Tuberculosis Care Research Articles

Quantifying gaps in the tuberculosis care cascade in Brazil: A mathematical model study using national program data.

In Brazil, many individuals with tuberculosis (TB) do not receive appropriate care due to delayed or missed diagnosis, ineffective treatment regimens, or loss-to-follow-up. This study aimed to estimate the health losses and TB program costs attributable to each gap in the care cascade for TB disease in Brazil. We constructed a Markov model simulating the TB care cascade and lifetime health outcomes (e.g., death, cure, postinfectious sequelae) for individuals developing TB disease in Brazil. We stratified the model by age, human immunodeficiency virus (HIV) status, drug resistance, state of residence, and disease severity, and developed a parallel model for individuals without TB that receive a false-positive TB diagnosis. Models were fit to data (adult and pediatric) from Brazil's Notifiable Diseases Information System (SINAN) and Mortality Information System (SIM) for 2018. Using these models, we assessed current program performance and simulated hypothetical scenarios that eliminated specific gaps in the care cascade, in order to quantify incremental health losses and TB diagnosis and treatment costs along the care cascade. TB-attributable disability-adjusted life years (DALYs) were calculated by comparing changes in survival and nonfatal disability to a no-TB counterfactual scenario. We estimated that 90.0% (95% uncertainty interval [UI]: 85.2 to 93.4) of individuals with TB disease initiated treatment and 10.0% (95% UI: 7.6 to 12.5) died with TB. The average number of TB-attributable DALYs per incident TB case varied across Brazil, ranging from 2.9 (95% UI: 2.3 to 3.6) DALYs in Acre to 4.0 (95% UI: 3.3 to 4.7) DALYs in Rio Grande do Sul (national average 3.5 [95% UI: 2.8 to 4.1]). Delayed diagnosis contributed the largest health losses along the care cascade, followed by post-TB sequelae and loss to follow up from TB treatment, with TB DALYs reduced by 71% (95% UI: 65 to 76), 41% (95% UI: 36 to 49), and 10% (95% UI: 7 to 16), respectively, when these factors were eliminated. Total health system costs were largely unaffected by improvements in the care cascade, with elimination of treatment failure reducing attributable costs by 3.1% (95% UI: 1.5 to 5.4). TB diagnosis and treatment of false-positive individuals accounted for 10.2% (95% UI: 3.9 to 21.7) of total programmatic costs but contributed minimally to health losses. Several assumptions were required to interpret programmatic data for the analysis, and we were unable to estimate the contribution of social factors to care cascade outcomes. In this study, we observed that delays to diagnosis, post-disease sequelae and treatment loss to follow-up were primary contributors to the TB burden of disease in Brazil. Reducing delays to diagnosis, improving healthcare after TB cure, and reducing treatment loss to follow-up should be prioritized to improve the burden of TB disease in Brazil.

The street as a space for care production: the singular therapeutic project and tuberculosis management in people experiencing homelessness during the Covid-19 pandemic in the city of Rio de Janeiro

From the theoretical perspective of the cartography of the micropolitics of living labor in action, the objective was to analyze the work process of the "street clinic" team based in a primary care unit in the city of Rio de Janeiro, Brazil, in the management of tuberculosis cases in the context of the Covid-19 pandemic. This is an exploratory qualitative research. Between May and December 2021, seven professionals from the street clinic team were interviewed, and participant observation was conducted with field diary records. Three thematic axes emerged from the interviews related to people experiencing homelessness in the context of the Covid -19 pandemic: 1) Challenges, potentialities, and weaknesses of tuberculosis care; 2) Building intersectoral care networks for monitoring individuals with tuberculosis; and 3) The street as a space for care production: the work process of the street clinic in tuberculosis management. It is concluded that caring for people experiencing homelessness with tuberculosis in the context of the Covid -19 pandemic requires not only managing clinical protocols but also building shared work with the intra and intersectoral network. In addition to the task of being in the territory, the outpatient service in the territory must also be a street outpatient service, especially regarding tuberculosis treatment.

Putting technology to the test in tuberculosis care

Putting technology to the test in tuberculosis care

National cross-sectional cluster survey of tuberculosis prevalence in Timor-Leste: a study protocol

IntroductionTimor-Leste has one of the world’s highest estimated tuberculosis (TB) incidences, yet the data which informs this estimate is limited and the true burden of TB disease is not known....

