End Tuberculosis Research Articles

End tuberculosis strategy also requires initiation and integration of a national silicosis control program with the ongoing tuberculosis elimination activities: A review of the silicotuberculosis situation in India

Background: Earlier studies conducted by Indian researchers have demonstrated that the elimination of tuberculosis (TB) requires proactive control of silicosis, given India’s significant burden of silicosis and its common comorbidity, pulmonary TB, also known as silicotuberculosis. The TB Control Indian Health Authority saw human immunodeficiency virus infection, diabetes, and malnutrition, among others, as important risk factors for case findings, but overlooked the significance of silicosis. Silicotuberculosis control is often confronted with challenges of detecting microorganisms, uncertain treatment outcomes, a higher likelihood of mono-drug and multi-drug resistance, and increased mortality due to treatment failure. In addition, silicosis has a long latent period, typically 15 years or more, from the onset of silica dust exposure to the appearance of opacities on radiological examination, which is the conventional method of diagnosis of the condition. Objective and recommendation: Facing the aforementioned situation, scientists of the Indian Council of Medical Research-National Institute of Occupational Health have identified a useful biomarker, Club cell secretory protein 16 (CC-16) (a lung protein), that might serve as a surrogate marker for early detection of silicosis among silica dust-exposed workers. An added benefit of CC-16 is its ability to detect sub-radiological silicosis, which is recognized as a risk factor for TB and multi-drug-resistant TB. At present, two researchers have developed point-of-care devices for detecting silica-dust-induced lung damage using serum CC-16, to support its further application. Conclusion: The present review highlights possible mechanisms for the early detection of silicosis and silicotuberculosis by assessing several relevant research publications, and the findings suggest that a national silicosis control program, to be integrated with existing TB elimination activities for sustainable and improved outcomes, should be initiated.

Toward a Clinical Decision Support System for Monitoring Therapeutic Antituberculosis Medical Drugs in Tanzania (Project TuberXpert): Protocol for an Algorithm' Development and Implementation.

The end tuberculosis (TB) strategy requires a novel patient treatment approach contrary to the one-size-fits-all model. It is well known that each patient's physiology is different and leads to various rates of drug elimination. Therapeutic drug monitoring (TDM) offers a way to manage drug dosage adaptation but requires trained pharmacologists, which is scarce in resource-limited settings. We will develop an automated clinical decision support system (CDSS) to help practitioners with the dosage adaptation of rifampicin, one of the essential medical drugs targeting TB, that is known for large pharmacokinetic variability and frequent suboptimal blood exposure. Such an advanced system will encourage the spread of a dosage-individualization culture, including among practitioners not specialized in pharmacology. Thus, the objectives of this project are to (1) develop the appropriate population pharmacokinetic (popPK) model for rifampicin for Tanzanian patients, (2) optimize the reporting of relevant information to practitioners for drug dosage adjustment, (3) automate the delivery of the report in line with the measurement of drug concentration, and (4) validate and implement the final system in the field. A total of 3 teams will combine their efforts to deliver the first automated TDM CDSS for TB. A cross-sectional study will be conducted to define the best way to display information to clinicians. In parallel, a rifampicin popPK model will be developed taking advantage of the published literature, complemented with data provided by existing literature data from the Pan-African Consortium for the Evaluation of Antituberculosis Antibiotics (panACEA), and samples collected within this project. A decision tree will be designed and implemented as a CDSS, and an automated report generation will be developed and validated through selected case studies. Expert pharmacologists will validate the CDSS, and finally, field implementation in Tanzania will occur, coupled with a prospective study to assess clinicians' adherence to the CDSS recommendations. The TuberXpert project started in November 2022. In July 2024, the clinical study in Tanzania was completed with the enrollment of 50 patients to gather the required data to build a popPK model for rifampicin, together with a qualitative study defining the report design, as well as the CDSS general architecture definition. At the end of the TuberXpert project, Tanzania will possess a new tool to help the practitioners with the adaptation of drug dosage targeting complicated TB cases (TB or HIV, TB or diabetes mellitus, and TB or malnutrition). This automated system will be validated and used in the field and will be proposed to other countries affected by endemic TB. In addition, this approach will serve as proof of concept regarding the feasibility and suitability of CDSS-assisted TDM for further anti-TB drugs in TB-burdened areas deprived of TDM experts, including second-line treatments considered important to monitor. DERR1-10.2196/58720.

