Tuberculosis Control Program Research Articles

Factors determining successful treatment outcome among notified tuberculosis patients in Belagavi district of North Karnataka, India

IntroductionIndian government has implemented various strategies to track newly diagnosed tuberculosis (TB) cases and ensure follow-up for registered cases. Appropriate measures have been adapted to combat the spread of TB. Success of the treatment determines the effectiveness of the national TB control program. AimPresent study analyzed the recorded data to study the clinico-epidemiological profile and explore the factors that might influence treatment outcome among notified tuberculosis patients. Design and settingsA retrospective cohort study was conducted using secondary data in Belagavi district. Subjects and methodsData of TB patients notified and registered under Nikshay portal in the year 2019 were collected from the district tuberculosis office and factors influencing treatment outcome were analyzed. Statistical analysisDescriptive statistics, bivariate and multivariate logistic regression analysis were used to analyze the data. ResultsThe study revealed that females, younger age group, absence of comorbidities, having extra-pulmonary TB, smear-negative pulmonary TB, and new TB patients exhibited a statistically significant association with successful treatment outcome. ConclusionIn the study area, the mean treatment success rate (83.8 %) aligned with the national success rate of 82 %. Early detection of tuberculosis may help in increasing treatment success rates. Delivering comprehensive counseling to TB patients regarding the disease, its treatment and management plays a decisive role in achieving successful treatment outcomes.

Tuberculosis and the Effectiveness of the Revised National Tuberculosis Control Program (RNTCP) to Control Tuberculosis: A Narrative Review.

The revised National Tuberculosis (TB) Control Program is an initiative undertaken by the government of India and was active from 1997 to 2020. Later it was renamed as National TB Elimination Program, which eyes the complete eradication of TB by 2025. The revised National Tuberculosis Control Programme (RNTCP) is preceded by the National TB Control Program which was activated when the cases of TB were on the rise in the early 1960s and police intervention was needed. National Tobacco Control Cell (NTCP) guided the efforts until 1997 when various shortcomings, which were registered over the course of time, were addressed and the revised program was launched. It has been a mixed success as beneficiaries belonging to the reachable, urban areas were benefitted, and tribal, and backward areas were lagging behind. Although the RNTCP proved to be effective in containing TB and curing it to a certain extent, the successor of the program, which is NTEP, has set an ambitious goal of eradicating TB by 2025 which needs concerted efforts on behalf of all stakeholders.

Peningkatan Kapasitas Kader dalam Penanganan Penyakit Tuberkulosis

Mycobacterium tuberculosis bacteria cause TB, which attacks the lungs and other organs. One of the countries with the highest level is Indonesia. The 2022 Global TB Report reports that the TB incidence in Indonesia in 2021 was 969,000 cases, ranking second highest, up 17% from 2020. To find and accompany people with TB, increasing cadre capacity is very important. The involvement of cadres in TB control programs produces efforts that are community-based and for the community. This activity uses lectures and discussions. The total number of activity participants was 45 cadres. Capacity building activities were carried out in Enrekang Regency. The results show an increase in cadres' knowledge, attitudes and actions regarding how to deal with tuberculosis, starting from case discovery, case care, to contact investigation. It is hoped that cadres who have received this capacity increase can disseminate information to the public.

Clinical and Demographic Patterns of Pulmonary Tuberculosis in Patients with Diabetes Mellitus: Impact of Diabetes Mellitus on Patient

