TB Mortality Research Articles

Rights-Based Legal Considerations for TB Isolation Practices in Community Settings in the Post-Pandemic Era.

State and local governments are free to enact infectious disease control laws to protect the public health but must conform those laws to right-based limitations imposed by the United States Constitution. TB control laws that empower public health agencies and their representatives to institute restrictions on movement and activities for persons with TB have remained largely unchanged for decades and warrant review to ensure consistency with modern legal principles. During the COVID-19 pandemic, there was increased attention to the tension between non-pharmaceutical public health interventions (masking, isolation, lock-downs) intended to reduce transmission and improve community health and their potential negative consequences on learning, mental health, individual finances and the economy at large. Increasing evidence suggests that much of TB transmission is likely to have occurred prior to diagnosis and treatment initiation, and there is limited scientific evidence for the efficacy of community-based isolation in reducing TB incidence or TB mortality; by contrast, there is evidence that treatment rapidly reduces infectiousness, and that prolonged isolation may have deleterious health and financial effects for persons with TB. The post-pandemic era presents an opportunity to reassess public health authorities' legal obligations in designing voluntary and involuntary isolation policies for persons with tuberculosis. In so doing, state and local governments can recalibrate the balance between respect for individual constitutional rights and achieving public health TB goals.

Tuberculosis in South Asia: A regional analysis of burden, progress, and future projections using the global burden of disease (1990–2021)

BackgroundTuberculosis (TB) is a major public health issue in South Asia and accounts for a large share of the global TB burden. Despite global efforts to curb TB incidence and mortality, progress in South Asia has been uneven, necessitating focused regional analysis to guide effective interventions. This study aims to analyse the trends in the TB burden in South Asia from 1990 to 2021 and project future TB incidence rates up to 2031. MethodsThis study utilized data from the Global Burden of Disease (GBD) 2021 results to analyse trends in age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (DALYs) rates (ASDR) associated with TB in South Asia from 1990 to 2021. Joinpoint regression analysis was employed to identify significant trends, whereas ARIMA models were used to project future TB incidence rates up to 2031. ResultsThis study revealed significant declines in the ASIR, ASPR, ASDR, and ASMR related to TB in South Asia over the past three decades. Prominent reductions were found in Bangladesh and Bhutan, whereas India, Pakistan, and Nepal continue to bear the highest TB burdens. The ARIMA model projections indicate a continued decline in TB incidence across the region, although the extent of the decline varies by country, with less favourable trends observed in Nepal and Pakistan. The analysis also highlights tobacco use, high fasting plasma glucose, and high body mass index as significant risk factors contributing to the TB burden. ConclusionsSubstantial progress has been made in reducing the TB burden in South Asia; however, sustained and intensified efforts are needed, particularly in countries with inconsistent progress. These findings emphasize the need for targeted interventions to meet the WHO End TB Strategy (WETS) targets by 2035. Continuous monitoring and adaptive strategies will be crucial in maintaining and accelerating progress toward TB elimination in South Asia.

Health and economic impacts of Vaccae vaccination incorporating active case finding in India and South Africa: a modelling study

IntroductionTuberculosis (TB) is a major global health issue, particularly, in India and South Africa. We aim to evaluate the potential of the new TB vaccine, Vaccae, to enhance TB control...

“Intensified Case Finding of Tuberculosis among Diabetes Mellitus Patients attending Non-Communicable Disease Clinic in a Tertiary Care Hospital – An Implementation Research”