Isoniazid Hybrids As Potential Antitubercular Agents

AbstractThe rapid emergence of various forms of drug‐resistant tuberculosis (TB) has massively impacted people's health globally. According to the WHO, TB care and facilities have been downgraded by 21% since the COVID‐19 pandemic, which has further slowed down the progress toward the “End TB Strategy.” Multiple studies have shown drug‐resistant tuberculosis to be resilient to front‐line antituberculosis drugs, including isoniazid (INH), thus constantly prompting researchers worldwide to probe new potent chemical entities to replace/supplement the current artillery of anti‐TB therapeutics. The molecular hybridization (MH) technique has recently been adopted by many synthetic and medicinal chemists to combine different pharmacophoric units into a single molecular architecture which in most cases has been reported to exhibit a better pharmacological profile as compared to its precursors. The present review provides a concise account of the MH hybridization strategies directed at the structural manipulations of isoniazid to develop new anti‐TB agents and their structure‐activity relationships. Furthermore, their toxicity profiles and docking studies with relevant receptors are also briefly discussed.

Evaluation of Multiplex loop-mediated isothermal amplification assay for the detection of Mycobacterium tuberculosis complex from clinically suspected cases of pulmonary tuberculosis

Tuberculosis (TB) is the second leading cause of death from a single infectious agent worldwide. Bangladesh ranks 7th among the 30 high TB burdened countries in the world. Accurate detection of Mycobacterium tuberculosis complex (MTBC) is challenging for developing countries as most of the resource poor settings are not suitable to perform molecular techniques.The purpose of the study was to compare the multiplex TB-LAMP assay with MTB/NTM qPCR, culture, Z-N staining, and fluorescence microscopy in order to assess the effectiveness of the LAMP assay for detecting cases of pulmonary tuberculosis.This research work was done from March 2022 to February 2023. Fulfilling the inclusion criteria 130 sputum samples were collected. TB-LAMP assay, qPCR, culture in L-J media, Z-N staining and fluorescence microscopy were performed.Out of 130 samples qPCR detected MTBC in 56.92% cases and TB-LAMP detected 53.85%. MTBC was detected by culture 46.15%, by Fluorescence microscopy 40.77% and Z-N staining 36.92%. TB-LAMP detected 16.93% more cases than Z-N staining and 13.08% more cases than fluorescence microscopy. The sensitivity, specificity, positive, and negative predictive values of multiplex-LAMP assay were 95%, 81.4%, 81.4% and 95% respectively considering culture as a gold-standard. MTBC negative culture samples (18.57%) showed positivity by LAMP assay as well as by qPCR. This study detected 7.69% non-tuberculous mycobacteria (NTM) by qPCR. All NTM positive samples were negative by TB-LAMP.TB-LAMP is an easy to perform, cost-effective, reliable assay with high sensitivity and specificity. World Health Organization recommended TB-LAMP as a rapid molecular test for rapid detection of tuberculosis and as replacement of microscopy in resource poor settings/hard to reach areas. Bangladesh being a high TB burden country it is essential to implement TB-LAMP to achieve End TB Strategy by 2035.

Tracking multidrug resistant tuberculosis: a 30-year analysis of global, regional, and national trends.

To provide valuable insights for targeted interventions and resource allocation, our analysis delved into the multifaceted burden, trends, risks, and projections of multi drug resistant tuberculosis (MDR-TB). This research employed data from the Global Burden of Disease (GBD) 2019 dataset, which used a comparative risk assessment to quantify the disease burden resulting from risk factors. Initially, this database was utilized to extract details concerning the disability-adjusted life years (DALYs), mortality, incidence, and the number of individuals afflicted by MDR-TB. Subsequently, regression analyses were conducted using the Joinpoint program to figure average annual percent change (AAPC) to ascertain the trend. Thirdly, the age-period-cohort model (APCM) was adopted to analyze evolutions in incidence and mortality. Finally, utilizing the Nordpred model within R software, we projected the incidence and mortality of MDR-TB from 2020 to 2030. MDR-TB remained a pressing global health concern in regions with lower socio-demographic indexes (SDI), where the AAPC in DALYs topped 7% from 1990 to 2019. In 2019, the cumulative DALYs attributed to MDR-TB tallied up to 4.2 million, with India, the Russian Federation, and China bearing the brunt. Notably, the incidence rates have shown a steadfast presence over the past decade, and a troubling forecast predicts an uptick in these areas from 2020 to 2030. Additionally, the risk of contracting MDR-TB grew with advancing age, manifesting most acutely among men aged 40+ in lower SDI regions. Strikingly, alcohol consumption had been identified as a significant contributor, surpassing the impacts of smoking and high fasting plasma glucose, leading to 0.7 million DALYs in 2019. A robust strategy is needed to end tuberculosis (TB) by 2030, especially in lower SDI areas.

