The Karamoja subregion in northeastern Uganda is disproportionately affected by tuberculosis (TB), with an estimated TB prevalence >3 times the national average. Recently introduced health systems strengthening (HSS) interventions, including active symptom screening campaigns covering approximately 20% of the population annually, have substantially increased the number of people initiated on TB treatment, improved TB treatment completion and increased uptake of TB preventive therapy. However, to achieve further reductions in TB incidence and mortality, additional interventions are needed. We aimed to assess the impact of four additional interventions, layered onto existing HSS interventions, on TB incidence and mortality. We developed a dynamic compartmental model calibrated to TB epidemiology in Karamoja (population 1.4 million, 50% children <15 years old, 34% undernourished; estimated annual TB incidence 670 per 100,000). In addition to the existing HSS interventions, we modelled four interventions: adding chest X-ray with computer aided detection to current case-finding campaigns; increased home-based contact investigation to cover all persons diagnosed with TB plus nutritional support for undernourished persons with TB; community-wide testing and treatment of TB infection; and nutritional support to undernourished persons with TB infection. We estimated the number of TB disease episodes and deaths averted over 20 years. Over 20 years, continued implementation of HSS would reduce TB incidence by 2.4% per year to 339/100,000 (95% UI 222-475) and TB mortality by 3.2% per year to 13/100,000 (95% UI 6-20), compared to current incidence and mortality. Implementation of all four additional interventions could accelerate impact, bringing TB incidence to 161/100,000 (95% UI 61-299) and TB mortality to 5/100,000 (95% UI 2-10), thereby averting 47,450 (95% UI 18,030-76,640) TB episodes and 2,880 (95% UI 1,040-3980) TB deaths compared to HSS alone. Combination interventions to reduce undernutrition and find people with TB disease and infection can have a meaningful epidemiological impact in Karamoja.

Indonesia is the second-highest contributor to global tuberculosis (TB) cases, accounting for 10% of the total. While previous studies have explored TB patterns in specific regions, a comprehensive nationwide analysis at a fine spatial scale is lacking. This study investigated spatiotemporal patterns of TB incidence and mortality, identified geographical hotspots, and examined their association with risk factors to inform public health policy. This retrospective study analyzed notified TB cases and deaths during treatment from Indonesia's National Tuberculosis Surveillance System across 514 districts between 2017 and 2022. Spatiotemporal Bayesian hierarchical modeling was employed to identify high-risk areas and assess associations with potential risk factors. The best-fitting model was determined by evaluating various spatial and temporal random effect structures and likelihood assumptions. TB incidence fluctuated with a trough during the COVID-19 pandemic and an overall increase, while mortality increased over time. Incidence hotspots clustered in urbanized areas, while mortality hotspots were scattered across the country. The best-fitting model to estimate risk factors for both outcomes was Poisson likelihood. This indicated that TB incidence was spatiotemporally positively linked to better healthcare access (RR: 1.016; 95% CI: 1.007-1.025) and higher municipal human development index (MHDI, RR: 1.062; 95% CI: 1.049-1.075). Mortality was associated with low treatment coverage (RR: 0.610; 95% CI: 0.552-0.674) and success rates (RR: 0.595; 95% CI: 0.491-0.721). Fluctuating TB incidence, hotspots concentrated in urbanized areas with better healthcare access and higher MHDI as well as increasing mortality linked to poor treatment outcomes underscore the need for targeted public health interventions to expand access to care, improve treatment adherence, and address the socioeconomic disparities driving TB mortality.

