Negative TB Patients Research Articles

A glimpse into the genotype and clinical importance of non tuberculous mycobacteria among pulmonary tuberculosis patients: The case of Ethiopia.

Laboratory identification of nontuberculous mycobacteria (NTM) species is not regularly performed while, they have a public health importance with a prevalence of more than 5% among pulmonary tuberculosis (PTB) patients in Ethiopia. Hence, this study aimed to identify the NTM species and their clinical significance among PTB patients. A retrospective study was conducted at the Ethiopian Public Health Institution’s (EPHI’s) national TB referral laboratory. Stored NTM isolates were genotyped using GenoType Mycobacterium CM/AS kit (Hain Life science, Germany). Data pertinent to the study was extracted from the EPHI’s database and patients’ medical records. Between January 2 & December 28 of 2017, a total of 3,834 samples were processed from 698 TB patients of whom 50% were female. Among 3,317 samples with mycobacterial culture results 7.3% were NTM and majority of them were identified from smear negative TB patients. M. simiae was the /predominant NTM among the genotyped isolates. All the studied NTM species were not clinically important however, considering the similarity of clinical and radiologic findings between NTM and MTBC infected patients, integrating NTM species identification in the routine TB laboratory diagnosis may augment clinicians’ decision particularly in DR-TB patients. Additional similar prospective study with a larger sample size is recommended. Moreover, urgent improvements on patients’ record keeping practice are required in the studied hospitals.

Persistent expression of activation markers on Mycobacterium tuberculosis-specific CD4 T cells in smear negative TB patients.

T cell activation (HLA-DR, CD-38), proliferation (KI-67), and functional (IFN-γ, TNF-α) markers have recently been shown to be useful in predicting and monitoring anti-TB responses in smear positive TB, but previous research did not characterize the activation and proliferation profiles after therapy of smear negative TB. In this study, we used polychromatic flow cytometry to assess selected PPD-specific T cell markers using fresh PBMC of smear negative and positive pulmonary tuberculosis (PTB) patients, recruited from health facilities in Addis Ababa. Levels of activation (HLA-DR, CD38) and proliferation (Ki-67) among total unstimulated CD4 T cells decreased significantly after therapy, particularly at month 6. Similarly, levels of PPD-specific T cell activation markers (HLA-DR, CD-38) were significantly lower in smear positive PTB patients following treatment, whereas a consistent decline in these markers was less apparent among smear negative PTB patients at the sixth month. After six months of standard anti-TB therapy, persistent levels of activation of HLA-DR and CD-38 from PPD specific CD4+T cells in this study could indicate that those markers have little value in monitoring and predicting anti-TB treatment response in smear negative pulmonary TB patients in Ethiopian context.

Accuracy of GeneXpert in Diagnosis of Smear Negative Tuberculosis: A Cross-Sectional Study

Objective: This study was aimed to compare the diagnostic accuracy of GeneXpert in smear negative as compared to smear positive pulmonary tuberculosis patients.
 Methods: This comparative cross sectional study was undertaken at Health Research Institute (National Institute of Health) TB Research Centre, Pulmonology King Edward Medical University Lahore, Pakistan. A total of 101 patients in each smear negative and positive groups were included. After taking the informed consent a predesigned questionnaire was used to collect the data.
 Results: A total of 202 patients consisting of 94 (46.5%) male and 108 (53.5%) females with mean age of patients as 39.83±18.14 years were included in this study. Highest proportion of 45% patients remained to be in age range of 18-35 years. Culture presented the highest accuracy of 96.1% with sensitivity, specificity and positive predictive value of 95.9%, 100%, and 100% respectively while GeneXpert remained to be 94.6%, 94.9%, 80%, and 99.5% respectively in this study.
 Conclusion: Accuracy of GeneXpert is excellent in diagnosis of smear positive pulmonary tuberculosis patients and very well in diagnosing smear negative pulmonary TB patients and a great addition in early and definite diagnosis of TB and keeps the ability to confirm around 75% smear negative pulmonary tuberculosis.

