Tuberculosis Notification Research Articles

Undernotification and underreporting of tuberculosis in Zambia: a national data quality assessment

BackgroundDespite national implementation of several high impact interventions and innovations to bolster tuberculosis (TB) detection and improve quality of TB services in Zambia, notifications have been declining since 2004. A countrywide data quality assessment (DQA) of Zambia’s National TB and Leprosy Programme (NTLP) was undertaken to quantify the degree to which undernotification and underreporting of TB notifications may be occurring.MethodsThe NTLP conducted a retrospective DQA of health facilities in high burden districts in all ten Zambian provinces. Multiple routine programmatic data sources were triangulated through a multi-step verification process to enumerate the total number of unique TB patients diagnosed between 1st January and 31st August 2019; both bacteriologically confirmed and clinically diagnosed TB patients were included. Undernotification was defined as the number of TB patients identified through the DQA that were not documented in facility treatment registers, while underreporting was defined as the number of notified TB cases not reported to the NTLP.ResultsOverall, 265 health facilities across 55 districts were assessed from which 28,402 TB patients were identified; 94.5% of TB patients were ≥ 15 years old, 65.1% were male, 52.0% were HIV-positive, and 89.6% were a new/relapse case. Among all TB cases, 32.8% (95%CI: 32.2–33.3) were unnotified. Undernotification was associated with age ≥ 15 years old (adjusted prevalence odds ratio [aPOR] = 2.4 [95%CI: 2.0–2.9]), HIV-positive status (aPOR = 1.6 [95%CI: 1.5–1.8]), being a new/relapse TB case (aPOR = 17.5 [95%CI: 13.4–22.8]), being a clinically diagnosed TB case (aPOR = 4.2 [95%CI:3.8–4.6]), and being diagnosed at a hospital (range, aPOR = 1.5 [95%CI: 1.3–1.6] to 2.6 [95%CI: 2.3–2.9]). There was substantial heterogeneity in the proportion of unnotified TB cases by province (range, 18.2% to 43.6%). In a sub-analysis among 22,199 TB patients with further data available, 55.9% (95%CI: 55.2–56.6) were notified and reported to the NTLP, 32.8% (95%CI: 32.2–33.4) were unnotified, and 11.3% (95%CI: 10.9–11.7) went unreported to the NTLP.ConclusionsThe findings from Zambia’s first countrywide TB programme DQA demonstrate substantial undernotification and underreporting of TB cases across all provinces. This underscores the urgent need to implement a robust and integrated data management system to facilitate timely registration and reporting of all TB patients who are diagnosed and treated.

Health intervention proposal during primary care for tuberculosis prevention: an observational cross-sectional study

The objective of the study was to evaluate the effectiveness of a health intervention to improve the knowledge of SUS patients about tuberculosis, after analyzing the epidemiological profile of this disease in a municipality in the interior of the state of São Paulo, based on the cases reported in the System of Tuberculosis Notification from 2006 to 2015. This intervention was carried out by the application of a questionnaire about this disease to users of the primary health service, before and after the delivery of an explanatory pamphlet containing various information in a simplified way about tuberculosis. The results were tabulated and statistically analyzed. Of the 1,281 cases reported during this period, the majority were males aged between 30 and 39 years and had studied for four to seven years. The analysis of the questionnaires showed that the interviewees' knowledge improved concerning most of the disease criteria after the delivery of the pamphlet. In this way, it is concluded that the intervention method, using the explanatory pamphlet on tuberculosis, proved to be efficient, in general, in making users of the Basic Health Unit aware of various aspects of tuberculosis.

