Tuberculosis Notification Research Articles

Impact of WHO-Recommended TB Control Measures on Occupational TB Risk Among Healthcare Workers in a High-Burden Tertiary Hospital in Brazil: A 24-Year Retrospective Analysis.

Tuberculosis (TB) remains a significant public health concern, particularly in low-to-middle-income countries. Healthcare workers (HCWs) are at a higher risk due to prolonged exposure. The World Health Organization (WHO) has proposed guidelines focusing on administrative interventions, structural interventions, and personal protective equipment (PPE) usage to mitigate this risk. Despite these recommendations, data on their efficiency in reducing occupational TB risk in Brazil is lacking. Evaluate the effectiveness of the WHO-recommended measures regarding the risk of developing TB among the HCWs. We conducted a retrospective analysis of TB incidence among patients admitted to a tertiary public Emergency Department (ED), and HCWs from 2000 to 2023. We extracted TB notifications among HCWs and the general population of Ribeirão Preto from a public database. We comparatively analysed the incidence rates between patients and HCWs to evaluate the effectiveness of WHO-recommended measures. From 2000 to 2023, the ED handled an average of 148,496 patients per quadrennium, with 202 TB patients per quadrennium. The prevalence ratio of TB per 100,000 patients increased from 80 to 170 (p=0.035) and the incidence rates rose from 39 to 157 per 100,000 patients (p=0.046). The incidence rate of TB among HCWs in our institution started at 412.0 (85.0;1201.0) and decreased to 179.0 (20.0;619.0). In total, 11 HCWs were diagnosed with TB. The relative risk of having TB between HCWs and the general population was significantly higher before the Program implementation and became equivalent after it. Implementing WHO-recommended TB control measures was demonstrated effective in reducing the incidence rate ratios between HCWs and the general population in a high-burden tertiary hospital in Brazil.

Enhancing tuberculosis case notifications through mapping sales of medicine in the private sector: a quasi-experimental study in Punjab province, Pakistan

IntroductionIn Pakistan, almost one-third of people who develop tuberculosis (TB) are missed by the National TB Program (NTP). A considerable number of people with TB receive treatment in the private sector but remain unnotified. This study documents the outcomes of an intervention to identify people with TB through private pharmacy engagement, building on mapping TB medicine sales in Punjab Province.MethodsA comprehensive intervention was carried out in four districts of Punjab with high anti-TB drug sales, comprising a policy change requiring mandatory notification of TB medication sales, mapping and engaging pharmacies selling anti-TB drugs, reporting through a novel ‘eTB’ mobile application and providing support via a call center. We collected both historical and prospective TB notification data from the intervention and control districts. The primary outcome was the change in TB notifications during the intervention period compared with historical and control notifications.ResultsOver the 12-month intervention period, 15,669 people with TB were reported from 2,943 pharmacies in four districts. Among the people identified, 88% were male (n = 13,673), 95% had pulmonary disease (n = 14,969), and 4,256 (27%) were bacteriologically confirmed. Chain pharmacies (n = 14) contributed to 39% of the yield. TB notifications increased by 17,462 (+ 34%) over the baseline period compared with an 8% increase in the control districts. The number of bacteriologically confirmed notifications increased by 32% compared with 16% in the control districts. The proportion of bacteriological confirmation was similar before and during the intervention.ConclusionThe results of the largest TB intervention with pharmacies globally showed incredible potential to link people with TB who are receiving care in the private sector. Mapping TB medicine sales in the private sector with tailored interventions can contribute to closing the gap in notifications where anti-TB drug sales in the private sector are prevalent.

The Effect of COVID-19 on Tuberculosis Care and Treatment Outcome in Pre-COVID, COVID, and Post-COVID Eras

Background: Coronavirus disease 2019 (COVID-19) pandemic has caused a significant disruption of all healthcare services. Tuberculosis (TB) services were also affected by the COVID-19 pandemic policies. Therefore, this study was planned to observe whether TB services and treatment outcome were affected in pre-COVID, COVID, and post-COVID eras among TB patients. Materials and Methods: Secondary data analysis was carried out from the data obtained from District Tuberculosis Centre. Comparison of TB care data includes notification, diagnosis, treatment services, and outcome for the pre-COVID, COVID, and post-COVID periods. Results: TB notifications and diagnostic services were significantly hampered during the COVID-19 period as compared to pre-COVID and post-COVID periods (P < 0.05). However, in those diagnosed with TB, treatment was initiated timely and regular follow-up was done by health care workers to ensure treatment adherence, and hence, more cure rate was reported in the study. High mortality during COVID-19 period was found. Conclusion: TB care was significantly restrained during COVID-19 pandemic, and further reclamation of services occurred during the declining phase of COVID-19.