BackgroundFor ending the epidemic of TB by the year 2030, along in line with Sustainable Development Goals, it is essential to address the TB associated co-morbidities. Prevalence of diabetes influencing TB incidence and mortality is higher when compared to other co-morbidities like HIV infection, cigarette smoking, alcohol use and under-nutrition. Therefore, this study was conducted with the following objectives: 1.To evaluate the effectiveness of the intervention on implementation of TB-DM collaborative activity using four symptom complex strategy and to explore the patient and health providers related factors that contribute to implementation of activity. Material and MethodsThe present study was undertaken by Department of Community Medicine, Sri Manankula Vinayagar Medical College and Hospital, Puducherry for a period of 18 months in the Out Patient Departments of General Medicine, General Surgery, Obstetrics and Gynecology, Orthopedics, DOTS center and Designated Microscopy Centre. It was an embedded sequential experimental study, done among the health care professionals (CRRI, Postgraduates and staff nurse) who were involved in process of 4s complex screening for DM patients and the stakeholders who were involved in implementation of NTEP activity. The study was conducted in three phases. Phase I: baseline survey and identification of intervention strategies, Phase II: implementation of the intervention and Phase III: end line survey. Data entry and analysisManual content analysis was done for Qualitative data. The Quantitative data were entered into Epi Info software (version 7.2.2.6) and analyzed in SPSS software (version 24). Comparison of knowledge among the health care professionals before and after sensitization was calculated using Mc nemar test. It was considered statistically significant when the p value was <0.005. The analysis of free list and pile sort data was undertaken using Anthropac 4.98.1/X software. ResultsChallenges obtained from stakeholders in implementing the activity were categorized as patient related factor, health care professional related factor and screening and reporting related factor. Suggested solutions were generating awareness at patient level, display of IEC tools, periodical sensitization for the staff, inter-departmental co-ordination, monitoring and re-enforcing the activity in core-committee meetings. After sensitization, the knowledge on joint TB-DM collaborative activity was significantly improved among the health care professionals. By implementing the four symptom complex screening activity in NCD clinic, 6480 DM patients were screened and 176 (2.7%) presumptive TB cases were identified. Of which, 136 of them reached DMC for sputum examination. Among them 44 (35.4%) had active TB infection. The Number Needed to Screen to yield a case of TB was 147. Conclusionand recommendations: We found improvement in identification of TB cases using ICF approach with minimal resources. Thus, we recommend a support group to maintain and strengthen the ongoing activity. The challenges and solutions identified may help in optimizing the screening process. Implementing the activity in special clinics like oncology OPDs, nephrology OPDs, antenatal clinics can be recommended.

Outcomes of people with TB reported to the WHO Global Clinical Platform of COVID-19.

TB is a leading infectious cause of death worldwide. The COVID-19 pandemic raised concerns that the burden of TB disease and death would increase due to the synergy between the two conditions. We used individual-level data submitted to the WHO Global Clinical Platform for COVID-19 on hospitalised patients to explore associations of TB with mortality using multivariable logistic regression. Data were available from 453,233 persons with COVID-19 and known TB status and mortality outcomes from 62 countries (96% SARS-CoV-2 test-positive). Of these, 48% were male, and the median age was 53 years (IQR 38-67). There were 8,214 cases with current TB reported by 46 countries, mainly from Africa. Of people with current TB, 31.4% were admitted with severe illness, and 24.5% died. Current TB was independently associated with higher mortality when adjusted for age, sex, HIV status, illness severity at hospital admission, and underlying conditions (adjusted RR 1.47, 95% CI 1.35-1.61). Current or past TB were independent risk factors for in-hospital mortality regardless of illness severity at admission. Caveats for interpretation include changes during the data collection period (viral variation, vaccination coverage) and opportunistic sampling. However, the platform exemplifies how timely, coordinated global reporting can inform our understanding of health emergencies and the vulnerable populations affected.

Student Synergy in Community Stage Field Practice and Cadre Collaboration Against Tuberculosis: Puskesmas Karyawangi Village-West Bandung

Tuberculosis is an aerosol infectious disease caused by Mycobacterium tuberculosis. WHO estimated that there are 10.6 million individuals in the world suffering from TB disease in 2021; reversing the downward trend that had occurred slowly over the previous years. The global TB mortality rate in 2021, with an estimate of 1.6 million people, has also increased compared to 1.4 and 1.5 million deaths in 2019 and 2020. Therefore, the problem of TB disease needs to be of concern to all parties, including nurses. One of the things community nurses can do is provide health education to the community to prevent the increasing number of TB sufferers. The aim of this final scientific work is to examine the factors that increase the risk of TB in the people of Karyawangi Village, Parongpong District, West Bandung Regency and to provide community nursing interventions according to the problems found. Based on the results of interviews and observations conducted on 40 families from RW 7, 9, 12 and 14; it was found that 92.5% of families lacked knowledge about TB, 87.5% of families had at least 1 member who smoked cigarettes at home, 62.5% of families did not regularly open the windows of the house, and 55% of families did not regularly consume vegetables and fruit. Based on these findings, health education was carried out with the aim of inviting residents to know about TB and practice healthy &amp; clean living which can help prevent TB disease.

