Browsing by Author "Brust, James C. M."

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Association between health systems performance and treatment outcomes in patients co-infected with MDR-TB and HIV in KwaZulu-Natal, South Africa: implications for TB programmes.
(Public Library of Science., 2014) Loveday, Marian Patricia.; Padayatchi, Nesri.; Wallengren, Kristina.; Roberts, Jacquelin.; Brust, James C. M.; Ngozo, Jacqueline.; Master, Iqbal.; Voce, Anna Silvia.
Objective: To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the relationship between health system performance and patient treatment outcomes at 4 decentralised MDR-TB sites. Methods: In this mixed methods case study which included prospective comparative data, we measured health system performance using a framework of domains comprising key health service components. Using Pearson Product Moment Correlation coefficients we quantified the direction and magnitude of the association between health system performance and MDR-TB treatment outcomes. Qualitative data from participant observation and interviews analysed using systematic text condensation (STC) complemented our quantitative findings. Findings: We found significant differences in treatment outcomes across the sites with successful outcomes varying from 72% at Site 1 to 52% at Site 4 (p<0.01). Health systems performance scores also varied considerably across the sites. Our findings suggest there is a correlation between treatment outcomes and overall health system performance which is significant (r = 0.99, p<0.01), with Site 1 having the highest number of successful treatment outcomes and the highest health system performance. Although the 'integration' domain, which measured integration of MDR-TB services into existing services appeared to have the strongest association with successful treatment outcomes (r = 0.99, p<0.01), qualitative data indicated that the 'context' domain influenced the other domains. Conclusion: We suggest that there is an association between treatment outcomes and health system performance. The chance of treatment success is greater if decentralised MDR-TB services are integrated into existing services. To optimise successful treatment outcomes, regular monitoring and support are needed at a district, facility and individual level to ensure the local context is supportive of new programmes and implementation is according to guidelines.
Chest radiograph findings and time to culture conversion in patients with multidrug-resistant tuberculosis and HIV in Tugela Ferry, South Africa.
(Plos., 2013) Brust, James C. M.; Berman, Andrew R.; Zalta, Benjamin.; Haramati, Linda B.; Ning, Yuming.; Heo, Moonseong.; Van der Merwe, Theo L.; Bamber, Sheila.; Moll, Anthony P.; Friedland, Gerald H.; Shah, N. Sarita.; Gandhi, Neel R.
Background: The majority of patients with multidrug-resistant tuberculosis (MDR-TB) in South Africa are co-infected with HIV, but the radiographic features of MDR-TB and their relationship with time to sputum culture conversion in the antiretroviral therapy era have not been described. Methods: We reviewed baseline chest radiographs for 56 patients with MDR-TB from a rural area of South Africa. We analyzed the association of cavities, consolidation, pleural effusion and hilar lymphadenopathy with time to sputum culture conversion, adjusting for HIV status, baseline sputum smear and CD4 count. Results: Of the 56 subjects, 49 (88%) were HIV-positive, with a median CD4 count of 136 cells/mm³ (IQR 65-249). Thirty-two (57%) patients were sputum smear positive. Twenty-two (39%) patients had a cavity and 37 (66%) patients had consolidations. Cavitary disease and consolidations were each associated with longer time to culture conversion on bivariate analysis but not after adjusting for sputum smear status (aORs 1.79 [0.94-3.42] and 1.09 [0.67-1.78], respectively). Positive baseline sputum smear remained independently associated with longer time to conversion (aOR 3.45 [1.39-8.59]). We found no association between pleural effusion or hilar lymphadenopathy and time to conversion. Seventy-nine percent of patients were cured at the end of treatment. Conclusions: Despite high rates of HIV co-infection and advanced immunodeficiency, the majority of patients had severe pathology on baseline chest radiograph. Nevertheless, culture conversion rates were high and treatment outcomes were favorable. Cavitation and consolidation do not appear to have an independent association with time to culture conversion beyond that of baseline sputum smear status.
Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa.
(International Union Against Tuberculosis and Lung Disease., 2015) Loveday, Marian Patricia.; Wallengren, Kristina.; Brust, James C. M.; Roberts, Jacquelin.; Voce, Anna Silvia.; Margot, Bruce.; Ngozo, Jacqueline.; Master, Iqbal.; Cassell, Gail H.; Padayatchi, Nesri.
