Survival of Patients with Tuberculosis in Retreatment Programme with Guardian Administered Streptomycin in Malawi
| dc.contributor.advisor | Prof. Fekadu, Abebaw (MD, MSc, PhD, MRCPsych) | |
| dc.contributor.author | Mboma, Fides Christina | |
| dc.date.accessioned | 2021-08-01T10:04:44Z | |
| dc.date.accessioned | 2023-11-06T08:10:35Z | |
| dc.date.available | 2021-08-01T10:04:44Z | |
| dc.date.available | 2023-11-06T08:10:35Z | |
| dc.date.issued | 2021-07 | |
| dc.description.abstract | Background: Current ambulatory approaches for delivering treatment to patients with tuberculosis in Malawi have significant operational delivery challenges. This led to a clinical trial aimed at establishing if guardian administered streptomycin is non-inferior to hospital administered streptomycin. In order to establish effectiveness of guardian administered streptomycin, all integral outcomes including survival need to be assessed. Objectives: Based on secondary analysis of existing trial dataset, this study aimed to compare survival of patients with tuberculosis who received streptomycin administered at hospital or at home by a guardian controlling for potential factors that may confound or mediate effect of the treatments. Methods: In the original study - a non-inferiority, parallel, randomised, open label, phase III trial –204 patients were randomized to receive streptomycin at the hospital or in their homes where it was administered by a patient nominated guardian. One hundred and one patients were randomized into hospital arm while 103 into home-based group. Patients were followed up for ten months. In this study, comparison of survival between the treatment delivery options employed Logrank test. Cox proportional hazard model was used to identify factors that confound or mediate survival of patients. Potential factors included age, sex, TB class, TB category, HIV status, smoking status, drinking status and employment status of participants and education level of household head. Results: No significant difference was observed in survival of patients between the two groups (p-value = 0.726, HR 1.15 (0.52 to 2.55). All covariates except unemployment had no effect on survival of patients (CI for HR had 1). Conclusion: Use of patient nominated trained lay carers to administer streptomycin provides a potential convenient and cost-effective approach for treating patients with recurrent and drug resistant TB. However, decision for its adoption should be cautious due to small sample size used, switching of critically ill patients from home-based group to hospital arm, inadequate information on how patients selected guardians and lack of details on how TB resistance was assessed. A follow up study on assessment of acceptability of the proposed model of care would help understand if it could be successfully adopted and used to deliver long term TB injectable agents to patients. | en_US |
| dc.identifier.uri | http://etd.aau.edu.et/handle/123456789/27526 | |
| dc.language.iso | en_US | en_US |
| dc.publisher | Addis Abeba University | en_US |
| dc.subject | Tuberculosis,Patients | en_US |
| dc.title | Survival of Patients with Tuberculosis in Retreatment Programme with Guardian Administered Streptomycin in Malawi | en_US |
| dc.type | Thesis | en_US |