Global burden of tuberculous meningitis in children aged 0-14 years in 2019: a mathematical modelling study.

Tuberculous meningitis is fatal if untreated and can lead to lifelong neurological sequelae. However, to our knowledge, there are no data on the number of children affected by this disease. We aimed to estimate the global disease burden and attributable mortality of childhood tuberculous meningitis by WHO regions, age groups, treatment status, and HIV status in 2019. We developed a Bayesian mathematical model to estimate the number of children aged 0-14 years who developed tuberculous meningitis, died from tuberculous meningitis, and did not die from tuberculous meningitis but had neurological sequelae in 2019. We reviewed the literature and used meta-analyses to quantify key parameters used as model inputs: risk of tuberculous meningitis after Mycobacterium tuberculosis infection, tuberculous meningitis as a proportion of tuberculosis notification data (ie, routine surveillance data that countries report to WHO), and risk ratios for tuberculous-meningitis mortality by age group. We identified routine tuberculosis surveillance data from countries and literature that reported the proportion of notified childhood tuberculosis that was due to tuberculous meningitis. Country-level data were from Brazil; the USA; Ukraine; South Africa; and the European Centre for Disease Prevention and Control, which included 29 countries but was aggregated and considered as one site. We assumed tuberculosis notification was synonymous with detection and treatment, combined age-disaggregated risk ratios and published meta-analytic estimates of the case-fatality rate in children who received treatment to produce estimates of tuberculous-meningitis mortality by age group and HIV status, and assumed that untreated tuberculous meningitis was always fatal. We assumed similar age-disaggregated risk ratios for neurological sequelae among children who had treatment for tuberculous meningitis and lived as for children who died. An estimated 24 000 (95% credible interval 22 300-25 700) children younger than 15 years developed tuberculous meningitis in 2019. Of these children, 13 000 (12 100-13 900) were estimated to have been diagnosed and treated for tuberculous meningitis. Most untreated children were younger than 5 years. Among the 24 000 children with tuberculous meningitis, 16 100 (14 900-17 300) were estimated to have died in 2019, of whom 1101 (6·8%) had HIV. 13 380 (83·1%) of 16 100 deaths were estimated to be in children younger than 5 years and 11 000 (68·3%) were estimated to be in children who did not receive tuberculous-meningitis treatment. Of the 7900 (5800-10 000) children who did not die, 5550 (5110-5980) were estimated to have neurological sequelae. Our estimates of tuberculous meningitis in children younger than 15 years showed substantial mortality and morbidity. Improved diagnostics and strong health-care systems to facilitate early diagnosis are crucial to improve outcomes, and tuberculosis prevention should be a public health priority. Fogarty International Center of the US National Institutes of Health.

Comparison of Tuberculosis and COVID-19 Prevention and Control Policies: A Systematic Review

mwymwAbstract:Tuberculosis, is a contagious respiratory condition caused by infection with the bacterium Mycobacterium tuberculosis. With the rapid prevalence of COVID-19, the multifaceted public health interventions, including non-pharmaceutical measures have been conducted. Results showed that the public health policies implemented by China during the COVID-19 outbreak have had a positive impact on controlling the development of tuberculosis. This paper explores the interplay between tuberculosis (TB) control and the public health measures implemented during the COVID-19 pandemic in China. It highlights how non-pharmaceutical interventions (NPIs) such as travel restrictions, social distancing, mask-wearing, and early case detection, initially designed to contain COVID-19, also contributed to reducing TB transmission. Additionally, the rapid development of China’s public health infrastructure and the use of digital technologies during the pandemic enhanced TB surveillance, diagnosis, and treatment adherence. Key interventions included electronic patient service systems, digital adherence technologies (DATs), and integrated digital platforms that improved treatment outcomes. However, challenges such as reduced TB notifications during COVID-19 and financial constraints in TB management were identified. The paper emphasizes the importance of policy adaptations, technological innovations, and sustainable healthcare reforms to address TB in a post-pandemic world. China’s experience provides valuable insights for future infectious disease control, demonstrating how coordinated public health strategies can effectively manage multiple health challenges simultaneously.