Background: Tuberculosis (TB) is a communicable infectious disease and one of the leading causes of death. Until the coronavirus pandemic, tuberculosis was the leading cause of death from a single infectious agent, more than HIV/AIDS. Due to urbanization and rapid social and economic development, there is a rapidly increasing diabetes mellitus (DM) epidemic and India has the second largest number of DM patients in the world. There are around 74.2 million DM cases and 40.1 million people with impaired glucose tolerance. Tuberculosis is more common in low- and middle-income countries. The increasing trend of the two diseases poses a major challenge for the tuberculosis control program.
 Methods: The main goal of this research was to investigate clinical and demographic patterns of pulmonary tuberculosis in patients with DM. It is a prospective, observational, in-hospital study. We studied 165 PTB patients associated with DM who were at least scanty/1+ positive on smear or had Mycobacterium TB sputum CBNAAT detected.
 Results: Of the 165 patients, 127 PTB-DM patients were male and 38 were female. The most common symptom was cough, which occurred in 164 (99.4%) patients. Fever was the second most common symptom in 152 (92.1%) patients and anorexia was the third most common symptom, occurring in 119 (72.1%) patients.
 Conclusion: The majority of patients were from IPD 88 (54%), suggesting that PTB–DM cases have a more severe and complicated presentation. Male patients are affected more frequently than female patients. People in the age group 31–60 years often suffer from PTB–DM. Cough, fever, and anorexia are the most common symptoms, while chest pain and breathlessness are more common in the older age group. The history of PTB in DM patients is also of concern as the present study shows that there is a possible association with relapse or reactivation of PTB as well as drug resistance of PTB.

Multidrug Resistant Tuberculosis (MDR-TB) Factors: Literature Review

Background: Multidrug-resistant tuberculosis (MDRTB) is the biggest problem in preventing and eradicating TB in the world. MDR-TB occurs if the tuberculosis germs are resistant to various first-line OAT, at least two drugs, namely isoniazid and rifampicin. The emergence of MDR-TB cases presents new obstacles and challenges to the effectiveness of TB control programs due to difficult diagnosis, high rates of therapy failure, and death. This literature review aims to determine the factors that cause multidrug-resistant tuberculosis (MDR-TB). Methods: The method used in this article is a literature review using journal databases from Pubmed and Google Scholar in the 2020-2023 time period with the keywords "drug MDR TB," "multi-drug TB MDR factors," "TB MDR," and " resistant TB medicine" found in 1,990 articles, 304 from Pubmed, and 1,960 from Google Scholar). Articles were selected according to the criteria, and the result was 20 articles ready to be reviewed Results: The results of this study show that risk factors have been proven to show that there is a significant relationship between history of diabetes mellitus, history of TB treatment, patient motivation, adherence to taking medication, duration of TB treatment, status of drug side effects, employment, marital status, economic level, history of contact with patients. MDR TB, stress level, and family support are related to the incidence of MDR TB Conclusion: The conclusion of the 20 articles reviewed shows that age, gender, compliance with taking medication, diabetes mellitus, and a history of contact with MDR TB patients are the factors that most influence the occurrence of MDR TB

Cost-effectiveness analysis of adding tuberculosis household contact investigation on passive case-finding strategy in Southwestern Uganda.

The standard passive case-finding strategy implemented by most developing countries is inadequate to detect new cases of Tuberculosis. A household contact investigation is an alternative approach. However, there is limited cost-effectiveness data to support planning and implementation in low and middle-income countries. The study aimed to evaluate the cost-effectiveness of adding household contact investigation (HCI) to the passive case-finding (PCF) strategy in the Tuberculosis control program in Southwestern Uganda. We conducted an economic evaluation using a retrospective study approach and bottom-up costing (ingredients) techniques. It was a synthesis-based evaluation of existing data extracted from the District Health Information System (DHIS 2), TB registers, and a primary cost survey. The study compared two methods of Tuberculosis (TB) case finding (PCF and HCI) strategies. Regarding PCF, patients either self-reported their signs and symptoms or were prompted by healthcare workers. At the same time, HCI was done by home visiting and screening contacts of TB patients. Patients and household contacts presumed to have Tuberculosis were requested to produce samples for analysis. We applied a static decision-analytic modeling framework to examine both strategies' costs and effectiveness. The study relied on cost and probability estimates from National Tuberculosis (TB) program data, activity costs, and published literature. It was performed from the societal and provider perspectives over 1.5 years across 12 facilities in Ntungamo, Sheema, and Rwampara Districts. The primary effectiveness measure was the number of TB cases detected (yield) and the number needed to screen (NNS). The TB yield was calculated from the number of patients screened during the period under study. The incremental cost-effectiveness ratio (ICER) was expressed as cost in 2021 US$ per additional TB case detected. We did not apply a discount rate because of the short analytic time horizon. The unit costs of detecting a Tuberculosis case were US$ (United States dollar) 204.22 for PCF and US$ 315.07 for HCI. Patient and caregiver costs are five times more in PCF than in HCI [US$26.37 Vs. US$ 5.42]. The ICER was US$ 3,596.94 per additional TB case detected. The TB screening yields were 0.52% (1496/289140) for passive case finding and 5.8% (197/3414) for household contact investigation. Household contact investigation yield among children 0-14 Vs. 15+ years [6.2% Vs.5.4%] P = 0.04. The Yield among People living with HIV (PLHIV) Vs. HIV-negative [15.8% Vs.5.3%] P = 0.03 in HHCI. The PCF yield in men Vs. Women [1.12% Vs.0.28%] P<0.01. The NNS in PCF was 193 [95% CI: 186-294] and 17 [95% CI: 14-22] in HCI. Our baseline assumptions and the specific implementations of adding HCI to existing PCF programs in the context of rural African settings prove to be not cost-effective, rather than HCI as a strategy. HCI effectively identifies children and PLHIV with TB and should be prioritized. Meanwhile, the Passive case-finding strategy effectively finds men with TB and costs lower than household contact investigation.

