Tuberculosis Program Research Articles

Tuberculosis and people who use drugs: why focus on this overlooked population is important and why adapted interventions are necessary.

People who use drugs show a higher incidence and prevalence of tuberculosis than people who do not use drugs in areas where Mycobacterium tuberculosis is endemic. However, this population is largely neglected in national tuberculosis programmes. Strategies for active case finding, screening, and linkage to care designed for the general population are not adapted to the needs of people who use drugs, who are stigmatised and difficult to reach. Moreover, access to care, linkage to care, and treatment adherence are challenging for such a marginalised population. Learning from the HIV field about successful interventions targeting this group, we advocate for the implementation of tuberculosis interventions adapted for people who use drugs, highlighting the key role that community-based approaches could have in both design and implementation. Alongside reducing health inequities by reducing the excess tuberculosis burden among people who use drugs, these targeted interventions can also reduce tuberculosis transmission at the population level.

Enhancing tuberculosis case notifications through mapping sales of medicine in the private sector: a quasi-experimental study in Punjab province, Pakistan

IntroductionIn Pakistan, almost one-third of people who develop tuberculosis (TB) are missed by the National TB Program (NTP). A considerable number of people with TB receive treatment in the private sector but remain unnotified. This study documents the outcomes of an intervention to identify people with TB through private pharmacy engagement, building on mapping TB medicine sales in Punjab Province.MethodsA comprehensive intervention was carried out in four districts of Punjab with high anti-TB drug sales, comprising a policy change requiring mandatory notification of TB medication sales, mapping and engaging pharmacies selling anti-TB drugs, reporting through a novel ‘eTB’ mobile application and providing support via a call center. We collected both historical and prospective TB notification data from the intervention and control districts. The primary outcome was the change in TB notifications during the intervention period compared with historical and control notifications.ResultsOver the 12-month intervention period, 15,669 people with TB were reported from 2,943 pharmacies in four districts. Among the people identified, 88% were male (n = 13,673), 95% had pulmonary disease (n = 14,969), and 4,256 (27%) were bacteriologically confirmed. Chain pharmacies (n = 14) contributed to 39% of the yield. TB notifications increased by 17,462 (+ 34%) over the baseline period compared with an 8% increase in the control districts. The number of bacteriologically confirmed notifications increased by 32% compared with 16% in the control districts. The proportion of bacteriological confirmation was similar before and during the intervention.ConclusionThe results of the largest TB intervention with pharmacies globally showed incredible potential to link people with TB who are receiving care in the private sector. Mapping TB medicine sales in the private sector with tailored interventions can contribute to closing the gap in notifications where anti-TB drug sales in the private sector are prevalent.

Tuberculosis healthcare service disruptions during the COVID-19 pandemic in Brazil, India and South Africa: A model-based analysis of country-level data.

Tuberculosis (TB) is the leading infectious disease cause of death worldwide. In recent years, stringent measures to contain the spread of SARS-CoV-2 have led to considerable disruptions of healthcare services for TB in many countries. The extent to which these measures have affected TB testing, treatment initiation and outcomes has not been comprehensively assessed. We aimed to estimate TB healthcare service disruptions occurring during the COVID-19 pandemic in Brazil, India, and South Africa. We obtained country-level TB programme and laboratory data and used autoregressive integrated moving average (ARIMA) time-series models to estimate healthcare service disruptions with respect to TB testing, treatment initiation, and treatment outcomes. We quantified disruptions as the percentage difference between TB indicator data observed during the COVID-19 pandemic compared with values for a hypothetical no-COVID scenario, predicted through forecasting of trends during a three-year pre-pandemic period. Annual estimates for 2020-2022 were derived from aggregated monthly data. We estimated that in 2020, the number of bacteriological tests conducted for TB diagnosis was 24.3% (95% uncertainty interval: 8.4%;36.6%) lower in Brazil, 27.8% (19.8;3 4.8%) lower in India, and 32.0% (28.9%;34.9%) lower in South Africa compared with values predicted for the no-COVID scenario. TB treatment initiations were 17.4% (13.9%;20.6%) lower than predicted in Brazil, 43.3% (39.8%;46.4%) in India, and 27.0% (15.2%;36.3%) in South Africa. Reductions in 2021 were less severe compared with 2020. The percentage deaths during TB treatment were 13.7% (8.1%; 19.7%) higher than predicted in Brazil, 1.7% (-8.9%;14.0%) in India and 21.8% (7.4%;39.2%) in South Africa. Our analysis suggests considerable disruptions of TB healthcare services occurred during the early phase of the COVID-19 pandemic in Brazil, India, and South Africa, with at least partial recovery in the following years. Sustained efforts to mitigate the detrimental impact of COVID-19 on TB healthcare services are needed.