A Scoping Review: Unveiling the Benefits of ACF on Tuberculosis Control

Background: Tuberculosis (TB) ranks among the top ten infectious diseases and causes of death worldwide. The implementation of active case-finding TV is crucial in achieving the objectives of the World Health Organization’s End TB strategy. Aims: This review aims to determine the role of active case finding in TB control in a community with high-burden TB. Methods: This review used databases Pubmed, Research Gate, Ebscohost, Science Direct, and Scopus. The search for articles used the main keywords community, active case finding, AND tuberculosis. The articles were selected in English, with a five-year time interval between 2019 to 2023. The type of article subject area included medicine, health, health care, environmental science, and social science. The documents were from journals and articles. The text availability was free full text. Results: This review was done on 3.561 articles that were screened and analyzed out of 6 articles. The articles were originated from Cambodia, China, India, and Africa. This scoping review describes the effect of ACF in the community on TB control (cohorts and cross-sectional) in high-burden TB. Results from 5 articles including 6 studies indicated that ACF in the community was significantly associated with TB control. One of the studies revealed that studies in which ACF reported a non-significant association. Conclusion: This review summarized that ACF provides greater benefits than the PCF strategy, especially in high-risk populations and those with limited access to healthcare facilities. It promotes prompt diagnosis and treatment improves treatment outcomes, minimizes health complications, and reduces the social and economic impact of TB.

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.

Factors associated with hospitalization and mortality in adult and pediatric extrapulmonary tuberculosis at a tertiary care hospital in Central India

Background Comorbidities complicate the management of tuberculosis (TB) and have become an essential part of the end TB strategy to eradicate TB. However, pulmonary TB has received the most attention, and little is known about the impact of comorbidities and other factors on outcomes in patients with extrapulmonary tuberculosis (EPTB). Objectives Our aim was to analyze the factors associated with hospitalization and mortality in EPTB at a hospital in Central India, using non-TB patients with similar clinical presentations as a comparison. Methods Patients with presumptive EPTB were prospectively enrolled and followed up until the end of treatment or for at least 6 months. Detailed demographic and clinical information was collected for all participants, and patients were categorized as TB or non-TB using a composite reference standard. Multivariate logistic regression was used to analyze the impact of various clinical findings and risk factors on hospitalization and mortality. Results A total of 276 patients were categorized as TB cases and 175 as non-TB cases. Factors associated with hospitalization in children were younger age and non-adenitis site of disease. In adults, factors associated with mortality were older age, non-adenitis site of disease and HIV infection regardless of TB diagnosis, while diabetes mellitus increased the odds of mortality in EPTB patients. Conclusion Our results show that comorbidities increase the odds of death in both TB and non-TB patients in low-resource settings. This argues for a shift away from the traditional vertical management of diseases in these areas and supports a continued focus on building robust healthcare systems.

Addressing the challenges in laboratory confirmation of paediatric tuberculosis: the role of induced sputum specimen

Tuberculosis (TB) remained the single leading infectious cause of ill health and death globally until the COVID-19 pandemic occurred. Tuberculosis contributes significantly to childhood mortality of about 16% among HIV-negative children worldwide. Childhood tuberculosis is a significant epidemiological tool as childhood TB represents recent transmission in the community and reflects the presence of an infected adult. Previously clinical research, diagnostic methods, and therapeutic discoveries have focused on adult tuberculosis to the neglect of childhood tuberculosis. Limited pediatric surveillance data, poor case ascertainment, and limited resources and capabilities have hindered the attainment of the true burden of childhood tuberculosis in countries with high tuberculosis disease burden. The difficulty in characterising the true burden of tuberculosis is mainly from the difficulty in obtaining adequate and reliable diagnostic samples to confirm TB in children. Sputum induction has proven to be feasible and effective in several LMIC settings. Gene Xpert MTB/Rif; polymerase chain reaction, performed on induced sputum samples is more sensitive in the detection of paucibacillary TB in children as compared to sputum smear testing. This allows for early diagnosis and timely initiation of therapy. It is necessary that we continue to utilize the available tools to improve TB diagnosis in children and ensure we meet End TB and SDG goal 3 targets on time