The community as an active part in the implementation of interventions for the prevention and care of tuberculosis: A scoping review.

Interventions involving direct community stakeholders include a variety of approaches in which members take an active role in improving their health. We evaluated studies in which the community has actively participated to strengthen tuberculosis prevention and care programs. A literature search was performed in Pubmed, Scopus, ERIC, Global Index Medicus, Scielo, Cochrane Library, LILACS, Google Scholar, speciality journals, and other bibliographic references. The primary question for this review was: ¿what is known about tuberculosis control interventions and programs in which the community has been an active part?. Two reviewers performed the search, screening, and selection of studies independently. In cases of discrepancies over the eligibility of an article, it was resolved by consensus. 130 studies were selected, of which 68.47% (n = 89/130) were published after 2010. The studies were conducted in Africa (44.62%), the Americas (22.31%) and Southeast Asia (19.23%). It was found that 20% (n = 26/130) of the studies evaluated the participation of the community in the detection/active search of cases, 20.77% (n = 27/130) in the promotion/prevention of tuberculosis; 23.07% (n = 30/130) in identifying barriers to treatment, 46.15% (n = 60/130) in supervision during treatment and 3.08% (n = 4/130) in social support for patient. Community participation not only strengthens the capacities of health systems for the prevention and care of tuberculosis, but also allows a better understanding of the disease from the perspective of the patient and the affected community by identifying barriers and difficulties through of the tuberculosis care cascade. Engaging key community stakeholders in co-creating solutions offers a critical pathway for local governments to eradicate TB.

Factors associated with mortality in HIV-TB co-infected patients during and after the course of TB treatment in high-burden settings, Mumbai, India: A cohort analysis.

Knowledge of factors associated with TB mortality during treatment and post treatment will help us develop better monitoring and implementation strategies for TB control. We designed the present study to examine the factors associated with mortality in HIV-TB co-infected patients during and after the course of TB treatment. This study is a cohort analysis of secondary data collected from 1804 HIV-TB co-infected individuals from 16 anti-retroviral therapy (ART) centres affiliated with the Mumbai Districts AIDS Control Society, Mumbai, India. We used Kaplan Meier survival curves and hazard ratios to estimate the mortality in patients. The overall mortality rate in this cohort was 1.14 per 100 per month. The mortality proportion was 18% (95% CI: 16.1%, 20.1%) during treatment and 10.6% (95% CI: 8.9%, 12.5%) in the post-treatment period. Mortality was significantly higher in those with a CD4 count 0-200 cells/mm3 (HR: 3.04, 95% CI: 2.13, 4.15; p < 0.001), and in patients who were ART naïve and referred to the ART centre with a diagnosis of TB (HR: 1.39, 95% CI: 1.06, 1.82; p = 0.016). Mortality was also significantly higher in the first 6 months after initiation of ART (HR: 1.36, 95% CI: 1.06, 1.75; p = 0.016). A decrease in the CD4 counts from initial levels at start of TB treatment to end of TB treatment was associated with higher mortality in the post-treatment period. The overall mortality remains high; early identification of TB and HIV disease, and use of rapid point of care tests for diagnosis of TB are needed across all health care facilities. Post-treatment follow-up and monitoring is important in HIV-TB co-infected patients, and post-treatment mortality should also be considered as one of the indicators for successful TB control programmes.

