TB Programme Research Articles

Latent TB and depressive symptoms in household contacts of persons with active TB.

BACKGROUND: Depression is common among persons with TB and is associated with poor clinical outcomes. However, little is known about the relationship between latent TB infection (LTBI) and depression. We assessed the association between LTBI and depressive symptoms among household contacts (HHCs) of patients receiving TB treatment.METHODS: We enrolled 1,009 HHCs of 307 patients receiving TB treatment in Lima, Peru, during 2016-2018. At enrollment, HHC LTBI status was assessed using the interferon-gamma release assay (IGRA). Depressive symptoms were assessed at baseline and 12 months later using the Patient Health Questionnaire-9 (PHQ-9) with a cut-off of <inline-formula id="IE1"><mml:math display="inline"><mml:mo>≥</mml:mo></mml:math></inline-formula>5. We used logistic regression to estimate the odds ratio (OR) for PHQ-9 <inline-formula id="IE2"><mml:math display="inline"><mml:mo>≥</mml:mo></mml:math></inline-formula>5, comparing HHCs with and without baseline LTBI.RESULTS: Among 921 HHCs, 374 (41.0%) had LTBI at baseline, and 69 (12.4%) of 567 HHCs had PHQ-9 <inline-formula id="IE3"><mml:math display="inline" id="im1"><mml:mo>≥</mml:mo></mml:math></inline-formula>5. Compared to HHCs without LTBI at enrollment, those with LTBI had almost two times the odds of PHQ-9 <inline-formula id="IE4"><mml:math display="inline" id="im2"><mml:mo>≥</mml:mo></mml:math></inline-formula>5 at follow-up after controlling for potential confounders (adjusted OR 1.93, 95% CI 1.09-3.39); this association was driven by greater severities of depressive symptoms.CONCLUSION: HHCs with LTBI had increased odds of depressive symptoms 1 year later. This population may benefit from mental health screening and interventions integrated into TB programs.

Implementation of The Pulmonary Tuberculosis Control Program at Sikumana Public Health Center

Introduction: According to the East Nusa Tenggara Provincial Health Office, Kupang City is the city with the highest contribution to pulmonary TB cases in 2021 with 491 cases and the Sikumana Health Center is the Public Health Center with the highest number of TB cases with 88 cases, patient recovery rate of 68.2%, and not reached the national target of 100%. The purpose of this study was to analyze the implementation of the pulmonary TB control program at the Sikumana Health Center. Methods : The research study was qualitative research using in-depth interview techniques. The number of informants was 11 informants. This research was conducted at the Sikumana Health Center, District Maulafa, City of Kupang from February to April 2023.Results: In the input aspect, the funds program, and human resources are sufficient, and the facilities for implementing the TB program are incomplete. In the process aspect, the planning and implementation stages have been going according to the proposed activity plan, but in the monitoring and supervision activities, it is still lacking because it is administrative and based on recording and reporting only. In the output aspect, the coverage of case detection in 2022 is 58.5%, the notification rate for all cases is 22.8%, the treatment success rate is 94.2%, and the cure rate is 98.2%.Conclusion: The Pulmonary Tuberculosis program implementation in Sikumana Health Center wasn’t implemented successfully because of process and input problems such as facilities and human resources. There should be regular training for TB program implementing officers, a special room for sputum collection, and routine supervision to the laboratory.

Potential facilitators and inhibitors to the implementation and sustainability of the community-based tuberculosis care interventions. A case study from Moshupa, Botswana.

