Tuberculosis Control Activities Research Articles

Monitoring and assessment of resource base of the medical institutions providing phthisiological care in the Russian Federation

In connection with the threat of a worsening epidem-ic situation in tuberculosis in Russia and in the world, the growth of drug resistance to anti-tuberculosis drugs, it is advisable to assess the dynamics of financing of anti-tu-berculosis activities, as well as the state of fixed assets of medical organizations providing TB care from the point of their readiness for these challenges. Aim. To study the financing of anti-tuberculosis activities and the state of fixed assets of organizations providing medical care to patients with tuberculosis. Methods. The authors stud-ied these forms of financial monitoring for 2016-2021. We calculated indicators of per capita financing, taking into account inflation, the structure of financing, the state of fixed assets according to official methods. Re-sults. The maximum per capita funding for tuberculosis control activities was observed in 2019; during the years of the COVID-19 pandemic, its level was approximately the same as in 2018. The share of funding for the pur-chase of innovative anti-TB drugs increased from 0.3% to 3.2%, as well as the cost of abacillation of one patient with MDR-TB, which is associated with the introduction of new clinical guidelines and the growth of drug re-sistance to fluoroquinolones. The COVID-19 pandemic led to a decrease in funds spent on training and super-vision, which was offset by the introduction of distance learning technologies. Depreciation of fixed assets was consistently high; funds for their renewal ensured their stable condition with a slight obsolescence of buildings and structures and equipment renewal. Conclusion. The challenges that the TB care system may face in the future will not allow working with its existing worn-out structure in the old way; it is necessary either to increase funds for the renewal of fixed assets, or to look for new methods of work in the conditions of depreciated fixed assets, redis-tributing funds for the renewal, first of all, of equipment and tools to work in the context of the widespread intro-duction of hospital-replacing technologies.

Characteristics and Treatment Outcomes among Migrants with Pulmonary Tuberculosis: A Retrospective Cohort Study in Japan, 2009-2018.

This study aimed to describe characteristics and treatment outcomes of overseas-born pulmonary tuberculosis (PTB) patients in Japan, and identify the factors associated with “treatment non-success”. We conducted a retrospective analysis of overseas-born patients with drug-susceptible PTB using cohort data of PTB cases newly registered in the Japan tuberculosis (TB) surveillance system between 2009 and 2018. Overall, 9151 overseas-born PTB cases were included in this study, and 70.3% were aged 34 years old or younger. “Students of high school and higher” (28.6%) and “regular workers other than service related sectors” (28.5%) accounted for over half of the study population, and they have continued to increase. Overall, the treatment success rate was 67.1%. Transferred-out constituted the largest proportion (14.8%) among the treatment non-success rate (32.9%). Multiple logistic regression analysis revealed patients whose health insurance type was “others and unknown”, including the uninsured (adjusted OR (AOR) = 3.43: 95% Confidence Intervals (CI) 2.57–4.58), those diagnosed as TB within “one year” (AOR = 2.61, 95% CI 1.97–3.46) and “1–5 years” (AOR = 2.44, 95% CI 1.88–3.17) of arrival in Japan, and males (AOR = 1.34, 95% CI 1.16–1.54), which were the main factors associated with treatment non-success. These findings imply that Japan needs to develop TB control activities considering the increasing trends of overseas-born PTB patients, the majority of whom are young and highly mobile. There is a need to pay greater attention to overseas-born PTB patients diagnosed within a short duration after entering Japan, who may be socially and economically disadvantaged for their treatment completion.

