Tuberculosis Mortality Research Articles

Exploring Accelerated Failure Time Models for Tuberculosis Survival: Loglogistic and Weibull Survival Regression Model

Tuberculosis (TB) remains a significant global health burden, necessitating robust statistical models to understand survival dynamics and inform interventions. Most survival analyses rely on the Cox Proportional Hazards (Cox PH) model, which may not adequately capture the survival time distribution. This study focuses on data from the National Tuberculosis and Leprosy Center (NTLC), Zaria, Kaduna State, Nigeria, to identify factors influencing TB survival and assess alternative parametric survival models. The study aims to identify factors associated with TB mortality, assess their impact on survival outcomes, and compare the performance of Weibull, and Log-Logistic Accelerated Failure Time (AFT) models to determine the most suitable model for TB survival data from NTLC Zaria. This study compares the performance of two Accelerated Failure Time (AFT) models, the Weibull, and the Log-Logistic in analyzing TB survival data. The analysis evaluates model fit using p-values, log-likelihood, and Akaike Information Criterion (AIC). Results indicate that the Weibull AFT model outperforms the Log-logistic, with the highest log-likelihood (-228.6) and the lowest AIC (485.11), and the Log-Logistic AFT model (AIC: 492.02, log-likelihood: -232.0). The p-values for both models demonstrate statistical significance, highlighting their effectiveness in modelling TB survival data. However, the Weibull model's higher performance suggests it better captures survival time variability in TB patients. These findings emphasize the importance of selecting appropriate survival models for TB data analysis and support the application of the Weibull AFT model for future studies. Further research should explore integrating advanced statistical techniques and machine learning approaches to enhance predictive accuracy and improve TB management strategies. This study contributes to this growing field by applying parametric survival models, to analyse TB survival data from the National Tuberculosis and Leprosy Centre (NTLC) in Zaria, Nigeria.

Health system and environmental factors affecting global progress towards achieving End TB targets between 2015 and 2020.

Health system and environmental factors play a significant role in achieving the World Health Organization (WHO) End Tuberculosis (TB) targets. However, quantitative measures are scarce or non-existent at a global level. We aimed to measure the progress made towards meeting the global End TB milestones from 2015 to 2020 and identify health system and environmental factors contributing to the success. We obtained data from ten different online data repositories and used principal component analysis to create domain-specific health system performance measures. We used radar charts and dumbbell plots to show the country's progress in ending TB with their health systems. Lastly, we used a linear regression model to identify key health systems and environmental predictors of the percent reduction in TB incidence and mortality. There was a high variation in TB incidence and mortality reduction between countries and WHO regions. Of all countries included, 75 (39.3%) achieved more than a 20% reduction in TB incidence between 2015 and 2020. However, only 31 (16.2%) reached a 35% reduction in TB mortality. The European Region achieved the highest incidence reduction, exceeding the 2020 milestone with a 25% reduction. The African Region also made notable progress, achieving an 18% mortality reduction despite its relatively poor health systems. Health system factors, such as TB financing, TB-specific health service delivery, access to medicine, and governance, were significantly associated with TB mortality reduction between 2015 and 2020. Environmental factors, such as average annual temperature and air particulate matter concentration, were found to have a significant negative effect on TB incidence and mortality reduction. Weak health systems were identified as major barriers to achieving the End TB milestones in most high-burden countries. Hence, strengthening health systems with a special focus on TB financing, service delivery, and access to medicine in these countries should be prioritised to achieve global TB mortality reduction targets. Countries should follow WHO's air quality guidelines and rapidly reduce carbon dioxide and other greenhouse gas emissions to mitigate the impact of environmental factors.

Tuberculosis disease burden in China: a spatio-temporal clustering and prediction study.