Eliminating Tuberculosis is one of the targets of Sustainable Development Goal Three. Decentralizing TB care beyond health facilities by leveraging community involvement is crucial for safeguarding effective tuberculosis care. In this study, we explored potential facilitators and inhibitors of the implementation and sustainability of community-based interventions for the prevention and treatment of TB in the Moshupa district, Botswana. This study adopted a qualitative approach using a collective case design. An interpretive paradigm based on relativist ontology and subjectivist epistemology along with abductive research logic was used. The study enrolled treatment supporters of tuberculosis patients diagnosed with drug-susceptible tuberculosis between January 2019 and December 2019 in Moshupa Village for semi-structured interviews, Health care professionals for in-depth interviews, and e community leaders for focus group discussions. Clinic-based observations in Mma-Seetsele clinic were also conducted to corroborate the participants' views. The data collected was analyzed using the NVivo version 12 software package, and statements of the participants were presented as quotes to substantiate the issues discussed. This study highlighted effective partnerships between health services and external stakeholders, community empowerment, and the availability of policies and standard operating procedures as facilitators of community TB implementation and sustainability. However, Insufficient funding, low service provider training, policies not embracing age and educational eligibility for treatment supporters, shortage of equipment, medicines, and supplies, inadequate transport availability and incentives to meet clients' basic needs, paper-based systems, inadequate supervision, incomplete data reporting, and low service quality affected the Community TB program efficacy and sustainability in Moshupa. We also found that there was low service provider motivation and retention and that clients had low trust in treatment supporters. The findings of this study imply that the operational effectiveness of the community TB care approach to disease elimination is compromised; therefore, initiatives addressing the key components, including the availability of resources, governance arrangements and supportive systems for community health workers, are required for successful community TB implementation and sustainability.

Prevalence of tuberculosis and associated factors among presumptive TB refugees residing in refugee camps in Ethiopia

BackgroundTuberculosis (TB) causes significant morbidity and mortality in refugee populations. Although Ethiopia is the third largest refugee-hosting country in Africa, there is limited published data on the prevalence and associated factors of TB in refugees. The objective of this study was to estimate the prevalence of bacteriologically confirmed pulmonary TB (PTB) and explore associated factors in presumptive TB refugees residing in refugee camps in Ethiopia.MethodsA facility-based cross-sectional study was conducted between February and August 2021 in refugee camps in Ethiopia. Data were collected consecutively from 610 presumptive TB refugees who attended for TB diagnosis in selected refugee camp clinics in Ethiopia. A pre-tested questionnaire was used to collect data, and sputum samples were collected from eligible study participants. The Xpert Mycobacterium tuberculosis (MTB)/Rifampicin (RIF) assay was performed on direct spot sputum samples, whereas morning sputum samples were processed and inoculated for bacteriological culture using Mycobacterium Growth Indicator Tube (MGIT) and Lowsteen Jensen (LJ) methods. The statistical software package (STATA version 14) was used for statistical analysis. A logistic regression model was used for the evaluation of the association between bacteriologically confirmed TB cases and the associated factors. Descriptive statistics were used for the expression of the results, and statistical significance was assumed at p < 0.05.ResultsOut of 610 study participants, more than half were female (54.9%), and the mean age was 37.9 years (SD, 16.64). The prevalence of bacteriologically confirmed PTB cases among refugees residing in refugee camps in Ethiopia was 13.3% (95% CI, 10.7–16.2%) using the Xpert MTB/RIF assay and/or culture. MTB was detected in 12.8% (95% CI, 10.2–15.7%) of the individuals using the Xpert MTB/RIF assay, while culture positivity was observed in 11.6% (95% CI, 9.2–14.5%). The multivariable logistic regression model showed South Sudan origins (adjusted odds ratio, AOR = 7.74; 95% CI, 3.05–19.64), age group, 19–38 years old (AOR = 5.66; 95% CI, 1.86–17.28), and male sex (AOR = 2.69; 95% CI, 1.58–4.56) were significantly associated with the bacteriologically confirmed TB among refugees residing in refugee camps in Ethiopia.ConclusionThe prevalence of bacteriologically confirmed PTB among presumptive TB refugees residing in refugee camps in Ethiopia was high. The national TB program should strengthen TB prevention and control activities in the refugee camps of Ethiopia. Moreover, an active TB survey program should be implemented in refugee camps in Ethiopia.