Molecular epidemiology and drug sensitivity of Mycobacterium tuberculosis in homeless individuals in the Addis Ababa city, Ethiopia

Although homeless segment of the society could be the hotspots for tuberculosis (TB) transmission, there is little data on TB in homeless individuals in Ethiopia. The objective of this study was to investigate the molecular epidemiology and drug sensitivity of Mycobacterium tuberculosis (M. tuberculosis) isolated from homeless individuals in Addis Ababa, Ethiopia. The study was conducted on 59 M. tuberculosis isolates, which were recovered by the clinical screening of 5600 homeless individuals and bacteriological examination of 641 individuals with symptoms of pulmonary tuberculosis (PTB). Region of difference-9 (RD9) based polymerase-chain reaction (PCR), Spoligotyping and 24-loci Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeat (MIRU-VNTR) typing were used for genotyping of the isolates. In addition, drug sensitivity test was performed on the isolates using BD Bactec Mycobacterial Growth Inhibition Tube (MGIT) 960. Fifty-eight of the 59 isolates were positive by spoligotyping and spoligotyping International type (SIT) 53, SIT 37, and SIT 149 were the dominant spoligotypes; each consisting of 19%, 15.5%, and10.3% of the isolates, respectively. The majority of the isolates (89.7%) were members of the Euro-American (EA) major lineage. MIRU-VNTR identified Ethiopia_3, Delhi/CAS, Ethiopia_2, TUR, X-type, Ethiopia_H37Rv-like strain, Haarlem and Latin-American Mediterranean (LAM) sub lineages. The proportion of clustering was 77.6% (45/58) in spoligotyping while it was 39.7% (23/58) in 24-loci MIRU-VNTR typing. Furthermore, the proportion of clustering was significantly lowered to 10.3% (6/58) when a combination of spoligotyping and 24-loci MIRU-VNTRplus was used. The recent transmission index (RTI) recorded by spoligotyping, 24-loci MIRU-VNTR typing, and a combination of the two genotyping methods were 58.6%, 27.6% and 5.2%, respectively. Young age and living in groups were significantly associated with strain clustering (P < 0.05). The drug sensitivity test (DST) result showed 8.9% (4/58) of the isolates were resistant to one or more first line ant-TB drugs; but multidrug resistant isolate was not detected. Clustering and RTI could suggest the transmission of TB in the homeless individuals, which could suggest a similar pattern of transmission between homeless individuals and the general population. Hence, the TB control program should consider homeless individuals during the implementation of TB control program.

Care-seeking pathways and diagnostic delays in extrapulmonary TB patients

SETTING: This study was conducted at a private tertiary hospital engaged with the TB control programme in the city of Lahore, Pakistan.OBJECTIVE: To assess the healthcare-seeking pathways, different delays and factors associated with delays among the patients who presented in the outpatient department with tuberculous lymphadenitis and pleuritis, the most common manifestations of extrapulmonary TB.DESIGN: This cross-sectional study was conducted prospectively from April 2016 to August 2017.RESULTS: The median age of the 339 patients analysed was 22 years (IQR 17–30); tuberculous lymphadenitis was predominant in females (63%), while pleuritis affected more males (64%). Overall, 62% reported seeking care from healthcare providers before diagnosis, of whom 62% sought care from private facilities, 32% visited facilities &gt;2 times and 8% visited traditional healers. Diagnostic delay was associated with tuberculous lymphadenitis, age 15–44 years, poor socio-economic status and poor TB knowledge.CONCLUSION: There was considerable delay in the management of extrapulmonary TB patients, and the health-system delay was the major contributor, leading to increased patient suffering. Efforts towards minimising health-system delay need to be prioritised for patient screening and diagnosis, with a feasible algorithm that is workable in resource-limited settings.

Predictors of multidrug-resistant tuberculosis in a teaching hospital in Ghana: A case-control study.

