Tuberculosis Morbidity Research Articles

Tuberculosis morbidity and mortality in the Aktobe province of Kazakhstan for the period 2008-2017

Tuberculosis constitutes an extraordinary significant social problem for the population in all over the world given 10.4 million new cases registered globally in 2016. This article describes a state and dynamics of the key indexes on Tuberculosis in the Aktobe province of Kazakhstan for the decade. Aim of the research is the general evaluation of the tuberculosis key indexes across the Aktobe province during the decade 2008-2017 comparing with the country’s ones. Methods — The study has been performed retrospectively based on official records in the Tuberculosis Register. Dynamics of the tuberculosis incidence during the last 10 years across the country and the province has been analysed, along with the trends of morbidity determined by the least squares method. Average annual rates of growth (Тgr) have been determined. Results — The number of the tuberculosis cases in the Aktobe province over the decade decreased by 44.4%, reaching 57.8 per every 100,000 population in 2017 (compared to 103.0 in 2008). Nevertheless, the trend of morbidity growth across the province is relatively high compared to the republican index (-3.34 vs. -4.87). Comparative data on the different strata of population indicate that the morbidity amongst the urban inhabitants is higher than in the countryside population across the region (61.6 vs. 51.4). The death rate across the province decreased in 6.3 times: 17.1 vs. 2.7 by 2017 per 100,000. Conclusion — Current situation is featured by significant decreasing of morbidity and mortality rates. Proper filling in the Register close to international standards is needed.

Increasing isoniazid preventive therapy in people living with HIV in north central Nigeria: outcomes from a quality improvement strategy

Abstract Background Isoniazid preventive therapy (IPT) significantly reduces the incidence of active tuberculosis in people living with HIV. However, despite high tuberculosis morbidity and mortality in people living with HIV, uptake of IPT remains grossly suboptimal, with implementation impeded by several barriers related to health workers and patients. We evaluated the use of a quality improvement approach to improve IPT in a tertiary hospital in north central Nigeria with a high HIV burden. Methods In July, 2018, a 4-week quality improvement pilot project was undertaken at the Federal Medical Centre in Keffi, Nigeria. The facility-based continuous quality-improvement committee, comprised of different cadres of staff working in the hospital's antiretroviral therapy clinic, reviewed their HIV quality-of-care indicators and noted that only 3% of eligible HIV clients received IPT between September, 2017, and March, 2018. The committee did a root cause analysis and identified poor knowledge of clinicians on the importance of IPT, fear of drug resistance, frequent stock-outs of isoniazid, and poor medication adherence as the key reasons for low rates of IPT. In response to these findings, the following key change ideas were implemented: IPT orientation for clinicians, incorporation of IPT education into routine health education for people living with HIV, display of IPT information education and communication materials in consulting and patient waiting rooms, and auditing of clients' folders prior to consultation to identify and tag eligible folders with IPT sticky notes. Findings Between June 19, 2018, and July 17, 2018, 278 adult clients with a clinic appointment had their folders audited for IPT eligibility and 108 eligible folders (39%) were identified and tagged with an IPT sticker. Of those eligible for IPT, 103 (95%) kept their clinic appointment and all had a 6-month course of isoniazid prescribed. However, of the patients who attended, only 93 (90%) received IPT because stock of the drug had run out. Interpretation A quality improvement strategy for improving IPT in HIV patients was effective, with 86% of eligible patients receiving treatment—an 83% increase from baseline. Quality-improvement principles such as team work and implementation of change ideas targeted at root causes of the problem were pivotal to success. Continued implementation and scale-up of effective change ideas to other hospitals could greatly reduce tuberculosis morbidity and mortality in people living with HIV, while ensuring continued availability of isoniazid. Funding CDC-PEPFAR.

Do health beliefs, personality traits, and interpersonal concerns predict TB prevention behavior among Japanese adults?

Despite public health measures and health-promotion efforts, the decline in tuberculosis (TB) morbidity in Japan has been slow, with a higher TB incidence rate relative to those observed in most developed countries. Because health behavior depends on multiple factors and is formulated within a social context, a theory-driven model would be necessary to increase TB prevention behavior. Based upon the Health Belief Model, this study examined the effects of health beliefs, personality traits, and social factors on TB prevention behavior among Japanese adults. A cross-sectional survey was carried out with a nationally representative sample (N = 911; 50.9% women; mean age 49.5, SD = 14.1). Path analyses gave empirical support for the hypothesized model, suggesting that TB prevention behaviors are influenced by not only perceived susceptibility to the illness but also social factors such as cues to action and one’s concern to benefit others. The findings have implications for research examining health communication tailored to individual differences in personality and interpersonal concern.