Quality Mindset: The Missing Ingredient in Tuberculosis Care and Control in Togo

Quality has been mentioned as the missing ingredient in TB care and control. In Togo, TB is a priority public health problem. We hypothesize that "quality mindset" is the missing ingredient for excellence in TB care and control in Togo. We used statistical process control (SPC) tools to analyze cohort data from the National Tuberculosis Control Program. There was an unstable quarterly variation in smear-positive pulmonary TB (TBP+) treatment success rate from 2017 to 2022. The general trend since the first instability was a quarterly variation around a success rate of 86%. Results showed stability in the quarterly variation of TBP+ case fatality rate at 7% since 2017. The root cause analysis of the low performance of the program revealed that TB management and DOTS strategy standards were not well adhered to. Based on the Pareto chart prioritizing the most affected health systems building blocks, health services delivery and health workforce building blocks accounted for 70% of all the dysfunctions. This study revealed that quality mindset is the missing ingredient for TB control program to be a center of excellence in Togo. It is therefore timely for a national project to verify the real contribution of total quality care to TB program performance in Togo.

Why TB programmes should assess for comorbidities, determinants and disability at the start and end of TB treatment.

Why TB programmes should assess for comorbidities, determinants and disability at the start and end of TB treatment.

Pilot implementation MitraTB application to strengthening district based public private mix tuberculosis control in Purwakarta district, Indonesia: A mixed-method study

BackgroundDistrict-based public private mix (DPPM) tuberculosis in Purwakarta district was strengthened by the MitraTB application. This research is aimed to explore perception of user about MitraTB application and measure their perception of this application in dimensions; design, usefulness, ease of use, and acceptance. MethodsThis study was exploratory sequential mixed methods research. A qualitative study was first conducted in order to gain an in-depth understanding about user's perception of MitraTB application through in-depth interviews. Data were analyzed through coding and categorizing. Based on qualitative finding, a questionnaire was developed and used in the following quantitative study. A cross sectional study was then conducted in quantitative phase. Data were analyzed using Rasch modeling. ResultThe design of the MitraTB application looks simple and attractive to users. This application is useful to make it easier for private practitioners to report TB cases and it is easy to use. Respondents can accept the MitraTB application well. Most respondents have good perception about MitraTB application in dimensions; design (56.25%), usefulness (69.79%), ease of use (55.20%), and acceptance (73.96%). ConclusionsMitraTB application has a good design feature, useful, easy to use, and acceptable. This application facilitates the private sector to be involved in the TB program by reporting TB cases. Follow-up and local regulations are required for the continued use of this application.

Factors associated with COVID-19 inpatient mortality cases within 24-hours South Africa.

African countries with limited healthcare capacity are particularly vulnerable to the novel coronavirus. The pandemic has left health systems short on resources to safely manage patients and protect health care workers. South Africa is still battling the epidemic of HIV/AIDS and tuberculosis which have had their programme/services interrupted due to the effects of the pandemic. Lessons learned from the HIV/AIDS and TB programme have shown that South Africans delay seeking health services when a new disease presents itself. The study sought to investigate the risk factors for COVID-19 inpatients' mortality within 24-hours of hospital admission in Public health facilities in Limpopo Province, South Africa. The study used retrospective secondary data obtained from the 1 067 clinical records of patients admitted between March 2020 and June 2021 by the Limpopo Department of Health (LDoH). A multivariable logistic regression model, both adjusted and unadjusted, was used to assess the risk factors associated with COVID-19 mortality within 24 hours of admission. This study, which was conducted in Limpopo public hospitals, discovered that 411 (40%) of COVID-19 patients died within 24-hours of admission. The majority of the patients were 60 years or older, mostly of female gender and had co-morbidities. In terms of vital signs, most had body temperatures less than 38°C. Our study findings revealed that COVID-19 patients who present with fever and shortness of breath are 1.8 and 2.5 times more likely to die within 24-hours of admission to the hospital, than patients without fever and normal respiratory rate . Hypertension was independently associated with mortality in COVID-19 patients within 24-hours of admission, with a high odds ratio for hypertensive patients (OR = 1.451; 95% CI = 1.013; 2.078) compared to non-hypertensive patients. Assessing demographic and clinical risk factors for COVID-19 mortality within 24-hours of admission aids in understanding and prioritising patients with severe COVID-19 and hypertension. Finally, this will provide guidelines for planning and optimising the use of LDoH healthcare resources and also aid in public awareness endeavours.

