TB Control Policies Research Articles

Analysis of Pulmonary Tuberculosis Incidence in the City of Bukittinggi in 2018-2020

Pulmonary tuberculosis (pulmonary TB) is still a major problem of infectious diseases in Indonesia, including in the city of Bukittinggi. Data for 2022 shows that Bukittinggi City has the highest TB incidence rate in West Sumatra Province, namely 199/100.00 population. The aim of this research is to analyze the incidence of pulmonary TB in Bukittinggi City in 2018-2020. The research method was carried out using an observational descriptive design with an epidemiological approach, spatially based on Geographic Information Systems (GIS) and pulmonary TB control policies. The results showed that the highest incidence rate of pulmonary TB was in Guguk Panjang District which had the highest density, while the lowest cure rate was in Aur Birugo Tigo Baleh District.

24 loci MIRU-VNTR analysis and pattern of drug resistance in pre-extensively drug resistant pulmonary tuberculosis in Bangladesh.

Phylogenetic diversity and distinct phylogeographic distribution of Mycobacterium tuberculosis (MTB) contribute to regional differences in drug resistance. The emergence of pre-extensively drug resistant tuberculosis (Pre-XDR-TB) becomes obstacles to achieve End TB strategy in Bangladesh. This cross-sectional study was conducted to identify the strains of different lineages of MTB, their variations of distribution among Pre-XDR-TB cases and to observe the linkage of particular strains of MTB with drug resistance. A total of 33 Pre-XDR-TB isolates were enrolled in this study. All isolates were confirmed as MTB by MPT 64 antigen detection and genotyped by 24 loci Mycobacterial Interspersed Repetitive Unit-Variable Number of Tandem Repeats (MIRU-VNTR) analysis. Drug resistance was detected by second line Line probe assay (LPA). Beijing was the predominant strain 16 (48.48%), followed by Delhi/CAS 5(15.15%), LAM 4 (12.12%) and Harlem 3(9.10%), EAI 2(6.06%), Cameroon 2(6.06%) and NEW-1 1(3.03%). There were 31 different genotypes consisting of 2 clusters and 29 singletons. All the clustered strains were belonged to Beijing lineage. Recent transmission occurred manly by Beijing strains, showed low transmission rate (12.1%). Of 33 isolates 30(90.90%) were Fluoroquinolones resistant, the mutations involved was Asp94Gly in gyr A MUT 3C gene 13(39.39%) in quinolone resistance determining region (QRDR) followed by 11 (33.33%) in gyr A MUT 1. Three (9.10%) isolates showed resistant to injectable 2nd line drugs and all mutation occurs in G1484T of rrs MUT 2. Beijing lineage was predominant in treatment failure and relapse cases. Levofloxacin was resistant to all Pre-XDR-TB cases, but moxifloxacin showed low level resistance. QUB 26 was the most discriminatory locus (0.85) among 24 loci whereas MIRU 2 was the least (0.03). 24 loci MIRU-VNTR analysis shows high discriminatory index (0.71), found to be powerful tool for genotyping of Pre-XDR-TB, which is the first study in Bangladesh that enhanced the current TB control policy.

Clinical profile of patients with tuberculosis in Dschang, Cameroon: Role of the therapeutic path in delaying diagnosis.

The results of the fight against tuberculosis in Cameroon remain far from the WHO goals for the eradication of tuberculosis on a global scale, which aim to achieve a global incidence rate of fewer than 100 cases per million inhabitants by 2035. The objective of this study was to describe the social, demographic, and clinical profiles of all patients (n=59) with tuberculosis at the Saint Vincent de Paul Hospital in Dschang, Cameroon, over a one-year period, with an emphasis on their healthcare paths to identify potential factors that may explain delays in their diagnosis and follow-up. Epi Info Version 3.5.3 and Microsoft Excel 2013 software were used to analyze the data. The results of the study showed men accounted for 57.6% of the patients (sex ratio: 1.36). The participants' mean age was 41.87 ± 12 years. The mean duration from onset of first symptoms to the clinical and laboratory diagnosis of TB was 3.26 months. Initially 38.98%, sought care from illicit drug sellers (street sellers), 23.73% from hospital facilities, and 22.03% from traditional medicine practitioners. The influence of illicit drug sellers and traditional practitioners in delaying the diagnosis of these TB infections should be taken into account in national TB control policies in Cameroon.

