Timing of treatment interruption among latently infected tuberculosis cases treated with a nine-month course of daily isoniazid: findings from a time to event analysis.

BACKGROUND: Treatment of latent tuberculosis infection (LTBI) in high-risk groups is an effective strategy for TB control and elimination in low incidence settings. A nine-month course of daily isoniazid (INH) has been the longest prescribed therapy; however, completion rates are suboptimal. We need data to guide TB program outreach efforts to optimize LTBI treatment completion rates. METHODS: We pooled seven (2009-2015) years of LTBI treatment outcome data. We computed the probability of INH treatment disruption over time by patient demographic and clinical risk factors. We used log-rank tests and Cox proportional hazards models to assess the risk factors for treatment disruption. RESULTS: We analyzed data from 12,495 persons with complete data on INH treatment initiation. Pediatric cases (0-17 years), recent contacts of active TB patients, and non-U.S.-born adults living in the United States ≤5 years represented 25.2, 13.0, and 59.2% of the study population, respectively. Overall, 48.4% failed to complete therapy. The median treatment duration was 306 days (95% CI: 297, 315). A significant drop in adherence could be observed around day 30 of treatment initiation. Indeed, by day 30 of treatment, 17.0% (95% CI: 16.4, 17.7) of patients had defaulted on therapy. Pediatric patients (HR = 0.83, 95% CI: 0.78, 0.89), recent contacts (HR = 0.74, 95% CI: 0.68, 0.81), patients with diabetes (HR = 0.77, 95% CI: 0.60, 0.98), and patients with HIV (HR = 0.39, 95% CI: 0.30, 0.51) had a lower risk of treatment default. However, black patients (HR = 1.57, 95% CI: 1.44, 1.70), Hispanic patients (HR = 1.54, 95% CI: 1.43, 1.66), and non-U.S.-born persons living in the United States ≤5 years (HR = 1.25, 95% CI: 1.18, 1.32) were significantly more likely to default on therapy. CONCLUSIONS: In this analysis of INH treatment outcome, we see high levels of treatment discontinuation. On average, patients defaulted on their prescribed nine-month daily INH therapy within 30 days of initiating treatment, and those at increased risk of progression to active disease were most likely to do so. We highlight the need to introduce patient-centered programs to increase treatment adherence in this population.

Health care workers' recommendations for strengthening tuberculosis infection control in the Dominican Republic.

OBJECTIVE: To describe health care workers' practical recommendations for strengthening adherence to Mycobacterium tuberculosis infection control practices in their health institutions and elsewhere across the Dominican Republic. METHODS: In this qualitative study, 10 focus groups, with a total of 40 clinicians (24 physicians, 16 nurses), were conducted in 2016 at two tertiary-level institutions in the Dominican Republic. Grounded theory guided the analysis to expand on health care workers' recommendations for empowering clinicians to adhere to M. tuberculosis infection control practices. To ensure reliability and validity, the authors analyzed data and incorporated both peer debriefing with qualitative experts and participant feedback or validation on the final themes. RESULTS: Six emerging themes were described: 1) education and training; 2) administrative policy; 3) infrastructure policy; 4) economic allocations; 5) research; and 6) public health policy. CONCLUSIONS: Future efforts may combine the health care workers' recommendations with evidence-based strategies in M. tuberculosis infection control in low-resource settings. This could pave the way for interventions that empower health care workers in their application of M. tuberculosis infection control measures in clinical practice.

The Role of Powerlessness Among Health Care Workers in Tuberculosis Infection Control.

Due to their occupational exposure in health care settings, health care workers (HCW) have increased risk of Mycobacterium tuberculosis infection. They face challenges to remain up-to-date with evidence-based clinical practices and translate educational information into actions in infection control practices. Our purpose was to examine this "knowledge-action" gap about how HCWs understand their occupational M. tuberculosis risk and use recommended infection control measures in clinical practices in the Dominican Republic (DR). We conducted 10 focus groups with 40 physicians and nurses at two tertiary-level DR institutions. Using grounded theory methods, we developed a theoretical model to describe the decision-making process related to adherence to M. tuberculosis infection control measures in clinical practice. Findings highlight intrinsic and extrinsic factors that influenced the observed knowledge-action gap related to M. tuberculosis infection control practices in two DR health institutions.

Empowering medical students through collaborative writing sessions.

