Acceptability, feasibility, and likelihood of stakeholders implementing the novel BPaL regimen to treat extensively drug-resistant tuberculosis patients
Abstract Background BPaL, a 6 month oral regimen composed of bedaquiline, pretomanid, and linezolid for treating extensively drug-resistant tuberculosis (XDR-TB) is a potential alternative for at least 20 months of individualized treatment regimens (ITR). The ITR has low tolerability, treatment adhe...
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doaj-2a75a922305d43da9b73ad2cad8e63a82021-07-18T11:15:07ZengBMCBMC Public Health1471-24582021-07-0121111310.1186/s12889-021-11427-yAcceptability, feasibility, and likelihood of stakeholders implementing the novel BPaL regimen to treat extensively drug-resistant tuberculosis patientsS. E. J. van de Berg0P. T. Pelzer1A. J. van der Land2E. Abdrakhmanova3A. Muhammad Ozi4M. Arias5S. Cook-Scalise6G. Dravniece7A. Gebhard8S. Juneja9R. Handayani10D. Kappel11M. Kimerling12I. Koppelaar13S. Malhotra14B. Myrzaliev15B. Nsa16J. Sugiharto17N. Engel18C. Mulder19S. van den Hof20KNCV Tuberculosis foundationKNCV Tuberculosis foundationKNCV Tuberculosis foundationNational TB Program KyrgyzstanNational Tuberculosis and Leprosy control Program NigeriaKNCV Tuberculosis foundationTB AllianceKNCV Tuberculosis foundationKNCV Tuberculosis foundationTB AllianceNational TB Program IndonesiaTB AllianceKNCV Tuberculosis foundationKNCV Tuberculosis foundationTB AllianceKNCV country office KyrgyzstanKNCV country office NigeriaYayasan KNCV IndonesiaMaastricht UniversityKNCV Tuberculosis foundationKNCV Tuberculosis foundationAbstract Background BPaL, a 6 month oral regimen composed of bedaquiline, pretomanid, and linezolid for treating extensively drug-resistant tuberculosis (XDR-TB) is a potential alternative for at least 20 months of individualized treatment regimens (ITR). The ITR has low tolerability, treatment adherence, and success rates, and hence to limit patient burden, loss to follow-up and the emergence of resistance it is essential to implement new DR-TB regimens. The objective of this study was to assess the acceptability, feasibility, and likelihood of implementing BPaL in Indonesia, Kyrgyzstan, and Nigeria. Methods We conducted a concurrent mixed-methods study among a cross-section of health care workers, programmatic and laboratory stakeholders between May 2018 and May 2019. We conducted semi-structured interviews and focus group discussions to assess perceptions on acceptability and feasibility of implementing BPaL. We determined the proportions of a recoded 3-point Likert scale (acceptable; neutral; unacceptable), as well as the overall likelihood of implementing BPaL (likely; neutral; unlikely) that participants graded per regimen, pre-defined aspect and country. We analysed the qualitative results using a deductive framework analysis. Results In total 188 stakeholders participated in this study: 63 from Kyrgyzstan, 51 from Indonesia, and 74 from Nigeria The majority were health care workers (110). Overall, 88% (146/166) of the stakeholders would likely implement BPaL once available. Overall acceptability for BPaL was high, especially patient friendliness was often rated as acceptable (93%, 124/133). In contrast, patient friendliness of the ITR was rated as acceptable by 45%. Stakeholders appreciated that BPaL would reduce workload and financial burden on the health care system. However, several stakeholders expressed concerns regarding BPaL safety (monitoring), long-term efficacy, and national regulatory requirements regarding introduction of the regimen. Stakeholders stressed the importance of addressing current health systems constraints as well, especially in treatment and safety monitoring systems. Conclusions Acceptability and feasibility of the BPaL regimen is high among TB stakeholders in Indonesia, Kyrgyzstan, and Nigeria. The majority is willing to start using BPaL as the standard of care for eligible patients despite country-specific health system constraints.https://doi.org/10.1186/s12889-021-11427-yBPaLPretomanidXDR-TBNovel TB regimenAcceptabilityFeasibility |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
S. E. J. van de Berg P. T. Pelzer A. J. van der Land E. Abdrakhmanova A. Muhammad Ozi M. Arias S. Cook-Scalise G. Dravniece A. Gebhard S. Juneja R. Handayani D. Kappel M. Kimerling I. Koppelaar S. Malhotra B. Myrzaliev B. Nsa J. Sugiharto N. Engel C. Mulder S. van den Hof |
spellingShingle |
