Tuberculosis Control Research Articles

Collaborative circle for the control and prevention of tuberculosis.

Collaborative circle for the control and prevention of tuberculosis.

Treatment for multidrug-resistant tuberculosis: A comparative analysis of programmatic outcome indicators between Buenaventura and other municipalities of Valle del Cauca, Colombia

Introduction. Proper management of multidrug-resistant tuberculosis is a prioritized strategy for tuberculosis control worldwide. Objective. To evaluate differences concerning demographic and clinical characteristics and programmatic indicators of Buenaventura patient cohort with confirmed diagnosis of multidrug-resistant tuberculosis, compared to those of the other municipalities from Valle del Cauca, Colombia, 2013-2016. Materials and methods. We conducted an analytical cohort study to compare records of patients older than 15 years with multidrug-resistant tuberculosis included in the Programa de Tuberculosis de Buenaventura (with para-aminosalicylic acid) versus the other municipalities of Valle del Cauca (without para-aminosalicylic). Results. Ninety-nine cases were recorded with a median age of 40 years (IQR = 26 - 53); in Buenaventura, 56% of the patients were women, while in the other municipalities, men predominated with 67%; 95% had health insurance. The most common comorbidity was diabetes (14%). Adverse reactions to antituberculosis medications in Buenaventura were 1.3 times more frequent than in the other municipalities (OR = 2.3; 95% CI = 0.993 - 5.568; p = 0.04). In Buenaventura, the mortality rate was 5% compared to the 15% reported in the other municipalities. Treatment failures were not reported in Buenaventura, but 35% did not continue with the follow-up. Treatment success was higher in Buenaventura (56 %). Conclusion. A strengthened program in Buenaventura presented better programmatic results than those from the other municipalities of Valle del Cauca. Access to molecular tests, availability of shortened treatments, and continuous monitoring to identify adverse reactions to antituberculosis medications are routes for all other control programs.

The Particularities of Pulmonary Tuberculosis in Children with Type 1 Diabetes: About 2 Cases

The combination of pulmonary tuberculosis and type 1 diabetes is a significant public health problem, especially in developing countries, where the incidence of both diseases is rising sharply. According to the World Health Organization (WHO), by 2022, 23% of tuberculosis cases will be in Africa. Morocco is one of the countries with a medium incidence of tuberculosis. The Ministry of Health has launched a national strategic plan for the prevention and control of tuberculosis. However, there is no national study on the prevalence of tuberculosis in diabetic children in Morocco. Several studies in the literature have investigated the specifics of this association, and have shown that there is a two-way association between tuberculosis and type 1 diabetes. Latent tuberculosis is most common in diabetic children, while active tuberculosis can give rise to severe and atypical presentations. In this study 2 cases have been reported of type 1 diabetes associated with pulmonary tuberculosis, of varying severity, in a 15-year-old child known to be diabetic and an 18-month-old infant with inaugural diabetes, in order to determine the clinical, paraclinical, therapeutic and evolutionary particularities of tuberculosis in these children.

Type 2 diabetes mellitus as an independent risk factor of pulmonary tuberculosis: A hospital based cross-sectional study

Background: The growing frequency of infectious and non-communicable illnesses on a global scale is primarily associated with the changing patterns observed in epidemiology. Diabetes mellitus (DM) significantly leads to the development of tuberculosis (TB) and less effective treatment outcomes if not identified early. Objective: This study aims to investigate type 2 DM as a risk factor for TB infection.Methods: Participants in this cross-sectional research study comprised DM patients who reported cough complaints at the TB treatment center and the internal medicine department of Zainoel Abidin Hospital. Random blood glucose and glycated hemoglobin (HbA1c) levels were measured in all respondents. The Chi-Square test assesses the association between DM and Pulmonary TB.Results: There are 48 DM patients with new pulmonary TB, an averageage of 53 years (SD 9.1). Most of them have symptoms of cough for more than 2 weeks (85.4%), loss of body weight (77.1%), chest pain (58.3%), and loss of appetite (72.9%). The high HbA1c levels were associated with TB, as detected by Xpert MTB/RIF assay and typical radiographic signs (p<0.05). DM patients with increased HbA1c were found to have a two times chance of showing results from a chest x-ray typical of TB and probability of TB infection (PR: 2.850, 95% CI (1.152-7.053); 2.745, 95% CI (0.969-7.780)) respectively.Conclusion: DM patients had two times the risk of lung damage based on chest X-rays and having TB. DM may seriously compromise the efficacy of TB control programs and impede a nation's progress toward TB elimination.

