TB Cases Research Articles

Detection and management of tuberculosis in Tunisia: challenges and outcomes

Abstract Introduction Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. In Tunisia, where TB remains endemic, the national control program ensures free vaccination, free outpatient TB treatment in addition to early detection of cases and directly observed treatment short course. However, available data on these activities and outcomes are limited. The objective of this study was to describe the evolution of TB detection and management indicators and outcomes from 2018 to 2021. Methods We analyzed data collected part of the epidemiological investigations of notified cases and active search for cases over a period of 4 years (2018-2021). In each governorate, dedicated teams collect samples from cases’ contacts for microscopic sputum examination for screening and ensure patients’ follow-up. All data related to contact tracing, treatment and outcomes were collected, entered and analyzed using SPSS-21. Results The number of screened cases decreased from 30337 in 2018 to 16045 in 2021. The number of investigations of reported cases also decreased; from 2408 in 2018 to 1295 in 2021 (proportion of 74.6% to 48.9% respectively). However, the percentage of positives increased from 1.4% to 2.1%. In 2021, therapeutic success was recorded among 81% of cases (compared to 86% in 2018). From 2018 to 2021, there was an increase in three indicators: fatality rate (1.55 to 2.53%), discontinuation of treatment (from 2.5% to 3.2%) and the proportion of multidrug-resistant TB cases (0.45 to 0.69%). Conclusions Despite free care and treatment, our study showed challenges in the prevention and management of TB. Several activities of the national tuberculosis program have decreased, probably due to the pandemic, as noted in general preventive and care activities worldwide. More education and awareness efforts should be made, not only for patients and their contacts, but also for health care professionals, to be more vigilant in early case detection and continued treatment. Key messages • Several activities of the national tuberculosis program have decreased from 2018 to 2021, probably due to the pandemic. • From 2018 to 2021, there was an increase in the fatality rate, discontinuation of treatment and multidrug-resistant TB cases.

Strategi Intervensi untuk Mengeliminasi Kasus Tuberkulosis

This study aims to analyze tuberculosis intervention strategies in Southeast Asia. The method used is a systematic review. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) as a guide and The Joanna Briggs Institute (JBI) were used to conduct quality assessment. Data were born in the Scopus, Science Direct, and Pubmed databases on articles published in the last five years. In the final review, ten papers were included. The research results show that the intervention strategy is divided into three categories: community-based support through health cadres, nutritional status support, and investigation of household contacts and early detection. In conclusion, efforts to eliminate TB cases require a full-scale strategy with evidence-based interventions in identifying risk factors, contact investigation, and successful treatment.
 
 Keywords: Southeast Asia, TB Elimination, İntervention, Strategy, Tuberculosis

Perspectives on pregnant women’s educational needs to prevent TB complications during pregnancy and the neonatal period. A qualitative study

BackgroundTuberculosis (TB) during pregnancy could confer a high risk for maternal and infant morbidity. Literature indicates that the global burden of active TB disease among pregnant women is not well researched. Statistics for South Africa from WHO give an estimated incidence of 360, 000 cases of TB in 2019; 14,000 people became ill with multidrug-resistant TB in 2019, with a rate of 615 per 100,000 population, implying that the cohorts included pregnant women with and without a diagnosis of TB infection. Therefore, the study aims to increase the understanding of the educational needs required to prevent TB complications during pregnancy and the neonatal period in women diagnosed with TB infection.MethodsThe study used cross-sectional qualitative and descriptive designs to collect data in the clinical setting of the primary health care services of Limpopo Province, South Africa. The population comprised pregnant women diagnosed with TB infection. A non-probability purposive sampling technique was used to sample 2 health centers and 5 clinics in each of the three sampled districts. The targeted sample size was 63 and it was achieved even though data saturation was observed. Individual interviews were conducted, audiotaped, and transcribed. Guided by the study questions, a thematic content analysis of the findings was used. Ethical considerations were also observed.ResultsDespite that pregnant women have general knowledge about TB disease, the knowledge and awareness regarding the prevention of TB complications in pregnancy and the neonatal period, information on TB/HIV and COVID-19 co-infections, and participants’ knowledge about other non-infectious diseases that may affect the mother with TB infection and foetus showed a deficit.ConclusionPregnant women with TB disease need to be educated on the negative effects of non-adherence to TB treatment during pregnancy and the neonatal period. There is a need to educate pregnant women about the variant signs and symptoms of TB, HIV and COVID-19 infections since there is a misconception that the three diseases are similar. It is important that pregnant mothers diagnosed with TB should start treatment as soon as possible.