Cost-effectiveness of targeted Next-Generation Sequencing (tNGS) for detection of tuberculosis drug resistance in India, South Africa and Georgia: a modeling analysis

Targeted next-generation sequencing (tNGS) is promising alternative to phenotypic drug susceptibility testing (pDST) for detecting drug-resistant tuberculosis (DRTB). This study explored the potential cost-effectiveness of tNGS for the diagnosis of DR-TB across 3 settings: India, South Africa and Georgia. To inform WHO guideline development group (GDG) on tNGS we developed a stochastic decision analysis model and assessed cost-effectiveness of tNGS for DST among rifampicin resistance individuals. We also assessed tNGS as initial test for TB drug resistance in bacteriologically confirmed TB. Diagnostic accuracy and cost data were sourced from a systematic review conducted for GDG, covering studies published until September 2022. The primary outcome was incremental cost (2021 US$) per disability-adjusted life year (DALY) averted. tNGS when compared with in-country DST, tNGS proved cost-effective in South Africa (ICER: $15,619/DALY averted, WTP: $21,165) but not in Georgia (ICER: $18,375/DALY averted, WTP: $15,069). In India, tNGS dominated in-country DST practice, providing greater health impact at lower cost. When comparing tNGS with universal pDST, tNGS was dominated by pDST in all three countries. In Georgia, using tNGS as initial test for TB drug-resistance compared to Xpert MTB/Rif followed by pDST appeared cost-effective. Scenario with 50% reduction in tNGS test kit costs made tNGS cost-effective across all three countries, while a high Bedaquiline resistance prevalence (30%) led to a worsening cost-effectiveness. tNGS may be cost-effective in India, South Africa and Georgia when comprehensive DST is not routinely performed. Thus, existing DST practice and healthcare infrastructure should be considered before implementation and scale-up of tNGS. Global Tuberculosis Program, World Health Organization (2022/1249364-0).

Exploring the perspectives of healthcare workers and Program managers on the use of Truenat as a new tool for TB and DR-TB diagnosis in Nigeria: A qualitative study.

World Health Organization in the year 2020 recommended the use of Truenat as a replacement for smear microscopy in Tuberculosis (TB) diagnosis and detection of rifampicin resistance. This study was designed to assess enablers and barriers to effective implementation of Truenat assays for TB diagnosis in Nigeria and determine the acceptability of use of Truenat among healthcare workers and TB Program managers in Nigeria. A descriptive exploratory study design was used. Qualitative data were collected via Zoom platform using a pre-tested focus group discussion (FGD) guide and key informant interview (KII) guide. Four FGDs were conducted among Truenat laboratory staff, State Quality Assurance Officers, Local Government Tuberculosis Supervisors and Clinicians working at Truenat sites. Three KIIs were conducted among laboratory leads of Truenat implementing partners and the National TB Control Program. All the participants attested to the reliability and acceptability of Truenat results, they also highlighted the portability and ease-of-use especially for community outreach testing. Stakeholder engagement, training of Truenat laboratory staff and the perceived low operational cost associated with Truenat were the enablers of Truenat implementation. Major barriers to the implementation included human resource for health constraints, lack of power supply, frequent Trueprep breakdown and Truenat machine connectivity. The same human resource constraint was viewed as the major barrier to scale up of Truenat while employment and retention of Truenat staff coupled with training were seen as the facilitators to scale-up. The participants implored the manufacturers of Truenat to increase the number of modules for Truenat, enable the use of stool for diagnosis of TB and attach a solar panel to the machine. Truenat has gained high acceptance among health workers and TB Program managers in Nigeria. The perceived low operational cost and low infrastructural requirements have been a major boost. There is a need to ensure the retention of health workers especially the Truenat laboratory staff. Training should be sustained including the payment of incentives. Increasing the number of modules of the Truenat machine, enabling the use of stool for TB diagnosis and having a solar panel attached to Truenat machine are essential.

