all children treated for TB with the FDCs from August 2016 to August 2017. RESULTS: Of 713 children included, 488 (68%) were diagnosed with pulmonary TB. Only 6 (0.8%) TB cases were bacteriologically confirmed and human immunodeficiency virus (HIV) status was known in 50%. Treatment outcomes were favourable in 425 (60%) children. Of 288 children with unfavourable outcomes, there were 242 (84%) with loss to follow-up (LTFU) and 25 (8.4%) were known to have died. Children who were severely underweight (weight-for-age Z score <-3) on presentation were at greater risk of LTFU compared to children of normal weight on multivariable analysis (aRR 1.3, 95%CI 1.0-1.6, P < 0.05). CONCLUSION: Alternative models of care to decrease LTFU during treatment are needed, including integration with nutritional support. Improving diagnosis through microbiological confirmation of TB and HIV are major challenges to be addressed.
Authors: Elisa Lopez-Varela; Victor Guillermo Sequera; Alberto L García-Basteiro; Orvalho Joaquim Augusto; Khatia Munguambe; Jahit Sacarlal; Pedro L Alonso Journal: J Trop Pediatr Date: 2017-04-01 Impact factor: 1.165
Authors: Stephen M Graham; Charalambos Sismanidis; Heather J Menzies; Ben J Marais; Anne K Detjen; Robert E Black Journal: Lancet Date: 2014-03-24 Impact factor: 79.321
Authors: Peter J Dodd; Courtney M Yuen; Charalambos Sismanidis; James A Seddon; Helen E Jenkins Journal: Lancet Glob Health Date: 2017-09 Impact factor: 26.763
Authors: Paul Aia; Margaret Kal; Evelyn Lavu; Lucy N John; Karen Johnson; Chris Coulter; Julia Ershova; Olga Tosas; Matteo Zignol; Shalala Ahmadova; Tauhid Islam Journal: PLoS One Date: 2016-03-22 Impact factor: 3.240
Authors: Paul Aia; Lungten Wangchuk; Fukushi Morishita; Jacob Kisomb; Robin Yasi; Margaret Kal; Tauhid Islam Journal: Western Pac Surveill Response J Date: 2018-06-15