Multidrug-resistant Tuberculosis (MDR-TB) remains a global health concern. The disease results in a prolonged treatment and hence, poses a financial burden to affected individuals and their families. The Ghana National TB Control Programme (NTP) has made extensive efforts to control the menace, however, it remains a concern. This study, therefore, aimed to determine the predictors of multidrug-resistant TB in the Cape Coast Teaching Hospital of Ghana. An unmatched case-control study involving 37 cases and 111 controls was conducted using data of TB cases registered for treatment between January 2018 and December 2020 at the Cape Coast Teaching Hospital. Socio-demographic, individual level and social characteristics information were collected from respondents through telephone surveys, face-to-face interviews and review of records using a structured questionnaire built in the Kobo Collect Toolbox. The data was exported to Stata version 16.0 for analysis. Chi-square test and multiple logistic regression were used to determine the predictors of MDR-TB. Associations were considered statistically significant at a 95% confidence interval with a p-value of less than 0.05. The results revealed that the majority (25 [67.6%]) of MDR-TB cases and controls (76 [68.5%]) were aged 30 years and above with a median age of 36.5 (IQR: 28-50) years for all respondents, while 20 (54.1%) of MDR-TB cases and 33 (29.7%) of controls lived in households with one room residences for their families. The following predictors for MDR-TB were identified: BCG vaccination status (AOR = 0.17,95% CI:0.07-0.45), long distance to health facility (AOR = 4.11, 95% CI: 1.55-10.87), number of rooms in residence (AOR = 0.37,95% CI: 0.14-0.99) and first place of visit upon noticing TB symptom (AOR = 4.22,95% CI:1.31-13.64). Predictors of MDR-TB in the current study were multi-faceted. Measures to control MDR-TB should target socio-demographic, health-seeking behaviour and social-related concerns.

Genomic transmission clusters and circulating lineages of Mycobacterium tuberculosis among refugees residing in refugee camps in Ethiopia

BackgroundUnderstanding the transmission dynamics of Mycobacterium tuberculosis (Mtb) could benefit the design of tuberculosis (TB) prevention and control strategies for refugee populations. Whole Genome Sequencing (WGS) has not yet been used to document the Mtb transmission dynamics among refugees in Ethiopia. We applied WGS to accurately identify transmission clusters and Mtb lineages among TB cases in refugee camps in Ethiopia. Method and designWe conducted a cross-sectional study of 610 refugees in refugee camps in Ethiopia presenting with symptoms of TB. WGS data of 67 isolates was analyzed using the Maximum Accessible Genome for Mtb Analysis (MAGMA) pipeline; iTol and FigTree were used to visualize phylogenetic trees, lineages, and the presence of transmission clusters. ResultsMtb culture-positive refugees originated from South Sudan (52/67, 77.6%), Somalia (9/67, 13.4%). Eritrea (4/67, 6%), and Sudan (2/67, 3%). The majority (52, 77.6%) of the isolates belonged to Mtb lineage (L) 3, and one L9 was identified from a Somalian refugee. The vast majority (82%) of the isolates were pan-susceptible Mtb, and none were multi-drug-resistant (MDR)-TB. Based on the 5-single nucleotide polymorphisms cutoff, we identified eight potential transmission clusters containing 23.9% of the isolates. Contact investigation confirmed epidemiological links with either family or social interaction within the refugee camps or with neighboring refugee camps. ConclusionFour lineages (L1, L3, L4, and L9) were identified, with the majority of strains being L3, reflecting the Mtb L3 dominance in South Sudan, where the majority of refugees originated from. Recent transmission among refugees was relatively low (24%), likely due to the short study period. The improved understanding of the Mtb transmission dynamics using WGS in refugee camps could assist in designing effective TB control programs for refugees.

Molecular Detection of Multidrug Resistance and Characterizations of Mutations in Mycobacterium Tuberculosis Using Polycarbonate Track-Etched Membrane Based DNA Bio-Chip.