The primary aim of this study is to investigate and predict the prevalence and determinants of tuberculosis disease burden in China. Leveraging high-quality data sources and employing a methodologically rigorous approach, the study endeavors to enhance our understanding of tuberculosis control efforts across different regions of China. First, through nationwide spatio-temporal cluster analysis, we summarized the status of tuberculosis burden in various regions of China and explore the differences, thereby providing a basis for formulating more targeted tuberculosis prevention and control policies in different regions; Subsequently, using a time series-based forecasting model, we conducted the first-ever national tuberculosis burden trend forecast to offer scientific guidance for timely adjustments in planning and resource allocation. This research seeks to contribute significantly to China's existing tuberculosis prevention and control system. This research draws upon publicly available pulmonary tuberculosis (PTB) incidence and mortality statistics from 31 provinces and municipalities of mainland China between 2004 and 2018. We organized and classified these data according to province, month, year, and patient age group. Overall, the sample included 14,816,329 new instances of PTB and 42,465 PTB-related fatalities. We used spatiotemporal cluster analysis to record the epidemiological characteristics and incidence patterns of PTB during this period. Additionally, a time series model was constructed to forecast and analyze the incidence and mortality trends of PTB in China. This study reveals significant regional variations in PTB incidence and mortality in China. Tibet (124.24%) and Xinjiang (114.72%) in western China exhibited the largest percentage change in tuberculosis (TB) incidence, while Zhejiang Province (-50.45%) and Jiangsu Province (-51.33%) in eastern China showed the largest decreases. Regions with significant percentage increases in PTB mortality rates (>100%) included four western regions, six central regions, and five eastern regions. The regions with relatively large percentage decreases in the mortality rate of PTB include Tianjin (-52.25%) and Shanghai (-68.30%). These differences are attributed to two main factors: (1) economic imbalances leading to poor TB control in underdeveloped areas, and (2) differences in TB-related policies among provinces causing uneven distribution of disease risks. Consequently, China may still face challenges in achieving the World Health Organization's 2030 tuberculosis control goals. Nationwide, the mortality rate of PTB in China increased between 2004 and 2018 (percentage change: 105.35%, AAPC: 4.1), while the incidence of PTB showed a downward trend (percentage change: -20.59%, AAPC: -2.1). Among different age groups, the 0-19 age group has the smallest disease burden. While incidence and mortality from TB were primarily found in adults 60 years of age or older, the age group of 0-19 years has the smallest burden of TB, highlighting obvious differences in age characteristics. It is predicted that the mortality rate of TB in China will continue to increase. In summary, the TB epidemic in China has been largely controlled due to the implementation of many public health programs and policies targeting specific groups and geographical areas. Finding and supporting effective health programs will make it possible to achieve the World Health Organization's goal of controlling tuberculosis in China.

Trends in tuberculosis mortality among older adults in China, 2004-2021: a Joinpoint regression and age-period-cohort analysis.

Tuberculosis (TB) remains a major public health problem in China and globally, particularly among older adults. This study aimed to examine secular trends in TB mortality among older adults in China and the net effects of age, period, and cohort. Data from the National Disease Surveillance Points (DSPs) system were analyzed using Joinpoint regression to determine annual changes in TB mortality among individuals aged 60 years and older from 2004 to 2021. An age-period-cohort (APC) analysis using the intrinsic estimator (IE) method was conducted to estimate the independent effects of age, period, and cohort. The age-standardized TB mortality rate was 5.68 per 100,000, with higher rates observed in men, rural areas, and western regions. TB mortality among older adults declined overall from 2004 to 2021, although the rate of decline has slowed in recent years. The APC analysis revealed increased TB mortality with age, with the relative risk (RR) rising from 0.57 in the 60-64 age group to 1.53 in the 80-84 age group. The period effect decreased from 2007 to 2021, showing a higher risk effect in rural areas (RR = 1.51) than in urban areas (RR = 1.16) during 2007-2011, but this trend reversed in the period 2017-2021. The cohort effect generally declined, with the exception of certain demographic groups that showed an increase in the 1952-1956 and 1957-1961 birth cohorts. TB mortality among older adults in China decreased from 2004 to 2021, although the decline has slowed in recent years. Variations in age, period, and cohort effects highlight differences by gender, urban and rural areas, and regions, providing insights for targeted intervention strategies.

Microbiological aspects and clinical impact of lower lung field tuberculosis: An observational cohort study in Peru.