Current status and future prospects of TB digital treatment adherence technology use in China.

BACKGROUND: Digital treatment adherence technologies (DATs) have been recommended by the Chinese National Tuberculosis Programme since 2015. However, until now the extent to which DATs have been adopted in China remain unclear. In this study, we aimed to understand the current status and future prospects of DAT use in China.METHODS: A cross-sectional study was undertaken to collect data from all 2,884 county-level TB-designated institutions across China using a quantitative questionnaire and extraction of information from the Chinese TB information management system. Data were collected between 1 July 2020 and 30 June 2021.RESULTS: All of the 2,884 county-level TB-designated institutions responded to the questionnaire. We found that the utilisation rate of DATs in China was 21.5% (n = 620). Among those using DATs, the uptake of DATs among TB patients was 31.0%. Lack of financial, policy and technology support were the main barriers to adoption and scale up DATs at the institution level.CONCLUSIONS: The use of DATs is in an early stage in China; however, the number of institutions who offer DATs have increased significantly after July 2020. To facilitate the use of DATs, the national TB programme should provide more financial, policy and technology support, and a national guideline is required.

Assessing Influence of HIV Status on Management outcomes of Drug Sensitive Pulmonary Tuberculosis in the Bo District of Southern Sierra Leone.

Purpose: Tuberculosis in Human immunodeficiency virus is a predictor of unfavourable outcome during the management of TB cases due to the synergy both bear in the patient. This study is to test the hypothesis that patient is more likely to be unfavourable in the co infected than the TB stand-alone patients with standard treatment in patients. The associated factors might not be exhaustive that leads to outcomes factored in the study.&#x0D; Methodology: The retrospective cohort study data of 1,947 patients admitted from 1st January 2020 to 1st January 2022 at TB treatment centres in Bo district of Sierra Leone was analysed using datatab software after data completeness was checked and cleaned. Both bi-variable and multi-variable logistics regression and other statistical methods were employed to assess the relationship between HIV+TB synergic as well as TB alone outcomes. Data was analysed based on 95% CI and p&lt;0.05.&#x0D; Findings: When an ANOVA was used to test for significance from zero, F=3.41, p = 0.002, R2 = 0.01. Regression coefficients for exits = 1.17 - 0.02., gender =-0.02, literacy = -0.1, family bread winner with TB= -0.02 and foods insecurity = +0.07. A point-biserial correlation was also computed to determine the relationship between HIV status and TB interms of outcome which showed a positive correlation between HIV status and exit code information, although no statistically significance (rpb = 0.04, n = 1987, p = .065).&#x0D; Unique contribution to theory, practice and policy: Successful treatment outcome was high among HIV/TB co-infected as well as TB mono-infected should both be treated with standard treatments. Strengthening patient management in a collaborative approach and use of novel drugs as well as research will increase the survival rate of patients treated. With standard treatment and patient centered care the outcome of TB patient management will not be hinged on their HIV status. The adoption of this theory into policy in TB programmes will improve the success rate in TB management.

