Performance Of Tuberculosis Control Program Research Articles

Qualitative Assessment of Challenges in Tuberculosis control in Public Health Facilities of Bule Hora Town, Ethiopia; Health Workers’ and Tuberculosis control Program Coordinators’ Perspectives, 2020

Introduction: The Millennium Development Goal target of halting and reversing TB incidence has been achieved on a global scale. Mortality from TB has fallen by 47% since 1990. Despite these gains, however, TB still remains a major worldwide health crisis. According to a recent WHO report, there where in 2018, an estimated 10 million people fell sick with tuberculosis (TB) worldwide. 5.7 million Men, 3.2 million women and 1.1 million children. Poor health systems pose many barriers to effective tuberculosis (TB) control. This study aimed at exploring health workers and TB control program coordinator’s perspectives on health systems challenges facing TB control in Bule Hora Town, Oromia Region, southern, Ethiopia. Objective: To identify challenges of health care workers and tuberculosis control program co-ordinator towards tuberculosis control at Public health facilities of Bule Hora town-2020. Method: Qualitative study was conducted at Public health facilities of Bule Hora town, Ethiopia. Four in-depth interviews with TB control program coordinators and two focus group discussions among 8 health workers were conducted. Purposive sampling was used to recruit study participants. Thematic analysis was used to identify and analyze main themes. Results: We identified that shortage of laboratory reagents, Shortages of TB diagnostic tools and intermittent supply of anti-TB drugs, shortage of trained and motivated health care staffs, Poor community TB mobilization and collaboration between health institutions were challenges facing the TB control program performance in the study area. Conclusion: Ensuring no proper supply of anti-TB drugs, laboratory reagents and Shortages of TB diagnostic tools to all health facilities is essential. Continuous updated training of health workers on standard TB care and data handling, developing and implementing a sound retention strategy to attract and motivate health professionals to work in study areas are necessary interventions to improve the TB control program performance in the study area.

Performance evaluation of the national tuberculosis control program 2016–2020: Souss-Massa region, Morocco

BackgroundTuberculosis constitutes a public health problem in Morocco. In an environment where results-based management and the evaluation of public policies become an imperative; the evaluation of the performance of the national tuberculosis control program finds its interest. ObjectivesThis study aims to analyze the performance of the tuberculosis control program in the Souss Massa region, based on the systemic approach model over a five-year period 2016–2020. MethodsThis is a descriptive secondary data analysis carried out in the Souss-Massa region in southern Morocco over a five year period 2016–2020. Data collection was carried out through the health information system of the NTCP and the various periodic reports produced by the primary health care establishments and diagnostic centers for tuberculosis and respiratory diseases, the delegations and the regional health directorate of the Ministry of Health. ResultsThe incidence of tuberculosis has fluctuated between 63 and 72 cases/100,000 inhabitants; the average number of cases detected is 1871 cases per year; the survey completion rate is 57.10%; the therapeutic success rate varies between 82% and 89%, the treatment failure rate varies between 0.62% and 2.32%; the death rate varies between 0.63% and 2.92%; the failure rate for tuberculosis/HIV cases is between 3.10% and 6.09%. ConclusionsThe results of the program tracer indicators at the level of the Souss-Massa region show that the latter combs to achieve the target objectives.

Synergizing early detection and comprehensive mandatory notification to improve Tuberculosis case finding through public private mix

Tuberculosis (TB) is a priority health problem in Indonesia. Incidence rate estimation for TB in 2020 was 301 per 100,000 population or 824,000 new cases per year which is the third highest worldwide. The Corona Virus Disease (COVID-19) Pandemic has caused decreasing performance of TB control program globally, including Indonesia. The treatment coverage was declined from 67% in 2019 to 48% in 2020 and 54% in 2021, far behind the 80% target. This fact signifies that around a half of people with TB in Indonesia are overlooked, which is estimated to be accounted for over 400,000 cases. Another TB Program’s main indicator, treatment success rate at 86%, remains below the target of 90%. Low achievement of the two main indicators may result in the increasing of TB transmission, morbidity and mortality in population. Besides, Indonesia also faces the triple burden of TB, high prevalence of drug resistance TB and coinfection of TB and HIV