A study to critically analyze Revised National Tuberculosis Control Program norms implementation at a medical college-level facility

Background: Tuberculosis (TB) control activities are implemented in the country for more than 50 years. The countrywide lockdown in 2020 adversely impacted routine health-care services including those for the management of TB. Operational research is needed to know whether Revised National Tuberculosis Control Program (RNTCP) (National Tuberculosis Elimination Program) is heading in the right direction as far as the pace and quality of implementation of the program are concerned. Aims and Objectives: The aim of the present study was to investigate the strength, weaknesses, and opportunities of RNTCP. An analysis of RNTCP was done to identify competencies and gaps. Materials and Methods: The present retroprospective and observational study was carried out at the RNTCP facility of a Government Medical College in the Central India in Madhya Pradesh during the year 2019–20. Samples of 238 patients registered under RNTCP for anti-tubercular treatment were taken in the study. Data were collected using a structured schedule from the RNTCP center and tabulated in a Microsoft Excel sheet, to assess the compliance of RNTCP norms in the management of TB. Results: The most commonly affected age was 16–49 years and the male: female ratio was 3:2. The most common basis of diagnosis was microbiological (60.92%). Follow-up sputum testing was done on time in 64.71% of patients. Adherence to anti-tubercular treatment (ATT) was regular in 78.57% of patients. All patients were telephoned while 43.14% of patients were home visited as a default action. After default action, 35.29% of patients return to regular ATT. Out of all registered patients initiated on ATT, 81.09% were treatment success, while 7.14% lost to follow-up, 2.1% became defaulters, and 4.62% patients died. Conclusion: We conclude that treatment success of TB unit was near the RNTCP norm of 85% which is below the national 88%. The probable reasons for the higher default rate and loss to follow-up rate during the study period could be the ongoing COVID-19 pandemic.

Fine-grain population structure and transmission patterns of Mycobacterium tuberculosis in southern Mozambique, a high TB/HIV burden area

Genomic studies of the Mycobacterium tuberculosis complex (MTBC) might shed light on the dynamics of its transmission, especially in high-burden settings, where recent outbreaks are embedded in the complex natural history of the disease. To this end, we conducted a 1 year prospective surveillance-based study in Mozambique. We applied whole-genome sequencing (WGS) to 295 positive cultures. We fully characterized MTBC isolates by phylogenetics and dating evaluation, and carried out a molecular epidemiology analysis to investigate further associations with pre-defined transmission risk factors. The majority of strains (49.5%, 136/275) belonged to lineage (L) 4; 57.8 % of them (159/275) were in genomic transmission clusters (cut-off 5 SNPs), and a strikingly high proportion (45.5%) shared an identical genotype (0 SNP pairwise distance). We found two ‘likely endemic’ clades, comprising 67 strains, belonging to L1.2, which dated back to the late 19th century and were associated with recent spread among people living with human immunodeficiency virus (PLHIV). We describe for the first time the population structure of MTBC in our region, a high tuberculosis (TB)/HIV burden area. Clustering analysis revealed an unforeseen pattern of spread and high rates of progression to active TB, suggesting weaknesses in TB control activities. The long-term presence of local strains in Mozambique, which were responsible for large transmission among HIV/TB-coinfected patients, calls into question the role of HIV in TB transmission.

Knowledge, attitude and uptake of tuberculosis screening services among gold miners in the Datuko sub-district in the Talensi District Ghana

Background: In Ghana, uptake of tuberculosis (TB) screening services among miners is sub-optimal. The study assessed the knowledge, attitude and uptake of TB screening services among gold miners in the Datuko sub-district in Talensi district Ghana. Methods: This was a cross-sectional study design using a mixed-method approach among 384 adult mine workers. A questionnaire and key informant interview guides were the instruments for data collection and both descriptive and inferential analysis was done using SPSS version 22.00. Results: About 94.5% of the respondents have heard of TB and the overall knowledge of the cause of TB was poor, as 66.1% of the participants said TB was caused by smoking. The majority of the participants (66.4%) had poor attitudes towards TB screening and a few of them (15.4%) had screened for TB. The composite score for knowledge and attitudes of the respondents towards TB screening was 1.61 and 1.41 respectively. There was an association between having heard of TB and recognizing the importance of TB screening service with a p-value of 0.001. There was also a connection between having heard of TB and uptake of screening service (p=0.001). The only factor that determined uptake of TB screening was the educational level of the respondents. The qualitative study among health staff revealed that awareness of TB was high among miners but they perceived those attitudes and use of the TB screening services were sub-optimal. Conclusion: Both knowledge and attitudes of TB screening services among miners were poor which resulted in a sub-optimal uptake of TB screening services. Also, the educational level of the respondents predicted uptake of TB screening service. It is therefore important for policy makers to strengthen TB control activities through health promotional programmes.