Survival and Its Predictors among Tuberculosis Patients on Treatment in Selected Health Centers of Addis Ababa, Ethiopia: A Retrospective Cohort Study

Tuberculosis is one of the leading causes of morbidity and mortality globally. Although different strategies have been designed and implemented to combat it, it has continuously increased in the past five years, resulting in 10 million new cases and 1.6 million deaths. This study aims to estimate survival and predictors among tuberculosis patients on treatment in selected health centers in Addis Ababa, Ethiopia. The study employed a retrospective cohort design where data were collected by reviewing medical records of tuberculosis patients who were registered from May 2016 to May 2017 on treatment in 20 selected health centers in Addis Ababa. Independent predictors were identified, and the strength of association between dependent and independent predictors was determined using the Weibull regression model. Before computing Weibull regression analysis, Cox proportional assumption, model diagnosis, and fitness were checked. The hazard ratio was calculated to indicate the strength of association. Of 371 TB patients, about 136 (36.7%) died during the treatment period. Most TB deaths occurred during the intensive phase, and the overall estimated median survival time was 157 days. In the multivariable Weibull model, age (HR = 0.98), baseline weight (HR = 0.96, P = 0.03), tuberculosis treatment phase (continuation phase, HR = 0.48), and tuberculosis type (pulmonary negative TB, HR = 19.92) were found to be independent predictors of time to death of tuberculosis patients. Finally, the study concluded that the survival time to death of the patients is high. The health care providers should give special attention and follow up for pulmonary negative and underweight TB patients.

Survival Analysis of HIV-Positive and Negative TB Patients Receiving Treatment: A Retrospective Cohort Study in the Kwabre East Municipality of Ghana

Survival Analysis of HIV-Positive and Negative TB Patients Receiving Treatment: A Retrospective Cohort Study in the Kwabre East Municipality of Ghana

Distribution patterns of drug resistance Mycobacterium tuberculosis among HIV negative and positive tuberculosis patients in Western Kenya

Distribution patterns of drug resistance Mycobacterium tuberculosis among HIV negative and positive tuberculosis patients in Western Kenya

Efficacy of GeneXpert in Diagnosing Smear Negative Pulmonary Tuberculosis and Comparison to Culture

Objectives: Aim of present study is to observe the efficiency of GeneXpert MTB/RIF Assay in comparison to MTB culture on Lowenstein Jensen media in diagnosis of smear negative pulmonary tuberculosis cases.
 Methods: This descriptive study was carried out in The University of Lahore in collaboration with King Edward Medical University/Mayo Hospital Lahore 11th September, 2020 to 10th April 2021. Smear negative for acid fast bacilli patients enrolled for anti TB treatment were the target population. After taking informed consent, patients were asked to submit first morning sputum sample for culture on Lowenstein Jensen Medium and GeneXpert.
 Results: A total of 345 smear negative TB patients were diagnosed clinically and/or on the basis of radiological findings with mean age of 38.28±17.93,consisting of 47.5% male and 52.5% females recruited in this study. History of TB contact was present among 41.4% patients whereas history of smoking and diabetes remained to be 27.2% and 17.4% respectively. Culture showed significantly higher rate (35.1%) (p-value <0.05) of detection of MTB as compared to GeneXpert (21.5%). A sensitivity of 56.01% was calculated for GeneXpert whereas for culture on LJ medium it was 60.63%.
 Conclusion: Sensitivity of GeneXpert MTB/RIF Assay is a bit low in diagnosing the SNPT patients as compared to the culture but still registers itself as a handsome tool in terms of promptness and definite detection of MTB complex. Further provision of rifampicin susceptibility is bonus in same time.

Impact of HIV-AIDS on tuberculosis treatment outcome in Southern Ethiopia – A retrospective cohort study

BackgroundGlobally, the Tuberculosis treatment success rate was worse for HIV-positive TB patients compared with HIV- negative TB patients. This study aimed at determining the impact of HIV-AIDS and factors associated with TB treatment outcomes. MethodsThis study was a retrospective cohort study of five years of tuberculosis data from four public health facilities in Hosanna Town. A total of 604 study participants were included using a systematic random sampling technique. Descriptive analysis of ratios, rates, and proportions was done and binary logistic regression, bivariable and multivariable, analysis was also done. ResultA total of 604 TB patients were enrolled in this study. 302 (50%) were HIV co-infected. The overall treatment success rate was 90.1% (544/604). Treatment success rates are 86.4% (261/302) for TB-HIV co-infected patients and 93.7% (283/302) for non-co-infected patients. TB-HIV co-infected patients had a higher risk of an unsuccessful treatment outcome (Adjusted Relative Risk [ARR]: 2.7; 95% Confidence Interval [CI]: 1.4 – 5.2). The risk of unsuccessful treatment outcome is also higher among rural residents (ARR: 3.3; CI: 1.4 – 5.0), patients on the re-treatment category (ARR: 2.7; CI: 1.4 – 5.1), and with chronic disease (ARR: 3.3; CI: 1.3 – 8.1). ConclusionTB treatment success rate is good as compared to the WHO minimum requirement. Successful treatment outcome is lower among patients with HIV infection, rural residents, patients on re-treatment, and patients with chronic disease. Therefore, due emphasis should be given to these high-risk groups.