Surveillance for TB drug resistance using routine rapid diagnostic testing data: Methodological development and application in Brazil

Effectively responding to drug-resistant tuberculosis (TB) requires accurate and timely information on resistance levels and trends. In contexts where use of drug susceptibility testing has not been universal (i.e. not all patients are offered testing), surveillance for rifampicin-resistance—one of the core drugs in the TB treatment regimen—has relied on resource-intensive and infrequent nationally-representative prevalence surveys. The expanded availability of rapid diagnostic tests (RDTs) over the past decade has increased testing coverage in many settings. However, RDT data collected in the course of routine (but not universal) use may provide biased estimates of resistance if the subset of patients receiving RDTs is not representative of the overall cohort. Here, we developed a method that attempts to correct for non-random use of RDT testing in the context of routine TB diagnosis to recover unbiased estimates of resistance among new and previously treated TB cases. Specifically, we employed statistical corrections to model rifampicin resistance among TB notifications with observed Xpert MTB/RIF (a WHO-recommended RDT) results using a hierarchical generalized additive regression model, and then used model output to impute results for untested individuals. We applied this model to 2017–2023 case-level data on over 800,000 patients from Brazil. Modeled estimates of the prevalence of rifampicin resistance were substantially higher than naïve estimates, with estimated prevalence ranging between 28–44% higher for new cases and 2–17% higher for previously treated cases. Our estimates of RR-TB incidence were estimated with narrower uncertainty intervals relative to WHO estimates for the same time period, and were robust to alternative model specifications. Our approach provides a generalizable method to leverage routine RDT data to derive timely estimates of RR-TB prevalence among notified TB cases in settings where testing for TB drug resistance is not universal.

Pediatric Tuberculosis Characteristic in West Nusa Tenggara Regional General Hospital During COVID-19 Pandemic 2019-2021

Tuberculosis (TB) infection is still an important health problem worldwide, especially in children. The Coronavirus Disease (COVID-19) pandemic has affected the priority of healthcare including TB services. Many health services reported a significant decrease in TB detection, notification, treatment and prevention due to COVID-19 policies. Therefore, we conducted a study to determine the characteristics of pediatric TB patients in West Nusa Tenggara Province General Hospital during COVID-19 pandemic. This study was a retrospective study using registry data from the Pediatric Respirology Division, Department of Child Health, West Nusa Tenggara Province General Hospital from March 2019 to December 2021. Of 225 children with TB disease, there were 66.2% outpatient and 33.8% inpatient. Thirty point seven percents (69/225) were in ages group 5 to 11 years old and mostly were males (69.8%). West Lombok Regency was the district with highest number of subjects (37.3%). Majority of subjects were visited in March-December 2019, nearly before pandemic. Polymerase Chain Reaction (PCR) test for TB were performed in 172 (76.5%) subjects and showed positive result in 22/172 (9.8%). Most of them were pulmonary TB (72.9%) and 9.8% bacteriologically confirmed. Only 4 (1.8%) of children were died. Pulmonary TB is the most common TB disease among pediatric TB patients in this study. During study period, the number of hospital visit was decreased due to COVID-19 policies. This findings can guided healthcare providers to improve detection, treatment and prevention of TB disease post COVID-19 pandemic.

Impact of COVID-19 pandemic on tuberculosis notification and outcome in a district of South Gujarat.