Assessment of risk factors associated with multi-drug resistant tuberculosis (MDR-TB) in Gulu regional referral hospital.

Multi-drug resistant tuberculosis (MDR-TB) is increasingly recognized as emerging infectious disease of public health concern. Globally, 206030 people were diagnosed with MDR-TB in 2019, representing a 10% increase from 186883people who had it in 2018. In Uganda, the prevalence of MDR among new TB cases is 4.4% and 17.7% among previously treated TB cases. To determine the risk factors associated with MDR-TB among tuberculosis patients in Gulu regional referral hospital. A cross-sectional analytical study using both quantitative and qualitative methods of data collection and analysis was used. Data was collected from 384 TB patients using data extraction form and 6 Key informant interviews conducted. Analysis using Pearson chi-square test was run. HIV positive patients were 2.6 times more likely to be infected with MDR-TB than HIV negative patients [AOR=2.6: 95% CI 1.34- 5.85: P=0.006]. Previously treated TB patients were 2.8 times more likely to be infected with MDR-TB than newly diagnosed TB patients [AOR=2.8: 95% CI 1.33- 5.85: P=0.006]. Defaulting TB patients were 3.1 times more likely to be infected with MDR-TB than the non-defaulting TB patients [AOR=3.1]. There is high prevalence of drug resistance among patients attending TB treatment at the facility.

Xpert MTB/RIF assay among the extra-pulmonary and non-sputum respiratory samples: One year experience at National Tuberculosis Reference Laboratory, Bangladesh

Background: Extra-pulmonary tuberculosis (EPTB) is a diagnostic and therapeutic challenge due to the paucity of suitable rapid diagnostic tools. Objectives: The aim was to assess the frequency of detection of Mycobacterium tuberculosis using Xpert MTB /RIF assay among the extra-pulmonary and non-sputum respiratory samples (NSRS) along with demographic profile, life style variables and proportion of Rifampicin resistant TB among those specimens. Methodology: This cross-sectional retrospective study was conducted at National Tuberculosis Reference Laboratory (NTRL) from January 2018 to December 2018 for period of 1 year. Total 3918 extra-pulmonary and non-sputum respiratory samples from suspected TB patients were enrolled. Detection of Mycobacterium tuberculosis and Rifampicin resistance was performed by Xpert MTB /RIF assay and culture in both liquid and solid media. Results: Among 3918 samples, 3152 were new cases and 766 were previously treated TB cases. A total of 853 (21.77%) MTB were detected by Xpert MTB /RIF assay. Among them, 713 (83.59%) were extra-pulmonary and 140 (16.41%) were non-sputum respiratory samples. Lymph node (LN) aspirates and tissues were the most frequent (37.9 and 9.9%) samples of EPTB. The proportion of RR cases among EPTB was 2.8% and 6.3% among new and previously treated cases. And 2.6% and 11.1% among NSRS new and previously treated cases respectively. Conclusion: This study will give an insight of EPTB and NSRS profile with a view to diagnostic and therapeutic approach in Bangladesh. Bangladesh Journal of Medical Microbiology, January 2023;17(1):21-28

Differential levels of anti-Mycobacterium tuberculosis-specific IgAs in saliva of household contacts with latent tuberculosis infection.

