Achieving Tuberculosis Elimination Research Articles

Implementation of isoniazid preventive therapy among children living with diagnosed pulmonary tuberculosis patients: A mixed methods study from Mumbai, India.

Tuberculosis remains a significant public health issue, particularly among children who are in close contact with tuberculosis patients. India accounts for a large proportion of global tuberculosis cases. Despite global recommendations for Isoniazid Preventive Therapy to prevent latent tuberculosis infection from progressing to active disease, the initiation and adherence to Isoniazid Preventive Therapy remain suboptimal, especially in high-burden settings. Understanding the barriers to Isoniazid Preventive Therapy implementation is crucial to improving treatment outcomes and achieving tuberculosis elimination goals. This study aimed to quantify the uptake of isoniazid among children under 6 years who were started on Isoniazid Preventive Therapy and to identify the challenges from the perspectives of caregivers and healthcare providers. The study was conducted in a slum in Mumbai, India, from June to December 2023, using a mixed-methods design. The quantitative phase involved a house-to-house survey, covering all 96 contacts started on Isoniazid Preventive Therapy in 2022, using a semi-structured questionnaire. The qualitative phase included key informant interviews with healthcare providers and in-depth interviews with caregivers. Quantitative data were analysed using Fisher's exact test and chi-square test, while qualitative data were analysed thematically. Of the 96 children, 11 (11.45%) completed therapy, with an average treatment duration of 2.5 months. Quantitative findings highlighted fear of side effects and family migration as major reasons for discontinuation. Completion of chemoprophylaxis was significantly associated with factors like male gender, support from extended family, home visits by tuberculosis health staff, and shorter travel time (under 30 min) to the tuberculosis unit. Qualitative data revealed challenges across themes of supply, staff, training, services, and adherence. Key challenges included lack of awareness, unavailability of isoniazid in syrup form, inadequate training for health workers, weak program monitoring, insufficient staffing, and fears related to tuberculosis exposure during outpatient department visits. Effective counselling, regular follow-ups, availability of medications in syrup form, increasing staffing based on case burden, timely training of staff, strengthening program monitoring, and ensuring infection control in tuberculosis outpatient departments are critical to achieving successful completion of isoniazid preventive therapy.

On the Role of Early Case Detection and Treatment Failure in Controlling Tuberculosis Transmission: A Mathematical Modeling Study

Tuberculosis (TB) remains a pressing global health concern, demanding urgent attention to mitigate its spread and impact. In this study, we present a rigorous mathematical model of TB transmission that incorporates early case detection and addresses the critical issue of treatment failure. Through the development of a system of nonlinear ordinary differential equations, we conduct comprehensive analyses to assess the dynamics of TB transmission and the efficacy of intervention strategies. Our findings underscore the urgent need for effective TB control measures. Mathematical analyses reveal that the model exhibits a TB-free equilibrium, which is globally asymptotically stable only if the control reproduction number falls below one. However, we identify a concerning phenomenon: the model demonstrates a forward bifurcation when the control reproduction number equals one, suggesting that the disease-free equilibrium loses its stability, while simultaneously, the stable unique endemic equilibrium begins to emerge. Moreover, sensitivity analysis highlights the complex interplay between case detection rates, treatment failure probabilities, and TB transmission dynamics. Contrary to expectations, increasing case detection rates and minimizing treatment failure probabilities may not consistently reduce the basic reproduction number or the size of the infected population. Instead, there exists a critical threshold for intervention effectiveness, beyond which TB transmission can be significantly curtailed. Biologically, this phenomenon may occur if there is no balance between case detection and treatment efforts. If treatment quality does not improve, then case detection will not have a significant impact, and in the worst case scenario, it can exacerbate the intervention’s negative effects. These findings underscore the urgency of implementing targeted intervention strategies to combat TB transmission effectively. Failure to meet the critical intervention threshold risks undermining TB elimination efforts and exacerbating the global TB burden. Through numerical simulations, we elucidate potential intervention scenarios necessary for achieving TB elimination goals in human populations. In conclusion, our study highlights the urgent imperative for coordinated action to control TB transmission effectively. By elucidating the dynamics of TB spread and intervention efficacy, we provide valuable insights to inform evidence-based policy decisions and accelerate progress towards TB elimination on a global scale.

