High TB Incidence Research Articles

Outcomes of latent tuberculosis infection treatment in Istanbul.

Increasing the extensity of latent tuberculosis infection (LTBI) treatment which is one of the important parameters of tuberculosis (TB) control and completing the treatment in success are important. The purpose of this study is to evaluate LTBI treatment indications and treatment outcomes of patients who received LTBI treatment in İstanbul between 2016 and 2018. The treatment outcomes of people who started LTBI treatment registered in TB dispensaries in Istanbul between 2016 and 2018 were analyzed retrospectively according to the variables of the age groups, gender, dispensary subgroups, and prevention treatment indications. Data collected from the health institutions were evaluated. 26.920 patients received LTBI treatment in all Istanbul TB dispensaries between 2016 and 2018. The evaluation of LTBI treatment indications; contact 15.696, Tuberculin skin test (TST) positivity 2224, immunosuppression 8746, TST conversion 58, sequelae lesion 15, and other indications are identified as 181. The groups which diagnosed with TB disease, mortality, transfer, other, and still in treatment are excluded from the analysis of LTBI treatment outcomes. A total of 25.253 patients were analyzed. 65 percent of the patients had completed LTBI treatment. Variables effective for treatment outcomes are analyzed with logistic regression. Treatment discontinuation was statistically significantly lower in 2017 (odds ratio [OR]: 0.906 confidence interval [CI] [95%] [0.849-0.968]) and 2018 (OR: 0.635 CI [95%] [0.594-0.679]) compared to 2016. Treatment lost to follow-up was statistically significantly lower in those receiving LTBI treatment with the indication of tuberculin skin test positivity (OR: 0.541 CI [95%] [0.487-0.600]) and the indication of immunosuppression (OR: 0.284 CI [95%] [0.142-0.569]) compared to those who received LTBI treatment due to contact. When the treatment results are evaluated according to the TB incidence of the region where the dispensaries are located, treatment lost to follow-up was higher in 101-200 per 100,000 incidence group (OR: 1.201 CI [95%] [1.123-1.285]) and incidence of 201-370 per 100,000 (OR: 1.461 CI [95%] [1.358-1.572]). Treatment lost to follow-up was higher in dispensaries on the European side (OR: 1.293 CI [95%] [1.203-1389]) and the 0-35 age group (OR: 1.248 CI [95%] [1.168-1.333]). In conclusion, the treatment completion rate should be improved for an effective LTBI treatment which is one of the important parameters of targeted TB elimination. Particularly people under the age of 35 years and regions with high-TB incidence should receive special care and close follow-up.

HUBUNGAN DUKUNGAN KELUARGA DENGAN KEPATUHAN MINUM OBAT ANTI TB PADA PASIEN TB PARU DI PUSKESMAS X KOTA BANDUNG

This research is motivated by the high TB ​​incidence rate in Indonesia and the success rate of treatment in West Java which has not reached the 88% target. Family support is important because it is an effort to improve medication adherence. This study aims to determine the relationship of family support with adherence to taking anti-TB drugs (OAT) in pulmonary TB patients. Analysis of the data used is bivariate analysis using the Chi-Square statistical test. Family support research results show that there are 13 people (44.8%) who support and 16 people (55.2%) do not support, and compliance shows that there are 20 people (69%) high adherence and 9 people (31%) low adherence. There is no relationship between family support with adherence to taking anti-TB drugs (OAT) in patients with pulmonary TB with a p value of 0.688 (α = 0.05). It is recommended for nurses to increase their promotive efforts by providing information and Health Education about the effects of tuberculosis treatment that is not complete and always reminds their families to motivate TB patients to not forget to take medication.

High incidence of pulmonary tuberculosis in an indigenous Saharia tribe in Madhya Pradesh, central India-A prospective cohort study.

