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1.
Afr Health Sci ; 22(2): 169-177, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36407334

RESUMO

Introduction: The objective of this study is to observe the trend in treatment outcomes and identify determinants of treatment success among patients recruited into care through the DOTS strategy. Methodology: A retrospective record review of tuberculosis patients (2012-2016) was carried out at the Tuberculosis and Leprosy Referral Centre, Eku, Delta State, Nigeria. Results: Records of four hundred and twenty five (425) tuberculosis patients under DOTS were reviewed over five years. The highest number of cases under treatment, 102 (24.0%), was recorded in 2013. The mean age (SD) of patients was 37.3 (±16.5) years, majority of the patients were male (62.4%) and 18% had TB/HIV co-infection. Treatment outcomes of patients were cured (53.4%), completed (27.8%), died (6.8%), failed (2.4%), lost to follow up (4.9%), transferred out (1.2%) and not evaluated (3.5%). Over all, treatment success rate was 81.2% with a trend of 88.7% (2012), 87.3% (2013), 85.9% (2014), 65.0% (2015) and 65.8% (2016) respectively. Patient characteristics were not associated with treatment success. Conclusion: The treatment success rate was high and in line with the national recommendation of 80% and above. The trend showed a reduction in number of new cases enrolled into the DOTS programme, reduction in success rate with a concomitant increase in loss to follow up. There was no association between patient characteristics and TB treatment success. System strengthening on patient follow up, community health education and treatment adherence is recommended.


Assuntos
Infecções por HIV , Tuberculose , Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Terapia Diretamente Observada , Antituberculosos/uso terapêutico , Estudos Retrospectivos , Nigéria/epidemiologia , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Resultado do Tratamento , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Encaminhamento e Consulta
2.
Med J Malaysia ; 77(6): 696-703, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36448387

RESUMO

INTRODUCTION: Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection is a global public health issue among people living with HIV. The objective was to assess the prevalence of TB treatment outcomes (successful and unsuccessful) and associated factors with TB treatment success among TB and HIV co-infected patients in Kelantan for 5 years (2014-2018). The successful TB treatment was defined as the sum of cured patients and those who completed the treatment. The unsuccessful treatment was defined as the sum of treatment failed, died, and default. MATERIALS AND METHODS: A cross-sectional study was conducted at the TB/Leprosy Unit of the State Health Department of Kelantan (JKNK) using secondary data from January 2014 to December 2018 assessed in the MyTB online system. The data were analyzed using SPSS 25.0 and STATA 14. Ethics approvals were obtained from Medical Research Ethics Committee (MREC) and UniSZA Human Research Ethics Committee (UHREC). RESULTS: Kelantan had 6,313 TB cases from January 2014 to December 2018. There were 703 (11.1%) cases of TB and HIV co-infection. The prevalence of successful treatment among TB and HIV co-infected patients was 57.1%. The duration of treatment and anatomy of TB location was significantly associated with TB treatment success. CONCLUSION: This study's findings showed that the prevalence of TB treatment success rate was 57.1%, and the unsuccessful rate was 42.9%. The treatment duration and the TB location's anatomy were significantly associated with the treatment success rate. Improving TB treatment outcomes should be started with anti-TB treatment immediately after TB diagnosis. Therefore, the government should strengthen the TB/HIV collaborative efforts to achieve good treatment outcomes among these vulnerable patients.


Assuntos
Coinfecção , Infecções por HIV , Tuberculose , Humanos , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Coinfecção/tratamento farmacológico , Coinfecção/epidemiologia , Estudos Transversais , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , HIV
3.
Curr Microbiol ; 79(11): 345, 2022 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-36209340

