Proceedings from the CIHLMU 2022 Symposium: "Availability of and Access to Quality Data in Health".

Data is an essential tool for valid and reliable healthcare management. Access to high-quality data is critical to ensuring the early identification of problems, the design of appropriate interventions, and the effective implementation and evaluation of health intervention outcomes. During the COVID-19 pandemic, the need for strong information systems and the value of producing high-quality data for timely response and tracking resources and progress have been very evident across countries. The availability of and access to high-quality data at all levels of the health systems of low and middle-income countries is a challenge, which is exacerbated by multiple parallels and poorly integrated data sources, a lack of data-sharing standards and policy frameworks, their weak enforcement, and inadequate skills among those handling data. Completeness, accuracy, integrity, validity, and timeliness are challenges to data availability and use. "Big Data" is a necessity and a challenge in the current complexities of health systems. In transitioning to digital systems with proper data standards and policy frameworks for privacy protection, data literacy, ownership, and data use at all levels of the health system, skill enhancement of the staff is critical. Adequate funding for strengthening routine information systems and periodic surveys and research, and reciprocal partnerships between high-income countries and low- and middle-income countries in data generation and use, should be prioritized by the low- and middle-income countries to foster evidence-based healthcare practices.

Cancer-directed surgery brings survival benefits for patients with advanced prostate cancer: a population-based propensity-score matching study.

Purpose: The purpose of this study was to evaluate the survival benefits of cancer-directed surgery (CDS) for localized prostate cancer (PCa) as well as advanced PCa. Methods: We retrospectively used the Surveillance, Epidemiology, and End Results (SEER) database and conducted a propensity score matching (PSM) study to investigate survival benefits and influencing factors of CDS in patients with PCa, especially for those with advanced PCa. Results: 19,729 cases were included. Patients who were recommended CDS had lower stages of disease (81.01% vs. 77.32% at stages I and II, p<0.01) than those who were not recommended CDS. It was primarily age, diagnosis year, cancer stage (American Joint Committee on Cancer Staging System), Gleason score, race, and home location and prostate-specific antigen, that influenced whether CDS was recommended or not (all p<0.05). Patients with PCa had lower rates of cancer specific mortality (CSM) and overall mortality (OM) when CDS was performed (CDS performed=CDSP). The unselected patients with CDSP decreased both rates of CSM by 79% and OM by 26% (both p<0.001). CDSP also benefited the young patients (with age ≤74 years old) with stage IV disease, promoting a rate decrease by 28% in CSM and by 31% in OM (both p<0.001). Conclusions: We found a decline in CSM and OM for unselected patients with PCa and patients less than 74 years old with stage IV disease. CDS as part of a multimodal treatment concept should be considered for an alternative treatment for patients with advanced PCa.

Comparison of Survival Outcomes and Risk Factors Between Ductal Carcinoma of the Prostate and Acinar Adenocarcinoma of the Prostate: A Population-based Propensity Score-matching Study.

Background: Ductal carcinoma of the prostate (DCP) is a rare type of prostate cancer (PCa) with a higher degree of infiltration and worse prognosis than acinar adenocarcinoma of the prostate (ACP). Previous reports comparing DCP and ACP have not been very reliable and involved small sample sizes. Objective: To assess differences in mortality between ACP and DCP in a large-scale study. Design setting and participants: Data were downloaded from the Surveillance, Epidemiology, and End Results database in June 2022. Data for 823 939 patients diagnosed with PCa from 2004 to 2019 were examined, excluding cases with survival data missing or pathological types other than DCP and ACP. Outcome measurements and statistical analysis: Prognostic and risk factors for DCP were analyzed by generating a propensity score-matched cohort of DCP and ACP cases (1:5). Adjusted Cox models were constructed to determine hazard ratios (HRs) with 95% confidence intervals (CIs) for cancer-specific mortality (CSM) and overall mortality (OM). Results and limitations: A total of 822 607 cases (99.8%) has ACP and 1332 (0.2%) had DCP. In comparison to ACP, age at diagnosis was significantly lower for DCP (≤66 yr: 38.0% vs 50.7%; p < 0.001) and a higher proportion of DCP patients distant metastases (13.7% vs 5.1%; p < 0.001). In comparison to the ACP group, significantly higher proportions of the DCP group underwent surgery (66.1% vs 38.1%; p < 0.001), radiotherapy (13.7% vs 3.1%; p < 0.001), or systemic therapy (18.2% vs 3.3%; p < 0.001). However, the median overall survival time was significantly shorter for DCP patients (44.0 vs 73.0 mo; p < 0.001). DCP patients also had higher risk of CSM (HR 2.07, 95% CI 1.68-2.56; p < 0.001) and OM (HR 2.73 95% CI 2.42-3.08; p < 0.001) after propensity score matching to adjust for the influence of baseline variables. Subgroup analysis showed that DCP patients who had surgical treatment had better CSM than those without surgery, while DCP patients with regional and lower stage had better OM than those with distant stage (both p < 0.05 for interaction). Conclusions: The risk of CSM and OM is significantly higher for DCP than for ACP. Earlier detection (lower stage) and surgical treatment are beneficial factors for DCP prognosis. Patient summary: We studied survival rates for two different types of prostate cancer. We found that survival is worse for the rarer ductal carcinoma of the prostate (DCP) than for the more common acinar adenocarcinoma of the prostate. Both early diagnosis when the cancer is at a lower stage and surgical treatment are beneficial for survival in patients with DCP.

