Explore the vast range of titles available.

The introduction of significantly shorter, all-oral regimens has significantly shifted the management of drug-resistant tuberculosis (DR-TB) towards a more tolerable and patient-centred therapeutic approach that aims to enhance treatment adherence, clinical outcomes, and quality of life among patients. Nigeria has gradually adopted this all-oral, shorter regimen, but the impact of this regimen in programmatic settings has not yet been studied. In 2022, a longitudinal, two-armed cohort study was conducted to explore the effectiveness, safety, and feasibility of the all-oral shorter regimen in the programmatic management of RR/MDR-TB in Nigeria. Consenting and eligible RR/MDR-TB patients receiving the all-oral regimen (intervention group) in four states were consecutively enrolled and compared to those receiving the standard of care (SOC). Treatment effectiveness, proportion, and 95% confidence intervals of favourable and unfavourable outcomes were measured at the end of treatment and during follow-up (six and 12 months post-treatment). In total 383 Participants were followed monthly throughout the 9–12-month treatment phase and then reassessed at 6 and 12 months after treatment completion, giving a total possible observation period of up to 24 months (185 received the intervention and 198 the standard of care). At the end of follow-up, there was a higher but non-significant proportion of favourable outcomes among the intervention vs. SOC group (80% vs. 69.7%); a higher proportion of favourable outcomes was also noted at the end of treatment among intervention participants (81.1 vs. 76.8%). Around one third of patients reported at least one serious adverse event (SAE), with no significant differences between arms, and none were deemed related to the use of medication. Intervention participants reported greater improvements in health-related quality of life between baseline and four months compared to those receiving the SOC. These findings support the programmatic use of all-oral shorter treatment for RR/MDR-TB as a regimen that is effective, tolerable, safe, and associated with enhanced health-related quality of life for patients in Nigeria.

tuberculosis (TB) remains a disease of global health importance. GeneXpert has emerged as a useful tool for the diagnosis of drug resistant TB (DR-TB). We determined the risk factors associated with DR-TB among presumptive pulmonary TB patients. a cross-sectional study was conducted among presumptive TB patients attending Directly Observed Treatments (DOTs) centres in Southwestern Nigeria. Sputum samples were obtained from individuals with suspected pulmonary TB, subjected to GeneXpert as the first-line test and then culture. Data were analysed using STATA 12. sputum samples were collected from 2,169 consecutive patients and processed. A greater proportion of the participants (52.14%) were female, most within the age range of 20-39 (38.36%) and 40-59 (36.93%) years. About two-thirds, 66.34% (1439/2169) were GeneXpert positive and of this, 47 (3.27%) were DR-TB. Overall, 44.04% (855/2169) samples were culture positive. 7.56% of the patients were HIV positive, while 19.50%, 1.52% and 61.96% were new, relapse and previously treated cases, respectively. Multivariate analysis identified case definition (OR=2.38; 95%CI: 1.92-3.03) and (OR= 8.33; 95%CI: 5.26-12.50) and HIV (OR= 1.85; 95%CI: 1.29-2.65) and (OR= 3.61; 95%CI: 2.59-5.02) based on GeneXpert and culture as important risk factors for TB and DR-TB infection among participants. we found a moderate level prevalence of DR-TB with gender, previous TB treatments, and HIV status as major factors associated with DR-TB among study participants.

BackgroundRapid detection of resistance to key drugs such as fluoroquinolones (FQ) and bedaquiline (BDQ) is essential for appropriate management of multi-drug resistant tuberculosis (MDR-TB). . Molecular tests available require either infrastructures not available in peripheral laboratories in low resource countries, or do not detect resistance to BDQ. Recently, two tests have been developed: GeneXpert MTB/XDR (Cepheid, USA) detecting resistance to isoniazid (INH), FQ and ethionamide (ETH), and TrueNat XDR (Molbio Diagnostics, India) for detection of resistance to INH, FQ and BDQ. MethodsIn the EDCTP-funded project (DIAMA) aimed at developing culture free approaches for diagnosis and management of MDR-TB patients, we assessed the performances of these tests in field conditions compared to phenotypic drug-susceptibility testing (pDST) and whole genome sequencing (WGS) using 1711 unique samples consecutively collected in the Sub-Saharan African region (Benin, Cameroon, DRC, Ethiopia, Guinea, Mali, Nigeria, Rwanda and Senegal).ResultsUsing a composite reference standard comprising pDST and WGS, Xpert-XDR showed a sensitivity of 87.3% for INH, 37.8% for ETH and 66.7% for FQ, with a respective specificity of 96.5%, 98.3% and 99.7%. For TrueNat, the sensitivity was 88.1% for INH and 47.4% for FQ, with a specificity of 85.7% for INH, 97.7% for FQ and 98.5% for BDQ.ConclusionThese tests showed promising results, particularly as screening test for detection of resistance to FQ and BDQ.