RESUMO

Tuberculosis (TB) is a major zoonotic disease of public health importance worldwide. Its burden is more in developing countries due to inadequate surveillance, co-infection with HIV/AIDS and poor social amenities; hence consumption of unpasteurized milk, contaminated meat and inhalation of infected droplets from animals or patients with active TB are the major risk practices. A survey was conducted on TB prevalence from 2013 to 2014 while patients records from TB and Leprosy units of hospitals in the three Agricultural zones (Ogoja, Ikom and Calabar) of Cross River State, Nigeria were assessed from 2000 to 2010. Out of 1,170 sampled patients, 8 (0.7%) were positive, of which 6 and 2 isolates were identified as M. tuberculosis and M. bovis, respectively. Out of 52,558 studied patients files, 235 (0.4%) were positive with varied annual prevalence; the highest (1.0%) and lowest (0.2%) in 2009 and 2011, respectively. The prevalence was higher in dry (0.9% and 0.5%) than the rainy season (0.5% and 0.4%), in females (0.9% and 0.5%) than the males (0.4% and 0.4%) in the survey and retrospective studies, respectively. The age distribution of TB among the patients were; (0% and 0.3%), (0.4% and 0.4%), (0.7% and 0.4%) and (1.5% and 0.7%) for those (≤ 18), (19-40), (41-60) and (> 60) yrs old in the survey and retrospective study, respectively. TB is prevalent in human patients in Cross River State hence, the need for sustainable campaign, continuous surveillance and private/ public health partnership in accurate and early diagnosis, treatment and one health approach to its control.


Assuntos
Infecções por HIV , Mycobacterium tuberculosis , Saúde Única , Tuberculose , Animais , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Nigéria/epidemiologia , Prevalência , Estudos Retrospectivos , Tuberculose/epidemiologia
5.
Int J Mol Sci ; 23(17)2022 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-36076909

RESUMO

In humans, mitochondria play key roles in the regulation of cellular functions, such as the regulation of the innate immune response and are targets of several pathogenic viruses and bacteria. Mycobacteria are intracellular pathogens that infect cells important to the immune system of organisms and target mitochondria to meet their energy demands. In this review, we discuss the main mechanisms by which mitochondria regulate the innate immune response of humans to mycobacterial infection, especially those that cause tuberculosis and leprosy. Notably, the importance of mitochondrial haplogroups and ancestry studies for mycobacterial diseases is also discussed.


Assuntos
Hanseníase , Mycobacterium , Tuberculose , Humanos , Sistema Imunitário , Hanseníase/genética , Mitocôndrias/genética , Mycobacterium/genética , Mycobacterium leprae , Tuberculose/genética , Tuberculose/microbiologia
6.
BMC Health Serv Res ; 22(1): 1074, 2022 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-35996175

RESUMO

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


Assuntos
Soropositividade para HIV , Tuberculose , Adolescente , Confiabilidade dos Dados , Feminino , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Zâmbia/epidemiologia
7.
Ann Agric Environ Med ; 29(2): 220-223, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35767754

RESUMO

INTRODUCTION AND OBJECTIVE: Mycobacteriosis are diseases caused by acid-fast mycobacteria other than M. leprae and tuberculous mycobacteria. Animal mycobacteriosis is often caused by M. avium ssp. hominissuis. Many species of animals are susceptible to infection with this bacterium, even those kept in Zoological Gardens. The aim of the study was to determine the species of bacterium responsible for causing the disease in the tested animals. MATERIAL AND METHODS: Tissue samples of two male sitatunga antelopes (Tragelaphus spekii) were analyzed. Lymph node and lung samples were subjected to anatomical examination and Ziehl-Neelsen staining. Real-time PCR was performed to confirm or rule out tuberculosis mycobacteria infection. In order to isolate the bacterial strain, tissue samples were inoculated on both solid and liquid media. HainLifescience CM tests, mass spectrometry and New Generation Sequencing were used to determine the mycobacterial species. RESULTS: Results showed that atypical mycobacteria are responsible for the antelope disease. The results of the HainLifescience CM test and mass spectrometry indicated that the mycobacterium responsible for causing mycobacteriosis was M. avium. New Generation Sequencing helped to identified a subspecies that was M. avium ssp. hominissuis. CONCLUSIONS: The sitatunga antelope is an animal susceptible to infection by M. avium ssp. hominissuis. Considering the wide range of hosts and the easiness of interspecies transmission of the pathogen, as well as its zoonotic nature, the mycobacteriosis induced by this microorganism should not be underestimated.