INTRODUCTION: Tuberculosis (TB) is a major health burden in the world, and particularly in individuals living with HIV. This study evaluated the comparative performance of GeneXpert MTB/ RIF and Lipoarabinomannan tests against TB culture, in HIV-positive and HIV-negative patients in the University Teaching Hospital of Kigali. METHODS: A total of 124 participants (37 HIV-positive and 87 HIV-negative) were enrolled. Sputum, urine, and other specimens were tested using GeneXpert MTB/RIF and urinary LF-LAM, with results compared against TB culture on Lowenstein–Jensen media as the diagnostic gold standard. RESULTS: In HIV-positive patients, LF-LAM had a sensitivity of 75% (95% CI: 47%-91%) and a specificity of 84% (95% CI: 65%-94%), whereas GeneXpert had a sensitivity of 67% (95% CI: 39%-86%) and a higher specificity of 96% (95% CI: 80%-99%). All tests performed better in HIV-positive patients (p-value = 0.0008 for LAM; p-value = 0.0001 for GeneXpert). In the HIV-negative group, GeneXpert's sensitivity was 65% (95% CI: 41%- 83%), significantly outperforming LF-LAM's sensitivity of 35% (95% CI: 17%- 59%). These findings underscore the importance of tailored diagnostic approaches based on patient immune status to optimize TB detection accuracy. The study elucidated the disparities between the LAM test and GeneXpert in diagnosing tuberculosis among patients with or without HIV, paving the way for more targeted and effective diagnostic interventions. CONCLUSION: The study findings showed a complementary role of both GeneXpert and LF-LAM. LF-LAM is strongly effective as a quick screening test in TB detection and an early intervention tool in HIV-positive patients because it has a much greater diagnostic sensitivity in this population. Integration of the LAM test into TB diagnostic algorithms for immunocompromised populations could improve early detection and treatment initiation, thus reducing TB morbidity and mortality.

This ecological time-series study analysed tuberculosis (TB) mortality trends in the Americas from 2000 to 2019 using data from the Pan American Health Organization. Age-adjusted mortality rates by country and sex were assessed with Joinpoint regression to estimate annual percentage changes. Results showed a general decline in TB mortality, with average annual reductions of -2.3% in men and -1.9% in women. Brazil, Colombia, and Canada exhibited continuous decreases, while Saint Lucia, Jamaica, and Honduras had episodes of increase or fluctuation. The highest mortality rates persisted in Bolivia, Mexico, Nicaragua, Honduras, and Peru. Regional analyses indicated periods of trend stabilisation, especially in Central and South America during the latter years. Despite overall progress, significant disparities by region and sex remain, reflecting complex social, economic, and healthcare factors. Strengthening surveillance systems and tailoring interventions to specific local contexts are crucial for further reducing TB mortality across the continent.

BackgroundNutrition is a critical determinant of tuberculosis (TB), providing a protective effect at high body mass index (BMI) and incurring an increased risk of TB disease at low BMI. Global nutritional transition and interventions to end hunger could directly affect the TB epidemic in high TB burden countries.MethodsWe constructed dynamic TB transmission models for 12 high TB burden countries with low HIV prevalence. We explicitly accounted for the effects of BMI on TB disease progression and treatment outcomes using a meta-analysis of longitudinal cohort studies, incorporating the effect of BMI mediated through diabetes. The models were calibrated to historical trends in TB epidemiology and mean BMI. We estimated potential changes in TB incidence and mortality between 2015 and 2030 under different scenarios of population nutrition.FindingsCompared with a scenario where mean BMI remained at 2015 levels, if past trends in mean BMI continued then by 2030 TB incidence and mortality would decline by a cumulative 14.7% (95% credible interval: 12.7%–16.7%) and 15.6% (12.5%–19.2%), respectively. In comparison, achieving zero hunger by 2030 would reduce incidence and mortality by 32.0% (20.0%–43.8%) and 37.3% (26.1%–49.6%), respectively. If past trends continued and zero hunger was also achieved, incidence and mortality would be reduced by 38.2% (27.0%–49.1%) and 42.4% (32.1%–53.5%), respectively, equivalent to preventing 20.6 million people developing TB disease and averting 5.4 million TB deaths over 15 years in the 12 high-burden countries.ConclusionsNutrition transitions and interventions to end hunger could have a major impact on the future epidemiology of TB in high-burden countries. Investment is urgently required to implement and scale up nutritional interventions.

From decline to rebound: a 25-year Joinpoint analysis of tuberculosis mortality in the United States, 1999-2023.