Asuhan Kebidanan Komprehensif Pada Ny. S Umur 42 Tahun Dengan Kehamilan Resiko Tinggi Umur, Anemia Dan Kekurangan Energi Kronis (KEK) Di Puskesmas Kaliwadas Kabupaten Brebes

. According to WHO (2019) TB mortality rate (AKI) in the world namely 303,000 people. Maternal Mortality Rate (MMR) in ASEAN (2020), namely amounting to 235/100,000 live births. Based on data from the Ministry of Health Figures Maternal mortality (MMR) in Indonesia in 2020 was 4,627 deaths. Data Health Department (2021) MMR 62 cases. Data from Kaliwadas Community Health Center (2022) MMR 0 case. The aim of this research was to reduce maternal and infant morbidity and mortality rates in Brebes district, especially the Kaliwadas Community Health Center area. This research method is qualitative research, namely a research method carried out by exploring, describing and explaining and predicting a phenomenon that occurs on the basis of it in the field. The results of this research are after carrying out comprehensive midwifery care in Mrs. S is 42 years old with risk factors: age, anemia and CED at the Community Health Center Kaliwadas from the third trimester of pregnancy, childbirth, newborns, postpartum and family planning using Varney and midwifery approaches SOAP found gaps between theory and practice.

Genetic Characterization and Population Structure of Drug-Resistant Mycobacterium tuberculosis Isolated from Brazilian Patients Using Whole-Genome Sequencing.

The present study aimed to determine the genetic diversity of isolates of Mycobacterium tuberculosis (Mtb) from presumed drug-resistant tuberculosis patients from several states of Brazil. The isolates had been submitted to conventional drug susceptibility testing for first- and second-line drugs. Multidrug-resistant (MDR-TB) (54.8%) was the most frequent phenotypic resistance profile, in addition to an important high frequency of pre-extensive resistance (p-XDR-TB) (9.2%). Using whole-genome sequencing (WGS), we characterized 298 Mtb isolates from Brazil. Besides the analysis of genotype distribution and possible correlations between molecular and clinical data, we determined the performance of an in-house WGS pipeline with other online pipelines for Mtb lineages and drug resistance profile definitions. Sub-lineage 4.3 (52%) was the most frequent genotype, and the genomic approach revealed a p-XDR-TB level of 22.5%. We detected twenty novel mutations in three resistance genes, and six of these were observed in eight phenotypically resistant isolates. A cluster analysis of 170 isolates showed that 43.5% of the TB patients belonged to 24 genomic clusters, suggesting considerable ongoing transmission of DR-TB, including two interstate transmissions. The in-house WGS pipeline showed the best overall performance in drug resistance prediction, presenting the best accuracy values for five of the nine drugs tested. Significant associations were observed between suffering from fatal disease and genotypic p-XDR-TB (p = 0.03) and either phenotypic (p = 0.006) or genotypic (p = 0.0007) ethambutol resistance. The use of WGS analysis improved our understanding of the population structure of MTBC in Brazil and the genetic and clinical data correlations and demonstrated its utility for surveillance efforts regarding the spread of DR-TB, hopefully helping to avoid the emergence of even more resistant strains and to reduce TB incidence and mortality rates.

