Tuberculosis Program Research Articles

Treatment success rate and associated factors among drug susceptible tuberculosis individuals in St. Kizito Hospital, Matany, Napak district, Karamoja region. A retrospective study.

Tuberculosis (TB) is the leading cause of death among infectious agents globally. An estimated 10 million people are newly diagnosed and 1.5 million die of the disease annually. Uganda is among the 30 high TB-burdenedd countries, with Karamoja having a significant contribution of the disease incidence in the country. Control of the disease in Karamoja is complex because a majority of the at-risk population remain mobile; partly because of the nomadic lifestyle. This study, therefore, aimed at describing the factors associated with drug-susceptible TB treatment success rate (TSR) in the Karamoja region. This was a retrospective study on case notes of all individuals diagnosed with and treated for drug-susceptible TB at St. Kizito Hospital Matany, Napak district, Karamoja from 1st Jan 2020 to 31st December 2021. Data were abstracted using a customised data abstraction tool. Data analyses were done using Stata statistical software, version 15.0. Chi-square test was conducted to compare treatment success rates between years 2020 and 2021, while Modified Poisson regression analysis was performed at multivariable level to determine the factors associated with treatment success. We studied records of 1234 participants whose median age was 31 (IQR: 13-49) years. Children below 15 years of age accounted for 26.2% (n = 323). The overall treatment success rate for the study period was 79.3%(95%CI; 77.0%-81.5%), with a statistically significant variation in 2020 and 2021, 75.4% (422/560) vs 82.4% (557/674) respectively, (P = 0.002). The commonest reported treatment outcome was treatment completion at 52%(n = 647) and death was at 10.4% (n = 129). Older age, undernutrition (Red MUAC), and HIV-positive status were significantly associated with lower treatment success: aPR = 0.87(95%CI; 0.80-0.94), aPR = 0.91 (95%CI; 0.85-0.98) and aPR = 0.88 (95%CI; 0.78-0.98); respectively. Patients who were enrolled in 2021 had a high prevalence of treatment success compared to those enrolled in 2020, aPR = 1.09 (95%CI; 1.03-1.16). TB TSR in Matany Hospital was suboptimal. Older age, poor nutrition, and being HIV-positive were negative predictors of treatment success. We propose integrating nutrition and HIV care into TB programming to improve treatment success.

Case fatality among people with drug-susceptible TB enrolled in a private health sector TB treatment support program in Bihar, India during the first year of the COVID-19 pandemic.

Experiencing 27% of the global tuberculosis (TB) burden, India's TB epidemic is the largest in the world. Due to COVID-19-related disruptions to TB programs, India has also seen the largest drop in TB case notifications of any country globally. We estimated case fatality among people treated for TB in India during the pandemic and compared these to pre-pandemic estimates. A random sample of 4,000 adults enrolled in World Health Partners (WHP), a private sector TB treatment support program (enrolling only people with drug-susceptible TB) in Bihar, India in the first year of COVID-19 (Mar 2020-Mar 2021) were contacted via phone to collect information on TB case fatality and other relevant covariates. Inverse probability of selection (IPS) weighting was used to obtain selection-bias-corrected in-treatment and post-treatment case fatality estimates. Covariates associated with (but not necessarily causal of) case fatality were identified by estimating adjusted hazard ratios (HRs) using the Cox proportional hazards model. WHP enrolled 19,826 adult drug-susceptible TB patients in the first year of COVID-19 (Mar 2020 to Mar 2021). Of our random sample of 4,000 patients, n = 2,962 (74.1%) answered the follow-up call. Unweighted and IPS-weighted in-treatment case fatality in the primary analysis were 6.12% (95%CI: 5.31-6.97%) and 6.07% (95%CI: 5.22-6.93%), respectively. Post-treatment case fatality estimates were 0.97% (95%CI: 0.61-1.33%) (unweighted) and 1.27% (95%CI: 0.79-1.79) (IPS-weighted). Our IPS-weighted estimates for in-treatment and post-treatment case fatality were similar to pre-pandemic IPS-weighted estimates (in-treatment: 7.27%, 95%CI: 5.97%- 8.49% and 12 months post-treatment: 1.23, 95%CI: 0.75-1.73). Although not higher than pre-pandemic estimates, the observed case fatality in this private sector cohort of people treated for drug-susceptible TB during COVID-19 in Bihar, India is above the level needed to reach the 2025 and 2030 End TB Strategy targets for reductions in TB deaths, underlining the extent of pandemic-related setbacks to TB elimination.