STUDI FARMAKOVIGILANS TERAPI TUBERKULOSIS PARU PASIEN RAWAT JALAN DI RSUD ULIN BANJARMASIN

Pulmonary tuberculosis (TB) is an infectious disease caused by the bacteria Mycobacterium tuberculosis. The prevalence of pulmonary TB sufferers in Indonesia is 8.4% and is number 3 in the world, however, because the treatment takes a long period of time, the TB program in Indonesia has not been completed and the target is to eliminate TB in Indonesia by 2030. Long treatment allows the occurrence of drug side effects. TB. Therefore, it is necessary to assess drug use in terms of side effects of pulmonary TB drugs using the Naranjo Algorithm. This study aims to determine the incidence of side effects that occur during pulmonary Tuberculosis (TB) therapy and identify categories of side effects using Naranjo Scale analysis. The method in this research is a descriptive observational approach Prospective Cross Sectional with the Naranjo Algorithm questionnaire. The results obtained showed that of the 62 respondents, 61 respondents experienced side effects of changes in urine color (40,32%), skin rashes (12,90%), joint pain (11,30%), nausea (11,30%), visual disturbances (8,06%) and headaches (14,51%). There were 62 respondents who experienced side effects from the Naranjo Doubtful Algorithm scale analysis, 1 patient with a percentage (1,7%), Possible 8 patients with a percentage (12,9%), Probable 26 patients with a percentage (41,9%) and Definite 27 patients with a percentage (43,5% ). In general, it can be concluded that from 62 respondents, 61 respondents experienced side effects of changes in urine color, skin rashes, joint pain, nausea, visual disturbances and headaches. There were 62 respondents who experienced side effects from the Naranjo Algorithm scale analysis: 1 patient was Doubtful, 8 patients were Possible, 26 patients were Probable and 27 patients were Definite.

Strategy to Increase the Availability and Accessibility of Funds for AIDS, Tuberculosis and Malaria (ATM) Programs in Indonesia: Literature Review

This literature review explores Indonesia's strategies to enhance funding accessibility for AIDS, Tuberculosis, and Malaria (ATM) programs, with a focus on its collaboration with the Global Fund (GF). It outlines the critical role of funding in combating ATM and Indonesia's extensive health diplomacy efforts with the GF. Utilizing a systematic review approach, findings from four studies between 2019 and 2024 were synthesized. Results reveal varied findings, including challenges in TB treatment services during the COVID-19 pandemic, deficiencies in TB Multi Drug Resistant (MDR) control programs, and insights into Indonesia's partnership with the GF. The analysis of HIV/AIDS expenditure highlights a decline in funding, emphasizing the need for advocacy and revised funding mechanisms. In conclusion, Indonesia's efforts in ATM combat through health diplomacy, notably with the GF, are substantial. Diversified funding sources, sustained collaboration, and increased self-sufficiency are crucial for meeting global health targets. Strengthening domestic resources, optimizing program implementation, and fostering partnerships are imperative to ensure equitable access to healthcare services and sustain progress in addressing ATM challenges. Innovative financing mechanisms can bolster initiatives, contributing significantly to achieving Sustainable Development Goals (SDGs) by 2030.

The Trend of Tuberculosis Case Notification Rates from 1995 to 2022 by Country Income and World Health Organization Region.