Enhanced surveillance for tuberculosis among foreign-born persons, Finland, 2014\u20132016

BackgroundTuberculosis (TB) in foreign-born residents is increasing in many European countries including Finland. We conducted enhanced TB surveillance to collect supplementary information on TB cases among recent immigrants and their children to provide data for revising TB control policies in Finland to take into account the decrease in native cases and increase in foreign-born cases.MethodsTB cases were identified from the National Infectious Diseases Register. Data on foreign-born (if not available, most recent nationality other than Finnish) TB cases notified during 2014–2016 (country of birth, date of arrival to Finland, participation in TB screening, date of first symptoms, and details of possible contact tracing) were requested from physicians responsible for regional communicable disease control through a web-based questionnaire.ResultsQuestionnaires were returned for 203 (65%) of 314 foreign-born TB cases; 36 (18%) were paediatric cases TB was detected in arrival screening in 42 (21%) and during contact tracing of another TB case in 18 (9%); 143 (70%) cases sought care for symptoms or were identified by chance (e.g. chest x-ray because of an accident). Of cases with data available, 48 (24%) cases were diagnosed within 3 months of arrival to Finland, 55 (27%) cases between 3 months and 2 years from arrival, and 84 (42%) cases after 2 years from arrival. Of all the foreign-born cases, 17% had been in a reception centre in Finland and 15% had been in a refugee camp abroad.ConclusionsIn addition to asylum seekers and refugees, TB screening should be considered for immigrants arriving from high TB incidence countries, since the majority of TB cases were detected among persons who immigrated to Finland due to other reasons, presumably work or study. Further evaluation of the target group and timing of TB screening is warranted to update national screening guidance.

Bovine Tuberculosis and Badger Control in Britain: Science, Policy and Politics

Bovine tuberculosis (bovine TB) is the most economically important animal health policy issue in Britain. The problem of what to do about badgers has plagued successive governments since a dead badger was discovered with bovine TB in 1971. Successive Labour governments (1997–2010) oversaw the Randomised Badger Culling Trial (RBCT) from 1998 to 2006. Despite the RBCT recommendation against culling, the 2010–2015 Coalition government implemented pilot badger culls. This paper provides an account of the evolution of bovine TB and badger control policy, focusing on the 1997–2010 Labour, the 2010–2015 Coalition and the 2015-present Conservative governments. Interviews with bovine TB policy stakeholders supplement discussion of the development of bovine TB policy. The paper discusses the science and politics of bovine TB policy, in which there are different badger control policies in Westminster, Welsh and Scottish governments. Badger control is a highly polarised issue, and the Coalition and Conservative governments have been heavily criticised for a culling policy opposed by the independent scientific community. Recent governments have defended badger culling on the basis of veterinary advice and experience in countries such as New Zealand. The paper concludes with two key recommendations to inform controversial animal health and welfare policy issues such as bovine TB. First, mandatory Animal Welfare Impact Assessment provides objective data on the impacts of policy options on cows and badgers. Second, robust ethical analysis, conducted by independent experts using established moral frameworks, should be applied to animal health and welfare issues for the benefit of decision makers.

Bovine Tuberculosis Policy in England: Would a Virtuous Government Cull Mr Badger?

Bovine tuberculosis (bovine TB) is the most important animal health and welfare policy issue in Britain. Badgers are a wildlife reservoir of disease, although the eight-year Independent Scientific Group (ISG) Randomised Badger Culling Trial concluded with a recommendation against culling. The report advised government that bovine TB could be controlled, and ultimately eradicated, by cattle-based measures alone. Despite the ISG recommendation against culling, the farming and veterinary industries continued to lobby government for a badger cull. The 2005–2010 Labour government followed the ISG advice and decided against a cull. The 2010–2015 Coalition and the 2015-present Conservative governments have followed a badger culling policy. This paper investigates whether a virtuous government would cull badgers. It provides an overview of virtue theory in the context of government animal health and welfare policy. Bovine TB and badger control policy options are then analysed in the context of the virtues of justice, wisdom, integrity, loyalty, curiosity, trust, empathy, compassion and aesthetics. Justice is the first virtue of government, and badger culling is seriously problematic from a virtue perspective given that five badgers are culled per cow that avoids slaughter as a result. Analysis based on other virtues strongly suggests that government should not cull badgers. The paper concludes that a virtuous government would not cull badgers as part of policy to control bovine TB in cattle.