Lack of TB incidence data is an important evidence gap among Saharia-a high TB burden indigenous community in Madhya Pradesh, central India. The present study was undertaken to calculate the incidence of pulmonary tuberculosis in this tribe. To calculate the incidence of pulmonary tuberculosis (PTB) among the Saharia tribal population in Madhya Pradesh, central India. A prospective cohort study was conducted among the Saharia tribal population (aged 15 years and above) of Shivpuri district in Madhya Pradesh state in central India. A total of 9,756 individuals were screened for TB in the baseline TB prevalence survey during 2012-13. All available household members were screened for symptoms suggestive of pulmonary TB (presumptive TB). Two sputum specimens were collected from persons having symptoms suggestive of TB and examined by smear and culture tests. A cohort of all non-TB individuals in the baseline survey was followed-up for one year and re-screened for the sysmptoms of PTB in the year 2014-15. Based on the data collected, the incidence of TB over one year period was estimated per 100,000 population. A total of 9756 and 9044 individuals (≥ 15 years) were screened for symptoms suggestive of PTB during baseline and endline surveys respectively. The sputum specimens of presumptive TB cases were collected and examined by smear and culture tests. The overall incidence of bacteriologically positive (smear and/or culture) PTB over one year period was 1504 (95% Confidence Interval (CI): 1273-1776) per 100,000 in the study population, the incidence of smear-positive PTB was 1106 (95% CI: 910-1343), and the incidence of culture-positive PTB was 1084 (95% CI: 890-1319) per 100,000 population. The incidence for both smear and culture-positive PTB was 686 (95% CI: 535-878) per 100,000 population in the year 2014-15. The incidence of PTB was 2.8 times higher in males compared to females (2259 vs 807 per 100,000) and was positively correlated with age. The findings of the study, the first of its kind in the Saharia tribal population, indicate a high incidence of TB in this tribal community thereby highlighting the urgent need for focused and intensified efforts to achieve the goal of TB elimination in the country.

Diagnostic Challenges in Childhood Pulmonary Tuberculosis-Optimizing the Clinical Approach.

The management of childhood tuberculosis (TB) is hampered by the low sensitivity and limited accessibility of microbiological testing. Optimizing clinical approaches is therefore critical to close the persistent gaps in TB case detection and prevention necessary to realize the child mortality targets of the End TB Strategy. In this review, we provide practical guidance summarizing the evidence and guidelines describing the use of symptoms and signs in decision making for children being evaluated for either TB preventive treatment (TPT) or TB disease treatment in high-TB incidence settings. Among at-risk children being evaluated for TPT, a symptom screen may be used to differentiate children who require further investigation for TB disease before receiving TPT. For symptomatic children being investigated for TB disease, an algorithmic approach can inform which children should receive TB treatment, even in the absence of imaging or microbiological confirmation. Though clinical approaches have limitations in accuracy, they are readily available and can provide valuable guidance for decision making in resource-limited settings to increase treatment access. We discuss the trade-offs in using them to make TB treatment decisions.

The role of counselling in tuberculosis diagnostic evaluation and contact tracing: scoping review and stakeholder consultation of knowledge and research gaps

BackgroundTuberculosis (TB) care cascade analyses show large gaps at early stages, including care-seeking and diagnostic evaluation, where promising interventions to decrease attrition are urgently needed. Person-centered care is prioritized in the World Health Organization’s End TB strategy; yet little is known about how it is delivered and can be optimized. Recommendations for counselling, a core component of person-centered care, are largely limited to its role in improving TB treatment adherence. The role of counselling to close key diagnostic gaps in the care cascade is poorly understood.MethodsWe conducted a scoping review to identify evidence on the use of counselling at TB diagnosis, for both people with presumptive TB and index patients to promote patient retention and contact tracing. Using search terms for TB, diagnosis and counselling, we systematically searched PubMed, EMBASE and Web of Science. Two independent reviewers screened all abstracts, full-texts, extracted data and conducted a quality assessment. We used thematic analysis to identify key themes.ResultsAfter screening 1785 articles, we extracted data from 15 studies and determined that the major themes best corresponded to the following gaps in the TB care cascade: care-seeking, pre-diagnosis, and pre-treatment. Studies were conducted across varied settings including pharmacies, primary health centres, and clinics, primarily in high TB incidence countries. No study directly evaluated the impact of counselling on outcomes such as treatment initiation or retention in care. Included studies suggested counselling may play an important role in improving the uptake of diagnostic testing and contact tracing. Barriers to counselling included time and personnel requirements. Stakeholder consultation emphasized the importance of high-quality counselling as a core tenet of TB care.ConclusionData on the impact of counselling to improve TB case detection are absent from the literature. The shift towards person-centred care for TB presents an opportunity to incorporate counselling during earlier stages of the TB care cascade; however, evidence-based approaches are needed. Implementation research is needed to operationalize and evaluate counselling to strengthen high-quality TB care delivery.