Improving tuberculosis control: assessing the value of medical masks and case detection-a multi-country study with cost-effectiveness analysis.

Tuberculosis (TB) remains a significant global health concern, necessitating effective control strategies. This article presents a mathematical model to evaluate the comparative effectiveness of medical mask usage and case detection in TB control. The model is constructed as a system of ordinary differential equations and incorporates crucial aspects of TB dynamics, including slow-fast progression, medical mask use, case detection, treatment interventions and differentiation between symptomatic and asymptomatic cases. A key objective of TB control is to ensure that the reproduction number, , remains below unity to achieve TB elimination or persistence if exceeds 1. Our mathematical analysis reveals the presence of a transcritical bifurcation when the signifies a critical juncture in TB control strategies. These results confirm that the effectiveness of case detection in diminishing the endemic population of symptomatic individuals within a TB-endemic equilibrium depends on exceeding a critical threshold value. Furthermore, our model is calibrated using TB yearly case incidence data per 100 000 population from Indonesia, India, Lesotho and Angola. We employed the bootstrap resampling residual approach to assess the uncertainty inherent in our parameter estimates which provides a comprehensive distribution of the parameter values. Despite a declining trend in new incidence, these four countries exhibit a reproduction number greater than 1, indicating persistent TB cases in the presence of ongoing TB control programmes. We employ the partial rank correlation coefficient in conjunction with the Latin hypercube sampling method to conduct a global sensitivity analysis of the parameter for each fitted parameter in every country. We find that the medical mask use is more sensitive to reduce compared with the case detection implementation. To further gain insight into the necessary control strategy, we formulated an optimal control and studied the cost-effectiveness analysis of our model to investigate the impact of case detection and medical mask use as control measures in TB spread. Cost-effectiveness analysis demonstrates that combining these interventions emerges as the most cost-effective strategy for TB control. Our findings highlight the critical importance of medical masks and their efficacy coupled with case detection in shaping TB control dynamics, elucidating the primary parameter of concern for managing the control reproduction number. We envisage our findings to have implications and be vital for TB control if implemented by policymakers and healthcare practitioners involved in TB control efforts.

Progress and challenges in achieving tuberculosis elimination in India by 2025: A systematic review and meta-analysis.

Tuberculosis (TB) continues to pose a significant public health challenge in India, which is home to one of the highest TB burdens worldwide. This systematic review and meta-analysis will aim to synthesize the anticipated progress and potential challenges in achieving TB elimination in India by 2025. A comprehensive search will be conducted across multiple databases, including PubMed, Scopus, and Web of Science, to identify relevant studies. The eligibility criteria will encompass individuals diagnosed with TB in India, interventions targeting TB treatment, prevention, or control, and various comparator groups. Outcomes of interest will include incidence reduction, mortality rate, treatment success rate, barriers to TB care, and more. Both quantitative and qualitative data will be synthesized, and the risk of bias will be assessed using established tools. The review is expected to provide a holistic understanding of the TB landscape in India, highlighting the effective interventions and potential challenges in the journey towards TB elimination. While it is anticipated that significant progress will be made in the fight against TB in India, challenges are likely to persist. This review will offer a comprehensive roadmap for researchers, policymakers, and healthcare professionals, emphasizing the importance of continued efforts, innovative strategies, and a multi-pronged approach in achieving the goal of TB elimination in India by 2025.

Knowledge and practices of private healthcare providers regarding tuberculosis case notification in Rural Maharashtra

India carries the highest share of active and missing tuberculosis (TB) cases globally. The Government of India is prioritizing private sector engagement (PSE) in TB elimination activities, as most healthcare-seeking in the country happens in this sector. This study aimed to understand the knowledge and practices of private healthcare providers (PHP) on various aspects of TB case notification through the National TB Elimination Programme (NTEP). This cross-sectional study was carried out between Oct 2020 to April 2021 amongst PHPs in the Junnar Tuberculosis Unit (TU), Pune District, Maharashtra. Junnar Block has 299 PHPs who assess, diagnose, and/or treat TB cases. A total of 97 participants were enrolled in the study. About 89 (91.8%) PHPs are aware that TB case notifications are mandatory by law. However, 80.4% are unaware of the Ni-kshay portal (web-based case surveillance system) by NTEP. Similarly, 74 (76.3%) must be aware of incentives for PHPs to collaborate with the government healthcare delivery system. 82.8% of total Ayurveda, Unani, Naturopathy, Siddha, and Homeopathy (AYUSH) practitioners and 46.2% of Allopathic practitioners have poor knowledge about TB case notification, with a Chi-square value of 14.36 (p<0.01). Our study shows that the active engagement of private providers (PPs), especially AYUSH practitioners in rural areas, is a need of the hour in achieving TB elimination.