Socioeconomic Determinants of Tuberculosis Cases in Indonesia, 2010–2013: An Ecological Study

BACKGROUND: Indonesia encounters a serious issue of disparity in tuberculosis cases among provinces. These disparities are crucial since they may reflect a macro-level factor that could be modified to further reduce the cases. Some factors are identified contributing to this variation, including socioeconomic determinants.
 AIM: This study investigated whether these socioeconomic determinants (i.e., poverty, unemployment, income inequality, and low education) can predict the variation of tuberculosis cases across provinces in Indonesia.
 METHODS: We conducted an ecological analysis by using public-use data files of the Annual Indonesian Health Profile Report and The Indonesian Social and Population Profile Report consisting of data from 33 provinces, 2010–2013. The main outcome measures were province-level tuberculosis notification cases for all form of tuberculosis cases and new smear-positive cases. The correlation between socioeconomic determinants and tuberculosis notification cases was analyzed with bivariate analyses and multivariate linear regression analyses.
 RESULTS: This study showed that poverty was strongly and positively correlated with tuberculosis notification cases, either all form or new smear-positive cases. Unemployment was also positively correlated with tuberculosis notification cases, but the power was lower. In contrast, income inequality and low education level were not statistically correlated with tuberculosis notification cases. In multivariate linear regression analyses, poverty is the strongest predictor for tuberculosis notification cases. Poverty had a bigger impact than unemployment in the increased tuberculosis notification cases.
 CONCLUSION: Findings from this study suggest that poverty has a profound influence on the variation for tuberculosis notification cases across provinces in Indonesia.

Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015–2020

ObjectivesWe verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.DesignA community-based survey, analysis of programme data and anti-TB drug...

Decreased Antibiotic Consumption Coincided with Reduction in Bacteremia Caused by Bacterial Species with Respiratory Transmission Potential during the COVID-19 Pandemic.

Nonpharmaceutical interventions implemented during the COVID-19 pandemic (2020–2021) have provided a unique opportunity to understand their impact on the wholesale supply of antibiotics and incidences of infections represented by bacteremia due to common bacterial species in Hong Kong. The wholesale antibiotic supply data (surrogate indicator of antibiotic consumption) and notifications of scarlet fever, chickenpox, and tuberculosis collected by the Centre for Health Protection, and the data of blood cultures of patients admitted to public hospitals in Hong Kong collected by the Hospital Authority for the last 10 years, were tabulated and analyzed. A reduction in the wholesale supply of antibiotics was observed. This decrease coincided with a significant reduction in the incidence of community-onset bacteremia due to Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, which are encapsulated bacteria with respiratory transmission potential. This reduction was sustained during two pandemic years (period 2: 2020–2021), compared with eight pre-pandemic years (period 1: 2012–2019). Although the mean number of patient admissions per year (1,704,079 vs. 1,702,484, p = 0.985) and blood culture requests per 1000 patient admissions (149.0 vs. 158.3, p = 0.132) were not significantly different between periods 1 and 2, a significant reduction in community-onset bacteremia due to encapsulated bacteria was observed in terms of the mean number of episodes per year (257 vs. 58, p < 0.001), episodes per 100,000 admissions (15.1 vs. 3.4, p < 0.001), and per 10,000 blood culture requests (10.1 vs. 2.1, p < 0.001), out of 17,037,598 episodes of patient admissions with 2,570,164 blood culture requests. Consistent with the findings of bacteremia, a reduction in case notification of scarlet fever and airborne infections, including tuberculosis and chickenpox, was also observed; however, there was no reduction in the incidence of hospital-onset bacteremia due to Staphylococcus aureus or Escherichia coli. Sustained implementation of non-pharmaceutical interventions against respiratory microbes may reduce the overall consumption of antibiotics, which may have a consequential impact on antimicrobial resistance. Rebound of conventional respiratory microbial infections is likely with the relaxation of these interventions.