Patient and healthcare delays in critical and non-critical pulmonary tuberculosis incidence areas in Portugal: are there differences?

ObjectivesTo characterize patient, healthcare, and total delay in diagnosing pulmonary tuberculosis (PTB) in critical (higher PTB incidence) and non-critical (lower PTB incidence) areas and their determinants considering clinical and sociodemographic factors. Study designRetrospective cohort study. MethodsData was retrieved from the Portuguese National Tuberculosis Surveillance System (SVIG-TB). Were included in the study all active PTB patients (n = 11,762) notified between 2008 and 2017. Spatial analysis was used to define critical and non-critical areas. Kaplan–Meier estimator, logrank test, and Cox regression were conducted, stratified by area. ResultsPTB cases in critical areas (n = 6594, 56.1%) presented longer patient median delay (41 vs 31days), shorter healthcare median delay (7 vs 10 days), and longer total median delay (63 vs 61days) t.han non-critical areas. Patient and total delay increased in both areas over time, while healthcare delay only increased in non-critical areas. Icn both areas, being from a high TB incidence country and alcohol abuse were associated with longer patient delays. Being female, older age, and oncologic diseases were associated with longer healthcare delays. Respiratory diseases were only associated with a longer healthcare delay in non-critical areas. Being female, older, and from a high TB incidence country were associated with a longer total delay in both areas. ConclusionsPatient delay was significantly longer in critical areas, and healthcare delay was significantly longer in non-critical areas. Several factors associated with longer delays have been identified, most of which are shared by critical and non-critical areas. Differences in patient and healthcare delay, for example, by sex, age, or country of birth, highlight the need for targeted public health interventions to help reduce these differences.

Phylogenomic analysis and Mycobacterium tuberculosis antibiotic resistance prediction by whole-genome sequencing from clinical isolates of Caldas, Colombia.

Mycobacterium tuberculosis (M. tuberculosis) was the pathogen responsible for the highest number of deaths from infectious diseases in the world, before the arrival of the COVID-19 pandemic. Whole genome sequencing (WGS) has contributed to the understanding of genetic diversity, the mechanisms involved in drug resistance and the transmission dynamics of this pathogen. The object of this study is to use WGS for the epidemiological and molecular characterization of M. tuberculosis clinical strains from Chinchiná, Caldas, a small town in Colombia with a high incidence of TB. Sputum samples were obtained during the first semester of 2020 from six patients and cultured in solid Löwenstein-Jensen medium. DNA extraction was obtained from positive culture samples and WGS was performed with the Illumina HiSeq 2500 platform for subsequent bioinformatic analysis. M. tuberculosis isolates were typified as Euro-American lineage 4 with a predominance of the Harlem and LAM sublineages. All samples were proven sensitive to antituberculosis drugs by genomic analysis, although no phenotype antimicrobial tests were performed on the samples, unreported mutations were identified that could require further analysis. The present study provides preliminary data for the construction of a genomic database line and the follow-up of lineages in this region.