Using Electronic Health Record Data to Measure the Latent Tuberculosis Infection Care Cascade in Safety-Net Primary Care Clinics

Prevention of tuberculosis disease through diagnosis and treatment of latent tuberculosis infection is critical for achieving tuberculosis elimination in the U.S. Diagnosis and treatment of latent tuberculosis infection in safety-net primary care settings that serve patients at risk for tuberculosis may increase uptake of this prevention effort and accelerate progress toward elimination. Optimizing tuberculosis prevention in these settings requires measuring the latent tuberculosis infection care cascade (testing, diagnosis, and treatment) and identifying gaps to develop solutions to overcome barriers. We used electronic health record data to describe the latent tuberculosis infection care cascade and identify gaps among a network of safety-net primary care clinics. Electronic health record data for patients seen in the OCHIN Clinical Network, the largest network of safety-net clinics in the U.S., between 2012 and 2019 were extracted. electronic health record data were used to measure the latent tuberculosis infection care cascade: patients who met tuberculosis screening criteria on the basis of current recommendations were tested for tuberculosis infection, diagnosed with latent tuberculosis infection, and prescribed treatment for latent tuberculosis infection. Outcomes were stratified by diagnostic test and treatment regimen. Among 1.9 million patients in the analytic cohort, 43.5% met tuberculosis screening criteria, but only 21.4% were tested for latent tuberculosis infection; less than half (40.4%) were tested using an interferon-gamma release assay. Among those with a valid result, 10.5% were diagnosed with latent tuberculosis infection, 29.1% of those were prescribed latent tuberculosis infection treatment, and only 33.6% were prescribed a recommended rifamycin-based regimen. Electronic health record data can be used to measure the latent tuberculosis infection care cascade. A large proportion of patients in this safety-net clinical network are at high risk for tuberculosis infection. Addressing identified gaps in latent tuberculosis infection testing and treatment may have a direct impact on improving tuberculosis prevention in primary care clinics and accelerate progress toward elimination.

Determinants of Antituberculosis Drug Acceptability among Children with Tuberculosis in Osun State Nigeria

Acceptability of antituberculosis drugs by affected caregivers and children is key to disease elimination. This is affected by many factors including drug, patients, and health institution-related factors. This study aims to assess the influence of the introduction of dispersible formulation on acceptability of antituberculosis drugs. A historical cohort design was used to assess and compare the acceptability of old loose non-dispersible and new dispersible antituberculosis drugs, using a convergent parallel mixed method of data collection. Determinants of tuberculosis drug acceptability were assessed using binary logistic regression. The findings were triangulated with results from the qualitative data. The rate of acceptability of the new dispersible formulation, 112 (88.2%) was significantly higher than the rate of acceptability of old loose non-dispersible drugs, 13 (10.5%), p<0.001. The median age of children with good acceptability, 7.0 (4.0 – 10.0) years was significantly lower than those with poor acceptability, 10.0 (8.0 – 13.0) years, p <0.001. Drug formulation was a significant predictor of acceptability; the fixed-dose dispersible drug had a higher probability of being acceptable relative to lose non-dispersible formulation, (Odd Ratio = 62.3, p <0.001, 95% CI= 25.3 – 153.3). The qualitative data showed that health education about tuberculosis has positive influences on drug acceptability. In conclusion, the formulation of drugs is a key factor in the acceptability of antituberculosis drugs. Hence, there is a need to further promote the recently introduced child-friendly antituberculosis drugs, coupled with strengthening the health education of caregivers to achieve tuberculosis elimination. Keywords: Antituberculosis, Acceptability, Fixed-Dose Combination, Dispersible, Tuberculosis.

Knowledge, Attitude, and Practices Among Healthcare Practitioners in the Context of Multidrug Resistance Tuberculosis: An Appraisal to Disease Elimination.