Assessment of health promotion action for tuberculosis of end tuberculosis action plan (2019–2022) in China

BackgroundTuberculosis is a chronic infectious disease that endangers people’s health, and China is a country with a high burden of tuberculosis. To accelerate the progress towards ending TB, the Chinese government implemented the End TB Action Plan (2019–2022), which consists of six actions. Among the End TB Action Plan, health promotion was conducted to improve the awareness of TB knowledge among Chinese people. The purpose of this study is to evaluate the effectiveness of implementing TB health promotion activities outlined in the End TB Action Plan, and to provide recommendations for future TB prevention and control plan.MethodsA cross-sectional study was conducted in nine Chinese provinces in 2022. A total of 11,920 Chinese people filled out the questionnaire. Logistic regression analysis was used to explore that overall awareness of TB core information is associated with whether they received TB health education.ResultsThe study involved 11,920 Chinese participants. The overall awareness rate of the core information of TB was 84.2%, which does not reach the 85% goal of the End TB Action Plan. The single awareness rate that TB is a chronic infectious disease and that the vast majority of TB patients can be cured were 75.3% and 76.0%. Participants who received TB health education had a higher awareness rate of TB core information. Participants who were elderly, retired or had a primary school education or below had poor awareness of the core information of TB. Participants who were elderly, lived in urban areas, were equipment operators or had a primary school education or below received less TB health education. Participants mainly received TB health education through TV (44.6%) and Internet (37.8%), preferred TV, broadcasts or movies (58.9%) and Internet advertising (54.7%). Participants preferred illustrated (46.2%) and audio-visual (44.8%) advertising materials. The common sources used to answer health-related questions on the internet were We-Medias (48.3%) and search engines (38.9%). Participants preferred to use short-form videos (66.8%) and illustrations (53.1%) to answer health-related questions.ConclusionsHealth promotion action for TB had a positive effect in China, but the awareness of TB was inadequate among Chinese people, and it is necessary to strengthen TB health education for those people. Moreover, TB prevention and control institutions should advertise TB more in audio-visual and illustrated forms on the Internet and audio-visual media. Health-related questions should be published in short-form video and illustrated forms in the We-Media and search engine more.

Retreatment and Anti-tuberculosis Therapy Outcomes in Brazil Between 2015 and 2022: A Nationwide Study.

Adherence to anti-tuberculosis treatment (ATT) in Brazil remains a challenge in achieving the goals set by the World Health Organization (WHO). Patients who are lost to follow-up during treatment pose a significant public health problem. This study aimed to investigate the factors associated with unfavorable ATT outcomes among those undergoing retreatment in Brazil. We conducted an observational study of patients aged ≥18 years with tuberculosis (TB) reported to the Brazilian National Notifiable Disease Information System between 2015 and 2022. Clinical and epidemiologic variables were compared between the study groups (new cases and retreatment). Regression models identified variables associated with unfavorable outcomes. Among 743 823 reported TB cases in the study period, 555 632 cases were eligible, consisting of 462 061 new cases and 93 571 undergoing retreatments (44 642 recurrent and 48 929 retreatments after loss to follow-up [RLTFU]). RLTFU (odds ratio [OR], 3.96 [95% confidence interval {CI}, 3.83-4.1]) was a significant risk factor for any type of unfavorable ATT. Furthermore, RLTFU (OR, 4.93 [95% CI, 4.76-5.11]) was the main risk factor for subsequent LTFU. For death, aside from advanced age, living with HIV (OR, 6.28 [95% CI, 6.03-6.54]) was the top risk factor. Retreatment is a substantial risk factor for unfavorable ATT outcomes, especially after LTFU. The rates of treatment success in RLTFU are distant from the WHO End TB Strategy targets throughout Brazil. These findings underscore the need for targeted interventions to improve treatment adherence and outcomes in persons who experience RLTFU.