QuantiFERON-TB Gold plus testing for the detection of LTBI among health care workers in major TB hospitals of the Northern Kyrgyz Republic.

BACKGROUND: Health care workers (HCW) are at increased risk of TB infection due to their close contact with infected patients with active TB. The objectives of the study were (1) to assess the prevalence of LTBI among HCW in the Northern Kyrgyz Republic, and (2) to determine the association of LTBI with job positions or departments. METHODS: HCWs from four TB hospitals in the Northern Kyrgyz Republic were tested with the interferon-gamma release assay (IGRA) Quantiferon-TB Gold plus (QFT) for the detection of an immune response to TB as marker of TB infection. Age was controlled for as a confounder. Univariate and multivariable analysis were performed using logistic regression to assess the association of the risk factors (job position, and department) with having a QTF positive result. Firth's penalized-likelihood estimates were used to account for the small-sample size. Pairwise comparisons using the Bonferroni correction (conservative) and comparisons without adjusting for multiple comparisons (unadjusted) were used to identify the categories where differences occurred. RESULTS: QFT yielded valid results for 404 HCW, with 189 (46.7%) having a positive test. In the National Tuberculosis Center there was an increased odds to have a positive QFT test for the position of physician (OR = 8.7, 95%, CI = 1.2-60.5, p = 0.03) and laboratory staff (OR = 19.8, 95% CI = 2.9-135.4, p < 0.01) when administration staff was used as the baseline. When comparing departments for all hospitals combined, laboratories (OR 7.65; 95%CI 2.3-24.9; p < 0.001), smear negative TB (OR 5.90; 95%CI 1.6-21.8; p = 0.008), surgery (OR 3.79; 95%CI 1.3-11.4; p = 0.018), and outpatient clinics (OR 3.80; 95%CI 1.1-13.0; p = 0.03) had higher odds of a positive QFT result than the admin department. Fifteen of the 49 HCW with follow-up tests converted from negative to positive at follow-up testing. CONCLUSIONS: This is the first report on prevalence and risk factors of LTBI for HCW in the Kyrgyz republic, and results indicate there may be an increased risk for LTBI among physicians and laboratory personnel. Further research should investigate gaps of infection control measures particularly for physicians and laboratory staff and lead to further improvement of policies.

Implementation of whole genome sequencing for tuberculosis diagnostics in a low-middle income, high MDR-TB burden country.

Whole genome sequencing (WGS) is revolutionary for diagnostics of TB and its mutations associated with drug-resistances, but its uptake in low- and middle-income countries is hindered by concerns of implementation feasibility. Here, we provide a proof of concept for its successful implementation in such a setting. WGS was implemented in the Kyrgyz Republic. We estimated needs of up to 55 TB-WGS per week and chose the MiSeq platform (Illumina, USA) because of its capacity of up to 60 TB-WGS per week. The project's timeline was completed in 93-weeks. Costs of large equipment and accompanying costs were 222,065 USD and 8462 USD, respectively. The first 174 WGS costed 277 USD per sequence, but this was skewed by training inefficiencies. Based on real prices and presuming optimal utilization of WGS capacities, WGS costs could drop to 167 and 141 USD per WGS using MiSeq Reagent Kits v2 (500-cycles) and v3 (600-cycles), respectively. Five trainings were required to prepare the staff for autonomous WGS which cost 48,250 USD. External assessment confirmed excellent performance of WGS by the Kyrgyz laboratory in an interlaboratory comparison of 30 M. tuberculosis genomes showing complete agreeance of results.

Implementing contact tracing for tuberculosis in Kyrgyz Republic and risk factors for positivity using QuantiFERON-TB Gold plus.

BACKGROUND: Effective active case finding (ACF) activities are essential for early identification of new cases of active tuberculosis (TB) and latent TB infection (LTBI). Accurate diagnostics as well as the ability to identify contacts at high risk of infection are essential for ACF, and have not been systematically reported from Central Asia. The objective was to implement a pilot ACF program to determine the prevalence and risk factors for LTBI and active TB among contacts of individuals with TB in Kyrgyz Republic using Quantiferon-TB Gold plus (QuantiFERON). METHODS: An enhanced ACF project in the Kyrgyz Republic was implemented in which close and household (home) contacts of TB patients from the Issyk-Kul Oblast TB Center were visited at home. QuantiFERON and the tuberculin skin test (TST) alongside clinical and bacteriological examination were used to identify LTBI and active TB cases among contacts. The association for QuantiFERON positivity and risk factors were analysed and compared to TST results. RESULTS: Implementation of ACF with QuantiFERON involved close collaboration with the national sanitary and epidemiological services (SES) and laboratories in the Kyrgyz Republic. From 67 index cases, 296 contacts were enrolled of whom 253 had QuantiFERON or TST results; of those 103 contacts had LTBI (positive TST or IGRA), and four (1.4%) active TB cases were detected. Index case smear microscopy (OR 1.76) and high household density (OR 1.97) were significant risk factors for QuantiFERON positivity for all contacts. When stratified by age, association with smear positivity disappeared for children below 15 years. TST was not associated with any risk factor. CONCLUSIONS: This is the first time that ACF activities have been reported for Central Asia, and provide insight for implementation of effective ACF in the region. These ACF activities using QuantiFERON led to increase in the detection of LTBI and active cases, prior to patients seeking treatment. Household density should be taken into consideration as an important risk factor for the stratification of future ACF activities.