TRENDS IN PULMONARY TB MORTALITY BETWEEN 1985 AND 2018: AN OBSERVATIONAL STUDY

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Pulmonary tuberculosis is common and has infected one-fourth of the population globally with peak incidence and mortality rates in the 1990s due to the HIV/AIDS epidemic, immigration, and the spread of multidrug-resistant TB (MDR TB). Few studies have reported pulmonary TB mortality trends. Our study reports and compares trends in pulmonary TB mortality between 1985 and 2018. METHODS: We utilized the World Health Organization (WHO) Mortality Database to extract Pulmonary TB mortality data based on the ICD 10 system. Based on the availability and quality of data region-wise, we included Canada and the USA from the Americas; Austria, Belgium, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Israel, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Republic of Moldova, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, and United Kingdom from Europe; Australia, New Zealand, and Japan from Western Pacific region. Crude mortality rates were dichotomized by sex and reported by year. We computed Age Standardized Death Rates (ASDRs) per 100,000 population using the World Standard Population. Pulmonary Tuberculosis mortality trends were compared using Joinpoint regression analysis and reported using Estimated Annual Percentage Changes (EAPCs). RESULTS: Overall, in all 33 countries studied, we observed a decrease in mortality in both males and females except the Republic of Moldova, which showed an increase in females' mortality (0.12). Among all countries, Lithuania had the largest negative Percentage Change (PC) in male mortality (-12.01) between 1993-2018, and Hungary had the largest negative PC in female mortality (-1.57) between 1985-2017. Male mortality declined at a steady rate across the study period. Slovenia had the most rapid recent mortality decline for males with an EAPC of -47% (2003-2016), followed by Australia (-33.6%, 2014-2017), whereas Croatia and Austria showed an increase in EAPC of 25.0% (2015-2017) and, 17.8% (2010-2014) respectively. For females, New Zealand showed the most rapid recent mortality decline (-47.2%, 1985-2015), followed by Hungary (-35.1%, 2004-2007), whereas Croatia showed an increase in EAPC (24.9%, 2014-2017). CONCLUSIONS: Pulmonary TB mortality is disproportionately higher among Central and Eastern European countries. CLINICAL IMPLICATIONS: This contagious disease cannot be eliminated from any one region without a global approach. Priority action areas include ensuring early diagnosis and appropriate treatment to the most vulnerable groups. In low- and middle-income countries with high TB incidence, attenuation of socioeconomic determinants including extreme poverty, inadequate living conditions, and malnutrition remains crucial. DISCLOSURES: No relevant relationships by Chinmay Jani, source=Web Response No relevant relationships by Dominic Marshall, source=Web Response no disclosure on file for Omar Omari; No relevant relationships by Arashdeep Rupal, source=Web Response No relevant relationships by Justin Salciccioli, source=Web Response No relevant relationships by Joseph Shalhoub, source=Web Response No relevant relationships by Harpreet Singh, source=Web Response no disclosure on file for Carey Thomson; no disclosure on file for ALEXANDER WALKER

Stages of pregnancy and HIV affect diagnosis of tuberculosis infection and Mycobacterium tuberculosis (MTB)-induced immune response: Findings from PRACHITi, a cohort study in Pune, India

BackgroundAccurate tuberculosis infection (TBI) tests are critical for pregnant women, especially those with HIV, who have a high risk of TB disease. MethodsWe enrolled interferon gamma release assay (IGRA)+ pregnant women with and without HIV in a longitudinal study, followed up at delivery and 6 months postpartum. Tuberculin skin test (TST) and IGRA were compared by HIV status at each timepoint. ResultsOf 165 enrolled IGRA+ pregnant women: 35 (21%) had HIV and were on antiretroviral therapy with median CD4 of 476 (IQR 399–586). Compared to antepartum, significantly fewer women remained IGRA+ at delivery [HIV+ n=21/35 (62%, p=0.009); HIV- n=100/130 (77%, p=0.002)] and postpartum [HIV+ n=30/35 (87%, p=0.03); HIV– n=116/130 (89%, p=0.01)]. IGRA/TST discordance was high in pregnant women (HIV+: 51%; HIV-: 25%). Median IFN-γ was lowest for all women at delivery; significantly lower in women with HIV at all timepoints compared to women without HIV. TB incidence was 50/ 1000 person-years and 18/1000 person-years among women with and without HIV respectively. ConclusionsPregnancy affects TBI test results and reduces IFN-γ response to M. tuberculosis stimulation. Despite adequate CD4 counts, women with HIV express less IFN-γ than women without HIV, which may explain the high TB incidence in postpartum women with HIV.

