Browsing by Author "Hirsch-Moverman, Yael."

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Lessons from a randomised clinical trial for multidrug-resistant tuberculosis.
(International Union against Tuberculosis and Lung Disease., 2012) Padayatchi, Nesri.; MacKenzie, William R.; Hirsch-Moverman, Yael.; Feng, P-J.; Villarino, E.; Saukkonen, J.; Heilig, Charles M.; Weiner, Marc.; El-Sadr, Wafaa M.
BACKGROUND: The treatment of multidrug-resistant tuberculosis (MDR-TB) is currently based upon expert opinion and findings from case series, rather than upon randomised clinical trials (RCTs). OBJECTIVE: To describe the challenges encountered during an RCT for the treatment of MDR-TB. METHODS: Tuberculosis Trials Consortium Study 30 was a pilot, Phase I/II, double-blind, placebo-controlled, RCT of the safety and tolerability of 16 weeks of daily, low-dose linezolid treatment for MDR-TB. RESULTS: A total of 36 patients, 56% of the target of 64 patients, consented to participate, for an average of 0.69 enrolments per week. Of the 36 patients enrolled, only 25 (69%) completed at least 90 doses of study treatment. Among the 12 (33%) patients who did not complete all 112 doses of the study treatment, the median time to study withdrawal was 15 days (range 0-92). After the study, we discovered discordance between treatment assignment and study drug for at least 9 (25%) of the 36 patients. CONCLUSIONS: Recruitment and retention in this MDR-TB clinical trial posed substantial challenges, suggesting the need for a large, multidisciplinary group of study staff to support the participants. Withdrawal tended to occur early in study treatment. The discrepancy in assigned study medication reflects the need for stronger administrative controls for study drugs.
Paediatric tuberculosis preventive treatment preferences among HIV-positive children, caregivers and healthcare providers in Eswatini: a discrete choice experiment.
(BMJ Open., 2021) Hirsch-Moverman, Yael.; Strauss, Michael.; George, Gavin.; Mutiti, Anthony.; Mafukidze, Arnold.; Shongwe, Siphesihle.; Dube, Gloria Sisi.; El Sadr, Wafaa M.; Mantell, Joanne E.; Howard, Andrea A.
Objective: Isoniazid preventive therapy initiation and completion rates are suboptimal among children. Shorter tuberculosis (TB) preventive treatment (TPT) regimens have demonstrated safety and efficacy in children and may improve adherence but are not widely used in high TB burden countries. Understanding preferences regarding TPT regimens’ characteristics and service delivery models is key to designing services to improve TPT initiation and completion rates. We examined paediatric TPT preferences in Eswatini, a high TB burden country. Design: We conducted a sequential mixed-methods study utilising qualitative methods to inform the design of a discrete choice experiment (DCE) among HIV-positive children, caregivers and healthcare providers (HCP). Drug regimen and service delivery characteristics included pill size and formulation, dosing frequency, medication taste, treatment duration and visit frequency, visit cost, clinic wait time, and clinic operating hours. An unlabelled, binary choice design was used; data were analysed using fixed and mixed effects logistic regression models, with stratified models for children, caregivers and HCP. Setting: The study was conducted in 20 healthcare facilities providing TB/HIV care in Manzini, Eswatini, from November 2018 to December 2019. Participants: Ninety-one stakeholders completed in-depth interviews to inform the DCE design; 150 children 10–14 years, 150 caregivers and 150 HCP completed the DCE. Results: Despite some heterogeneity, the results were fairly consistent among participants, with palatability of medications viewed as the most important TPT attribute; fewer and smaller pills were also preferred. Additionally, shorter waiting times and cost of visit were found to be significant drivers of choices. Conclusion: Palatable medication, smaller/fewer pills, low visit costs and shorter clinic wait times are important factors when designing TPT services for children and should be considered as new paediatric TPT regimens in Eswatini are rolled out. More research is needed to determine the extent to which preferences drive TPT initiation, adherence and completion rates.
Re-inventing adherence : toward a patient-centered model of care for drug-resistant tuberculosis and HIV.
(International Union against Tuberculosis and Lung Disease., 2016) O’Donnell, Max Roe.; Daftary, Amrita.; Frick, Mike Watson.; Hirsch-Moverman, Yael.; Amico, Kathy Rivet.; Senthilingam, Meera.; Wolf, Allison.; Metcalfe, John Z.; Isaakidis, Petros.; Davis, Luke J.; Zelnick, Jennifer R.; Brust, James C. M.; Naidu, Naressa.; Garretson, Marné.; Bangsberg, David R.; Padayatchi, Nesri.; Friedland, Gerald H.
Abstract available in PDF file.
Using mHealth for HIV/TB treatment support in Lesotho : enhancing patient–provider communication in the START study.
(Wolters Kluwer Health., 2017) Hirsch-Moverman, Yael.; Daftary, Amrita.; Yuengling, Katharine A.; Saito, Suzue.; Ntoane, Moeketsi.; Frederix, Koen.; Maama, Llang B.; Howard, Andrea A.
Abstract available in pdf.