The job burnout of tuberculosis healthcare workers and associated factors under integrated tuberculosis control model: a mixed-method study based on the two-factor theory

BackgroundChina has made remarkable achievements in tuberculosis (TB) prevention and control, but it still takes long way to achieve the End TB goal especially in underdeveloped Southwest China. TB healthcare workers (HCWs) are core forces in TB prevention and control but often face job burnout. This study aimed to explore the burden and associated factors of job burnout among TB HCWs in Southwest China.MethodsThis cross-sectional study used both survey questionnaires and semi-structured interviews, to assess job burnout among TB HCWs based on Malasch Model and explore the associated factors based on Herzberg’s two-factor theory (different hygiene and motivation factors). Quantitative data analysis adopts multiple linear regression to in SPSS 22.0, and qualitative data were analyzed through a framework approach.ResultsA total of 1140 TB HCWs were included in questionnaire surveys. The overall job burnout rates of TB HCWs in Centers for Disease Control and Prevention (CDC), designated hospitals and Primary Health Care (PHC) sectors were 55%, 70.1% and 67.5%, respectively. TB HCWs in CDC who scored lower in interpersonal factors had a higher risk of depersonalization (DP) [B(95%CI): -0.89 (-1.71 to -0.80)]. TB HCWs in designated hospitals who scored lower in doctor-patient relationship factors [B (95%CI): 6.63 (-12.06 to -1.20)] were more likely to have emotional exhaustion (EE). TB HCWs who were less satisfied with training, supervision and assessment in PHC sectors [B(95%CI): 0.65 (0.03 to 1.26)] had less personal accomplishment (PA). Interviews with nine TB HCWs showed that poor environment could lead to high infection and heavy workload could lead to work pressure among TB HCWs in Chongqing. It is also found that performance assessment and management of TB HCWs, communication and cooperation and so on are related to job burnout.ConclusionsTB HCWs had different levels of job burnout in CDC, designated hospitals, and PHC sectors of Chongqing, which were affected by different hygiene and motivation factors. Governments, organizations and individuals should take cooperative measures such as strengthening communication to deal with job burnout among TB HCWs.

SARS-CoV-2 coinfection in children with severe airway obstruction due to pulmonary tuberculosis.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had a significant impact on tuberculosis (TB) control globally, with the number of new TB diagnoses decreasing. Coinfection with some viruses, especially measles, could aggravate TB in children. This is presumably a result of depressed cellular immunity. Reports on children with TB and SARS-CoV-2 coinfection are limited. A retrospective analysis of children up to 13 years old admitted to Tygerberg Hospital, Cape Town, South Africa, from March 2020 to December 2022 with suspected TB-induced airway compression requiring bronchoscopy. Children were included if they presented with severe intrathoracic airway obstruction and/or radiographic evidence of complicated TB. The patients were divided into two groups based on SARS-CoV-2 respiratory polymerase chain reaction results. Demographics, TB exposure, microbiology, SARS-CoV-2 laboratory data, imaging, inflammatory cytokine levels, and bronchoscopy data were collected. Statistical analyses compared SARS-CoV-2 positive and negative groups. Of the 50 children undergoing bronchoscopy for TB airway obstruction, 7 (14%) were SARS-CoV-2 positive. Cough was more prevalent in the SARS-CoV-2 positive group (p = 0.04). There was no difference in TB culture yield between groups. However, SARS-CoV-2 positive children showed slower radiological improvement at 1 month (p = 0.01), pleural effusions (p < 0.001), and a higher need for endoscopic enucleation (p < 0.001). FDG PET/CT scans indicated an ongoing inflammation in the SARS-CoV-2 positive group. Coinfection with SARS-CoV-2 in children with TB airway obstruction appears to complicate the disease course, necessitating more medical interventions and demonstrating a longer duration of the TB inflammatory process. Further research is needed to understand the impact of viral infections on TB progression and outcomes in pediatric patients.