An Evaluation of the Tuberculosis Prevention and Care Program in Gweru District, 2022: The Need to Increase Bacteriological Coverage

Introduction: Tuberculosis remains a disease of public health concern. The national TB program has onsite laboratories (with Gene Xpert and CXR services) and is supported by a partner with mobile screening trucks that are equipped with the same equipment.

Detection of a historic reservoir of bedaquiline/clofazimine resistance-associated variants in Mycobacterium tuberculosis

BackgroundDrug resistance in tuberculosis (TB) poses a major ongoing challenge to public health. The recent inclusion of bedaquiline into TB drug regimens has improved treatment outcomes, but this advance is threatened by the emergence of strains of Mycobacterium tuberculosis (Mtb) resistant to bedaquiline. Clinical bedaquiline resistance is most frequently conferred by off-target resistance-associated variants (RAVs) in the mmpR5 gene (Rv0678), the regulator of an efflux pump, which can also confer cross-resistance to clofazimine, another TB drug.MethodsWe compiled a dataset of 3682 Mtb genomes, including 180 carrying variants in mmpR5, and its immediate background (i.e. mmpR5 promoter and adjacent mmpL5 gene), that have been associated to borderline (henceforth intermediate) or confirmed resistance to bedaquiline. We characterised the occurrence of all nonsynonymous mutations in mmpR5 in this dataset and estimated, using time-resolved phylogenetic methods, the age of their emergence.ResultsWe identified eight cases where RAVs were present in the genomes of strains collected prior to the use of bedaquiline in TB treatment regimes. Phylogenetic reconstruction points to multiple emergence events and circulation of RAVs in mmpR5, some estimated to predate the introduction of bedaquiline. However, epistatic interactions can complicate bedaquiline drug-susceptibility prediction from genetic sequence data. Indeed, in one clade, Ile67fs (a RAV when considered in isolation) was estimated to have emerged prior to the antibiotic era, together with a resistance reverting mmpL5 mutation.ConclusionsThe presence of a pre-existing reservoir of Mtb strains carrying bedaquiline RAVs prior to its clinical use augments the need for rapid drug susceptibility testing and individualised regimen selection to safeguard the use of bedaquiline in TB care and control.

Ubuntu Is a Critical Component in the Fight against Human Immunodeficiency Virus and Tuberculosis Stigma: Nursing Students' Perceptions.

Stigma is one of the documented barriers to achieving universal access to human immunodeficiency virus (HIV) and tuberculosis (TB) prevention, treatment, care, and support programs. The lack of African social theories to emphasize these issues may be the cause of the continent's failure to reduce stigma. We can use Ubuntu, an African philosophy that emphasizes sociability and ethics, to deepen our understanding of how to reduce HIV- and TB-related stigma in South Africa. In many African regions, Ubuntu values and principles were found to assist in reducing problems related to HIV. Ubuntu is a comprehensive phrase used by Africans to signify the characteristics that incorporate the core human virtues of compassion and humanity. We explored the perceptions of nursing students regarding the use of Ubuntu in the fight against HIV and TB stigma. Qualitative participatory research was used to engage all first- and second-level nursing students enrolled for the 2023 academic year at the selected university in South Africa. Purposive sampling was used to recruit the participants. An interactive workshop was used to gather data. The data from the recordings and flip charts were analysed together. Throughout the study, trustworthiness and ethical principles were upheld. Two primary themes emerged as expressions of Ubuntu in relation to a reduction in HIV and TB stigma and recognition of Ubuntu as a tool to combat stigma associated with HIV and TB. This confirms that within Ubuntu, there are elements that might be applied to reduce stigma attached to HIV and TB.

Pediatric Tuberculosis Infection Care Facilitators and Barriers: A Qualitative Study.