Trends of unsuccessful treatment outcomes and associated factors among tuberculosis patients in public hospitals of Bale Zone, Southeast Ethiopia: A 5-year retrospective study

IntroductionTuberculosis (TB) is a curable disease caused by the tubercle bacillus and its treatment is designed to cure, interrupt transmission, and prevent drug resistance. These aims have not yet been achieved in many regions of the world, particularly in developing countries like Ethiopia. Thus, this study was designed to assess the trends of unsuccessful treatment outcomes and associated factors among patients with TB in two public hospitals in the Bale zone, southeast Ethiopia. MethodsA 5-year retrospective data among 1281 patients with TB who registered and started treatment (from July 2013 to June 2018/19) in two selected Bale zone hospitals was retrieved. Together with descriptive statistics, binomial and multinomial logistic regression modeling were carried out using STATA version 14 to estimate the odds ratio. ResultsThe overall unsuccessful TB treatment outcomes in this study was 10.4% and moderately decreased over the year of treatment (from 14.1% to 8.4%, x2 = 7.35, and p = 0.011). Approximately 34 (7.6%) of pulmonary positive and 34 (7.4%) of pulmonary negative TB patients had experienced treatment failure and death, respectively. The level of the hospital, patients with smear-negative and extrapulmonary, transferred in, aged, and human immunodeficiency virus status were found to have a statistically significant association with unsuccessful treatment outcomes of patients with TB. ConclusionIn this study, approximately one-tenth of patients with TB had unsuccessful treatment outcomes that moderately declined over the year of treatment. Strengthening control efforts like counseling during the intensive and continual phases of treatment and scheduling home visits is recommended.

Urine lipoarabinomannan in HIV uninfected, smear negative, symptomatic TB patients: effective sample pretreatment for a sensitive immunoassay and mass spectrometry

Our study sought to determine whether urine lipoarabinomannan (LAM) could be validated in a sample cohort that consisted mainly of HIV uninfected individuals that presented with tuberculosis symptoms. We evaluated two tests developed in our laboratory, and used them on clinical samples from Lima, Peru where incidence of HIV is low. ELISA analysis was performed on 160 samples (from 140 adult culture-confirmed TB cases and 20 symptomatic TB-negative child controls) using 100 μL of urine after pretreatment with Proteinase K. Two different mouse monoclonal antibodies-CS35 and CHCS9-08 were used individually for capture of urine LAM. Among cases, optical density (OD450) values had a positive association with higher bacillary loads. The 20 controls had negative values (below the limit of detection). The assay correctly identified all samples (97–100% accuracy confidence interval). For an alternate validation of the ELISA results, we analyzed all 160 urine samples using an antibody independent chemoanalytical approach. Samples were called positive only when LAM surrogates—tuberculostearic acid (TBSA) and d-arabinose (d-ara)—were found to be present in similar amounts. All TB cases, including the 40 with a negative sputum smear had LAM in detectable quantities in urine. None of the controls had detectable amounts of LAM. Our study shows that urinary LAM detection is feasible in HIV uninfected, smear negative TB patients.

Application of CBNAAT (Xpert MTB/RIF assay) in new smear negative pulmonary tuberculosis patients.

Presumptive pulmonary tuberculosis (PTB) patients whose sputum are detected to be smear negative for acid fast bacilli (AFB) present a significant challenge for a treating physician. Initiating these patients on anti tuberculous treatment (ATT) on empirical basis is not a good strategy as many were found to be sputum culture for tuberculosis negative on further evaluation according to many previous studies. In India due to resource limited settings and lack of knowledge about newest diagnostic modalities patients are often initiated only on the basis of characteristic clinical symptoms and chest radiographic abnormalities. This study was conducted to identify the advantage of application of sputum cartridge based nucleic acid amplification test (CBNAAT) in sputum AFB smear negative presumptive pulmonary TB patients. Our study concluded that clinical symptoms and radiological characteristics cannot differentiate TB patients from non-TB patients. Treating patients only on empirical basis would have resulted in unnecessary treatment of 41 patients.

