Treatment outcomes of standardized injectable shorter regimen for multi-drugs resistant tuberculosis in Ethiopia: a retrospective cohort study.

BACKGROUND: The injectable shorter multi-drug resistant tuberculosis (MDR-TB) regimen, has been reported to be less costly and more effective in the treatment of MDR-TB compared to the longer regimen. Ethiopia introduced the injectable shorter regimen (SR) in April 2018 following official recommendation by the World Health Organization (WHO) in 2016. While the WHO recommendation was based on evidence coming from extensive programmatic studies in some Asian and African countries, there is paucity of information on patient outcomes in the Ethiopian context. Thus, we aimed to assess the treatment outcomes and identify factors associated with the outcomes of MDR-TB patients on injectable SR. METHODS: A multi-center facility-based retrospective cohort study was conducted in Ethiopia on 245 MDR-TB patients who were treated between April 2018 and March 2020. Data were collected from patients' medical records and analyzed using SPSS version 25. Descriptive statistics was used to summarize the results while inferential analysis was employed to investigate predictors of treatment outcomes and survival status. RESULTS: A total of 245 patients were included in the study, with 129 (52.7%) of them being female. Median age of the patients was 27 (IQR: 21-33). The overall treatment success rate was 87.8%, with 156 (63.7%) cured and 59 (24.1%) patients who completed treatment. The unfavorable outcomes accounted for 12.2%, with 16 (6.5%) treatment failure, 8 (3.3%) death and 6 (2.4%) lost to follow up. Majority of the unfavorable outcomes occurred during the early phase of therapy, with median time to event of 1.8 months (95% CI: 0.99-2.69). The use of khat (a green leafy shrub abused for its stimulant like effect) and being diagnosed with MDR-TB than rifampicin resistant only, were identified as independent factors associated with unfavorable outcomes. CONCLUSION: The injectable SR for MDR-TB was found to have positive treatment outcomes in the context of programmatic management in Ethiopia.

Postdischarge opioid use and persistent use after general surgery: A retrospective study.

BACKGROUND: Opioid overprescribing after surgery is a significant public health issue in most developed countries, including New Zealand. However, there is a lack of literature on the patterns and risk factors for postoperative opioid use among general surgical patients in New Zealand. This study aimed to examine opioid use in patients undergoing general surgery at Auckland District Health Board between January and December 2019 and to identify factors associated with opioid use after surgery and persistent opioid use (defined as having filled ≥1 opioid prescription in the 91 to 180 days after surgery). METHODS AND MATERIALS: This is a retrospective cohort study. Data from patients' electronic clinical records and community pharmacy dispensing records were extracted to obtain data on sociodemographics, surgical characteristics, comorbidities, co-prescribed medications, and opioid use. RESULTS: A total of 1,110 patients were included in the study, with 42.4% dispensed an opioid following discharge after surgery. Of opioid-naïve patients who filled opioids after surgery (n = 401), 9.5% became persistent opioid users. Preoperative use of nonopioid analgesics, longer hospital stays, higher operation severity, procedure type, and higher pain scores were positively associated with opioid use, whereas older age was a negative predictor. Longer hospital stays, an initial discharge prescription with high opioid load, and female sex increased the risk of persistent opioid use. Conversely, a higher severity of surgery was associated with lower risk of persistent opioid use. CONCLUSION: The findings suggest that a considerable proportion of patients become persistent opioid users after surgery. The risk factors identified can guide clinicians to prescribe in a manner that reduces opioid-related adverse outcomes and help guide future interventions.

Highly active antiretroviral therapy adherence and its determinants in selected hospitals from south and central Ethiopia.

OBJECTIVE: To determine the adherence rate and its determinants among people living with HIV/AIDS on highly active antiretroviral therapy (HAART) in selected governmental hospitals from central and south Ethiopia. METHODOLOGY: A cross-sectional study involving both qualitative and quantitative methods was conducted between August and October 2007 in Yirgalem, Hawassa, and Shashemene Hospitals. Quantitative data collection techniques include patient self-report and unannounced pill count and the qualitative methods employed were focus group discussions (FGDs), semi-structured interviews, and observations of health facilities. RESULTS: Whereas females accounted for 56.4% (238), male participants were 43.6% (184) of the total participants. Adherence rate was 93.1% using 15-days self-report, but the rate came down to 88.1% when calculated using the unannounced pill count method (n = 90). Multivariate analysis revealed that being unmarried (OR = 0.119, CI = 0.016-0.901, p = 0.039), unemployment (OR = 0.011, CI = 0.000-0.288, p = 0.007); failure to disclose HIV status (OR = 0.433, CI = 0.198-0.949, p = 0.037); lack of support from family (OR = 0.393, CI = 0.163-0.947, p = 0.037); or others (OR = 0.332, CI = 0.144-0.845, p = 0.043); alcohol drinking (OR = 0.210, CI = 0.071-0.617, p = 0.003); treatment regimen, stavudine(40)-lamuvidine-nevirapine (OR = 0.174, CI = 0.033-0.923, p = 0.040), azathymidine-lamuvidine-nevirapine (OR = 0.172, CI = 0.034-0.867, p = 0.033) and dosing three times daily (OR = 0.073, CI = 0.018-0.290, p = 0.000) regimens were found to be associated with non-adherence. Moreover, time since diagnosis was associated with adherence, as those tested HIV-positive >or= 6 months prior to date of interview (OR = 4.064, CI = 1.23-19.316, p = 0.047) had better adherence rate. CONCLUSION: The adherence rate obtained in this study was higher than the rates seen in developed countries despite the fact that many of the participants live in very poor conditions.