Tuberculosis Case Detection Research Articles

Effect of integrating paediatric tuberculosis services into child healthcare services on case detection in Africa: the INPUT stepped-wedge cluster-randomised trial

IntroductionPaediatric tuberculosis (TB) underdiagnosis is a critical concern. The INPUT stepped-wedge cluster-randomised trial assessed the impact of integrating child TB services into child healthcare on TB case detection among children...

Cost-effectiveness of integrating paediatric tuberculosis services into child healthcare services in Africa: a modelling analysis of a cluster-randomised trial

BackgroundIn 2021, over one million children developed tuberculosis, resulting in 214 000 deaths, largely due to inadequate diagnosis and treatment. The diagnosis and treatment of tuberculosis is limited in most...

COVID-19 policies and tuberculosis services in private health sectors of India, Indonesia, and Nigeria

IntroductionThe COVID-19 pandemic created unprecedented challenges in the field of global health. Nigeria, Indonesia and India are three high tuberculosis (TB) burden countries with large private health sectors. Both TB and the private health sector faced challenges in these countries because of COVID-19. This study aimed to compare the COVID-19 control measures and policies in the provision of TB care services and gain insights from policymakers on how the pandemic affected the provision of TB services in the private healthcare sector, how each country adapted, and identify lessons learned for health system preparedness MethodsQualitative, in-depth interviews were conducted among a purposive sample of 11 national and sub-national policymakers in each country. Thematic content analysis was conducted on the data collected using an adapted WHO Health Equity Policy Framework. ResultsResults revealed three policy dimensions under costs, access, and quality. Under healthcare costs, policymakers highlighted resource allocation and diversion of TB resources to COVID response, and increased operational costs for private provider. Under healthcare access, key themes included key themes included reduced TB case detection due to fear of COVID-19, disrupted diagnostic services, and adaptations such as extended medicine supplies and virtual consultations. Under healthcare quality, themes included compromised TB diagnostic accuracy due to similar respiratory symptoms with COVID-19, and strain on laboratory infrastructure due to competing demands from both diseases. Policymakers across the three countries pointed to the need for strengthening private–public partnerships (PPP) for healthcare service delivery and continued private sector investment to facilitate the continuity of TB care within a pandemic context. ConclusionThe results of this study provide an overview of the impact of the pandemic from the perspective of private facilities and policymakers in Nigeria, Indonesia and India, which can inform future policy and ways forward in strengthening PPP for healthcare service delivery in high TB burden countries.

Adapting a mobile TB screening unit to provide integrated screening services and linkage to primary care.

We adapted a mobile TB screening unit to create an integrated screening program for noncommunicable diseases and TB, using community health worker (CHW) navigators to support linkage to care. We piloted the model in underserved communities of Lima, Peru, evaluating its feasibility, acceptability, and ability to continue supporting TB case detection. The program provided screening for TB, hypertension, diabetes, and depression and was rebranded to avoid TB-associated stigma. CHW navigators were trained to link people to care for all four conditions. Implementation barriers and facilitators were identified from the implementation team's meeting minutes. During August-December 2023, we screened 1,000 adults, of whom 254 (25%) were referred for evaluation and paired with CHW navigators. Of these, 197 (78%) underwent evaluation at a health center, and 151 (59%) initiated some form of treatment, including 4 for TB. Completion of the linkage cascade was 93% for TB, 81% for hypertension, 71% for diabetes and 69% for depression. Limitations in equipment and staff were implementation barriers, while multiple flexibility-related facilitators were identified. The integrated screening program was acceptable and feasible and still identified people with TB. CHW navigators were effective in supporting linkage to primary care services.

