Tuberculosis Treatment Programs Research Articles

Exploring health care providers’ engagement in prevention and management of multidrug resistant Tuberculosis and its factors in Hadiya Zone health care facilities: qualitative study

BackgroundEngagement of healthcare providers is one of the World Health Organization strategies devised for prevention and provision of patient centered care for multidrug resistant tuberculosis. The need for current research question rose because of the gaps in evidence on health professional’s engagement and its factors in multidrug resistant tuberculosis service delivery as per the protocol in the prevention and management of multidrug resistant tuberculosis.PurposeThe purpose of this study was to explore the level of health care providers’ engagement in multidrug resistant tuberculosis prevention and management and influencing factors in Hadiya Zone health facilities, Southern Ethiopia.MethodsDescriptive phenomenological qualitative study design was employed between 02 May and 09 May, 2019. We conducted a key informant interview and focus group discussions using purposely selected healthcare experts working as directly observed treatment short course providers in multidrug resistant tuberculosis treatment initiation centers, program managers, and focal persons. Verbatim transcripts were translated to English and exported to open code 4.02 for line-by-line coding and categorization of meanings into same emergent themes. Thematic analysis was conducted based on predefined themes for multidrug resistant tuberculosis prevention and management and core findings under each theme were supported by domain summaries in our final interpretation of the results. To maintain the rigors, Lincoln and Guba’s parallel quality criteria of trustworthiness was used particularly, credibility, dependability, transferability, confirmability and reflexivity.ResultsTotal of 26 service providers, program managers, and focal persons were participated through four focus group discussion and five key informant interviews. The study explored factors for engagement of health care providers in the prevention and management of multidrug resistant tuberculosis in five emergent themes such as patients’ causes, perceived susceptibility, seeking support, professional incompetence and poor linkage of the health care facilities. Our findings also suggest that service providers require additional training, particularly in programmatic management of drug-resistant tuberculosis.ConclusionThe study explored five emergent themes: patient’s underlying causes, seeking support, perceived susceptibility, professionals’ incompetence and health facilities poor linkage. Community awareness creation to avoid fear of discrimination through provision of support for those with multidrug resistant tuberculosis is expected from health care providers using social behavioral change communication strategies. Furthermore, program managers need to follow the recommendations of World Health Organization for engaging healthcare professionals in the prevention and management of multidrug resistant tuberculosis and cascade trainings in clinical programmatic management of the disease for healthcare professionals.

Tuberculosis treatment outcomes and associated factors among tuberculosis patients treated at healthcare facilities of Motta Town, Northwest Ethiopia: a five-year retrospective study

Tuberculosis (TB) remains a significant public health concern, particularly in low-resource settings. The treatment outcome is a crucial indicator of the effectiveness of TB treatment programs. Assessing the current treatment outcome and its associated factors is essential for improving patient care and reducing the spread of TB. Therefore, this study aimed to assess TB treatment outcomes and their associated factors among TB patients who received treatment at public healthcare facilities in Motta Town, Northwest Ethiopia. A facility-based retrospective cross-sectional study design was employed in two TB treatment centers in Motta town from January 2017 to December 2021. The study participants were all patients diagnosed with TB who received treatment. A p-value of 0.05 with a 95% confidence interval (CI) was used to determine statistical significance. A total of 362 TB patients were included in the study. The overall treatment success rate was 88.4% (95% CI 85.1, 91.7). Male gender (AOR = 2.40, 95% CI 1.16, 4.98), normal nutritional status (AOR = 3.11, 95% CI 1.33, 7.25), HIV negative status (AOR = 3.35, 95% CI 1.31, 8.60), and non-presumptive drug resistance to TB (AOR = 3.72, 95% CI 1.74, 7.98) were significantly associated with successful TB treatment outcomes (p < 0.05). In the current study, nine out of ten study participants had successful TB treatment outcome rates. Male gender, normal nutritional status, non-presumed drug resistance to TB, and HIV-negative status were significantly associated with successful TB treatment outcomes. By taking risk factors associated with poor treatment outcomes like those found in this study into account, patient management and treatment can be optimized. Sufficient TB control measures for populations are imperative and could significantly reduce the nation's total TB burden.

Trends of Drug-Resistant Tuberculosis in an Urban and a Rural Area in China: A 10-Year Population-Based Molecular Epidemiological Study.