Over the past 27 years, three major global TB control strategies have been implemented, and it is important at this stage to evaluate their impact on tuberculosis (TB) case notification rates (CNRs). This study, therefore, analyzed TB CNR trends from 1995 to 2022 across 208 countries and islands, using data from the WHO Global TB Programme database. Countries were classified by income level and population size based on World Bank criteria. The analysis revealed significant disparities in TB CNRs across income groups: Low-income, lower-middle-income, and upper-middle-income countries consistently reported higher CNRs compared to high-income countries. Regional analysis further demonstrated notable variations influenced by both economic and geographical factors. These findings reaffirm the strong link between TB and poverty, underscoring the need for a holistic approach to combat the disease. Efforts must extend beyond enhancing health care access and delivery to addressing the social determinants that drive TB transmission and progression.

Implementation strategies for providing optimised tuberculosis and diabetes integrated care in LMICs (POTENTIAL): protocol for a multiphase sequential and concurrent mixed-methods study

IntroductionAlmost a quarter of patients with tuberculosis (TB) in Pakistan may also have diabetes, with an additional quarter in a pre-diabetic state. Diabetes is a risk factor for TB. When...

Interventions and implementation considerations for reducing pre-treatment loss to follow-up in adults with pulmonary tuberculosis: A scoping review.

Tuberculosis (TB) is a leading cause of death worldwide with over 90% of reported cases occurring in low- and middle-income countries (LMICs). Pre-treatment loss to follow-up (PTLFU) is a key contributor to TB mortality and infection transmission. We performed a scoping review to map available evidence on interventions to reduce PTLFU in adults with pulmonary TB, identify gaps in existing knowledge, and develop a conceptual framework to guide intervention implementation. We searched eight electronic databases up to February 6 2024, medRxiv for pre-prints, and reference lists of included studies. Two review authors independently selected studies and extracted data using a predesigned form. We analysed data descriptively, presented findings in a narrative summary and developed a conceptual framework based on the Practical, Robust Implementation, and Sustainability Model to map the factors for effective intervention implementation. We reviewed 1262 records and included 17 studies. Most studies were randomized controlled trials (8/17, 47%). Intervention barriers included stigma and inadequate resources; enablers included mobile phones and TB testing and results on the same day. We identified eight interventions that reduced PTLFU: treatment support groups; mobile notifications; community health workers; integrated HIV/TB services; Xpert MTB/RIF as the initial diagnostic test; computer-aided detection with chest radiography screening; active linkage to care; and multi-component strategies. Given the variation of healthcare settings, TB programs should consider contextual factors such as user acceptability, political commitment, resources, and infrastructure before adopting an intervention. Future research should utilize qualitative study designs, be people-centred, and include social and economic factors affecting PTLFU.

Survival analysis shows tuberculosis patients with silicosis experience earlier mortality and need employer-led care models in occupational settings in India

India’s high tuberculosis (TB) burden is exacerbated by concurrent silicosis, which increases TB susceptibility and worsens treatment outcomes. Limited studies on TB patients with silicosis highlight the need to address this vulnerable group’s specific challenges, particularly to improve diagnosis and management. This retrospective cohort study analyzed survival data from 137 silico-tuberculosis and 2,605 TB-only patients in Khambhat, India, using Kaplan-Meier curves, log-rank tests, and comparisons between Cox proportional hazards and accelerated failure time (AFT) models. The lognormal AFT model, selected for its lowest Akaike Information Criterion (AIC), estimated survival times based on age, gender, HIV status, and prior TB treatment. Among the 2,742 patients, 309 (11%) died within 27 months. Median time from diagnosis to outcome was shorter for deceased patients (1.7 months) than for censored patients (5.6 months, p < 0.001, median test). Kaplan-Meier analysis showed a significantly steeper survival decline for silico-tuberculosis patients (p < 0.001, log-rank test). Silico-tuberculosis was associated with a two-fold increased mortality risk (HR = 2.0, 95% CI: 1.4-3.0, p < 0.001, Cox-proportional hazards regression). The lognormal AFT model indicated silico-tuberculosis patients had 36% of the median survival time compared to TB-only patients (16 vs. 44 months). These findings highlight significantly earlier mortality in silico-tuberculosis patients, underscoring the need for targeted, employer-led care models and TB-silicosis collaborative screening within India’s TB program for high-risk occupational groups.