Tuberculosis and epidemiological profile of the indigenous population of the Alto Rio Negro - Brazilian Amazon

The dissemination of information about Tuberculosis (TB), the types of manifestation of the disease, its main symptoms, which preventive measures are taken and how treatment is carried out are fundamental strategies for coping with it today, in addition to informing the rates of notifications of TB on a global, national and regional scale. The objective of this article is to present the epidemiological profile of the indigenous population of the Alto Rio Negro region, in the State of Amazonas (Brazil), regarding tuberculosis. Methodologically, the article was built through a bibliographical survey, eight articles were read and only two were selected to carry out the literature review identifying the epidemiological aspects of tuberculosis for the indigenous population of the Alto Rio Negro region – AM. By carrying out a literature review, it was possible to identify how essential the relationship between health, society and the environment is in a social group, determining the possible diseases that can affect this population. It was concluded that the social conditions of Indians and non-Indians are different in economic, social, political, cultural and territorial aspects, thus making it difficult to access not only the diagnosis of the disease, but also the direct treatment observed, and information about the transmission of tuberculosis, its diagnosis, prevention and therapeutic procedure.

Outcomes and predictors of tuberculosis mortality in Kweneng West District, Botswana: a retrospective cohort study

IntroductionBotswana is among the countries with the highest tuberculosis (TB) notification rates in the world. However, there is paucity of data on the outcomes and predictors of TB mortality at district level in Botswana. This study was aimed at describing the TB outcomes and identifying the predictors of mortality in Kweneng West district, Botswana.Methodsthis was a retrospective cohort study of TB outcomes in Kweneng West, from January 2008 to December 2016. All documented drug-sensitive TB (DS-TB) patients aged 16 years and above were included. The World Health Organization (WHO) definitions of treatment outcomes for DS-TB were used. Binary logistic regression was used to identify predictors of mortality.Resultsthere were 1475 TB notifications in the study period. The median age was 36 years and 41.5% were female. A total of 728 (49.4%) were HIV positive. Pulmonary TB (PTB) accounted for 87.3% of all cases. The overall treatment success rate (TSR) was 81.9% and the mortality rate was 9.4%. Compared to the 16-25 years age group, patients aged more than 65 years had the highest risk of mortality (AOR=9.63). Other significant predictors of mortality were male sex (AOR=1.63), no sputum microscopy (AOR=1.77), positive HIV (AOR=2.13) and unknown HIV status (AOR=4.47). Positive sputum microscopy (AOR=0.50) and extra-pulmonary TB (EPTB) (AOR=0.56) were associated with less mortality.Conclusionwhile Botswana has relatively good TB treatment success rates, the mortality rates are high. Public health interventions should target the identified risk factors of mortality.

An evaluation of childhood tuberculosis program in Chegutu District, Zimbabwe, 2020: a descriptive cross-sectional study

BackgroundChildhood tuberculosis (TB) is a major global public health concern contributing to significant child morbidity and mortality. A records review of the TB notification for Chegutu District Health Information System 2 (DHIS2) showed a low childhood TB case detection rate. For 2018 and 2019, childhood TB notifications were 4% and 7% respectively against the annual national childhood 12% case detection rate. We evaluated the performance of the childhood TB program in Chegutu.MethodsWe conducted a descriptive cross-sectional study. Sixty-six health workers (HW) participated in the study. Interviewer-administered questionnaires and checklists were used to collect data on reasons for low TB case detection, HW childhood TB knowledge, program inputs, processes, and outputs. Strengths, Weaknesses, Opportunities and Threats analysis was used to assess the childhood TB processes. We analyzed the data using Epi Info 7™ to generate frequencies, proportions and means. A Likert scale was used to assess health worker knowledge.ResultsThe majority 51/66(77%) of HW were nurses and 51/66(67%) of respondents were females. Reasons for the low childhood TB case detection were lack of HW confidence in collecting gastric aspirates 55/66(83%) and HW’s negative attitudes towards gastric aspirate collection 23/66(35%). HW 24/66 (37%) had a fair knowledge of childhood TB notification. The district had only one functional X-ray machine for 34 health facilities. Only 6/18 motorcycles were functional with inadequate fuel supply. No desk guide for the management of TB in children for HW (2018) was available in 34 health facilities. Ethambutol 400 mg was out of stock and adult 800 mg tablets were used. Funds allocated for motor vehicle and motorcycles service ($1612USD/year) were inadequate. The district failed to perform planned quarterly TB review meetings, contact tracing and childhood TB training due to funding and COVID-19 lockdown restrictions.ConclusionThe childhood TB program failed to meet its targets due to inadequate inputs, HW suboptimal knowledge and COVID-19 lockdown measures. Case detection and notification can be improved through on-job training, mentorship, support and supervision and adequate resources.