Abstract available in pdf.
Comparing early treatment outcomes of MDR-TB in a decentralised setting with a centralised setting in KwaZulu-Natal, South Africa.
(International Union against Tuberculosis and Lung Disease., 2012) Loveday, Marian Patricia.; Wallengren, Kristina.; Voce, Anna Silvia.; Margot, Bruce.; Reddy, T.; Master, Iqbal.; Brust, James C. M.; Chaiyachati, K.; Padayatchi, Nesri.
Setting—In KwaZulu-Natal, South Africa, a TB and HIV endemic setting, prolonged hospitalisation for the treatment of the growing number of MDR-TB patients is not possible or effective. Objective—We compared early treatment outcomes in patients with MDR-TB, with and without HIV co infection, at a central, urban, referral hospital with four decentralised rural sites. Design—This is an operational, prospective cohort study of patients between 1 July 2008 to 30 November 2009, where culture conversion, time-to-culture-conversion, survival and predictors of these outcomes were analysed. Results—Of the 860 patients with MDR-TB, 419 were at the decentralised sites and 441 at the central hospital. Overall, 71% were HIV co-infected.
High treatment failure and default rates for patients with multidrug-resistant tuberculosis in KwaZulu-Natal, South Africa, 2000–2003.
(The Union., 2009) Brust, James C. M.; Gandhi, Neel R.; Carrara, H.; Osburn, G.; Padayatchi, Nesri.
SETTING: Multidrug-resistant tuberculosis (MDR-TB) has emerged as a significant public health threat in South Africa. OBJECTIVE: To describe treatment outcomes and determine risk factors associated with unfavorable outcomes among MDR-TB patients admitted to the provincial TB referral hospital in KwaZulu-Natal Province, South Africa. DESIGN: Retrospective observational study of MDR-TB patients admitted from 2000 to 2003. RESULTS: Of 1209 MDR-TB patients with documented treatment outcomes, 491 (41%) were cured, 35 (3%) completed treatment, 208 (17%) failed treatment, 223 (18%) died and 252 (21%) defaulted. Of the total number of patients with known human immunodeficiency virus (HIV) status, 52% were HIV-infected. Treatment failure, death and default each differed in their risk factors. Greater baseline resistance (aOR 2.3-3.0), prior TB (aOR 1.7), and diagnosis in 2001, 2002 or 2003 (aOR 1.9-2.3) were independent risk factors for treatment failure. HIV co-infection was a risk factor for death (aOR 5.6), and both HIV (aOR 2.0) and male sex (aOR 1.9) were risk factors for treatment default. CONCLUSION: MDR-TB treatment outcomes in KwaZulu-Natal were substantially worse than those published from other MDR-TB cohorts. Interventions such as concurrent antiretroviral therapy and decentralized MDR-TB treatment should be considered to improve MDR-TB outcomes in this high HIV prevalence setting.
MDR-TB patients in KwaZulu-Natal, South Africa: cost-effectiveness of 5 models of care.
(Public Library of Science., 2018) Loveday, Marian Patricia.; Wallengren, Kristina.; Reddy, Tarylee.; Besada, Donela.; Brust, James C. M.; Voce, Anna Silvia.; Desai, Harsha.; Ngozo, Jacqueline.; Radebe, Zanele.; Master, Iqbal.; Padayatchi, Nesri.; Daviaud, Emmanuelle.
Abstract available in pdf.
Re-inventing adherence : toward a patient-centered model of care for drug-resistant tuberculosis and HIV.
(International Union against Tuberculosis and Lung Disease., 2016) O’Donnell, Max Roe.; Daftary, Amrita.; Frick, Mike Watson.; Hirsch-Moverman, Yael.; Amico, Kathy Rivet.; Senthilingam, Meera.; Wolf, Allison.; Metcalfe, John Z.; Isaakidis, Petros.; Davis, Luke J.; Zelnick, Jennifer R.; Brust, James C. M.; Naidu, Naressa.; Garretson, Marné.; Bangsberg, David R.; Padayatchi, Nesri.; Friedland, Gerald H.
Abstract available in PDF file.
TB/HIV: an orphan disease?
(American Thoracic Society., 2011) Brust, James C. M.; O'Donnell, Max Roe.; Metcalfe, John Z.
No abstract available.