Influence of work conditions on clinical and epidemiologic manifestations of tuberculosis in uranium extraction enterprise workers

Objective was to evaluate influence of work conditions on clinical and epidemiologic manifestations of tuberculosis in workers engaged into extraction and processing of uranium ores.Materials and methods. Retrospective study with total sampling method covered tuberculosis cases in working inhabitants of Krasnokamensk town in Zabaikalsk region, aged 20–60 years (2005–2015). Formed sample (n=94) was divided into two groups: main group — workers of uranium-extracting enterprise (n=40), reference group — workers of enterprises not connected with uranium production (n=54). In the groups analyzed, the study covered longstanding dynamics of morbidity and clinical manifestations of tuberculosis process. Evaluation also included tuberculosis risk in workers of uranium production, in dependence on levels of radiation exposure and length of service.Results. Higher average long-term level of tuberculosis morbidity was proved to be characteristic for the uranium production workers (Me=70.10/0000 [40.2–115.5]), not depending on level (Me=13.20/0000 [9.7–31.8]) and trend of morbidity among working inhabitants of the town (rs=0.382; p=0.247). Tuberculosis process has more unfavorable clinical manifestations in the uranium production workers with higher level of radiation exposure (group A personnel). Among them, more frequent discharge of the causative agent, in comparison with workers suffering from tuberculosis and having less level of radiation exposure (group B personnel) (52% and 16% respectively; p=0.022). Th e maximal tuberculosis risk was demonstrated for group A personnel with length of service from 5 to 15 years (OP=2.7 [1.1–7.0]).Conclusion. Work conditions of uranium enterprise workers have negative influence on tuberculosis morbidity level and result in highly contagious types of tuberculosis.

Особенности разработки программы НАССР на пищеблоках в учреждениях здравоохранения

Tuberculosis remains a widespread social disease, both in Russia and in the Republic of Buryatia. According to the Ministry of Health of the Republic of Buryatia, the region ranked 8th according to tuberculosis morbidity in 2017 in the Siberian Federal district. It was preceded by the Republic of Tuva, Irkutsk, Novosibirsk, Kemerovo regions, Altai territory, Omsk region, and Krasnoyarsk region. The Republic ranked 18th among all the federal entities of the Russian Federation. Tuberculosis remains one of the top 10 mortality factors in the world. The disease affects various organs, a fairly easy mode of infection, and a long treatment period. Therefore, it requires an intensive medical treatment and a high-calorie diet provided by nutrition departments of medical institutions. The present paper features the experience of nutrition departments of the Republican Clinical Tuberculosis Dispensary, i.e. the aspect of food production for a certain population group. The research defines the critical control points of the technological stage of production, taking into account the existing risks and maximum permissible values. The authors developed some elements of the HACCP program in the form of maps and block diagrams of each stage of the technological process. The research results make it possible to create a quality management program based on the principles of HACCP fat nutrition department of the Republican Clinical Tuberculosis Dispensary.

Introduction and evaluation of multidrug-resistant tuberculosis supplemental surveillance in the United States

The current tuberculosis (TB) case reporting system for the United States, the Report of Verified Case of TB (RVCT), has minimal capture of multidrug-resistant (MDR) TB treatment and adverse events. Data were abstracted in five states using the form for 13 MDR TB patients during 2012–2015. The Centers for Disease Control and Prevention Guidelines for Evaluating Public Health Surveillance Systems were used to evaluate attributes of the form. Unstructured interviews with pilot sites and stakeholders provided qualitative feedback. The form was acceptable, simple, stable, representative, and provided high-quality data but was not flexible or timely. For the 13 patients on whom data were collected, the median duration of treatment with an injectable medication was 216 days (IQR 203–252). Six (46%) patients reported a side effect requiring a medication change and eight (62%) had a side effect present at treatment completion. A standardized MDR TB supplemental surveillance form was well received by stakeholders whose feedback was critical to making modifications. The finalized form will be implemented nationally in 2020 and will provide MDR TB treatment and morbidity data in the United States to help ensure patients with MDR TB receive the most effective treatment regimens with the least toxic drugs.