ENHANCING TUBERCULOSIS CASE FINDING THROUGH SULI SIMULATOR APP: A CASE STUDY IN LUBUKLINGGAU CITY, SOUTH SUMATERA PROVINCE, INDONESIA

Introduction: Tuberculosis (TB) remains a significant public health challenge and is included as one of the targets in the Sustainable Development Goals (SDGs). TB case finding in Lubuklinggau City decreased from 967 in 2019 to 273 (24,37%) in 2020. Aims: This study aims to analyze the TB disease management program strategy implementation in contact investigation activities by utilizing the SULI SIMULATOR application. Method: A qualitative design with a participatory action research (PAR) approach was employed, involving focus group discussions, in-depth interviews with 36 informants, and document review. Data were validated using triangulation methods and sources, followed by thematic analysis. Result: The findings revealed that, in terms of input, some PHC lacked analysts in their human resources. In terms of process, the successful implementation of the TB disease prevention program, with the application of SULI SIMULATOR for TB contact investigation, led to an increase in the case detection rate (CDR) to 255 cases (22.76%) in 2021 compared to the previous year's 237 patients (21.16%). Conclusion: The active involvement of the community and family is crucial in promoting early detection of TB cases through contact investigation activities, as well as providing support for treatment in family and community-based health efforts

Determinants of an unfavorable treatment outcome among tuberculosis patients in the Jimma Zone, Southwest Ethiopia.

Tuberculosis (TB) is a major public health challenge in Ethiopia. TB treatment outcomes were suboptimal compared to the expected target of the national TB control Program. The provision of standard anti-TB treatment is the primary component of the directly observed treatment, short-course strategy. The aim of this study was to assess the TB treatment outcomes and the determinants of an unfavorable treatment outcome. The study used a cross-sectional study design at baseline and record review to identify treatment outcomes. A total of 1,161TB patients were recruited from eight randomly selected districts and one town administration in the Jimma Zone, Ethiopia. Treatment outcomes were grouped into favorable and unfavorable. Of the total participants, 86.9% had a favorable treatment outcome, and 5.7% an unfavorable treatment outcome. The rest were transferred out and not recorded cases. Women were more likely to experience an unfavorable treatment outcome [adjusted odds ratio (AOR) = 1.96, 95% CI 1.06, 3.64]. Patients who were perceived to not be stigmatized were less likely to have an unfavorable treatment outcome (AOR = 0.32, 95% CI 0.15, 0.73). Patients who had a monthly income of > 3,500 Ethiopian birr were less likely to have an unfavorable outcome than patients who did not have a regular income (AOR = 0.04, 95% CI 0.01, 0.45). The observed treatment success rate is lower than the World Health Organization's target of successfully treating > 90% of detected TB cases. It is imperative to ensure that information, education and communication/behavior change communication strategies consider the needs of women and patients with perceived TB stigma. Furthermore, designing locally acceptable and affordable interventions may help to address the financial challenges of TB treatment adherence.

Five-year tuberculosis trends analysis in eight districts of Mwanza region, Tanzania; (2017-2021).

In Tanzania like other developing countries, TB detection is hindered by totally missed, late notification, and delayed diagnosis of active cases. Apart from having TB control strategies and interventions to detect patients and put them on treatment to cut down the chain of transmission, TB remains a health concern. Limited data exist on the burden and trends of tuberculosis in Mwanza, which includes fishing communities and living conditions that are associated with high TB transmission like overcrowding. This study aimed to determine tuberculosis trends in the Mwanza region of Tanzania for five years, from 2017 to 2021. We extracted routine TB diagnostic data from 2017 to 2021 from eight districts of the Mwanza region of Tanzania from the electronic TB database. Data were captured in Microsoft Office Excel 2007 with district TB and leprosy coordinators and then imported into STATA 13 (Stata Corp LLC, College Station, TX, USA) for analysis. We estimated the TB case detection rate per 100,000 population. A total of 6,414 laboratory-confirmed tuberculosis cases were detected in eight districts of the Mwanza region in Tanzania from 2017 to 2021. The average tuberculosis detection rate in five years was 34.7 per 100,000 population. Overall, the TB detection rate was two times higher in people without HIV (30.5) compared to those infected with HIV; 13.4 per 100,000 population. Of the 15 rifampicin-resistant TB cases detected in the year 2018, 66.7% (10/15) were HIV-negative compared to 33.3% (5/15) infected with HIV. The TB case detection rate decreased in Mwanza region from 43.9 in 2017 to 21.4 per 100,000 population in 2021. Other parameters were missing in the database, which indicates remarkable gaps in the established database to monitor TB management in the region. The program may consider investigating and improving the documentation of information necessary to attain its goals.