Predicting risk of tuberculosis disease in people migrating to a low-TB incidence country: development and validation of a multivariable dynamic risk prediction model using health administrative data.

Tuberculosis (TB) incidence remains disproportionately high in people migrating to Canada and other low TB incidence countries, but systematic TB screening and prevention in migrants is often cost-prohibitive for TB programs. We aimed to develop and validate a TB risk prediction model to inform TB screening decisions in foreign-born permanent residents of Canada. We developed and validated a proportional baselines landmark supermodel for TB risk prediction using health administrative data from British Columbia and Ontario, two distinct provincial healthcare systems in Canada. Demographic (age, sex, refugee status, year of entry, TB incidence in country of origin), TB exposure, and medical (HIV, kidney disease, diabetes, solid organ transplantation, cancer) covariates were used to derive and test models in British Columbia; one model was chosen for external validation in the Ontario cohort. The model's ability to predict 2- and 5-year TB risk in the Ontario cohort was assessed using discrimination and calibration statistics. The study included 715,423 individuals (including 1,407 people with TB disease) in the British Columbia derivation cohort, and 958,131 individuals (including 1,361 people with TB disease) in the Ontario validation cohort. The 2- and 5-year concordance statistic in the validation cohort was 0.77 (95%CI: 0.75-0.78) and 0.77 (95%CI: 0.76-0.78), respectively. Calibration-in-the-large values were 0.14 (95% CI: 0.08-0.21) and -0.05 (95% CI: -0.12-0.02) in 2- and 5-year prediction windows. This prediction model, available online at https://tb-migrate.com, may improve TB risk stratification in people migrating to low incidence countries and may help inform TB screening policy and guidelines.

Exploring Managers' Insights on Integrating Mental Health into Tuberculosis and HIV Care in the Free State Province, South Africa.

The integration of mental health (MH) services into tuberculosis (TB) and HIV care remains a significant challenge in South Africa's Free State province. This study seeks to understand the perspectives of public health programme managers on the barriers to such integration and to identify potential strategies to overcome these challenges. Data were collected between February and October 2021 using qualitative methods including four individual semi-structured interviews and two focus group discussions with a total of 15 managers responsible for the MH, primary healthcare, TB, and HIV programmes. Thematic data analysis was guided by an adapted version of the World Health Organization's "building blocks" framework encompassing "service delivery", "workforce", "health information", "essential medicines", "financing", and "leadership/governance". Additionally, the analysis underscored the crucial role of "people", acknowledging their significant contributions as both caregivers and recipients of care. Managers highlighted significant concerns regarding the insufficient integration of MH services, identifying structural barriers such as inadequate MH management structures and staff training, as well as social barriers, notably stigma and a lack of family treatment adherence support. Conversely, they recognised strong management structures, integrated screening, and social interventions, including family involvement, as key facilitators of successful MH integration. The findings emphasise the need for a whole-system approach that addresses all building blocks while prioritising the role of "people" in overcoming challenges with integrating MH services into TB and HIV care.

Leveraging Social Networks to Integrate Depression Treatment into Primary Health and Tuberculosis Care in Brazil.

Tuberculosis (TB) and depression are highly comorbid and linked to higher rates of death and disability. Several evidence-based treatments for depression have been successfully implemented in low- and middle-income countries, but more knowledge is needed on how to bring these innovations to scale within complex 'real world' public health systems. To explore whether the principles of social network analysis could be used to enhance receptivity to integrating depression treatment into primary care for individuals with and without TB in Brazil. We used existing scales to identify settings and providers with high receptivity and connectivity within the primary care network. We trained and supervised existing staff in three primary care sites to deliver a brief evidence-based intervention over one year, coupled with active dissemination activities. Afterwards, we reassessed receptivity among individuals involved, and not involved, in the pilot. Highly significant changes were observed in mental health literacy, attitudes towards evidence-based practices, work self-efficacy, and implementation leadership supporting our hypothesis. Limited social connections between primary care clinics precluded the examination of the hypothesis that targeting settings with high connectivity could capitalize on the information flow between and transcend the decentralized structure of the network, but leveraging the centralized nature of the TB program to integrate mental health services emerged as a promising alternative. The findings of this study strongly suggest that social networks may be leveraged to change individual providers' attitudes, thereby contributing to the enhanced dissemination of evidence-based interventions.