EVALUATING THE RISK FACTORS AFFECTING THE SURVIVAL TIME OF TB/HIV CO-INFECTED PATIENTS TO EARLY DEATH AT RASHID SHEKONI TEACHING HOSPITAL, JIGAWA STATE

Tuberculosis is a serious health threat, especially for people living with HIV. people living with HIV are more likely than others to become sick with TB. Worldwide TB is one of the leading courses of death among people living with HIV (CDC 2015). A retrospective cohort study was conducted in which all patients registered for TB/HIV at Rashid shekoni teaching hospital from 1st January 2017 to 31st December 2021. Kaplan Meier and log rank test were used to determine the survival pattern and the survival experience of two or more different groups. Cox regression was used to identify factors affecting the survival time of the patients. This study consists of 274 TB and HIV co-infected adult patient out of these 120 were died during the study period, and 154 were censored.it was found that massive death occurred at 1.3years of follow up period and the over roll median survival time was (56 months). the multivariate cox regression analysis indicated that an old age patient&gt;39yrs, HIV+, low CD4 cell count&lt;456, weight&lt;42 were significant risk factors associated with death of TB/HIV co-infected patients. In this study the death of TB/HIV adult co-infection was found to be very high at 1.3yr. The risk factors leading to early death of TB/HIV co-infection was associated with age, weight, HIV+ positive, CD4 cell count. The medical decision and policy makers should give these risk factors identified in this study more priority when implementing target improvement in the National TB and HIV program.

Effectiveness of family support health education intervention to improve health-related quality of life among pulmonary tuberculosis patients in Melaka, Malaysia

BackgroundPulmonary Tuberculosis (PTB) is an important public health problem in Malaysia. In this country, limited research has been carried out on the impact of the disease on the health-related quality of life (HRQoL). Family support interventions had been shown to be effective in improving the PTB treatment outcomes.ObjectivesThis study aims to determine the effectiveness of a newly developed Family Support Health Education (FASTEN) intervention in improving the health-related quality of life (HRQoL) among PTB patients in Melaka, as compared to the current conventional disease management.Materials and methodsA single-blinded, randomized controlled field trial study design was conducted in Melaka from September 2019 until August 2021, involving newly diagnosed PTB patients. The participants were randomized either into the intervention group (FASTEN intervention) or into the control group (conventional management). They were interviewed by using a validated questionnaire that includes the Short Form 36 Health Survey version 2 (SF-36v2), at three time points: at diagnosis, two months and six months after diagnosis. Data were analyzed using IBM SPSS Statistics for Windows version 24. The Generalized Estimating Equations (GEE) analysis was used to evaluate the effectiveness of the intervention, in terms of the HRQoL score difference between the groups, adjusted for baseline covariates.ResultsThe HRQoL among PTB patients was lower than the HRQoL of general Malaysian population. Among the total 88 respondents, the three lowest HRQoL domains scores at baseline were Social Functioning (SF), Role limitation due to Physical condition (RP) and Vitality (VT) with the median (IQR) scores of 27.26 (10.03), 30.21 (11.23) and 34.77 (8.92) respectively. The median (IQR) for Physical Component Score (PCS) was 43.58 (7.44) and for Mental Component Score (MCS) was 40.71 (8.77). There were significant difference in the HRQoL median scores between the intervention group compared to the control group, as the Physical Functioning (PF) (p = 0.018), RP (p < 0.001), General Health (GH) (p < 0.001), VT (p < 0.001), SF (p < 0.001), Role limitation due to Emotional condition (RE) (p < 0.001), General Mental Health (MH) (p < 0.001), and the MCS (p < 0.001).ConclusionThe FASTEN intervention is effective to improve the overall HRQoL among PTB patients, as the HRQoL scores were significantly higher in the intervention group compared to the control group who received conventional management. Therefore, it is recommended that the TB program should incorporate the involvement of family members in the patient’s management.Date of registration and numberThe protocol was registered with RCT registered body on 05/12/2019 (Australian New Zealand Clinical Trial Registry – Registration Number: ACTRN12619001720101).