BACKGROUND: Scientific writing and critical appraisal of the literature are fundamental skills for future physicians. However, these skills have been inconsistently prioritised across medical curricula, leaving medical trainees to seek these skills through continuing education courses. APPROACH: We conducted a series of complementary collaborative writing sessions (introductory workshop with 3-month practical sessions) with direct supervision to medical trainees (medical students and recent medical graduates) in the Dominican Republic between 2017 and 2020. We also examined medical trainees' perceptions of  these collaborative writing sessions, as a mechanism to advance technical writing and critical analysis skills for their professional training and personal growth. EVALUATION: Participants described the perceived enabling factors of the collaborative writing sessions that led to their publications as: (1) detailed agenda; (2) direct mentorship; (3) effective teamwork; (4) personal investment and dedication; and (5) future vision. IMPLICATIONS: These collaborative writing sessions, consisting of a viable agenda and timeline, direct mentorship with timely feedback, and team dynamics, are recognised as an innovative model for medical trainees in the Dominican Republic. This academic model and approach can be adapted to meet the specific needs of health professional students across the globe. By mastering these fundamental written communication skills, medical trainees can contribute to research and policy development, lead health education initiatives, advocate for best clinical practices in patient care, and mentor the next generation of trainees.

Integrating One Health topics to enhance health workers' leadership in health promotion activities.

Moving into the next decade, the global health workforce can lead efforts to identify emerging health threats and develop immediate action plans to mitigate adverse effects on community health and well-being. To prepare health workers in their delivery of health education activities, the authors propose three didactic ('train the trainers') approaches: essential 'learning moments', critical analyses of One Health challenges, and the use of innovative real-time visualizations. Health workers' leadership is vital to achieve the targets of the 2030 Agenda for Sustainable Development, to safeguard population health, and ultimately to strengthen global health security.

Lessons Learned During the COVID-19 Pandemic to Strengthen TB Infection Control: A Rapid Review.

INTRODUCTION: Over the past 5 years, substantial global investment has resulted in reduced TB incidence rates by 9% and mortality rates by 14%. However, the coronavirus disease (COVID-19) pandemic has hindered access and availability of TB services to maintain robust TB control. The objective of this rapid review was to describe the challenges to be addressed and recommendations to strengthen health system preparedness for optimal TB control across low- and middle-income countries during and after the COVID-19 pandemic. METHODS: Five databases were used to systematically search for relevant articles published in 2020. The 5-step framework proposed by Arskey and O'Malley and adapted by Levac et al. guided the review process. Thematic analysis with grounded theory principles was used to summarize themes from selected articles and integrate analyses with barriers reported from authors' previous TB research. RESULTS: Of the 218 peer-reviewed articles, 20 articles met the inclusion criteria. Four emerging themes described challenges: (1) unprepared health system leadership and infrastructure, (2) coexisting health priorities, (3) insufficient health care workforce support for continued training and appropriate workplace environments, and (4) weak connections to primary health centers hindering community engagement. Four recommendations were highlighted: (1) ensuring leadership and governance for sustainable national health budgets, (2) building networks of community stakeholders, (3) supporting health care workforce training and safe workplace environments, and (4) using digital health interventions for TB care. CONCLUSIONS: National health systems must promote patient-centered TB care, implement ethical community interventions, support operational research, and integrate appropriate eHealth applications. TB program managers and primary care practitioners can serve as instrumental leaders and patient advocates to deliver high-quality and sustainable TB care that leads to achieving the targets of the End TB Strategy.

One Health and veterans' post-deployment health.

Since 2001, more than 3.3 million US service members have been deployed to operations Iraqi Freedom, Enduring Freedom, New Dawn, Inherent Resolve and Freedom's Sentinel. Visible and invisible war wounds from direct combat experiences, coupled with environmental exposures to harmful substances, can complicate veterans' health throughout their lifespan. While promoting a holistic view of health, health professionals should be attentive for potential risks associated with environmental or animal exposures (One Health concept). During deployment, infectious and non-infectious environmental exposures and harmful substances in the air, on the land and in the water may result in immediate- or long-term health effects. Veterans can also face psychosocial health risks when home that may impact their concentration, emotional responses and social interactions. To strengthen health professions education, the authors recommend that curricula incorporate a comprehensive overview of veterans' physical and psychosocial health risks as a result of their deployment. They describe four specific curriculum topics, competencies and didactic methods that can reinforce veteran-specific content for clinical education and training. By applying the One Health concept, health professionals can document harmful environmental exposures during deployment, report gaps in clinical practice, and provide support for veterans' physical and psychosocial health needs when returning to civilian life.

A survey on the effectiveness of WhatsApp for teaching doctors preparing for a licensing exam.

