Delivery of long-term-injectable agents for TB by lay carers : pragmatic randomised trial
| العنوان: | Delivery of long-term-injectable agents for TB by lay carers : pragmatic randomised trial |
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| المؤلفون: | Kuzani Mbendera, Helen Mangochi, Bertel Squire, Geraint Davies, Mavuto Mukaka, Jason Madan, Elizabeth L. Corbett, Hendramoorthy Maheswaran, Linna Phiri, Danielle B. Cohen |
| المصدر: | Thorax THORAX |
| بيانات النشر: | BMJ, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Adult, Male, Pulmonary and Respiratory Medicine, Malawi, medicine.medical_specialty, Reduced risk, streptomycin, Home Nursing, 030231 tropical medicine, Antitubercular Agents, Injections, Intramuscular, recurrent TB, Sputum culture, 03 medical and health sciences, 0302 clinical medicine, Primary outcome, Standard care, Intervention (counseling), Tuberculosis, Multidrug-Resistant, Tuberculosis, Humans, Medicine, 030212 general & internal medicine, Community-based care, Trial registration, community-based care, retreatment TB, medicine.diagnostic_test, business.industry, drug-resistant TB, Absolute risk reduction, catastrophic household costs, OPAT, Anti-Bacterial Agents, 3. Good health, Caregivers, Emergency medicine, Health Resources, Female, business, RA, RC |
| الوصف: | BackgroundPeople with recurrent or drug-resistant TB require long courses of intramuscular injections. We evaluate a novel system in which patient-nominated lay carers were trained to deliver intramuscular injections to patients in their own homes.MethodsA pragmatic, individually randomised non-inferiority trial was conducted at two hospitals in Malawi. Adults starting TB retreatment were recruited. Patients randomised to the intervention received home-based care from patient-nominated lay people trained to deliver intramuscular streptomycin. Patients receiving standard care were admitted to hospital for 2 months of streptomycin. The primary outcome was successful treatment (alive and on treatment) at the end of the intervention.ResultsOf 456 patients screened, 204 participants were randomised. The trial was terminated early due to futility. At the end of the intervention, 97/101 (96.0%) in the hospital arm were still alive and on treatment compared with 96/103 (93.2%) in the home-based arm (risk difference −0.03 (95% CI −0.09 to 0.03); p value 0.538). There were no differences in the proportion completing 8 months of anti-TB treatment; or the proportion experiencing 2-month sputum culture conversion. The mean cost of hospital-based management was US$1546.3 per person, compared to US$729.2 for home-based management. Home-based care reduced risk of catastrophic household costs by 84%.ConclusionsAlthough this trial failed to meet target recruitment, the available data demonstrate that training patient-nominated lay people has potential to provide a feasible solution to the operational challenges associated with delivering long-term-injectable drugs to people with recurrent or drug-resistant TB in resource-limited settings, and substantially reduce costs. Further data under operational conditions are required.Trial registration numberISRCTN05815615. |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 0040-6376 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::af0fef8310b3eeb18579e7651ba58833Test http://wrap.warwick.ac.uk/135652/1/WRAP-delivery-long-term-injectable-agents-TB-lay-carers-pragmatic-randomised-trial-Madan-2020.pdfTest |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....af0fef8310b3eeb18579e7651ba58833 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 00406376 |
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