An influence of dew point temperature on the occurrence of Mycobacterium tuberculosis disease in Chennai, India

Climate factors such as dew point temperature, relative humidity and atmospheric temperature may be crucial for the spread of tuberculosis. This study was conducted for the first time to investigate the relationship of climatic factors with TB occurrence in an Indian setting. Daily tuberculosis notification data during 2008–2015 were generated from the National Treatment Elimination Program, and analogous daily climatic data were obtained from the Regional Meteorological Centre at Chennai city, Tamil Nadu, India. The decomposition method was adopted to split the series into deterministic and non-deterministic components, such as seasonal, non-seasonal, trend and cyclical, and non-deterministic climate factors. A generalized linear model was used to assess the relation independently. TB disease progression from latent stage infection to active was supported by higher dew point temperature and moderate temperature. It had a significant association with TB progression in the summer and monsoon seasons. The relative humidity may be favored in the winter and post-monsoon. The water tiny dew droplets may support the TB bacterium to recuperate in the environment.

Tuberculosis Co-Infection Is Common in Patients Requiring Hospitalization for COVID-19 in Belarus: Mixed-Methods Study.

A significant drop in tuberculosis (TB) case-finding has been widely reported during the period of the COVID-19 pandemic. To address a decrease in TB notification, Belarus introduced laboratory TB testing in patients with the laboratory-confirmed coronavirus disease 2019 (COVID-19). We conducted a secondary analysis of health records among 844 patients with laboratory-confirmed COVID-19 diagnosis who were admitted to repurposed departments at TB hospitals and who were tested by Xpert MTB/RIF (Cepheid Inc., Sunnyvale, CA, USA) in five Belarus regions between April and October 2021. Quantitative analysis followed by 13 individual interviews with health managers, physicians, and nurses participating in the intervention. Most patients were male (64%) and mean age was 43.5 ± 16 years. One in twenty (n = 47, 5.6%) patients were co-infected with active pulmonary TB, and over one-third of them (n = 18) had rifampicin resistance. In-hospital mortality was comparable in patients with and without TB co-infection (2.1% and 2.3% respectively, p > 0.99). Laboratory TB testing among patients with COVID-19 at repurposed departments of TB hospitals is feasible in Belarus and may improve TB case-finding.

Tuberculosis Surveillance in Romania Among Vulnerable Risk Groups Between 2015 and 2017.

PurposeRomania has the highest tuberculosis (TB) burden in the European Union/European Economic Area (EU/EEA) comprising almost a quarter (23.4%) of the reported patients in 2017, and a TB notification rate six times higher than the EU/EEA average. Although the overall TB notification rate in Romania declined from 154/100.000 individuals to 66/100.000 individuals in the general population between 2002 and 2017, TB notification rates remain high in certain vulnerable populations groups such as prisoners, the homeless population and among drug users.Patients and MethodsWe conducted a descriptive study regarding TB monitoring data in Romania, including the aforementioned TB risk groups.ResultsAnalysis regarding notified TB cases among these risk groups indicates that TB rates are 7 to 18 times higher than in the general population. One of the most alarming aspects regards the exceedingly high proportion of HIV-seropositivity among drug users and the high mortality rates among the homeless population and among drug users with TB.ConclusionThis data underlines the importance of early identification among social risk groups using outreach active case-finding (ACF) activities, possibly combining TB screening with screening for other common, possibly life-threatening, co-morbidities for which an effective treatment is available. ACF could have a decisive role in TB control and eradication in Romania, when aimed at these high-risk groups.