BackgroundTuberculosis preventive treatment (TPT) is crucial for reducing tuberculosis (TB) incidence and related mortality among people with human immunodeficiency virus (HIV); however, its implementation in Georgia faces challenges. In this study, we aimed to explore the TPT care cascade among people with HIV (PWH) in Georgia.MethodsUsing a mixed-methods approach, we assessed TPT uptake, adherence, and impact on TB development within the 2019–2020 cohort of newly diagnosed PWH across 4 major HIV service providers in Georgia. With qualitative analysis under the Consolidated Framework for Implementation Research, we identified barriers and facilitators to its implementation.ResultsAmong 1165 PWH, only 11.8% initiated TPT with isoniazid. Thirty-two developed active TB (incidence rate, 10/1000 person-years [95% confidence interval, 9.6–10.4]), none of whom received TPT. Only 43% of 137 PWH on TPT adhered for 3–6 months; 29 (21.1%) completed the full course. The study revealed poor TPT service coordination, worsened by major data limitations. Interviews identified several barriers to effective TPT implementation, summarized into 3 broad categories: the need for TPT service integration into HIV care, the potential development of an integrated electronic data system, and training gaps.ConclusionsOur study revealed low TPT coverage among Georgian PWH and significant data gaps. Findings underscore the need to reevaluate the TPT care cascade, emphasizing improved record-keeping and reporting practices through an integrated electronic system. Enhancing access by integrating TPT into HIV care, reducing stigma through streamlined referrals, and strengthening healthcare worker training are critical to increasing TPT uptake and ultimately reducing TB morbidity and mortality among PWH in Georgia.

The present study aimed to examine the temporal dynamics of tuberculosis incidence, mortality, and TB–HIV coinfection in the First Health Region of Alagoas from 2001 to 2022, with particular attention to sex-specific differences. The analysis revealed pronounced divergences between men and women. The male series exhibited significant positive autocorrelation and high interannual variability, indicating strong temporal dependence and heightened sensitivity to external disruptions such as the COVID-19 pandemic. The female series displayed a more regular pattern without autocorrelation. Although both sexes showed declining incidence, only the reduction among women reached statistical significance; the male trend remained unstable and inconclusive. Disease burden was consistently higher among men, who accounted for most cases and maintained incidence levels above elimination targets. TB–HIV coinfection increased in both sexes, with a sharper rise among men and a statistically significant upward trend among women, accompanied by a structural shift in 2010. Additional change points in 2014 and 2018 are likely to reflect alterations in surveillance or broader public health events. The weak performance of linear models underscores the role of persistent social determinants and inequities in healthcare access. Overall, the findings demonstrate that tuberculosis remains a major public health concern and that differentiated strategies by sex are essential for effective prevention and care.

ObjectiveTo determine the survival rate and prognostic factors associated with tuberculosis (TB) mortality in Medellín between 2018 and 2023.DesignQuantitative observational analytical study of a retrospective cohort.SettingBased on notifications made to the Public Health Surveillance System and managed by the Secretary of Health of Medellín—Colombia between 2018 and 2023.ParticipantsA total of 11 202 individuals diagnosed with TB, aged between 1 and 103 years.Primary and secondary outcome measuresThe Kaplan-Meier method was employed to determine survival and risk functions, as well as median survival. Crude HRs and adjusted HRs (aHRs) were estimated using Cox proportional hazards regression models.ResultsA median overall survival of 1410 days (3.86 years) and an adjusted mortality rate of 40 cases per 100 000 population were estimated for the study period (6 years). Factors associated with TB mortality were age (>59 years) (aHR 5.53; 95% CI 3.17 to 9.65), renal disease (aHR 2.98; 95% CI 2.27 to 3.90), HIV infection (aHR 2.82; 95% CI 1.39 to 3.32) and cancer (aHR 2.56; 95% CI 1.95 to 3.34).ConclusionsTB survival is influenced by age and comorbidities, indicating the need for targeted strategies to protect high-risk groups. Strengthening comprehensive TB control through timely diagnosis, integrated management of chronic conditions and patient-centred care is essential to reduce preventable deaths. Furthermore, improving case notification and follow-up through integrated information platforms will contribute to more effective public health interventions.

