Decentralising DOT for drug-susceptible TB from the health facilities to the community level in Togo.

In Togo, the COVID-19 pandemic paved the way for decentralising directly observed treatment (DOT) to the community level through the evaluation of two innovative community-based DOT approaches-a community health worker-based (CHW-DOT) and family-based (FB-DOT). METHODS We conducted an observational prospective study from April 2021 to January 2022. Sputum conversion at Month 2 and favourable treatment outcomes at Month 6 were assessed and compared between the two groups. Sociodemographic and clinical factors related to these outcomes were identified. RESULTS A total of 182 TB patients were enrolled. The CHW-DOT group had significantly increased odds of sputum conversion (aOR 2.95, 95% CI 1.09-7.98) and lower odds of unsuccessful treatment outcomes (aOR 0.37, 95% CI 0.13-1.1). Non-smokers had 4.85 higher odds of converting than smokers (aOR 4.85, 95% CI 1.76-13.42) and lower odds of an unsuccessful treatment than smokers (aOR 0.11, 95% CI 0.04-0.32). CONCLUSION CHW-DOT is associated with higher sputum smear conversion rates and a more favourable treatment outcome. The use of tobacco, significantly associated with outcomes, also suggests that a smoking cessation component may be a valuable adjunct to a CHW-DOT approach during TB treatment..

WHO target product profiles for TB preventive treatment.

BACKGROUND: The WHO has developed target product profiles (TPPs) describing the most appropriate qualities for future TPT regimens to assist developers in aligning the characteristics of new treatments with programmatic requirements.METHODS: A technical consultation group was convened by the WHO to determine regimen attributes with greatest potential impact for patients (i.e., improved risk/benefit profile) and populations (i.e., reduction in transmission and TB prevalence). The group categorised regimen attributes as 'priority´ or 'desirable´; and defined for each attribute the minimum requirements and optimal targets.RESULTS: Nine priority attributes were defined, including efficacy, treatment duration, safety, drug-drug interactions, barrier to emergence of drug resistance, target population, formulation, dosage, frequency and route of administration, stability and shelf life. Regimens meeting optimal targets were characterised, for example, as having superior efficacy, treatment duration of ≤2 weeks, and improved tolerability and safety profile compared with current regimens. The four desirable attributes included regimen cost, safety in special populations, treatment adherence and need for drug susceptibility testing in the index patient.DISCUSSION: It may be difficult for a single regimen to satisfy all characteristics so regimen developers may have to consider trade-offs. Additional operational aspects may be relevant to the feasibility and public health impact of new TPT regimens.

Towards the WHO target of zero childhood tuberculosis deaths: an analysis of mortality in 13 locations in Africa and Asia.

SETTING: Achieving the World Health Organization (WHO) target of zero paediatric tuberculosis (TB) deaths will require an understanding of the underlying risk factors for mortality. OBJECTIVE: To identify risk factors for mortality and assess the impact of human immunodeficiency virus (HIV) testing during anti-tuberculosis treatment in children in 13 TB-HIV programmes run by Médecins Sans Frontières. DESIGN: In a retrospective cohort study, we recorded mortality and analysed risk factors using descriptive statistics and logistic regression. Diagnosis was based on WHO algorithm and smear microscopy. RESULTS: A total of 2451 children (mean age 5.2 years, SD 3.9) were treated for TB. Half (51.0%) lived in Asia, the remainder in sub-Saharan Africa; 56.0% had pulmonary TB; 6.4% were diagnosed using smear microscopy; 211 (8.6%) died. Of 1513 children tested for HIV, 935 (61.8%) were positive; 120 (12.8%) died compared with 30/578 (5.2%) HIV-negative children. Risk factors included being HIV-positive (OR 2.6, 95%CI 1.6-4.2), age <5 years (1.7, 95%CI 1.2-2.5) and having tuberculous meningitis (2.6, 95%CI 1.0-6.8). Risk was higher in African children of unknown HIV status than in those who were confirmed HIV-negative (1.9, 95%CI 1.1-3.3). CONCLUSIONS: Strategies to eliminate childhood TB deaths should include addressing the high-risk groups identified in this study, enhanced TB prevention, universal HIV testing and the development of a rapid diagnostic test.