Browsing by Author "Heysell, Scott K"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Impact of early diagnosis of impaired glucose regulation in tuberculosis: Comparison of clinical outcomes in people with tuberculosis in Tanzania
    (John Wiley & Sons, Inc., 2022-08-04) Byashalira, Kenneth; Chamba, Nyasatu; Alkabab, Yosra; Mbelele, Peter; Mpolya, Emmanuel; Ntinginya, Nyanda; Shayo, PendoMartha; Ramaiya, Kaushik; Lillebaek, Troels; Heysell, Scott K; Mmbaga, Blandina; Bygbjerg, Ib; Mpagama, Stellah; Christensen, Dirk
    Objective Diabetes mellitus (DM) has been known to compromise tuberculosis (TB) treatment outcomes. Association data are limited for early hyperglycaemia detection and TB treatment outcomes. Thus, we assessed treatment outcomes including time to sputum conversion and death in TB participants with or without hyperglycaemia. Methods A prospective cohort study recruited TB participants receiving anti-TB treatment at health facilities in Tanzania between October 2019 and September 2020. Hyperglycaemia was defined as having pre-existing DM or pre-treatment random blood glucose of ≥7.8mmol/L, in combination categorised as impaired glucose regulation (IGR). Those with IGR were further screened for hyperglycaemia severity using glycated haemoglobin. In case of unknown status, participants were tested for HIV. Time to death was determined at 6 months of TB treatment. Results Of 1,344 participants, 187 (13.9%) had IGR, of whom 44 (23.5%) were HIV co-infected. Overall treatment success was 1,206 (89.7%), and was similar among participants with or without IGR (p>0.05). Time to death for participants with and without IGR was 18 versus 28 days (p=0.870), respectively. Age ≥40 years (p=0.038), bacteriological positive (p=0.039), HIV (p=0.009), or recurrent TB (p=0.017) predicted death or treatment success during TB treatment in adjusted multivariable models. Conclusion IGR did not influence clinical outcomes in TB patients with or without IGR in a programme of early IGR diagnosis and integration TB, HIV and DM care. Early detection and co-management of multi-morbidities among people diagnosed with TB may reduce likelihood of poor treatment outcomes in a programmatic setting.
  • Thumbnail Image
    Item
    Mycobactericidal effect of different regimens measured by molecular bacterial load assay among people treated for multidrug-resistant tuberculosis in Tanzania.
    (American Society for Microbiology, 2021-02-03) Mbelele, Peter M; Mpolya, Emmanuel A; Sauli, Elingarami; Mtafya, Bariki; Ntinginya, Nyanda E; Addo, Kennedy K; Kreppel, Katharina; Mfinanga, Sayoki; Phillips, Patrick P J; Gillespie, Stephen H; Heysell, Scott K; Sabiiti, Wilber; Mpagama, Stellah G
    Rifampicin or multidrug-resistant-tuberculosis (RR/MDR-TB) treatment has largely transitioned to regimens free of the injectable aminoglycoside component despite the drug class' purported bactericidal activity early in treatment. We tested whether () killing rates measured by molecular bacterial load assay (TB-MBLA) in sputa correlate with composition of the RR/MDR-TB regimen. Serial sputa were collected from patients with RR/MDR- and drug-sensitive TB at day 0, 3, 7, 14, and then monthly for 4 months of anti-TB treatment. TB-MBLA was used to quantify viable 16S rRNA in sputum for estimation of colony-forming-unit per mL (eCFU/mL). killing rates were compared among regimens using nonlinear-mixed-effects modelling of repeated measures. Thirty-seven patients produced 296 serial sputa: 13 patients received an injectable-containing but bedaquiline-free reference regimen, 9 received an injectable and bedaquiline-containing regimen, 8 received an all-oral bedaquiline-based regimen, and 7 patients were treated for drug-sensitive TB with conventional rifampin/isoniazid/pyrazinamide/ethambutol (RHZE). Compared to the adjusted killing of -0.17 (95% CI; -0.23 to -0.12) for the injectable-containing but bedaquiline-free reference regimen, the killing rates were -0.62 (95% CI; -1.05 to -0.20) log eCFU/mL for the injectable and bedaquiline-containing regimen (p = 0.019), -0.35 (95% CI; -0.65 to -0.13) log eCFU/mL for the all-oral bedaquiline-based regimen (p = 0.054), and -0.29 (95% CI; -0.78 to +0.22) log eCFU/mL for RHZE (p = 0.332). killing rates from sputa were higher among patients who received bedaquiline but were further improved with the addition of an injectable aminoglycoside.