Tuberculosis (TB) remains one of the leading infectious causes of death worldwide, and India is among the countries with the highest TB burden. TB control is facing several roadblocks in our country with the rapid development of multidrug-resistant (MDR) as well as extensively drug-resistant TB (XDR) and as an after-effect of the global COVID-19 pandemic.With the target of TB elimination by 2025 (National Tuberculosis Elimination Program, NTEP), there is a need that treating physicians in our country be well aware of MDR-TB and be able to diagnose and treat it at an appropriate time. The present study is conducted to explore the knowledge levels, attitudes, and practices concerning MDR-TB amongst healthcare professionals working in different healthcare sectors. A total of 250 allopathic medical practitioners (Bachelor of Medicine and Bachelor of Surgery [MBBS], specialists, and superspecialists) working in any sector (private or government), who are directly involved in managing any form of TB patient and are willing to undertake the assessment, were included in this online questionnaire-based survey that was circulated using various social media platforms like WhatsApp, Facebook, Linked In, and Gmail. Responses to the questionnaires created in Google Forms were analyzed by capturing data in a Microsoft Excel® spreadsheet for further statistical analysis. The data were analyzed using multiple measures of dispersion and cross-tabulations. Among the 250 participants, most of the participants had encountered MDR-TB in their clinical practice, and the majority believe that MDR-TB is a rising problem. Although 88% of the participants did a GeneXpert assay before the start of anti-tubercular therapy (ATT), three-fourths of the participants knew that the assay detects the MTB genome and rifampicin resistance. MDR-TB was suspected in participants after no clinical improvement was observed after 3-6 weeks of a trial of ATT. Two-thirds of the participants knew that linezolid is currently being used as a second-line drug for the treatment of MDR- TB. The respondents in our survey mostly do not themselves treat MDR-TB and refer the patients to an MDR-TB center or a pulmonary medicine specialist. Healthcare practitioners (HCPs) with good knowledge levels can diagnose and treat TB patients appropriately, thus decreasing the rising MDR-TB problem, and they can educate patients and the general population about TB and the emerging MDR-TB situation. With the current level of knowledge about MDR-TB management, there is certainly an urgent need for educational and persuasive measures for the training of doctors in both the public and private sectors so as to achieve TB elimination by 2025.

1441. LTBI screening cascade for non-US-born persons in a large health system assessed using EMR data

Abstract Background The majority of tuberculosis (TB) diagnosed in the US is reactivation TB in non-US-born (nUSb) persons. Guidelines recommend screening persons born in high TB burden countries for latent TB infection (LTBI) and treating if positive. We evaluated the LTBI cascade in primary care among nUSb persons in a large academic medical system in Washington State. Methods We used electronic medical record (EMR) data to evaluate the LTBI screening cascade. nUSb individuals were identified using the primary language recorded in the EMR. Place of birth is not routinely collected in the EMR. All persons with a non-English primary language who entered care and attended one or more primary care visits in UW clinics between April 2016- April2021 were identified and considered eligible for LTBI screening. Persons with a documented IGRA or tuberculin skin test were considered screened for LTBI. Prescription records were reviewed to determine LTBI treatment. Results 5148 persons with non-English primary language attended primary care visits 2016-2021 and considered eligible for LTBI screening. Eligible persons were 58.5% female, median age 41 (IQR 30-58). Primary WHO regions of origin were Asia (37%), the Americas (36%), and Africa (19%), with a minority from North Africa, Middle East, and Europe. 1012 (20%) had a documented history of LTBI testing (Quantiferon-GOLD (N=949) or tuberculin skin testing (N=63)). Among 296 (29%) persons with a positive test for LTBI, 140 (47%) were treated for LTBI. The highest proportion of persons tested for LTBI were patients attending the HIV clinic (120, 66%) and the International/Refugee clinic (227, 81%). The majority of eligible patients were seen outside these clinics (N=4687) in whom the percent of persons tested ranged from 3-18% (14% overall). LTBI cascade among non-US-born primary care patients IGRA: interferon-gamma release assay; TST: tuberculin skin test. Conclusion Although this subset underestimates the number of non-US-born individuals (since many non-US-born individuals use English as their primary language) eligible for screening, it nonetheless highlights the significant gap between actual and guideline-recommended screening in primary care, as well as further drop-off on the cascade from positive LTBI test to LTBI treatment. EMR platforms could be leveraged to prompt LTBI screening and treatment initiations in primary care to help achieve TB elimination goals in the US. Disclosures Adrienne E. Shapiro, MD, PhD, Vir Biotechnology: Support as a trial site paid to my institution and non-financial support for medical writing GlaxoSmithKline third party funding to Vir support H. Nina Kim, MD, MSc, Gilead Sciences: Grant/Research Support.