Approximately 40% of tuberculosis (TB) cases remain undiagnosed globally. Lower lung field TB (LLF TB) presents atypically and is often misidentified as other lung diseases, leading to diagnostic delays in resource-limited settings. It may contribute to increased TB transmission and mortality. We aimed to identify microbiological determinants of LLF TB and evaluate treatment responses to optimize care. We conducted an observational cohort study in Lima, Peru, enrolling adults with microbiologically confirmed pulmonary TB (PTB) diagnosed by GeneXpert MTB/RIF assay or sputum culture. Mycobacterium tuberculosis (MTB) lineage was determined using whole-genome sequencing. Due to the delayed chest radiograph changes in LLF TB compared to non-LLF TB, we measured changes in the St. George's Respiratory Questionnaire (SGRQ) score at 2-month treatment mark and evaluated World Health Organization-specified final treatment outcomes. We used logistic regression to evaluate the associations between LLF TB and microbiological determinants and treatment outcomes. We used linear regression to assess whether the change in SGRQ scores over the first 2 months of treatment varied by LLF TB status. Among 1316 PTB patients, 84 (6%) had LLF TB. Compared to non-LLF TB patients, LLF TB patients were more likely to be smear-negative (adjusted odds ratio [aOR] [95% CI] = 2.04 [1.28-3.23], P = 0.002) and to be infected with Lineage 2 (aOR [95% CI] = 1.95 [95% CI: 1.07-3.41; P = 0.024]). People with LLF TB had less improvement in SGRQ scores after 2 months of treatment (adjusted score difference [95% CI] = -6.29 [-10.99 to -1.59], P = 0.009), while they experienced better final outcomes compared to non-LLF TB patients, though this difference did not reach statistical significance (aOR = 0.43 [95% CI: 0.13-1.05], P = 0.103). Patients with LLF TB are more likely than those with upper lung lesions to be sputum-negative on conventional tests, to be infected with Lineage 2, and to show less clinical improvement after treatment.

Determinants of Tuberculosis Mortality in an Urban Residents: A hospital-based Cohort Study in China

Determinants of Tuberculosis Mortality in an Urban Residents: A hospital-based Cohort Study in China

Evaluation of the Effectiveness of Tuberculosis Intervention in the US

This study evaluates the effectiveness of tuberculosis (TB) interventions implemented in the United States by comparing actual TB incidence and mortality data with predicted data that assumes no interventions. The analysis focuses on two key intervention periods: the introduction of strict infection control measures and enhanced environmental controls in 2005, and the update to TB screening guidelines for healthcare personnel in 2019. This study trained the Auto-regressive Integrated Moving Average (ARIMA) model on pre-2005 data in order to forecast the number of tuberculosis cases and the proportion of cases overall that did not get these interventions. The predicted data was then compared with actual post-intervention data to assess the impact of these public health measures. Results show that without these interventions, TB cases and mortality rates would have remained significantly higher. The actual data, in contrast, demonstrated a marked decline in both metrics following the implementation of these measures. The findings underscore the critical role of comprehensive public health interventions in reducing the burden of TB. The long-term impact of these measures is evident in the sustained reduction in TB incidence and mortality, highlighting the importance of continuous monitoring and adaptation of TB control strategies to maintain effective disease management.

Impact of military conflict in Ukraine on the achievement of the goals of the WHO “End TB” strategy

BACKGROUND. In 2014, the World Health Organization approved the “End TB” strategy with the goal of eliminating tuberculosis (TB) as a global threat by 2035. OBJECTIVE. To assess the impact of military conflicts in Ukraine on the dynamics of TB incidence, prevalence, and mortality indicators within the framework of achieving the “End TB” strategy goals. MATERIALS AND METHODS. An analysis of TB epidemiological indicators in Ukraine in general and in the Chernivtsi region in particular was conducted from 2013 to 2023. RESULTS. Military actions in eastern Ukraine in 2014 led to delays in TB diagnosis and treatment. The incidence and mortality rates of TB in Ukraine remained higher than the target levels set by the “End TB” strategy. The 2020 quarantine resulted in a 29.8 % reduction in TB incidence. The onset of military actions in 2022 caused massive population migration, destruction of healthcare facilities, and increased health risks, creating epidemiologically unfavorable conditions for TB. By 2023, TB incidence had decreased by 31.3 % and mortality by 36.1 % compared to 2015; however, the TB epidemiological situation remains threatening. CONCLUSIONS. Achieving the strategy’s 2025 target indicators appears unlikely due to the negative impact of war and post-pandemic consequences, considering recent trends of gradually increasing TB incidence.