Health worker perspectives on barriers and facilitators of tuberculosis investigation coverage among index case contacts in rural Southwestern Uganda: a qualitative study

BackgroundIn 2012, the World Health Organization recommended screening and investigation of contacts of index tuberculosis patients as a strategy to accelerate detection of tuberculosis (TB) cases. Nine years after the adoption of this recommendation, coverage of TB contact investigations in Uganda remains low. The objective of this study was to examine health care providers’ perceptions of factors influencing coverage of TB contact investigations in three selected rural health facilities in Mbarara district, southwestern Uganda.MethodsThis study identified provider opinions on the barriers and facilitators to implementation of TB contact investigation using the Consolidated Framework for Implementation Research. Using an exploratory qualitative study design, semi-structured interviews with 19 health workers involved in the TB program at district, health facility and community levels were conducted from April 2020 and July 2020. Analysis was conducted inductively using reflexive thematic analysis in six iterative steps: familiarizing with the data, creating initial codes, searching for themes, reviewing themes, developing theme definitions, and writing the report.ResultsNineteen health care workers participated in this study which translates to a 100% response rate. These included two district TB and leprosy supervisors, five nurses, five clinical officers, six village health team members and one laboratory technician. The three themes that emerged from the analysis were intervention-related, health system and contextual factors. Health system-related barriers included inadequate or delayed government funding for the TB program, shortage of human resources, insufficient personal protective equipment, and a stock-out of supplies such as Xpert MTB cartridges. Contextual barriers included steep terrain, poverty or low income, and the stigma associated with TB and COVID-19. Facilitators comprised increased knowledge and understanding of the intervention, performance review and on-the-job training of health workers.ConclusionsThis study found that most of the factors affecting TB contact investigations in this rural community were related to health system constraints such as inadequate or delayed funding and human resource shortages. This can be addressed by strengthening the foundational elements of the health system - health financing and human resources - to establish a comprehensive TB control program that will enable the efficient identification of missing TB patients.

Influence of tuberculosis knowledge on acceptance of preventive treatment and the moderating role of tuberculosis stigma among China’s general population: cross-sectional analysis

BackgroundPreventive treatment of tuberculosis infection (TBI) is considered a crucial strategy to prevent and control tuberculosis (TB). However, the acceptance and completion rates of preventive therapy for TBI are still far from optimistic. Evidence is mounting that TB knowledge and stigma may have a substantial effect on acceptance of TBI treatment. This study aimed to explore the effect of stigma on the relationship between the level of TB knowledge and acceptance of TBI treatment.Methods7017 general population were included in the study. We adjusted for the covariates at the individual. Stepwise logistic regression was used to examine the moderating role of TB stigma and also explore the association between TB knowledge and acceptance of TBI treatment.ResultsThe acceptance rate of TBI treatment among the respondents was 84.38% (n = 5921). Among respondents, a significant positive correlation between acceptance of TBI treatment and TB knowledge (OR = 1.096,95%CI = 1.073,1.118). Additionally, the association between TB knowledge and acceptance of TBI treatment was found to be moderated by TB stigma. In other words, TB stigma was found to weaken the impact of TB knowledge on acceptance of TBI treatment (OR = 0.994,95%CI = 0.991,0.996).ConclusionThe findings of the study indicated that having a high level of awareness about TB can enhance the general population’s acceptability of TBI treatment. TB stigma moderated this association; it weakened the relationship between TB knowledge and individuals’ willingness to accept TBI treatment. To mitigate TB stigma and enhance the intention of individuals with TBI to accept preventive therapy, it is imperative to enhance TB-related health education.