Gender-age peculiarities of disability-adjusted life years (DALYs) in tuberculosis in a high-density region: a retrospective cohort study

Background. Infections associated with socially significant diseases considerably contribute to a decrease in the quality of public health. Tuberculosis, though declining in Russia, is still recognized as a pressing public health problem. Meanwhile, an assessment of the burden of tuberculosis on society, using such comprehensive methods as measuring disability-adjusted life years, is yet to be investigated in Russia. Objective. To estimate the tuberculosis burden by calculating the index of disability adjusted life years in a high-density region.Methods. The retrospective cohort study involved data on newly-diagnosed and died of tuberculosis cases that corresponded to the annual reporting form of federal statistical surveillance No. 8 “Information on active tuberculosis cases” for the Republic of North Ossetia-Alania; information on patients who died of tuberculosis or tuberculosis combined with infection caused by human immunodeficiency virus, was obtained from the Department of Civil Status Records of the Republic of North Ossetia-Alania and verified with data from the Federal State Statistics Service; data on tuberculosis-associated disability was received from Main Bureau of Medical and Social Expertise in the Republic of North Ossetia-Alania of the Ministry of Labor and Social Protection of the Russian Federation for 2018 and 2022. Following the analytic dataset, 691 people with newly-diagnosed tuberculosis, who received TB-associated disability and died from TB in 2018 (318 people) and 2022 (373 people) were identified. The study involved calculation of gender and age standardized TB morbidity and mortality rates as well as DALY index with its components: Years of Life Lost due to tuberculosis and Years Lost due to Disability. The study involved comparing data between 2018 and 2022 and gender/age-specific indicators within the same year. Mathematical data processing was performed using Microsoft Excel 2017 (Microsoft Corporation, USA) and SPSS 26.0 (SPSS Inc., USA). Differences between the compared indicators were evaluated by Chi-square criterion with variations, the initial data were grouped in a contingency table, the significance of differences was expressed by p-value.Results. The burden of tuberculosis in the Republic of North Ossetia-Alania refers predominantly to the male population: with a gender difference in the decrease in the disability-adjusted life years in 2018 and 2022 by 4.4 and 9.0 times (p &lt; 0.05), respectively; 2.8 times among males, 5.5 times among females (p &lt; 0.05). The burden of tuberculosis is mainly associated with premature mortality due to tuberculosis among males aged 35–54 years and among females aged 35–44 years with a pronounced decrease in Years of Life Lost. Years of Life Lost among males aged 20–34 in 2022 appears two times higher than the cohort average. The increase in Years of Life Lost among males aged 60–64 accounted for 1.7 times, in Years Lost Due to Disability — 11.2 times (p &lt; 0.05). Years Lost Due to Disability among females aged 20–44 years appeared to be the highest, exceeding the cohort average by more than two times in 2018.Conclusion. The burden of tuberculosis is predominantly due to tuberculosis-related premature mortality among the male population. According to the disturbing conclusion, Years of Life Lost among young males aged 20–34 years and tuberculosis-related premature mortality shift towards the male population of pre-retirement age (60–64 years) with an increase in Years Lost Due to Disability among them. Notably, the study reveals high rates of Years Lost Due to Disability among females aged 20–44. The results obtained should be taken into account when developing regional tuberculosis programs with their targeted use in “vulnerable” age and gender groups of the population.

Tuberculosis preventive treatment uptake among adults living with human immunodeficiency virus: Analysis of Zimbabwe population-based human immunodeficiency virus impact assessment 2020.

Tuberculosis remains the leading cause of death by an infectious disease among people living with HIV (PLHIV). TB Preventive Treatment (TPT) is a cost-effective intervention known to reduce morbidity and mortality. We used data from ZIMPHIA 2020 to assess TPT uptake and factors associated with its use. ZIMPHIA a cross-sectional household survey, estimated HIV treatment outcomes among PLHIV aged ≥15years. Randomly selected participants provided demographic and clinical information. We applied multivariable logistic regression models using survey weights. Variances were estimated via the Jackknife series to determine factors associated with TPT uptake. The sample of 2419 PLHIV ≥15years had 65% females, 44% had no primary education, and 29% lived in urban centers. Overall, 38% had ever taken TPT, including 15% currently taking TPT. Controlling for other variables, those screened for TB at last HIV-related visit, those who visited a TB clinic in the previous 12months, and those who had HIV viral load suppression were more likely to take TPT. The findings show suboptimal TPT coverage among PLHIV. There is a need for targeted interventions and policies to address the barriers to TPT uptake, to reduce TB morbidity and mortality among PLHIV.