HIV Prevalence Among Tuberculosis Patients in Sub-Saharan Africa: A Systematic Review and Meta-analysis.

HIV associated tuberculosis (TB) morbidity and mortality is a major concern in sub-Saharan Africa. Understanding the level of HIV infection among TB patients is vital for adequate response. We conducted a systematic review and meta-analysis to estimate the prevalence of HIV in TB patients in sub-Saharan Africa. We searched PubMed, EMBASE, Web of Science and CINAHL databases. A meta-analysis with a random-effects model was performed. Potential sources of heterogeneity in the prevalence estimates were explored using meta-regression analysis. We identified 68 studies that collectively included 62,969TB patients between 1990 and 2017. The overall estimate of HIV prevalence in TB patients was 31.8% (95% CI 27.8-36.1). There was substantial heterogeneity in the prevalence estimates in Southern, Central, Eastern, and Western sub-Saharan Africa regions (43.7, 41.3, 31.1 and 25.5%, respectively). We noted an apparent reduction in the estimate from 33.7% (95% CI 27.6-40.4) in the period before 2000 to 25.7% (95% CI 17.6-336.6) in the period after 2010. The Eastern and Southern sub-Saharan Africa region had higher prevalence [34.4% (95% CI 29.3-34.4)] than the Western and Central region [27.3% (95% CI 21.6-33.8)]. The prevalence of HIV in TB patients has declined over time in sub-Saharan Africa. We argue that this is due to strengthened HIV prevention and control response and enhanced TB/HIV collaborative activities. Countries and regions with high burdens of HIV and TB should strengthen and sustain efforts in order to achieve the goal of ending both HIV and TB epidemics in line with the Sustainable Development Goals.

UNDERSTANDING TUBERCULOSIS MORTALITY FLUCTUATION IN THE PHILIPPINES BY ARTIFICIAL INTELLIGENCE

The Philippines is one of the countries with high tuberculosis (TB) mortality across the globe. This study investigates the trends of the TB mortality and morbidity incidence from 1998 to 2010 based on the surveillance data of the Department of Health. From the dataset, symbolic regression was used to forecast yearly morbidity cases of TB. Using the same analysis, a significant non-linear correlation between TB morbidity and TB mortality was revealed. Analyzing the equation, the trend component represented by the first two terms shows that the morbidity cases increases like a quadratic function. The correction factor, however, tells us that there are fluctuations around the trend curve because of the presence of the cosine terms. Following the equation generated through symbolic regression, in the next 15 years (2011–2025), there is an increasing number of TB morbidity cases considering the present TB Control Programs of the country. Mortality cases follow the same increasing trend but with evident fluctuations over the years. Therefore, without the presence of government and non-government-initiated TB prevention and control programs, there would be an increase in both TB morbidity and mortality cases in the Philippines. Conversely, the existence of such interventions will slow down the rise of TB mortality and morbidity. Full implementation of anti-TB programs is to be mandated to and must be adhered by all public and private healthcare institutions to help realize the vision of a TB-free Philippines.

And Epidemiological Characteristics of Tuberculosis in Children in the Astrakhan Region

The article presents the results of the analysis of the epidemiological situation of tuberculosis in children of the Astrakhan region for the period from 2013 to 2017. The incidence of tuberculosis of children in the region exceeds the average Russian Federation 2.9, the southern Federal district in 3.2 time. In the structure of morbidity of children is dominated by tuberculosis of intrathoracic lymph nodes (75.6%). The increase of tuberculosis morbidity of children population of the region could also be: the increasing incidence and delayed diagnosis of tuberculosis in adults introduction in practice of modern methods of diagnostics (computer tomography, PCR, Diaskintest) allowing to identify the disease in a larger number of patients, lack of alertness of doctors of general medical network on early diagnosis of tuberculosis.