Whole genome sequencing of M. tuberculosis for disease control in high-burden settings: study protocol for a cluster randomized controlled trial evaluating different community-wide intervention strategies in rural Madagascar

BackgroundRetrospective and descriptive molecular epidemiology studies have shown that Mycobacterium tuberculosis whole genome sequencing can identify outbreaks and disease transmission events with higher resolution than conventional epidemiological investigations. Those studies have strengthened our understanding of genomic polymorphisms correlating with person-to-person transmission and helped resolve putative transmission clusters. To date, systematic genomic surveillance programs implemented for M. tuberculosis were only implemented in low-incidence settings. The purpose of this study is to determine whether there is an impact of routine M. tuberculosis whole genome sequencing on tuberculosis case detection in a high-incidence setting.MethodsA cluster randomized controlled trial will be performed. Forty-eight rural village groups (or Fokontany) in the Vohibato district of Madagascar will be randomized to one of three interventions arms. Arm 1 (standard of care) involves healthcare facility-based passive case detection with smear microscopy testing. Arm 2 (best practice) consists of active case finding and Xpert MTB/RIF Ultra PCR testing followed by household contact investigations. Arm 3 (novel intervention) includes the same interventions as arm 2, with addition of sputum culture and M. tuberculosis whole genome sequencing for all newly diagnosed cases. In arm 3, molecular suggested putative outbreaks are investigated, and additional TB suspects are appropriately tested. The intervention observational period will be 2 years. The primary outcome will be the number of detected cases/100,000/year in each arm after 1 year of intervention.DiscussionThis study is designed to determine whether there is an impact of prospective whole genome sequencing-based molecular typing on tuberculosis case detection in high-incidence settings. Investigating potential outbreaks and focusing active case finding in spatiotemporal settings where disease transmission is suggested by genomic typing is hypothesized to improve case detection in rural communities.Trial registrationClinicalTrials.gov NCT05406453. Retrospectively registered on June 6, 2022.

Sputum and tongue swab molecular testing for the in-home diagnosis of tuberculosis in unselected household contacts: a cost and cost-effectiveness analysis.

Delayed and missed diagnosis are a persistent barrier to tuberculosis control, partly driven by limitations associated with sputum collection and an unmet need for decentralized testing. Household contact investigation with point-of-care testing of non-invasive specimens like tongue swabs are hitherto undescribed and may be a cost-effective solution to enable community-based active case finding. In-home, molecular point-of-care testing was conducted using sputum and tongue specimens collected from all household contacts of confirmed tuberculosis cases. A health economic assessment was executed to estimate and compare the cost and cost-effectiveness of different in-home, point-of-care testing strategies. Incremental cost effectiveness ratios of strategies utilizing different combination testing algorithms using sputum and/or tongue swab specimens were compared. The total implementation cost of delivering the standard of care for a 2-year period was $84 962. Strategies integrating in-home point-of-care testing ranged between $87 844 - $93 969. The cost-per-test for in-home, POC testing of sputum was the highest at $20·08 per test. Two strategies, Point-of-Care Sputum Testing and Point-of-Care Combined Sputum and Individual Tongue Swab Testing were the most cost-effective with ICERs of $543·74 and $547·29 respectively, both below a $2,760 willingness-to-pay threshold. An in-home, point-of-care molecular testing strategy utilizing combination testing of tongue swabs and sputum specimens would incur an additional 10.6% program cost, compared to SOC, over a 2-year period. The increased sample yield from tongue swabs combined with immediate result notification following, in-home POC testing would increase the number of new TB cases detected and linked to care by more than 800%.