Drug resistance is the critical determinant for appropriate tuberculosis (TB) treatment regimens and an important indicator of the local TB burden. We aimed to investigate and compare trends in TB drug resistance in the urban Songjiang District of Shanghai from 2011 to 2020, and the rural Wusheng County of Sichuan Province from 2009 to 2020, to assess the effectiveness of local TB control and treatment programs. Whole-genome sequencing data of Mycobacterium tuberculosis were used to predict drug-resistance profiles and identify genomic clusters. Clustered, retreated cases of drug-resistant TB with identical resistance mutations, as well as all new resistant cases, were defined as transmitted resistance. The Cochran-Armitage trend test was used to identify trends in the proportions. Differences between groups were tested using the Wilcoxon rank sum or chi-square tests. The annual proportions of rifampicin-resistant (RR), isoniazid-resistant (INH-R) and multidrug-resistant (MDR) TB cases did not change significantly in Songjiang. In Wusheng, however, the percentage of total TB cases that were RR decreased from 13.2% in 2009 to 3.7% in 2020, the INH-R cases decreased from 16.5% to 7.3%, and the MDR cases decreased from 10.7% to 3.7%. In retreated cases, the percentage of drug resistance decreased in both Songjiang and Wusheng, suggesting improved treatment programs. Transmitted resistance accounted for more than two thirds of drug-resistant cases over the entire study periods, and in recent years this proportion has increased significantly in Songjiang. In both urban Songjiang and rural Wusheng, drug-resistant TB is mostly the result of transmission of drug resistant strains and the percentage of transmitted resistance will likely increase with on-going improvements in the TB treatment programs. Reducing the prevalence of drug resistance depends principally upon decreasing transmission through the prompt diagnosis and effective treatment of drug-resistant TB cases.

Ubuntu Is a Critical Component in the Fight against Human Immunodeficiency Virus and Tuberculosis Stigma: Nursing Students' Perceptions.

Stigma is one of the documented barriers to achieving universal access to human immunodeficiency virus (HIV) and tuberculosis (TB) prevention, treatment, care, and support programs. The lack of African social theories to emphasize these issues may be the cause of the continent's failure to reduce stigma. We can use Ubuntu, an African philosophy that emphasizes sociability and ethics, to deepen our understanding of how to reduce HIV- and TB-related stigma in South Africa. In many African regions, Ubuntu values and principles were found to assist in reducing problems related to HIV. Ubuntu is a comprehensive phrase used by Africans to signify the characteristics that incorporate the core human virtues of compassion and humanity. We explored the perceptions of nursing students regarding the use of Ubuntu in the fight against HIV and TB stigma. Qualitative participatory research was used to engage all first- and second-level nursing students enrolled for the 2023 academic year at the selected university in South Africa. Purposive sampling was used to recruit the participants. An interactive workshop was used to gather data. The data from the recordings and flip charts were analysed together. Throughout the study, trustworthiness and ethical principles were upheld. Two primary themes emerged as expressions of Ubuntu in relation to a reduction in HIV and TB stigma and recognition of Ubuntu as a tool to combat stigma associated with HIV and TB. This confirms that within Ubuntu, there are elements that might be applied to reduce stigma attached to HIV and TB.

Epidemiology of multi-drug resistant Tuberculosis in the western region of Kenya

&lt;abstract&gt; &lt;p&gt;Multidrug-resistant tuberculosis (TB) (MDR-TB), or TB that is simultaneously resistant to both isoniazid (INH) and rifampicin (RIF), is a barrier to successful TB control and treatment. Stratified data on MDR-TB, particularly in the high-burden western Kenya region, remain unknown. This data is important to monitor the efficacy of TB control and treatment efforts. Herein, we determined the molecular epidemiology of drug-resistant TB and associated risk factors in western Kenya. This was a non-experimental, population-based, cross-sectional study conducted between January and August 2018. Morning sputum samples of individuals suspected of pulmonary TB were collected, processed, and screened for &lt;italic&gt;Mycobacterium tuberculosis&lt;/italic&gt; (Mtb) and drug resistance using line probe assay (LPA) and &lt;italic&gt;Mycobacterium&lt;/italic&gt; growth indicator tubes (MGIT) culture. MGIT-positive samples were cultured on brain heart infusion (BHII) agar media, and the presence of Mtb was validated using Immunochromatographic assay (ICA). Drug sensitivity was performed on MGIT and ICA-positive but BHI-negative samples. Statistical significance was set at &lt;italic&gt;P&lt;/italic&gt; &amp;lt; 0.05. Of the 622 Mtb isolates, 536 (86.2%) were susceptible to RIF and INH. The rest, 86 (13.83%), were resistant to either drugs or both. A two-sample proportional equality test revealed that the MDR-TB prevalence in western Kenya (5%) did not vary significantly from the global MDR-TB estimate (3.9%) (P = 0.196). Men comprised the majority of susceptible and resistant TB (75.9% and 77.4%%, respectively). Also, compared with healthy individuals, the prevalence of HIV was significantly higher in MDR-TB patients (35.9% vs 5.6%). Finally, TB prevalence was highest in individuals aged 25–44 years, who accounted for 58.4% of the total TB cases. Evidently, the prevalence of MDRTB in western Kenya is high. Particular attention should be paid to men, young adults, and those with HIV, who bear the greatest burden of resistant TB. Overall, there is a need to refine TB control and treatment programs in the region to yield better outcomes.&lt;/p&gt; &lt;/abstract&gt;

Success Factors in Improving Patients’ Adherence to Tuberculosis Treatment Program: Case Study in Sleman, Yogyakarta, Indonesia