Factors associated with Tuberculosis Mortality in Selected Health Facilities in Lusaka, Zambia, 2016

Introduction: Zambia is among the 30 countries with the highest burden of tuberculosis (TB), with an estimated incidence rate of 346 per 100,000 population in 2018. Lusaka is among the districts with the highestTB incidence in Zambia. In 2015, TB mortality (6%) exceeded the national target of less than 5%. We sought to assess factors associated with TB mortality in selected public health facilities in Lusaka, in order to gain knowledge required to design appropriate strategies for reduction. Methods: We conducted a cross-sectional study in three purposively selected public health facilities in Lusaka including a 1st level-hospital, an urban-clinic, and a peri-urban clinic. We used the 2013 World Health Organisation’s (WHO), definitions and reporting framework for TBand defined TB mortality as any TB patient who died for any reason during the course of TB treatment. We abstracted data from treatment registers for TB cases on treatment in 2016. Using multivariable logistic regression, we analysed the associations between TB mortality and age, health facility type or HIV status and reported adjusted odds ratios(AOR), and 95% confidence intervals(CI). Results: We included 1,537 registered TB patients from the three sites in 2016 (urban-clinic(n=676), 1st-level-hospital(n=630) and peri-urban-clinic(n=231)). The overall mortality rate was 9%, and by facility: 8%(urban-clinic), 11%(1st-level-hospital) and 8%(peri-urban-clinic). The odds of TB mortality were higher among patients >64 years (AOR=7.6, 95%CI:1.97–29.55), TB/HIV co-infected (AOR=3.1, 95%CI:1.91–4.93) and those treated at the 1st-level-hospital (AOR=1.6, 95%CI:1.08–2.40). Conclusion: TB mortality in the selected facilities was high compared to the national target. We recommend scaling up of TB treatment and preventive therapy among people living HIV especially those >64 years old in the selected health facilities.

TB risk by time since U.S. entry among non-U.S.-born residents of Washington State, USA.

BACKGROUND: Progress towards TB elimination in the United States will require improved detection and treatment of latent TB infection among non-U.S.-born residents who remain at disproportionate risk of TB disease. To inform targeted testing efforts, we evaluated risk of TB disease among non-U.S.-born residents of Washington State, USA, by region of origin and time from U.S. entry.METHODS: We conducted a retrospective cohort study among non-U.S.-born residents diagnosed with TB disease in Washington State from 2005 to 2014, for which country-specific population estimates were also available. The risk of TB disease among non-U.S.-born residents was estimated by time since U.S. entry, World Bank region of origin, and WHO TB incidence category.RESULTS: Risk of TB disease for non-U.S.-born residents was highest within the first year after U.S. entry. Among persons from countries with high TB incidence who had resided in the United States for more than 20 years, risk for TB remained elevated.CONCLUSION: Elevated risk of developing TB disease among individuals not born in the United States persisted long after U.S. entry, particularly among persons originating from certain regions and from high-burden countries. These findings contribute to evidence supporting a refinement of existing screening guidelines.

Persistent chronic respiratory symptoms despite TB cure is poorly correlated with lung function.

SUMMARYBACKGROUND:Persistent respiratory symptoms and lung function deficits are common after patients with TB. We aimed to define the burden of post-TB lung disease (PTLD) and assess associations between symptoms and impairment in two high TB incidence communities.METHODS:This was a cross-sectional survey of adults in Cape Town, South Africa who completed TB treatment 1–5 years previously. Questionnaires, spirometry and 6-minute walking distance (6MWD) were used to assess relationships between outcome measures and associated factors.RESULTS:Of the 145 participants recruited (mean age: 42 years, range: 18–75; 55 [38%] women), 55 (38%) had airflow obstruction and 84 (58%) had low forced vital capacity (FVC); the mean 6MWD was 463 m (range: 240–723). Respiratory symptoms were common: chronic cough (n = 27, 19%), wheeze (n = 61, 42%) and dyspnoea (modified MRC dyspnoea score 3 or 4: n = 36, 25%). There was poor correlation between FVC or obstruction and 6MWD. Only low body mass index showed consistent association with outcomes on multivariable analyses. Only 19 (13%) participants had a diagnosis of respiratory disease, and 16 (11%) currently received inhalers.CONCLUSION:There was substantial burden of symptoms and physiological impairment in this “cured” population, but poor correlation between objective outcome measures, highlighting deficits in our understanding of PTLD.

Paediatric tuberculosis during universal and selective Bacillus Calmette-Guérin vaccination policy: a nationwide population-based retrospective study, Finland, 1995-2015.