Cost-effective analysis of active case finding (ACF) strategy to detect pulmonary tuberculosis (PTB) in selected public health care facilities of the northern state, India

BackgroundIn addition to passive case finding (PCF), active case finding (ACF) strategy under National Tuberculosis Elimination Program is a vital secondary prevention intervention under National Strategic Plan (NSP). The present study was conducted to assess ACF's cost-effectiveness compared to PCF in selected public health facilities for the detection of presumptive TB cases under NTEP. Material and methodsA cross-sectional study was carried out in randomly selected seven public health facilities of a health block of one district of Himachal Pradesh. Bottom-up costing method was used with bootstrapping of results to assess incremental cost-effectiveness ratio (CEAC) and cost-effectiveness acceptability curve (CEAC). ResultsMean cost for ACF and PCF with US$ 3325.8 and 3006.0 respectively to detect all presumptive PTB cases; and US$ 4121.2 and to US$ 3709.0 to confirm all PTB cases. Below WTP threshold (per capita income US$ 2735), WTP 80.3% of simulated ICER values were cost-effective. CEAC showed that saturation was achieved around US$ 300 indicating a likely WTP threshold at which 79.5% of simulated values were cost-effective. For both strategies, One way sensitivity analysis showed the cost is influenced mostly by human resources. ConclusionCurrent study used bottom-up costing method in public health care facilities observed ACF as a cost-effective strategy in reaching out for presumptive PTB. The major cost driver in both strategies is human resource for training, travelling, and administration.

Cachexia in tuberculosis in South-East Asian and African regions: knowledge gaps and untapped opportunities.

Tuberculosis (TB) and cachexia are clinical entities that have a defined relationship, making them often found together. TB can lead to cachexia, while cachexia is a risk factor for TB. This article reviews cachexia in Tuberculosis patients in Southeast Asian and African regions by conducting a comprehensive literature search across electronic databases such as PubMed, Google Scholar, and Research Gate between 2013 and 2024 using keywords including 'Africa', 'cachexia', 'prevalence', 'implications', 'tuberculosis', and 'Southeast Asia. This article utilized only studies that satisfied the inclusion criteria, revealing knowledge gaps and untapped opportunities for cachexia in TB across Southeast Asian and African regions. Many Southeast Asian and Western Pacific patients initially receive a tuberculosis diagnosis. Sub-Saharan African countries are among the 30 high TB burden nations, according to the WHO. Food inadequacy and heightened energy expenditure can impair the immune system, leading to latent TB and subsequently, active infection. Symptoms needing attention: shortness of breath, productive cough, hyponatremia at 131mmol/l, hypoalbuminemia at 2.1g/dl, elevated aspartate transaminase at 75U/l, increased lactate dehydrogenase at 654, and normocytic anemia. Comorbidities, such as kidney disease, cardiovascular disease, and asthma, can influence the nutritional status of individuals with TB. While efforts like screening, contact tracing, and utilizing gene Xpert to detect TB cases were implemented, only a few proved effective. It is essential to conduct further studies, including RCTs, in Southeast Asia and Africa to evaluate and manage cachexia in TB patients.

CORRELATION OF COMMUNITY PHARMACIST KNOWLEDGE, ATTITUDES, AND PRACTICES IN THE DETECTION OF TUBERCULOSIS CASES IN WEST JAVA PROVINCE

Tuberculosis (TB) control is hampered by suboptimal case detection and treatment delays. Pharmacies are reported as a first-aid treatment for patients with TB. Therefore, researchers analyzed knowledge, attitudes, and practices (KAP) regarding TB case detection among community pharmacists, aiming to find innovative strategies to involve community pharmacists in TB case detection. The research aims to determine the level of knowledge, attitudes, and practices, and the relationship between knowledge and attitude, knowledge-practice, and attitude-practice of community pharmacists in detecting tuberculosis cases in West Java Province. This research uses a descriptive observational method with 419 pharmacists who practice pharmacies. The results showed that pharmacists had a sufficient level of knowledge (14.94 ± 1.99), an adequate level of attitude (63.58 ± 9.12), and a sufficient level of practice (20.58 ± 8.55) regarding TB case detection. There is a very low relationship between knowledge and attitude (p-value 0.024<0.05), knowledge and practice ( p-value 0.018>0.05), and attitude and practice ( p-value 0.000< 0.05). This study concluded that community pharmacists in West Java Province have sufficient knowledge, attitudes, and practices in detecting TB cases, but the level of relationship between knowledge attitude and detecting TB cases, and the level of association between knowledge attitude and knowledge practice was very low, while the relationship between attitude practice was low. Keywords: Pharmacist, Knowledge, Practice, Attitude, Tuberculosis