Improving patients’ adherence to treatment programs is important for the success of tuberculosis (TB) treatment. The study aims to identify the underlying factors of TB treatment program success. A qualitative approach, i.e., an in-depth interview, and the purposive sampling method in selecting respondents were used to conduct this study. There are 15 persons involved, i.e., 3 persons each: pharmacists as providers, TB programmers, medicines supervisor (MS), TB cadres as supporters, and recovered TB patients as actors (17 years old and over). The data obtained were analyzed using the triangulation method (providers, actors, and supporters). The results of the study show that the family's role is very important in MS by taking medicines from primary health care and giving medicines on time. TB counselors play a role in monitoring the treatment program and making occasional home visits to motivate patients to recover. TB programmers and pharmacists play a role in providing patients’ education and MS, as well as monitoring medication-taking schedules and medical check-ups. Patients play a role in motivating themselves to get back to work soon. In conclusion, the underlying factors in TB treatment program success are the discipline of providers, supervisors, supporters, and patients’ motivation

Impact of the COVID-19 Pandemic on tuberculosis management in India: A Brief Overview

Chronicles suggests that emerging and re-emerging viral infections disrupting the normal lifestyle of humankind, whether in the form of HIV, Ebola, Influenza, Nepah, or the current SARS-CoV-2 pandemic. Such viral infections disrupt the healthcare system along with the prevention and control of epidemics and pandemics, resulting in an increased burden of such diseases in the post-pandemic period. Tuberculosis (TB) routine services are interfered with by severe lockdowns due to the new COVID-19 virus. This article tried to measure the long-term epidemiological effects of such interruptions on TB prevalence in high-burden countries. The participating facilities performed a comprehensive review based on modifications to the care of TB patients during the COVID-19 pandemic. Retrospectively, clinical factors and household contact information were collected from a literature survey. Researchers looked at numerous strategies over the following five years to see whether they might lessen the effects on TB incidence and death. Present comprehensive literature was collected and analyzed using suitable keywords such as "COVID-19," "Pandemics," "Tuberculosis," and "India" during the current COVID-19 pandemic to investigate the influence of COVID-19 on tuberculosis management. The present article looks at the effects of the breaks in the delivery of TB care in hospital and primary care settings. Lockdown, social isolation, measures to prevent viral transmission, and public health guidelines impacted tuberculosis care. The present study revealed that the COVID-19 pandemic has adversely affected numerous TB prevention, monitoring, and treatment programs. Still, these adverse effects are diminished by the prompt restoration of TB services and the application of particular therapies as soon as restrictions are lifted.

Tingkat Pengetahuan Pasien Penderita Tuberculosis Dalam Program Pengobatan Tuberculosis di Puskesmas

Tuberculosis is an infectious disease caused by bacteria known as mycobacterium tuberculosis. In Indonesia, tuberculosis is the third common public health problem the prevalence of the disease in this country is among the highest in the world after China and India. Sufficient knowledge of diseases and medicines correlates with the result of therapy in general. Knowledge about drugs is important for patients since it helps them to consume drugs properly (which result in maximum therapy) and to avoid complications. The purpose of this descriptive study is to determine the level of knowledge of patients suffering from tuberculosis in the tuberculosis treatment program at Bulango Utara Puskesmas (Community Health Center) by a questionnaire. It applied a cross-sectional approach with primary data obtained from the result of a sample questionnaire totaling 24 patients taken by saturated sampling. The result of this present study reveal that the level knowledge of patients with tuberculosis in the area is still relatively low at 75%, while only 25% is classified as moderate.

Rifampicin resistant Mycobacterium tuberculosis and associated factors among presumptive pulmonary tuberculosis patients in Mogadishu, Somalia.

Multi-drug resistant Mycobacterium tuberculosis is a growing public health problem in developing countries including Somalia. Although, the prevalence of multi-drug resistant tuberculosis among new and retreated cases is high, data on GeneXpert- Mycobacterium tuberculosis/rifampicin-resistant assay, which is a surrogate marker for multidrug resistance, is not well explored in Mogadishu. To determine the prevalence of rifampicin-resistant Mycobacterium tuberculosis and its associated factors among presumptive pulmonary tuberculosis patients visiting tuberculosis centers in Mogadishu, Somalia. A multicenter cross-sectional study was conducted in three tuberculosis treatment centers from March 12 to April 30, 2021. Laboratory professionals collected sputum sample consecutively from presumptive pulmonary tuberculosis participants and performed a GeneXpert assay to determine the rifampicin resistance. Socio-demographic and clinical data were collected using structured questionnaire. Logistic regression analyses were performed to assess factors associated with rifampicin resistance using an adjusted odds ratio at a 95% confidence interval. Statistical significance was considered at a p-value of less than 0.05. A total of 370 presumptive tuberculosis suspects were included; of whom 58.4% were females and the mean age of the participants was 44.3 ± 14 years. Mycobacterium tuberculosis was detected in 63 (17%) (95% confidence interval = 13.2-20.8) suspects. Of these the prevalence of rifampicin-resistant Mycobacterium tuberculosis was 35% (95% confidence interval = 30.2-39.8). Anti-tuberculosis treatment history (adjusted odds ratio = 4.1; 95% confidence interval = 1.91-6.75), monthly income less than $100 USD (adjusted odds ratio = 2.2; 95% confidence interval = 1.77-5.98) and being diagnosed with Asthma (adjusted odds ratio = 2.63; 95% confidence interval = 1.3-7.3) were significantly associated with rifampicin-resistant tuberculosis. A considerable proportion of rifampicin-resistant tuberculosis is reported in these study settings. The strong association between multidrug resistance tuberculosis and patients' retreatment history of tuberculosis, low income, and co-morbidity with asthma highlights the need for more efforts in tuberculosis treatment and monitoring programs to limit the emergence of multi-drug resistant strain in the study areas.