Sepsis causes high mortality among people living with HIV in Africa, yet immune response data are limited. We identified immune subphenotypes of adults with sepsis and a high prevalence of HIV in East Africa. We determined the association of serum cytokine and antibody concentrations with CD4+ T-cell and blood lactate concentration, tuberculosis, and 30-day mortality with K-means clustering, principal component analysis (PCA), and logistic regression. We validated results in a separate cohort of adults with sepsis in East Africa. Of 208 participants in the discovery cohort, 117 (56%) were female and 175 (84%) were living with HIV, with a mean (±SD) age of 35 (±10) years. Participants with tuberculosis had higher concentrations of G-CSF, IFN-γ, IL-1β, IL-6, IL-8, and MCP1MCAF, whereas mortality was associated with higher concentrations of G-CSF, IL-6, IL-8, IL-10, and MIP-1β, and lower concentrations of IgM antibodies against oxidation-specific epidopes (IgM OSE ). PCA identified G-CSF, IL-5, IL-6, IL-8, and IL-13 as the main contributors to tuberculosis, and IL-4, IL-6, IL-8, IL-12, and IL-13 as the main contributors to mortality. Comprehensive biomarker and clinical and multivariable models accurately predicted tuberculosis (AUC = 0.84) and mortality (AUC = 0.78), which was replicated in the validation cohort. Cross-testing showed that the tuberculosis model delineated pathogen-specific immune activation, while the mortality model represented non-pathogen-specific immune dysregulation. In adults with sepsis and high HIV prevalence in East Africa, tuberculosis was associated with pathogen-specific inflammation, and mortality was associated with broader immune dysregulation and diminished IgM OSE antibody responses.

Epidemiology, outcomes, and factors associated with mortality in pediatric tuberculosis in Thailand: A National Health Security Office Data Analysis from 2015 to 2023.

Tuberculosis (TB) remains a global health priority aligned with the 2030 Sustainable Development Goals (SDGs). However, financing challenges persist in many districts and cities across Indonesia, including West Sumatra Province. Funding for TB programs still relies heavily on external sources, particularly the Global Fund (GF), while local health budgets remain minimal, covering only 0.05–0.1% of total health expenditures. This study aimed to identify the key problems in TB financing policies at the district level. A descriptive qualitative design with a case study approach was employed, involving seven informants from the District Health Office and two community health centers (puskesmas) with the highest TB cases, selected through purposive sampling. Findings revealed that limited and fragmented financing has hindered the implementation of TB services and the achievement of Minimum Service Standards for TB suspect management. Contributing factors include a shortage of skilled human resources for recording and reporting, inadequate infrastructure, and insufficient operational funds across programs. These constraints have reduced the quality and coverage of TB examination and treatment services. Weak local government commitment to prioritizing TB programs has further slowed progress toward achieving national targets as set by Presidential Regulation No. 67 of 2021, which aims to reduce TB mortality to 6 per 100,000 and incidence to 65 per 100,000 by 2030. To strengthen policy implementation, the District Health Office must establish and ratify standardized TB referral flows and ensure adequate budget allocations. Furthermore, these financing standards and guidelines need to be effectively disseminated across the entire community health center network.

Introduction: Tuberculosis (TB) keeps worsening public health making it important to assess TB burden using more sensitive methods than traditional epidemiological indicators. Objective: To estimate the TB burden using the disability-adjusted life years (DALYs). Materials and Methods: The total burden of tuberculosis was calculated as the sum of years of life lost due to TB death (YLL) and years lost due to disability (YLD) in Russia in the years 2016 and 2023 based on statistical forms and data of the Federal State Statistics Service (Rosstat). Results: The TB burden in Russia is primarily due to premature mortality, with YLL being twice as high as YLD in 2016 for the total population and men and 1.4-fold for women. The YLL was the highest among men aged 25–59, particularly among those aged 35–44, equaling 450.2 and 165.6 per 100,000 population of the same age and sex group in 2016 and 2023, respectively. The YLL decreased between 2016 and 2023 by 2.6 times for the whole and male population and by 2.7 times among women, compared to 1.8 and 1.9-fold declines in YLD. A slower decline in the YLL is observed for those aged 45 and older, indicating a buildup and shift in the TB burden toward older age groups. Premature TB mortality persists among children aged 0–14, predominantly among girls, and with a slower decline among boys. Conclusions: The study results should be taken into account when developing targeted TB programs in Russia and improving TB prevention in vulnerable age groups, i.e. among children and adults over 45 years of age, where the reduction in the TB burden is noticeably slower in terms of YLL.