IntroductionIn 2006, the Bacillus Calmette–Guérin (BCG) vaccination policy in Finland changed from universal to selective.AimWe assessed the impact of the policy change on tuberculosis (TB) morbidity in children under 5 years and epidemiological trends of paediatric TB in Finland.MethodsWe conducted a nationwide, population-based, retrospective registry study of all newly diagnosed active TB cases younger than 15 years in Finland from 1995 to 2015 by linking data from the National Infectious Diseases Register, Finnish Care Register for Health Care, medical patient records and Finnish Population Information System. We compared the TB incidence rate ratio of under 5 year-olds with universal and selective BCG vaccinations with a Poisson log-linear model and analysed incidence trends among those younger than 15 years with a negative binomial model.ResultsWe identified 139 paediatric TB cases: 50 native (including 24 second-generation migrants) and 89 foreign-born children. The TB rate of under 5 year-olds remained stable after changing to selective BCG vaccination (incidence rate ratio (IRR): 1.3; 95% confidence interval (CI): 0.7–2.3). TB rate in the native population under 15 years increased slightly (IRR = 1.06; 95% CI: 1.01–1.11).DiscussionPaediatric TB cases in Finland were concentrated in families with migrant background from high-TB incidence countries. The native TB morbidity in under 5-year-olds did not increase after the BCG policy revision, suggesting that selective vaccinations can prevent TB in the most vulnerable age group in low-incidence settings. Second-generation migrants under 15 years in Finland with high TB risk are probably increasing.

Hubungan faktor lingkungan fisik, sosial dan ekonomi dengan kejadian Tuberkulosis Paru di Kecamatan Tambang Kabupaten Kampar

Pulmonary tuberculosis is an infectious disease caused by Mycobacterium tuberculosis which mostly attacks the lungs and can also attack other organs. Tuberculosis is transmitted by smear positive tuberculosis patients, Tuberculosis germs are transmitted through the air when the patient coughs and sneezes so that the germs spread in the air in the form of droplets (sputum sparks), so people can become infected if they inhale the droplet into the respiratory tract (Ministry of Health Republic of Indonesia, 2014 ). According to Achmadi (2010) risk factors for tuberculosis transmission are environmental and behavioral factors. Environmental factors include ventilation, occupancy density, temperature, lighting and humidity. Whereas behavioral factors include smoking, spitting or sputum in any place, coughing or sneezing not closing the mouth and habit of not opening the window. Based on the results of a survey in Indonesia by the Directorate General of Communicable Disease Eradication and Environmental Health (2011), the high incidence of pulmonary TB is caused by a lack of knowledge. Knowledge of tuberculosis sufferers will affect the attitude and behavior such as throwing up spit or sputum that can be carelessly a source of transmission for people around him. Prabu in Fitriani (2013) explained that family heads who have an income below the regional minimum wage (UMR) will consume foods with nutrient levels that are not in accordance with the needs of each family member so that they have an nutritional status that is lacking and will make it easier to contract infectious diseases including Lung TB. According to WHO the number of cases of tuberculosis is ranked above HIV / AIDS. In 2016 there were an estimated 10.4 million new cases of tuberculosis or 142 cases / 100,000 population, 60% of new cases occurred in 6 (six) countries namely India, Indonesia, China, Nigeria, Pakistan and South Africa, and Indonesia ranked second (WHO Global Tuberculosis Report, 2017). Based on data on Indonesia's health profile in 2018 the number of tuberculosis cases in Indonesia in 2017 was 420,994 cases and increased in 2018 to reach 511,873 cases (Ministry of Health Republic of Indonesia, 2018). The number of pulmonary tuberculosis in Riau Province in 2018 is 11,135 cases (Ministry of Health of the Republic of Indonesia, 2018). Based on data on the health profile of Kampar Regency in 2017, tuberculosis is an environmentally-based direct infectious disease that ranks second with a total of 1,071 cases after diarrheal disease with a total of 1,076 cases. The number of positive AFB cases in 2017 in Kampar District reached 1071 cases, with the highest number of sufferers found in Tambang District, 78 cases. In 2018 the number of TB cases was 1079 cases, with the highest cases also occurring at the Tambang Health Center with a total of 67 cases and 43 new cases, followed by the Siak Hulu I Health Center with a total of 57 cases (Dinkes District Health Office, 2018). Based on this, this study aims to analyze and the risk of the relationship between the physical, social and economic environment with the incidence of pulmonary tuberculosis in Tambang District, Kampar Regency.