A public health intervention package for increasing tuberculosis notifications from private practitioners in Bandung, Indonesia (INSTEP2): A cluster-randomised controlled trial protocol

Background. A significant proportion of tuberculosis (TB) patients globally make their initial visit for medical care to either an informal provider or a private practitioner, and many are not formally notified. Involvement of private practitioners (PPs) in a public–private mix for TB (TB-PPM) provides an opportunity for improving TB control. However, context-specific interventions beyond public–private agreements and mandatory notification are needed. In this study we will evaluate whether a tailored intervention package can increase TB notifications from PPs in Indonesia. Methods. This is a cluster-randomized trial of a multi-component public health intervention. 36 community health centre (CHC) areas will be selected as study locations and randomly allocated to intervention and control arms (1:1). PPs in the intervention areas will be identified using a mapping exercise and recruited into the study if they are eligible and consent. They will receive a tailored intervention package including in-person education about TB management along with bimonthly electronic refreshers, context-specific selection of referral pathways, and access to a TB-reporting app developed in collaboration with the National TB programme. The primary hypothesis is that the intervention package will increase the TB notification rate. The primary outcome will be measured by collecting notification data from the CHCs in intervention and control arms at the end of a 1-year observation period and comparing with the 1-year pre-intervention. The primary analysis will be intention-to-treat at the cluster level, using a generalised mixed model with repeated measures of TB notifications for 1 year pre- and 1 year post-intervention. Discussion. The results from this study will provide evidence on whether a tailored intervention package is effective in increasing the number of TB notifications, and whether the PPs refer presumptive TB cases correctly. The study results will guide policy in the development of TB-PPM in Indonesia and similar settings.

Addressing the Data Gaps on Child and Adolescent Tuberculosis.

The burden of tuberculosis (TB) among children and young adolescents (<15 years old) is estimated at 1.1 million; however, only 400,000 are treated for TB, indicating a large gap between the number who are cared for and the number estimated to have TB. Accurate data on the burden of pediatric TB is essential to guide action. Despite several improvements in estimating the burden of pediatric TB in the last decade, as well as enhanced data collection efforts, several data gaps remain, both at the global level, but also at the national level where surveillance systems and collaborative research are critical. In this article, we describe recent advances in data collection and burden estimates for TB among children and adolescents, and the remaining gaps. While data collection continues to improve, burden estimates must evolve in parallel, both in terms of their frequency and the methods used. Currently, at the global level, there is a focus on age-disaggregation of TB notifications, the collection of data on TB-HIV, multi-drug resistant (MDR)-TB and treatment outcomes, as well as estimates of the disease burden. Additional data from national surveillance systems or research projects on TB meningitis, as well as other forms of extra-pulmonary TB, would be useful. We must capitalize on the current momentum in child and adolescent TB to close the remaining data gaps for these age groups to better understand the epidemic and further reduce morbidity and mortality due to TB.

What makes community health worker models for tuberculosis active case finding work? A cross-sectional study of TB REACH projects to identify success factors for increasing case notifications

BackgroundIn the field of tuberculosis (TB), Community Healthcare Workers (CHWs) have been engaged for advocacy, case detection, and patient support in a wide range of settings. Estimates predict large-scale shortfalls of healthcare workers in low- and middle-income settings by 2030 and strategies are needed to optimize the health workforce to achieve universal availability and accessibility of healthcare. In 2018, the World Health Organization (WHO) published guidelines on best practices for CHW engagement, and identified remaining knowledge gaps. Stop TB Partnership’s TB REACH initiative has supported interventions using CHWs to deliver TB care in over 30 countries, and utilized the same primary indicator to measure project impact at the population-level for all TB active case finding projects, which makes the results comparable across multiple settings. This study compiled 10 years of implementation data from the initiative’s grantee network to begin to address key knowledge gaps in CHW networks.MethodsWe conducted a cross-sectional study analyzing the TB REACH data repository (n = 123) and primary survey responses (n = 50) of project implementers. We designed a survey based on WHO guidelines to understand projects’ practices on CHW recruitment, training, activities, supervision, compensation, and sustainability. We segmented projects by TB notification impact and fitted linear random-effect regression models to identify practices associated with higher changes in notifications.ResultsMost projects employed CHWs for advocacy alongside case finding and holding activities. Model characteristics associated with higher project impact included incorporating e-learning in training and having the prospect of CHWs continuing their responsibilities at the close of a project. Factors that trended towards being associated with higher impact were community-based training, differentiated contracts, and non-monetary incentives.ConclusionIn line with WHO guidelines, our findings emphasize that successful implementation approaches provide CHWs with comprehensive training, continuous supervision, fair compensation, and are integrated within the existing primary healthcare system. However, we encountered a great degree of heterogeneity in CHW engagement models, resulting in few practices clearly associated with higher notifications.