A total of 700 000 US children and adolescents are estimated to have latent tuberculosis (TB) infection. Identifying facilitators and barriers to engaging in TB infection care is critical to preventing pediatric TB disease. We explored families' and clinicians' perspectives on pediatric TB infection diagnosis and care. We conducted individual interviews and small group discussions with primary care and subspecialty clinicians, and individual interviews with caregivers of children diagnosed with TB infection. We sought to elicit facilitators and barriers to TB infection care engagement. We used applied thematic analysis to elucidate themes relating to care engagement, and organized themes using a cascade-grounded pediatric TB infection care engagement framework. We enrolled 19 caregivers and 24 clinicians. Key themes pertaining to facilitators and barriers to care emerged that variably affected engagement at different steps of care. Clinic and health system themes included the application of risk identification strategies and communication of risk; care ecosystem accessibility; programs to reduce cost-related barriers; and medication adherence support. Patient- and family-level themes included TB knowledge and beliefs; trust in clinicians, tests, and medical institutions; behavioral skills; child development and parenting; and family resources. Risk identification, education techniques, trust, family resources, TB stigma, and care ecosystem accessibility enabled or impeded care cascade engagement. Our results delineate an integrated pediatric TB infection care engagement framework that can inform multilevel interventions to improve retention in the pediatric TB infection care cascade.

Investigating socio-ecological factors influencing implementation of tuberculosis infection prevention and control in rural Papua New Guinea.

Tuberculosis (TB) is a highly transmissible infectious disease killing millions of people yearly, particularly in low-income countries. TB is most likely to be transmitted in healthcare settings with poor infection control practices. Implementing TB infection prevention and control (TB-IPC) is pivotal to preventing TB transmission in healthcare settings. This study investigated diverse stakeholders' perspectives relating to barriers and strategies for TB-IPC in rural hospitals in Papua New Guinea. Multiple qualitative case studies were conducted with 32 key stakeholders with experience in TB services. Data collection drew on three primary sources to triangulate data: semi-structured interviews, document reviews and field notes. The data were analyzed using hybrid deductive-inductive thematic analysis. Our results reveal that key stakeholders perceive multiple interdependent factors that affect TB-IPC practice. The key emerging themes include strategic planning for and prioritizing TB-IPC guidelines; governance, leadership and accountability at the provincial level; community attitudes towards TB control; institutional capacity to deliver TB care, healthcare workers' safety, and long-term partnership and integration of TB-IPC programmes into the broad IPC programme. The evidence suggests that a multi-perspective approach is crucial for TB-IPC guidelines in healthcare institutions. Interventions focusing on addressing health systems strengthening may improve the implementation of TB-IPC guidelines.

Syndemic Burden: Bridging the gap between Tuberculosis and Mental Health Care for Integrated Patient-Centered Solutions – a comprehensive review

Introduction: Mental health issues are prevalent, yet their treatment remains inadequate. Tuberculosis presents substantial mental health challenges. Their co-occurrence is a frequent phenomenon. However, the integration of mental health professionals or services is not a common practice. Purpose: To review the evidence about the relation between tuberculosis and mental health, and its consequences concerning the implementation of policies and services. Methodology: We conducted a comprehensive review using the MeSH terms "Tuberculosis" and "Mental Health" on PubMed, spanning from 2011 to December 2021. We identified and assessed systematic reviews, regular reviews, scoping review and meta-analyses for their appropriateness and relevance. Results: A total of 341 studies were accessed for eligibility and 19 studies were included. Mental disorders and tuberculosis are frequent comorbidities. Their relation is commonly described as “syndemic”. Shared risk factors, social vulnerabilities, and upstream social determinants are prevalent in both conditions. There is a potential for the integration of both conditions into policy and service organization. Conclusions: Mental disorders treatment gap could be shortened by addressing mental health problems among TB patients. The WHO Global End TB Strategy prioritizes integrated patient-centered care, and fostering collaborative partnerships between tuberculosis and mental health services could enhance its implementation

Depression care integration in tuberculosis services: A feasibility assessment in Pakistan.