Mass incarceration as a driver of the tuberculosis epidemic in Latin America and projected effects of policy alternatives: a mathematical modelling study

Tuberculosis incidence is increasing in Latin America, where the incarcerated population has nearly quadrupled since 1990. We aimed to quantify the impact of historical and future incarceration policies on the tuberculosis epidemic, accounting for effects in and beyond prisons. In this modelling study, we calibrated dynamic compartmental transmission models to historical and contemporary data from Argentina, Brazil, Colombia, El Salvador, Mexico, and Peru, which comprise approximately 80% of the region's incarcerated population and tuberculosis burden. The model was fit independently for each country to incarceration and tuberculosis data from 1990 to 2023 (specific dates were country dependent). The model does not include HIV, drug resistance, gender or sex, or age structure. Using historical counterfactual scenarios, we estimated the transmission population attributable fraction (tPAF) for incarceration and the excess population-level burden attributable to increasing incarceration prevalence since 1990. We additionally projected the effect of alternative incarceration policies on future population tuberculosis incidence. Population tuberculosis incidence in 2019 was 29·4% (95% uncertainty interval [UI] 23·9-36·8) higher than expected without the rise in incarceration since 1990, corresponding to 34 393 (28 295-42 579) excess incident cases across countries. The incarceration tPAF in 2019 was 27·2% (20·9-35·8), exceeding estimates for other risk factors like HIV, alcohol use disorder, and undernutrition. Compared with a scenario where incarceration rates remain stable at current levels, a gradual 50% reduction in prison admissions and duration of incarceration by 2034 would reduce population tuberculosis incidence by over 10% in all countries except Mexico. The historical rise in incarceration in Latin America has resulted in a large excess tuberculosis burden that has been under-recognised to date. International health agencies, ministries of justice, and national tuberculosis programmes should collaborate to address this health crisis with comprehensive strategies, including decarceration. National Institutes of Health.

Endogenous reactivation cases identified by whole genome sequencing of Mycobacterium tuberculosis: Exploration of possible causes in Latvian tuberculosis patients

BackgroundThe recurrence of tuberculosis (TB) continues to place a significant burden on patients and TB programs worldwide. Repeated TB episodes can develop either due to endogenous reactivation of previously treated TB or exogenous reinfection with a distinct strain of Mycobacterium tuberculosis (Mtb). Determining the precise cause of the recurrent TB episodes and identifying reasons for endogenous reactivation of previously successfully treated patients is crucial for introducing effective TB control measures. MethodsHere, we aimed to provide a retrospective individual analysis of the clinical data of pulmonary TB patients with assumed endogenous infection reactivation based on WGS results to identify the reasons for reactivation. Patient medical files were reviewed to describe the provoking factors for endogenous reactivation. ResultsIn total, 25 patients with assumed endogenous TB reactivation were included in the study group, and 30 patients with one TB episode during the study period were included in the control group. There were no statistically significant differences identified between studied patient groups in patients age (t(53) = −1.53, p = 0.13), body mass index (t(53) = 0.82, p = 0.42), area of residency (χ2(1;55) = 0.015, p = 0.9), employment status (χ2(1;55) = 0.076, p = 0.78) and presence of comorbidities (χ2(1;55) = 3.67, p = 0.78). Study group patients had statistically significantly more frequently positive sputum smear microscopy results (χ2(1;55) = 8.72, p = 0.0031), longer time to sputum smear (t(31) = −2.2, p = 0.036) and sputum culture conversion (W (55) = 198.5, p = 0.0029). Smoking was statistically significantly (χ2(1;55) = 5.77, p = 0.016) more frequently represented among study group patients. The median treatment duration for drug susceptible TB was 6 months in both in the control group (IQR 6–6) and among study group patients (IQR 6–7.75). The median treatment duration for multidrug-resistant TB was 20 months (IQR 17–23) in the control group and 19 months (IQR 16–19) in the study group patients. ConclusionPositive SSM for acid-fast bacteria, delayed time to sputum smear and sputum culture conversion, smoking, and incomplete therapy in the study group patients with multidrug-resistant TB should be considered as potential reasons for reactivation in recurrent TB patient group in our study.