Competing risks multi-state model for time-to-event data analysis of HIV/AIDS: a retrospective cohort national datasets, Ethiopia

IntroductionTuberculosis (TB) remains the most common opportunistic infection and leading cause of death among individuals living with HIV/AIDS in Ethiopia. Its significant impact on morbidity and mortality underscores the crucial link between these two diseases. While the advent of antiretroviral therapy (ART) has led to a dramatic decline in mortality rates among HIV/AIDS patients, TB continues to pose a substantial threat. This study aims to estimate the probability of death due to TB among HIV/AIDS patients on ART, considering the presence of various competing risks, including diarrhea, other infections, and unknown/unspecified causes. Also we have assessed the effects of prognostic factors on HIV/AIDS cause specific deaths, compared with the death from other competing risks, and exploring leading cause of death among HIV/AIDS patients on Antiretroviral Therapy.MethodsData from a retrospective research examining the effectiveness of antiretroviral therapy (ART) in Ethiopia were used in this investigation. The data came from medical records of patients who were part of the national ART program. A total of 39,590 records were gathered between October 2019 and March 2020 from all regions of Ethiopia as well as the administration cities of Addis Ababa and Dire Dawa. The study facilities were grouped using a multi-stage sample technique and simple random selection was used to select health facility and a person record from medical records. In the presence of the competing causes of death, Cause specific hazard, subdistribution hazard model and flexible parametric proportional hazard model have been used to assess the effect of covariates on the risk of death, with the cmprisk package in R4.3.2 software.ResultsOut of the total 1212 deaths, 542(44.7%) died competing with other opportunistic infection (TE-Esophageal Candidiasis, TO-oral, CT-CNS Toxoplasmosis, CM-Crypotococcal Meningitis…), 421 (34.7%) died due to tuberculosis and the remaining death were unknown/Not specified infection 222(18.3%) and diarrhea 27(2.2%). Rates of mortality caused by tuberculosis, competing with other opportunistic infection, diarrhea and unknown/Not specified were 3.5, 4.5, 0.2 and 1.8 per 1000 person-months, respectively. Having a higher CD4 count at diagnosis, responding to combination antiretroviral treatment (cART) six months after start, and having prophylactic treatment for pneumocystis pneumonia (PCP) decreased the risk of tuberculosis, other opportunistic infections, and unidentified and diarrheal causes of death. However, older age, late HIV.AIDS diagnosis, and the last HIV/AIDS WHO clinical stages increased the hazard of tuberculosis and other opportunistic disease mortality. Additionally, male gender, older age and last HIV clinical stages increased the mortality HIV/AIDS patients.ConclusionThe findings of this study demonstrated that TB, an opportunistic infection, was the primary cause of death in HIV/AIDS patients, despite the presence of several competing risks, such as diarrhea, other infections, and an undetermined or unclear cause. It's important to use effective techniques to quickly detect those who have HIV or AIDS and provide them with care and treatment to increase their chances of surviving.

Interaction between type 2 diabetes and past COVID-19 on active tuberculosis

BackgroundThe global setback in tuberculosis (TB) prevalence and mortality in the post-COVID-19 era has been partially attributed to pandemic-related disruptions in healthcare systems. The additional biological contribution of COVID-19 to TB is less clear. The goal of this study was to determine if there is an association between COVID-19 in the past 18 months and a new TB episode, and the role played by type 2 diabetes mellitus (DM) comorbidity in this relationship.MethodsA cross-sectional study was conducted among 112 new active TB patients and 373 non-TB controls, identified between June 2020 and November 2021 in communities along the Mexican border with Texas. Past COVID-19 was based on self-report or positive serology. Bivariable/multivariable analysis were used to evaluate the odds of new TB in hosts with past COVID-19 and/or DM status.ResultsThe odds of new TB were higher among past COVID-19 cases vs. controls, but only significant among DM patients (aOR 2.3). The odds of TB in people with DM was 2.7-fold higher among participants without past COVID-19 and increased to 7.9-fold among those with past COVID-19.ConclusionDM interacts with past COVID-19 synergistically to magnify the risk of TB. Latent TB screening and prophylactic treatment, if positive, is recommended in past COVID-19 persons with DM. Future studies are warranted with a longitudinal design and larger sample size to confirm our findings.