Assuntos
Antílopes , Infecções por Mycobacterium não Tuberculosas , Mycobacterium tuberculosis , Tuberculose , Animais , Masculino , Mycobacterium avium/genética , Tuberculose/microbiologia
8.
BMJ Open ; 12(4): e055295, 2022 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-35414551

RESUMO

INTRODUCTION: Population-wide interventions offer a pathway to tuberculosis (TB) and leprosy elimination, but 'real-world' implementation in a high-burden setting using a combined approach has not been demonstrated. This implementation study aims to demonstrate the feasibility and evaluate the effect of population-wide screening, treatment and prevention on TB and leprosy incidence rates, as well as TB transmission. METHODS AND ANALYSIS: A non-randomised 'screen-and-treat' intervention conducted in the Pacific atoll of South Tarawa, Kiribati. Households are enumerated and all residents ≥3 years, as well as children <3 years with recent household exposure to TB or leprosy, invited for screening. Participants are screened using tuberculin skin testing, signs and symptoms of TB or leprosy, digital chest X-ray with computer-aided detection and sputum testing (Xpert MTB/RIF Ultra). Those diagnosed with disease are referred to the National TB and Leprosy Programme for management. Participants with TB infection are offered TB preventive treatment and those without TB disease or infection, or leprosy, are offered leprosy prophylaxis. The primary study outcome is the difference in the annual TB case notification rate before and after the intervention; a similar outcome is included for leprosy. The effect on TB transmission will be measured by comparing the estimated annual risk of TB infection in primary school children before and after the intervention, as a co-primary outcome used for power calculations. Comparison of TB and leprosy case notification rates in South Tarawa (the intervention group) and the rest of Kiribati (the control group) before, during and after the intervention is a secondary outcome. ETHICS AND DISSEMINATION: Approval was obtained from the University of Sydney Human Research Ethics Committee (project no. 2021/127) and the Kiribati Ministry of Health and Medical Services (MHMS). Findings will be shared with the MHMS and local communities, published in peer-reviewed journals and presented at international conferences.


Assuntos
Hanseníase , Mycobacterium tuberculosis , Tuberculose , Criança , Humanos , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Hanseníase/prevenção & controle , Micronésia/epidemiologia , Tuberculose/epidemiologia
9.
Indian J Pathol Microbiol ; 65(2): 406-409, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35435380

RESUMO

The most common cause of granulomatous lymphadenitis in countries like ours is mycobactrium tuberculosis followed by atypical mycobacterial infection, fungal infections, parasitic infection, cat scratch disease, lymphogranuloma venereum (inguinal lymphadenopathy), and leprosy Here, we present three cases of lymphadenopathy due to histoplasmosis in immunocompetent children. Two of them presented with fever, lymphadenopathy, initially diagnosed as granulomatous lymphadenitis consistent with tuberculosis on FNAC and were put on antitubercular drugs. However, their condition gradually became worse. As the patients continued to deteriorate, subsequent lymph node biopsies were done and diagnosed as histoplasmosis. Third case presented with acute loss of vision with hepatosplenomegaly and lymphadenopathy. Initially considered as acute leukemia, but eventually established as histoplasmosis. Histoplasmosis should be considered as one of the possible causes of granulomatous lymphadenitis in children.


Assuntos
Histoplasmose , Linfadenite , Linfadenopatia , Tuberculose , Granuloma/diagnóstico , Histoplasmose/diagnóstico , Humanos , Linfadenopatia/diagnóstico , Tuberculose/diagnóstico
10.
Front Cell Infect Microbiol ; 12: 792617, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35281437