Facilitators and barriers to implementing chest radiography in tuberculosis systematic screening of clinically high-risk groups in Ethiopia: A qualitative study.

Chest X-ray has been included in national tuberculosis screening algorithms as a sensitive tuberculosis screening tool among high-risk groups. However, the implementation was influenced by multiple factors. We aimed to explore facilitators and barriers to implementing chest X-ray in systematic tuberculosis screening of clinically high-risk groups in Addis Ababa, Ethiopia. We conducted face-to-face, in-depth interviews with purposively selected participants at tertiary-level hospitals and a tuberculosis program coordinator at the Ethiopian Ministry of Health, who coordinates chest X-ray-guided systematic tuberculosis screening. A framework analysis was conducted using the consolidated framework for implementation research. We identified 11 constructs that influenced the implementation of the chest X-ray intervention. Facilitators included the relative sensitivity of chest X-ray over symptom-based screening, its potential integration into existing systems, technological advancements in the area, policies and laws supporting the screening intervention, and the quality of the evidence of the screening intervention. Barriers included implementation complexity, high costs of the intervention, knowledge gaps among healthcare providers, training gaps, low priority for chest X-ray screening at the healthcare facility level, and a lack of external support from the Ministry of Health and stakeholders. This study identified contextual factors that influence the implementation of chest X-ray guided systematic tuberculosis screening among clinically high-risk groups that healthcare facilities and health ministries may use for decision-making. Addressing the barriers identified by the study would help to improve the implementation of chest X-rays for improved tuberculosis case detection and prompt treatment in clinically high-risk groups.

A proposal to evaluate the management of tuberculosis programs: a qualitative, evaluability assessment in the border region of Brazil and Venezuela.

This study aims to analyze the feasibility of building an evaluative model for the management of the Tuberculosis Prevention and Control Program in the State of Roraima, located on the border between Brazil and Venezuela. This is an evaluability assessment, a type of study used as a pre-evaluation of the development and implementation stages of a program, as well as throughout its execution. The study was developed in stages comprising the: (i) definition of the intervention to be analyzed and its objectives and goals; (ii) construction of the intervention logical model; (iii) screening of parties interested in the evaluation; (iv) definition of the evaluative questions; and (v) design of the evaluation matrix. Four priority components were defined for the evaluation: management of the organization and implementation of tuberculosis (TB) prevention and control policy; epidemiological surveillance management; care network management; and management of expected/achieved results. In this model, and based on theoretical references, we defined the necessary resources, activities, outputs, outcomes, and the expected impact for each of the policy management components. The management of the TB control program is feasible for evaluation based on the design of its components, the definition of structure and process indicators, and relevant results for the analysis of the management of TB prevention and control actions, as well as its influence on compliance with the agreed indicators and targets aiming at eradicating the disease by 2035.

A comparative analysis of two national tuberculosis reporting systems and their impact on tuberculosis case notification in Uganda.

Before 2018, the use of parallel tuberculosis (TB) reporting systems was resource intensive with duplication of efforts and hence the need to select one that contributed to better TB case notification at the National TB and Leprosy Program (NLTP) in Uganda. We sought to analyse the difference in reporting rates between the two systems in order to improve NTLP TB case notification rates, logistics management, and planning for better health service delivery initiatives. We conducted a comparative study to assess TB case notification between the web-based DHIS2 and the district TB supervisor-led health management information system between January 2016 to December 2017. We used Poisson regression analysis to assess the statistical differences in reporting rates between the two reporting systems. The association between TB case notification and the type of reporting system was statistically significant (Prob > chi2 = 0.0000). The Incident Rate Ratio (IRR) for the web-enabled DHIS2 system versus the district TB supervisor-led health management information system was 1.106625. The web-based integrated DHIS2 system was more effective in reporting missing TB cases. It presents an opportunity for better planning and allocation of resources for improved service delivery in a low-income setting.

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

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

Reducing Initial Loss to Follow-up Among People With Bacteriologically Confirmed Tuberculosis: LINKEDin, a Quasi-experimental Study in South Africa.