With the widespread use of rifampicin (RMP) and isoniazid (INH), multidrug resistance (MDR) in Mycobacterium tuberculosis (M.tb) poses a threat to the success of tuberculosis (TB) control programs. We have developed a new polycarbonate track-etched membranes(PC-TEM) based DNA bio-chip designed for rapid detection of mutations conferring MDR inM.tbculture isolates. Bio-chips were designed to contain 14 specific probes for wild type and mutated allele of selected codons within 80bprifampicin resistance determining region of rpoB gene, katGgene andmabA-inhAregulatory region. RMP-resistance-associated gene mutation pointsrpoB 516, 526, 531and533, and the INH-resistance-associated gene mutation pointskatG315andinhA-15were targeted. Bio-chip signal was detected using enhanced chemiluminescence. A total of 50 culture isolates that were sensitive or resistant to RMP and/or INH were analyzed by bio-chip. The results of culture-based drug susceptibility testing (DST)were used as the gold standard and gene sequencing was performed to resolve the discordance. Amongst 50 culture isolates, we have detected 18 MDR, 9 RMP mono-resistant, 6 INH mono-resistant, and 17 fully susceptible isolates. The developed DNA bio-chip has a sensitivity of 90% for RMP and MDR and 100% for INH resistance. The bio-chip has a specificity of 100% for RMP and MDR and 88.8% for INH detection. The identification of mutations using the DNA bio-chip was 100% concordant with the sequencing data for the probes covered by the bio-chip. The detection ofrpoB, katGand inhA gene mutation points by a DNA bio-chip may be used as a rapid, accurate, and economical, clinical detection method for MDR detection in M.tb. This is very valuable for the control of TB epidemics.

Evaluation of treatment outcomes among adult patients diagnosed with tuberculosis in Ghana: A 10 year retrospective review

ObjectivesThe study determined tuberculosis (TB) treatment outcomes in Southern Ghana from 2012 to 2021. MethodsA retrospective analysis of service data on TB cases was conducted. Treatment success was defined as TB cure or completion of treatment course, whereas unsuccessful outcomes was defined as death, failure of treatment and lost to follow up. Bivariate and multivariate logistic regression was used to determine factors associated with treatment outcomes. ResultsA total of 4106 adult TB cases were reported with a median age of 41 (interquartile range 32-52) years. Of these, 93.1% (n = 3823) were newly diagnosed. The treatment success rate declined from 71.0% in 2012 to 55.7% in 2021 (ktau-b = −0.56, P = 0.0318). Clinically diagnosed TB and extra-pulmonary TB had 7.0% (adjusted prevalence ratio [aPR]: 0.93, 95% confidence interval [CI]: 0.88-1.00) and 24.0% (aPR: 0.76, 95% CI: 0.69-0.84) respectively, less successful treatment outcome compared to pulmonary TB patients. HIV negative status was associated with 22% higher successful treatment outcome compared with being HIV positive (aPR: 1.22, 95% CI: 1.12-1.33). ConclusionTuberculosis treatment success rate declined over the period. There is a need for the TB Control Programme to review the national and sub-national TB data to ascertain poor performing TB treatment sites to identify and address context specific challenges with treatment interventions and system inadequacies to improve treatment success rates.

Analisis Implementasi Kebijakan Permenkes Nomor 67 Tahun 2016 Tentang Penanggulangan Tuberkulosis di Kabupaten Kudus Tahun 2021 (Studi Kasus di Wilayah Kerja Puskesmas Purwosari Kudus)

Tuberculosis is an infectious disease that is still a public health problem and one of the causes of death so it is necessary to carry out TB control programs on an ongoing basis. The purpose of the study was to analyze the implementation of policies on TB control in Kudus Regency. The number of positive cases found in Kudus Regency in 19 health centers in 2019 was 681 cases. The case notification rate = CNR of all tuberculosis cases per 100,000 population is 79 per 100,000 population. Based on data obtained by interviews with TB program management officers of the Kudus Regency health office, the highest number of cases were in the Kudus City District work area at the Purwosari Health Center as many as 67 cases with 41 men and 26 women, with a prevalence of 6.7 percent and an incidence rate of 31.3 percent. &#x0D; This research was conducted from August to September 2021. This type of research is descriptive qualitative research with informant retrieval techniques by purposive sampling. The main informants are TB program managers at health center and associate doctors at health center. Test validity with source triangulation informants to the head of the Purwosari Kudus health center, health survey officers and tuberculosis patients. The results showed that the implementation of policy implementation has not run optimally. Of several variables that affect the implementation of policy implementation, namely; human resources; cross-sector relations; and environmental conditions, in the study, it was found that there were still variables that had not run optimally so that they hampered the implementation of this implementation, namely the lack of community support in TB control, and affected by the COVID 19 pandemic.