Evaluating the effect of short-course rifapentine-based regimens with or without enhanced behaviour-targeted treatment support on adherence and completion of treatment for latent tuberculosis infection among adults in the UK (RID-TB: Treat): protocol for an open-label, multicentre, randomised controlled trial

IntroductionThe successful scale-up of a latent tuberculosis (TB) infection testing and treatment programme is essential to achieve TB elimination. However, poor adherence compromises its therapeutic effectiveness. Novel rifapentine-based regimens and...

Evaluating the Quality of Latent Tuberculosis Infection Screening in Ireland: A Single-Centre Retrospective Cohort Study.

Ireland is a country with a low incidence of tuberculosis (TB) (5.6 cases per 100,000 population in 2019) that should be aiming for TB elimination (fewer than 1 case per million of population). To achieve TB elimination in low-incidence countries, programmatic latent tuberculosis infection (LTBI) management is important. This requires high-quality latent tuberculosis infection (LTBI) screening. Aim: To assess the quality of LTBI screening in a tertiary centre in Ireland using a framework. Methods: A retrospective review of the health care records of patients screened for TB in a tertiary centre in Ireland using an interferon-gamma release assay (IGRA) between 2016 and 2018 was performed. Three domains from the Institute of Medicine framework for health care quality, effectiveness, efficiency, and equity, were applied to measure the quality of LTBI screening. Results: Forty patients had LTBI and an indication for treatment, of whom 20% (8/40) were not offered treatment by the health care provider, 2.5% (1/40) did not accept treatment, and 10% (4/40) did not complete treatment. Seventy-five percent (6/8) of patients not offered treatment were non-Irish. The cost of screening per LTBI case identified was EUR 2048. Conclusions: This study evaluated the quality of LTBI screening using a framework and identified that LTBI screening in this tertiary centre needs to be scaled and expanded, and that treatment initiation needs to be improved, particularly among non-Irish nationals.

COMING OUT AFTER A DECADE OF HIDING: A 35-YEAR-OLD FEMALE WITH CHRONIC COUGH AND UNINTENTIONAL WEIGHT LOSS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Tuberculosis is one of the oldest infectious causes of death in adults, with archeological evidence of Potts disease in bones 9,000 years old. Incidence of tuberculosis in the United States continues to decline even though the pace of decline has slowed in the recent years. Most infections are diagnosed with exposures in the highly endemic, homeless, or prison population. Here we present a case of tuberculosis after a decade of possible exposure CASE PRESENTATION: A 35-year-old female with no prior medical history presented with one-year history of chronic productive cough with brown sputum associated with generalized weakness, dizziness, and shortness of breath. At an outside hospital, she was treated for bacterial pneumonia with continued worsening of symptoms. She also endorsed about 80 pounds of unintentional weight loss in the past year. She denied fever, chills, night sweat, chest pain, palpitations, heartburn, sick contacts, or hemoptysis. She denied any prior or current alcohol or illicit drug and was employed at a convenience store. She denied international traveling but admitted that she was incarcerated in 2010 for six months. She was born at term in the United States without any significant childhood illness. She denied family history of lung disease, tuberculosis, or malignancy. Work up showed extensive cavitary lesions in the left upper lobe and left lower lobe and some bronchiectasis. Sputum acid fact bacilli culture was positive. Human immunodeficiency was negative. Patient was diagnosed with pulmonary tuberculosis and started on appropriate treatment. DISCUSSION: Mycobacterium tuberculosis is most commonly transmitted by droplet nuclei from an infected person. The intimacy, duration of contact, the degree of infectiousness, and the shared environment in which contact takes place are all important determinants of the likelihood of transmission. The majority of active tuberculosis cases manifest soon after infection, rarely occurring more than two years of infection. Reactivation of latent tuberculosis is thought to occur later in life, when immunity wanes from natural aging or immunocompromised states. In our patient, the distinction between primary and reactivation tuberculosis is challenging as she has no recent risk of acquiring tuberculosis and reactivation in relatively young patient with no significant underlying medical problems is uncommon. CONCLUSIONS: In low transmission countries such as the United States, we usually see tuberculosis disease in elderly or in immigrants from high transmission area. Detecting and treating all tuberculosis patients is important to prevent outbreaks and untreated tuberculosis is often fatal. This case illustrates the importance of a wide differential during patient assessment. REFERENCE #1: Behr MA, Edelstein PH, Ramakrishnan L. Revisiting the timetable of tuberculosis. BMJ 2018; 362:k2738. REFERENCE #2: Cain KP, Haley CA, Armstrong LR, et al. Tuberculosis among foreign-born persons in the United States: achieving tuberculosis elimination. Am J Respir Crit Care Med 2007; 175:75. REFERENCE #3: Kasper, D. L., Fauci, A. S., Hauser, S. L., Longo, D. L. 1., Jameson, J. L., & Loscalzo, J. (2015). Harrison's principles of internal medicine (19th edition.). New York: McGraw Hill Education. DISCLOSURES: No relevant relationships by Samapon Duangkham, source=Web Response No relevant relationships by Megan Hughes, source=Web Response No relevant relationships by Kenneth Iwuji, source=Web Response No relevant relationships by Cristina Morataya, source=Web Response No relevant relationships by Upama Sharma, source=Web Response No relevant relationships by Divya Vangipuram, source=Web Response No relevant relationships by Alexandra Wichmann, source=Web Response