Characteristics of pulmonary multidrug-resistant tuberculosis patients in Tigray Region, Ethiopia: A cross-sectional study

Tuberculosis (TB) is among the top 10 causes of mortality and the first killer among infectious diseases worldwide. One of the factors fuelling the TB epidemic is the global rise of multidrug resistant TB (MDR-TB). The aim of this study was to determine the magnitude and factors associated with MDR-TB in the Tigray Region, Ethiopia. This study employed a facility-based cross-sectional study design, which was conducted between July 2018 and August 2019. The inclusion criteria for the study participants were GeneXpert-positive who were not under treatment for TB, PTB patients' ≥15 years of age and who provided written informed consent. A total of 300 participants were enrolled in the study, with a structured questionnaire used to collect data on clinical, sociodemographic and behavioral factors. Sputum samples were collected and processed for acid-fast bacilli staining, culture and drug susceptibility testing. Drug susceptibility testing was performed using a line probe assay. Logistic regression was used to analyze associations between outcome and predictor variables. The overall proportion of MDR-TB was 16.7% (11.6% and 32.7% for new and previously treated patients, respectively). Of the total MDR-TB isolates, 5.3% were pre-XDR-TB. The proportion of MDR-TB/HIV co-infection was 21.1%. A previous history of TB treatment AOR 3.75; 95% CI (0.7-2.24), cigarette smoking AOR 6.09; CI (1.65-2.50) and patients who had an intermittent fever (AOR = 2.54, 95% CI = 1.21-5.4) were strongly associated with MDR-TB development. The magnitude of MDR-TB observed among new and previously treated patients is very alarming, which calls for an urgent need for intervention. The high proportion of MDR-TB among newly diagnosed cases indicates ongoing transmission, which suggests the need for enhanced TB control program performance to interrupt transmission. The increased proportion of MDR-TB among previously treated cases indicates a need for better patient management to prevent the evolution of drug resistance. Assessing the TB control program performance gaps and an optimal implementation of the WHO recommended priority actions for the management of drug-resistant TB, is imperative to help reduce the current high MDR-TB burden in the study region.

Applying tuberculosis management time to measure the tuberculosis infectious pool at a local level in Ethiopia

BackgroundMeasuring the size of the infectious pool of tuberculosis (TB) is essential to understand the burden and monitor trends of TB control program performance. This study applied the concept of TB management time to estimate and compare the size of the TB infectious pool between 2009 and 2014 in West Gojjam Zone of Amhara Region, Ethiopia.MethodsNew sputum smear-positive and smear-negative pulmonary TB (PTB) and retreatment cases who attended 30 randomly selected public health facilities in West Gojjam Zone from October 2013 to October 2014 were consecutively enrolled in the study. In order to determine the infectious period, the TB management time (number of days from the onset of cough until start of anti-TB treatment) was computed for each patient category. The number of undiagnosed TB cases was estimated and hence the TB management time for the undiagnosed category was calculated. The total size of the TB infectious pool during the study period for the study zone was estimated as the annual number of infectious person days.ResultsNew smear-positive and smear-negative PTB cases contributed 25,050 and 12,931 infectious person days per year to the TB infectious pool, respectively. The retreatment and presently undiagnosed cases contributed 8840 and 34,310 infectious person days per year, respectively. The total size of the TB infectious pool in West Gojjam Zone during the study period was estimated at 81,131 infectious person days per year or 3405 infectious person days per 100,000 population per year. Compared to a similar study done in 2009 in the study area, the current study showed reduction of the TB infectious pool by 244,279 infectious person days.ConclusionsTB management time is a simple and practical tool that may help to estimate and compare the changes in the size of the TB infectious pool at local level. It may also be used as an indicator to monitor the changes in TB control program performance.

DO XPERT MTB/RIF CYCLE THRESHOLD VALUES PROVIDE INFORMATION ABOUT PATIENT DELAYS FOR TUBERCULOSIS DIAGNOSIS?

BackgroundEarly diagnosis and initiation to appropriate treatment is vital for tuberculosis (TB) control. The Xpert MTB/RIF (Xpert) assay offers rapid TB diagnosis and quantitative estimation of bacterial burden through Cycle...