Evaluating determinants of treatment outcomes among tuberculosis patients in the mining district of Butha Buthe, Lesotho

Before the COVID-19 pandemic, tuberculosis (TB) was the leading infectious cause of death globally. In low- and middle-income countries (LMIC) including Lesotho, treatment outcome is lower than the recommended rate and poor TB treatment outcomes remain a programmatic challenge. The aim of this study was to determine unfavourable treatment outcomes and associated risk factors among TB patients in Butha Buthe district. This was a retrospective record review of TB patients registered between January 2015 and December 2020. Data were collected from TB registers and patients' files and entered Microsoft Excel 2012. Analysis was conducted using R and INLA statistical software. Descriptive statistics were presented as frequencies and percentages. The differences between groups were compared using Pearson's X 2 test in bivariate analysis. Frailty Cox proportional hazards model was used to determine the risk of unfavourable outcomes among the variables. A total of 1792 TB patients were enrolled in the study with about 70% males (1,257). Majority (71.7%) of the patients were between 20 and 59 years old, with 48% of the patients being unemployed. Almost a quarter of the patients (23.1%) had unfavourable outcomes with death (342 patients) being the most common unfavourable outcome. Our study has shown that patients older than 59 years, and unemployment increased the risk of having unfavourable treatment outcomes. Death was the most common unfavourable outcome followed by lost-to-follow up. We also observed that the patients in the initiation phase of treatment died at a faster rate compared to those in the continuation phase (p=0.02). TB treatment programs should have efficient follow-up methods geared more toward elderly patients. Active case finding to identify population at risk should be part of a TB program which would improve early diagnosis and treatment initiation. Patients in the intensive phase of the treatment program should be monitored more closely to determine adverse drug effects and nutritional requirement to prevent death during this phase of treatment.

HEALTH PROMOTION AND LITERACY MODELS TO INCREASE THE AUTONOMY OF TUBERCULOSIS PATIENTS

Autonomy was the main element in improving the ability of Tuberculosis patients to care for and improve healing. The success rate of the Tuberculosis program in Tanjungpinang City was less than 90% so there was a risk of an increase in Tuberculosis drug resistance. The purpose of this research was to prove the effectiveness of health promotion and literacy models in increasing the autonomy of Tuberculosis patients. This research used a quasi-experimental approach, carried out for 2 (two) months in the intensive phase of the Tuberculosis treatment program. The research sample was 60 people with simple random sampling. The research variables consisted of nursing actions based on health promotion, health literacy, and autonomy of Tuberculosis patients. The analysis study used an independent t-test to determine the effectiveness of the health promotion and literacy models for the autonomy of Tuberculosis patients. The results showed that the health promotion and literacy models were effective in increasing the autonomy of Tuberculosis patients undergoing treatment and care with p &lt;0.05. The autonomy of Tuberculosis patients on treatment and care has an impact on the improvement of cure rates for Tuberculosis patients, reducing drug resistance, preventing transmission to family members, and improving healthy behavior in Tuberculosis patients.&#x0D;  &#x0D; Keywords/Kata Kunci: Autonomy; Health Promotion; Literacy; Tuberculosis.

Evaluating the effect of short-course rifapentine-based regimens with or without enhanced behaviour-targeted treatment support on adherence and completion of treatment for latent tuberculosis infection among adults in the UK (RID-TB: Treat): protocol for an open-label, multicentre, randomised controlled trial

IntroductionThe successful scale-up of a latent tuberculosis (TB) infection testing and treatment programme is essential to achieve TB elimination. However, poor adherence compromises its therapeutic effectiveness. Novel rifapentine-based regimens and...

Tuberculosis in Ethiopia: Optimal Intervention Strategies and Cost-Effectiveness Analysis

This paper searches for optimal strategies for the minimization of the number of high-risk latent and active tuberculosis (TB) infectious individuals using real data from Ethiopia. Optimal control theory is harnessed for investigation and analysis of the optimal combination of interventions for controlling the transmission of TB using distancing, case finding, and case holding as controls. We calculate and compare the incremental cost-effectiveness ratio (ICER) for each of the strategies to determine the most effective combination of interventions for curbing the spread of the disease. Our findings suggest that, for optimal cost-effective management of the TB disease, the government of Ethiopia must focus more on prevention strategies such as isolation of infectious people, early TB patient detection, treatment, and educational programs. The optimal strategy is quantified through simulation.