Determinants of patient and health care services delays for tuberculosis diagnosis in Italy: a cross-sectional observational study

BackgroundPrompt diagnosis of active tuberculosis (TB) has paramount importance to reduce TB morbidity and mortality and to prevent the spread of Mycobacterium tuberculosis. Few studies so far have assessed the diagnostic delay of TB and its risk factors in low-incidence countries.MethodsWe present a cross-sectional multicentre observational study enrolling all consecutive patients diagnosed with TB in seven referral centres in Italy. Information on demographic and clinical characteristics, health-seeking trajectories and patients’ knowledge and awareness of TB were collected. Diagnostic delay was assessed as patient-related (time between symptoms onset and presentation to care) and healthcare-related (time between presentation to care and TB diagnosis). Factors associated with patient-related and healthcare-related delays in the highest tertile were explored using uni- and multivariate logistic regression analyses.ResultsWe enrolled 137 patients, between June 2011 and May 2012. The median diagnostic delay was 66 days (Interquartile Range [IQR] 31–146). Patient-related and healthcare-related delay were 14.5 days (IQR 0–54) and 31 days (IQR: 7.25–85), respectively. Using multivariable analysis, patients living in Italy for < 5 years were more likely to have longer patient-related delay (> 3 weeks) than those living in Italy for > 5 years (Odds Ratio [OR] 3.47; 95% Confidence Interval [CI] 1.09–11.01). The most common self-reported reasons to delay presentation to care were the mild nature of symptoms (82%) and a good self-perceived health (76%). About a quarter (26%) of patients had wrong beliefs and little knowledge of TB, although this was not associated with longer diagnostic delay. Regarding healthcare-related delay, multivariate analysis showed that extra-pulmonary TB (OR 4.3; 95% CI 1.4–13.8) and first contact with general practitioner (OR 5.1; 95% CI 1.8–14.5) were both independently associated with higher risk of healthcare-related delay > 10 weeks.ConclusionsIn this study, TB was diagnosed with a remarkable delay, mainly attributable to the healthcare services. Delay was higher in patients with extra-pulmonary disease and in those first assessed by general practitioners. We suggest the need to improve knowledge and raise awareness about TB not only in the general population but also among medical providers. Furthermore, specific programs to improve access to care should be designed for recent immigrants, at significantly high risk of patient-related delay.Trial registrationThe study protocol was registered under the US National Institute of Health ClinicalTrials.gov register, reference number: NCT01390987. Study start date: June 2011.

Coordinating the prevention, treatment, and care continuum for HIV-associated tuberculosis in prisons: a health systems strengthening approach.

To advance a re-conceptualized prevention, treatment, and care continuum (PTCC) for HIV-associated tuberculosis (TB) in prisons, and to make recommendations for strengthening prison health systems and reducing HIV-associated TB morbidity and mortality throughout the cycle of pretrial detention, incarceration, and release. Despite evidence of increased HIV-associated TB burden in prisons compared to the general population, prisoners face entrenched barriers to accessing anti-TB therapy, antiretroviral therapy, and evidence-based HIV and TB prevention. New approaches, suitable for the complexities of healthcare delivery in prisons, have emerged that may address these barriers, and include: novel TB diagnostics, universal test and treat for HIV, medication-assisted treatment for opioid dependence, comprehensive transitional case management, and peer navigation, among others. Realizing ambitious international HIV and TB targets in prisons will only be possible by first addressing the root causes of the TB/HIV syndemic, which are deeply intertwined with human rights violations and weaknesses in prison health systems, and, second, fundamentally re-organizing HIV and TB services around a coordinated PTCC. Taking these steps can help ensure universal access to comprehensive, good-quality, free and voluntary TB/HIV prevention, treatment, and care, and advance efforts to strengthen health resourcing, staffing, information management, and primary care access within prisons.

Tuberculosis and other chronic morbidity profile of sewage workers of Delhi

BackgroundSewage management is hazardous due to chronic exposure to chemical gases, bioaerosols and micro-organisms through inhalation; accidental oral intake and penetration through skin or mucous membranes through injuries or breech in personal protective equipment. While there has been some research on isolated infections and multisystem symptom profiling of sewage workers, there is little research on the burden of chronic illnesses like Tuberculosis and Non Communicable Diseases (NCDs). MethodsA cross sectional observational study was conducted on chronic comorbidity profile of sewage workers with more than five years of occupational experience and employed in three contiguous districts of NCT of Delhi. ResultsThe study sample consisted of 104 sewage workers with mean age of 50.71 (±8.43) years, an average of 7.35 (±3.75) years of formal education and an average occupational exposure to sewage work of 21.28 (±10.54) years.21.15% sewage workers had Tuberculosis and 92.31% had at least one of the chronic respiratory diseases (COPD, Asthma or ACOS). 85.6% of participants were smokers. The most common NCD was Hypertension (67.3%) followed by Dyslipidaemia (50%) and Diabetes Mellitus (43.3%). There was clustering of NCDs with 53.85% subjects having three or more chronic disorders. Less than 5% of study participants were free from all the investigated chronic diseases. ConclusionThe sewage workers have an adverse chronic morbidity profile for both Tuberculosis and NCDs. There is an urgent need for epidemiological research and targeted screening and public health intervention for Tuberculosis and other NCDs in sewage workers as an occupational group.