The effectiveness of integrated health professional organization collaboration in the treatment of pulmonary tuberculosis: A qualitative study

Background: Tuberculosis (TB) is an infectious disease, the high incidence of tuberculosis and its impact have caused the world to pay special attention, one of which is through the target of the third issue of the sustainable development goals (SDGs), namely tackling the TB epidemic in 2030. Efforts to prevent and reduce TB incidence in Indonesia through to find, treat, and cure TB program. Approaches to finding, diagnosing, treating, and curing TB patients and stopping transmission in the community. The treatment is being carried out actively, massively, and intensively, but the problem-solving has not yet been completed, innovation is needed through the collaboration of integrated health professional organizations, to anticipate the treatment of TB independently, in the service units of private hospitals, clinics and doctors' independent practice places. This innovation is to increase the new case detection rate, and the tracking of initial lost to follow up patients. Purpose: To analyze the effectiveness of integrated health professional organization collaboration in the treatment of pulmonary tuberculosis Method: Qualitative research with descriptive and exploratory design. The source of data and information is informants from the health profession determined by purposive sampling. In-depth interview and focus group discussion interview methods. Informants are representative members of each health profession organization appointed by the organization's leadership. Results: Health professional organizations are committed to and contribute to the well-organized treatment of TB. Integrated activity programs, increasing the discovery of new case detection rates, identification of drug-resistant pulmonary tuberculosis (DR-PTB) and drug-sensitive pulmonary tuberculosis (DS-PTB), and active monitoring of patients initially lost to follow-up, as well as preventing independent case handling. Conclusion: The collaboration of health professional organizations is very effective in helping the government handle Tuberculosis, has a commitment to increase the new case detection rate, identification of drug-resistant pulmonary tuberculosis (DR-PTB) and drug-sensitive pulmonary tuberculosis (DS-PTB), and actively monitor patients who are initially Lost to follow up, which is carried out in an integrated manner.

The role and value of counsellors in the treatment journeys of people with tuberculosis and their families: Qualitative insights from the South Fly District of Papua New Guinea.

Combined education and counselling can contribute to person-centred care for tuberculosis (TB), improving uptake, adherence, and outcomes of treatment for TB disease and TB infection. Though strongly recommended by the World Health Organization for all people diagnosed with TB, education and counselling is not widely implemented in TB programs around the world. In 2016, a pilot TB education and counselling program, delivered by trained professionals and peers, was initiated to support people on TB treatment in the South Fly District of Papua New Guinea. This article reports on select findings from a qualitative study that examined the socio-cultural dimensions of TB, including treatment support such as education and counselling, in the South Fly District. An assessment on data collected during 128 semi-structured in-depth interviews of the role of counsellors on TB treatment journeys revealed strong participant support for the counsellors and the services they delivered, with particular emphasis on the emotional support provided to address fears and concerns related to TB diagnosis and treatment, and to support treatment adherence; valuable attributes of counsellors; their role as intermediaries between patients and health workers; their provision of biomedical knowledge of TB transmission and disease; and their assistance in addressing stigma and discrimination from family and community. Participants also noted how tackling the socio-structural issues that drive TB transmission in people's homes and communities were beyond the remit of counsellors' work. TB education and counselling should be an essential part of all TB services to provide support and encouragement for people to continue treatment to completion.

Psychological morbidity and quality of life of patients with pulmonary tuberculosis.