The COVID-19 pandemic affected the health care services worldwide, with the target of END TB 2025; it was important to make sure that the TB notification and linkage services were not hampered. The current study aims to document the overall impact of COVID-19 on TB notification and treatment services. To document the impact of COVID-19 on notification and comparison of their outcome between pre-COVID-19 and COVID-19 era. Programmatic data of 9893 notified TB cases reported from Surat rural between 2019 and 2021 were collected from Nikshay portal through DTO Surat. Detailed comparison of pre- and COVID-19 era was performed using stratified analysis. There was a significant (P = 0.02) 29% decline in cases reported in 2020 as compared to the cases reported in the previous year. The impact of COVID-19 was also seen on mortality of the reported cases (18% increase). The overall proportion of treatment failure was increased (28%), whereas difference of 20% was seen in cases where treatment regimen was required to be changed. Despite the overall impact of COVID-19 on TB services (2020), the health department has proactively countered and bounce back in 2021 with an overall increase in notification and treatment services.

Risk factors for and timing of presumptive recurrent TB.

<sec><title>INTRODUCTION</title>Understanding factors associated with increased risk for tuberculosis (TB) recurrence is essential in lowering the TB burden. We aimed to quantify the burden, risk factors, and timing of TB presumptive recurrence.</sec><sec><title>METHODS</title>We analyzed test results from 2013 to 2017 in the South African National Health Laboratory Service's database. We defined a person's TB episode to start with their first positive TB test. In the absence of treatment outcome data, we assumed the episode concluded 6 months later for rifampicin-susceptible TB (RS-TB) and 18 months later for rifampicin-resistant TB (RR-TB), provided that at least one negative smear or culture test was recorded within this period. We defined a presumptive recurrent TB episode to start with a positive TB test after the completion of a prior episode. We calculated recurrence measures stratified by various demographics and RR-TB status.</sec><sec><title>RESULTS</title>Of 574,316 people with RS-TB, 4.7% experienced at least one presumptive recurrent TB episode. Higher local TB notification rates, HIV coinfection, and males experienced higher recurrence rates. Most (89.4%) of the first RS-TB recurrences occurred within a year of the initial episode.</sec><sec><title>CONCLUSION</title>Our findings of when and among whom recurrent TB is more likely to occur can be used to assist early interventions and inform impact on patient care.</sec>.

Analysis of the epidemiological trends of Tuberculosis in China from 2000 to 2021 based on the joinpoint regression model

BackgroundChina is ranked third globally in terms of burden and has a moderately high to high prevalence of tuberculosis (TB). This study meticulously investigated the notification rates of TB and assessed the epidemic in China from 2000 to 2021. The aim of the study was to provide robust supporting data that is crucial for enhancing TB prevention and control strategies.MethodsExtensive data regarding TB notification rates in China between 2000 and 2021 was collected. The joinpoint regression model was subsequently utilized to assess the temporal trends in the notification rates of TB, which were analyzed through the annual percentage change (APC) and the average annual percentage change (AAPC).ResultsDuring the study period (2000–2021), the standardized notification rates of TB in China ranged from 38.89/100,000 to 101.15/100,000, with a significant annual average decrease of 4.43% (P < 0.05). Before the COVID-19 pandemic, a marked acceleration in this decline was observed from 2006 to 2015, with an APC of 4.62% (P < 0.05). Stratified by age and sex, the age group with the most significant annual decline in overall standardized notification rates of TB among males in China was < 15 years old, followed by 55–64 years old, and the group with the least decrease was 25–44 years old. Similarly, the age group with the most significant annual decline in standardized notification rates of TB among females was < 15 years old.ConclusionsThe epidemic of TB in China exhibited a downward trajectory between 2000 and 2021. However, it is imperative to prioritize the attention given to males and older adults, and to promote specific and effective prevention and control strategies for these populations.

Individual, community and health systems factors influencing time to notification of tuberculosis: situating software and hardware bottlenecks in local health systems