Tuberculosis control: recalling past insights

The Article by Florian Marx and colleagues (April, 2018)1Marx FM Yaesoubi R Menzies NA et al.Tuberculosis control interventions targeted to previously treated people in a high-incidence setting: a modelling study.Lancet Glob Health. 2018; 6: e426-e435Summary Full Text Full Text PDF PubMed Scopus (28) Google Scholar represents an important advance in the understanding of tuberculosis and its management. The conventional wisdom has been that short-course chemotherapy for tuberculosis is a sterilising cure but the very high incidence of tuberculosis in previously treated patients suggests otherwise, with important implications for managing this infectious disease that continues to be one of the most important causes of mortality worldwide. In this context, it is of interest to recall the observations of Anthony Davies2Davies JCA The eradication of tuberculosis in Rhodesia with particular reference to the midlands and south eastern provinces. Phase one. London School of Hygiene & Tropical Medicine, 1966: 19Google Scholar who was concerned with the control of tuberculosis in the 1960s in what was then Rhodesia but is now Zimbabwe. In his thesis at the London School of Hygiene & Tropical Medicine (London, UK), written 52 years ago, he noted the following: “We must eradicate [tuberculosis] TB, and we must do it now, both as crusaders and as properly equipped scientists. All available resources must be used. Chemotherapy, computers, prophylaxis and prevention, case finding and kindness can be blended in a properly constructed epidemiological model which will tell us exactly where we are going and how fast… Tuberculosis is a relapsing disease—this was well recognized and emphasized before specific chemotherapy was available. In the early days of chemotherapy when the custom of resecting residual diseased lung was widespread I was able to study first-hand the specimens from several hundred such resections—there is little doubt that even after chemotherapy encapsulated lesions may contain pus under tension, and that without chemotherapy tubercle bacilli may survive in this type of lesion for many years… Life-long follow up is an arduous, and with modern chemotherapy a somewhat tedious and boring process for both doctor and patient… It may be suggested that in the absence of a comprehensive health infrastructure this task is impossible. On the other hand, for the very same reason it may be mandatory. In a country where the infrastructure is not ideal the body of patients known to have had tuberculosis provide a ready-made… network of people with whom an intimate doctor/patient relationship has been forged by many months of chemotherapy—this is a dividend from the money invested in treatment and to discard it would be prodigal.” Davies' insights into the pathology of tuberculosis and his understanding of tuberculosis management in resource-poor countries remain a lesson to us all. I declare no competing interests. Tuberculosis control interventions targeted to previously treated people in a high-incidence setting: a modelling studyIn this high-incidence setting, the use of targeted active case finding in combination with secondary isoniazid preventive therapy in previously treated individuals could accelerate decreases in tuberculosis morbidity and mortality. Studies to measure cost and resource implications are needed to establish the feasibility of this type of targeted approach for improving tuberculosis control in settings with high tuberculosis and HIV prevalence. Full-Text PDF Open Access

Translational Potential of Therapeutics Targeting Regulatory Myeloid Cells in Tuberculosis.

Despite recent advances in tuberculosis (TB) drug development and availability, successful antibiotic treatment is challenged by the parallel development of antimicrobial resistance. As a result, new approaches toward improving TB treatment have been proposed in an attempt to reduce the high TB morbidity and mortality rates. Host-directed therapies (HDTs), designed to modulate host immune components, provide an alternative approach for improving treatment outcome in both non-communicable and infectious diseases. Many candidate immunotherapeutics, designed to target regulatory myeloid immune components in cancer, have so far proven to be of value as repurposed HDT in TB. Several of these studies do however lack detailed description of the mechanism or host pathway affected by TB HDT treatment. In this review, we present an argument for greater appreciation of the role of regulatory myeloid cells, such as myeloid-derived suppressor cells (MDSC), as potential targets for the development of candidate TB HDT compounds. We discuss the role of MDSC in the context of Mycobacterium tuberculosis infection and disease, focussing primarily on their specific cellular functions and highlight the impact of HDTs on MDSC frequency and function.