Predictors of tuberculosis incidence and the effects of multiple deprivation indices on tuberculosis management in OR Tambo district over a 5-year period.

BackgroundThis study investigated the associations between socio-economic deprivation and tuberculosis (TB) treatment outcomes, alongside well-known TB risk factors. The effects of healthcare expenditures and their growth on trends in TB incidence from 2009 to 2013 were also assessed.MethodsSecondary data analysis was performed on data obtained from various sources including governmental, non-governmental and research institutions. Indicators for TB treatment outcomes included TB death rate, TB rate among the household contacts of the Index TB cases, TB treatment failure, HIV associated TB death rate, TB defaulter rate, and new TB smear positive cases. Analysis of variance (ANOVA) and Turkey’s tests for post-hoc analysis were used to compare means of variables of interest considering a type I error rate of 0.05. Regression models and canonical discriminant analysis (CDA) were used to explore the associations between trends in TB incidence and independent TB predictors. During CDA, Fischer’s linear functions, Eigen values, and Mahalanobis distances were determined with values of Wilk’s Lambda closer to zero being the evidence for well discriminated patient groups. Data analysis was performed using SPSS® statistical software version 23.0 (Chicago, IL).ResultsIn total, 62 400 records of TB notification were analyzed for the period 2009–2013. The average TB incidence rate over a 5-year period was 298 cases per 100,000 inhabitants per year. The incidence of TB was reduced by 79.70% at the end of the evaluation as compared to the baseline data in 2009. Multiple linear regression analysis showed that the Expenditure per patient day equivalent (PDE) and PHC expenditure per capita were significantly and independently associated with the decline of TB incidence (adjusted R2 = 60%; ρ = 0.002) following the equation: Y = (- 209× Expenditure per PDE) + (- 0.191 × PHC expenditure per capita). CDA showed that in the most socio-economically deprived communities (quintile 1), HIV associated TB death rates were significantly more likely to be higher as compared to the least socio-economically deprived group (quintile 5) [Eigen value (12.95), function coefficient (1.49) > (.77); Wilk’s Lambda = .019, p < .0001].ConclusionsAlthough TB control programs in OR Tambo district have averted thousands of TB incident cases, their effects on HIV associated TB deaths among the most deprived communities remain insignificant. There is an urgent need for strengthening integration of TB/HIV services in most deprived settings.

Changing Epidemiology of TB in Shandong, China Driven by Demographic Changes.

Tuberculosis (TB) incidence has been in steady decline in China over the last few decades. However, ongoing demographic transition, fueled by aging, and massive internal migration could have important implications for TB control in the future. We collated data on TB notification, demography, and drug resistance between 2004 and 2017 across seven cities in Shandong, the second most populous province in China. Using these data, and age-period-cohort models, we (i) quantified heterogeneities in TB incidence across cities, by age, sex, resident status, and occupation and (ii) projected future trends in TB incidence, including drug-resistant TB (DR-TB). Between 2006 and 2017, we observed (i) substantial variability in the rates of annual change in TB incidence across cities, from -4.84 to 1.52%; (ii) heterogeneities in the increments in the proportion of patients over 60 among reported TB cases differs from 2 to 13%, and from 0 to 17% for women; (iii) huge differences across cities in the annual growths in TB notification rates among migrant population between 2007 and 2017, from 2.81 cases per 100K migrants per year in Jinan to 22.11 cases per 100K migrants per year in Liaocheng, with drastically increasing burden of TB cases from farmers; and (iv) moderate and stable increase in the notification rates of DR-TB in the province. All of these trends were projected to continue over the next decade, increasing heterogeneities in TB incidence across cities and between populations. To sustain declines in TB incidence and to prevent an increase in Multiple DR-TB (MDR-TB) in the future in China, future TB control strategies may (i) need to be tailored to local demography, (ii) prioritize key populations, such as elderly and internal migrants, and (iii) enhance DR-TB surveillance.