Every person diagnosed with tuberculosis (TB) needs to initiate treatment. The World Health Organization estimated that 61% of people who developed TB in 2021 were included in a TB treatment registration system. Initial loss to follow-up (ILTFU) is the loss of persons to care between diagnosis and treatment initiation/registration. LINKEDin, a quasi-experimental study, evaluated the effect of 2 interventions (hospital recording and an alert-and-response patient management intervention) in 6 subdistricts across 3 high-TB burden provinces of South Africa. Using integrated electronic reports, we identified all persons diagnosed with TB (Xpert MTB/RIF positive) in the hospital and at primary health care facilities. We prospectively determined linkage to care at 30 days after TB diagnosis. We calculated the risk of ILTFU during the baseline and intervention periods and the relative risk reduction in ILTFU between these periods. We found a relative reduction in ILTFU of 42.4% (95% CI, 28.5%-53.7%) in KwaZulu Natal (KZN) and 22.3% (95% CI, 13.3%-30.4%) in the Western Cape (WC), with no significant change in Gauteng. In KZN and the WC, the relative reduction in ILTFU appeared greater in subdistricts where the alert-and-response patient management intervention was implemented (KZN: 49.3%; 95% CI, 32.4%-62%; vs 32.2%; 95% CI, 5.4%-51.4%; and WC: 34.2%; 95% CI, 20.9%-45.3%; vs 13.4%; 95% CI, 0.7%-24.4%). We reported a notable reduction in ILTFU in 2 provinces using existing routine health service data and applying a simple intervention to trace and recall those not linked to care. TB programs need to consider ILTFU a priority and develop interventions specific to their context to ensure improved linkage to care.

Spatial distribution and determinants of tuberculosis incidence in Mozambique: A nationwide Bayesian disease mapping study

IntroductionMozambique is a high-burden country for tuberculosis (TB). International studies show that TB is a disease that tends to cluster in specific regions, and different risk factors (HIV prevalence, migration, overcrowding, poverty, house condition, temperature, altitude, undernutrition, urbanization, and inadequate access to TB diagnosis and treatment) are reported in the literature to be associated with TB incidence. Although Mozambique has a higher burden of TB, the spatial distribution, and determinants of TB incidence at the sub-national level have not been studied yet for the whole country. Therefore, we aimed to analyze the spatial distribution and determinants of tuberculosis incidence across all 154 districts of Mozambique and identify the hotspot areas. MethodWe conducted an ecological study with the district as our unit of analysis, where we included all cases of tuberculosis diagnosed in Mozambique between 2016 and 2020. We obtained the data from the Mozambique Ministry of Health and other publicly available open sources. The predictor variables were selected based on the literature review and data availability at the district level in Mozambique. The parameters were estimated through Bayesian hierarchical Poisson regression models using Markov Chain Monte Carlo simulation. ResultsA total of 512 877 people were diagnosed with tuberculosis in Mozambique during our five-year study period. We found high variability in the spatial distribution of tuberculosis incidence across the country. Sixty-two districts out of 154 were identified as hotspot areas. The districts with the highest incidence rate were concentrated in the south and the country's central regions. In contrast, those with lower incidence rates were mainly in the north. In the multivariate analysis, we found that TB incidence was positively associated with the prevalence of HIV (RR: 1.23; 95 % CrI 1.13 to 1.34) and negatively associated with the annual average temperature (RR: 0.83; 95 % CrI 0.74 to 0.94). ConclusionThe incidence of tuberculosis is unevenly distributed across the country. Lower average temperature and high HIV prevalence seem to increase TB incidence. Targeting interventions in higher-risk areas and strengthening collaboration between HIV and TB programs is paramount to ending tuberculosis in Mozambique, as established by the WHO's End TB strategy and the Sustainable Development Goals.

A qualitative assessment on the acceptability of providing cash transfers and social health insurance for tuberculosis-affected families in Ho Chi Minh City, Vietnam.

To achieve the Sustainable Development Goal's targets of universal health coverage (UHC) and poverty reduction, interventions are required that strengthen and harmonize both UHC and social protection. Vietnam is committed to achieving financial protection and over 90% of the general population has enrolled in its social health insurance (SHI) scheme. However, an estimated 63% of tuberculosis (TB)-affected households in Vietnam still face catastrophic costs and little is known about the optimal strategies to mitigate the costs of TB care for vulnerable families. This study assessed the acceptability of a social protection package containing cash transfers and SHI using individual interviews (n = 19) and focus group discussions (n = 3 groups). Interviews were analyzed through framework analysis. The study's main finding indicated that both conditional and unconditional cash transfers paired with SHI were acceptable, across six dimensions of acceptability. Cash transfers were considered beneficial for mitigating out-of-pocket expenditure, increasing TB treatment adherence, and improving mental health and general well-being, but the value provided was inadequate to fully alleviate the economic burden of the illness. The conditionality of the cash transfers was not viewed by participants as inappropriate, but it increased the workload of the TB program, which brought into question the feasibility of scale-up. SHI was viewed as a necessity by almost all participants, but people with TB questioned the quality of care received when utilizing it for auxiliary TB services. Access to multiple sources of social protection was deemed necessary to fully offset the costs of TB care. Additional research is needed to assess the impact of cash transfer interventions on health and economic outcomes in order to create an enabling policy environment for scale-up.