Do Xpert MTB/RIF Cycle Threshold Values Provide Information about Patient Delays for Tuberculosis Diagnosis?

IntroductionEarly diagnosis and initiation to appropriate treatment is vital for tuberculosis (TB) control. The XpertMTB/RIF (Xpert) assay offers rapid TB diagnosis and quantitative estimation of bacterial burden through Cycle threshold (Ct) values. We assessed whether the Xpert Ct value is associated with delayed TB diagnosis as a potential monitoring tool for TB control programme performance.Materials and MethodsThis analysis was nested in a prospective study under the routine TB surveillance procedures of the National TB Control Program in Manhiça district, Maputo province, Mozambique. Presumptive TB patients were tested using smear microscopy and Xpert. We explored the association between Xpert Ct values and self-reported delay of Xpert-positive TB patients as recorded at the time of diagnosis enrolment. Patients with >60 days of TB symptoms were considered to have long delays.ResultsOf 1,483 presumptive TB cases, 580 were diagnosed as TB of whom 505 (87.0%) were due to pulmonary TB and 302 (94.1%) were Xpert positive. Ct values (range, 9.7–46.4) showed a multimodal distribution. The median (IQR) delay was 30 (30–45) days. Ct values showed no correlation with delay (R2 = 0.001, p = 0.621), nor any association with long delays: adjusted odds ratios (AOR) (95% confidence interval [CI]) comparing to >28 cycles 0.99 (0.50–1.96; p = 0.987) for 23–28 cycles, 0.93 (0.50–1.74; p = 0.828) for 16–22 cycles; and 1.05 (0.47–2.36; p = 0.897) for <16 cycles. Being HIV-negative (AOR [95% CI]), 2.05 (1.19–3.51, p = 0.009) and rural residence 1.74 (1.08–2.81, p = 0.023), were independent predictors of long delays.ConclusionXpert Ct values were not associated with patient delay for TB diagnosis and cannot be used as an indicator of TB control program performance.

Qualitative Assessment of Challenges in Tuberculosis Control in West Gojjam Zone, Northwest Ethiopia: Health Workers' and Tuberculosis Control Program Coordinators' Perspectives.

Background. Weak health systems pose many barriers to effective tuberculosis (TB) control. This study aimed at exploring health worker's and TB control program coordinator's perspectives on health systems challenges facing TB control in West Gojjam Zone, Amhara Region, Ethiopia. Methods. This was a qualitative descriptive study. Eight in-depth interviews with TB control program coordinators and two focus group discussions among 16 health workers were conducted. Purposive sampling was used to recruit study participants. Thematic analysis was used to identify and analyse main themes. Results. We found that intermittent interruptions of laboratory reagents and anti-TB drugs supplies, absence of trained and motivated health workers, poor TB data documentation, lack of adherence to TB treatment guideline, and lack of access to TB diagnostic tools at peripheral health institutions were challenges facing the TB control program performance in the study zone. Conclusions. Ensuring uninterrupted supply of anti-TB drugs and laboratory reagents to all health institutions is essential. Continuous refresher training of health workers on standard TB care and data handling and developing and implementing a sound retention strategy to attract and motivate health professionals to work in rural areas are necessary interventions to improve the TB control program performance in the study zone.

Tuberculosis Case Notification and Treatment Outcomes in West Gojjam Zone, Northwest Ethiopia: A Five-Year Retrospective Study

Introduction: Tuberculosis (TB) is a major public health concern in Ethiopia. Analysis of TB case notification and treatment outcomes is crucial to understand the TB control program performance. The current study was carried out to assess trends of TB case notifications, treatment success rate and factors associated with unsuccessful treatment outcome among TB patients in West Gojjam Zone of Amhara Region, Ethiopia. Method: A retrospective cohort study was conducted in West Gojjam Zone. Demographic and clinical data were reviewed for all TB patients registered between July 2007 and June 2012 at 30 randomly selected public health facilities of the study zone. In addition, annual case notification reports of the study zone were used to analyze trends in TB case notifications. Logistic regression analysis was used to assess the association between potential predictor variables and unsuccessful treatment outcomes. Results: Tuberculosis case notification for all forms of TB decreased from 203/100,000 population in 2007 to 155/100,000 population in 2012. Among patients whose treatment outcomes were evaluated, 94.4% were successfully treated, 0.3% had treatment failure, 1.5% defaulted and 3.7% died. In multivariate analysis, the odds of unsuccessful treatment outcome was higher among retreatment cases than new cases (adjusted OR, 3.44; 95% CI: 1.92, 6.19). HIV co-infected cases were more likely to have unsuccessful treatment outcome compared to HIV negatives (adjusted OR, 2.68; 95% CI: 1.92, 3.72). Conclusion: Tuberculosis case notification rates showed a decreasing trend between 2007 and 2012. The treatment success rate exceeded the 90% treatment success rate target as set by the WHO. Special attention is required for patients with high risk of unsuccessful treatment outcome. Therefore, retreatment cases, and HIV positive cases need strict follow up throughout their treatment period.