Epidemiology of extensively drug-resistant tuberculosis among patients with multidrug-resistant tuberculosis: A systematic review and meta-analysis

ObjectivesTo estimate the pooled proportion of extensively drug-resistant tuberculosis (XDR-TB) and pre-extensively drug-resistant tuberculosis (pre-XDR-TB) in patients with multidrug-resistant TB (MDR-TB). MethodsWe systematically searched articles from electronic databases: MEDLINE (PubMed), ScienceDirect, and Google Scholar. We also searched gray literature from the different literature sources main outcome of the review was either XDR-TB or pre-XDR-TB in patients with MDR-TB. We used the random-effects model, considering the substantial heterogeneity among studies. Heterogeneity was assessed by subgroup analyses. STATA version 14 was used for analysis. ResultsA total of 64 studies that reported on 12,711 patients with MDR-TB from 22 countries were retrieved. The pooled proportion of pre-XDR-TB was 26% (95% confidence interval [CI]: 22-31%), whereas XDR-TB in MDR-TB cases was 9% (95% CI: 7-11%) in patients treated for MDR-TB. The pooled proportion of resistance to fluoroquinolones was 27% (95% CI: 22-33%) and second-line injectable drugs was 11% (95% CI: 9-13%). Whereas the pooled resistance proportions to bedaquiline, clofazimine, delamanid, and linezolid were 5% (95% CI: 1-8%), 4% (95% CI: 0-10%), 5% (95% CI; 2-8%), and 4% (95% CI: 2-10%), respectively. ConclusionThe burden of pre-XDR-TB and XDR-TB in MDR-TB were considerable. The high burdens of pre-XDR-TB and XDR-TB in patients treated for MDR-TB suggests the need to strengthen TB programs and drug resistance surveillance.

Performance of Tuberculosis Program Officers in the Implementation of Contact Investigations in Medan City

Indonesia is the second country with the most TB cases in the world. One of the efforts to overcome TB in Indonesia is the active discovery of TB cases through contact investigations. However, the implementation of contact investigations has not been fully optimal, including in Medan City. The implementation of contact investigations still reached 14.79 percent in 2020. The performance of TB program officers is one of the factors that determine the achievement of the implementation of contact investigations. This study aims to explore the performance and factors that contribute to the performance of TB program officers in the implementation of contact investigations in Medan City. This research was qualitative research conducted from December 2022 to January 2023. The data collection method was an in-depth interview and review of documentation. The location of study was conducted at six health centers in Medan City. The research informants totaled 37 people consisting of the Deputy TB Supervisor (Wasor TB) of the Medan City Health Office, TB program officers of health centers, TB cadres, heads of health centers, laboratory analysts, doctors, TB sufferers, and drug swallowing supervisor (PMO). The results showed that the performance of TB program officers was not optimal. Factors that contributed to performance were the limited number of TB program officers at health centers, limited time from TB program officers because they had other duties, limited funds for the implementation of contact investigations, suboptimal coordination between TB program officers and cadres, and obstacles from the community who were not willing to conduct contact investigations.

Potential and weak links in the management of tuberculosis by Pakistani private pharmacy staff.

The emergence of MDR-TB is a global threat and an obstacle to the effective control of TB in Pakistan. A lack of proper TB knowledge among the staff in private pharmacies and the sale of compromised quality anti-TB drugs are the main instigators of multidrug-resistant tuberculosis (MDR-TB). Thus, this study was aimed at investigating the quality and storage conditions of fixed-dose combination (FDC) anti-TB drugs along with the awareness of staff working in private pharmacies regarding the identification of potential patients with TB and dispensing the inappropriate treatment regimens contributing to MDR-TB. The study is completed in two phases. In phase I a cross-sectional study is performed using two quantitative research designs, i.e., exploratory and descriptive, to evaluate the knowledge of private pharmacy staff. The sample of 218 pharmacies was selected. While in phase II cross sectional survey is conducted in 10 facilities from where FDC anti TB drugs were sampled for analyzing their quality. Results revealed the presence of pharmacists only at 11.5% of pharmacies. Approximately 81% of staff at pharmacies had no awareness of MDR-TB, while 89% of pharmacies had no TB-related informative materials. The staff identified that most of the patients with TB (70%) were of poor socio-economic class, which restricted their purchase of four FDCs only up to 2-3 months. Only 23% were acquainted with the Pakistan National TB Program (NTP). Except for MDR-TB, the results showed a significant correlation between the experiences of staff with TB awareness. Findings from the quality evaluation of four FDC-TB drugs indicated that the dissolution and content assay of rifampicin were not according to the specifications, and overall, 30% of samples failed to comply with specifications. However, the other quality attributes were within the limits. In light of the data, it can be concluded that private pharmacies could be crucial to the effective management of NTP through the timely identification of patients with TB, appropriate disease and therapy-related education and counseling, and proper storage and stock maintenance.