PENGARUH HEALTH LITERACY TERHADAP PENGETAHUAN PENDAMPING MENELAN OBAT PASIEN TUBERKULOSIS DI BENGKULU

Problems: The achievement of the prevalence of pulmonary TB in Bengkulu is not yet optimal, it is still a health problem for the community. Province ranks first with 17,419 cases, while Bengkulu City ranks first with 334 souls. The independence of companions to the treatment of tuberculosis patients is very important in the tuberculosis treatment and care program at home. The aim of the research to analyze the effect of health literacy on drug swallowing assistance (PMO) for tuberculosis patients. Research method: Research design "quasy experiment". The population was all PMO tuberculosis patients who underwent a 1-2 month treatment program at the Nusa Indah Public Health Center, Sukamerindu, Small Bridge, Muara Bangkahulu and Bengkulu City Fish Market as many as 80 people. Samples were taken using purposive sampling technique and were divided into treatment groups (40 people) and control groups (40 people). The independent variable is health literacy. The dependent variable is PMO independence. The instruments in the study were questionnaires and observation sheets. The first step is that the researcher obtains the identity of the respondent and then conducts a pre-test to assess the independence of the PMO before conducting health literacy. After that, according to the agreement, the researcher made a home visit for 1 time in the first month after that the treatment was for 1 week, then in the 3rd month the researcher conducted a post test. Research data processing using SPSS version 25. Previously, the instrument was tested on the modified PMO independence questionnaire with a reliability value of r table 0.220 and a Chronbach r alpha value of 0.764 which means reliable. The value of the r validity test is 0.771 where r is greater than r table so that the keyword is valid. Then analyzed using ANOVA at a significant level of 0.05. Results: showed that there was a significant effect of health literacy on PMO knowledge (p=0.000). Conclusion: knowledge is an important element in the independence of PMO and the success of tuberculosis patients in treatment. Future researchers are expected to conduct research with other variables such as quality of life of pulmonary tuberculosis patients and more samples.Keywords: health literacy, knowledge, tuberculosis

World Tuberculosis Day 2022: aligning COVID-19 and tuberculosis innovations to save lives and to end tuberculosis