Relationship between National TB program and prevalence of TB drug resistance in Algeria, 1965 to 2013

The Algerian National TB program was first implemented in Algeria in 1965. Since 1965, the Ministry of Health has endorsed many instructions which have given important improvements in the fight against tuberculosis (TB) in the country.The government has actively participated in the fight against TB as expressed in its endorsement of many decisions to this end, such as the withdrawal of TB medications from the private pharmacies, the free-of-charge diagnostics and the treatment for TB patients until the completion of their treatment, and the creation of the National TB Laboratory, as well as many other tasks to control the TB epidemic in the whole country.According to this policy, the surveillance of TB drug resistance has been followed continuously since 1965 up to the present. The National TB Laboratory is a unique laboratory performing the DST for TB strains and is also able to conduct the national drug resistance surveys.The different steps will be presented of the development of the National TB program in Algeria between 1964 and 2014, and in the same way the variations of the prevalence rate of TB drug resistance to demonstrate that the drug resistance surveillance is an acceptable indicator of the performance of TB control program in the country.

Transmission Classification Model To Determine Place and Time of Infection of Tuberculosis Cases in an Urban Area

We conducted a population-based study in the Rotterdam region of The Netherlands to determine the place and time of infection of tuberculosis (TB) cases using conventional epidemiological and genotyping information. In particular, we focused on the extent of misclassification if genotyping was not combined with epidemiological information. Cases were divided into those with a unique mycobacterial DNA fingerprint, a clustering fingerprint, and an unknown fingerprint. We developed transmission classification trees for each category to determine whether patients were infected in a foreign country or recently (<or=2 years) or remotely (>2 years) infected in The Netherlands. Of all TB cases during the 12-year study period, 38% were infected in a foreign country, 36% resulted from recent transmission in The Netherlands, and 18% resulted from remote infection in The Netherlands, while in the remaining cases (9%) either the time or place of infection could not be determined. The conventional epidemiological data suggested that at least 29% of clustered cases were not part of recent chains of transmission. Cases with unknown fingerprints, almost all culture negative, relatively frequently had confirmed epidemiological links with a recent pulmonary TB case in The Netherlands and were more often identified by contact tracing. Our findings highlight the idea that genotyping should be combined with conventional epidemiological investigation to establish the place and time of infection of TB cases as accurately as possible. A standardized way of classifying TB into recently, remotely, and foreign-acquired disease provides indicators for surveillance and TB control program performance that can be used to decide on interventions and allocation of resources.

Surveillance of resistance to antituberculosis drugs in developing countries

Resistance to antituberculosis drugs is caused by poor management of tuberculosis control. It gives rise to treatment failure, relapse, further transmission of resistant tuberculosis, and multidrug-resistant tuberculosis. Widespread occurrence of multidrug-resistant tuberculosis would constitute a major threat to tuberculosis control in resource-poor countries. Although the impact of HIV on drug resistance is not yet fully understood, it is likely to exacerbate problems caused by drug resistance. In particular, HIV-related adverse effects of thiacetazone, together with the risks of transmission of HIV by parenteral administration of streptomycin, reduce the armamentarium available to tuberculosis control programmes in high HIV prevalence countries, and could encourage the development of resistance to the remaining drugs. While the prime need is to ensure, by good management and supervision, that resistance does not occur in the first place, surveillance of drug resistance is essential to determine the current scale and nature of the drug resistance problem, as well as to define the correct solutions.