The co-occurrence of depression among tuberculosis (TB) patients is a critical issue, contributing to poor treatment outcomes, prolonged hospitalisations and increased healthcare expenses. The objective of this study was to assess the feasibility of delivering a co-designed depression care pathway within TB services in Pakistan. Mixed-method study. Routine depression screening for TB patients was conducted at three TB facilities in Peshawar, Pakistan, encompassing primary, secondary and tertiary care settings. All patients aged 18 or above (male and female) attending the three TB facilities between November 2021 and February 2022 were included in the study using the consecutive sampling technique. A total of 301 people with confirmed TB, within the past 4 weeks, visited the three TB care facilities; 191/301 patients were screened for depression. Approximately 35% of the 191 TB patients screened positive for depression, with varying severity levels. Qualitative findings highlighted the acceptability of integrated depression care, emphasising the importance of open communication and empathetic attitudes. Barriers to integration include stigma, logistical challenges, patient noncompliance and cost burdens. Facilitators included the empathetic attitude of healthcare providers and the availability of mental health services within the same facility. There is a high burden of depression in patients with TB, highlighting the pressing need for mental health support in this population. Acceptability of integrated care was evident, with factors such as co-located mental health services, training healthcare providers and provider empathetic attitudes playing a crucial role. Further research is required to evaluate the effectiveness of the integrated TB-depression screening systems towards improved health outcomes, implementation, scalability and impact on the broader healthcare system. To create a more inclusive and comprehensive TB and depression care pathway, we gathered input from both service providers and service users (TB patients, their carers). Reflective meetings with community leaders, social activists and health professionals from various sectors were also conducted during pathway delivery to get their insights. Power, gender and age imbalances were addressed by encouraging participation of patients and carers across gender and age groups. This approach ensured that the perspectives of all stakeholders were considered in the development of the care pathway.

Approaches to deliver depression care and understanding barriers and facilitators to implementation in people with tuberculosis in LMICs: a systematic review

Background Depression is a common comorbidity in people with tuberculosis. Various approaches to delivering depression care for people with tuberculosis have been implemented in low- and middle-income countries. To date, there are no comprehensive reviews that summarise and explore the implementation of these approaches to delivering depression care for people with tuberculosis. Objectives To identify the various interventions and approaches to delivering depression care as part of routine tuberculosis care in low- and middle-income countries, and to summarise the barriers and facilitators to their implementation. Review methods We conducted a systematic review to identify the relevant evidence. We conducted searches in June and July 2020 in the following databases, from inception: MEDLINE, Scopus, PsycINFO, Web of Science, PubMed, EMBASE, Cochrane Library, SciELO and LILACS, Health Management Information Consortium. We also hand-searched the reference lists of the included studies. Two reviewers independently screened the titles and abstracts of all records. Two reviewers independently screened the full texts. We used the Mixed Methods Appraisal Tool for quality appraisal. We coded and synthesised the findings using the constructs of the Consolidated Framework for Implementation Research as an a priori guide to analyse the barriers and facilitators. Results The search retrieved 10,982 records, 39 studies were selected for full-text screening and 10 studies were included in the analysis. We categorised the interventions as psychological, combined (pharmacological and psychological), combined with socioeconomic support and screening-only approaches. The most commonly implemented types of intervention were psychological interventions, on their own or combined with pharmacological interventions or socioeconomic support. The most common barrier to implementation was the costs associated with the intervention and its implementation. There were multiple facilitators for implementation for all types of interventions in different Consolidated Framework for Implementation Research domains. Facilitators were related to the characteristics of the intervention (relative advantage), the inner setting (compatibility of the intervention with existing workflows) and the process of implementation (the positive attitudes of innovation participants). Limitations This study relied on published information; thus, it is possible that important barriers and facilitators were not reported in the published studies and were, therefore, absent from this evidence synthesis. Conclusion We identified psychological interventions as the most commonly implemented approach to the delivery of depression care for people with tuberculosis, alone or in combination with other approaches. We identified the increase in costs as a barrier experienced for all intervention types. We identified the relative advantage of the intervention, its compatibility and the beliefs and attitudes of people with tuberculosis, their families and communities as facilitators that were reported in all intervention types. The integration of depression care for people with tuberculosis in existing tuberculosis services is possible but will require the barrier of the costs associated with delivery and implementation to be addressed. This review was carried out during the COVID-19 pandemic, when the effects of the pandemic on tuberculosis and mental health services were yet to be seen. Future research should focus on the impact of the pandemic on tuberculosis and mental health services, and on people with tuberculosis and their mental health. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 17/63/130. A plain language summary of this article is available on the NIHR Journals Library website https://doi.org/10.3310/GRWH1425.