Suppression of host gene expression is associated with latent TB infection: a possible diagnostic biomarker

The World Health Organization End TB strategy aims for a 90% reduction of tuberculosis (TB) incidence by 2035. Systematic testing and treatment of latent TB infection (LTBI) among contacts of active TB patients is recommended as one of the ways to curtail TB incidence. However, there is a shortage of tools to accurately diagnose LTBI. We assessed the appropriateness of whole blood host transcriptomic markers (TM) to diagnose LTBI among household contacts of bacteriologically confirmed index cases compared to HIV negative healthy controls (HC). QuantiFERON-TB Gold Plus Interferon gamma release assay (IGRA) and reverse-transcriptase quantitative PCR were used to determine LTBI and quantify TM expression respectively. Association between TM expression and LTBI was evaluated by logistic regression modelling. A total of 100 participants, 49 TB exposed (TBEx) household contacts and 51 HC, were enrolled. Twenty-five (51%) TBEx individuals tested positive by IGRA, and were denoted as LTBI individuals, and 37 (72.5%) HC were IGRA-negative. Expression of 11 evaluated TM was significantly suppressed among LTBI compared to HC. Out of the 11 TM, ZNF296 and KLF2 expression were strongly associated with LTBI and successfully differentiated LTBI from HC. Paradoxically, 21 (49%) TBEx participants who tested IGRA negative exhibited the same pattern of suppressed TM expression as IGRA positive (LTBI-confirmed individuals). Results suggest that suppression of gene expression underlies LTBI and may be a more sensitive diagnostic biomarker than standard-of-care IGRA.

Diagnostic accuracy of the Xpert® MTB/XDR assay for detection of Isoniazid and second-line antituberculosis drugs resistance at central TB reference laboratory in Tanzania

IntroductionEarly diagnosis of tuberculosis (TB) and universal access to drug-susceptibility testing (DST) are critical elements of the WHO End TB Strategy. Current rapid tests (e.g., Xpert® MTB/RIF and Ultra-assays) can detect rifampicin resistance-conferring mutations, but cannot detect resistance to Isoniazid and second-line anti-TB agents. Although Line Probe Assay is capable of detecting resistance to second-line anti-TB agents, it requires sophisticated laboratory infrastructure and advanced skills which are often not readily available in settings replete with TB. A rapid test capable of detecting Isoniazid and second-line anti-TB drug resistance is highly needed.MethodsWe conducted a diagnostic accuracy study to evaluate a new automated Xpert MTB/XDR 10-colour assay for rapid detection of Isoniazid and second-line drugs, including ethionamide, fluoroquinolones, and injectable drugs (Amikacin, Kanamycin, and Capreomycin). Positive Xpert MTB/RIF respiratory specimens were prospectively collected through routine diagnosis and surveillance of drug resistance at the Central TB Reference Laboratory in Tanzania. Specimens were tested by both Xpert XDR assay and LPA against culture-based phenotypic DST as the reference standard.FindingsWe analysed specimens from 151 TB patients with a mean age (SD) of 36.2 (12.7) years. The majority (n = 109, 72.2%) were males. The sensitivity for Xpert MTB/XDR was 93.5% (95% CI, 87.4–96.7); for Isoniazid, 96.6 (95% CI, 92.1–98.6); for Fluoroquinolone, 98.7% (95% Cl 94.8–99.7); for Amikacin, 96.6%; and (95% CI 92.1–98.6) for Ethionamide. Ethionamide had the lowest specificity of 50% and the highest was 100% for Fluoroquinolone. The diagnostic performance was generally comparable to that of LPA with slight variations between the two assays. The non-determinate rate (i.e., invalid M. tuberculosis complex detection) of Xpert MTB/XDR was 2·96%.ConclusionThe Xpert MTB/XDR demonstrated high sensitivity and specificity for detecting resistance to Isoniazid, Fluoroquinolones, and injectable agents. This assay can be used in clinical settings to facilitate rapid diagnosis of mono-isoniazid and extensively drug-resistant TB.