Cost of inaction: a framework to estimate the economic cost of missing a patient with tuberculosis in the Indian context

ObjectivesTo estimate the economic impact of failure to find and treat tuberculosis disease and prevent tuberculosis infection from progressing to active disease.DesignEstimating the economic cost of not finding and treating...

Nurses Monitor Medication with a Schedule for Undrop-Out Program (SRAGAM) for TBC Clients

Regulation Minister of Health Republic Indonesia Number 15 of 2022 through 6 pillars of health transformation, one of which is primary service, namely medication adherence education. Ministry of Health Republic Indonesia, (2020) the 2020-2024 RPJMN policy directions and Sustainable Development Goals (SDGs) regarding six diseases, one is Tuberculosis (TBC). TBC prevalence in Southeast Asia (44%), Indonesia (8.5%), Lampung (40.2%), and South Lampung (41%). Indonesia's strategy to reduce the incidence of TBC has six plans: the 2020-2024 national tuberculosis program, optimizing promotion and prevention efforts, providing tuberculosis prevention treatment, and controlling. TBC treatment 6-24 months resulted in drop-out treatment. Nurses play a supervisory role and carry out counseling to increase patient adherence. The Schedule For Undrop-Out Program (SRAGAM) is a media innovation to improve patient medication adherence. SRAGAM makes it easier for patients, PMOs, and health workers to arrange medication-taking schedules. The purpose is to determine the effect of SRAGAM on increasing patient adherence. Research is a quantitative one-group pretest-posttest with a control group preexperimental design. Respondents were patients who were taking drugs. The number of samples was 32 respondents (16 intervention:16 control). The research was from December 2022 to May 2023 in Hajimena Health Center, South Lampung. Data analysis using t-test. The results of the study mean value intervention group (5.6875) and control group (4.1250). The P-value of 0.000 concluded that SRAGAM effectively increased the number of patients taking medication. The results will become educational media in preventing the incidence of dropping medication in patients.

Implementation of national whole-genome sequencing of Mycobacterium tuberculosis, National Public Health Laboratory, Singapore, 2019-2022.

The National Tuberculosis Programme (NTBP) monitors the occurrence and spread of tuberculosis (TB) and multidrug-resistant TB (MDR-TB) in Singapore. Since 2020, whole-genome sequencing (WGS) of Mycobacterium tuberculosis isolates has been performed at the National Public Health Laboratory (NPHL) for genomic surveillance, replacing spoligotyping and mycobacterial interspersed repetitive unit-variable number tandem repeats analysis (MIRU-VNTR). Four thousand three hundred and seven samples were sequenced from 2014 to January 2023, initially as research projects and later developed into a comprehensive public health surveillance programme. Currently, all newly diagnosed culture-positive cases of TB in Singapore are prospectively sent for WGS, which is used to perform lineage classification, predict drug resistance profiles and infer genetic relationships between TB isolates. This paper describes NPHL's operational and technical experiences with implementing the WGS service in an urban TB-endemic setting, focusing on cluster detection and genomic drug susceptibility testing (DST). Cluster detection: WGS has been used to guide contact tracing by detecting clusters and discovering unknown transmission networks. Examples have been clusters in a daycare centre, housing apartment blocks and a horse-racing betting centre. Genomic DST: genomic DST prediction (gDST) identifies mutations in core genes known to be associated with TB drug resistance catalogued in the TBProfiler drug resistance mutation database. Mutations are reported with confidence scores according to a standardized approach referencing NPHL's internal gDST confidence database, which is adapted from the World Health Organization (WHO) TB drug mutation catalogue. Phenotypic-genomic concordance was observed for the first-line drugs ranging from 2959/2998 (98.7 %) (ethambutol) to 2983/2996 (99.6 %) (rifampicin). Aspects of internal database management, reporting standards and caveats in results interpretation are discussed.