Molecular Epidemiology and Genetic Diversity of Multidrug-Resistant Mycobacterium tuberculosis Isolates in Bangladesh.

ABSTRACTAlthough the number of multidrug-resistant (MDR) tuberculosis (TB) cases is high overall, a major gap exists in our understanding of the molecular characteristics and transmission dynamics of the MDR Mycobacterium tuberculosis isolates circulating in Bangladesh. The present study aims to characterize the MDR-TB isolates of Bangladesh and to investigate the mode of transmission. A total of 544 MDR-TB isolates were obtained from a nationwide drug-resistant TB surveillance study conducted between October 2011 and March 2017 covering all geographic divisions of Bangladesh. The isolates were characterized using TbD1 deletion analysis, spoligotyping, and mycobacterial interspersed repetitive-unit–variable-number tandem-repeat (MIRU-VNTR) typing. Deletion analysis showed that 440 (80.9%) isolates were the modern type, while the remainder were the ancestral type. The largest circulating lineage was the Beijing type, comprising 208 isolates (38.2%), followed by T, EAI, and LAM with 93 (17.1%), 58 (10.7%), and 52 (9.5%) isolates, respectively. Combined MIRU-VNTR and spoligotyping analysis demonstrated that the majority of the clustered isolates were of the Beijing and T1 lineages. The overall rate of recent transmission was estimated at 33.8%. In conclusion, the MDR M. tuberculosis isolates circulating in Bangladesh are mostly of the modern virulent type. The Beijing and T lineages are the predominant types and most of the transmission of MDR-TB can be attributed to them. The findings also suggest that, along with the remarkable transmission, the emergence of MDR-TB in Bangladesh is largely due to acquired resistance. Rapid and accurate diagnosis and successful treatment will be crucial for controlling MDR-TB in Bangladesh.IMPORTANCE Multidrug-resistant TB is considered to be the major threat to tuberculosis control activities worldwide, including in Bangladesh. Despite the fact that the number of MDR-TB cases is high, a major gap exists in our understanding of the molecular epidemiology of the MDR-TB isolates in Bangladesh. In our study, we characterized and classified the MDR-TB isolates circulating in Bangladesh and investigated their mode of transmission. Our results demonstrated that the MDR M. tuberculosis isolates circulating in Bangladesh are mostly of the modern virulent type. The Beijing and T lineages are the predominant types and are implicated in the majority of MDR-TB transmission. Our findings reveal that, along with the remarkable transmission, the emergence of MDR-TB in Bangladesh is largely due to acquired resistance, which may be due to nonadherence to treatment or inadequate treatment of TB patients. Rapid diagnosis and adherence to an appropriate treatment regimen are therefore crucial to controlling MDR-TB in Bangladesh.

Epidemiological Aspects of Tuberculosis in Children and Adolescents from 0 to 17 Years Old during the Improved Tuberculosis Situation

Between 2008 and 2018, the overall tuberculosis incidence in Novosibirsk Region went down with the moderate annual decrease of 3.9% on average. By the end of 2018, the number of new tuberculosis cases decreased, while the incidence of multiple drug resistant tuberculosis increased. Tuberculosis situation in children from 0 to 17 years old was characterized by stabilization of incidence. In adolescents, these rates moderately decreased (-2 .9%), and in children under 14 years old, this rate demonstrated the annual growth of 4.8%. In the context of the large burden of tuberculosis infection (2008), in 61.3% of tuberculosis cases in children aged 0-1 7 years, the index case of tuberculosis infection ( ITBI ) was not identified; by 2018, this rate dropped to 30.3%. However, the family exposure to a tuberculosis case was rather a predictor of the disease in children versus adolescents. And among adolescents, the role of casual contacts with ITBI was high (60.6%). Regardless of the epidemic situation, most of the children from 0 to 17 years old who developed tuberculosis were not covered by tuberculosis control activities, one of the reasons was the late detection of the source of tuberculosis infection.