ABSTRACT Undernutrition is a major driver of the tuberculosis (TB) epidemic, with one in five TB cases worldwide attributable to undernutrition. Nutritional interventions may reduce TB incidence and mortality for those at increased risk of developing TB. The TB LION (Tuberculosis - Learning the Impact Of Nutrition) study provides nutritional supplementation to household contacts (HHC) of TB index cases (n = 60) to examine the impact of supplementation on progression from latent to active TB disease. TB LENS (Learning about Experience with Nutritional Supplementation), a qualitative sub-study of TB LION, was designed to examine attitudes and opinions regarding the provided nutritional supplementation to inform future interventions. We conducted in-depth interviews with HHCs from the TB LION study, local healthcare workers (HCWs) treating persons with TB, and with the two lead study nutritionists. Additionally, we held focus group discussions among HHCs and HCWs. We identified barriers and facilitators to intervention uptake and perspectives for future interventions. The results demonstrate the importance of culturally acceptable interventions with foods that participants enjoy eating and can prepare quickly. We also found an overwhelming preference for in-kind food delivery to the home over cash transfers. These results can inform future interventions to improve nutrition for households with TB.

Air pollution is the fifth and sixth leading risk factor for global mortality and reduced life expectancy. Studies have established a link between atmospheric pollution and the incidence, hospitalization, and mortality rates of pulmonary tuberculosis (PTB). The city of Zabol has experienced persistent dust storms for several years, with an average annual PM10 concentration of 206 µg/m³—more than nine times the permissible limit. The results of this study indicate a significant correlation between increased PM10 levels and the incidence of tuberculosis. To model the disease, machine learning (ML) techniques, including support vector machines (SVM) and k-nearest neighbors (KNN), were employed. Among these, SVM demonstrated the highest accuracy, with a correlation coefficient of 92.4% between the experimental data and the model’s training outputs.

This study examines long-term trends in mortality from HIV infection and tuberculosis in Russia. We use age-specific mortality data for men and women from the Russian Fertility and Mortality Database (RusFMD/RosBRiS) of the NES Center for Demographic Research for the period 1989–2022. Based on these data, cohort mortality rates were calculated, and an age–period–cohort (APC) model was constructed. The results show a steady decline in the cohort effect on tuberculosis mortality in both sexes starting with cohorts born in the late 1970s. In contrast, for HIV infection the cohort effect indicates higher mortality risks among women compared to men, while the period effect remains similar for both sexes. The reduction in HIV mortality observed after 2017 does not reflect improved cohort characteristics among younger generations, but rather the influence of situational factors, primarily expanded access to antiretroviral therapy. These findings suggest that the HIV epidemic has moved beyond its initial high-risk birth cohorts of 1975–1985 and now poses a significant threat to younger cohorts, particularly women.