RESUMO

Mycobacteria are members of the Actinomycetales order, and they are classified into one family, Mycobacteriaceae. More than 20 mycobacterial species cause disease in humans. The Mycobacterium group, called the Mycobacterium tuberculosis complex (MTBC), has nine closely related species that cause tuberculosis in animals and humans. TB can be detected worldwide and one-fourth of the world's population is contaminated with tuberculosis. According to the WHO, about two million dies from it, and more than nine million people are newly infected with TB each year. Mycobacterium tuberculosis (M. tuberculosis) is the most potential causative agent of tuberculosis and prompts enormous mortality and morbidity worldwide due to the incompletely understood pathogenesis of human tuberculosis. Moreover, modern diagnostic approaches for human tuberculosis are inefficient and have many lacks, while MTBC species can modulate host immune response and escape host immune attacks to sustain in the human body. "Multi-omics" strategies such as genomics, transcriptomics, proteomics, metabolomics, and deep sequencing technologies could be a comprehensive strategy to investigate the pathogenesis of mycobacterial species in humans and offer significant discovery to find out biomarkers at the early stage of disease in the host. Thus, in this review, we attempt to understand an overview of the mission of "omics" approaches in mycobacterial pathogenesis, including tuberculosis, leprosy, and other mycobacterial diseases.


Assuntos
Hanseníase , Mycobacterium tuberculosis , Tuberculose , Animais , Genômica , Humanos , Hanseníase/diagnóstico , Mycobacterium tuberculosis/genética , Proteômica
11.
Recurso na Internet em Português | LIS | ID: lis-48575

RESUMO

Foi sancionada, nesta terça-feira (4) a Lei nº 14.289, que obriga o sigilo sobre a condição de pessoas infectadas pelo vírus HIV e hepatites crônicas. A medida também abrange pessoas com hanseníase ou tuberculose. O sigilo é obrigatório no âmbito dos serviços de saúde, estabelecimentos de ensino, locais de trabalho, administração pública, segurança pública, processos judiciais e mídias escrita e audiovisual. O texto foi publicado no Diário Oficial da União.


Assuntos
HIV , Hepatite , Tuberculose , Hanseníase , Confidencialidade/normas
12.
Expert Opin Investig Drugs ; 31(2): 139-144, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35034512

RESUMO

INTRODUCTION: Tuberculosis is an infectious disease that affected more than 50 million people and killed 6.7 million patients in the past 5 years alone. Additionally, rising incidence of treatment resistance threatens the global effort to eradicate this disease. With limited options available, additional novel antibiotics are needed for the treatment of multidrug-resistant tuberculosis (MDR-TB). Telacebec is a first-in-class antibiotic that targets the pathogen's energy metabolism. AREAS COVERED: This paper provides an overview of the recent progress in the development and testing of telacebec. We discuss published clinical data and examine the design and setup of its clinical trials. We also offer insights on the therapeutic potential of telacebec and aspects of which should be evaluated in the future. EXPERT OPINION: The first phase 2a trial showed a correlation between dosage and bacterial load in patient sputum, which should be confirmed using a direct measurement method such as colony-forming unit counting. Its clinical efficacy, favorable pharmacokinetic properties, low arrhythmogenic risk, and activity against MDR-TB strains make telacebec a suitable candidate for further development. Future clinical testing in combination with approved second-line drugs will reveal its full potential against MDR-TB. Considering recent preclinical studies, we also recommend initiating clinical trials for Buruli ulcer and leprosy.


Assuntos
Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos , Tuberculose , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Humanos , Imidazóis , Piperidinas/uso terapêutico , Piridinas/uso terapêutico , Tuberculose/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico
13.
Buenos Aires; s.n; 2022. 9 p.
Não convencional em Espanhol | InstitutionalDB, BINACIS, UNISALUD | ID: biblio-1398448

RESUMO

El presente informe da cuenta de los objetivos propuestos y las actividades realizadas en el marco de la rotación electiva en la Coordinación de Tuberculosis y Lepra del Ministerio de Salud de la Nación, llevada adelante desde el 2 de marzo hasta el 13 de mayo de 2022. La elección de este espacio está vinculada al proceso de inserción en el área de tuberculosis iniciado en la rotación interna en el CeSAC 24 el primer cuatrimestre de 2021. Luego de haber participado en el consultorio interdisciplinario, se propuso conocer las acciones implementadas a nivel central y programático para el abordaje de la tuberculosis, con el objetivo de comprender los puntos de encuentro y desencuentro entre las intervenciones del primer nivel de atención y las particularidades de la gestión y la política pública. (AU)