Tuberculosis (TB) is associated with psychological distress, poor coping, deterioration in health-related quality of life (HRQL), and stigma. However, these issues have never received sufficient attention as a part of routine care. The healthcare workers and physicians of primary contact are not sensitized to use discrete screening questionnaires to identify and address these issues. A longitudinal study was hence conducted in the Department of Pulmonary Medicine in collaboration with the Department of Psychiatry. 75 microbiologically confirmed 'new' pulmonary TB patients were enrolled. Socio-demographic and clinical details were noted. The patients were then evaluated for psychological distress using the General Health Questionnaire-12-Hindi version (GHQ-12) and Patient Distress Thermometer (PDT); coping strategies using the Coping Strategy Check List-Hindi Version (CSCL); HRQL using the World Health Organization Quality of Life-Brief-Hindi version (WHOQOL-Bref), and stigma using the Explanatory Model Interview Catalogue-affected persons Stigma Scale (EMIC-SS), at the start of treatment. Those having a GHQ-12 score ≥3 were labeled as 'screen positive' for psychological distress and referred to a consultant psychiatrist for detailed psychological assessment. Treatment was given by the psychiatrist if diagnosed with a psychiatric illness. All those without the diagnosis of a psychiatric illness were counseled by a pulmonologist. All patients were called for a follow-up visit and repeat assessments on the 15th day at the end of the intensive phase, using the same instruments employed at baseline. The patients already on treatment by the psychiatrist were again evaluated for their psychiatric illness. 32 (42.7%) patients had psychological distress (GHQ-12≥3) at baseline. 20 of them (26.7%) were diagnosed with a psychiatric illness. However, only 2 (2.7%) patients had psychological distress and psychiatric illness at follow-up (p<0.001). Mean scores of GHQ-12, PDT, CSCL, WHOQOL-Bref-26, and EMIC-SS at baseline were 3.000±1.9590, 2.333±1.2980, 3.480±2.2017, 311.63±30.201 and 5.267±1.8478, respectively. All the scores improved significantly at follow-up (p<0.001). The scores of the various instruments used in the study significantly correlated with each other. Comprehensive screening for psychological distress and assessment of HRQL should be part of routine TB care. The healthcare workers under the program should be sensitized to use the various screening tools on a day-to-day basis to identify patients who require expert psychiatrist care. The majority of the patients with distress, but without a psychiatric illness, can be handled well with dedicated counseling sessions by the healthcare workers themselves. The ancillary staff should be encouraged and trained to meet the demands in resource-constrained settings. A multidisciplinary approach, with close integration of TB programs with mental health services, is urgently required to eliminate TB.

Individual, community and health systems factors influencing time to notification of tuberculosis: situating software and hardware bottlenecks in local health systems

BackgroundDespite several global interventions, tuberculosis (TB) remains a leading cause of death affecting millions of people globally. Many TB patients either have no access to quality care or go undetected by national health systems. Several multilevel factors account for under-detection of persons with TB. This study sought to explore patient-related software, community and health systems software and hardware factors influencing time to notification of TB in Lusaka District, Zambia.MethodsThis was an exploratory qualitative case study that adopted a software and hardware lens of conceptualizing health systems. Data were collected from across three sites – urban and peri-urban areas: Chongwe, Kafue, and Lusaka – within Lusaka Province, Zambia. Sixteen key informants - TB corner nurses, community TB treatment supporters, and TB program managers - were interviewed. Six focus groups were held with TB patients. Data were analyzed using thematic analysis.ResultsThe study identified factors influencing timely TB notification, categorized into software and hardware elements.Patient-related software elements, including TB knowledge and awareness, and health-seeking behavior, are crucial for prompt notification among TB patients.In the community health system, software elements like social stigma and undesirable community attitudes towards contact tracing, and hardware elements such as unbalanced schedules, excessive workload and limited capacity of community TB treatment supporters contribute to delayed TB notification.In the formal health system, software elements like negative attitudes of health providers towards TB patients and demotivation of TB staff, and hardware elements such as high diagnostics and transportation costs, outdated diagnostics in primary care facilities, and slow referral mechanisms, can also delay TB notification.ConclusionDelays in time to TB notification are influenced by a combination of software (attitudinal and behavioral) and hardware (resource-related) elements across TB patients, community health systems, community TB treatment supporters, health providers, and TB staff. Addressing these factors, particularly social stigma, negative attitudes, and resource constraints, is crucial to improving timely TB detection and treatment.