Accessibility of Finding Tuberculosis Case Actively, Separate Safely and Treat Effectively (FAST) Strategy for Early Detection of Suspected and Symptomatic Tuberculosis Patients: A Hospital Based Quantitative Study

Introduction: Tuberculosis is a contagious disease which has always been a challenge over the course of human history. It is known to spread mostly from persons with undiagnosed and suspected tuberculosis cases. Diagnosing tuberculosis in an early stage with effective treatment is one of the best ways to reduce the burden of tuberculosis. Finding cases Actively, Separate safely and Treat effectively (FAST) Strategy in Nepal, is a rapid diagnostic tool for rapid tuberculosis case detection. Aims: To access tuberculosis case Actively, Separate safely and Treat effectively (FAST) strategy for suspected and symptomatic tuberculosis patients coming to the hospital for early case detection and also to identify patient’s health care behaviour, technical barrier during surveillance. Methods: An observational quantitative study of active cough surveillance was carried at an entry point of FAST corner of Nepalgunj Medical College Teaching Hospital, Banke from April 2023 to December 2023. Scrutinized data was obtained by purposive sampling method with sample size 128 from FAST corner. Results: Maximum cases belonged to the aged group 65 and above having lower middle to lower socioeconomic status. Most of them were from joint family with contact history of tuberculosis in 35 (27.3) % of total cases. Out of total cases, 72 (56.25) % were confirmed with tuberculosis. Among those confirmed tuberculosis cases, multi drug resistance TB was found in 6 (4.7) %. Uses of mask was found significant (P< 0.05) in our study although number of these health care behaviour were less appropriate. Pneumonia was a significant association 17 (P = 0.004) with tuberculosis patient. Insufficient volunteers, and limited Gene xpert machine were major barriers to implement FAST strategy screening in Hospital. Conclusion: FAST strategy is feasible tool in high tuberculosis burden healthcare settings in Nepal. However, the technical and behavioral factors should be managed to ensure an effective approach.

Effectiveness of Providing Cash Incentives and Training To Community Health Workers on Active Case Finding for Tuberculosis In Nigeria: A Cluster-Randomized Control Trial

Background Case detection for Tuberculosis remains low in high-burden communities. Community Health Workers (CHWs) are the first point of contact for many rural Nigerians and have been useful in active case finding. This study assessed the effectiveness of cash incentives and training on tuberculosis case detection by CHWs in six Local Government Areas in Nigeria. Materials and Methods A cluster randomized control trial with three arms was conducted. Arm A received cash incentives and training, Arm B received only training, and the control arm (C) received neither. CHWs already working in the communities participated. TB case notification and number of community outreaches held were used to assess intervention effects. Data were analyzed using STATA (v.13) and GraphPad Prism (v.8). Effect sizes were calculated using odds ratios and 95% confidence intervals. Associations were tested using Chi-square (χ²) tests, with significance set at P=0.05. Results Arm A had a 14.4% increase in case notification, Arm B showed a 7.4% increase, and the control arm showed a 39.7% increase from the previous year. Arms A and B had lower odds of TB case notification post-intervention, compared to the control (OR = 0.819 and 0.769, respectively), with no significant difference between them. Arm A also saw a 144.8% increase in community outreaches, compared to 46.7% in Arm B and 22.7% in Control Arm C. Arms A and B had higher odds of carrying out community outreaches post-intervention compared to the control (OR = 1.995 and 1.195, respectively), but no significant differences were found between the groups regarding community outreach. Conclusion While the interventions resulted in an increased number of community outreaches compared to the control, case notification improved more in the control arm than in the intervention arms. Nevertheless, the findings highlight the potential of combining cash incentives with training to improve TB control efforts at the community level. Further exploration of the implementation process may shed light on the observed outcomes and guide future intervention strategies.