Mucosal immunity is strongly elicited in early stages of many respiratory and enteric infections; however, its role in tuberculosis pathogenesis has been scarcely explored. We aimed to investigate Mycobacterium tuberculosis (Mtb) specific IgA levels in saliva in different stages of latent Tuberculosis Infection (TBI). A multiplex bead-based Luminex immunoassay was developed to detect specific IgA against 12 highly immunogenic Mtb antigens. A prospective cohort of household contacts (>14 years) of pulmonary TB cases was established in Santiago, Chile. Contacts were classified as Mtb-infected or not depending on serial interferon-γ release assay results. Saliva samples were collected and tested at baseline and at a 12-week follow-up. Mtb-specific IgA was detectable at all visits in all participants (n = 168), including the "non-Mtb infected" (n = 64). Significantly higher median levels of IgA were found in the "Mtb infected" compared to the uninfected for anti-lipoarabinomannan (LAM) (110 vs. 84.8 arbitrary units (AU), p < 0.001), anti-PstS1 (117 vs. 83 AU, p < 0.001), anti-Cell Membrane Fraction (CMF) (140 vs. 103 AU, p < 0.001) and anti-Culture Filtrate Proteins (CFP) (median 125 vs. 96 AU, p < 0.001), respectively. Nonetheless, the discriminatory performance of these specific mucosal IgA for TBI diagnosis was low. Saliva holds Mtb-specific IgA against several antigens with increased levels for anti-LAM, anti-PstS1, anti-CMF and anti-CFP found in household contacts with an established TBI. The role of these mucosal antibodies in TB pathogenesis, and their kinetics in different stages of Mtb infection merits further exploring.

Impact of COVID-19 on TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa

We assessed the impact of the pandemic on TB diagnostics at primary healthcare clinics (PHCs) during the different stages of COVID-19 in eThekwini district, South Africa. Data from the District Health Information System (DHIS) were used to conduct an interrupted time series analysis that assessed the changes in TB investigations and confirmed TB cases during four pandemic periods: lockdown and the subsequent three peaks of infection compared to the two years prior (2018–2022). The initial lockdown resulted in − 45% (95% CI − 55 to − 31) and − 40% (95% CI − 59 to − 28) immediate declines in TB investigations and confirmed cases, respectively. Both indicators showed substantial recovery in the months after the first wave (p < 0.05). However, while TB investigations sustained smaller declines throughout the pandemic, they rebounded and surpassed pre-COVID-19 levels by the end of the investigation period. On the other hand, confirmed cases experienced reductions that persisted until the end of the investigation period. TB diagnostic services at PHCs were considerably disrupted by COVID-19, with the confirmation of cases being the most adversely affected throughout the pandemic. The reasons for these persistent declines in TB detection must be determined to inform the development of sustainable diagnostic systems that are capable of withstanding future pandemics.

Impact of COVID-19 Pandemic on Tuberculosis Care and Treatment in Puducherry - A Mixed Method Study.

The shift of focus toward pandemic control had an impact on public health issues that need to be addressed. As the impact may vary in the different areas based on COVID-19 cases and strictness of measures to control the disease, studying the local situation and related factors is essential to strengthening the TB program. The objective is to compare the TB care before and during the COVID-19 pandemic and to explore the challenges faced by stakeholders during the pandemic. A mixed method study was conducted in Puducherry with a quantitative phase involving data extraction from the National TB Elimination Programme (NTEP), followed by in-depth interviews to explore the challenges faced by stakeholders. In 2020, there were 67% and 23% reductions in number of presumptive TB case and notified TB cases, respectively, while the decline was lesser in the year 2021 (reduction of 59% and 13%, respectively). The main challenges faced in providing and accessing TB care were social stigma, lockdown restrictions, fear of getting COVID-19, redeployment of staff to COVID-19-related activities and increased COVID-19 workload. There is a need to strengthen active case finding for the missed TB cases through the mobile vans equipped with diagnostics, combined testing for COVID-19 and TB, greater inclusion of private sector and dispensaries as well as community awareness for stigma prevention.

Transcriptomic and proteomic analyses of Mycobacterium tuberculosis strains isolated from tuberculous meningitis patients.