Tuberculosis Mortality in Transylvania: Some Data and an Analysis

Tuberculosis was one of the most significant causes of mortality in Transylvania during the 19th and early 20th centuries, accounting for 10–15% of all deaths. This study examines the historical context, demographic factors, and mortality trends of tuberculosis in the region, from 1850 to 1920. Relying on a variety of sources, including parish records, civil registers, and official statistics, the research highlights the challenges posed by inconsistent data, linguistic diversity, and the medical practices of the time. The study provides a comprehensive overview of tuberculosis mortality patterns in Transylvania and explores their correlation with economic and social factors. Additionally, it evaluates the public health measures implemented, particularly after 1906, when government attention to tuberculosis increased. While some improvement in survival rates was observed, particularly among females, mortality remained high among the working poor and rural populations, emphasizing the limitations of medical intervention in combating this disease.

Modelling the epidemiological and economic impact of digital adherence technologies with differentiated care for tuberculosis treatment in Ethiopia

BackgroundDigital adherence technologies (DATs) with associated differentiated care are potential tools to improve tuberculosis (TB) treatment outcomes and reduce associated costs for both patients and healthcare providers. However, the balance...

Interventions and implementation considerations for reducing pre-treatment loss to follow-up in adults with pulmonary tuberculosis: A scoping review.

Tuberculosis (TB) is a leading cause of death worldwide with over 90% of reported cases occurring in low- and middle-income countries (LMICs). Pre-treatment loss to follow-up (PTLFU) is a key contributor to TB mortality and infection transmission. We performed a scoping review to map available evidence on interventions to reduce PTLFU in adults with pulmonary TB, identify gaps in existing knowledge, and develop a conceptual framework to guide intervention implementation. We searched eight electronic databases up to February 6 2024, medRxiv for pre-prints, and reference lists of included studies. Two review authors independently selected studies and extracted data using a predesigned form. We analysed data descriptively, presented findings in a narrative summary and developed a conceptual framework based on the Practical, Robust Implementation, and Sustainability Model to map the factors for effective intervention implementation. We reviewed 1262 records and included 17 studies. Most studies were randomized controlled trials (8/17, 47%). Intervention barriers included stigma and inadequate resources; enablers included mobile phones and TB testing and results on the same day. We identified eight interventions that reduced PTLFU: treatment support groups; mobile notifications; community health workers; integrated HIV/TB services; Xpert MTB/RIF as the initial diagnostic test; computer-aided detection with chest radiography screening; active linkage to care; and multi-component strategies. Given the variation of healthcare settings, TB programs should consider contextual factors such as user acceptability, political commitment, resources, and infrastructure before adopting an intervention. Future research should utilize qualitative study designs, be people-centred, and include social and economic factors affecting PTLFU.

Trends and annual percentage changes in tuberculosis mortality estimated by Joinpoint regression and age-period-cohort analyses, Taiwan, 1978–2022

Tuberculosis (TB) was a public health problem in the past and remained a threat worldwide, including in Taiwan. We aimed to estimate annual percentage changes (APC) in TB mortality and the age-period-cohort effects on TB mortality. Taiwan TB mortality data from 1978 to 2022 was used to estimate the APC through the Joinpoint regression analysis and age-period-cohort models. Crude and age-standardized mortality rates (ASMR) reduced from 23.46 to 3.02 and 41.70 to 1.59 per 100,000 population in males, while 8.84 to 1.09 and 14.58 to 0.45, respectively, in females. During the COVID-19 pandemic, the crude rates still significantly declined in males from 2020 to 2022 but not in females. APC in ASMR significantly decreased in males and females (-7.17% and -7.64%), while after adjusted age-period-cohort effects, the estimated APC were -8.83% and -9.77%. Age-period-cohort effects were observed, with the highest peaks in the youngest (aged 0–4) and the period 1978–1982 in both sexes and peaks in the male cohort 1898–1902 and female cohort 1903– 1907. TB mortality in Taiwan has declined in all ages, sexes, periods, and cohorts. However, the COVID-19 pandemic stopped TB mortality from decreasing.