Fc-engineered antibodies promote neutrophil-dependent control of Mycobacterium tuberculosis

Mounting evidence indicates that antibodies can contribute towards control of tuberculosis (TB). However, the underlying mechanisms of humoral immune protection and whether antibodies can be exploited in therapeutic strategies to combat TB are relatively understudied. Here we engineered the receptor-binding Fc (fragment crystallizable) region of an antibody recognizing the Mycobacterium tuberculosis (Mtb) capsule, to define antibody Fc-mediated mechanism(s) of Mtb restriction. We generated 52 Fc variants that either promote or inhibit specific antibody effector functions, rationally building antibodies with enhanced capacity to promote Mtb restriction in a human whole-blood model of infection. While there is likely no singular Fc profile that universally drives control of Mtb, here we found that several Fc-engineered antibodies drove Mtb restriction in a neutrophil-dependent manner. Single-cell RNA sequencing analysis showed that a restrictive Fc-engineered antibody promoted neutrophil survival and expression of cell-intrinsic antimicrobial programs. These data show the potential of Fc-engineered antibodies as therapeutics able to harness the protective functions of neutrophils to promote control of TB.

Overview of Tuberculosis: Causes, Symptoms and Risk Factors

Tuberculosis (TB) remains a global health threat, exacerbated by factors such as drug resistance, co-infections, and social determinants of health. This comprehensive review examines various aspects of TB, including epidemiology, pathophysiology, diagnosis, treatment, prevention, and control measures. The bacterium Mycobacterium tuberculosis causes TB and primarily affects the lungs, although it can also affect other organs. Risk factors for TB include poverty, malnutrition, overcrowded living conditions, and immunocompromised states such as HIV/AIDS. Symptoms of TB include cough, fever, weight loss, and night sweats, but can vary depending on the site of infection. Diagnosis typically involves clinical evaluation, imaging studies, and microbiological testing, with rapid molecular tests such as the Xpert MTB/RIF assay revolutionizing TB diagnostics. Treatment consists of multidrug therapy for six to nine months, with drug-resistant TB requiring longer and more complex regimens. Prevention and control efforts focus on early case detection, treatment adherence, infection control measures, and Bacille Calmette-Guérin (BCG) vaccine vaccination. TB research and innovation aim to develop new diagnostics, drugs, and vaccines to improve TB control and treatment outcomes. Challenges to TB control include stigma, healthcare access barriers, and the rise of drug-resistant TB strains. Collaboration and advocacy efforts are essential for addressing TB in special populations, high-risk settings, and co-infection scenarios. Integrating a One Health approach, harnessing technology, and addressing climate change impacts is critical for advancing TB control efforts and achieving the goal of ending the global TB epidemic.

Implementation of “Test and Treat” Strategy: Analysis of Deaths of People Living with HIV from 2017 to 2022 in Baise City, China