Does directly observed therapy improve tuberculosis treatment? More evidence is needed to guide tuberculosis policy.

BackgroundTuberculosis (TB) now ranks alongside HIV as the leading infectious disease cause of death worldwide and incurs a global economic burden of over $12 billion annually. Directly observed therapy (DOT) recommends that TB patients complete the course of treatment under direct observation of a treatment supporter who is trained and overseen by health services to ensure that patients take their drugs as scheduled. Though the current WHO End TB Strategy does not mention DOT, only “supportive treatment supervision by treatment partners”, many TB programs still use it despite the fact that the has not been demonstrated to be statistically significantly superior to self-administered treatment in ensuring treatment success or cure.DiscussionDOT is designed to promote proper adherence to the full course of drug therapy in order to improve patient outcomes and prevent the development of drug resistance. Yet over 8 billion dollars is spent on TB treatment each year and thousands undergo DOT for all or part of their course of treatment, despite the absence of rigorous evidence supporting the superior effectiveness of DOT over self-administration for achieving drug susceptible TB (DS-TB) cure. Moreover, the DOT component burdens patients with financial and opportunity costs, and the potential for intensified stigma.To rigorously evaluate the effectiveness of DOT and identify the essential contributors to both successful treatment and minimized patient burden, we call for a pragmatic experimental trial conducted in real-world program settings, the gold standard for evidence-based health policy decisions. It is time to invest in the rigorous evaluation of DOT and reevaluate the DOT requirement for TB treatment worldwide.SummaryRigorously evaluating the choice of treatment supporter, the frequency of health care worker contact and the development of new educational materials in a real-world setting would build the evidence base to inform the optimal design of TB treatment protocol. Implementing a more patient-centered approach may be a wise reallocation of resources to raise TB cure rates, prevent relapse, and minimize the emergence of drug resistance. Maintaining the status quo in the absence of rigorous supportive evidence may diminish the effectiveness of TB control policies in the long run.

Mind the gap: TB trends in the USA and the UK, 2000–2011

BackgroundTB remains a major public health concern, even in low-incidence countries like the USA and the UK. Over the last two decades, cases of TB reported in the USA have...

Nosocomial tuberculosis exposures at a tertiary care hospital: A root cause analysis

Exposure of health care workers (HCWs) to patients with active TB continues to occur despite implementation of TB control policies. We conducted a root-cause analysis of TB exposures at a tertiary care hospital. Clinical and management details of all confirmed cases identified in 2011 were summarized. Cases were independently reviewed by an expert panel that determined the type (ie, delay in initiating, incorrect use of or premature removal of control measures), preventability, and root cause(s) of each error (exposure). Fifteen cases were reviewed. Ten errors were identified in 7 (47%) cases. Cases associated with errors were older than those without errors (68 y vs 40 y; P = .037). Most cases (12/15) were foreign born. A delay in initiating airborne precautions accounted for 70% (7/10) of the errors. The expert panel determined that 80% (8/10) of the errors were preventable or possibly preventable. The most common root causes were failure to consider TB and failure to obtain and interpret imaging. Advanced age, atypical presentation, and presence of comorbid illnesses were common among the preventable cases. TB control policies do not prevent all exposures. Our findings suggest that consideration of TB in elderly patients with risk factors, even if their signs and symptoms can be explained by an alternative diagnosis or are atypical, followed by a review of imaging studies, can further reduce this risk.