BackgroundDespite several global interventions, tuberculosis (TB) remains a leading cause of death affecting millions of people globally. Many TB patients either have no access to quality care or go undetected by national health systems. Several multilevel factors account for under-detection of persons with TB. This study sought to explore patient-related software, community and health systems software and hardware factors influencing time to notification of TB in Lusaka District, Zambia.MethodsThis was an exploratory qualitative case study that adopted a software and hardware lens of conceptualizing health systems. Data were collected from across three sites – urban and peri-urban areas: Chongwe, Kafue, and Lusaka – within Lusaka Province, Zambia. Sixteen key informants - TB corner nurses, community TB treatment supporters, and TB program managers - were interviewed. Six focus groups were held with TB patients. Data were analyzed using thematic analysis.ResultsThe study identified factors influencing timely TB notification, categorized into software and hardware elements.Patient-related software elements, including TB knowledge and awareness, and health-seeking behavior, are crucial for prompt notification among TB patients.In the community health system, software elements like social stigma and undesirable community attitudes towards contact tracing, and hardware elements such as unbalanced schedules, excessive workload and limited capacity of community TB treatment supporters contribute to delayed TB notification.In the formal health system, software elements like negative attitudes of health providers towards TB patients and demotivation of TB staff, and hardware elements such as high diagnostics and transportation costs, outdated diagnostics in primary care facilities, and slow referral mechanisms, can also delay TB notification.ConclusionDelays in time to TB notification are influenced by a combination of software (attitudinal and behavioral) and hardware (resource-related) elements across TB patients, community health systems, community TB treatment supporters, health providers, and TB staff. Addressing these factors, particularly social stigma, negative attitudes, and resource constraints, is crucial to improving timely TB detection and treatment.

Analyzing the seasonality of tuberculosis case notifications in the UK, 2000-2018.

Globally, there is seasonal variation in tuberculosis (TB) incidence, yet the biological and behavioural or social factors driving TB seasonality differ across countries. Understanding season-specific risk factors that may be specific to the UK could help shape future decision-making for TB control. We conducted a time-series analysis using data from 152,424 UK TB notifications between 2000 and 2018. Notifications were aggregated by year, month, and socio-demographic covariates, and negative binomial regression models fitted to the aggregate data. For each covariate, we calculated the size of the seasonal effect as the incidence risk ratio (IRR) for the peak versus the trough months within the year and the timing of the peak, whilst accounting for the overall trend. There was strong evidence for seasonality (p < 0.0001) with an IRR of 1.27 (95% CI 1.23-1.30). The peak was estimated to occur at the beginning of May. Significant differences in seasonal amplitude were identified across age groups, ethnicity, site of disease, latitude and, for those born abroad, time since entry to the UK. The smaller amplitude in older adults, and greater amplitude among South Asians and people who recently entered the UK may indicate the role of latent TB reactivation and vitamin D deficiency in driving seasonality.

Putting TB notification into practice among private pharmacies in Mangalore city, India – Did we succeed?

Problem consideredGlobally, tuberculosis (TB) is the second leading infectious killer after Covid-19 with 1.18–1.43 million deaths in 2022. As per the Global TB Report 2023, an estimated 10.6 million people developed TB in 2022. An estimated 3.1 million cases were missed globally, posing a challenge in breaking the chain of transmission. India is one of the major contributors to the missed cases. Almost 50 % of patients are being treated in the Private sector in India, but fewer are notified to the public health system. This study explored the role of sensitization of pharmacies in TB Case Notification in Mangalore city. MethodsIn this study using a before and after intervention design, the programmatic data was utilized to compare the TB case notifications by the private pharmacies using TB reporting formats for mandatory notification. The intervention was sensitization of the pharmacy owners and pharmacists by a trained field assistant and monthly reminder messages using a social media tool. The data was collected for 2 consecutive quarters October 2019–March 2020 in the prescribed formats. ResultsPost Intervention, there was an increase in the number of pharmacies reporting TB cases from 6 to 14, and prescriptions were being maintained and shared with the District TB Office. An increased number of case reporting was also observed post-intervention. ConclusionIntensified sensitization led to improvement in the reporting mechanism of TB case notification by private pharmacies, though it did not translate into a concurrent rise in notification of TB cases in the district.