Pharmacokinetics, SAfety/tolerability, and EFficacy of high-dose RIFampicin in tuberculosis-HIV co-infected patients on efavirenz- or dolutegravir-based antiretroviral therapy: study protocol for an open-label, phase II clinical trial (SAEFRIF)

BackgroundTuberculosis (TB) is a significant public health problem that causes substantial morbidity and mortality. Current first-line anti-TB chemotherapy, although very effective, has limitations including long-treatment duration with a possibility of non-adherence, drug interactions, and toxicities. Dose escalation of rifampicin, an important drug within the regimen, has been proposed as a potential route to higher treatment efficacy with shorter duration and some studies have suggested that dose escalation is safe; however, these have almost entirely been conducted among human immunodeficiency (HIV)-negative TB patients. TB-HIV co-infected patients on antiretroviral therapy (ART) are at increased risk of drug-drug interactions and drug-related toxicities. This study aims to determine the safety of higher doses of rifampicin and its effect on the pharmacokinetics of efavirenz (EFV) and dolutegravir (DTG) in TB-HIV co-infected patients.MethodsThis study is a randomized, open-label, phase IIb clinical trial among TB-HIV infected adult outpatients attending an HIV clinic in Kampala, Uganda. Patients newly diagnosed with TB will be randomized to either standard-dose or high-dose rifampicin (35 mg/kg) alongside standard TB treatment. ART-naïve patients will be randomly assigned to first-line ART regimens (DTG or EFV). Those who are already on ART (DTG or EFV) at enrollment will be continued on the same ART regimen but with dose adjustment of DTG to twice daily dosing. Participants will be followed every 2 weeks with assessment for toxicities at each visit and measurement of drug concentrations at week 6. At the end of intensive-phase therapy (8 weeks), all participants will be initiated on continuation-phase treatment using standard-dose rifampicin and isoniazid.DiscussionThis study should avail us with evidence about the effect of higher doses of rifampicin on the pharmacokinetics of EFV and DTG among TB-HIV co-infected patients. The trial should also help us to understand safety concerns of high-dose rifampicin among this vulnerable cohort.Trial registrationClinicalTrials.gov, ID: NCT03982277. Registered retrospectively on 11 June 2019.

Factors associated with patient delay among tuberculosis patients in border hospitals, Chiang Rai province, Thailand

Purpose The purpose of this paper is to determine the factors associated with patient delay among tuberculosis patients in border hospitals, Chiang Rai province, Thailand. Design/methodology/approach A cross-sectional study was conducted in the four biggest border hospitals in Chiang Rai province, Thailand during May to July 2018 among 103 identified TB cases. Data were collected by a face-to-face interview with structured questionnaire on patients’ general characteristics, HIV status and patient delay status. Descriptive statistics were used to analyze the patients’ general characteristics, HIV and patient delay status. The association among variables and patient delay was analyzed by χ2-test. The variables with p-value<0.20 obtained in bivariate analysis were further analyzed by binary logistic regression and considered significant with p-value<0.05. Findings All patients enrolled, most were reported with patient delay (65.0 percent). Bivariate analysis demonstrated that level of education, nationality and HIV status were associated factors for patient delay. Among these factors, binary logistic regression revealed that HIV negative TB patients were increased 6.806-fold odds of being patient delay (OR = 6.806; 95% CI: 1.174–39.462), while non-Thai TB patients were also increased 2.824-fold odds of being patient delay (OR = 2.824; 95% CI: 1.041–7.660). Originality/value Patient delay among TB patients in Chiang Rai province was high. This study further supports the requirement on promoting of TB knowledge and awareness emphasized on non-Thai population and general public along the border areas of Chiang Rai province.