Piloting the Complex Ground of Drug- Resistant Extrapulmonary Tuberculosis in Adolescent Females: Unraveling Challenges and shaping future Strategies

Introduction: Tuberculosis (TB) is a global infectious disease, causing approximately 10.6 million new cases and 1.6 million deaths in 2021, with 450,000 patients annually having rifampicin-resistant (RR)/multi-drug resistant (MDR) TB. Despite higher pulmonary TB notifications in males, TB in females remains a significant threat, reflecting potential barriers to healthcare access. Background: This study addresses the challenging landscape of Rifampicin-resistant extrapulmonary TB in adolescent females, aiming to unravel recurrence patterns and treatment complexities. It serves as a call to action, advocating for tailored interventions to mitigate the impact of drug-resistant TB in this vulnerable population. Overview: Adolescence poses unique challenges for individuals diagnosed with tuberculosis, especially for females who exhibit higher susceptibility, facing stigma and potential impacts on self-esteem. The presentation of drug-resistant tuberculosis in adolescents differs from early childhood, necessitating differentiated care; however, there's a notable lack of recognition and specific guidelines for this age group in national TB programs. W.H.O. outlines plan with a comprehensive five-year strategy, detailing ten crucial steps to improve tuberculosis prevention, treatment, and care for children and adolescents. Additionally, the Roadmap targets a 90% coverage in diagnosis and treatment services and aims to provide TB preventive treatment to 90% of those at high risk between 2023 and 2027. Rifampicin-resistant tuberculosis, comprising MDR and XDR types, requires microbiological confirmation through genotypic or phenotypic tests. Treatment in adolescents aligns with adult regimens, including novel drugs like Delanamid and Bedaquiline, with consideration for exposure history and drug susceptibility.

Long-term survival experience of tuberculosis patients in a rural district of Ghana

There are limited epidemiological studies on the survival of Tuberculosis (TB) patients in Ghana despite the high endemicity of TB in the country. The present study estimated the overall survival time of TB patients and developed a model to determine co-variates associated with death. This was a retrospective cohort study that employed a complete enumeration technique to review patient data from the TB register of the Ajumako Enyan Essiam District, Central Region, Ghana, between August and October 2023. All patients registered for TB care between 1st January 2018 and 31st December 2022, excluding patients with incomplete data and drug-resistant cases were included. We applied descriptive statistics, Kaplan-Meier survival analysis, Log-rank test, and a Cox proportional hazard model for multivariate analysis. Out of the 226 eligible patients, 149 (65.9%) were males, 205 (90.7%) were new cases and 37 (17.3%) were TB/HIV co-infected. Those who experienced death were 37 (16.4%), with an overall survival time of 5.5 months (95% CI = 5.4 – 5.7). Older age (aHR=2.6; 95% CI: 1.1-6.3), male gender (aHR=4.9; 95% CI: 1.7-14.3), relapsed TB patients (aHR=5.2; 95% CI: 2.4-10.9), and TB/HIV co-infected patients (aHR=7.1; 95% CI: 3.6-13.9) were implicated as plausible predictors for survival time to death of TB patients. We concluded there was a significantly low overall survival time for older age, male gender, relapsed TB patients, and TB/HIV co-infected patients. The provision of enhanced training for targeted health professionals and tailored community awareness creation can boost early case detection, treatment adherence, and improve overall survival.

Ensuring Continuity of Tuberculosis Care during Social Distancing through Integrated Active Case Finding at COVID-19 Vaccination Events in Vietnam: A Cohort Study.

COVID-19 significantly disrupted tuberculosis (TB) services in Vietnam. In response, the National TB Program (NTP) integrated TB screening using mobile chest X-rays into COVID-19 vaccination events. This prospective cohort study evaluated the integrated model's yield, treatment outcomes, and costs. We further fitted regressions to identify risk factors and conduct interrupted time-series analyses in the study area, Vietnam's eight economic regions, and at the national level. At 115 events, we conducted 48,758 X-ray screens and detected 174 individuals with TB. We linked 89.7% to care, while 92.9% successfully completed treatment. The mean costs per person diagnosed with TB was $547. TB risk factors included male sex (aOR = 6.44, p < 0.001), age of 45-59 years (aOR = 1.81, p = 0.006) and ≥60 years (aOR = 1.99, p = 0.002), a history of TB (aOR = 7.96, p < 0.001), prior exposure to TB (aOR = 3.90, p = 0.001), and symptomatic presentation (aOR = 2.75, p < 0.001). There was a significant decline in TB notifications during the Delta wave and significant increases immediately after lockdowns were lifted (IRR(γ1) = 5.00; 95%CI: (2.86, 8.73); p < 0.001) with a continuous upward trend thereafter (IRR(γ2) = 1.39; 95%CI: (1.22, 1.38); p < 0.001). Similar patterns were observed at the national level and in all regions but the northeast region. The NTP's swift actions and policy decisions ensured continuity of care and led to the rapid recovery of TB notifications, which may serve as blueprint for future pandemics.