Tuberculous meningitis (TBM) is caused by the dissemination of Mycobacterium tuberculosis (MTB) from the primary site of infection to the central nervous system. However, the bacterial factors associated with the pathogenesis of TBM remain unclear. This study employed transcriptomic and proteomic methods to comprehensively analyze the changes in genes and proteins and their associated pathways in MTB strains isolated from cerebrospinal fluid (CSF) of TBM and sputum of pulmonary TB (PTB) cases. Five MTB strains were subjected to OMICs (transcriptomic and proteomic) analysis. Among five MTB strains, two were isolated from CSF and sputum samples of the same patient with PTB and TBM infections, one from the sputum of a different PTB patient, and a strain obtained from the CSF of another TBM patient. H37Rv was used as a reference strain. The reliability of transcriptomic results was validated by real time polymerase chain reaction with selected genes from 100 MTB isolates (CSF, 50 and sputum, 50). The transcriptomic study revealed that overlapping differentially expressed genes of MTB strains isolated from TBM patients showed featured enrichment in benzoate degradation, lysine degradation, tryptophan metabolism, fatty acid degradation, ATP binding cassette transporters, microbial metabolism in diverse environments, biosynthesis of antibiotics, and metabolic pathways. Eleven genes were upregulated, and four were downregulated in MTB strains isolated from TBM compared to PTB. From proteomic analysis, we identified three candidate proteins belonging to plasminogen binding proteins (PBP) (enolase, dnaK, and isocitrate lyase 1) that were significantly upregulated in MTB strains isolated from TBM. Overall, the transcriptomic and proteomic analyses provided an important base for understanding the unique feature of TBM pathogenesis. To the best of our knowledge, this is the first report highlighting the importance of PBPs on TBM pathogenesis.

Outcomes of TB contact tracing and predictors of success: a 10-year retrospective cohort analysis in Birmingham, UK.

BACKGROUND: Contacts of TB cases in Birmingham and Solihull, UK, are offered screening for TB infection. Between 1990 and 2010, only 59.1% of contacts completed screening. The service has since increased screening staff numbers, changed screening locations and increased screening follow-up. Our primary aim was to identify whether screening completion rates have improved. Our secondary aim was to identify predictors of screening completion.METHODS: This was a retrospective analysis of all contacts of TB patients in Birmingham and Solihull between 1 January 2011 and 31 December 2020, stratified by pulmonary and extrapulmonary TB (PTB or EPTB) index infection. Multiple logistic regression analysis for predictors of screening completion was performed.RESULTS: A total of 3,255 index cases and 27,820 contacts were identified. TB incidence has declined, in keeping with national trends. Screening completion has improved from 59.1% of contacts to 74.9% overall since service improvements were made, with improvement in screening completion for contacts of both PTB and EPTB index cases (OR 1.087, 95% CI 1.074-1.101; P < 0.001) and (OR 1.048, 95% CI 1.019-1.078; P = 0.001), respectively.CONCLUSIONS: Changes made to the TB service have improved screening outcomes over the last decade. Significant predictors of screening completion have been identified, highlighting areas for targeted resource allocation.

Knowledge, attitude and practice on prevention and control of pulmonary tuberculosis index cases family in Shebedino District, Sidama Region, Ethiopia

IntroductionTuberculosis is a leading cause of death, despite being a largely curable and preventable disease. The goals of TB control are to reduce infection transmission, morbidity, and mortality until TB cannot be a threat to public health any longer while preventing drug resistance. Assessing KAP on TB control and prevention among family members is more essential, and taking action based on the result can break the transmission of TB infection. MethodsFrom August to September 2022, a community-based cross-sectional study method was used. A total of 422 participants were selected from a list of sample frames who were family members of PTB patients who had used anti-TB medication in the previous 12 months prior to the study period using a systematic random sampling method. SPSS version 25 software was used to analyze the data. Bivariate and multivariate analyses were used to determine variables related to KAP on TB prevention and control. A variable with p-values less than 0.25 was included in the multivariable logistic regression model to find independent determinant factors. In the multivariate logistic regression, variables with p-values ≤0.05 were identified as statistically significant. ResultA total of 414 family members responded to the survey questionnaire. The average knowledge score on TB was 17.11 ± 6.34. The majority (51.9%) of respondents had a good knowledge of TB cases. One-third of those polled had an unfavorable attitude towards PTB prevention, with a mean score of 3.16 ± 1.78 and 55.1% had good practice in preventing tuberculosis. Marital status (AOR = 1.7, 95% CI: 1.5–2.5) was an independent predictor of knowledge. Practice level is independently affected by occupation (AOR = 3.9; 95% CI = (1.7–8.7)) and health education on PTB (AOR = 2.4; 95% CI = (1.6–3.9). ConclusionKnowledge, attitudes, and preventive practices about tuberculosis were not satisfactory when compared to several national and international studies. It is necessary to strengthen the program for health education and awareness-building on PTB.