Introduction: Despite advances in effective therapies, tuberculosis remains one of the leading causes of death worldwide. In 2022, 10.6 million new cases and 1.3 million deaths were estimated, constituting a relevant public health problem. The COVID-19 pandemic has generated an economic crisis that has exacerbated socioeconomic gaps. Considering the established association between tuberculosis and poverty, we aimed to describe and analyze variations in the inequity of tuberculosis mortality in Colombia between 2018 and 2022, in relation to the epidemiological context of the COVID-19 pandemic. Materials and methods: Individual-level death data from the National Administrative Department of Statistics (DANE) were accessed for the study period. Standardized mortality rates at the departmental tuberculosis level were estimated, and the departments were grouped by quintiles according to the departmental multidimensional poverty index. Statistically significant differences between the extreme quintiles were estimated using the t-test. Results: In 2018, Colombia reported a standardized tuberculosis mortality rate of 2,199 per 100,000 inhabitants, whereas in 2022, this rate was 2,303 per 100,000 inhabitants. In 2018, quintile 1 had a mean rate of 4,09 (CI = 2,097 - 6,083) while quintile 5 had a mean rate of 1,494 (CI = 0,921 - 2,068) according to the t-test, there were statistically significant differences (p = 0,0056). In 2022, quintile 1 had a mean rate of 4,346 (CI= 1,872–6,820), while quintile 5 had a mean rate of 1,685 (CI= 0,979–2,392); according to the t-test, there were also statistically significant differences (p= 0,0162). Discussion: The COVID-19 pandemic slightly increased tuberculosis mortality in the country and generated health inequity at the department level.

Abstract Background: In April 2022, Tamil Nadu, with 0.1 million annual tuberculosis (TB) notifications, launched Tamil Nadu Kasanoi Erappila Thittam (TN-KET), streamlining the triaging for severe TB at diagnosis and prioritizing comprehensive care and admission within the existing health system. After 1 year, target process indicators related to triaging, referral, and inpatient care were met. TB death rates significantly reduced after two quarters of statewide implementation. To effectively refine the initiative and further accentuate the potential impact, it is essential to explore qualitatively the enablers and barriers in implementing TN-KET and the suggested solutions to overcome them. Methods: This was a descriptive qualitative study. Interviews with experienced TB program staff and people with TB were conducted between June 2022 and November 2023. Descriptive thematic analysis was carried out using ATLAS.ti9 software. Results: The enablers were around optimum utilization of available resources; strategizing action for effective implementation; motivated staff; local initiatives and leadership; reorientation training and regular monitoring. Suboptimal knowledge, especially among non-National TB Elimination Program (NTEP) staff; issues in coordinating with non-NTEP staff; shortage of resources, and negative attitude of providers and family members were the key barriers. Suggested solutions were around quality improvement strategies and health system changes. Conclusion: The identified barriers and proposed solutions can help refine the initiative. Future efforts should prioritize quality triaging, better involvement of non-TB program staff, and support nodal inpatient facility physicians through regular training and untied local funds. A limitation was the lack of detailed insights into isolation beds and therapeutic nutrition.

Cause of non-cancer related death among patients diagnosed with lymphoid neoplasm: A SEER-based study

BackgroundThis study investigated the effect of population ageing on the epidemiology of tuberculosis (TB) in South Korea.MethodsWe conducted a retrospective cohort study using an integrated database from three national databases. We analysed trends in age-specific TB incidence, mortality, case fatality rates and risk factors for all-cause mortality among 328 637 patients with drug-susceptible TB from 2011 to 2020.ResultsFrom 2011 to 2020, the proportion of patients aged ≥65 years increased from 30.5% to 50.7% of TB cases and from 74.3% to 86.8% of deaths. The TB incidence rate decreased from 90.3 to 39.5 per 100 000 (average annual per cent change (AAPC) −8.5%; 95% confidence interval (CI) −9.2 to −7.7). The crude mortality rate remained largely unchanged, shifting from 4.6 to 5.4 per 100 000 (AAPC 1.6%; 95% CI −0.1 to 3.1). The case fatality rate increased from 5.1% to 13.5% (AAPC 11.3%; 95% CI 10.5 to 12.1). Although incidence and mortality declined across all age groups, the rate of decline slowed with increasing age. Patients aged ≥80 years showed the slowest decline in incidence (AAPC −4.3%; 95% CI −5.4 to −3.5) and stagnation in mortality (AAPC 0.5%; 95% CI −1.4 to 2.2).ConclusionsThis study highlights the challenges of population ageing on TB control, including increasing case fatality rates and slower declines in TB incidence and mortality. These findings call for a reassessment of current strategies to address the needs of the elderly.