Hematological Changes in Newly Diagnosed Pulmonary Tuberculosis Patients on Standard Anti-TB Treatment Regimen and their Influence on Smear Conversion

Pulmonary tuberculosis (PTB) mortality remains high despite the availability of effective anti-TB therapy. Disease and treatment-associated hematological derangements at diagnosis and during therapy might contribute to this high TB mortality rate. This paper aims to determine hematological changes in newly diagnosed pulmonary tuberculosis patients on standard anti-TB treatment regimen and their influence on smear conversion. The study adopted a longitudinal design in which 55 newly diagnosed HIV negative PTB patients were followed up to the fifth month of anti-TB therapy. Blood samples (5ml) were collected for diagnosis during the second and fifth months and analyzed using automated HumaCount 5D hematology analyzer. Data was analyzed using Kruskal-wallis test with Dunn’s multiple comparisons test in Graph-Pad prism version 6.0. Throughout therapy, there was a statistically significant time-dependent decrease in median total white blood cell counts from 6.82x103/ uL at diagnosis to 5.87x103/ uL at the fifth month (P=0.0358). This decrease in total WBC count was majorly driven by significant decrease in the neutrophil numbers from 4.31x103/ uL at diagnosis to 2.97x103/ uL at the fifth month. The proportion of patients who had anemia at the fifth month of treatment increased compared to the second month post intensive phase. There was also a significant decrease in MCV, MCH and MCHC at the second month compared to diagnosis. Moreover, the median platelet count, MPV, PDW and PCT% decreased from 314x103/ uL, 8.9 fL, 10.4 fL and 0.273 at diagnosis to 232x103/ uL, 10.15 fL, 12.5 fL and 0.235 at the fifth month, respectively. High WBC count, high platelet count, low lymphocyte count and low HGB at the end of month two of therapy were shown to increase the likelihood of sputum non-conversion (OR-2.42 (95% Ci 2.07-2.82)), (OR-1.5 (95% Ci 1.01-2.22)), (OR-1 (95% Ci 1-1)) and (OR-2.58 (95% Ci 1.68-3.95)), respectively (P<0.05). A significant number of PTB patients presented with anemia, thrombocytosis and leukocytosis. The proportion of patients with anemia increased over time. The study recommends screening for hematological abnormalities in patients for tailored patient interventions for better clinical outcomes.

Modeling the epidemiologic impact of age-targeted vaccination for drug-resistant tuberculosis

This study used a calibrated mathematical model to evaluate age-specific tuberculosis (TB) vaccination strategies, for drug-resistant (DR)-TB management in China. Prioritizing elderly vaccination significantly reduced multidrug-resistant or rifampicin-resistant TB incidence and mortality, while avoiding the need for second-line treatment, offering a promising approach to mitigate DR-TB burden by 2050.

Diversity Presentation of Pulmonary Tuberculosis in Children: A Case Series of Three Patients

Malaysia, among other developing countries has significant tuberculosis (TB) morbidity and mortality. Variation in presentations with subtle symptoms plays a crucial role in diagnosis challenges. Depending on the stage of the disease, patient may be presented with spectrum of no symptoms up to severe complications of the disease including extensive miliary TB. Diagnosis requires a high index of suspicion. In addition to that, positive yield of the sampling for microbiological investigation is difficult as the pathophysiology involving paucibacillary tuberculous. In this case series, we discuss three cases of diversity in presentation of pulmonary tuberculosis in children.

Africa Health Research Institute (AHRI) Household Contact study: a study protocol, statistical analysis and modelling plan