Characterization of rifampicin-resistant Mycobacterium tuberculosis in Khyber Pakhtunkhwa, Pakistan

Tuberculosis (TB), caused by Mycobacterium tuberculosis, is endemic in Pakistan. Resistance to both firstline rifampicin and isoniazid drugs (multidrug-resistant TB; MDR-TB) is hampering disease control. Rifampicin resistance is attributed to rpoB gene mutations, but rpoA and rpoC loci may also be involved. To characterise underlying rifampicin resistance mutations in the TB endemic province of Khyber Pakhtunkhwa, we sequenced 51 M. tuberculosis isolates collected between 2016 and 2019; predominantly, MDR-TB (n = 44; 86.3%) and lineage 3 (n = 30, 58.8%) strains. We found that known mutations in rpoB (e.g. S405L), katG (e.g. S315T), or inhA promoter loci explain the MDR-TB. There were 24 unique mutations in rpoA, rpoB, and rpoC genes, including four previously unreported. Five instances of within-host resistance diversity were observed, where two were a mixture of MDR-TB strains containing mutations in rpoB, katG, and the inhA promoter region, as well as compensatory mutations in rpoC. Heteroresistance was observed in two isolates with a single lineage. Such complexity may reflect the high transmission nature of the Khyber Pakhtunkhwa setting. Our study reinforces the need to apply sequencing approaches to capture the full-extent of MDR-TB genetic diversity, to understand transmission, and to inform TB control activities in the highly endemic setting of Pakistan.

Diagnostic accuracy of GeneXpert MTB/RIF assay for detection of tubercular pleural effusion.

India has been engaged in tuberculosis (TB) control activities for over 50 years and yet TB continues to remain India's important public health problem. The present study was conducted to compare the performance of GeneXpert MTB/RIF (GXpert) assay with composite reference standard in diagnosing cases of tubercular pleural effusion (TPE) and to evaluate the reliability of rifampicin resistance. A cross-sectional study was performed in a Department of Medicine of a rural teaching tertiary care hospital in central India. In all consecutive patients with pleural effusion on chest radiograph presenting to Department of Medicine, GXpert assay and composite reference standard was performed to evaluate the diagnostic accuracy of GXpert assay for detecting TPE in comparison to composite reference standard. Standard formulae were used to calculate the sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), positive likelihood ratios (LR+) and negative likelihood ratios (LR-). Mc-Nemar's test was applied to compare variables. All comparisons were two-tailed. We considered the difference to be statistically significant if the P value was less than 0.05. The sensitivity of the GXpert assay in diagnosing TPE was 16.6% among 158 study participants, the specificity was 100% and diagnostic accuracy was 52.5% which was statistically significant (p value < 0.05). It had a PPV of 100% (95%CI: 88.3% - 100%) and a NPV of 47.5% (95%CI: 39.3% - 55.7%). The LR+ and LR-were 23.5 (95%CI: 1.43-38.6) and 0.83 (95%CI: 0.76-0.91) respectively. GXpert assay has a very high specificity in diagnosing TPE but has a low sensitivity. In comparison to composite reference standard Thus its clinical utility is limited when used as a standalone test. A physician's clinical acumen in combination with routine pleural fluid analysis should be the key factor in the diagnosis of TPE in clinically and radiologically suspected patients, especially in high TB burden countries.

"Their place is beyond the town's border": A qualitative exploration of stigma associated with tuberculosis in rural and urban areas of Lagos, Nigeria.