Background: Acquired immune deficiency syndrome (AIDS) remains a significant public health concern in China. Treatment coverage has been expanded by revising the antiretroviral therapy (ART) for people living with HIV (PLWH). Several years after implementing the new “Test and Treat” strategy, it is essential to evaluate its impact on people living with HIV since its implementation. Objectives: This study was conducted to comprehensively analyze the deaths of PLWH from 2017 to 2022 in Baise City, China. Methods: A retrospective cohort study was conducted to comprehensively analyze the deaths of PLWH in Baise from 2017 to the first half of 2022. The data was acquired from the AIDS Information System (AIDSIS). The all-cause and AIDS-related mortality rates were calculated for PLWH, along with the proportion of specific death causes. Interrupted time series analysis was utilized to examine changes in all-cause mortality pre- and post-implementation of the new strategy. Kaplan-Meier curves were drawn to compare the mortality risk within 1 year of diagnosis between treated and untreated patients, as well as between late discoverers and non-late discoverers. Related factors of death were also analyzed using the Cox proportional hazards regression model. Results: During the observation period, among a total of 8,922 PLWH cases, 1,265 people died, resulting in an all-cause mortality rate of 4.19 per 100 person-years. Acquired immune deficiency syndrome -related deaths numbered 438, accounting for 34.62% of the total deaths, with a mortality rate of 1.45 per 100 person-years. There were 730 non-AIDS-related deaths, representing 57.71%, with a mortality rate of 2.42 per 100 person-years. The overall mortality rate from all causes within 1 year after diagnosis was 5.58 per 100 person-years. No significant difference was identified in the all-cause mortality rate between the periods before and after the implementation of the new strategy. Untreated PLWH and late discoverers exhibited a high risk of death within 1 year of diagnosis. Most deaths were caused by common chronic diseases, while AIDS-related mortality was mainly due to opportunistic infections. Factors such as gender, age at diagnosis, occupation, educational background, ethnic group, infection route, history of ART, and baseline CD4 level were associated with the risk of all-cause mortality and AIDS-related mortality. Conclusions: After the implementation of the “Test and Treat” strategy, no significant difference in mortality among PLWH was recorded in Baise City, China. We recommend that the health department strengthen the testing of PLWH and improve treatment options. Additionally, we suggest encouraging the maintenance of long-term ART treatment and taking measures to prevent and control tuberculosis and common chronic diseases in individuals who are HIV positive.

Transmission dynamics of tuberculosis in a high-burden area of China: An 8-year population-based study using whole genome sequencing

ObjectivesThis study investigated the transmission patterns of tuberculosis (TB) and its associated risk factors in Hunan province to inform the development of prevention and control strategies in the region. MethodsAn 8-year retrospective population-based genomic epidemiological study was conducted. Genomic clusters were defined using distance thresholds of 12-single-nucletide-polymorphisms. Risk factors associated with TB transmission were analyzed using logistic regression model. Kernel Density analysis was used to locate hotspots where transmission occurred. ResultsAmong 2649 TB cases included in this study, 275 clusters were identified, with an overall clustering rate of 24.7% (654/2649). Nearly 95% (620/654) of clustered strains were isolated from the same county. Of the 275 clusters, 23 (8.4%, 23/275) had differences in drug-resistant profiles, with FQs resistance mutations occurring most frequently (52.2%, 12/23). Multivariate analysis identified male TB patients, those aged 30-60 years, ethnic minorities, nonfarmers, retreated TB patients, and individuals infected with MDR/RR-TB as independent risk factors for TB transmission (P < 0.05). Kernel density analysis showed that among the 5 drug-resistant surveillance sites, Leiyang had the highest clustering rate, followed by Yongshun, Qidong, Hecheng, and Taojiang. ConclusionRecent transmission in the region is predominantly occurring within counties. The risk factors related to TB transmission and the hotspots where transmission occurs can provide a scientific basis for the formulation of targeted TB prevention and control strategies.

Trends of drug resistance in M. tuberculosis in a reference laboratory in Central India: Forging ahead towards TB elimination

PurposeThe National Tuberculosis Elimination Programme (NTEP) of the Government of India has strived to control tuberculosis (TB) in the country through various interventions. Understanding the trends of resistance patterns may provide insights into the effectiveness of TB control activities in the country. MethodsA total of 31,144 clinical samples were received from 2013 to 2022 from presumptive drug-resistant TB patients. All the specimens were decontaminated and subjected to the line probe assay for detection of resistance to rifampicin and isoniazid. Mycobacterium tuberculosis (MTB) was detected in 28,814 samples. Autoregressive integrated moving average model (ARIMA) was fitted to assess the trend over time. ResultsA decreasing trend in multi-drug resistant TB from 19 % in 2013 to 4 % in 2022 was seen. A decreasing trend in rifampicin monoresistance from 11.2 % in 2013 to 1.5 % in 2022 was seen, though there was an increase in resistance in 2017. No significant decreasing trends were seen in the proportion of isoniazid monoresistance from 8.3 % in 2013 to 7 % in 2022. ConclusionThe findings are encouraging, and to a considerable extent, affirm that India is well on track with regard to the goal of TB elimination.