Prevalence of Various Forms of Active Tuberculosis in Patients with Diabetes

A diabetic foot ulcer (DFU) is a persistent complication of diabetes mellitus. Diabetes is linked to a two to four-fold higher likelihood of developing peripheral arterial disease (PAD) when compared to individuals without diabetes. Objective: To determine the incidence of various forms of active tuberculosis in patients with diabetes. Methods: It was a cross-sectional study conducted at the Department of General Medicine from August 2022 to February 2023. 175 patients, including both males and females, participated in this study. Comprehensive demographic information was meticulously documented for each patient following the appropriate consent procedures. These patients had symptoms such as cough with or without phlegm, hemoptysis, persistent fever, and unexplained weight loss, and their ages ranged from 10 to 85 years. Comprehensive medical history, clinical examination, and TB screening tests were conducted and data analysis were done by SPSS version-24 for further analysis. Results: The mean age was 51.34 years with a standard deviation of 3.61. Among the patients, 107 (61.14%) were male, and 68 (38.85%) were female. The overall prevalence of active TB was 38 cases, accounting for 21.71% of the total. Among these cases, 18 were pulmonary TB, making up 47.36% of the active TB cases, while 13 were extra-pulmonary TB, constituting 34.21% of the total. Additionally, 5 cases were identified as multidrug-resistant TB, representing 13.15% of the active TB cases. Conclusions: In conclusion, our study reveals a higher prevalence of various forms of active tuberculosis in patients with diabetes with pulmonary tuberculosis accounting for 47.35% and extra pulmonary tuberculosis for 34.21% of cases.

Hubungan Faktor Risiko Lingkungan Fisik Rumah dan Perilaku Kesehatan dengan Kejadian TB Paru di Wilayah Kerja UPT Puskesmas Bandar Khalifah Deli Serdang

Pulmonary TB cases at the Bandar Khalifah Health Center increased in 2021 by 219 cases, while in 2022 there were 268 cases. This study aims to determine the risk factors of the physical environment of the house and health behavior with the incidence of Pulmonary TB in the Working Area of UPT Puskesmas Bandar Khalifah Deli Serdang. This study used a case control design, with a sample of 120 people consisting of 60 cases and 60 controls. Using univariate and bivariate analysis. The results of the bivariate analysis showed a significant relationship between occupancy density (p value = 0.009, OR= 2.891), ventilation (p value = 0.010, OR= 0.351), lighting (p value = 0.045, OR= 2.486) and the presence of room windows (p value = 0.026, OR= 0.660) with the incidence of Pulmonary TB in the working area of the Bandar Khalifah Health Center. Meanwhile, knowledge (p value = 0.231, OR= 0.229), attitude (p value = 0.778, OR= 0.351), and floor type (p value = 0.601, OR= 0.660) were not related to the incidence of Pulmonary TB in the working area of the Bandar Khalifah Health Center.&#x0D; Keywords: Risk factor; Incidence of Pulmonary TB

Histoplasma Seropositivity in TB Patients in The Gambia: Evidence to Drive Research on a High-Priority Fungal Pathogen.