Costs incurred by people with co-morbid tuberculosis and diabetes and their households in the Philippines.

Diabetes is a risk factor for TB mortality and relapse. The Philippines has a high TB incidence with co-morbid diabetes. This study assessed the pre- and post-TB diagnosis costs incurred by people with TB and diabetes (TB-DM) and their households in the Philippines. Longitudinal data was collected for costs, income, and coping mechanisms of TB-affected households in Negros Occidental and Cebu, the Philippines. Data collection was conducted four times during TB treatment. The data collection tools were developed by adapting WHO's cross-sectional questionnaire in the Tuberculosis Patient Cost Surveys: A Handbook into a longitudinal study design. Demographic and clinical characteristics, self-reported household income, number of facility visits, patient costs, the proportion of TB-affected households facing catastrophic costs due to TB (>20% of annual household income before TB), coping mechanisms, and social support received were compared by diabetes status at the time of TB diagnosis. 530 people with TB were enrolled in this study, and 144 (27.2%) had TB-DM based on diabetes testing at the time of TB diagnosis. 75.4% of people with TB-DM were more than 45 years old compared to 50.3% of people with TB-only (p<0.001). People with TB-DM had more frequent visits for TB treatment (120 vs 87 visits, p = 0.054) as well as for total visits for TB-DM treatment (129 vs 88 visits, p = 0.010) compared to those with TB-only. There was no significant difference in the proportion of TB-affected households facing catastrophic costs between those with TB-DM (76.3%) and those with TB-only (68.7%, p = 0.691). People with TB-DM in the Philippines face extensive health service use. However, this does not translate into substantial differences in the incidence of catastrophic cost. Further study is required to understand the incidence of catastrophic costs due to diabetes-only in the Philippines.

Detection of mycobacterium tuberculosis by microscopic examination and gene expert in a suspected patient with pulmonary tuberculosis disease, in Dili City, East Timor

Tuberculosis is one of the most dangerous and deadly diseases, so control is needed to reduce the transmission rate of TB disease and mortality among the community, so the gene method is very appropriate to be able to help in diagnosing TB. Acid-resistant bacilli are bacteria that have a very thick lipid content so that the staining cannot be affected by other dye reactions, except by using phenol and through the heating process. Mycobacterium tuberculosis has a cell wall consisting of a waxy coating and mycolic acid; therefore, these bacteria can only color with BTA. Mycbakterium Tuberculosis can maintain the first color, namely Carbun Fuchin, and fight decolorization with alcoholic acid, so this bacterium is called an acid-resistant bacillus. The right examination method to diagnose TB disease is necessary to be able to follow the appropriate treatment so as to reduce transmission and death rates due to TB disease. The aim of this research is to analyze the difference in examination results using microscopes and Gene Xpert machines in Dili district in suspected patients with pulmonary tuberculosis.

Key drivers of the TB epidemic in Suriname and priority actions to reduce incidence and mortality.

The WHO has recently published updated guidance for national strategic planning for TB. To address the TB epidemic comprehensively, it is necessary to conduct an epidemiological review as part of the situation analysis in the national strategic plan. A descriptive epidemiological study was conducted using data from the national TB register for the period of 2010-2020. Simple frequencies were calculated for demographic and clinical variables. Trends in TB notification rates for the period 2010-2020 were also calculated. TB notification rates between 2011 (24.3/100,000) and 2019 (23.9/100,000) remained almost the same. The HIV status was known for 97.1% of TB cases, 22.7% of whom had HIV co-infection; 10.9% of patients with detected Mycobacterium tuberculosis were also resistant to rifampicin. Case fatality rate for all cases was 13.0%. Of the identified contacts, 66% were screened; 28.3-47.5% of those with TB infection started treatment, 63.3-75.9% of whom completed treatment. The review identified the following areas of concern: no decline in TB rates, high proportion of TB-HIV co-infection, high rate of resistance to rifampicin, high case-fatality rates and suboptimal contact investigation care cascade . The review was used to inform interventions and key actions to reduce TB morbidity and mortality in Suriname.