Cost-effectiveness analysis with surrogate endpoint: mobile targeted active case detection for early detection of tuberculosis

Abstract Objective This study aimed to determine cost-effectiveness analysis with the surrogate endpoint of mobile targeted active case detection (MTACD) programmes in the early detection of tuberculosis (TB) cases. Methods A cross-sectional study to determine the cost-effectiveness with the surrogate endpoint of MTACD as compared with passive case detection (PCD) from the provider’s perspective. Data were gathered on the costs and significant dates (TB screening date, first TB symptoms date, TB diagnosis date, and TB treatment starting date) for 904 patients from five Sabah districts in 2022. A combined step-down and activity-based costing method was used to estimate provider costs. The health outcome measures used were the time taken by the day to detect TB cases. Cost-effectiveness analysis with surrogate endpoint was assessed using cost per TB screening by MTACD and PCD, and the mean of the time taken by the day to detect TB cases. Key findings The total cost for a patient to be screened by MTACD was Malaysian Ringgit (MYR) 96.6 (MYR 1 = USD 0.22), while the cost by PCD was MYR 43.1. The MTACD generally costs MYR 1727.1 to detect a case of TB, compared with MYR 586.9 for PCD. However, MTACD used a shorter mean time to detect TB cases (52.7 days) than PCD (98.9 days). Conclusions Despite the higher costs per screening, MTACD may shorten the days of diagnosis from the onset of TB symptoms when compared with PCD. This study is beneficial when budgeting for TB programmes since MTACD can detect TB cases earlier and lead to early treatment.

Development and assessment of “college student to community strategy” for enhancing tuberculosis case detection

BACKGROUND: Tuberculosis (TB) elimination is the top-most public health priority for India. Taking into account the dire need to enhance the detection of TB cases, an innovative model was developed and implemented. AIM: The aim is to develop and assess “college student to community strategy” for enhancing TB case detection. MATERIAL AND METHODS: A quasi-experimental study was conducted in seven different nonmedical degree colleges. A total of 134 students participated in this study. Information, education, and communication (IEC) sessions describing the epidemiology, presumptive case definition, control, and prevention of TB were conducted. Pretest and posttest were administered to capture knowledge about TB, including identification of presumptive TB cases. Data were analyzed with SPSS V. 25.0. RESULTS: A total of 134 participants were included in this study. Only 108 (80.6%) participants were aware of TB before the IEC session. There was a statistically significant difference in knowledge about transmission, symptoms, diagnosis, treatment, and prevention of TB before and after IEC activity. 118 (88.06%) participants felt confident regarding presumptive TB case detection. Two participants and three close contacts having presumptive TB symptoms were linked to the TB care pathway. CONCLUSION: College students who are equipped with the presumptive TB case detection knowledge can be instrumental in diagnosing the hidden burden of TB in the community. This will detect additional cases along with routine case detection through the National Tuberculosis Elimination Program.

Health worker perspectives on barriers and facilitators of tuberculosis investigation coverage among index case contacts in rural Southwestern Uganda: a qualitative study

BackgroundIn 2012, the World Health Organization recommended screening and investigation of contacts of index tuberculosis patients as a strategy to accelerate detection of tuberculosis (TB) cases. Nine years after the adoption of this recommendation, coverage of TB contact investigations in Uganda remains low. The objective of this study was to examine health care providers’ perceptions of factors influencing coverage of TB contact investigations in three selected rural health facilities in Mbarara district, southwestern Uganda.MethodsThis study identified provider opinions on the barriers and facilitators to implementation of TB contact investigation using the Consolidated Framework for Implementation Research. Using an exploratory qualitative study design, semi-structured interviews with 19 health workers involved in the TB program at district, health facility and community levels were conducted from April 2020 and July 2020. Analysis was conducted inductively using reflexive thematic analysis in six iterative steps: familiarizing with the data, creating initial codes, searching for themes, reviewing themes, developing theme definitions, and writing the report.ResultsNineteen health care workers participated in this study which translates to a 100% response rate. These included two district TB and leprosy supervisors, five nurses, five clinical officers, six village health team members and one laboratory technician. The three themes that emerged from the analysis were intervention-related, health system and contextual factors. Health system-related barriers included inadequate or delayed government funding for the TB program, shortage of human resources, insufficient personal protective equipment, and a stock-out of supplies such as Xpert MTB cartridges. Contextual barriers included steep terrain, poverty or low income, and the stigma associated with TB and COVID-19. Facilitators comprised increased knowledge and understanding of the intervention, performance review and on-the-job training of health workers.ConclusionsThis study found that most of the factors affecting TB contact investigations in this rural community were related to health system constraints such as inadequate or delayed funding and human resource shortages. This can be addressed by strengthening the foundational elements of the health system - health financing and human resources - to establish a comprehensive TB control program that will enable the efficient identification of missing TB patients.