Inclusion of Histoplasma in the World Health Organization's first Fungal Priority Pathogens List under "high-priority" fungal species highlights the need for robust surveillance of Histoplasma spp. in endemic and underrepresented regions. Despite increasing reports of histoplasmosis in Africa, data on the burden of this fungal disease are sparse in The Gambia. This baseline study examined the human seroprevalence of anti-Histoplasma antibody in a TB patient group in The Gambia, explored associations between seropositivity and demographic and clinical variables, and proposes future research directions. Biobanked plasma samples were selected from active TB cases with variable HIV infection status. Latex agglutination tests were performed on samples from 52 study participants to detect the presence of anti-Histoplasma antibodies. Potential risk factors for Histoplasma exposure were explored using logistic regression analysis. The sample seroprevalence of anti-Histoplasma antibody was 28.8% (n = 15/52; 95% CI, 17.1%-43.1%). Multivariable logistic regression analysis identified a statistically significant association between Histoplasma seropositivity and age (odds ratio, 0.91; 95% CI, 0.84-0.98; P = .008). This baseline study provides evidence of Histoplasma seropositivity in TB patients in The Gambia and explores risk factors for exposure. The small sample size and use of the LAT in TB and HIV-positive patient groups are significant study limitations. Future research directions are proposed to ascertain the burden of Histoplasma in general and patient populations and explore the context-specific risk factors for exposure and infection in The Gambia.

Risks of recurrence in people with pulmonary tuberculosis

OBJECTIVE. To assess the risk of relapse in patients with pulmonary tuberculosis (PTB).&#x0D; MATERIALS AND METHODS. 569 people with relapsed PTB (RPTB) were selected from the TB register (e-TB manager programme): 300 with a first case treatment outcome of “completed treatment” and 269 “cured”. The groups were compared according to the course and outcome of treatment of RPTB, clinical characteristics of the first case, medical and social risk factors, and all patients with RPTB were compared with the group of newly diagnosed PTB (NDPTB). Mathematical and conventional statistical methods were used to analyse.&#x0D; RESULTS AND DISCUSSIONS. It was found that patients with RPTB are a difficult group because more than 1⁄2 of them have lung destruction, 3⁄4 isolate mycobacterium tuberculosis (MBT), and more than 1⁄2 have resistance to antimycobacterial drugs (AMBD). In 73.6 % of them, medical and social risk factors were noted that may have caused or contributed to TB relapse and negatively affected the results of treatment. These factors include: severe comorbidities in 53.7 %, alcohol and drug abuse in 34.9 %, HIV infection in 30.5 %, and others (homelessness, release from prison, contact with a TB patient, unemployment, smoking, etc.); 62.1 % of patients had ≥2 risk factors at the same time.&#x0D; We consider the effectiveness of treatment of this category of patients to be insufficient, as the outcome of the main course of treatment was unsatisfactory in more than half of them (48.5 % of unsuccessfully treated, 4.7 % interrupted treatment, 8.3 % died), and taking into account repeated courses, the rate of effective treatment in some of them was only 65.6 %.&#x0D; There was no significant difference (neither in clinical characteristics nor in medical and social risk factors) between the groups of patients “cured” or “completed treatment” as a result of treatment of the first case of TB, but it was found that only 23.2 % of patients with RPTB were found to be resistant to AMBD at the first case of the disease, and 50.0 % of them had it, with multidrug resistance (MDR) in half of them.&#x0D; It has been statistically proven that patients with RPTB are more likely to have the following symptoms than patients with NDPTB: lung destruction (43.2±3.2 vs. 20.4±4.0 %, p&lt;0.05), sputum isolation of MBT (38.1±3.3 vs. 24.9±3.9 %, p&lt;0.05), multi- and poly-resistance of MBT to AMBD (30.2±8.1 vs. 9.5±4.3 %, p&lt;0.05), various medical and social risks (73.6±2.2 vs. 44.5±3.4 %, p&lt;0.05), including alcohol abuse (21.3±3.7 vs. 8.7±4.3 %, p&lt;0.05 %), unemployment (51.1±2.9 vs. 21.9±4.0 %, p&lt;0.05), concomitant diseases (39.5±3.3 vs. 8.5±4.3 %, p&lt;0.05), HIV infection (22.5±4.0 vs. 4.9±4.4 %, p&lt;0.05) and others – lack of a fixed place of residence, release from prison, contact with a TB patient, lack of permanent employment, smoking, etc. (64.3±2.5 vs. 8.3±4.3 %, p&lt;0.05), as well as ≥2 risk factors at the same time (45.7±3.1 vs. 20.0±4.0 %, p&lt;0.05), which confirms the role of the above factors as probable risks of relapse in TB patients.&#x0D; CONCLUSIONS. Since the role of unfavourable NDPTB course, medical and social risk factors such as unemployment, severe comorbidities, alcohol abuse, HIV infection and some others (belonging to persons of no fixed abode, release from prison, contact with a TB patient) as possible causes of the development (or contributing to) RPTB, which subsequently negatively affect treatment outcomes, patients with these factors should be considered a particularly dangerous population for the development of PTB and, accordingly, should be screened and monitored for life in risk groups accordingly.&#x0D; Given that the detection of MDR-TB in the first case of PTB is the most dangerous risk factor for RPTB, it is necessary to introduce the determination of MDR-TB resistance in all patients with NDPTB and, despite the results of their treatment, to follow up such persons in risk groups.&#x0D; Late detection of RPTB (in 3⁄4) indicates organisational shortcomings of primary care in TB control, primarily in the formation of risk groups and work with them, and requires the implementation of preventive measures taking into account the new realities and challenges of wartime.