INTRODUCTION: The use of WhatsApp for health professional education is not novel and is described increasingly in literature as an affordable, familiar, and convenient tool for collaboration. Social media technologies for health practitioner education allow the use of text and audio-visual aids, peer-to-peer based learning, and problem-based learning. This study presents a survey on the effectiveness of WhatsApp in doctors' preparation for a medical licensing exam. METHODS: A cross-sectional study was conducted among one hundred and ninety-four participants of a WhatsApp group preparing for the PLAB exam over a three-month period. A twenty-item questionnaire designed on Google Form was completed by consenting participants on the publication of exam results. RESULTS: Of the one hundred and ninety-four participants, one hundred and fourteen met the eligibility criteria, 57.9 percent were male and 42.1 percent were female, aged between twenty-four and forty-three years of age ([Formula: see text] years). A total of 88.6 percent of participants passed the exam in contrast to the global average pass rate of 69 percent, while the average score among participants was 131.5 compared to a global average score of 128. Passing the exam was significantly associated with combining the WhatsApp group with the online question bank Plabable (p = 0.001). While the mean age of those who passed the PLAB exam was lower than those who did not pass the exam, the number of years post-graduation had no significant association with passing the exam. A total of 93.8 percent stated that moderators were knowledgeable, 83.3 percent reported that the platform increased their motivation to learn, 72.8 percent felt that the session were organised and easy-to-follow, and 97.4 percent of participants reported they would recommend the PLAB network. CONCLUSION: WhatsApp can be an effective tool for health professional education, using a pre-defined curriculum coupled with organizational structure. This study reported both subjective and objective measures of effectiveness and demonstrated that the use of multiple e-learning resources can lead to improved learning outcomes.

Increasing Research Productivity across Africa.

Empowering scientific innovation, building knowledge management and strengthening research capacity across Africa are fundamental for improving high-level policy decision-making. Such contributions can distinguish the continent as a reputable source of scientific expertise, prepared to manage local and global challenges towards achieving the Sustainable Development Goals (SDGs).

Cholera in Haiti: A public health challenge in the Dominican Republic and Americas Region

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Tobacco use in Nigerian youth: A systematic review.

BACKGROUND: Tobacco use is the most important preventable cause of premature death and major risk factor for non-communicable diseases. Due to strict tobacco legislation in the western hemisphere, many African nations like Nigeria have shifted from being a tobacco-producing nation to a tobacco-consuming one. The purpose of this study was to systematically review existing literature on tobacco use among Nigerian adolescents and young people and identify the prevalence, distribution and factors influencing of tobacco smoking. These data are necessary to formulate and adapt control measures aimed at tobacco cessation among young people, and preventing long-term smoking behaviors. METHODS: Three databases (African Journals Online, PsychInfo, PubMed) were searched for peer-reviewed publications, published between January 2000 and March 2017. Additional searches were completed on Google Scholar, and other documents and reports of the Nigerian government and the Global Youth Tobacco Survey were consulted. Using the PRISMA guidelines to evaluate studies, we included studies that reported prevalence of tobacco use in adolescents or youths, aged 10 to 24, and excluded evaluations of tobacco-related medical conditions. RESULTS: A total of 30 studies with a total population of 26,709 were reviewed. Prevalence rates of tobacco smoking ranged from 0.2% to 32.5%. Among the gender-specific studies, the prevalence of smoking among females ranged between 2.2% to 10% while that of males ranged from 1% to 32.5%. Gender distribution among these studies was mixed (80.0%), males only (13.3%) and females only (6.7%). Smoking prevalence was higher among males than females. The most common risk factors for tobacco use included peer influence, family conditions, psychosocial factors and male gender. Additional risk factors included concomitant substance abuse, media advertisements and increasing age. CONCLUSIONS: Tobacco smoking poses a huge burden to Nigerian youths and various determinants were highlighted in this review. It is imperative that all stakeholders engage in concerted efforts to target both in-school and out-of-school youths in tobacco control strategies.

Moving Closer to Tuberculosis Elimination through Institutional Scientific Collaboration: Opportunities for Cuba and the USA.

Global efforts to eliminate tuberculosis by 2050 continue to challenge health systems. In countries with low reported tuberculosis incidence, such as the USA (3.1/100,000 population) and Cuba (6.9/100,000), differences in classification by income level and health systems' overall organizational structure are evident. However, the two countries' low tuberculosis incidence, geographic proximity, robust research capacity and shared health priority for tuberculosis elimination provide fertile territory to strengthen collaboration for tuberculosis control in clinical, laboratory and community settings. Two tuberculosis symposia in Cuba-one at the Cuba Salud Convention in 2015 and the other at the International Forum on Hygiene and Epidemiology in 2016-were instrumental in stimulating dialogue on continued efforts towards eliminating tuberculosis by 2050. In this article, we describe tuberculosis burden in the USA and Cuba, critically analyze strengths and challenges experienced in areas of low tuberculosis incidence and provide recommendations for future institutional collaboration to support tuberculosis elimination and improved population health. KEYWORDS Tuberculosis/epidemiology, Mycobacterium tuberculosis, prevention, communicable disease control, disease eradication, disease elimination, international cooperation, Cuba, USA.