METHODOLOGY: This cross-sectional study was conducted using a validated self-administered questionnaire at 18 hospitals in six states of Malaysia, namely, Selangor, Kuala Lumpur, Penang, Kelantan, Sabah, and Sarawak in 2015. The study sample comprised 1600 TB patients who were randomly selected using data obtained from the Disease Control Division, Ministry of Health Malaysia. A total of 1368 of the completed questionnaires were considered usable and included in the statistical analysis.
RESULTS: Overall, the level of TB awareness was found to be high, and the respondents possessed positive attitudes towards TB and health-seeking behaviours. Self-preventive care among the TB patients was determined as being at a moderate level. With regard to contact with others, the patients were more comfortable around their families than their friends and neighbours.
CONCLUSIONS: More health education programmes are recommended to cultivate positive attitudes towards TB, to encourage communities to have a better understanding of TB, and to create awareness among patients of the proper ways to practice self-preventive care.
SETTING: The study was conducted at a tertiary hospital in the northern region of Peninsular Malaysia. Methods Action research methodology was used.
MAIN OUTCOME MEASURE: Pharmaceutical care issues.
RESULTS: The prevalence of diabetes mellitus among newly diagnosed tuberculosis patients was 15% (53/352). Out of 53 patients identified, 35 participated in the study. Patients' ages ranged between 29 and 73 years (mean of 52 ± 10 years). The male: female ratio was 1.7:1. Pharmaceutical care issues identified by pharmacists were nonadherence, uncontrolled diabetes mellitus, adverse drug reactions and individual patient's medication related problems. Pharmacists were able to intervene and resolve some of the pharmaceutical care issues.
CONCLUSION: Pharmacists played an important role in integrating the provision of care for tuberculosis and diabetes mellitus by providing individualised pharmaceutical care management. There still remains a need to address logistic barriers that impinged on the ability to conduct the pharmaceutical care service to its full potential.
METHOD: Retrospective data were collected from medical records and the patients were observed until the completion of their medication. A pharmacoeconomic evaluation was applied to calculate direct and indirect costs.
MAIN OUTCOME MEASURE: Direct and indirect costs of tuberculosis treatment in a government health institution.
RESULTS: Two hundred and one tuberculosis patients were included in the study. Different regimens with various durations of treatments were used. The direct medical and non-medical costs as well as indirect costs were calculated and were found to be as follows: US$61.44 for anti-tuberculosis drugs and supplies, US$28.63 for X-ray examinations, US$28.53 for laboratory tests, US$20.03 for healthcare staff time, US$4.28 for hospitalisation, US$43.20 for overhead costs, US$608.11 for transportation and meals and US$118.78 for time away from work. The cost to the patients constitutes approximately 80% of the total cost of the treatment.
CONCLUSION: The cost of treating the illness of tuberculosis per patient was US$916.4. The cost of anti-tuberculosis drugs constituted the highest proportion of the cost to the public health services (31.7%) while the cost to the patient constituted the major proportion of the total cost of the illness (79.4%).
METHODS: Adults living with HIV enrolled in a regional observational cohort in Asia who had initiated combination antiretroviral therapy (cART) were included in the analysis. Factors associated with new TB diagnoses after cohort entry and survival after cART initiation were analysed using Cox regression, stratified by site.
RESULTS: A total of 7355 patients from 12 countries enrolled into the cohort between 2003 and 2016 were included in the study. There were 368 reported cases of TB after cohort entry with an incidence rate of 0.99 per 100 person-years (/100 pys). Multivariate analyses adjusted for viral load (VL), CD4 count, body mass index (BMI) and cART duration showed that CTX reduced the hazard for new TB infection by 28% (HR 0.72, 95% CI l 0.56, 0.93). Mortality after cART initiation was 0.85/100 pys, with a median follow-up time of 4.63 years. Predictors of survival included age, female sex, hepatitis C co-infection, TB diagnosis, HIV VL, CD4 count and BMI.
CONCLUSIONS: CTX was associated with a reduction in the hazard for new TB infection but did not impact survival in our Asian cohort. The potential preventive effect of CTX against TB during periods of severe immunosuppression should be further explored.
Methods: The genomes of 24 MTBC isolated from sputum and pus samples were sequenced. The phenotypic drug susceptibility testing (DST) of the isolates was determined for ten anti-TB drugs. Bioinformatic analysis comprising genome assembly and annotation and single-nucleotide polymorphism (SNP) analysis in genes associated with resistance to the ten anti-TB drugs were done on each sequenced genome.
Results: The draft assemblies covered an average of 97% of the expected genome size. Eleven isolates were aligned to the Indo-Oceanic lineage, eight were East-Asian lineage, three were East African-Indian lineage, and one was of Euro-American and Bovis lineages, respectively. Twelve of the 24 MTBC isolates were phenotypically MDR M. tuberculosis: one is polyresistance and another one is monoresistance. Twenty-six SNPs across nine genes associated with resistance toward ten anti-TB drugs were detected where some of the mutations were found in isolates that were previously reported as pan-susceptible using DST. A haplotype consisting of 65 variants was also found among the MTBC isolates with drug-resistance traits.
Conclusions: This study is the first effort done in Malaysia to utilize 24 genomes of the local clinical MTBC isolates. The high-resolution molecular epidemiological data obtained provide valuable insights into the mechanistic and epidemiological qualities of TB within the vicinity of Southeast Asia.