Predictive capabilities of baseline radiological findings for early and late disease outcomes within sensitive and multi-drug resistant tuberculosis cases

PurposeThis study compares performance of Timika Score to standardized, detailed radiologist observations of Chest X rays (CXR) for predicting early infectiousness and subsequent treatment outcome in drug sensitive (DS) or multi-drug resistant (MDR) tuberculosis cases. It seeks improvement in prediction of these clinical events through these additional observations. MethodThis is a retrospective study analyzing cases from the NIH/NIAID supported TB Portals database, a large, trans-national, multi-site cohort of primarily drug-resistant tuberculosis patients. We analyzed patient records with sputum microscopy readings, radiologist annotated CXR, and treatment outcome including a matching step on important covariates of age, gender, HIV status, case definition, Body Mass Index (BMI), smoking, drug use, and Timika Score across resistance type for comparison. Results2142 patients with tuberculosis infection (374 with poor outcome and 1768 with good treatment outcome) were retrospectively reviewed. Bayesian ANOVA demonstrates radiologist observations did not show greater predictive ability for baseline infectiousness (0.77 and 0.74 probability in DS and MDR respectively); however, the observations provided superior prediction of treatment outcome (0.84 and 0.63 probability in DS and MDR respectively). Estimated lung abnormal area and cavity were identified as important predictors underlying the Timika Score’s performance. ConclusionsTimika Score simplifies the usage of baseline CXR for prediction of early infectiousness of the case and shows comparable performance to using detailed, standardized radiologist observations. The score’s utility diminishes for treatment outcome prediction and is exceeded by the usage of the detailed observations although prediction performance on treatment outcome decreases especially in MDR TB cases.

TB programme stakeholder views on lessons from the COVID-19 response in South Africa.

The global COVID-19 pandemic has reversed many of the hard-won gains made in TB programmes and the associated reduction in the number of TB deaths, case notifications and incidence over the last three decades. Modelling estimates show that the impact will be lasting. There are global calls to recover the shortfalls along the TB care cascade that have resulted from COVID-19, with the recognition that the COVID-19 response holds lessons to inform more robust and comprehensive TB programmes and services. To explore lessons from response measures to the COVID-19 pandemic in two high TB burden South African provinces. This was an exploratory qualitative study. We conducted interviews with TB programme stakeholders (managers and facility-level staff: n = 35) between February and June 2022. We identified eight facilitators of the COVID-19 response, including political will, rapid policy development, multi-sectoral collaboration, patient-centred models of care delivery, community engagement, mHealth and telehealth technologies, rigorous contact tracing and widespread mask wearing. Political will was singled out as a critical driver of the response. Leveraging COVID-19 inspired collaborations, technologies and avenues for health service delivery is an opportunity to maximise benefits for the TB programme. Reinvestment in national TB programmes and political prioritisation of TB are critical.