Determinant of Successful Tuberculosis Treatment in Puskesmas Singosari in 2020-2022

Indonesia is one of the countries that contribute the most mortality of TB in the world. The tuberculosis treatment success rate in Indonesia is 86% meanwhile is still far from the target coverage of the TB treatment success rate (90%). This study conducted to determine the determinant factors of successful TB treatment in Puskesmas Singosari. A cross-sectional design study was constructed for this study and used SITB and form TB as a research instrument. The population of this study were all drug-susceptible TB patients who had completed treatment at the Puskesmas Singosari in 2020, 2021, and QI-QII in 2022. The sample of this study was 71 people from 99 total population. The dependent variable is the success of drug-susceptible TB treatment. Independent variables are sex, age, weight, regular use of anti-tuberculosis drugs, and comorbidities. The data processing and analysis are being conducted using SPSS software. Chi-square analysis showed that the variable weight changes have a significant assosiation to successful tuberculosis treatment (p = 0,014; OR = 9,818). Puskesmas Singosari's TB Team can collaborate with the nutritionist team to optimize TB treatment by monitoring nutritional status and weight gain of drug-susceptible TB patients.

The Burden of Bacteriologically Negative TB Diagnosis: A Four-Year Review of Tuberculosis Cases at a Tertiary Facility.

We aimed to investigate the demographic and clinical factors associated with TB mortality in patients managed at a tertiary TB referral center. We conducted a retrospective review of the medical records of 1,933 TB patients seen between January 2017 and December 2020 at the Korle-Bu Teaching Hospital (KBTH) Chest Department in Accra, Ghana. TB mortality was defined as any TB patient who died for any reason during the course of treatment. Multivariable logistic regression was used to estimate adjusted odds ratios with 95% confidence intervals for factors associated with TB mortality. A total of 1,933 patients with TB were registered at the chest clinic over the study period. Males accounted for 1,227 (63.5%), and majority of participants were between 24 and 64 years old. Pulmonary TB (PTB) and extrapulmonary TB (EPTB) cases accounted for 51% and 48.4% of the total TB cases, respectively. A significant proportion (69%) of the patients managed for TB had no bacteriological confirmation of the disease. About 34% of tested TB patients were HIV positive. Mortality among patients was 33.6%. In a multivariable regression model, patients with HIV positive status had over 3-fold increased risk of mortality, compared to those with HIV negative status. TB patients diagnosed empirically had an increased risk of death compared to those with a confirmed diagnosis. The proportion of clinically diagnosed TB was high among the patients seen at the chest clinic. Mortality was high among the patients with HIV/TB coinfection as well as in patients with empirical TB diagnosis.

Sustained high fatality during TB therapy amid rapid decline in TB mortality at population level: A retrospective cohort and ecological analysis from Shiselweni, Eswatini.

Despite declining TB notifications in Southern Africa, TB-related deaths remain high. We describe patient- and population-level trends in TB-related deaths in Eswatini over a period of 11 years. Patient-level (retrospective cohort, from 2009 to 2019) and population-level (ecological analysis, 2009-2017) predictors and rates of TB-related deaths were analysed in HIV-negative and HIV-coinfected first-line TB treatment cases and the population of the Shiselweni region. Patient-level TB treatment data, and population and HIV prevalence estimates were combined to obtain stratified annual mortality rates. Multivariable Poisson regressions models were fitted to identify patient-level and population-level predictors of deaths. Of 11,883 TB treatment cases, 1302 (11.0%) patients died during treatment: 210/2798 (7.5%) HIV-negative patients, 984/8443 (11.7%) people living with HIV (PLHIV), and 108/642 (16.8%) patients with unknown HIV-status. The treatment case fatality ratio remained above 10% in most years. At patient-level, fatality risk was higher in PLHIV (aRR 1.74, 1.51-2.02), and for older age and extra-pulmonary TB irrespective of HIV-status. For PLHIV, fatality risk was higher for TB retreatment cases (aRR 1.38, 1.18-1.61) and patients without antiretroviral therapy (aRR 1.70, 1.47-1.97). It decreases with increasing higher CD4 strata and the programmatic availability of TB-LAM testing (aRR 0.65, 0.35-0.90). At population-level, mortality rates decreased 6.4-fold (-147/100,000 population) between 2009 (174/100,000) and 2017 (27/100,000), coinciding with a decline in TB treatment cases (2785 in 2009 to 497 in 2017). Although the absolute decline in mortality rates was most pronounced in PLHIV (-826/100,000 vs. HIV-negative: -23/100,000), the relative population-level mortality risk remained higher in PLHIV (aRR 4.68, 3.25-6.72) compared to the HIV-negative population. TB-related mortality rapidly decreased at population-level and most pronounced in PLHIV. However, case fatality among TB treatment cases remained high. Further strategies to reduce active TB disease and introduce improved TB therapies are warranted.