Engaging frontline providers: an important key to eliminating tuberculosis in Canada, and other high-income countries.

The greatest human cost of the rapidly moving pandemic of SARS-CoV-2 may be due to its impact on the response to other diseases. One such other disease is tuberculosis (TB). All indications suggest that COVID-19-related diversions of healthcare resources and disruptions to public health programming will exacerbate the slower moving pandemic of TB. This is expected to set back TB elimination efforts by years. This is a prediction that is especially relevant to Canada, which has repeatedly failed to meet pre-set targets for the elimination of TB even before the COVID-19 pandemic began. A collaborative approach to achieve TB elimination, one that engages all care providers, has recently been emphasized by the STOP-TB Partnership. Among TB elimination strategies, frontline providers (e.g., family physicians, emergency room physicians, and others) are well positioned to identify candidates for the treatment of latent TB infection, and make the diagnosis of infection-spreading cases of TB in a timely manner, thereby interrupting forward-moving chains of transmission. Electronic medical records offer the promise of automating these processes. In this commentary, we promote broader engagement of the workforce across multiple sectors of medicine to reduce TB associated morbidity and mortality, interrupt transmission, and shrink the reservoir of latent TB infection.

Digital communication in health promotion in handling tuberculosis sputum

The Covid-19 pandemic that has caught the attention of not only Indonesia but the rest of the world. The 3M movement, namely using masks, washing hands and keeping a distance to minimize the transmission of tuberculosis, is very useful for the eradication of TB tuberculosis. However, this is a challenge in itself for microscopic officers at the Microscopic Reference Center (MRC) in education and handling of sputum for tuberculosis patients who are currently being treated. The purpose of this study was to test VisKomLAM 1, 2, 3 and 4 in bridging communication between officers in sputum management education for tuberculosis sufferers at each examination during the Covid-19 pandemic. The research locations took MRC Tuminting, Wawonasa and Tikala Baru in Manado City and MRC Telaga in Gorontalo District. Analysis with paired t test showed a significance below 5%, which means that VisKomLAM 1, 2, 3 and 4 can bridge education from officers to tuberculosis sufferers in the Covid-19 pandemic era. It is recommended that health workers always strive to promote tuberculosis health in achieving tuberculosis elimination by 2050.

Invited Commentary: The Role of Tuberculosis Screening Among Migrants to Low-Incidence Settings in (Not) Achieving Elimination.