For the past 2 years the world's attention has rightly been focused on COVID-19, the most lethal pandemic seen for over a century that has amplified the enormous global toll of respiratory tract infections. COVID-19 remains the top cause of death from an infectious disease worldwide, shifting tuberculosis to second place.1WHOGlobal tuberculosis report 2021.https://www.who.int/publications/i/item/9789240037021Date: 2021Date accessed: January 18, 2022Google Scholar In areas highly endemic with tuberculosis, scarce resources have been moved to the COVID-19 response, which has undermined tuberculosis testing and treatment programmes. The effects of COVID-19 on global tuberculosis control efforts have been catastrophic,1WHOGlobal tuberculosis report 2021.https://www.who.int/publications/i/item/9789240037021Date: 2021Date accessed: January 18, 2022Google Scholar, 2Wu Z Chen J Xia Z et al.Impact of the COVID-19 pandemic on the detection of TB in Shanghai, China.Int J Tuberc Lung Dis. 2020; 24: 1122-1124Crossref PubMed Google Scholar, 3Pai M Kasaeva T Swaminathan S Covid-19's devastating effect on tuberculosis care – a path to recovery.N Engl J Med. 2022; (published online Jan 5.)https://doi.org/10.1056/NEJMp2118145Crossref Google Scholar setting back by several years any progress being made in achieving the WHO End TB Strategy targets by 2030.4WHOThe End TB strategy. Global strategy and targets for tuberculosis prevention, care and control after.https://www.who.int/teams/global-tuberculosis-programme/the-end-tb-strategyDate: 2015Date accessed: February 24, 2022Google Scholar For the first time since 2015, the annual numbers of tuberculosis deaths have started increasing and more than 1·5 million people died of tuberculosis in 2020.1WHOGlobal tuberculosis report 2021.https://www.who.int/publications/i/item/9789240037021Date: 2021Date accessed: January 18, 2022Google Scholar Furthermore, COVID-19 disruptions to health services have impeded diagnosing and treating everyone with active tuberculosis, drug-resistant tuberculosis, multidrug-resistant or extensively drug-resistant tuberculosis, latent tuberculosis, and tuberculosis and HIV co-infection, as well as access to tuberculosis medicines, counselling and follow-up, and lowered treatment adherence.1,3–7 This impedance in turn promotes the development of multidrug-resistant strains of tuberculosis and increases treatment failure rates, suffering, and death. Thus, in the foreseeable future, tuberculosis will continue to pose multiple challenges and negatively impact on already fragile health systems in countries with a high burden of tuberculosis. The theme for this year's World Tuberculosis Day is “Invest to End TB. Save Lives'”. Although this theme is appropriate to refocus attention from COVID-19 to tuberculosis, it is a difficult task to achieve. The call for donors to invest more to end tuberculosis is again sadly familiar, yet essential because strategies for holding governments accountable and that advocate for increased investments have been in place ever since WHO declared tuberculosis a global emergency in 1993.8Marais BJ Raviglione MC Donald PR et al.Scale-up of services and research priorities for diagnosis, management, and control of tuberculosis: a call to action.Lancet. 2010; 375: 2179-2191Summary Full Text Full Text PDF PubMed Scopus (102) Google Scholar It is unlikely that in light of the poor global economic situation, major financial commitments to global tuberculosis control programmes will be forthcoming. However, while the tuberculosis community awaits financial commitments, despair can be turned to hope through more creative and innovative ways of health services delivery. We already have all the tools required to achieve global tuberculosis control targets,8Marais BJ Raviglione MC Donald PR et al.Scale-up of services and research priorities for diagnosis, management, and control of tuberculosis: a call to action.Lancet. 2010; 375: 2179-2191Summary Full Text Full Text PDF PubMed Scopus (102) Google Scholar, 9Treatment Action Group2021 Pipeline Report.https://www.treatmentactiongroup.org/resources/pipeline-report/2021-pipeline-report/Date: 2021Date accessed: January 21, 2022Google Scholar, 10United States Agency for International Development and Stop TB PartnershipImplementation of simultaneous diagnostic testing for COVID-19 and TB in high TB burden countries. Stop TB Partnership, Geneva2021Google Scholar and much more can be achieved via new ways of working, innovative strategies, and using existing resources maximally. Over the past 2 years, several promising new developments in approaches to screening, diagnosis, and management for both tuberculosis and COVID-19, if skilfully used, aligned, and synergised, could overcome the negative effects of COVID-19 disruptions in health services for airborne infectious diseases. Several lessons learnt from COVID-19 responses, including innovative new ways of health services working,3,5–7 also provide a fresh approach to management of respiratory infectious diseases with overlapping clinical symptoms and signs. Several practical steps, using recently updated diagnostics, treatments, patient follow-up, and community care guidelines for both COVID-19 and tuberculosis,6Chapman HJ Veras-Estévez BA Lessons learned during the COVID-19 pandemic to strengthen tb infection control: a rapid review.Glob Health Sci Pract. 2021; 9: 964-977Crossref PubMed Scopus (3) Google Scholar, 7Ruhwald M Carmona S Pai M Learning from COVID-19 to reimagine tuberculosis diagnosis.Lancet Microbe. 2021; 2: e169-e170Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 8Marais BJ Raviglione MC Donald PR et al.Scale-up of services and research priorities for diagnosis, management, and control of tuberculosis: a call to action.Lancet. 2010; 375: 2179-2191Summary Full Text Full Text PDF PubMed Scopus (102) Google Scholar, 9Treatment Action Group2021 Pipeline Report.https://www.treatmentactiongroup.org/resources/pipeline-report/2021-pipeline-report/Date: 2021Date accessed: January 21, 2022Google Scholar, 10United States Agency for International Development and Stop TB PartnershipImplementation of simultaneous diagnostic testing for COVID-19 and TB in high TB burden countries. Stop TB Partnership, Geneva2021Google Scholar if immediately taken forward, could have a synergistic, enhancing, and multiplier effect. Thus, COVID-19 programme innovations and adaptations from within the COVID-19 response should be built upon, to enhance access to integrated, patient-centred tuberculosis services (figure).3Pai M Kasaeva T Swaminathan S Covid-19's devastating effect on tuberculosis care – a path to recovery.N Engl J Med. 2022; (published online Jan 5.)https://doi.org/10.1056/NEJMp2118145Crossref Google Scholar, 5Hopewell PC Reichman LB Castro KG Parallels and mutual lessons in tuberculosis and covid-19 transmission, prevention, and control.Emerg Infect Dis. 2021; 27: 681-686Crossref PubMed Scopus (6) Google Scholar, 6Chapman HJ Veras-Estévez BA Lessons learned during the COVID-19 pandemic to strengthen tb infection control: a rapid review.Glob Health Sci Pract. 2021; 9: 964-977Crossref PubMed Scopus (3) Google Scholar, 7Ruhwald M Carmona S Pai M Learning from COVID-19 to reimagine tuberculosis diagnosis.Lancet Microbe. 2021; 2: e169-e170Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar The ongoing COVID-19 mass testing and vaccination rollout in wealthy nations are the result of unprecedented financial investments, rapid research and development, collaborative science, and innovation in delivery systems. Diseases that affect wealthier nations receive immediate attention and the required funding is made available quickly. However, the history of tuberculosis, and now COVID-19, is one of scientific and medical advances, accompanied by political failure to invest appropriately in rolling them out to all in need. The issues of inequities in COVID-19 vaccine distribution to Africa and unfulfilled pledges by wealthier nations, highlights that more visionary leadership, coupled with serious investments, are required from national governments to make countries with a high burden of tuberculosis self-reliant. Continued disinvestments in Africa into both tuberculosis and COVID-19 resulting from lack of political will is unacceptable. Countries that are highly endemic for tuberculosis have all the experience and knowledge on social, economic, and operational determinants that drive the tuberculosis epidemic. There is an urgent need for countries that are highly endemic with tuberculosis to move away from donor dependency and invest in resilient and sustainable health systems. This would provide reassurance to all tuberculosis stakeholders in this unprecedented COVID-19 era of uncertainty. Tuberculosis-endemic countries should focus on revamping health services, recalibrating them, and making the health sector more inclusive of all other WHO-declared global emergencies. The time is also now ripe for countries endemic with tuberculosis to build goodwill on the current global attention on COVID-19 to better address existing tuberculosis care models, One Health approaches to prevent future zoonotic pandemics and the burgeoning problem of global antimicrobial resistance. KGC declares salary support to serve as US Agency for International Development (USAID) senior tuberculosis scientific advisor through an intergovernmental personnel act award between Emory University and USAID. AZ, FN, and DY-M acknowledge support from the EU-EDCTP funded PANDORA-ID-NET, CANTAM-3, and EACCR-3 programmes. AZ is in receipt of a UK National Institute for Health Research Senior Investigator Award. JBN acknowledges support from the US National Institutes of Health (NIH) Fogarty International Center (grants 1R25TW011217-01, 1R21TW011706-01, and 1D43TW010937-01A1) and NIH National Institute of Allergy and Infectious Diseases (grant U01 AI096299). All other authors declare no competing interests. All authors have a specialist interest in global epidemics of COVID-19, tuberculosis, and HIV. The views expressed in this editorial are entirely those of the authors and do not reflect the views of their respective institutions.