Assuntos
Tuberculose/prevenção & controle , Planos e Programas de Saúde , Internato e Residência , Internato não Médico , Hanseníase/prevenção & controle , Educação em Saúde , Promoção da Saúde
14.
PLoS Negl Trop Dis ; 15(12): e0010018, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34914694

RESUMO

T cell receptors (TCRs) encode the history of antigenic challenge within an individual and have the potential to serve as molecular markers of infection. In addition to peptide antigens bound to highly polymorphic MHC molecules, T cells have also evolved to recognize bacterial lipids when bound to non-polymorphic CD1 molecules. One such subset, germline-encoded, mycolyl lipid-reactive (GEM) T cells, recognizes mycobacterial cell wall lipids and expresses a conserved TCR-ɑ chain that is shared among genetically unrelated individuals. We developed a quantitative PCR assay to determine expression of the GEM TCR-ɑ nucleotide sequence in human tissues and blood. This assay was validated on plasmids and T cell lines. We tested blood samples from South African subjects with or without tuberculin reactivity or with active tuberculosis disease. We were able to detect GEM TCR-ɑ above the limit of detection in 92% of donors but found no difference in GEM TCR-ɑ expression among the three groups after normalizing for total TCR-ɑ expression. In a cohort of leprosy patients from Nepal, we successfully detected GEM TCR-ɑ in 100% of skin biopsies with histologically confirmed tuberculoid and lepromatous leprosy. Thus, GEM T cells constitute part of the T cell repertoire in the skin. However, GEM TCR-ɑ expression was not different between leprosy patients and control subjects after normalization. Further, these results reveal the feasibility of developing a simple, field deployable molecular diagnostic based on mycobacterial lipid antigen-specific TCR sequences that are readily detectable in human tissues and blood independent of genetic background.


Assuntos
Hanseníase/diagnóstico , Lipídeos/imunologia , Técnicas de Diagnóstico Molecular/métodos , Mycobacterium/imunologia , Receptores de Antígenos de Linfócitos T alfa-beta/imunologia , Tuberculose/diagnóstico , Antígenos CD1/genética , Antígenos CD1/imunologia , Parede Celular/genética , Parede Celular/imunologia , Estudos de Coortes , Humanos , Hanseníase/sangue , Hanseníase/imunologia , Hanseníase/microbiologia , Mycobacterium/genética , Mycobacterium/isolamento & purificação , Nepal , Reação em Cadeia da Polimerase , Receptores de Antígenos de Linfócitos T alfa-beta/sangue , Receptores de Antígenos de Linfócitos T alfa-beta/genética , África do Sul , Linfócitos T/imunologia , Linfócitos T/microbiologia , Tuberculose/sangue , Tuberculose/imunologia , Tuberculose/microbiologia
15.
Immunotherapy ; 13(18): 1555-1563, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34743608

RESUMO

Leprosy and tuberculosis are infectious diseases that are caused by bacteria, and both share primary risk factors. Mediators of these diseases are regulated by a heterogeneous immature population of myeloid cells called myeloid-derived suppressor cells (MDSCs) that exhibit immunosuppressive activity against innate and adaptive immunity. During pathological conditions, endoplasmic reticulum (ER) stress occurs in MDSCs, and high levels of ER stress affect MDSC-linked immunosuppressive activity. Investigating the role of ER stress in regulating immunosuppressive functions of MDSCs in leprosy and tuberculosis may lead to new approaches to treating these diseases. Here the authors discuss the immunoregulatory effects of ER stress in MDSCs as well as the possibility of targeting unfolded protein response elements of ER stress to diminish the immunosuppressive activity of MDSCs and reinvigorate diminished adaptive immune system responses that occur in leprosy and tuberculosis.