Household case-contact studies are an established method to estimate the relative infectiousness of people with pulmonary tuberculosis. Testing of child household contacts with a QuantiFERON TB Gold plus (QFT) assay provides a proxy measure of M. tuberculosis infection in exposed household members. This study aims to generate data about the effect of antiretroviral treatment (ART) and of tuberculosis symptoms on risk of intra-household M. tuberculosis transmission to children and investigate the conditions under which symptom-agnostic screening should be considered, which could provide evidence to support a paradigm shift in tuberculosis screening strategy. Index people diagnosed with bacteriologically-confirmed pulmonary tuberculosis who have been identified by routine health services and starting tuberculosis treatment at one of the 12 health facilities serving the population of the Africa Health Research Institute health and demographic surveillance area will be eligible for recruitment. For each consenting index participant, we will enroll all household members aged 2-14 years who will undergo a symptom screen and provide a blood sample for a QFT and HIV test. We will compare the proportion of child contacts who are QFT-positive in households of (i) index adults who are living with HIV and taking ART vs not taking ART and (ii) index adults engaged in ART care who report no symptoms vs those who report symptoms. We will use a novel mathematical model, incorporating new insights into TB natural history and transmission, to determine the circumstances under which screening for TB, regardless of reported symptoms, would have most impact on tuberculosis incidence and mortality, and explore comparative cost-effectiveness of interventions along the diagnostic pathway at different levels of the health system. Estimates of relative risk of intra-household M. tuberculosis transmission, combined with healthcare utilisation and cost data, will allow us to generate mathematical model estimates of the potential epidemiological impact and relative cost-effectiveness of different approaches to tuberculosis case-finding including symptom-agnostic tuberculosis screening at different levels of the health system.

A predictive score for early in-patient tuberculosis mortality: A case-control study

IntroductionIn-hospital mortality rates for tuberculosis (TB) patients are high within the first seven days of admission. This study sought to identify predictors of early inpatient mortality and assess the performance of a predictive score for early mortality in a Ugandan tertiary hospital. Materials and methodsA case-control study was conducted at Kiruddu National Referral Hospital in Kampala, Uganda. Cases included patients admitted with TB who died within seven days of admission, while controls survived beyond this period. Logistic regression was utilized to identify early mortality predictors. The performance of an adapted predictive score (PROS score) was evaluated, assigning scores based on the following criteria: Pulse rate >100 beats/min (1 point), Respiratory rate >20 breaths/min (2 points), Oxygen saturation <92 % (4 points), and Systolic blood pressure <90 mmHg (2 points). ResultsOf 602 hospitalized TB patients, 187 (31.0 %) died during admission. Among these, 78 (41.7 %) died within seven days. Wasting (adjusted odds ratio [aOR] = 5.76, 95 % confidence interval [CI] 2.12–15.63, p = 0.001) and respiratory rate >20 breaths/min (aOR = 2.89, 95 % CI 1.19–7.00, p = 0.019) predicted early mortality. PROS score of ≥1 demonstrated a sensitivity of 87.8 % and negative predictive value of 90.0 %. The ultimate TB treatment success rate of all hospitalized patients (n = 599) was 47.4 % with 275 (45.9 %) dying during TB treatment. ConclusionEarly and long term mortality rates among hospitalized TB patients are high. Wasting and tachypnea predict early inpatient mortality. The PROS score could be useful in ruling out low-risk patients in low-resource settings.

Effects of the COVID-19 pandemic on TB outcomes in the United States: a Bayesian analysis.

Tuberculosis (TB) cases and deaths in the United States fluctuated substantially during the COVID-19 pandemic. We analyzed multiple data sources to understand the factors contributing to these changes and estimated future TB trends. We identified four mechanisms potentially contributing to observed TB trends during 2020-2023: immigration, respiratory contact rates, rates of accurate diagnosis and treatment initiation, and mortality rates for persons with TB disease. We employed a Bayesian approach to synthesize evidence on how these mechanisms changed during the pandemic and how they might have combined to produce observed 2020-2023 TB data, using a transmission-dynamic model to link mechanisms to TB outcomes. We also simulated a no-pandemic counterfactual scenario that assumed mechanisms followed pre-pandemic trends. We estimated TB outcomes associated with the pandemic until 2035 to capture lagged effects. We evaluated additional scenarios to estimate the individual effect of each mechanism. Over the 2020-2035 study period, we estimate an additional 2,784 (95% uncertainty interval: 2,164-3,461) TB cases and 1,138 (1,076-1,201) TB deaths in the United States associated with changes occurring during the COVID-19 pandemic. The four mechanisms had offsetting effects - decreases in TB diagnosis rates and increases in TB mortality rates led to more TB deaths, while reductions in contact rates reduced TB deaths. Immigration changes initially reduced TB deaths, but increased deaths over time. While the direct impacts of the COVID-19 pandemic occurred between 2020-2023, these changes may continue to influence TB incidence and mortality in future years.