The cost-effectiveness of migrant tuberculosis prevention programs is highly relevant to many countries with low tuberculosis incidence as they attempt to eliminate the disease. Dale et al. (Am J Epidemiol. 2022;191(2):255-270) evaluated strategies for tuberculosis infection screening and treatment among new migrants to Australia. Screening for infection before migration, and then administering preventive treatment after arrival, was more cost-effective than performing both screening and treatment after arrival. From the Australian health payer perspective, the improved cost-effectiveness of premigration screening partly reflected the shift of screening costs to migrants, which may raise ethical concerns. Key sensitivity analyses highlighted the influence of health disutility associated with tuberculosis preventive treatment, and of posttreatment sequelae of tuberculosis disease. Both considerations warrant greater attention in future research. For all strategies, the impact on tuberculosis incidence among migrants was modest (<15%), suggesting enhanced migrant screening will not achieve tuberculosis elimination in low-incidence settings. This emphasizes the need to increase investment and effort in global tuberculosis prevention and care, which will ultimately reduce the prevalence of tuberculosis infection and therefore the risk of tuberculosis disease among migrants. Such efforts will benefit high and low tuberculosis incidence countries alike, and advance all countries further toward tuberculosis elimination.

Tuberculosis in Migrants is Among the Challenges of Tuberculosis Control in High-Income Countries.

The incidence of tuberculosis (TB) is high among migrants in high-income countries. The migration process could contribute to the high incidence of TB among them. Achieving TB elimination from these settings will be difficult unless countries address the burden of TB among migrants. The aim of this review was to describe the challenges of international migration on TB control in high-income, low TB incidence countries. Among migrants, there is a high prevalence of risk factors for TB, such as exposure to TB, HIV, malnutrition, substance use, delayed diagnosis, low education, poor health-seeking, the culture, stigma and marginalization. Discriminatory policies of TB care and social barriers such as language, cultural issues and unfriendly health services may also contribute to the high prevalence of TB among them. TB control among migrants in these settings is important as migrants are vulnerable to TB infection and disease, and implementing TB care among them is difficult; it is important to reduce the TB burden in migrants and the community at large and the high risk of multidrug-resistant TB (MDR-TB). TB elimination from high-income countries requires acquiring data and analyzing it to measure the burden, having migrant-sensitive health systems, having policy and legal frameworks and multi-country partnerships and conducting research.

Adverse drug reactions among new sputum positive pulmonary tuberculosis patients on daily treatment regimen: a prospective study from Haryana, India

Background: Daily regimen anti-tuberculosis treatment was adopted by Revised National Tuberculosis Control Programme (RNTCP) as a step to achieve tuberculosis elimination by 2025 in India. The change was implemented prior to completion of pilot study, which necessitated this study to note the self-reported Adverse Drug Reactions (ADRs).Methods: A prospective study with concurrent sampling design was carried on from June 2018 to June 2020 in the state of Haryana, India. Pre-tested semi-structured schedule was used to collect data based on RNTCP outcome definitions through two monthly (four visits) home visits. Mean±standard deviation, percentage, proportion and chi-square test was used. The p-value of &lt;0.05 was considered as statistically significant.Results: Amongst 122 study participants 74 (60.7%) were males and 48 (39.3%) were females with mean age of 39.4±18.9 years. Majority were urban residents 87 (71.3%) and 35 (28.7%) rural residents. There were 25 (20.5%) tobacco smokers, nine (7.4%) alcohol consumers, and three (2.5%) smokeless tobacco users. Forty-five participants had ADRs and 54 ADR events had occurred, but none required change in treatment regimen. Sixteen (13.1%) reported loss of appetite followed by 10 (8.2%), flu-like symptoms, eight (6.6%) nausea, seven (5.7%) pain in joints, three (2.5%) abdomen pain, three (2.5%) headache, two (1.6%) itching and rash, one (0.8%) burning in hands and feet and one (0.8%) giddiness. Daily regimen ADR cases (36.9%) and events (44.3%) when comparatively higher than intermittent regimen (25.6%).Conclusions: The ADRs cases and events had occurred in higher proportion but were mild and hence did not require any regimen change.

Distribution of molecular strains of Mycobacterium tuberculosis in an intermediate burden Asia Pacific city.

Hong Kong is an intermediate tuberculosis (TB) burden city in Asia Pacific with slow decline of case notification in the last decade. By 24-loci mycobacterial interspersed repetitive units - variable number of tandem repeats genotyping, we examined 534 Mycobacterium tuberculosis isolates collected from culture-positive hospitalised TB patients in a 1.7 million population geographic region in the city. Overall, 286 (75%) were classified as Beijing genotype, of which 216 (76%) and 59 (21%) belonged to modern and ancient sub-lineage, respectively. Only two cases were genetically clustered while spatial clustering was absent. Male gender, permanent residency in Hong Kong and born in Hong Kong or Mainland China were associated with Beijing genotype. The high prevalence of Beijing modern lineage was similar to that in East Asia, which reflected the pattern resulting from population migration. The paucity of clustering suggested that reactivation accounted for most of the TB disease cases, which was and echoed by observation that half were 60 years old or above, and the presence of co-morbid medical conditions. The predominance of reactivation TB cases in intermediate burden localities implies that the detection and control of latent TB infection would be the major challenge in achieving TB elimination.