Assuntos
Estresse do Retículo Endoplasmático/imunologia , Hanseníase , Células Supressoras Mieloides/imunologia , Tuberculose , Resposta a Proteínas não Dobradas/imunologia , Humanos , Tolerância Imunológica , Imunidade Inata , Hanseníase/imunologia , Hanseníase/terapia , Tuberculose/imunologia , Tuberculose/terapia
16.
J Int AIDS Soc ; 24 Suppl 6: e25809, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34713974

RESUMO

INTRODUCTION: Providing more convenient and patient-centred options for service delivery is a priority within global HIV programmes. These efforts improve patient satisfaction and retention and free up time for providers to focus on new HIV diagnoses or severe illness. Recently, the coronavirus disease 2019 (COVID-19) pandemic precipitated expanded eligibility criteria for these differentiated service delivery (DSD) models to decongest clinics and protect patients and healthcare workers. This has resulted in dramatic scale-up of DSD for antiretroviral therapy, cotrimoxazole and tuberculosis (TB) preventive treatment. While TB treatment among people living with HIV (PLHIV) has traditionally involved frequent, facility-based management, TB treatment can also be adapted within DSD models. Such adaptations could include electronic tools to ensure appropriate clinical management, treatment support, adherence counselling and adverse event (AE) monitoring. In this commentary, we outline considerations for DSD of TB treatment among PLHIV, building on best practices from global DSD model implementation for HIV service delivery. DISCUSSION: In operationalizing TB treatment in DSD models, we consider the following: what activity is being done, when or how often it takes place, where it takes place, by whom and for whom. We discuss considerations for various programme elements including TB screening and diagnosis; medication dispensing; patient education, counselling and support; clinical management and monitoring; and reporting and recording. General approaches include multi-month dispensing for TB medications during intensive and continuation phases of treatment and standardized virtual adherence and AE monitoring. Lastly, we provide operational examples of TB treatment delivery through DSD models, including a conceptual model and an early implementation experience from Zambia. CONCLUSIONS: COVID-19 has catalysed the rapid expansion of differentiated patient-centred service delivery for PLHIV. Expanding DSD models to include TB treatment can capitalize on existing platforms, while providing high-quality, routine treatment, follow-up and patient education and empowerment.


Assuntos
COVID-19 , Infecções por HIV , Tuberculose , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Pessoal de Saúde , Humanos , SARS-CoV-2 , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico
17.
BMC Public Health ; 21(1): 1928, 2021 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-34688266

RESUMO

BACKGROUND: Tuberculosis (TB) care can be costly for patients and their families. The End TB Strategy includes a target that zero TB affected households should experience catastrophic costs associated with TB care. Costs are catastrophic when a patient spends 20% or more of their annual household income on their TB diagnosis and care. In Solomon Islands the costs of TB care are unknown. The aim of this study was to determine the costs of TB diagnosis and care, the types of costs and the proportion of patients with catastrophic costs. METHODS: This was a nationally representative cross-sectional survey of TB patients carried out between 2017 and 2019. Patients were recruited from health care facilities, from all ten provinces in Solomon Islands. During an interview they were asked about the costs of TB diagnosis and care. These data were analysed using descriptive statistics to describe the costs overall and the proportions of different types of costs. The proportion of patients with catastrophic costs was calculated and a multivariate logistic regression was undertaken to determine factors associated with catastrophic costs. RESULTS: One hundred and eighty-three TB patients participated in the survey. They spent a mean of 716 USD (inter quartile range: 348-1217 USD) on their TB diagnosis and care. Overall, 62.1% of costs were attributable to non-medical costs, while income loss and medical costs comprised 28.5 and 9.4%, respectively. Overall, 19.7% (n = 36) of patients used savings, borrowed money, or sold assets as a financial coping mechanism. Three patients (1.6%) had health insurance. A total of 92.3% (95% CI: 88.5-96.2) experienced catastrophic costs, using the output approach. Being in the first, second or third poorest wealth quintile was significantly associated with catastrophic costs (adjusted odds ratio: 67.3, 95% CI: 15.86-489.74%, p <  0.001). CONCLUSION: The costs of TB care are catastrophic for almost all patients in Solomon Islands. The provision of TB specific social and financial protection measures from the National TB and Leprosy Programme may be needed in the short term to ameliorate these costs. In the longer term, advancement of universal health coverage and other social and financial protection measures should be pursued.