Sociocultural understanding of Tuberculosis and implications for care-seeking among adults in the province of Zambezia, Mozambique: Qualitative research.

Mozambique has a high burden of Tuberculosis (TB) with an incidence of 368 per 100,000 population in 2020, coupled with a low all-form TB detection rate. The COVID-19 pandemic has exacerbated delays in timely diagnosis and treatment of new TB cases. Promoting active TB case finding is a national priority in Mozambique. We conducted qualitative research to explore factors influencing TB testing in Zambezia province in Mozambique. One-to-one, semi-structured, audio-recorded telephone interviews were conducted to explore TB-related knowledge, and barriers and facilitators to TB testing. A sample of two TB Program staff, two community providers of TB services, and 19 community members (10 women and 9 men) was recruited, with support from provincial government TB staff, from four districts in Zambezia with a high TB burden. Interviews were transcribed verbatim, and thematic analysis was conducted. The Mozambican National Bioethics Committee for Health approved the study protocol. Our study highlights that knowledge about TB symptoms and its causes is low, which could delay timely TB testing. Sociocultural beliefs often implicate certain types of sexual activity and women as causes of TB symptoms; for example, having sex with a widow who has not been traditionally purified, or with a woman who has had an abortion. Therefore, people usually tend to first seek care from traditional healers instead of going to a health facility. Additionally, stigma associated with HIV and TB also delays care seeking. Gender-related disparities in TB care seeking were also evident. This study provides valuable insights into how healthcare seeking for TB is influenced by sociocultural understanding of symptoms and gender dynamics. Therefore, interventions to promote timely and appropriate care seeking for TB should be contextually tailored, culturally appropriate, and gender sensitive.

Patient level barriers to accessing TB care services during the COVID-19 pandemic in Uganda, a mixed methods study

IntroductionLockdown measure has been utilized widely to mitigate COVID-19 pandemic transmission and recently during the 2022 Sudan Ebola Virus Disease outbreak in Uganda. These have setback effects on the continuity of essential health services such as tuberculosis (TB) care, reversing progress made in the fight against tuberculosis (TB) over the past decade. We set out to understand patient-reported barriers to accessing TB care services during the COVID-19 pandemic in Uganda.MethodsMixed methods study involving review of medical records of TB patients who received TB care from January to September 2020. We used quantitative and qualitative methods including phone questionnaires and in-depth interviews. We carried out descriptive statistics, a chi-square test and conducted a thematic analysis.ResultsWe carried out phone interviews with 672 participants. The majority (60%) were male and with an average of 35 years (SD:11). A significantly higher proportion of patients reported a barrier to TB care access during the COVID-19 lockdown than pre-lockdown (79.9% vs. 68.1% p = 0.027). We carried out in-depth interviews with 28 participants (54% (15/28): male). Barriers experienced by these participants included lack of a means of transport to reach the health facility, lack of money to pay the transport fares, long distances to the facility, fear of COVID-19 infection, stigma due to overlap between TB and COVID-19 symptoms, and few health care workers available during the lockdown period.ConclusionLockdown measures instituted to mitigate the transmission of COVID1-19 affected access to TB care services in Uganda. Uganda is at risk of future emerging and re-emerging diseases of epidemic potential. Therefore, there should be measures to ensure the continuity of essential services such as tuberculosis care during the implementation of future epidemic response interventions such as a lockdown.