Despite antiretroviral therapy (ART) rollout, most cases of tuberculosis among people with HIV in Adama, Ethiopia, occur before ART initiation

ABSTRACT Introduction Although antiretroviral therapy (ART) leads to reduced tuberculosis (TB) incidence in people with HIV (PWH), ART recipients remain at higher risk of TB compared to HIV-seronegative people. With accelerated ART rollout in sub-Saharan Africa, increasing proportions of TB cases among PWH in people receiving long-term ART have been reported. Objective To determine TB notifications among PWH by ART status in a mainly urban uptake area in Ethiopia during an 8-year period in connection to the introduction of the ‘test-and-treat’ strategy for HIV. Methods PWH were identified from registers at health facilities providing ART in Adama and surrounding areas, Ethiopia 2015–2022. Annual TB notifications were compared over time. PWH within TB were categorized by ART status at the time of TB diagnosis (pre-ART TB: TB diagnosed before or ≤6 months after starting ART; ART-associated TB: TB diagnosed >6 months after starting ART). Results Among a total of 8,926 PWH, 993 had been diagnosed with TB (11.1%); mean age 40.0 years [SD 11.8], 53.5% were men). Throughout the study period, most TB cases had been notified before ART initiation (617/993; 62.1%). ART-associated TB cases constituted a mean of 37.4% (range 23.8%–44.2%) of all TB cases among PWH annually. Median time from ART initiation to TB diagnosis among ART-associated TB was 6.0 years. Conclusion TB notifications among PWH in this area did not decrease 2015–2022, implying persistently high risk of TB among PWH in this setting. Most TB cases occurred in ART-naïve persons, illustrating late HIV diagnosis in this population.

A health impact assessment of tuberculosis notifications attributable to long-term exposure to PM2.5 in Ningxia Hui Autonomous Region, China

A health impact assessment of tuberculosis notifications attributable to long-term exposure to PM2.5 in Ningxia Hui Autonomous Region, China

Impact of the COVID-19 pandemic and migration on tuberculosis notifications: a retrospective analysis with 5-year data from three centers.

We aimed to determine the incidence of TB among immigrants and non-immigrants in Sanliurfa, Türkiye between 2018 and 2022 and to examine the effect of COVID-19 on the incidence, location, and drug resistance patterns of tuberculosis. This study was a retrospective review of patients diagnosed with tuberculosis in Şanlıurfa Tuberculosis Dispensary between January-2018 and May-2022. Patients were assessed in terms of age, sex, site of tuberculosis, and drug resistance profiles before and during the COVID-19 pandemic. A total of 887 patients with TB were included in the study. The mean age of patients diagnosed with tuberculosis was 40.63 ± 17.50 years. Of the total number of patients diagnosed, 50.7% were women, 85.8% were Turkish citizens, and 91.9% were new cases. Comparing the rate of positive cultures between the pre-COVID-19 and COVID-19 periods revealed a statistically significant rate of positive culture during the COVID-19 period (p < 0.001). In terms of mortality, the mean age of the patients who died was 60.2 ± 18.4 years and that of the survivors was 39.1 ± 16.6 years; these values were statistically significant (p < 0.001). Among the patients who survived, the rate of pulmonary tuberculosis was statistically significantly higher than that of extrapulmonary tuberculosis (p < 0.001). The prevalence of pulmonary TB is high and the proportion of women is increasing. During the COVID-19 period, the number of patients diagnosed with TB decreased, but interestingly, the rate of positive cultures remained high, and the rate of resistance to INH also decreased. The results revealed rates similar to those reported by the World Health Organization.

Pulmonary Tuberculosis Notification Rate Within Shenzhen, China, 2010-2019: Spatial-Temporal Analysis.

Pulmonary tuberculosis (PTB) is a chronic communicable disease of major public health and social concern. Although spatial-temporal analysis has been widely used to describe distribution characteristics and transmission patterns, few studies have revealed the changes in the small-scale clustering of PTB at the street level. The aim of this study was to analyze the temporal and spatial distribution characteristics and clusters of PTB at the street level in the Shenzhen municipality of China to provide a reference for PTB prevention and control. Data of reported PTB cases in Shenzhen from January 2010 to December 2019 were extracted from the China Information System for Disease Control and Prevention to describe the epidemiological characteristics. Time-series, spatial-autocorrelation, and spatial-temporal scanning analyses were performed to identify the spatial and temporal patterns and high-risk areas at the street level. A total of 58,122 PTB cases from 2010 to 2019 were notified in Shenzhen. The annual notification rate of PTB decreased significantly from 64.97 per 100,000 population in 2010 to 43.43 per 100,000 population in 2019. PTB cases exhibited seasonal variations with peaks in late spring and summer each year. The PTB notification rate was nonrandomly distributed and spatially clustered with a Moran I value of 0.134 (P=.02). One most-likely cluster and 10 secondary clusters were detected, and the most-likely clustering area was centered at Nanshan Street of Nanshan District covering 6 streets, with the clustering time spanning from January 2010 to November 2012. This study identified seasonal patterns and spatial-temporal clusters of PTB cases at the street level in the Shenzhen municipality of China. Resources should be prioritized to the identified high-risk areas for PTB prevention and control.