Tuberculosis and gender parity in a TB Referral Centre, South –South Nigeria

Background: Epidemiological information shows that there are differences between men and women in prevalence of TB infection, rate of progression from infection to disease, HIV and TB co-infection rate, and mortality due to pulmonary tuberculosis. Study of gender differences in prevalence and treatment outcome of patients will assist in targeting those at higher risk and ensure successful TB control planning. Aim: This study is aimed at determining gender differences in the prevalence of clinical disease, HIV and TB co-infection rate and treatment outcome amongst TB patients that attended this referral hospital between January 2003 to December 2012. Methodology: A retrospective survey was carried out on the records of all Acid Fast Bacilli (AFB) smear positive Pulmonary Tuberculosis patients who attended this hospital during the period under review. Epidemiological information was collected retrospectively from the tuberculosis laboratory and treatment registers to explore gender disparity in the prevalence of clinical disease, HIV and TB co-infection rate and treatment outcome among the TB patients. Results: A total number of 1612 HIV negative male TB patients attended the DOTS centre of this hospital as against 1013 females during the study period. Male had a higher prevalence ,the male: female ratio was 1.59. There were a total number of 156 HIV - TB co-infected female subjects constituting 9.7% of the female TB patients while 106 males were HIV-TB co-infected constituting 4.7% of the male patients. The difference was statistically significantly (P<0.00). Conclusion: Our findings bring into sharp focus the gender disparity in the TB prevalence and HIV-TB co-infection among the study subjects. TB control programme should routinely review and monitor programme reports and take appropriate measures to improve the current TB control policies and programme.

Contact Tracing of Tuberculosis: A Systematic Review of Transmission Modelling Studies

The WHO recommended intervention of Directly Observed Treatment, Short-course (DOTS) appears to have been less successful than expected in reducing the burden of TB in some high prevalence settings. One strategy for enhancing DOTS is incorporating active case-finding through screening contacts of TB patients as widely used in low-prevalence settings. Predictive models that incorporate population-level effects on transmission provide one means of predicting impacts of such interventions. We aim to identify all TB transmission modelling studies addressing contact tracing and to describe and critically assess their modelling assumptions, parameter choices and relevance to policy. We searched MEDLINE, SCOPUS, COMPENDEX, Google Scholar and Web of Science databases for relevant English language publications up to February 2012. Of the 1285 studies identified, only 5 studies met our inclusion criteria of models of TB transmission dynamics in human populations designed to incorporate contact tracing as an intervention. Detailed implementation of contact processes was only present in two studies, while only one study presented a model for a high prevalence, developing world setting. Some use of relevant data for parameter estimation was made in each study however validation of the predicted impact of interventions was not attempted in any of the studies. Despite a large body of literature on TB transmission modelling, few published studies incorporate contact tracing. There is considerable scope for future analyses to make better use of data and to apply individual based models to facilitate more realistic patterns of infectious contact. Combined with a focus on high burden settings this would greatly increase the potential for models to inform the use of contract tracing as a TB control policy. Our findings highlight the potential for collaborative work between clinicians, epidemiologists and modellers to gather data required to enhance model development and validation and hence better inform future public health policy.

Anisotropic spatial clustering of TB in cattle - the implications for control policy

Bovine TB is a disease that affects cattle and the wildlife badger, species Meles meles, in Ireland and the UK, and badgers have been implicated in the spread of the disease in cattle. Efforts to eradicate the disease that have included localized badger culling, have not been successful. In a study to understand how the disease spreads, Kelly and More [1] determined that the disease spatially clusters in cattle herds and estimated the practical spatial ranges at which this occurs. We extend this work by examining possible anisotropy in clustering and the consequences for TB control policy.

Badgers' behaviour could thwart TB control policy

Badgers' behaviour could thwart TB control policy

Missed opportunities? Coercion or commitment: policies of prevention.

The DOTS strategy (directly observed therapy, short course) has been the cornerstone of international TB control policy since the early 1990s. This strategy has provided the international community with an advocacy tool to harness funds for TB as well as a method for helping country programs to achieve high cure rates for TB. But as much as the strategy is seen as successful by some, it is perceived as unsuccessful by others. This paper looks at the results of the introduction of DOTS into control programs and discusses research relating to direct observation of treatment. It asks how policies like DOTS are created, and how they are administered and transferred from the international to the national and finally to the local level. The discipline of public health policy is used to interrogate the creation and history of the DOTS strategy in order to find ways of aiding the transfer of the policy to national and local levels. Finally, the paper asks whether the concepts of "control" and "elimination" continue to be useful in the management of infectious diseases. We ask whether it is time to change the perspective to policies that focus more on the context of implementation and the importance of the development of care, integration, and flexibility rather than cure, targets, and short-term solutions.