Pemberdayaan Masyarakat tentang Tuberkulosis serta Pelatihan Etika Batuk di Kelurahan Sendang Mulyo

Tuberculosis control requires synergy between the government and the community. The success of TB control in an area is inseparable from the role of the community, which can be pursued by empowering the community. Community empowerment in TB control is to foster awareness, ability and willingness in breaking the chain of TB transmission. This activity aims to increase the knowledge and ability of the community in breaking the chain of TB transmission. The method of activity is carried out by providing counseling and training directly to the community. The results of the activity showed an increase in knowledge and ability of the community in understanding about TB. Direct counseling on TB and direct training on how to cough properly have a good and effective impact in increasing the knowledge and abilities of the community. It is recommended that empowerment activities by providing direct material about TB and direct training on how to cough properly be carried out more intensively and also involve health cadres.

Pan-Lineage Mycobacterium tuberculosis Reference Genome for Enhanced Molecular Diagnosis.

In Mycobacterium tuberculosis (MTB) control, whole genome sequencing-based molecular drug susceptibility testing (molDST-WGS) has emerged as a pivotal tool. However, the current reliance on a single-strain reference limits molDST-WGS's true potential. To address this, we introduce a new pan-lineage reference genome, "MtbRf". We assembled "unmapped" reads from 3,614 MTB genomes (751 L1; 881 L2; 1,700 L3; and 282 L4) into 35 shared, annotated contigs (54 CDSs). We constructed MtbRf through: 1) searching for contig homologs among genome database that precipitating results uniquely within Mycobacteria genus; 2) comparing genomes with H37Rv ("lift-over") to define 18 insertions; and 3) filling gaps in H37Rv with insertions. MtbRf adds 1.18% sequences to H37rv, salvaging >60% of previously unmapped reads. Transcriptomics confirmed gene-expression of new CDSs. The new variants provided a moderate DST predictive value (AUROC 0.60-0.75). MtbRf thus unveils previously hidden genomic information, and lays the foundation for lineage-specific molDST-WGS.

Assessing the impact of COVID-19 management on the workload of human resources working in India’s National Tuberculosis Elimination Program

BackgroundIn 1993, WHO declared tuberculosis (TB) as a global health emergency considering 10 million people are battling TB, of which 30% are undiagnosed annually. In 2020 the COVID-19 pandemic took an unprecedented toll on health systems in every country. Public health staff already engaged in TB control and numerous other departments were additionally tasked with managing COVID-19, stretching human resource (HR) capacity beyond its limits. As part of an assessment of HR involved in TB control in India, The World Bank Group and partners conducted an analysis of the impact of COVID-19 on TB human resources for health (HRH) workloads, with the objective of describing the extent to which TB-related activities could be fulfilled and hypothesizing on future HR requirements to meet those needs.MethodsThe study team conducted a Workload Indicators and Staffing Needs (WISN) analysis according to standard WHO methodology to classify the workloads of priority cadres directly or indirectly involved in TB control activities as over-, adequately or under-worked, in 18 districts across seven states in India. Data collection was done via telephone interviews, and questions were added regarding the proportion of time dedicated to COVID-19 related tasks. We carried out quantitative analysis to describe the time allocated to COVID-19 which otherwise would have been spent on TB activities. We also conducted key informant interviews (KII) with key TB program staff about HRH planning and task-shifting from TB to COVID-19.ResultsWorkload data were collected from 377 respondents working in or together with India’s Central TB Division (CTD). 73% of all respondents (n = 270) reported carrying out COVID-19 tasks. The average time spent on COVID-19 tasks was 4 h / day (n = 72 respondents). Multiple cadres highly instrumental in TB screening and diagnosis, in particular community outreach (ASHA) workers and CBNAAT/TrueNAAT laboratory technicians working at peripheral, block and district levels, were overworked, and spending more than 50% of their time on COVID-19 tasks, reducing time for TB case-finding. Qualitative interviews with laboratory technicians revealed that PCR machines previously used for TB testing were repurposed for COVID-19 testing.ConclusionsThe devastating impact of COVID-19 on HR capacity to conduct TB case-finding in India, as in other settings, cannot be overstated. Our findings provide clear evidence that NTEP human resources did not have time or essential material resources to carry out TB tasks during the COVID pandemic without doing substantial overtime and/or compromising on TB service delivery. To minimize disruptions to routine health services such as TB amidst future emerging infectious diseases, we would do well, during periods of relative calm and stability, to strategically map out how HRH lab staff, public health resources, such as India’s Health and Wellness Centers and public health cadre, and public-private sector collaboration can most optimally absorb shocks to the health system.