Detection of pulmonary tuberculosis in the republic of Tajikistan

Objective: To study the dynamics and main reasons for the significant detection of pulmonary tuberculosis with a negative sputum test result in the Republic of Tajikistan over the past 5 years. Material and methods: An analysis of the estimated data of the WHO, as well as official statistics on TB incidence using the National TB Data Registry for 2019-2023, was carried out. Definitions of clinically established cases of pulmonary TB are noted. Information is presented on the introduction of the express PCR method of bacteriological verification of TB diagnosis in all regions of the country. Results: Over the past 5 years (2019-2023), WHO estimates on TB incidence in the Republic of Tajikistan have significantly decreased, indicating improved accessibility of the population to specialized anti-TB services. At the same time, during the COVID period (2019-2020), the prognosis was more unfavorable due to deteriorating accessibility to medical and social services than in the post-COVID period (2021-2023). At the same time, official statistics on the detection of new TB cases indicate the opposite dynamics: during the COVID period, the number of TB patients sharply decreased from 5976 to 4299 cases that is, by 1677 cases (more than 28%) and began to gradually increase in subsequent years, but has not yet reached the pre-COVID level. At the same time, in proportion to the indicated data, the number of clinically established cases of pulmonary TB decreased during the COVID period from 1422 to 720 cases (2019-2021), that is, almost twofold, and in the following years (2022-2023) began to gradually increase, still not reaching the pre-COVID period. Conclusion: Thus, despite the active introduction of new innovative methods for verifying the diagnosis of TB and improving the population's access to diagnostic services, including molecular genetic methods for rapid diagnostics of both sensitive and drug-resistant forms of TB, the proportion of clinically established cases of pulmonary TB remains high (34% of all pulmonary forms of TB) and tends to increase.

Decentralisation and integration of paediatric tuberculosis services to primary healthcare facilities as an approach to optimise management in Cameroon and Kenya: a descriptive cohort study

IntroductionTuberculosis (TB) remains a major cause of morbidity and mortality for children less than 5 years. Diagnosis and treatment of children with active TB is often centralised in district hospital...

A mixed-methods study on impact of active case finding on pulmonary tuberculosis treatment outcomes in India

BackgroundTuberculosis (TB) remains a significant public health burden in India, with elimination targets set for 2025. Active case finding (ACF) is crucial for improving TB case detection rates, although conclusive evidence of its association with treatment outcomes is lacking. Our study aims to investigate the impact of ACF on successful TB treatment outcomes among pulmonary TB patients in Gujarat, India, and explore why ACF positively impacts these outcomes.MethodsWe conducted a retrospective cohort analysis in Gujarat, India, including 1,638 pulmonary TB cases identified through ACF and 80,957 cases through passive case finding (PCF) from January 2019 to December 2020. Generalized logistic mixed-model compared treatment outcomes between the ACF and PCF groups. Additionally, in-depth interviews were conducted with 11 TB program functionaries to explore their perceptions of ACF and its impact on TB treatment outcomes.ResultsOur analysis revealed that patients diagnosed through ACF exhibited 1.4 times higher odds of successful treatment outcomes compared to those identified through PCF. Program functionaries emphasized that ACF enhances case detection rates and enables early detection and prompt treatment initiation. This early intervention facilitates faster sputum conversion and helps reduce the infectious period, thereby improving treatment outcomes. Functionaries highlighted that ACF identifies TB cases that might otherwise be missed, ensuring timely and appropriate treatment.ConclusionACF significantly improves TB treatment outcomes in Gujarat, India. The mixed-methods analysis demonstrates a positive association between ACF and successful TB treatment, with early detection and prompt treatment initiation being key factors. Insights from TB program functionaries underscore the importance of ACF in ensuring timely diagnosis and treatment, which are critical for better treatment outcomes. Expanding ACF initiatives, especially among hard-to-reach populations, can further enhance TB control efforts. Future research should focus on optimizing ACF strategies and integrating additional interventions to sustain and improve TB treatment outcomes.