Identifying enablers and barriers to the control of multidrug-resistant tuberculosis in Abia State, Nigeria: A qualitative study

ObjectiveDrug-resistant tuberculosis (TB) is a significant public health threat in high-burden TB countries, including Nigeria, constraining the achievement of End TB targets. Nonetheless, Nigeria's health system factors shaping the care of patients with multidrug-resistant tuberculosis (MDR-TB) are understudied. The study assessed the enablers and barriers to implementing MDR-TB care and treatment in Abia State, Nigeria. MethodsThis is a qualitative interview study adopting a phenomenological approach. We interviewed twelve participants comprising health workers and TB policymakers with roles in MDR-TB patient management at the national (n = 2) and state (n = 10) levels in May 2022. We used maximum variation sampling to purposively select participants based on their roles, availability, and consent. The data were analysed thematically. ResultsThe factors enhancing care for patients with MDR-TB include using a certificate of readiness, community involvement, donor financing, availability of treatment centre, effective facility-community linkage, treatment support, multidisciplinary care team, training service providers, availability of oral drugs, expansion of diagnostic facilities, data tool availability, review meetings, and data-focused supervision. In contrast, the factors constraining MDR-TB management are poor implementation of infection control policy, donor dependence, delayed initiation of treatment, poorly motivated health workers, health worker stigma, shortage of personal protective equipment, and role conflict in data management. ConclusionThe findings highlight critical health systems strengths and weaknesses in MDR-TB control. MDR-TB care policies must build on the enablers and address the barriers to strengthen the care for patients with MDR-TB.

Strengthening the transportation network to improve diagnosis of multidrug-resistant tuberculosis: role of postal services

Tuberculosis (TB) has been acknowledged as one of the major public health concerns, being present in all the nations and has the potential to affect people from all age groups. Ensuring prompt diagnosis of TB is an essential step to improve the prognosis of the patients and minimize the development of complications. To accomplish the set targets under the end TB strategy, the diagnostic arm in TB control activities needs to be immensely strengthened and expanded. We have to ensure that the quality of the sample remains the same during the transport, especially in those regions where reference laboratories are present in distant locations. In conclusion, in the battle against TB, there is an immense need to strengthen the diagnostic services to enable early detection and prompt initiation of treatment. However, the same becomes a major challenge in resource-constrained settings, especially for making a diagnosis of multidrug-resistant-TB. This calls for the need to explore alternative options to expedite the process and roping in the postal network have emerged as a feasible and effective mechanism to overcome the existing challenges.

Activating Law and Human Rights to End Tuberculosis: An Empirical Assessment of Ten Countries' Fulfillment of United Nations Commitments

Activating Law and Human Rights to End Tuberculosis: An Empirical Assessment of Ten Countries' Fulfillment of United Nations Commitments

Identification of the health education targeted susceptible population of tuberculosis in Ningxia, Northwest China

Knowledge, Attitude, and Practice (KAP) survey, as an effective measure tool, is of practical significance for identifying the susceptible population in high-incidence regions of tuberculosis (TB). We aim to identify the health education targeted susceptible population of TB and discuss the acting pathway of KAP in Ningxia. A multistage random sampling method was used to conduct a face-to-face questionnaire survey for residents. The latent class analysis (LCA) model was used to classify susceptible populations of TB, and the structural equation modeling (SEM) model was also employed to investigate the interaction mechanisms of KAP (mediation analysis). We further applied the ordered logistic regression model to explore the associated factors. A total of 973 residents were enrolled, 70.6% were male, aged from 16 to 89. The LCA analysis demonstrated that 3 categories of susceptible populations of TB ("overall good", "positive attitude" and "overall poor") have optimal goodness of fit (BIC = 7889.5, Entropy = 0.923). SEM model indicated that the attitude plays a significant mediation effect from knowledge to practice toward TB (an indirect effect of 0.038, and a direct effect of 0.138). The ordered logistic regression results found that age, sex, marital status, education level, occupation, family income, self-perceived health status, having a family member or friend with TB, and knowing the DOTS strategy were significantly associated with classifications of KAP level towards TB. Based on the LCA model, we accurately classified the susceptible population of TB into 3 groups with different degrees of KAP. We found that TB attitude plays a mediating role between knowledge and practice. Therefore, we should pay more attention and carry out targeted health education in the community to these populations with overall poor KAP towards TB, and develop effective strategies and measures to realize the End TB Plan.