Risk factors of pulmonary tuberculosis in Indonesia: A case-control study in a high disease prevalence region.

Tuberculosis (TB) remains one of the most widespread infectious diseases in the world, with high mortality and morbidity rates, contributing to a significant disease burden, particularly in developing countries. The aim of this study was to determine the risk factors of TB among the population aged 17 years (late adolescent) and above in one of the high TB prevalence countries, Indonesia. A case-control study was conducted in Banda Aceh, Indonesia, involving newly diagnosed pulmonary TB patients who visited one of the eleven community health centers in Banda Aceh. The controls were individuals matched by age and sex who lived near the cases and had no TB infection. A total of 16 risk factors were assessed. Hierarchical multivariable logistic regression models were used to examine the association between the risk factors and the occurrence of TB. A total of 196 cases and 196 controls were included in the study. Multivariable logistic regression analysis identified 11 independent predictors for the occurrence of TB after controlling possible confounders. Patients who lived in houses with insufficient light exposure were 77 times more likely to develop TB compared to those living in houses with sufficient light exposure (adjusted odds ratio (AOR): 77.69; 95%CI: 27.09, 222.79). The study also showed that people who had close contact with TB patients (AOR: 25.39; 95%CI: 2.10, 306.52), had poor knowledge of TB (AOR: 24.2; 95%CI: 6.89, 85.17), had comorbidities (AOR: 4.49; 95%CI: 1.35, 14.89), insufficient food utilization (AOR: 3.41; 95%CI: 1.51, 7.71), negative preventive behavior (AOR: 3.39; 95%CI: 1.49, 7.72), low education level (AOR: 3.08; 95%CI: 1.26, 7.55), and insufficient housing humidity (AOR: 2.89; 95%CI: 1.18, 7.12) were associated with increased the odds of having TB. Being employed, having income above minimum wage, and having good nutritional intake were protective factors for developing TB. In conclusion, the determinants of TB among people aged 17 years and older are a clear indication of the need for TB prevention programs targeting not only individual risk factors but also environmental risk factors, particularly providing adequate housing conditions. This study provided useful information that might help to develop and adopt effective policies for TB control in Indonesia.

Empowerment Tuberculosis Cadres with Participatory Socialization as Effort to Improve The TB Suspect's Achievements at The Sempu’s Public Health Center

Background: Tuberculosis (TB) is an infectious disease with high mortality and morbidity rates in Indonesia, caused by the bacterium Mycobacterium tuberculosis. The Case Detection Rate (CDR) in Banyuwangi is still relatively low at 54% compared to the set target. In Banyuwangi, one of the Non-Governmental Organizations (NGOs), Yayasan Bhanu Yasa Sejahtera Yabhysa, supports the TB control program in the region. Since 2021, this community has collaborated with the Banyuwangi Health Department to implement community-based TB interventions in 28 Community Health Centers (Puskesmas) spread across 16 districts, with a total of 66 active TB cadres. The aim of this community service is to train Tuberculosis (TB) cadres through socialization to improve the performance of TB suspects in Sempu Banyuwangi Community Health Center. Methods: The analysis of knowledge improvement data used a paired T-test with a 95% Confidence Interval. The test was conducted to evaluate the difference in knowledge improvement before and after education. Results: From the results of this community service, there was an increase in knowledge before and after socialization by 0.06 or 6%. The formation of TB cadres through contact investigation simulation carried out in community service activities resulted in the formation of four cadres. Conclusion: Based on the pre-test and post-test results, respondents showed a 6% increase in knowledge. The hope of this community service is to improve the achievement of TB suspect cases and reduce TB cases in Sempu Community Health Center.