Improving TB control: efficiencies of case-finding interventions in Nigeria.

KNCV Nigeria implements seven key TB case-finding interventions. It was critical to evaluate the efficiency of these interventions in terms of TB yield to direct future prioritisation in the country. To compare the efficiency of active case-finding (ACF) interventions for TB in Nigeria. Data from the 2020-2022 implementing period were analysed retrospectively. Intervention efficiencies were analysed using the number needed to screen (NNS), the number needed to test (NNT) and the true screen-positive (TSP) rate. Across the interventions, 21,704,669 persons were screened for TB, 1,834,447 (8.5%) were presumed to have TB (7.7% pre-diagnostic drop-out rate) and 122,452 were diagnosed with TB (TSP rate of 7.2%). The average TSP rate of interventions that used both the WHO four-symptom screen (W4SS) and portable digital X-ray (PDX) screening algorithm was significantly higher (22.6%) than those that employed the former alone (7.0%; OR 3.9, 95% CI 3.74-3.98; P < 0.001). The average NNT for interventions with W4SS/PDX screening was 4 (range: 4-5), while that of W4SS-only screening was 14 (range: 11-22). Interventions using the PDX in addition to W4SS for TB screening were more efficient in terms of TB case yield than interventions that used symptom-based TB screening only.

THE EFFECTIVENESS OF HEALTH EDUCATION USING VIDEO MEDIA ON KNOWLEDGE OF PULMONARY TB PREVENTION IN NURSING STUDENT IN WAMENA

Indonesia is the fifth country in Southeast Asia with the most cases of pulmonary TB. Papua is one of the provinces with a high incidence of pulmonary TB. One of the efforts to reduce the number of pulmonary TB is providing health education about tuberculosis prevention efforts using audiovisual media. This study aims to determine the effectiveness of health education using video media on knowledge of pulmonary TB prevention. The research used the design of The One Group Pre Test – Post Test, with the type of research being Quasi Experiment. It was carried out in the Wamena Nursing DIII Study Program with a sample of 32 respondents. Respondents were given a pre-test questionnaire and a health education intervention using video. After ten days of providing health education, respondents were given a questionnaire (post-test). Statistical analysis using Wilcoxon. The results showed a significant increase in knowledge about pulmonary TB prevention between the pre-test and post-test (p=0.000). It was concluded that health education using audiovisual media was more effective in providing information on the prevention of pulmonary TB.

Comparative performance evaluation of QIAreach QuantiFERON-TB and tuberculin skin test for diagnosis of tuberculosis infection in Viet Nam

Current WHO-recommended diagnostic tools for tuberculosis infection (TBI) have well-known limitations and viable alternatives are urgently needed. We compared the diagnostic performance and accuracy of the novel QIAreach QuantiFERON-TB assay (QIAreach; index) to the QuantiFERON-TB Gold Plus assay (QFT-Plus; reference). The sample included 261 adults (≥ 18 years) recruited at community-based TB case finding events. Of these, 226 underwent Tuberculin Skin Tests and 200 returned for interpretation (TST; comparator). QIAreach processing and TST reading were completed at lower-level healthcare facilities. We conducted matched-pair comparisons for QIAreach and TST with QFT-Plus, calculated sensitivity, specificity and area under a receiver-operating characteristic curve (AUC), and analyzed concordant-/discordant-pair interferon-gamma (IFN-γ) levels. QIAreach sensitivity and specificity were 98.5% and 72.3%, respectively, for an AUC of 0.85. TST sensitivity (53.2%) at a 5 mm induration threshold was significantly below QIAreach, while specificity (82.4%) was statistically equivalent. The corrected mean IFN-γ level of 0.08 IU/ml and corresponding empirical threshold (0.05) of false-positive QIAreach results were significantly lower than the manufacturer-recommended QFT-Plus threshold (≥ 0.35 IU/ml). Despite QIAreach’s higher sensitivity at equivalent specificity to TST, the high number of false positive results and low specificity limit its utility and highlight the continued need to expand the diagnostic toolkit for TBI.