Factors associated with mortality in HIV-TB co-infected patients during and after the course of TB treatment in high-burden settings, Mumbai, India: A cohort analysis.

Knowledge of factors associated with TB mortality during treatment and post treatment will help us develop better monitoring and implementation strategies for TB control. We designed the present study to examine the factors associated with mortality in HIV-TB co-infected patients during and after the course of TB treatment. This study is a cohort analysis of secondary data collected from 1804 HIV-TB co-infected individuals from 16 anti-retroviral therapy (ART) centres affiliated with the Mumbai Districts AIDS Control Society, Mumbai, India. We used Kaplan Meier survival curves and hazard ratios to estimate the mortality in patients. The overall mortality rate in this cohort was 1.14 per 100 per month. The mortality proportion was 18% (95% CI: 16.1%, 20.1%) during treatment and 10.6% (95% CI: 8.9%, 12.5%) in the post-treatment period. Mortality was significantly higher in those with a CD4 count 0-200 cells/mm3 (HR: 3.04, 95% CI: 2.13, 4.15; p < 0.001), and in patients who were ART naïve and referred to the ART centre with a diagnosis of TB (HR: 1.39, 95% CI: 1.06, 1.82; p = 0.016). Mortality was also significantly higher in the first 6 months after initiation of ART (HR: 1.36, 95% CI: 1.06, 1.75; p = 0.016). A decrease in the CD4 counts from initial levels at start of TB treatment to end of TB treatment was associated with higher mortality in the post-treatment period. The overall mortality remains high; early identification of TB and HIV disease, and use of rapid point of care tests for diagnosis of TB are needed across all health care facilities. Post-treatment follow-up and monitoring is important in HIV-TB co-infected patients, and post-treatment mortality should also be considered as one of the indicators for successful TB control programmes.

Effect of integrating traditional care with modern healthcare to improve tuberculosis control programs in Ethiopia: a protocol for a cluster-randomized controlled trial