Prevalence of tuberculosis, multidrug resistant tuberculosis and associated risk factors among smear negative presumptive pulmonary tuberculosis patients in Addis Ababa, Ethiopia

BackgroundThe diagnoses of active smear negative PTB, remains difficult. As a result, treatment is often carried out empirically relaying on clinical criteria. The distribution and magnitude of smear negative PTB, smear negative MDR-TB and associated factors in the same day diagnosis strategy are not clearly known in the study area. Therefore, this study aimed to determine the prevalence of TB, MDR-TB and associated risk factors among presumptive smear negative pulmonary tuberculosis patients in Addis Ababa, Ethiopia.MethodsAnalytic cross sectional study design was used. A total of 418 smear negative presumptive pulmonary TB patients were enrolled from selected health facilities since August 01, 2017 to January 5, 2018. Sputum samples were examined by Ziehl Neelsen microscopy, Xpert MTB/RIF assay and Culture. Drug susceptibility testing was performed by line probe assay and BACTEC MGIT 960 system. These laboratory tests were performed in Ethiopian Public Health Institute, National TB Reference Laboratory. Data was analyzed by SPSS Ver.20.ResultsFrom the total of 418 enrolled patients, 27 (6.5%) were Xpert MTB/ RIF and 26 (6.4%) were culture confirmed smear negative PTB patients. The positivity rate among male and female was 10.2 and 3.5% (p = 0.005) respectively. From 26 culture positive isolates 3 (11.54%) were MDR TB; from MDR-TB confirmed isolates 2/23 (8.7%) were among new and 1/3 (33.3%) was among retreatment smear negative presumptive pulmonary TB patients. All Rifampicin resistant smear negative pulmonary TB isolates by Xpert MTB/ RIF assay were found to be MDR TB and 7/26 (26.9%) isolates were INH mono resistant. History of migration found to be a potential factor for developing smear negative pulmonary TB.ConclusionIn this study a significant proportion of smear negative pulmonary TB was diagnosed. Furthermore, a high smear negative multi drug resistant (MDR) TB and other mono drug resistant TB prevalence was confirmed. Due to the limitations of smear microscopy which is used as a primary diagnostic tool, these TB strains are missed to be diagnosed and transmission continues in the community.

Tuberculosis care services in Armenia: What has changed since the 2014 reform?

In efforts to reach the 2020 Tuberculosis targets, the WHO advocates for an outpatient, people-centered model of TB care. To this end, the TB care system in Armenia underwent structural and financing reforms in 2014. Financing mechanism for inpatient TB facilities was changed from a fee per bed/day to a mixed type of financing that includes fixed and variable costs eliminating incentives for unnecessary and extended hospitalizations. Unfortunately, outpatient facilities continue to be financed through per-capita mechanism, resulting in high number of referrals and draining resources. This study aimed to assess the implementation of these reforms within the Armenian TB care system. This was a retrospective cross-sectional study using nationwide programme data and survey data collected from healthcare facilities. In 2017 a total of 901 TB patients were registered in outpatient facilities. Only 7.6% of total TB cases were diagnosed in outpatient facilities and 30.9% of the presumptive TB cases were referred to inpatient facilities. The number of hospitalizations was reduced by 76% from 2013 to 2017. The average duration of stay reduced as well from 55+ days to 37 days. However, the proportion of smear negative TB patients remains high among all hospitalized patients (63.8%). Overall, the reform has been successful, however unnecessary hospitalizations persist. Our results indicate there a need to go upstream for a structural and financial reform of the outpatient sector to complete Armenia's TB healthcare reform and improve both patient outcomes and efficient use of system resources.

Toxoplasma gondii and Tuberculosis Co-infection among Tuberculosis patients at the Bamenda Regional Hospital, North West Region, Cameroon

Aim: To determine the prevalence of toxoplasmosis and tuberculosis co-infection among (TB) patients. 
 Study Design: A cross-sectional study was employed to gather data on 147 sputum positive TB patients.
 Place and Duration of Study: Bamenda Regional Hospital (BRH), Tuberculosis Reference Laboratory and Treatment Centre from October 2015 to April, 2016. 
 Method: An epidemiological questionnaire was applied to gather data on positive-sputum pulmonary TB patients of both sexes on whom some risk factors for Toxoplasma were explored, followed by blood sampling. T. gondii IgM and IgG antibodies were researched in sera samples using indirect ELISA.
 Results: T. gondii antibodies prevalence amongst the TB population was 83% (122/147, 95% CI 112-130). 85.25% of the Toxoplasma infection in the study population were recent infections with T.gondii parasite while up to 53.28% of patients were reactivating, no significant difference in prevalence between HIV negative or HIV positive TB patients was established.
 Conclusion: The high seroprevalence of toxoplasmosis among TB subjects attending treatment at the Bamenda Regional Hospital is suggestive of co-infection. Toxoplasmosis and tuberculosis co-infection are opportunistic infections for HIV/AIDS, and life threatening to TB patients and could be the reason for unexplained deaths among these patients on treatment.