Prevalence of Extensively Drug-Resistant Tuberculosis: a Descriptive Study

Background. Extensively drug-resistant tuberculosis (XDR-TB) is a threat to community health. Goal. The estimation of the prevalence of extensively drug-resistant tuberculosis in Omsk region, along with the clinical and epidemiological description of patients with XDRTB. Methodology. A retrospective descriptive epidemiologic research of tuberculosis morbidity in Omsk region in 2006–2017 was conducted.Results. The prevalence of extensively drug-resistant tuberculosis in Omsk region in 2006–2017 was stable at 35.6 per 100ths population with Tinc.=1.0%. The prevalence of extensively drug-resistant tuberculosis in Omsk region was 13.6 per 100ths population (n = 267). Among patients with XDR-TB the majority was of young working age 25–44 years (63.2%), male gender (80.9%), officially unemployed (75.6%), ill for at least 3 years (57.0%), suffering from infiltrative pulmonary tuberculosis (69.2%) and HIV-infected (31.8%). The resistance to seven first and second line antituberculosis drugs was found in 10.1% of patients with XDR-TB. Conclusions. The optimisation of approaches to the organization of additional measures for the prevention of extensively drug-resistant tuberculosis is needed.

Biological risk factor of occupational morbidity with tuberculosis among medical professionals

The article presents molecular genetic characteristics of M. tuberculosis circulating in Omsk region, as a biologic risk factor of tuberculosis morbidity among medical institutions workers. The authors used descriptive method of epidemiologic study, method of MIRUVNTR-typing of M. tuberculosis DNA. Findings are M. tuberculosis stains of Beijing genotype with VNTR-profile 233325173533424, isolated out of tuberculosis patients cluster being under stationary treatment. 65.2% of the stains had multiple drug-resistance to anti-tuberculosis medications. Respiratory tuberculosis was diagnosed in 85.4% of the cases, extra-pulmonary tuberculosis (urinary system, peripheral lymph nodes, eyes, CNS tuberculosis) equaled 14.6%. Nearly 30% of tuberculosis cases in the health care workers were associated with the bacterioexcretion.

Features of the development of tuberculosis in children not vaccinated with BCG

According to the data from the State Institution Public Health Center of the Ministry of Healthcare of Ukraine in region, starting from 2014, there is observed the increased rate of tuberculosis among children aged 0-17 years, in particular: in 2014 - 12.1 per 100 thousand of the population, in 2015 - 16.4 per 100 thousand of the population and in 2016 - 24.9 per 100 thousand of the population. At the same time, in 2016 this rate exceeded the national one by 2.3 times (10.5 if compared to 24.9). According to the Professor V.P. Kostorminova, the prophylactic activity of the BCG vaccine is 70-85% of the quality BCG vaccination and reduces the tuberculosis morbidity by 10 times and infectivity by 1.5-3 times.The purpose of the paper is to attract attention of pediatricians and parents to the issue of development of severe forms of tuberculosis in children not vaccinated with BCG.The article covers the clinical case of the development of severe form of tuberculosis in a child not vaccinated with BCG, who is periodically treated at the children's department of the clinical base of the Department of phthisiology and pulmonology of ZSMU at the State Institution Zaporizhzhia Regional Antituberculous Clinical Dispensary. It has been found that the features of the development of tuberculosis in a child not vaccinated with BCG from a family contact with a patient suffering from multidrug-resistant tuberculosis, in 2,5 years after birth there develops a multidrug-resistant tuberculosis combined with a specific destructive spondylitis. The absence of anti-TB immunity caused a rapid progressive involvement of the spine and lungs that was quickly complicated by a nonspecific pathology. Early detection of this pathology, adequate treatment, and the persistence of doctors ensured positive results and rehabilitation is still going on. At the same time, we would like to underscore the importance of BCG vaccination.

TB preventive therapy for people living with HIV: key considerations for scale-up in resource-limited settings.