Tuberculosis (TB) remains a major public health challenge in Nigeria with a minimum yield of various TB control efforts due to sociocultural determinants of health including TB-associated stigma. Therefore, to achieve the Sustainable Development Goal targets for TB control, an understanding and reduction in TB-associated stigma is necessary. The study aims to explore the perspective of community members and investigate the possible ways of mitigating TB-associated stigma in rural and urban areas in Lagos State, Nigeria. Eight focus group discussions (FGD) were conducted among eight homogenous groups of participants living in the community in rural and urban areas of Lagos state who were stratified by gender, between July and November 2017. Analysis of data was done using the modified grounded theory. A total of 86 participants took part in the FGDs. There were various stigmatising behaviours towards people infected with TB in rural and urban communities studied. This includes: Not willing to eat with people suffering from TB, withdrawal from TB patients in social gatherings, verbal abuse of TB patients and refusing to visit their houses because of their illness. There were also misconceptions about the cause of TB in our study which includes spiritual attack, ingestion of cat hair and inhalation of dust. However, participants in the study believed that mitigating the effect of TB-associated stigma will require adequate community education on TB, provision of financial and emotional support to the patients, as well as the involvement of community leaders in TB control activities and stigma reduction interventions. TB-associated stigma exists in rural and urban communities, with a lack of appropriate knowledge of TB and fear of infection as a major determinant in rural and urban areas respectively. Health education and sensitisation about TB, with community leaders as champions could help to mitigate the effect of TB-associated stigma.

Performance assessment of primary healthcare services in tuberculosis control in a city in Southeast Brazil

The World Health Organization highlights the importance of health services organization and performance in tuberculosis (TB) control activities. This study aimed to assess the performance of primary healthcare services in Belo Horizonte, Minas Gerais State, Brazil, in TB control activities in the dimensions Structure and Process, before and after the use of a validated instrument called Stratification by Degree of Clinical Risk and Tuberculosis Treatment Dropout (ERTB). This was a descriptive and prospective study with two interviews (455 professionals), the second of which after the ERTB. Performance classification was: ≤ 49.9%, critical; 50-79.9%, unsatisfactory, and ≥ 80%, satisfactory. The comparative assessment used the McNemar statistical test with p < 0.05. After risk stratification, most of the variables in each dimension improved significantly. The authors conclude that it was possible to identify satisfactory performance in most of the variables assessed in the Structure and Process dimensions in primary healthcare services in Belo Horizonte in relation to TB control activities, using a standardized questionnaire.

The impact of COVID-19 on the tuberculosis control activities in Addis Ababa.

The first COVID-19 case was reported in Ethiopia on 13th March 2020 and series of announcements of set of measures, proclamation and directives have been enacted to fight the coronavirus pandemic. These have implications for the regular health services including the TB control program. This brief communication assesses the impact of the COVID-19 response on the TB control activities of Addis Ababa health centers based on research project data. We compared the patient flows in pre-COVID-19 period (quarter 1, Q1) and during COVID-19 (quarter 2, Q2 and quarter 3, Q3) of 2020 at 56 health centers in Addis Ababa from all 10 sub-cities per sub-city. The patient flow declined from 3,473 in Q1 to 1,062 in Q2 and 1,074 in Q3, which is a decrease by 62-76% and 52-80% in Q2 and Q3 respectively as compared to that of Q1. In Q2, Kolfe keranio and Kirkos sub-cities recorded the biggest decline (76 and 75% respectively) whereas Yeka sub-city had the least decline (62%). In Q3, Kirkos sub-city had the biggest decline (80%) and Addis ketema sub-city had the lowest (52%). We conclude that the series of measures, state of emergency proclamation and government directives issued to counter the spread of COVID-19 and the public response to these significantly affected the TB control activities in Addis Ababa city as attested by the decrease in the patient flow at the clinics. Health authorities may inform the public that essential health services are still available and open to everyone in need of these services.

To Assess the Knowledge and Awareness of Interns Regarding the Management of Tuberculosis as per Recent RNTCP (2017-2025) Guidelines – A Cross Sectional Study