Tuberculosis Surveillance and Monitoring under the National Public-Private Mix Tuberculosis Control Project in South Korea 2016-2017.

Background The national Public-Private Mix (PPM) tuberculosis (TB) control project provides for the comprehensive management of TB patients at private hospitals in South Korea. Surveillance and monitoring of TB under the PPM project are essential toward achieving TB elimination goals.Methods TB is a nationally notifiable disease in South Korea and is monitored using the surveillance system. The Korea Centers for Disease Control and Prevention quarterly generates monitoring indicators for TB management, used to evaluate activities of the PPM hospitals by the central steering committee of the national PPM TB control project. Based on the notification date, TB patients at PPM hospitals were enrolled in each quarter, forming a cohort, and followed up for at least 12 months to identify treatment outcomes. This report analyzed the dataset of cohorts the first quarter of 2016 through the fourth quarter of 2017.Results The coverage of sputum, smear, and culture tests among the pulmonary TB cases were 92.8% and 91.5%, respectively. The percentage of positive sputum smear and culture test results were 30.7% and 61.5%, respectively. The coverage of drug susceptibility tests among the culture-confirmed cases was 92.8%. The treatment success rate among the smear-positive drug-susceptible cases was 83.2%. The coverage of latent TB infection treatment among the childhood TB contacts was significantly higher than that among the adult contacts (85.6% vs. 56.0%, p=0.001).Conclusion This is the first official report to analyze monitoring indicators, describing the current status of the national PPM TB control project. To sustain its effect, strengthening the monitoring and evaluation systems is essential.

The diagnosis of latent tuberculosis infection (LTBI): currently available tests, future developments, and perspectives to eliminate tuberculosis (TB).

Introduction:Despite great efforts, tuberculosis (TB) is still a major public health threat worldwide. For decades, TB control programs have focused almost exclusively on infectious TB active cases. However, it is evident that this strategy alone cannot achieve TB elimination. To achieve this objective a comprehensive strategy directed toward integrated latent tuberculosis infection (LTBI) management is needed. Recently it has been recognized that LTBI is not a stable condition but rather a spectrum of infections (e.g., intermittent, transient or progressive) which may lead to incipient, then subclinical, and finally active TB disease.Aim:Provide an overview of current available LTBI diagnostic test including updates, future developments and perspectives.Results:There is currently no test for the direct identification of live MT infection in humans. The diagnosis of LTBI is indirect and relies on the detection of an immune response against MT antigens, assuming that the immune response has developed after a contact with the biological agent. Tuberculin skin test (TST) and interferon gamma release assays (IGRAs) are the main diagnostic tools for LTBI, however, both present strengths and limitations. The most ancient diagnostic test (TST) can be associated with several technical errors, has limited positive predictive value, is being influenced by BCG vaccination and several conditions can reduce the skin reactivity. Notwithstanding these limitations, prompt identification of TST conversion, should orientate indications for preventive therapy of LTBI. IGRAs have superior specificity, are not affected by M. bovis, BCG vaccination and other environmental mycobacteria. However, they present some logistical and organisational constraints and are more expensive. Currently, the WHO guidelines recommend that either a TST or an IGRA can be used to detect LTBI in high-income and upper middle-income countries with estimated TB incidences less than 100 per 100,000 population. Two skin tests (C-TB and Diaskintest), using only two specific M. tuberculosis antigens (ESAT-6 and CFP-10) instead of the tuberculin solution, have recently been developed but, to date, none of these tests is available on the European market.Conclusion:Early identification and treatment of individuals with LTBI is an important priority for TB control in specific groups at risk within the population: this is of crucial meaning in recently infected cases both at the community level and in some occupational settings. Currently there is no gold standard test for LTBI: an improved understanding of the available tests is needed to develop better tools for diagnosing LTBI and predicting progression to clinical active disease.