Browsing by Author "Heysell, S.K."
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Item Meta-narrative review of molecular methods for diagnosis and monitoring of multidrug-resistant tuberculosis treatment in adults(International Journal of Mycobacteriology, 2018-10) Mbelele, P.M.; Mohamed, S.Y.; Sauli, E.; Mpolya, E.A.; Mfinanga, S.G.; Addo, K.K.; Heysell, S.K.; Mpagama, S.G.Early and accurate diagnosis and rigorous clinical and microbiological monitoring of multidrug-resistant tuberculosis (MDR-TB) treatment can curb morbidity and mortality. While others are still under evaluation, the World Health Organization has recommended few novel molecular methods for MDR-TB diagnosis only. We present current molecular methods for diagnosis and monitoring of MDR-TB treatment in TB-endemic settings. A systematic meta-narrative review was conducted according to the RAMESES recommendations. Electronic databases were searched for relevant articles published in English language from January 2013 to June 2018. Based on predefined criteria, two independent reviewers extracted the key messages from relevant articles. Disagreement between them was resolved through discussion and the involvement of a third reviewer, if needed. Key messages were synthesized to create the meta-narratives for method's accuracy, drug-susceptibility capability, and laboratory infrastructure required. We included 33 articles out of 1213 records retrieved, of which 16 (48%) and 12 (36%) were conducted in high- and low-TB-endemic settings, respectively. Xpert® MTB/RIF, GenoType MTBDRplus, GenoType MTBDRsl, FlouroType™ MTBDR, TB TaqMan® array card, and DNA sequencers can accurately guide effective treatment regimens. Molecular bacterial load assay quantifies mycobactericidal impact of these regimens. Although they present inherent advantages compared to the current standard of care, they carry important limitations to implementation and/or scale-up. Therefore, considerable effort must now be directed to implementation and health systems research to maximize these forecasted benefits for individual patient's health outcomes.Item Mycobactericidal Effects of Different Regimens Measured by Molecular Bacterial Load Assay among People Treated for Multidrug-Resistant Tuberculosis in Tanzania(Journal of Clinical Microbiology, 2021) Mbelele, P.M.; Mpolya, E.A.; Sauli, E.; Mtafya, B.; Ntinginya, N.E.; Addo, K.K.; Kreppel, K.; Mfinanga, S.; Phillips, P.P.J.; Gillespie, S.H.; Heysell, S.K.; Sabiiti, W.; Mpagama, S.G.Rifampin or multidrug-resistant tuberculosis (RR/MDR-TB) treatment has largely transitioned to regimens free of the injectable aminoglycoside component, despite the drug class’ purported bactericidal activity early in treatment. We tested whether Mycobacterium tuberculosis killing rates measured by tuberculosis molecular bacterial load assay (TB-MBLA) in sputa correlate with composition of the RR/MDRTB regimen. Serial sputa were collected from patients with RR/MDR- and drug-sensitive TB at days 0, 3, 7, and 14, and then monthly for 4 months of anti-TB treatment. TB-MBLA was used to quantify viable M. tuberculosis 16S rRNA in sputum for estimation of colony forming units per ml (eCFU/ml). M. tuberculosis killing rates were compared among regimens using nonlinear-mixed-effects modeling of repeated measures. Thirty-seven patients produced 296 serial sputa and received treatment as follows: 13 patients received an injectable bedaquiline-free reference regimen, 9 received an injectable bedaquiline-containing regimen, 8 received an all-oral bedaquiline-based regimen, and 7 patients were treated for drug-sensitive TB with conventional rifampin/isoniazid/ pyrazinamide/ethambutol (RHZE). Compared to the adjusted M. tuberculosis killing of 20.17 (95% confidence interval [CI] 20.23 to 20.12) for the injectable bedaquiline-free reference regimen, the killing rates were 20.62 (95% CI 21.05 to 20.20) log10 eCFU/ml for the injectable bedaquiline-containing regimen (P=0.019), 20.35 (95% CI 20.65 to 20.13) log10 eCFU/ml for the all-oral bedaquiline-based regimen (P=0.054), and 20.29 (95% CI 20.78 to 10.22) log10 eCFU/ml for the RHZE regimen (P=0.332). Thus, M. tuberculosis killing rates from sputa were higher among patients who received bedaquiline but were further improved with the addition of an injectable aminoglycoside.