India has been engaged in Tuberculosis control activities for more than 50 years as India is the highest TB burdened country in the world. One such initiative is Revised National Tuberculosis Control Programme (RNTCP) which has been rechristened as National Tuberculosis Elimination Programme (NTEP). The change in name is in line with the larger goal of eliminating the disease by 2025. Objective: The aim of this cross-sectional study is to assess the knowledge and awareness of interns regarding the management of tuberculosis as per recent RNTCP guidelines. Materials &amp; Methods: A structured questionnaire was provided to 111 interns to be filled in a stipulated time. The data collected was analyzed using descriptive statistical parameters and expressed in percentage. Result: Out of a total of 111 interns, 48 (43.24%) were males and 63 (56.75%) were females. Good knowledge was seen among the interns regarding the cardinal symptoms of TB as well as definition of MDR-TB. 92.79% of the participants responded rightly about two sputum samples being taken for diagnosis of TB. Only 76.57% of interns knew the principle of treatment of TB as daily administration of fixed-dose combination of first-line anti-tubercular drugs as per appropriate weight bands and 61.27% of interns were unfamiliar of chemoprophylaxis of tuberculosis according to the recent RNTCP guidelines. Only 71.17% of the participants were updated about the follow-up procedure according to new guidelines. But only 36.93% of participants could answer Cotrimoxazole as the effective drug used in HIV-TB co-infection apart from routine TB drugs to reduce mortality. Conclusion: This survey is providing valuable information that there is deficiency of knowledge among the interns regarding management of tuberculosis according to recent RNTCP guidelines which can lead to treatment failure and thereby causing a hindrance to elimination of TB from our country by 2025

Essential Components of a Public Health Tuberculosis Prevention, Control, and Elimination Program: Recommendations of the Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Controllers Association.

SummaryThis report provides an introduction and reference tool for tuberculosis (TB) controllers regarding the essential components of a public health program to prevent, control, and eliminate TB. The Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Controllers Association recommendations in this report update those previously published (Advisory Council for the Elimination of Tuberculosis. Essential components of a tuberculosis prevention and control program. Recommendations of the Advisory Council for the Elimination of Tuberculosis. MMWR Recomm Rep 1995;44[No. RR-11]). The report has been written collaboratively on the basis of experience and expert opinion on approaches to organizing programs engaged in diagnosis, treatment, prevention, and surveillance for TB at state and local levels.This report reemphasizes the importance of well-established priority strategies for TB prevention and control: identification of and completion of treatment for persons with active TB disease; finding and screening persons who have had contact with TB patients; and screening, testing, and treatment of other selected persons and populations at high risk for latent TB infection (LTBI) and subsequent active TB disease.Health departments are responsible for public safety and population health. To meet their responsibilities, TB control programs should institute or ensure completion of numerous responsibilities and activities described in this report: preparing and maintaining an overall plan and policy for TB control; maintaining a surveillance system; collecting and analyzing data; participating in program evaluation and research; prioritizing TB control efforts; ensuring access to recommended laboratory and radiology tests; identifying, managing, and treating contacts and other persons at high risk for Mycobacterium tuberculosis infection; managing persons who have TB disease or who are being evaluated for TB disease; providing TB training and education; and collaborating in the coordination of patient care and other TB control activities. Descriptions of CDC-funded resources, tests for evaluation of persons with TB or LTBI, and treatment regimens for LTBI are provided (Supplementary Appendices; https://stacks.cdc.gov/view/cdc/90289).

Trend and determinants of tuberculosis treatment outcome in a tertiary hospital in Southeast Nigeria

IntroductionNigeria ranked 7th among the high TB burden nations globally and second most endemic in Africa. There are several highly effective interventions available for tuberculosis control. Operational challenges have been reported to interfere with the success of these interventions. This review was conducted to ascertain the treatment outcome using the Directly Observed Short Course Strategy implemented in the hospital. MethodsA retrospective review of the Tuberculosis treatment was conducted in former Ebonyi State Teaching Hospital and Federal Teaching Hospital from 2008 to 2014 as part of the departmental critique of patients’ clinical care and tuberculosis control activities. Using the facility’s TB treatment register, information on the patient’s demography, clinical characteristics and treatment outcome was extracted. The data were analyzed using Epi Info version 7.2. Frequencies and proportions were calculated. ResultsA total of 1070 cases were reviewed with majority 491 (45.9%) belonging to 25–44 years age group. There were 585 (54.7%) males and 68 (11.6%) paediatrics. Pulmonary tuberculosis (667, 62.3%) was the most common presentation. Among those that did sputum smear AFB, 53.2% were smear negative. In all, 91.2% of the cases were treatment naïve, 59.1% were HIV negative at beginning of their treatment while 8% had unknown HIV status. Of the treatment outcome, 40.5% were classified as treatment completed, 16.0% cured, 17.4% of the cases defaulted while 14.1% of the cases died on treatment. These patients were often referred from primary and secondary level hospitals. ConclusionsThe cure rate was very poor and treatment default rate high. The high default rate could be due to the referral nature of the hospital. The treatment success rate of 56.5% is still far below the national target of 85% treatment success rate for effective tuberculosis control. An operational research is recommended to elicit the root causes of low treatment success rate and high patient default rate.

Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia

BackgroundAt least 13–20% of all Tuberculosis (TB) cases are recurrent TB. Recurrent TB has critical public health importance because recurrent TB patients have high risk of Multi-Drug Resistant TB (MDR-TB). It is critical to understand variations in the prevalence and treatment outcomes of recurrent TB between different geographical settings.The objective of our study was to estimate the prevalence of recurrent TB among TB cases and compare risk of unfavorable treatment outcomes between rural and urban settings.MethodsIn a retrospective cohort study conducted in southern province of Zambia, we used mixed effects logistic regression to asses associations between explanatory and outcome variables. Primary outcome was all-cause mortality and exposure was setting (rural/urban). Data was abstracted from the facility TB registers.ResultsOverall 3566 recurrent TB cases were diagnosed among 25,533 TB patients. The prevalence of recurrent TB was 15.3% (95% CI: 14.8 15.9) in urban and 11.3% (95% CI: 10.7 12.0) in rural areas. Death occurred in 197 (5.5%), 103 (2.9%) were lost to follow-up, and 113 (3.2%) failed treatment. Rural settings had 70% higher risk of death (adjusted OR: 1.7; 95% CI: 1.2 2.7). Risk of lost to follow-up was twice higher in rural than urban (adjusted OR: 2.0 95% CI: 1.3 3.0). Compared to HIV-uninfected, HIV-infected individuals on Antiretroviral Treatment (ART) were 70% more likely to die (adjusted OR: 1.7; 95% CI: 1.2 3.1).ConclusionRecurrent TB prevalence was generally high in both urban and rural settings. The risk of mortality and lost to follow-up was higher among rural patients. We recommend a well-organized Directly Observed Therapy strategy adapted to setting where heightened TB control activities are focused on areas with poor treatment outcomes.

Tuberculosis infectious pool and associated factors in East Gojjam Zone, Northwest Ethiopia

BackgroundGlobally, tuberculosis (TB) lasts a major public health concern. Using feasible strategies to estimate TB infectious periods is crucial. The aim of this study was to determine the magnitude of TB infectious period and associated factors in East Gojjam zone.MethodsAn institution-based prospective study was conducted among 348 pulmonary TB (PTB) cases between December 2017 and December 2018. TB cases were recruited from all health facilities located in Hulet Eju Enesie, Enebse Sarmider, Debay Tilatgen, Dejen, Debre-Markos town administration, and Machakel districts. Data were collected through an exit interview using a structured questionnaire and analyzed by IBM SPSS version25. The TB infectious period of each patient category was determined using the TB management time and sputum smear conversion time. The sum of the infectious period of each patient category gave the infectious pool of the study area. A multivariable logistic regression analysis was used to identify factors associated with the magnitude of TB infectious period.ResultsOf the total participated PTB cases, 209(60%) were male, 226(65%) aged < 30 years, 205(59%) were from the rural settings, and 77 (22%) had comorbidities. The magnitude of the TB infectious pool in the study area was 78,031 infectious person-days. The undiagnosed TB cases (44,895 days), smear-positive (14,625 days) and smear-negative (12,995 days) were major contributors to the infectious pool. The overall average median TB management time was 142.4 days (IQR, 98–238 days). Similarly, the average sputum smear conversion time of PTB cases (new and repeat) was 46 days. Residence, knowledge, form of TB, smoking, alcohol history, distance from the facility, comorbidity history and stigma were statistically significant factors TB infectious period (p-value< 0.05).ConclusionsThe magnitude of the TB infectious pool is high even if it is lower than the findings of previous studies. This might be an indicator of poor access to TB services, service delays, low community awareness, impaired facility readiness, and poor transportation. Improving personal awareness and behavior, timely management of commodities, and using the TB management time in TB control are crucial to improving TB control activities.