BackgroundTuberculosis (TB) remains a major cause of morbidity and mortality in the world, despite being a preventable and curable disease. The World Health Organization (WHO) End-TB Strategy, aligned with the Sustainable Development Goals (SDGs), sets a target of reducing the TB mortality rate by 95%, TB incidence rate by 90%, and catastrophic costs due to TB by 2035, compared with a 2015 level. To achieve these ambitious targets, several interventions have been implemented in the last few years, resulting in major progress toward reducing the burden of TB. However, over one-third of the global TB cases remained undetected and never received treatment. Most of those undetected cases were found in low- and middle-income countries such as Ethiopia. Though several interventions were implemented to increase TB case detection and mitigate catastrophic costs associated with TB, sustaining these interventions in resource-constrained settings remains challenging. Consequently, an alternative method is needed to increase TB case detection while decreasing diagnosis delays and catastrophic costs. Therefore, this study aimed to integrate traditional TB care into modern TB care to improve TB control programs, including early TB case detection, and reduce catastrophic costs in high TB burden settings such as Ethiopia.MethodsA cluster randomized controlled trial will be conducted in northwest Ethiopia to determine the effectiveness of integrating traditional care with modern TB care. The intervention will be conducted in randomly selected districts in the South Gondar Zone. The control group will be an equal number of districts with usual care. The intervention comprised three key components, which include referral linkage from traditional to modern health care; training of health professionals and traditional care providers in three different rounds to increase their knowledge, attitude, and skills toward the referral systems; and TB screening at traditional health care sites. The primary outcomes of interest will be an increase in case detection rate, and the secondary outcomes of interest will be decreased diagnosis delays and catastrophic costs for TB patients. Data will be collected in both the intervention and control groups on the main outcome of interest and a wide range of independent variables. Generalized linear mixed models will be used to compare the outcome of interest between the trial arms, with adjustment for baseline differences.DiscussionThis cluster-randomized controlled trial study will assess the effectiveness of a strategy that integrates traditional healthcare into the modern healthcare system for the control and prevention of TB in northwest Ethiopia, where nearly 90% of the population seeks care from traditional care systems. This trial will provide information on the effectiveness of traditional and modern healthcare integration to improve TB case detection, early diagnosis, and treatment, as well as reduce the catastrophic costs of TB.Trial registrationClinicalTrials.gov NCT05236452. Registered on July 22, 2022.

Tuberculosis Diagnosis Using Deep Transferred EfficientNet.

Tuberculosis is a very deadly disease, with more than half of all tuberculosis cases dead in countries and regions with relatively poor health care resources. Fortunately, the disease is curable, and early diagnosis and medication can go a long way toward curing TB patients. Unfortunately, traditional methods of TB diagnosis rely on specialist doctors, which is lacking in areas with high TB mortality rates. Diagnostic methods based on artificial intelligence technology are one of the solutions to this problem. We propose a Deep Transferred EfficientNet with SVM (DTE-SVM), which replaces the pre-trained EfficientNet classification layer with an SVM classifier and achieves auspicious performance on a small dataset. After ten runs of 10-fold Cross-Validation, the DTE-SVM has a sensitivity of 93.89±1.96, a specificity of 95.35±1.31, a precision of 95.30±1.24, an accuracy of 94.62±1.00, and an F1-score of 94.62±1.00. In addition, our study conducted ablation studies on the effect of the SVM classifier on model performance and briefly discussed the results.

Effect of gaseous pollutant and greenness exposure on mortality during treatment of newly treated tuberculosis patients: a provincial population-based cohort study.

Previous studies addressing the impact of environmental factors on TB prognosis are scarce, with only some studies examining the effect of particulate pollutants on TB mortality. Moreover, few studies have evaluated the effects of multiple gaseous pollutants and greenness exposures on newly treated TB patients on a large population scale. Through the Centers for Disease Control and Prevention, data were collected from January 1, 2015 to December 31, 2020 for newly treated TB patients in Anhui Province, China. Data on gaseous pollutants sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone were collected through the National Earth System Science Data Center of China. Normalized vegetation index data were obtained through NASA. The Cox proportional risk model was also applied to calculate the hazard ratios of SO2, NO2, CO, O3, and NDVI with 95% confidence intervals for mortality among newly treated TB patients. Multifactorial Cox regression analysis showed that for every 0.10μg/m3 increase in SO2, the risk of death among newly treated TB patients increased by 13.2% (HR = 1.132, 95% CI: 1.045-1.1.225), for every 10μg/m3 increase in NO2, the risk of death among newly treated TB patients increased by 11.4%, and for each 0.1 mg/m3 increase in CO, the risk of death among newly treated TB patients increased by 5.8%. For each 0.1 increase in NDVI 250m-buffer and 500m-buffer, the risk of death among newly treated TB patients decreased by 8.5% and 6.4%, respectively. The effect of gaseous pollutants on mortality decreased progressively with elevated greenness exposure when greenness exposure was grouped from low to high. Gaseous pollutants are a risk factor during the treatment of newly treated TB patients and greenness exposure is a protective factor. Higher greenness exposure reduces the risk of death due to exposure to gaseous pollutants.