Health system productivity in sub-Saharan Africa: tuberculosis control in high burden countries

BackgroundSixteen of the 30 countries with a high tuberculosis (TB) burden are in Sub-Saharan Africa (SSA). Over 25% of TB deaths occur in the Africa region. This study aims to estimate the productivity changes of TB programs in 16 SSA countries where TB is endemic.MethodsWe used Hicks-Moorsteen index to compute and decompose Total factor productivity (TFP), and the β-convergence and σ-convergence tests to check for convergence patterns among SSA countries.ResultsWe found that technological change has been the main driver of the TFP growth, and that increasing technical efficiency may be the first objective in efforts to improve TFP of TB programs. Moreover, the convergence tests reveal significant homogeneity in terms of TFP change between SSA countries studied.ConclusionThe findings suggest that improving technical efficiency of TB programs mainly calls for better resource allocation, capacity building in governance and management of programs, improved training of the health providers and stronger prevention policies. Policymakers must design models for integration of TB treatment under the universal health insurance schemes.

Community Health Service in Tuberculosis Cases in the Lawawoi Health Center Working Area

Tuberculosis is a directly infectious disease caused by tuberculosis germs, namely Myobacterium Tuberculosis. The majority of tuberculosis germs attack the lungs, but tuberculosis germs can also attack other body organs. Tuberculosis is a direct infectious disease caused by tuberculosis germs (Mycobacterium Tuberculosis). The aim of this research is to determine factors related to the role as a tuberculosis program officer in tuberculosis cases in the Lawawoi Community Health Center work area. This research method uses an analytical research design, which is research to find out how and why a phenomenon occurs through statistical analysis such as the correlation between cause and effect or risk factors and effects and then it can be continued to find out how big the contribution of the cause or risk factor is to the effect. or effect. The results of this research show that good training with the role of a tuberculosis program officer is good at (23.7%) for the discovery of tuberculosis cases in the work area of the Lawawoi health center, which means that training is very important because it is a method used by institutions such as the health center in Lawawoi to maintain and safeguard, maintain the competence of tuberculosis program officers in finding tuberculosis cases. The research conclusion is that there is a relationship between training and the role as a tuberculosis program officer on the discovery of tuberculosis cases in the working area of the Lawawoi Community Health Center. Significant Value 0.000&lt;0.05. There is a relationship between attitudes and the role as a tuberculosis program officer towards finding tuberculosis cases in the Lawawoi Community Health Center working area. Significant Value 0.006&lt;0.05. There is a relationship between motivation and the role as a tuberculosis program officer on the discovery of tuberculosis cases in the working area of the Lawawoi Community Health Center. Significant Value 0.001&lt;0.05.

Health evaluation: the level of implantation of the tuberculosis program in primary health care

Health evaluation: the level of implantation of the tuberculosis program in primary health care

A costing framework to compare tuberculosis infection tests

ObjectiveTo develop a framework to estimate the practical costs incurred from, and programmatic impact related to, tuberculosis (TB) infection testing—tuberculin skin tests (TST) versus interferon gamma release assay (IGRA)—in a...

Integration Challenges and Opportunity of Implementing Non-Communicable Disease Screening Intervention with Tuberculosis Patient Care: A Mixed Implementation Study.

Despite the comorbidity, early detection and treatment of the two diseases are highly recommended; however, a few pilot studies were conducted, which are mainly focused on diabetes mellitus screening and the integration opportunity and challenges were not known. The study aimed to identify integrated implementation challenges and opportunities of non-communicable disease and risk factors screening intervention with tuberculosis patient care. A mixed implementation study design was used. Data were collected from a sample of 443 tuberculosis patients, 21 key informants and facility observations. For quantitative data, descriptive statistics for proportion were summarized in tables and figures. Four distinct implementation frame was adapted for thematic analysis of audio recordings, daily verbatim transcription, and descriptive field notes. The prevalence of hypertension and diabetes mellitus among tuberculosis patients were 6.55% and 5.64%, respectively. Totally 9 subthemes and 21 new codes were developed, of which 13 and 8 new codes were developed for integrated implementation challenges and opportunities, respectively. The absence of medical equipment, skill and knowledge training, record and report system, cooperative integration, feedback, referral system, shortage of supporting agencies, and services not free were external challenges, whereas lack of trained health workers, focal persons, and increased workload and absence of awareness creation were internal challenges. Despite the challenges, the presence of health extension programs, non-governmental organizations, community health care insurance and associations for diabetes mellitus were external opportunities. Availability of assigned focal persons, trained stakeholders, guidelines, information systems and compatible tuberculosis program structure were internal opportunities. The majority of TB patients were not comorbid with NCDs. We build a favourable system for integrated implementation developing an integration platform and structural authority at a different organization by addressing identified challenges and applying facilitators is crucial.