Public-Private Mix Tuberculosis Control Activities in Private Hospitals in Myanmar: Providers' Perspective

Public-Private Mix Tuberculosis Control Activities in Private Hospitals in Myanmar: Providers' Perspective

THE COMPREHENSIVE ASSESSMENT OF THE EFFECTIVENESS OF ACTIVITIES AIMED TO CONTROL THE SPREAD OF HIV/TB CO-INFECTION IN NORTH-WEST RUSSIA

In Russia, the downward trends in tuberculosis transmission are leveled by the growing HIV infection spread. In order to improve the situation, it is necessary to know the strengths and weaknesses of tuberculosis control activities among people living with HIV. The objective of the study: the comprehensive assessment of the effectiveness of activities aimed to control the spread of HIV/TB co-infection in North-West Russia. Subjects and methods. The authors used epidemiological and clinical-diagnostic methods, ranking, correlation analysis, and expert assessment. The epidemiological and clinical analyses were based on the reporting forms of Rosstat on tuberculosis and HIV, data from analytical reports on monitoring visits and data from the questionnaires developed by the authors, for 2007-2017. The correlation between the studied parameters was assessed using Spearman's rank correlation. Results. In North-West Russia, the main tuberculosis control activities among people living with HIV, including logistical support and provision of personnel (Spearman's rank ratio (-0.32177), p &lt; 0.05), a set of preventive measures aimed at the coverage with antiretroviral therapy, preventive treatment and screening for tuberculosis in HIV-positive people (Spearman's rank ratio (-0.03226), p &gt; 0.05) did not provide any statistically significant impact on the spread of HIV/TB co-infection, which indicated of their imperfection and inequality. Conclusion. In the North-West of Russia, the system aimed to control the spread of HIV/TB co-infection requires some optimization.

Factors Associated with the Development of Secondary Multidrug-resistant Tuberculosis.

Background:Spread of multidrug-resistant tuberculosis (TB) is a threat to India's TB control program. We conducted this study with the objective to determine the risk factors for the development of secondary multidrug-resistant TB.Methods:We conducted an unmatched case–control study involving 247 multidrug-resistant TB patients as “cases” and 494 individuals who were declared as “cured” after category I DOTS treatment as “controls.” Data were collected through face-to-face interviews and review of treatment records. Multivariable logistic regressions were used to analyze the collected data.Results:The mean duration for which cases took first-line anti-TB drug was 19.7 months. The mean duration between initial diagnosis of TB and diagnosis of multi-drug resistant TB (MDR-TB) was 28.3 months. In our study, 26.7%, 50.2%, and 23.1% of MDR-TB cases had one, two, or more previous episodes of TB before being diagnosed as MDR-TB. In multivariable analysis, low or no formal education (album-oriented rock [AOR] =1.63 [confidence interval (CI) = 1.03–3.11]), labor occupation (AOR = 2.15 [CI = 1.18–3.90]), smoking (AOR = 2.56 [CI = 1.19–3.26]), having HIV (AOR = 9.45 [CI = 6.80–15.9]), migration for job (AOR = 3.70 [CI = 1.96–5.67]), stopping TB treatment due to comorbid conditions (AOR = 8.86 [CI = 5.45–11.2]), and having type 2 diabetes (AOR = 3.4 [CI = 1.96–5.16]) were associated with MDR-TB.Conclusions:Government of India should devise strategy to prevent interruption of treatment to stop the emergence and spread of MDR-TB. We need to better integrate TB control activities with diabetes and tobacco control programs for better health outcome among patients.