Interrupted time-series analysis of active case-finding for tuberculosis during the COVID-19 pandemic, Zambia.

ObjectiveTo evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic and the subsequent implementation of tuberculosis response measures on tuberculosis notifications in Zambia.MethodsWe used an interrupted time-series design to compare monthly tuberculosis notifications in Zambia before the pandemic (January 2019 to February 2020), after implementation of national pandemic mitigation measures (April 2020 to June 2020) and after response measures to improve tuberculosis detection (August 2020 to September 2021). The tuberculosis response included enhanced data surveillance, facility-based active case-finding and activities to generate demand for services. We used nationally aggregated, facility-level tuberculosis notification data for the analysis.FindingsPre-pandemic tuberculosis case notifications rose steadily from 2890 in January 2019 to 3337 in February 2020. After the start of the pandemic and mitigation measures, there was a −22% (95% confidence interval, CI: −24 to −19) immediate decline in notifications in April 2020. Larger immediate declines in notifications were seen among human immunodeficiency virus (HIV)-positive compared with HIV-negative individuals (−36%; 95% CI: −38 to −35; versus −12%; 95% CI: −17 to −6). Following roll-out of tuberculosis response measures in July 2020, notifications immediately increased by 45% (95% CI: 38 to 51) nationally and across all subgroups and provinces. The trend in notifications remained stable through September 2021, with similar numbers to the predicted number had the pandemic not occurred.ConclusionImplementation of a coordinated public health response including active tuberculosis case-finding was associated with reversal of the adverse impact of the pandemic and mitigation measures. The gains were sustained throughout subsequent waves of the pandemic.

Retrospective Cohort Study of Effects of the COVID-19 Pandemic on Tuberculosis Notifications, Vietnam, 2020.

We evaluated the effects of the coronavirus disease pandemic on diagnosis of and treatment for tuberculosis (TB) in Vietnam. We obtained quarterly notifications for TB and multidrug-resistant/rifampin-resistant (MDR/RR) TB from 2015–2020 and evaluated changes in monthly TB case notifications. We used an interrupted time series to assess the change in notifications and treatment outcomes. Overall, TB case notifications were 8% lower in 2020 than in 2019; MDR/RR TB notifications were 1% lower. TB case notifications decreased by 364 (95% CI −1,236 to 508) notifications per quarter and MDR/RR TB by 1 (95% CI −129 to 132) notification per quarter. The proportion of successful TB treatment outcomes decreased by 0.1% per quarter (95% CI −1.1% to 0.8%) in 2020 compared with previous years. Our study suggests that Vietnam was able to maintain its TB response in 2020, despite the pandemic.

Socio-Demographic Profile and Treatment Outcomes of Tuberculosis Patients Diagnosed In a Government Civil Hospital of Northern India: A Cross-Sectional Study