Hepatotoxicity during anti tuberculosis chemotherapy

Introduction: Despite their efficacy in tuberculosis treatment, side-effects of anti-tuberculosis drugs can be serious or fatal. The aim of our study is to determine the prevalence of hepatic toxicities associated with anti-tuberculosis drugs, their evolutionary aspects, and their management. Patients and methods: A retrospective descriptive study including 82 patients having received antituberculosis treatment and who pre-sented a hepatic cytolysis, collected at the Tuberculosis and Respiratory Diseases Control Department of Batna- Algeria between 2016 -2023. The aim of our study is to determine the prevalence of hepatic toxicities of anti-tuberculosis drugs, their evolutionary aspects, as well as the modalities of their management. Results: 82 out of 119 (69.23%) patients who experienced other adverse events were recruited between 2016 and 2023, aged between 15 and 86 years, with an average age of 43 years and a female predominance of 63.41%. Cholestasis syndrome was noted in 21 patients and frank jaundice in 4. Cytolysis was discovered incidentally in 68% of patients; it was mild in 56 (68.29%), moderate in 16 (19.51%) and severe in 10 (12.19%). Transaminase disturbance appeared within 3 months in 76.82% of cases, whereas a delay of 30 days was noted for normalisation of the liver function test after cessation of anti-tuberculosis treatment in 62 (76%) patients. Definitive discontin-uation of isoniazid (INH) was adopted in 17 (20%) patients, while a reduction in the doses of rifampicin and isoniazid was decided in 65 (80%) patients. Conclusion: Drug-induced hepatitis is one of the major side-effects of anti-tuberculosis drugs and can be lethal, hence the need for rapid and appropriate management. Healthcare professionals need to be informed about the types of suspected adverse drug reactions, they should report in subjects at risk.

Characterising the urinary acylcarnitine and amino acid profiles of HIV/TB co-infection, using LC–MS metabolomics

IntroductionThe human immunodeficiency virus (HIV) and tuberculosis (TB) co-infection presents significant challenges due to the complex interplay between these diseases, leading to exacerbated metabolic disturbances. Understanding these metabolic profiles is crucial for improving diagnostic and therapeutic approaches.ObjectiveThis study aimed to characterise the urinary acylcarnitine and amino acid profiles, including 5-hydroxyindoleacetic acid (5-HIAA), in patients co-infected with HIV and TB using targeted liquid chromatography mass spectrometry (LC–MS) metabolomics.MethodsUrine samples, categorised into HIV, TB, HIV/TB co-infected, and healthy controls, were analysed using HPLC–MS/MS. Statistical analyses included one-way ANOVA and a Kruskal-Wallis test to determine significant differences in the acylcarnitine and amino acid profiles between groups.ResultsThe study revealed significant metabolic alterations, especially in TB and co-infected groups. Elevated levels of medium-chain acylcarnitines indicated increased fatty acid oxidation, commonly associated with cachexia in TB. Altered amino acid profiles suggested disruptions in protein and glucose metabolism, indicating a shift towards diabetes-like metabolic states. Notably, TB was identified as a primary driver of these changes, affecting protein turnover, and impacting energy metabolism in co-infected patients.ConclusionThe metabolic profiling of HIV/TB co-infection highlights the profound impact of TB on metabolic pathways, which may exacerbate the clinical complexities of co-infection. Understanding these metabolic disruptions can guide the development of targeted treatments and improve management strategies, ultimately enhancing the clinical outcomes for these patients. Further research is required to validate these findings and explore their implications in larger, diverse populations.