Finding the missing many: improving Tuberculosis care in Kajiado county through active case finding and community approaches

BackgroundTuberculosis related deaths remain a priority globally. Despite advancements in TB care, access to quality care remains inequitable to the disadvantage of those in rural and urban informal settlements. The Awareness, Traditions, and Innovation in combating Tuberculosis (ATI TB) project incorporated active case finding (ACF), use of GeneXpert technology and decentralized services to improve TB care in Kajiado County. This study sought to establish the impact of the project as well as implementation lessons learnt during its tenure in Kajiado County, Kenya.MethodsThis evaluation adopted a mixed-methods approach with retrospective cohort analysis for the quantitative data and qualitative data sought through key informant interviews with 28 purposively sampled respondents. The qualitative data was analyzed thematically using Taguette while quantitative data was analyzed using R Software yielding descriptive statistics and measures of association.ResultsWhile the males were a minority among the presumptive cases (623; 46%), they were the majority (59.3%) among the confirmed TB cases. 70% of the confirmed cases were aged between 15 and 44 years; with those aged between 25- and 34-years being majority (30% of the cases). Majority of the confirmed cases within the project were from rural Kajiado West (79; 66.9%). Though 61% of the presumptive cases were through ACF, only 7% of these tested positive. Conversely, 13% of the self-referrals tested positive. 53% (66) of the positive cases with valid data were self-referrals while ACF accounted for 47% (58) of the positives.ConclusionContinued capacity development among health workers, sustained and targeted sensitization and screening among vulnerable groups, strategic collaborations, alongside increased budgetary prioritization of health and TB care by government and partners, and government investments in Social Determinants of Health can ensure gains in TB care are sustained.

A protocol for a systematic review and meta-analysis of tuberculosis care around the time of pregnancy.

Tuberculosis is estimated to cause 1.5 million deaths annually and is most common during the reproductive years. Despite that fact, we found that tuberculosis screening, prevention or care recommendations for people around the time of pregnancy were absent from some national policy recommendations and varied in others. To address the apparent gaps and inconsistencies in policy, we aim to design a systematic review and meta-analysis of the original research evidence informing tuberculosis care around the time of pregnancy. With assistance from librarians at the Biomedical library of the University of Gothenburg, Pubmed, CINAHL and Scopus databases will be searched. Search terms will aim to identify studies generating original research evidence informing care for tuberculosis around the time of pregnancy. Evidence may include: the outcome of TB and/or of pregnancy; the cost-effectiveness or acceptability of any intervention; the sensitivity and specificity of any assessment, selection, diagnostic or test criterion. The output from these literature searches will be screened by two independent reviewers to select the eligible studies for inclusion. Discrepancies will be resolved with a third reviewer. Firstly, publications that provide contextual data will be tabulated, summarising their main contributions. Secondly, studies that provide evidence directly guiding patient care will be our focus and will be considered to be key. The key studies will be subject to quality assessment, data extraction and when possible, meta-analysis. This systematic review and meta-analysis aims to guide policy, practice and future research priorities concerning tuberculosis care around the time of pregnancy.

Using intersectional gender analysis to identify challenges in tuberculosis care at four health care facilities in Uganda

BackgroundTuberculosis (TB) care could be considered as a continuum from symptom recognition, decision to seek care, diagnosis, treatment initiation and treatment completion, with care along the continuum influenced by several factors. Gender dimensions could influence TB care, and indeed, more men than women are diagnosed with TB each year. The study was done to identify social stratifiers that intersect with gender to influence TB care.MethodsA cross-sectional qualitative study was done at four health facilities in 3 districts in central Uganda between October 2020 and December 2020. Data was collected from patients seeking a diagnosis or on TB treatment through focus group discussions and key informant interviews. Key themes around gender guided by a gender and intersectionality lens were developed and thereafter thematic content analysis was done.ResultsWomen have increased vulnerability to TB due to bio mass exposure through roles like cooking. Women have increased access to health care services as they interface with the health care system frequently given their role as child bearers and child care givers. Men have a duty to provide for their families and this most often is prioritised over healthcare seeking, and together with belief that they are powerful beings leads to poor healthcare seeking habits and delays in healthcare seeking. Decisions on when and where to seek care were not straightforward for women, who most often rely on their husbands/partners to make decisions.ConclusionsMen and women experience challenges to TB care, and that these challenges are deeply rooted in roles assigned to them and further compounded by masculinity. These challenges need to be addressed through intersectional gender responsive interventions if TB control is to be improved.Graphical