Assuntos
Custos de Cuidados de Saúde , Tuberculose , Análise Custo-Benefício , Estudos Transversais , Humanos , Renda , Tuberculose/diagnóstico , Tuberculose/terapia
18.
mSphere ; 6(4): e0053521, 2021 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-34287002

RESUMO

Mycobacterium tuberculosis complex (MTBC) species are classic examples of genetically monomorphic microorganisms due to their low genetic variability. Whole-genome sequencing made it possible to describe both the main species within the complex and M. tuberculosis lineages and sublineages. This differentiation is based on single nucleotide polymorphisms (SNPs) and large sequence polymorphisms in the so-called regions of difference (RDs). Although a number of studies have been performed to elucidate RD localizations, their distribution among MTBC species, and their role in the bacterial life cycle, there are some inconsistencies and ambiguities in the localization of RDs in different members of the complex. To address this issue, we conducted a thorough search for all possible deletions in the WGS data collection comprising 721 samples representing the full MTBC diversity. Discovered deletions were compared with a list of all previously described RDs. As with the SNP-based analysis, we confirmed the specificities of 79 regions at the species, lineage, or sublineage level, 17 of which are described for the first time. We also present RDscan (https://github.com/dbespiatykh/RDscan), an open-source workflow, which detects deletions from short-read sequencing data and correlates the results with high-specificity RDs, curated in this study. Testing of the workflow on a collection comprising ∼7,000 samples showed a high specificity of the found RDs. This study provides novel details that can contribute to a better understanding of the species differentiation within the MTBC and can help to determine how individual clusters evolve within various MTBC species. IMPORTANCE Reductive genome evolution is one of the most important and intriguing adaptation strategies of different living organisms to their environment. Mycobacterium offers several notorious examples of either naturally reduced (Mycobacterium leprae) or laboratory-reduced (Mycobacterium bovis BCG) genomes. Mycobacterium tuberculosis complex has its phylogeny unambiguously framed by large sequence polymorphisms that present unidirectional unique event changes. In the present study, we curated all known regions of difference and analyzed both Mycobacterium tuberculosis and animal-adapted MTBC species. For 79 loci, we have shown a relationship with phylogenetic units, which can serve as a marker for diagnosing or studying biological effects. Moreover, intersections were found for some loci, which may indicate the nonrandomness of these processes and the involvement of these regions in the adaptation of bacteria to external conditions.


Assuntos
Genoma Bacteriano , Mycobacterium tuberculosis/genética , Filogenia , Sequenciamento Completo do Genoma , Animais , Genômica , Humanos , Mycobacterium tuberculosis/classificação , Polimorfismo de Nucleotídeo Único , Tuberculose/microbiologia
19.
Lancet Infect Dis ; 21(11): 1590-1597, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34237262

RESUMO

BACKGROUND: Trials of BCG vaccination to prevent or reduce severity of COVID-19 are taking place in adults, some of whom have been previously vaccinated, but evidence of the beneficial, non-specific effects of BCG come largely from data on mortality in infants and young children, and from in-vitro and animal studies, after a first BCG vaccination. We assess all-cause mortality following a large BCG revaccination trial in Malawi. METHODS: The Karonga Prevention trial was a population-based, double-blind, randomised controlled in Karonga District, northern Malawi, that enrolled participants between January, 1986, and November, 1989. The trial compared BCG (Glaxo-strain) revaccination versus placebo to prevent tuberculosis and leprosy. 46 889 individuals aged 3 months to 75 years were randomly assigned to receive BCG revaccination (n=23 528) or placebo (n=23 361). Here we report mortality since vaccination as recorded during active follow-up in northern areas of the district in 1991-94, and in a demographic surveillance follow-up in the southern area in 2002-18. 7389 individuals who received BCG (n=3746) or placebo (n=3643) lived in the northern follow-up areas, and 5616 individuals who received BCG (n=2798) or placebo (n=2818) lived in the southern area. Year of death or leaving the area were recorded for those not found. We used survival analysis to estimate all-cause mortality. FINDINGS: Follow-up information was available for 3709 (99·0%) BCG recipients and 3612 (99·1%) placebo recipients in the northern areas, and 2449 (87·5%) BCG recipients and 2413 (85·6%) placebo recipients in the southern area. There was no difference in mortality between the BCG and placebo groups in either area, overall or by age group or sex. In the northern area, there were 129 deaths per 19 694 person-years at risk in the BCG group (6·6 deaths per 1000 person-years at risk [95% CI 5·5-7·8]) versus 133 deaths per 19 111 person-years at risk in the placebo group (7·0 deaths per 1000 person-years at risk [95% CI 5·9-8·2]; HR 0·94 [95% CI 0·74-1·20]; p=0·62). In the southern area, there were 241 deaths per 38 399 person-years at risk in the BCG group (6·3 deaths per 1000 person-years at risk [95% CI 5·5-7·1]) versus 230 deaths per 38 676 person-years at risk in the placebo group (5·9 deaths per 1000 person-years at risk [95% CI 5·2-6·8]; HR 1·06 [95% CI 0·88-1·27]; p=0·54). INTERPRETATION: We found little evidence of any beneficial effect of BCG revaccination on all-cause mortality. The high proportion of deaths attributable to non-infectious causes beyond infancy, and the long time interval since BCG for most deaths, might obscure any benefits. FUNDING: British Leprosy Relief Association (LEPRA); Wellcome Trust.