S. E. J. van de Berg P. T. Pelzer A. J. van der Land E. Abdrakhmanova A. Muhammad Ozi M. Arias S. Cook-Scalise G. Dravniece A. Gebhard S. Juneja R. Handayani D. Kappel M. Kimerling I. Koppelaar S. Malhotra B. Myrzaliev B. Nsa J. Sugiharto N. Engel C. Mulder S. van den Hof Acceptability, feasibility, and likelihood of stakeholders implementing the novel BPaL regimen to treat extensively drug-resistant tuberculosis patients BMC Public Health BPaL Pretomanid XDR-TB Novel TB regimen Acceptability Feasibility |
author_facet |
S. E. J. van de Berg P. T. Pelzer A. J. van der Land E. Abdrakhmanova A. Muhammad Ozi M. Arias S. Cook-Scalise G. Dravniece A. Gebhard S. Juneja R. Handayani D. Kappel M. Kimerling I. Koppelaar S. Malhotra B. Myrzaliev B. Nsa J. Sugiharto N. Engel C. Mulder S. van den Hof |
author_sort |
S. E. J. van de Berg |
title |
Acceptability, feasibility, and likelihood of stakeholders implementing the novel BPaL regimen to treat extensively drug-resistant tuberculosis patients |
title_short |
Acceptability, feasibility, and likelihood of stakeholders implementing the novel BPaL regimen to treat extensively drug-resistant tuberculosis patients |
title_full |
Acceptability, feasibility, and likelihood of stakeholders implementing the novel BPaL regimen to treat extensively drug-resistant tuberculosis patients |
title_fullStr |
Acceptability, feasibility, and likelihood of stakeholders implementing the novel BPaL regimen to treat extensively drug-resistant tuberculosis patients |
title_full_unstemmed |
Acceptability, feasibility, and likelihood of stakeholders implementing the novel BPaL regimen to treat extensively drug-resistant tuberculosis patients |
title_sort |
acceptability, feasibility, and likelihood of stakeholders implementing the novel bpal regimen to treat extensively drug-resistant tuberculosis patients |
publisher |
BMC |
series |
BMC Public Health |
issn |
1471-2458 |
publishDate |
2021-07-01 |
description |
Abstract Background BPaL, a 6 month oral regimen composed of bedaquiline, pretomanid, and linezolid for treating extensively drug-resistant tuberculosis (XDR-TB) is a potential alternative for at least 20 months of individualized treatment regimens (ITR). The ITR has low tolerability, treatment adherence, and success rates, and hence to limit patient burden, loss to follow-up and the emergence of resistance it is essential to implement new DR-TB regimens. The objective of this study was to assess the acceptability, feasibility, and likelihood of implementing BPaL in Indonesia, Kyrgyzstan, and Nigeria. Methods We conducted a concurrent mixed-methods study among a cross-section of health care workers, programmatic and laboratory stakeholders between May 2018 and May 2019. We conducted semi-structured interviews and focus group discussions to assess perceptions on acceptability and feasibility of implementing BPaL. We determined the proportions of a recoded 3-point Likert scale (acceptable; neutral; unacceptable), as well as the overall likelihood of implementing BPaL (likely; neutral; unlikely) that participants graded per regimen, pre-defined aspect and country. We analysed the qualitative results using a deductive framework analysis. Results In total 188 stakeholders participated in this study: 63 from Kyrgyzstan, 51 from Indonesia, and 74 from Nigeria The majority were health care workers (110). Overall, 88% (146/166) of the stakeholders would likely implement BPaL once available. Overall acceptability for BPaL was high, especially patient friendliness was often rated as acceptable (93%, 124/133). In contrast, patient friendliness of the ITR was rated as acceptable by 45%. Stakeholders appreciated that BPaL would reduce workload and financial burden on the health care system. However, several stakeholders expressed concerns regarding BPaL safety (monitoring), long-term efficacy, and national regulatory requirements regarding introduction of the regimen. Stakeholders stressed the importance of addressing current health systems constraints as well, especially in treatment and safety monitoring systems. Conclusions Acceptability and feasibility of the BPaL regimen is high among TB stakeholders in Indonesia, Kyrgyzstan, and Nigeria. The majority is willing to start using BPaL as the standard of care for eligible patients despite country-specific health system constraints. |
topic |
BPaL Pretomanid XDR-TB Novel TB regimen Acceptability Feasibility |
url |
https://doi.org/10.1186/s12889-021-11427-y |
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