The Accessibility, Affordability, and Early Detection of Tuberculosis

Tuberculosis (TB) stands as the leading cause of death from an infectious agent worldwide, with a high fatality rate. It is primarily transmitted through the airborne Mycobacterium tuberculosis (M. tb) from an infected patient to a healthy individual. Annually, millions of people go undiagnosed for TB at an early stage and lose the opportunity for timely treatment, making early TB diagnosis a high priority. Prevalence surveys also have shown that many individuals with lab-confirmed TB disease lack symptoms and do not seek diagnosis or care. Moreover, delays in initiating treatment are commonly observed even after TB diagnosis, heightening the risk of disease transmission in the community. This research paper aims to address these challenges by analyzing the impact of various socioeconomic, policy, and healthcare factors on the accessibility of TB diagnosis. Furthermore, it aims to analyze current effective tuberculosis diagnosis techniques, assessing their strengths and weaknesses. Despite the presence of promising new drugs in the clinical trial stage offering hope for patients with extensively drug-resistant tuberculosis (XDR-TB) or very drug-resistant TB, the primary challenge remains the timely and species-specific detection of Tuberculosis. In addition to the detection of disease, identifying its drug resistance patterns and ensuring the availability of highly active short-course drug treatments are imperative, ideally lasting just a few weeks. This is essential to support the World Health Organization’s (WHO) Global efforts to “END TB” by 2030, to reach 90% of people primarily through early diagnosis, innovative treatments, and vaccine development.

Do pharmacists have roles in Tuberculosis? A Narrative Review

Tuberculosis (TB) is a disease that is caused by bacteria called, “Mycobacterium tuberculosis”. It usually affects the lungs. Pharmacists can play an important role in facilitating optimal pathways to the care of tuberculosis. This narrative review aims to describe the multiple roles of different types of pharmacists in tuberculosis. It analyses the role of different types of pharmacists in the prevention, diagnosis, and treatment of tuberculosis. This narrative review is divided into four main sections: (1) the role of the pharmacist in tuberculosis in medication management; (2) the pharmacists’ role in tuberculosis patient support and education; (3) public health collaboration; and (4) role of the pharmacist in resource-limited settings. In the first section, the review presents the roles of pharmacists in medication management, such as dispensing, preventing drug-resistant TB, and promoting medication adherence. The second section describes counseling, and diagnosis, and refers to the role of pharmacists in tuberculosis patient support and education. The third section includes public health roles such as prevention of TB transmission and involvement in DOTS (Directly Observed Treatment, Short-Course). Finally, the role of pharmacists in resource-limited settings, such as, the role in low- and middle-income countries and other roles are described, along with strategies to strengthen the role of pharmacists in tuberculosis. Professional support, improved public sector patient care, and media campaigns would help strengthen the role of pharmacists in tuberculosis. In efforts to align with the WHO’s new End TB Strategy 2016–2035, health systems should consider utilizing hospital, clinical, industrial, community, and other types of pharmacists to assist in improving tuberculosis identification, diagnosis, and treatment to prevent morbidity and mortality.

Potential molecular patterns for tuberculosis susceptibility in diabetic patients with poor glycaemic control: a pilot study.

Type 2 diabetes (DM2) is an increasingly prevalent disease that challenges tuberculosis (TB) control strategies worldwide. It is significant that DM2 patients with poor glycemic control (PDM2) are prone to developing tuberculosis. Furthermore, elucidating the molecular mechanisms that govern this susceptibility is imperative to address this problem. Therefore, a pilot transcriptomic study was performed. Human blood samples from healthy controls (CTRL, HbA1c < 6.5%), tuberculosis (TB), comorbidity TB-DM2, DM2 (HbA1c 6.5-8.9%), and PDM2 (HbA1c > 10%) groups (n = 4 each) were analyzed by differential expression using microarrays. We use a network strategy to identify potential molecular patterns linking the differentially expressed genes (DEGs) specific for TB-DM2 and PDM2 (p-value < 0.05, fold change > 2). We define OSM, PRKCD, and SOCS3 as key regulatory genes (KRGs) that modulate the immune system and related pathways. RT-qPCR assays confirmed upregulation of OSM, PRKCD, and SOCS3 genes (p < 0.05) in TB-DM2 patients (n = 18) compared to CTRL, DM2, PDM2, or TB groups (n = 17, 19, 15, and 9, respectively). Furthermore, OSM, PRKCD, and SOCS3 were associated with PDM2 susceptibility pathways toward TB-DM2 and formed a putative protein-protein interaction confirmed in STRING. Our results reveal potential molecular patterns where OSM, PRKCD, and SOCS3 are KRGs underlying the compromised immune response and susceptibility of patients with PDM2 to develop tuberculosis. Therefore, this work paved the way for fundamental research of new molecular targets in TB-DM2. Addressing their cellular implications, and the impact on the diagnosis, treatment, and clinical management of TB-DM2 could help improve the strategy to end tuberculosis for this vulnerable population.