Phenotypic and functional heterogeneity of peripheral \u03b3\u03b4 T cells in pulmonary TB and HIV patients in Addis Ababa, Ethiopia

BackgroundPrevious studies reported HIV infection alters the distribution and function of γδ T cells and their subsets. γδ T phenotypes in healthy and diseased individuals has received little attention in Ethiopia. We conducted this study to analyze the distribution of γδ T cells, the subsets and levels of expression of activation (CD38), exhaustion or anergy (CD95, PD1), adhesion (N-CAM/CD56 and CD103), among HIV and TB infected patients.MethodThe distributions of total γδ T cells, Vδ1 and Vδ2 T cells subsets were analyzed in clinical samples collected from asymptomatic HIV, pulmonary TB patients and apparently healthy controls. Multicolor flow cytometry and IFN-γ ELISA were used to assess surface markers and functional responses of Vδ2 T cells to isopentenyl pyrophosphate stimulation, respectively.ResultA total of 52 study participants were enrolled in this study, 22 HIV + TB-, 10 HIV-TB+ and 20 healthy controls. No significant differences were observed in the distribution of total γδ T cells and in the proportion of Vδ1 subsets in all study groups, though slightly higher proportions were observed in HIV + TB- patients for the latter, of borderline statistical significance (p = 0.07). However, the proportion of Vδ2 T cells, as well as the IFN-γ response to IPP stimulation, was significantly reduced in HIV + TB- patients compared to healthy controls (p < 0.002). Expression of the activation marker CD38 (p < 0.001) and adhesion marker CD103 (αEβ7) were significantly higher in the Vδ1 T cell subset among both HIV + TB- (p = 0.013) and HIV-TB+ (p = 0.006) patients compared to healthy controls. Similarly, exhaustion markers, CD95 and PD1, were significantly higher in these two T cell subsets among both HIV + TB- and HIV-TB+ patients (p < 0.01). Interestingly, we also observed an increased proportion of effector memory (CD45RA-CD27-) and effector cytotoxic (CD45RA + CD27-) Vδ2 T cell subsets in HIV negative pulmonary TB patients.ConclusionIn sum, HIV infection was associated with an increase in Vδ1 and a decrease in the function and frequencies of Vδ2 T cells. Moreover, increased effector Vδ2 T cells were observed among HIV negative pulmonary TB patients suggesting a potential role of these T cells in the host response to TB.

ВНЕЛЕГОЧНЫЕ ЛОКАЛИЗАЦИИ ТУБЕРКУЛЕЗА У БОЛЬНЫХ ВИЧ-ИНФЕКЦИЕЙ

The objective of the study: to investigate the prevalence of extrapulmonary tuberculosis in HIV patients in Moscow and to study the potential of computed tomography to detect extrapulmonary tuberculosis in the HIV infected. Subjects and Methods . Data of 6,588 new TB patients, detected in Moscow in 2014-2015 were analyzed, as well as CTs of 118 of TB/HIV patients, which were performed in 2014-2016. Results. In Moscow, the absolute number of extrapulmonary tuberculosis patients went down by 67.5% from 2012 to 2016 (140 persons). In Russia and in Moscow, the number of new extrapulmonary tuberculosis patients tends to decrease and currently makes approxamtely 3% versus 4-5% in 2011-2012. Among HIV negative TB patients the part of those with lesions within pulmonary parenchyma made 94%, and among the HIV positive it made 74.8% (p < 0,05). As expected HIV infected patients prevailed among those suffering from extrapulmonary tuberculosis (4.6% versus 2.1%). According to the data of TB/HIV register, out of 593 new TBpatients, 41.3% had two and more sites of tuberculosis lesions (95% CI 37.4-45.3%). When estimating results of advanced CTprotocol in 118 patients with TB/HIV co-infection and the average CD4+ count of 134.0±19.8 cells/mcl, additional sites with tuberculous lesions were detected in all of them. Conclusion. According to the official statistics, the number of extrapulmonary tuberculosis patients is going down. According to data from personal registers, extrapulmonary tuberculosis is several times more prevalent in HIV/TB patients due to generalized forms.