Practices and challenges in implementing tuberculosis program at medical colleges in Karnataka, India

Background: The study aimed to evaluate the implementation status of the National Tuberculosis Elimination Program (NTEP) at medical colleges in Karnataka, India, and identify the challenges encountered by the medical college core committee members. Methods: A cross-sectional study was conducted among 14 medical colleges in 2019-20, using a pre-tested, semi-structured questionnaire to collect data on various NTEP components. Results: The implementation status of NTEP activities was categorized as adequate, partially adequate, or inadequate. Results showed that certain activities such as TB notification, DMC infrastructure, TB-HIV coordination, and the formation of the NTEP core committee were adequately implemented. However, challenges such as work overload, lack of dedicated manpower, and salary constraints were encountered. Conclusions: Overall, the medical colleges involved in the study were actively implementing NTEP, but there is still room for improvement to fully optimize the implementation.

Acceptability of using the medication monitor and experience of a differentiated care approach for TB treatment adherence among people living with TB in South Africa.

The introduction of digital adherence technologies (DATs) such as medication monitors in tuberculosis (TB) programmes supports treatment adherence among people with tuberculosis (PWTB). We evaluated the acceptability of using medication monitors (Wisepill evriMED) prompting a stepwise differentiated care approach (DCA), involving short message service (SMS), phone calls, home visits and motivational counselling, among PWTB in South Africa. We conducted 62 in-depth interviews with participants in local languages across three provinces (January-October 2020), purposively selected by treatment month, adherence history and gender. Interviews were audio recorded, transcribed verbatim and translated. Using a deductive approach and the Theoretical Framework for Acceptability (TFA), we explored acceptability across the sample attributes. PWTB across adherence histories showed a positive attitude to using the evriMED device and receiving the DCA support. PWTB described the SMS reminders and phone calls as effective reminders, though home visits were less acceptable, due to perceived stigma. Despite willingness to participate in the intervention, the large size of the monitor and sound of the alarm drew attention, potentially causing embarrassment and stigma. Due to perceived stigma, some PWTB adapted the intervention by leaving the monitor at home after removing the pills to ensure that someone else tracked usage, while the PWTB used alternative reminders such as cell phones to take their medication. Although PWTB showed a positive attitude towards the intervention, perceived stigma contributed to participants adapting their lifestyle to meet treatment adherence requirements without using the monitor. However, the medication monitor was a tool that seemed to prompt this personal change in behaviour. Achieving people-centered TB care, including the introduction of DATs, will require that TB programmes incorporate PWTB insights to maximize their use and effectiveness.

Detection and management of tuberculosis in Tunisia: challenges and outcomes

Abstract Introduction Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. In Tunisia, where TB remains endemic, the national control program ensures free vaccination, free outpatient TB treatment in addition to early detection of cases and directly observed treatment short course. However, available data on these activities and outcomes are limited. The objective of this study was to describe the evolution of TB detection and management indicators and outcomes from 2018 to 2021. Methods We analyzed data collected part of the epidemiological investigations of notified cases and active search for cases over a period of 4 years (2018-2021). In each governorate, dedicated teams collect samples from cases’ contacts for microscopic sputum examination for screening and ensure patients’ follow-up. All data related to contact tracing, treatment and outcomes were collected, entered and analyzed using SPSS-21. Results The number of screened cases decreased from 30337 in 2018 to 16045 in 2021. The number of investigations of reported cases also decreased; from 2408 in 2018 to 1295 in 2021 (proportion of 74.6% to 48.9% respectively). However, the percentage of positives increased from 1.4% to 2.1%. In 2021, therapeutic success was recorded among 81% of cases (compared to 86% in 2018). From 2018 to 2021, there was an increase in three indicators: fatality rate (1.55 to 2.53%), discontinuation of treatment (from 2.5% to 3.2%) and the proportion of multidrug-resistant TB cases (0.45 to 0.69%). Conclusions Despite free care and treatment, our study showed challenges in the prevention and management of TB. Several activities of the national tuberculosis program have decreased, probably due to the pandemic, as noted in general preventive and care activities worldwide. More education and awareness efforts should be made, not only for patients and their contacts, but also for health care professionals, to be more vigilant in early case detection and continued treatment. Key messages • Several activities of the national tuberculosis program have decreased from 2018 to 2021, probably due to the pandemic. • From 2018 to 2021, there was an increase in the fatality rate, discontinuation of treatment and multidrug-resistant TB cases.