Effects of migration on tuberculosis epidemiological indicators in low and medium tuberculosis incidence countries: A systematic review

BackgroundTuberculosis (TB) remains one of the top ten causes of death each year globally. While the risk of migrant TB is linked to the TB incidence in their country of origin, the migration process can increase the TB risk. ObjectiveWe aimed to synthesis the evidence on key differences in the epidemiological profile of TB between migrants from high TB incidence birth countries and non-migrants resident in low to medium incidence TB countries. MethodsWe conducted a systematic review where the population was all active TB cases in countries with low to medium TB incidence (<40/100,000 population), the exposure was migration to a low or medium TB incidence country and the comparator was non-migrant TB cases in low or medium incidence countries. Overall proportions were compared between migrants and non-migrants, using Fisher’s exact test. Meta-analysis of proportions was carried out for the primary outcome (active TB) while meta-analyses of odds ratios (ORs) were performed using a random effects model for secondary outcomes; sputum-smear positivity, any first line drug resistance, multi-drug resistance (MDR), clustered cases, HIV coinfections and successful treatment. Heterogeneity was evaluated and sources were investigated using subgroup and sensitivity analysis. ResultsSignificant differences were found in the overall proportions of high TB incidence migrants and non-migrants for MDR cases, clustered cases, HIV coinfections and successful treatment, as well as a significant difference in the OR among MDR cases (3.91). ConclusionThis review has demonstrated significant differences in key epidemiological indicators between high TB incidence migrants and non-migrants, indicating policy implications.

Comparison of N-acetyl-L-cysteine-sodium hydroxide and Modified Petroff's Decontamination Methods for Mycobacterium tuberculosis Culture

Indonesia is one of 22 countries with a high incidence of TB in the world, particularly related to TB-HIV and MDR-TB cases. Contamination of normal flora from nasopharyngeal tract is the main problem to isolate Mycobacterium tuberculosis (MTB) from sputum. It is needed a safe solution to decontaminate without killing MTB bacilli. N-acetyl-L-cysteine-sodium hydroxide (NALC-NaOH) is compared with modified Petroff’s which is widely used in laboratories, to get better outcome. Of the 110 sputum samples were collected from suspected cases of Pulmonary TB. Decontamination using 2% NALC-NaOH and Modifed Petroff (4% NaOH) was performed before AFB smear and culture on LJ medium. Each group was assessed for contamination and culture positive rate. The positive culture was validated using chromatography test for detected antigen MPT-64 and PNB. Result of this study showed that NALC-NaOH and modified Petroff’s methods did not significantly affect positivity rate of Acid-Fast Bacillus (AFB) smear, 71% and 66% respectively. Contamination on culture was significantly (p=0,034) higher in samples treated with NALC-NaOH (21%) compared to Modified Petroff methods(13%). Proportion of positive culture on samples treated with NALC-NaOH was lower than Modified Petroff, 65% and 70% respectively with p value=1. Conclusion of this study showed that sputum decontamination using Modified Petroff methods is still more effective than NALC-NaOH to increase positivity rate of MTB culture. However, the two methods were not significantly different to get positivity result on the microscopic examination of AFB.

Incidence of socially significant infectious diseases (HIV, TB and HIV/TB coinfection) in the Arctic regions of Russia)

ABSTRACT The study is aimed to evaluate the HIV, TB, and HIV/TB coinfection incidence per 100,000 population/year in Russian Arctic, based on official statistical data. The epidemics’ incidence in Russian Arctic is uneven. The highest HIV incidence in 2019 was registered in Krasnoyarsk region (94,6), and the highest TB incidence in ChAD (136,1). ChAD was also identified as the region with the worst indicators, where the HIV incidence in 2007–2019 was evaluated at (315,8%), TB (136,1%), HIV/TB coinfection (150,0%). Despite the significant reduction in TB incidence in Arkhangelsk oblast (−63,9%), Karelia (−57,3%) and Komi (−56,2%) republics, it is alarming to observe dramatic increases in HIV incidence in the aforementioned regions (592,3%, 331,8%, 156,5% respectively). External factors influence HIV and TB incidence in most regions. Prevailing in men, HIV and TB incidence disparities between the general population and permanent residents occurred in all regions, except in ChAD and NAD, where the infections were diagnosed only among permanent residents. It is necessary to provide more detailed studies focusing on HIV, TB, and HIV/TB coinfection features in each circumpolar district in order to determine the main risk factors, especially among indigenous peoples as a vulnerable group, and to evaluate the HIV/TB collaborative services’ capacity.