Background: Tuberculosis remain a worldwide public health problem and is one of the top 10 causes of death globally. Millions of people continue to fall sick with TB each year. We conducted the present study to evaluate the Socio-demographic Profile and treatment outcomes of Tuberculosis Patients Diagnosed in a Government Civil Hospital of Northern India. Material and Methods: This cross-sectional record-based study was conducted at Civil Hospital Jogindernagar of Himachal Pradesh. We collected information using a self-designed, structured questionnaire containing information regarding various sociodemographic and clinical variables. Information was collected from Tuberculosis (TB) notification register kept at DOTS centre. Statistical analysis was done using statistical software Epi Info v7.2.2. Results: There were total 74 patients of tuberculosis were registered from Jan 2020 to June 2020 at DOTS center in Civil Hospital, Jogindernagar, Himachal Pradesh Among the total, 54 27(73%%) were 21-60 years of age. Mean age of patients were 44.78±17.01 years. Majority of patients, 56(75.7%) were male and 51(68.9%) belong to lower middle class. 46 (62.25) were pulmonary TB cases while 28 (37.8%) were extra pulmonary cases. Among the total, 26(35.1%) cases were clinically diagnosed, 11(14.9%) cases were Clinically diagnosed or Diagnosed by FNAC while 37(50.0%) cases Microbiological confirmed cases. 29( 39.2%) cases were Contact of TB/DRTB Cases , 29(39.2%) were tobacco user while 16(21.6%) had other risk factors. None of the case Reactive HIV status, 8(10.8%) had Diabetes while 27(35.5%) had associated Cervical lymphadenopathy. 71(95.8%) were cured after completing ATT, 1(1.4%) were become defaulter , 1(1.4%) Shifted to MDR Treatment and (1.4%) was died. Conclusion: Study concluded that most of the patients were males, belonged to lower socioeconomic status , in productive age group and of pulmonary TB. Treatment success rate is good but still need to improve, to make it 100 percent.

A Cross-sectional Study on Knowledge, Section Attitude, and Practice Regarding Notification of Tuberculosis Patients by Private Practitioners of Urban Chennai, India

Introduction: India accounts for one-fourth of global incidence of Tuberculosis (TB) with 2.79 million estimated cases annually. To improve and intensify case finding, the Government of India declared TB a notifiable disease in May 2012. It is now mandatory that all public and private health providers notify TB cases to the designated public health authorities. To facilitate notification, the central government has created a web-based, case-based notification system called NIKSHAY. Notification also provides support to the private sector in adherence to standards of TB care which helps in the monitoring of the patients, contact screening and adherence to the treatment. Aim: To assess the knowledge, opinion and barriers regarding TB notification and its processes amongst private practitioners offering TB services. Materials and Methods: This was a cross-sectional study with both analytical and descriptive components which was conducted on the private practitioners of urban Chennai for a period of three months from April 2021 to June 2021. Study was done on a convenient sample of 150 private practitioners in Urban Chennai. Any registered medical practitioner with a bachelor degree in medicine (MBBS) with private practice in Urban Chennai with a minimum of 1 year practice was included in the study. The knowledge, attitude and practice of notification of TB among private practitioners and other proportions were summarised into percentages and 95% confidence intervals were calculated. The categorical data was analysed by Chisquare (χ2 ) test. Strength of associations was assessed through odds ratio and 95% confidence intervals. Tha analysis of the data was done using Statistical Package for Social Sciences (SPSS) version 28.0.1.1. Results: Amongst the total sample of 150 study participants, 90% had said that TB notification was mandatory, of whom 80% said that they had prior sensitisation on the notification procedures. Only 46% were aware of the honorarium given after notification. Attitude of the study participants towards notification though 100% of the study participants agreed that TB notification was necessary, while 56.7% said that government should do more towards the sensitisation of the notification procedures. Only 5.3% of the study participants had initiated treatment on their own and 4% had started treatment based on clinical suspicion Nikshay registration was more among those whose duration of practice was more than or equal to 5 years (p=0.03), those who had prior sensitisation on TB notification procedures (p&lt;0.001), those who had TB patients in their Outpatient Department (OPD) (p&lt;0.001), and among those who were aware of the honorarium given for notification (p&lt;0.001). Conclusion: Nikshay registration was significantly more among those who had prior sensitisation and those who were aware about the honorarium that they will receive after notifying. This shows that simple awareness creation can significantly increase the Nikshay registration thereby increasing the TB notification.