Tuberculosis cohort analysis in Zimbabwe: The need to strengthen patient follow-up throughout the tuberculosis care cascade.

Globally people with tuberculosis (TB) continue to be missed each year. They are either not diagnosed or not reported which indicates possible leakages in the TB care cascade. Zimbabwe is not spared with over 12000 missed cases in 2020. A preliminary review of TB treatment outcomes indicated patient leakages throughout the presumptive cascade and undesirable treatment outcomes in selected cities. Chegutu District had pre-diagnosis and pretreatment losses to follow-up while Mutare City among others had 22.0% of outcomes not evaluated in the second quarter of 2021, and death rates as high as 14% were recorded in Gweru District. The problem persists despite training on data analysis and use. The TB cohorts were analysed to determine the performance of the care cascade and the spatial distribution of treatment outcomes in Zimbabwe. Using data from district health information software version 2.3 (DHIS2.3), a secondary data analysis of 2020 drug-sensitive (DS) TB treatment cohorts was conducted. We calculated the percentage of pre-diagnosis, and pre-treatment loss to follow-up (LTFU). For TB treatment outcomes, 'cured' and 'treatment completed' were categorized as treatment success, while 'death', 'loss to follow-up (LTFU), and 'not evaluated' were categorized as undesirable outcomes. Univariate analysis of the data was conducted where frequencies were calculated, and data was presented in graphs for the cascade, treatment success, and undesirable outcomes while tables were created for the description of study participants and data quality. QGIS was used to generate maps showing undesirable treatment outcomes. An analysis of national data found 107583 people were presumed to have TB based on symptomatic screening and or x-ray and 21.4% were LTFU before the specimen was investigated. Of the 84534 that got tested, 10.0% did not receive their results. The treatment initiation rate was 99.1%. Analysis of treatment outcomes done at the provincial level showed that Matabeleland South Province had the lowest treatment success rate of 77.3% and high death rates were recorded in Matabeleland South (30.0%), Masvingo (27.3%), and Matabeleland North (26.1%) provinces. Overall, there were high percentages of not-evaluated treatment outcomes. Pre-diagnosis LTFU was high, and high death and loss to follow-up rates were prevalent in provinces with artisanal and small-scale mining (ASM) activities. Unevaluated treatment outcomes were also prevalent and data quality remains a challenge within the national TB control program. We recommended strengthening patient follow-up at all levels within the TB care cascade, strengthening capacity-building for data analysis and use, further analysis to determine factors associated with undesirable outcomes and a study on why LTFU remains high.

Latent tuberculosis infection treatment completion in Biscay: differences between regimens and monitoring approaches.

Contact tracing and treatment of latent tuberculosis infection (LTBI) is a key element of tuberculosis (TB) control in low TB incidence countries. A TB control and prevention program has been active in the Basque Country since 2003, including the development of the nurse case manager role and a unified electronic record. Three World Health Organization-approved LTBI regimens have been used: isoniazid for 6 months (6H), rifampicin for 4 months (4R), and isoniazid and rifampicin for 3 months (3HR). Centralized follow-up by a TB nurse case manager started in January 2016, with regular telephone follow-up, telemonitoring of blood test results, and monitoring of adherence by electronic review of drugs dispensed in pharmacies. To estimate LTBI treatment completion and toxicity of different preventive treatment regimens in a real-world setting. Secondary objective: to investigate the adherence to different approaches to preventive treatment monitoring. A multicentre retrospective cohort study was conducted using data collected prospectively on contacts of patients with TB in five hospitals in Biscay from 2003 to 2022. A total of 3,066 contacts with LTBI were included. The overall completion rate was 66.8%; 86.5% of patients on 3HR (n = 699) completed treatment vs. 68.3% (n = 1,260) of those on 6H (p < 0.0001). The rate of toxicity was 3.8%, without significant differences between the regimens. A total of 394 contacts were monitored by a TB nurse case manager. In these patients, the completion rate was 85% vs. 67% in those under standard care (p < 0.001). A multivariate logistic regression model identified three independent factors associated with treatment completion: being female, the 3HR regimen, and nurse telemonitoring. 3HR was well tolerated and associated with a higher rate of treatment completion. Patients with nurse telemonitoring follow-up had better completion rates.