Tuberculosis (TB) is the leading cause of death for persons living with the human immunodeficiency virus (PLHIV). TB preventive therapy (TPT) works synergistically with, and independently of, antiretroviral therapy to reduce TB morbidity, mortality and incidence among PLHIV. However, although TPT is a crucial and cost-effective component of HIV care for adults and children and has been recommended as an international standard of care for over a decade, it remains highly underutilized. If we are to end the global TB epidemic, we must address the significant reservoir of tuberculous infection, especially in those, such as PLHIV, who are most likely to progress to TB disease. To do so, we must confront the pervasive perception that barriers to TPT scale-up are insurmountable in resource-limited settings. Here we review available evidence to address several commonly stated obstacles to TPT scale-up, including the need for the tuberculin skin test, limited diagnostic capacity to reliably exclude TB disease, concerns about creating drug resistance, suboptimal patient adherence to therapy, inability to monitor for and prevent adverse events, a 'one size fits all' option for TPT regimen and duration, and uncertainty about TPT use in children, adolescents, and pregnant women. We also discuss TPT delivery in the era of differentiated care for PLHIV, how best to tackle advanced planning for drug procurement and supply chain management, and how to create an enabling environment for TPT scale-up success.

The Analysis of Morbidity of Tuberculosis of Respiratory Organs of Women of Reproductive Age on the Territory of the Nizhny Novgorod Oblast

The article presents analysis of epidemiological situation with tuberculosis of respiratory organs among women of reproductive age on the territory of the Nizhny Novgorod oblast in 2009-2013. The average age of women with primarily diagnosed tuberculosis of respiratory organs was 38.8 years. In dynamics, a trend was established directed to decreasing of indicator of morbidity of tuberculosis of respiratory organs among women of fertile age that testifies a certain stabilization of situation. Among patients with primarily diagnosed tuberculosis of respiratory organs at the territory of the region women of reproductive age (18-44 years) are dominated (60%). The higher values of index of morbidity of bacillary forms of tuberculosis of respiratory organs are noted. The patients being the most dangerous in epidemiological respect, with bacterioexcretion established by microscopy prevail. In the women aged 25-34 years main epidemiological indices exceed the average oblast indices that testifies epidemiological troubles in the oblast. Because women are a main group of population being a labor and reproductive potential of state, the organizational methodological activities are to be targeted to timely diagnostic of disease and increasing of quality of phthisiology care.

Multidrug-Resistant Tuberculosis in the End Tuberculosis EraMultidrug-Resistant Tuberculosis in the End Tuberculosis Era.

Multidrug-resistant (MDR) tuberculosis (TB) emerged shortly after introduction of rifamycins in the 1960s; isoniazid resistance had already emerged by the mid-1950s. Without these two drugs, tuberculosis is very difficult and costly to treat, with unacceptably high rates of treatment failure, death, loss to follow-up, and no known preventive treatment. Global attention first focused on MDR TB in the early 1990s when nosocomial outbreaks with high case fatality rates were reported in many countries. Prevalence data for MDR TB on a global scale first became available in 1997. In 2016, about 4.1% of estimated ~10.4 million new TB patients plus 19% of ~1 million previously treated patients, that is ~600,000 people develop MDR TB or rifampicin resistant TB; 250,000 die annually. Ten years ago, <5% of them were diagnosed and enrolled on treatment, increasing to about 21.6% in 2016, leaving much room for improvement. Over that same period of time, momentum has been building to combat MDR TB, including advances in diagnostics, therapeutics, and care; decentralizing patient-centered care coupled with social support; growing improvements in prevention of transmission; increasing use of highly effective antiretroviral treatment; communications, advocacy, and social mobilization; leadership and updated policy guidance. Taking into account long-term epidemiological trends, all of these factors coupled with funding from the Global Fund and other major donors, suggest we may be on the verge of accelerating declines in MDR TB morbidity and mortality. Extreme poverty, which allows tuberculosis to flourish, has actually decreased by about one billion people over the past 25 years. What is needed now is political will on the part of national governments to apply these advances diligently and further reductions in poverty, pushing epidemiological trends past the inflection point to the downward slope. All these can be accelerated with increased support for science leading to better diagnosis, treatment and an effective vaccine to sustain and accelerate the meager declines reported thus far.