The burden of HIV on Tuberculosis patients in the Volta region of Ghana from 2012 to 2015: implication for Tuberculosis control

BackgroundThe impact of HIV on TB, and the implications for TB control, has been acknowledged as a public health challenge. It is imperative therefore to assess the burden of HIV on TB patients as an indicator for monitoring the control efforts of the two diseases in this part of the world. This study aimed at determining the burden of HIV infection in TB patients.MethodsWe conducted a retrospective review of TB registers in five districts of the Volta Region of Ghana. Prevalence of TB/HIV co-infection was determined. Bivariate and multivariate logistic regression were used to identify the predictors of HIV infection among TB patients and statistical significance was set at p-value <0.05.ResultsOf the 1772 TB patients, 1633 (92.2%) were tested for HIV. The overall prevalence of TB/HIV co-infection was (18.2%; 95% CI: 16.4–20.1). The prevalence was significantly higher among females (24.1%; 95%CI: 20.8–27.7), compared to males (15.1%; 95% CI: 13.1–17.4) (p < 0.001) and among children <15 years of age (27.0%; 95% CI: 18.2–38.1), compared to the elderly ≥70 years (3.5%; 95% CI: 1.6–7.4) (p < 0.001). Treatment success rate was higher among patients with only TB (90%; 95% CI: 88.1–91.5) than among TB/HIV co-infected patients (77.0%; 95% CI: 71.7–81.7) (p < 0.001). Independent predictors of HIV infection were found to be: being female (AOR: 1.79; 95% CI: 1.38–2.13; p < 0.001); smear negative pulmonary TB (AOR: 1.84; 95% CI: 1.37–2.47; p < 0.001); and patients registered in Hohoe, Kadjebi, and Kpando districts with adjusted odds ratios of 1.69 (95% CI: 1.13–2.54; p = 0.011), 2.29 (95% CI: 1.46–3.57; p < 0.001), and 2.15 (95% CI: 1.44–3.21; p < 0.001) respectively. Patients ≥70 years of age and those registered in Keta Municipal were less likely to be HIV positive with odds ratios of 0.09 (95% CI: 0.04–0.26; p < 0.001) and 0.62 (95% CI: 0.38–0.99; p = 0.047) respectively.ConclusionTB/HIV co-infection rate in five study districts of the Volta region is quite high, occurs more frequently in female patients than males; among smear negative pulmonary TB patients, and children <15 years of age. Findings also demonstrate that HIV co-infection affects TB treatment outcomes adversely. Strengthening the TB/HIV collaborative efforts is required in order to reduce the burden of co-infection in patients.

Treatment Outcomes of Patients with Tuberculosis in Districts of Buriezuria, Jabitehinan and Fenoteselamadministrative town health facilities, North West Ethiopia

Background: Assessment of treatment outcome, monitoring and evaluation of its Risk factors of Directly Observed Treatment are among the major important indicators for performance of tuberculosis prevention and control program. Objectives: The aim of this study was to assess anti-TB treatment outcomes and associated factors among patients with tuberculosis in Districts of Buriezuria, Jabitehinan and Fenoteselam town government owned health institution. Methods: Retrospective data (2012-2016) of tuberculosis patients (n=832) registered for Anti-TB treatments at Districts of Buriezuria, Jabitehinan and Fenoteselam town government owned health facility, were reviewed. Data were entered using Epi-info and transported to SPSS version 20 for analysis. Descriptive Statistics and binary regression models were used to present data. The odds ratio and 95% confidence intervals were calculated. A P-Value of <0.05 was considered statistically significant. Results: The overall treatment success rate was 82.5%. The odds of HIV negative TB patients were about four times more likely to have successful treatment outcome than the odds of TB patients with unknown HIV sero-status (AOR=4.4(1.83,10.79)). Study subjects whose age group is 50 years of age respectively. Urban dwellers were two times more likely to have successful treatment outcome compared to their rural counterparts (AOR=2.2(1.50, 3.33)). Pulmonary tuberculosis patients were also three times more likely to have successful treatment outcome(AOR=2.9(2.00,4.46)) compared to EPTB patients. Conclusion and recommendation: The overall treatment success rate was lower than National Treatment success rate target 87%. Patients who are HIV negative, whose age<14 years, whose age 15-24 years, 25-34years, urban residents and those having Pulmonary tuberculosis TB patients were identified associated factors for successful tuberculosis treatment outcome