National TB elimination programme - What has changed.

Before the start of Coronavirus (COVID-19) pandemic, TB was the leading cause of death due to a single infectious agent, ranking well above HIV/AIDS. Almost one-fourth of the world's population is infected with M.tuberculosis. TB is curable and preventable. About 85% of people who develop TB can be successfully treated with drug regimens of 6 months. Universal health coverage (UHC) is necessary to ensure that all those with the disease can access these treatments. Research breakthroughs (e.g., newer rapid diagnostic techniques, drugs, newer vaccine) are needed to rapidly reduce the number of new cases each year (TB incidence) worldwide. Changes in the National TB Elimination Programme since its inception. The Government of India launched the "National TB Programme" in 1962 as District TB Centre model involved with BCG vaccination and TB treatment to fight tuberculosis, a major public health problem. The tuberculosis control programme has come a long way since then and has undergone major changes over the past few years The Ministry of Health and Family Welfare has developed the "National Strategic Plan" for Tuberculosis Elimination (2017-25) which encapsulates the bold and innovative steps required to eliminate TB in India by 2025, five years ahead of the global targets. By 2020 it was clear that the NSP- 2017-25 will not be able to meet these objectives, so another new NSP India 2025 had been launched in 2020. India has been actively involved in TB control activities for more than 50 years now. TB still continues to be a severe health problem in India. The country is now better prepared to tackle TB than before. It now has advanced and effective interventions and technologies for diagnosis, treatment and care of TB cases.

First evaluation of the performance of portable IGRA, QIAreach® QuantiFERON®-TB in intermediate TB incidence setting.

Diagnosis and treatment of tuberculosis infection (TBI) are the core elements of tuberculosis elimination. Interferon gamma release assays have advantages over the tuberculin skin test, although their implementation in low-resource settings is challenging. The performance of a novel digital lateral flow assay QIAreach® QuantiFERON®-TB (QIAreach QFT) against the QuantiFERON®-TB Gold Plus (QFT-Plus) assay was evaluated in an intermediate incidence setting (Malaysia) according to the manufacturer's instructions. Individuals aged 4-82 years, who were candidates for TB infection screening for contact investigation were prospectively recruited. On 196 samples, the QIAreach-QFT showed a positive percent agreement (sensitivity) was 96.5% (CI 87.9-99.6%), a negative percent agreement (specificity) 94.2% (CI 88.4% to 97.6%) and an overall percentage of agreement was 94.9% (95% CI 90.6-97.6%) with a Cohen's κ of 0,88. Out of 196, 5.6% (11/196) samples gave an error result on QIAreach-QFT and 4.1% (8/196) samples gave indeterminate result on QFT-plus. The TTR for QIAreach QFT positive samples varied from 210-1200 seconds (20 min) and significantly correlated with IFN-γ level of QFT-Plus. QIAreach QFT could be considered an accurate and reliable point-of-need test to diagnose TB infection helping to achieve the WHO End TB programme goals even in decentralised settings where laboratory expertise and infrastructure may be limited.

What Makes People With Chronic Illnesses Discontinue Treatment? A Practice Theory Informed Analysis of Adherence to Treatment among Patients With Drug-Resistant Tuberculosis in Pakistan.