Incorporating patient reporting patterns to evaluate spatially targeted TB interventions

PurposeTuberculosis (TB) is geographically heterogeneous, and geographic targeting can improve the impact of TB interventions. However, standard TB notification data may not sufficiently capture this heterogeneity. Better understanding of patient reporting patterns (discrepancies between residence and place of presentation) may improve our ability to use notifications to appropriately target interventions. MethodsUsing demographic data and TB reports from Dhaka North City Corporation and Dhaka South City Corporation, we identified wards of high TB incidence and developed a TB transmission model. We calibrated the model to patient-level data from selected wards under four different reporting pattern assumptions and estimated the relative impact of targeted versus untargeted active case finding. ResultsThe impact of geographically targeted interventions varied substantially depending on reporting pattern assumptions. The relative reduction in TB incidence, comparing targeted with untargeted active case finding in Dhaka North City Corporation, was 1.20, assuming weak correlation between reporting and residence, versus 2.45, assuming perfect correlation. Similar patterns were observed in Dhaka South City Corporation (1.03 vs. 2.08). ConclusionsMovement of individuals seeking TB diagnoses may substantially affect ward-level TB transmission. Better understanding of patient reporting patterns can improve estimates of the impact of targeted interventions in reducing TB incidence. Incorporating high-quality patient-level data is critical to optimizing TB interventions.

Pharmacokinetics and Drug-Drug Interactions of Isoniazid and Efavirenz in Pregnant Women Living With HIV in High TB Incidence Settings: Importance of Genotyping.

The World Health Organization guidelines recommend that individuals living with HIV receive ≥ 6 months of isoniazid preventive therapy, including pregnant women. Yet, plasma isoniazid exposure during pregnancy, in the antiretroviral therapy era, has not been well‐described. We investigated pregnancy‐induced and pharmacogenetic‐associated pharmacokinetic changes and drug‐drug interactions between isoniazid and efavirenz in pregnant women. Eight hundred forty‐seven women received isoniazid for 28 weeks, either during pregnancy or at 12 weeks postpartum, and 786 women received efavirenz. After adjusting for NAT2 and CYP2B6 genotype and weight, pregnancy increased isoniazid and efavirenz clearance by 26% and 15%, respectively. Isoniazid decreased efavirenz clearance by 7% in CYP2B6 normal metabolizers and 13% in slow and intermediate metabolizers. Overall, both isoniazid and efavirenz exposures were reduced during pregnancy, but the main determinants of drug concentration were NAT2 and CYP2B6 genotypes, which resulted in a five‐fold difference for both drugs between rapid and slow metabolizers.

Status and challenges for tuberculosis control in India – Stakeholders' perspective

BackgroundTuberculosis is one of the ten major causes of mortality worldwide. The trend of increasing TB cases and drug resistance in India is very disturbing. The objectives of the study were to study the perspectives and opinions of different stakeholders on the status, challenges and the ways to tackle the issues of TB in India. MethodsThe online survey was done for the data collection from national and international experts. The data collection took place during October 2017. We received 46 responses. ResultsThe experts had varied answers as to the menace of TB in India, effect of TB on individuals, family and society, failure of government plans in India, TB awareness campaign and ways to create awareness. Everyone believed that urgent action needs to be taken against the disease like improving the healthcare infrastructure of the country (improving the quality and quantity of medical facilities and doctors) and creating awareness about the TB. ConclusionGovernment of India is making lot of efforts to bring down the problems associated with TB through. In spite of this, there is a long way to go to achieve significant reduction in high incidence and prevalence of TB in India. Factors like lack of awareness and resources, poor infrastructure, increasing drug resistant cases, poor notification and overall negligence are the major challenges. If we eradicate poverty and undernourishment, educate the masses and eliminate the stigma attached with TB, we can hope for a disease free future.