Sero-epidemiology of bovine tuberculosis in dairy cattle in Chattogram, Bangladesh

Mycobacterium bovis-caused bovine tuberculosis (bTB) is a global public health concern and commercially significant zoonotic disease. Many wild and domesticated animals, including cattle, are susceptible to this fatal disease and play an important role in cross-species transmission. To gain a better understanding of bTB in dairy cattle, a bTB serological study is also necessary in order to identify efficient bTB control strategies in Bangladesh. In Bangladesh, however, seroepidemiological research is either non-existent or limited (particularly Chattogram). To determine the seroprevalence of bTB and related possible risk factors in dairy cattle, a serological cross-sectional study was conducted (both animal and farm level). We estimated the seroprevalence of bTB was 7.5%(N=442) in this investigation, which also identified one animal-level and two farm-level possible risk factors. Individual animal risk factors included cattle source (own stock: OR=3.4, 95% CI: 1.4-8.1, p=0.006), and farm risk factors included population size (Larger: OR= 26.2, 95% CI: 2.2-319.1, p=0.010) and stocking density (Low and moderate: OR=19.6, 95%CI: 1.5-261.5, p=0.024). In the face-in housing system, there was also a higher risk of bTB seropositivity (OR=4.5). The research's key findings are thoroughly explored, and the findings will aid in the prevention and control of bTB in Bangladesh. In addition, early detection of positive cases, as well as their prompt removal and good farm management practices, can assist in preventing the spread of bTB to new human or bovine hosts. In underdeveloped nations like Bangladesh, a coordinated effort with local public health officials is critical for implementing an efficient TB control program.

Latent Tuberculosis: Challenges in Diagnosis and Treatment, Perspectives, and the Crucial Role of Biomarkers.

Tuberculosis (TB) is the major cause of morbidity and mortality globally, which is caused by a single infectious agent Mycobacterium tuberculosis. For years, many TB control programmes are established for effective diagnosis and treatment of active TB cases, but these approaches alone are insufficient for TB eradication. This review aims to discourse on the crucial management of latent tuberculosis infection. This review will first summarize the current status, and methods for diagnosing latent tuberculosis then describes the challenges involved in the diagnosis and treatment of latent tuberculosis, and finally encounters the purpose of biomarkers as predicting tool in latent tuberculosis.

Converging Epidemics: A Narrative Review of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) Coinfection.

Tuberculosis (TB), primarily caused by Mycobacterium tuberculosis (MTB), remains a leading cause of mortality in individuals living with human immunodeficiency virus (HIV) infection, posing a significant strain on healthcare systems. Coinfection of HIV and TB results in a mutually advantageous relationship that accelerates the progression of both diseases. TB is a major contributor to mortality in individuals with HIV. However, diagnosing coinfected individuals is challenging due to the prevalence of extrapulmonary TB and smear-negative disease. Overthe past decade, significant progress has been made in the fight against TB, thanks to advances in molecular techniques. Yet, these molecular diagnostic assays remain inaccessible to many individuals coinfected with HIV and TB due to their high cost. To expedite treatment and reduce transmission, it is crucial to integrate HIV and TB control programs more closely, thereby minimizing diagnostic delays and enhancing early case detection. This review aims to provide a comprehensive overview of the current state of knowledge regarding the interplay between HIV and TB. It highlights recent developments in sensitive and rapid TB diagnostic tests, cutting-edge preventive strategies, and the screening of individuals coinfected with both HIV and TB. The objectives of this review are to shed light on the complex relationship between these two diseases and to emphasize the importance of integrated efforts in combating their impact on public health.