Impact of Xpert MTB/RIF implementation in tuberculosis case detection and control in Brazil: a nationwide intervention time-series analysis (2011–2022)

Since 2014, Brazil has gradually implemented the Xpert MTB/RIF (Xpert) test to enhance early tuberculosis (TB) and drug-resistant (DR-TB) detection and control, yet its nationwide impact remains underexplored. Our study conducts an intervention time-series analysis (ITSA) to evaluate how the Xpert's implementation has improved TB and DR-TB detection nationwide. 1,061,776 cases from Brazil's National TB Registry (2011-2022) were reviewed and ITSA (2011-2019) was used to gauge the impact of the Xpert's adoption on TB and DR-TB notification. Granger Causality and dynamic regression modelling determined if incorporating Xpert testing as an external regressor enhanced forecasting accuracy for Brazil's future TB trends. Xpert implementation resulted in a 9.7% increase in TB notification and substantial improvements in DR-TB (63.6%) and drug-susceptible TB (92.1%) detection compared to expected notifications if it had not been implemented. Xpert testing counts also presented a time-dependent relationship with DR-TB detection post-implementation, and improved predictions in forecasting models, which depicted a potential increase in TB and DR-TB detection in the next six years. This study underscores the critical role of Xpert's adoption in boosting TB and DR-TB detection in Brazil, reinforcing the case for its widespread use in disease control. Improvements in prediction accuracy resulting from integrating Xpert data are crucial for allocating resources and reducing the incidence of TB. By acknowledging Xpert's role in both disease control and improving predictions, we advocate for its expanded use and further research into advanced molecular diagnostics for effective TB and DR-TB control. FIOCRUZ.

Factors associated with underreporting of tuberculosis cases among private healthcare providers in Semarang City

Tuberculosis (TB) continues to be a global public health challenge, with accurate case reporting being crucial for the implementation of effective control measures. In Semarang City, Indonesia, private healthcare providers play a pivotal role, yet the under-reporting of TB cases in this sector compromises the management and containment of the disease. This study investigates the factors influencing the under-reporting of TB cases among private healthcare providers and explores their consequences for public health strategies. The primary aim of this research is to elucidate the relationship between various determinants such as physicians’ knowledge of TB notification protocols, their commitment to notification processes, the availability of dedicated staff for notification, incentive mechanisms, and the notification format used, and the phenomenon of TB case under-reporting. Methods: Employing the Spearman correlation coefficient, this study evaluates the associations between the identified factors and the under-reporting of TB cases. The findings indicate significant correlations between under-reporting of TB cases and several variables: the physicians' awareness of notification requirements, their commitment to notification procedures, the existence of incentives, the appointment of designated staff for notification tasks, and the format of the notification system (Sig &lt; 0.05). Discussion: The under-reporting of TB cases hinders accurate disease surveillance and timely intervention, thereby perpetuating transmission and increasing the risk of drug-resistant TB strains. The results underscore the necessity for targeted interventions aimed at enhancing TB reporting practices among private healthcare providers. Enhancing these practices is crucial for strengthening the overall TB control strategy and protecting public health.

Long-term exposure to ambient fine particulate matter (PM2.5) and attributable pulmonary tuberculosis notifications in Ningxia Hui Autonomous Region, China: a health impact assessment

IntroductionLong-term exposure to fine particulate matter (≤2.5 µm (PM2.5)) has been associated with pulmonary tuberculosis (TB) notifications or incidence in recent publications. Studies quantifying the relative contribution of long-term PM2.5...