Non-adherence to treatment is a frequently observed phenomenon amongst those on long-term treatment for chronic illnesses. This qualitative study draws upon the tenets of 'practice theory' to reveal what shapes patients' ability to adhere to the demanding treatment for drug-resistant tuberculosis (DR-TB) at three treatment sites in Khyber-Pakhtunkhwa (KP) province of Pakistan. This qualitative study involved observation of service provision over a period of nine months of stay at, and embedment within the three treatment sites and in-depth interviews with 13 service providers and 22 patients who became non-adherent to their treatment. Consistent with the extensive research based on the barriers and facilitator approach, both patients, and providers in our study also talked of patients' doubts about diagnosis and treatment efficacy, side-effects of drugs, economic constraints, unreliable disbursements of monetary incentive, attitude of providers and co-morbidities as reasons for non-adherence to treatment. Applying a practice theory perspective yielded more contextualised insights; inadequate help with patients' physical complaints, unempathetic responses to their queries, and failure to provide essential information, created conditions which hindered the establishment and maintenance of the 'practice' of adhering to treatment. These supply-side gaps created confusion, bred resentment, and exacerbated pre-existing distrust of public health services among patients, and ultimately drove them to disengage with the TB services and stop their treatment. We argue that the lack of supply-side 'responsiveness' to patient needs beyond the provision of a few material inputs is what is lacking in the existing DR-TB program in Pakistan. We conclude that unless Pakistan's TB program explicitly engages with these supply side, system level gaps, patients will continue to struggle to adhere to their treatments and the TB program will continue to lose patients. Conceptually, we make a case for reimagining the act of adherence (or not) to long-term treatment as a 'Practice.'

The Pattern of Tuberculosis in Iran: A National Cross-Sectional Study.

Despite of the remarkable achievement in control of tuberculosis, it is still a challenging health problem in Iran. Success in any health program depends on monitor the diseases epidemiology and finding the gaps. We aimed to describe the epidemiological profile of TB patients in Iran to find the gaps in the TB program and using the finding to set the program activities. This cross-sectional study was performed based on the data of tuberculosis patients registered in Iran in 2016-2017. The information of all TB patients is registered in the TB registry software. The patients were followed during the treatment phase. The data were analyzed by SPSS 23 software using Chi-Square test. Overall 12% of cases were Afghans and 72.3% of patients had pulmonary tuberculosis. There was a significant difference in the success rate of treatment in smear-positive pulmonary patients by gender, HIV status, marital status, history of hospitalization and incarceration (P <0.01). The highest prevalence of antibiotic resistance was related to isoniazid (9.9%). In close contact persons who requiring prophylaxis, 65.3% of adults and 73.6% of children received full period of prophylaxis. Despite of the TB treatment success and low prevalence of MDR cases, TB incidence has not been decreased significantly in Iran. Delay in diagnosis, high TB burden in refugees and close contact investigation and prophylaxis are important issues in the TB control program in Iran to be considered in the control planning.

The Relationship Between the Quality of Health Services and Tuberculosis Patients' Satisfaction at The Palu City Health Center

Introduction: Tuberculosis is an infectious disease that is still a global concern, and most sufferers are of productive age. Factors for treatment failure are usually related to treatment supervision and the quality of health services. This study aimed to analyze the relationship between the quality of health services and the level of satisfaction of tuberculosis patients at the Palu City Health Center. Methods: This research is quantitative research with cross sectional study conducted on 116 respondents. The instrument used in this research is a questionnaire. The analysis in this study used the Chi-Square and Multiple logistic regression. Results: The results of the analysis showed that availability (p&lt;0.001), respect and caring (p&lt;0.001), safety (p&lt;0.001), timeliness (p&lt;0.001) and tangible (p&lt;0.001) were associated with tuberculosis patient satisfaction. The multivariate analysis found that timeliness (p=0.002; OR=17.692) was the most dominant factor in influencing patient satisfaction. Conclusions: Availability, respect and caring, safety, timeliness, and tangibles are related to the satisfaction of tuberculosis patients. Timeliness service is the most dominant factor influencing the satisfaction of tuberculosis. Palu City Health Center are expected to continue to make efforts to improve health services by health workers in the TB program to increase comfort and improve patient health.