Examining family planning and adverse pregnancy outcomes for women with active tuberculosis disease: a systematic review.

Objectives(1) Summarise and evaluate the current evidence of tuberculosis (TB)-associated pregnancy outcomes, (2) evaluate the state of the science of family planning during TB treatment and (3) provide recommendations to move forward to improve care and outcomes during TB disease.DesignSystematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.Data sourcesPubMed, Embase, CINAHL, Cochrane, Web of Science and Scopus were searched from September 2009 to November 2021.Eligibility criteriaStudies were included if they assessed pregnant women with active TB, drug-resistant TB (DR-TB) or TB/HIV coinfection and examined pregnancy, maternal, fetal/birth and TB or TB/HIV coinfection outcomes. Studies were also included if they examined family planning services among women initiating TB treatment.Data extraction and synthesisTwo independent reviewers extracted data using PRISMA guidelines and conducted quality assessment using the Joanna-Briggs Institute Critical Appraisal Tools. The level of evidence was reported using the Johns Hopkins Evidence-Based Practice guidelines.Results69 studies were included in this review. Case reports, case series, case controls, cohort studies, secondary data analyses and a service delivery improvement project conducted in 26 countries made up the totality of the evidence. Most studies reported pregnancy complications for mothers (anaemia, postpartum haemorrhage, deaths) and fetuses or newborns (low birth weight, premature birth, and spontaneous or induced abortions). Few studies discussed the value of offering family planning to prevent adverse pregnancy outcomes. One study examined the effect of a provider training on contraceptive use with reported increased contraceptive use.ConclusionsIntegrating family planning services within a TB treatment programme is essential to reduce adverse TB-associated maternal-child outcomes. Despite well-established adverse pregnancy outcomes, little attention has been paid to family planning to prevent poor pregnancy outcomes for women with TB/DR-TB. Recommendations for clinicians, TB programmes and researchers are provided and reflect evidence presented in this review.

Children caught in the long shadow of COVID-19

Despite the more transmissible delta variant being associated with higher rates of COVID-19 in unvaccinated adolescents, children have remained relatively spared from severe disease. Nevertheless, children are indirectly affected by the COVID-19 pandemic, which threatens to have far-reaching consequences. The effect of disruptions of seasonal patterns of circulation of respiratory pathogens on future immunity against such pathogens, childhood immunisation programmes, and HIV and tuberculosis treatment programmes poses a threat to the future wellbeing of children. Furthermore, the economic devastation caused by the pandemic, including an increase in unemployment, gives rise to numerous challenges, such as food insecurity, which is likely to worsen childhood nutritional status. Also, COVID-19 has ongoing effects on the mental wellbeing of children, driven in part by the interruption of schooling and other opportunities to socialise. An increase in psychological illnesses has manifested in children consequent to the stresses of the pandemic, lockdowns, caregiver deaths. In this article, we highlight the indirect effects of COVID-19 on children, and suggest solutions to mitigate against the long-term sequelae. A focused health, nutrition, education and child protection response is required from government and healthcare practitioners to safeguard the health and wellbeing of South African children.

Analysis of Factors Associated with Compliance with Taking Medicines for Pulmonary Tuberculosis Patients at Lut Tawar Health Center, Central Aceh Regency

There is a worldwide epidemic of tuberculosis (TB). As of May 31st, 2021, the Lut Tawar Health Center had recorded 10 instances in 2019, and 17 cases had been recorded as of that date. The purpose of this research is to evaluate the analysis of variables influencing medication adherence in pulmonary TB patients at the Lut Tawar Health Center, Lut Tawar District, Central Aceh Regency. Research is conducted using a cross-sectional design using quantitative analytic techniques. As many as 33 tuberculosis patients are enrolled in the Lut Tawar Health Center's TB treatment program. Total sampling was employed as the sampling strategy. Univariate, bivariate and multivariate analyses were used to analyze the data. There were no statistically significant differences in the p-values for education (0.000), employment (0.000), distance from home (0.000), knowledge (0.00), medication side effects (0.024), or family support (0.024) in the chi square analysis. Multivariate analysis indicated that the pharmacological side effect variable had a value (p=0.000) that was the most significant. Patients and families should be supported by the puskesmas, or health professionals, in charge of running the TB treatment program, so that they can keep tabs on their loved ones' medication compliance and avoid drug withdrawal and resistance. As part of the health education provided by health professionals, they describe the side effects of TB medications and encourage patients to continue taking them until they are well enough to do so.