Assuntos
Vacina BCG/administração & dosagem , Imunização Secundária/estatística & dados numéricos , Mortalidade , Vacinação/métodos , Adolescente , Adulto , Idoso , Vacina BCG/imunologia , COVID-19/epidemiologia , COVID-19/imunologia , COVID-19/prevenção & controle , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Imunogenicidade da Vacina , Hanseníase/imunologia , Hanseníase/mortalidade , Hanseníase/prevenção & controle , Malaui/epidemiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium leprae/imunologia , SARS-CoV-2/imunologia , Resultado do Tratamento , Tuberculose/imunologia , Tuberculose/mortalidade , Tuberculose/prevenção & controle , Vacinação/estatística & dados numéricos , Adulto Jovem
20.
BMJ Open ; 11(7): e044715, 2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-34257091

RESUMO

BACKGROUND: As infectious diseases approach global elimination targets, spatial targeting is increasingly important to identify community hotspots of transmission and effectively target interventions. We aimed to synthesise relevant evidence to define best practice approaches and identify policy and research gaps. OBJECTIVE: To systematically appraise evidence for the effectiveness of spatially targeted community public health interventions for HIV, tuberculosis (TB), leprosy and malaria. DESIGN: Systematic review. DATA SOURCES: We searched Medline, Embase, Global Health, Web of Science and Cochrane Database of Systematic Reviews between 1 January 1993 and 22 March 2021. STUDY SELECTION: The studies had to include HIV or TB or leprosy or malaria and spatial hotspot definition, and community interventions. DATA EXTRACTION AND SYNTHESIS: A data extraction tool was used. For each study, we summarised approaches to identifying hotpots, intervention design and effectiveness of the intervention. RESULTS: Ten studies, including one cluster randomised trial and nine with alternative designs (before-after, comparator area), satisfied our inclusion criteria. Spatially targeted interventions for HIV (one USA study), TB (three USA) and leprosy (two Brazil, one Federated States of Micronesia) each used household location and disease density to define hotspots followed by community-based screening. Malaria studies (one each from India, Indonesia and Kenya) used household location and disease density for hotspot identification followed by complex interventions typically combining community screening, larviciding of stagnant water bodies, indoor residual spraying and mass drug administration. Evidence of effect was mixed. CONCLUSIONS: Studies investigating spatially targeted interventions were few in number, and mostly underpowered or otherwise limited methodologically, affecting interpretation of intervention impact. Applying advanced epidemiological methodologies supporting more robust hotspot identification and larger or more intensive interventions would strengthen the evidence-base for this increasingly important approach. PROSPERO REGISTRATION NUMBER: CRD42019130133.


Assuntos
Infecções por HIV , Hanseníase , Malária , Tuberculose , Brasil , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Índia , Indonésia , Quênia , Hanseníase/epidemiologia , Hanseníase/prevenção & controle , Malária/epidemiologia , Malária/prevenção & controle
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