Patterns of non-communicable comorbidities at start of tuberculosis treatment in three regions of the Philippines: The St-ATT cohort.

Diabetes and undernutrition are common risk factors for tuberculosis (TB), associated with poor treatment outcomes and exacerbated by TB. Limited data exist describing patterns and risk factors of multiple comorbidities in persons with TB. Nine-hundred participants (69.6% male) were enrolled in the Starting Anti-TB Treatment (St-ATT) cohort, including 133 (14.8%) initiating treatment for multi-drug resistant TB (MDR-TB). Comorbidities were defined as: diabetes, HbA1c ≥6.5% and/or on medication; hypertension, systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg and/or on medication; anaemia (moderate/severe), haemoglobin <11g/dL; and, undernutrition (moderate/severe) body-mass-index <17 kg/m2. The most common comorbidities were undernutrition 23.4% (210/899), diabetes 22.5% (199/881), hypertension 19.0% (164/864) and anaemia 13.5% (121/899). Fifty-eight percent had ≥1 comorbid condition (496/847), with 17.1% having ≥2; most frequently diabetes and hypertension (N = 57, 6.7%). Just over half of diabetes (54.8%) and hypertension (54.9%) was previously undiagnosed. Poor glycemic control in those on medication (HbA1c≥8.0%) was common (N = 50/73, 68.5%). MDR-TB treatment was associated with increased odds of diabetes (Adjusted odds ratio (AOR) = 2.48, 95% CI: 1.55-3.95); but decreased odds of hypertension (AOR = 0.55, 95% CI: 0.39-0.78). HIV infection was only associated with anaemia (AOR = 4.51, 95% CI: 1.01-20.1). Previous TB treatment was associated with moderate/severe undernutrition (AOR = 1.98, 95% CI: 1.40-2.80), as was duration of TB-symptoms before starting treatment and household food insecurity. No associations for sex, alcohol or tobacco use were observed. MDR-TB treatment was marginally associated with having ≥2 comorbidities (OR = 1.52, 95% CI: 0.97-2.39). TB treatment programmes should plan for large proportions of persons requiring diagnosis and management of comorbidities with the potential to adversely affect TB treatment outcomes and quality of life. Dietary advice and nutritional management are components of comprehensive care for the above conditions as well as TB and should be included in planning of patient-centred services.

Barriers to and enablers of uptake of antiretroviral therapy in integrated HIV and tuberculosis treatment programmes in sub-Saharan Africa: a systematic review and meta-analysis

IntroductionProgrammes that merge management of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) aim to improve HIV/TB co-infected patients’ access to comprehensive treatment. However, several reports from sub-Saharan Africa (SSA) indicate suboptimal uptake of antiretroviral therapy (ART) even after integration of HIV and TB treatment. This study assessed ART uptake, its barriers and enablers in programmes integrating TB and HIV treatment in SSA.MethodA systematic review was performed. Seven databases were searched for eligible quantitative, qualitative and mixed-methods studies published from March 2004 through July 2019. Random-effects meta-analysis was used to obtain pooled estimates of ART uptake. A thematic approach was used to analyse and synthesise data on barriers and enablers.ResultsOf 5139 references identified, 27 were included in the review: 23/27 estimated ART uptake and 10/27 assessed barriers to and/or enablers of ART uptake. The pooled ART uptake was 53% (95% CI: 42, 63%) and between-study heterogeneity was high (I2 = 99.71%, p < 0.001). WHO guideline on collaborative TB/HIV activities and sample size were associated with heterogeneity. There were statistically significant subgroup effects with high heterogeneity after subgroup analyses by region, guideline on collaborative TB/HIV activities, study design, and sample size. The most frequently described socioeconomic and individual level barriers to ART uptake were stigma, low income, and younger age group. The most frequently reported health system-related barriers were limited staff capacity, shortages in medical supplies, lack of infrastructure, and poor adherence to or lack of treatment guidelines. Clinical barriers included intolerance to anti-TB drugs, fear of drug toxicity, and contraindications to antiretrovirals. Health system enablers included good management of the procurement, supply, and dispensation chain; convenience and accessibility of treatment services; and strong staff capacity. Availability of psychosocial support was the most frequently reported enabler of uptake at the community level.ConclusionsIn SSA, programmes integrating treatment of TB and HIV do not, in general, achieve high ART uptake but we observe a net improvement in uptake after WHO issued the 2012 guidelines on collaborative TB/HIV activities. The recurrence of specific modifiable system-level and patient-level factors in the literature reveals key intervention points to improve ART uptake in these programmes.Systematic review registration: CRD42019131933.