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Servicios de Salud del Indígena , Pueblos Indígenas , Tamizaje Masivo , Tuberculosis Pulmonar/prevención & control , Adulto , Antituberculosos/uso terapéutico , Niño , Servicios de Salud Comunitaria , Agentes Comunitarios de Salud , Demografía , Femenino , Humanos , India/epidemiología , Masculino , Prevalencia , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/etnologíaRESUMEN
SETTING: The diagnosis of multidrug-resistant tuberculosis (MDR-TB) and gaps in linkage to care are the principal health challenges in Mozambique. Five GeneXpert machines and GxAlert, an eHealth platform, were installed in Sofala and Manica Provinces between 2012 and 2014. OBJECTIVE: To test the effects of Xpert® MTB/RIF testing and GxAlert on rifampin-resistant TB (RR-TB) diagnosis and second-line treatment initiation rates. DESIGN: We conducted a retrospective clinical review of patients with RR-TB from March 2012 to September 2015 at these five sites. Time-series analyses were conducted to investigate the impact of Xpert on case detection and treatment. Pre- and post- analyses were conducted to investigate the impact of GxAlert. RESULTS: A total of 32 182 Xpert tests were conducted: 4010 (12.5%) detected TB without rifampin resistance, and 306 (7.1%) had RR-TB. Of the RR-TB cases, 161 (52.6%) were started on MDR-TB treatment, 6.9% had documented culture results, and time from diagnosis to treatment initiation decreased over time. The absolute number of patients diagnosed and started on MDR-TB treatment increased by 0.26 (95%CI 0.15-0.38, P < 0.001) and 0.16 (95%CI 0.089-0.24, P < 0.001) every 6 months. GxAlert did not affect treatment initiation rates. CONCLUSION: Implementation of Xpert testing was associated with increases in the number of patients diagnosed and started on MDR-TB treatment.
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Técnicas de Diagnóstico Molecular/métodos , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Adulto , Antibióticos Antituberculosos/farmacología , Proteínas Bacterianas/análisis , Proteínas Bacterianas/genética , ADN Bacteriano/análisis , ADN Bacteriano/genética , Farmacorresistencia Bacteriana/efectos de los fármacos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mozambique/epidemiología , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/genética , Estudios Retrospectivos , Rifampin/farmacología , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adulto JovenRESUMEN
SETTING: Many children with tuberculosis (TB) remain undiagnosed due to the absence of services, lack of child-friendly diagnostics and underappreciation of TB as a common cause of childhood illness. OBJECTIVE: To show the impact of systematic verbal screening and contact tracing with appropriate management services on TB case finding in pediatric populations. DESIGN: Between October 2014 and March 2016, children were verbally screened at the pediatric out-patient departments of four public hospitals in Jamshoro District, Pakistan. Children with symptoms or risk of TB were referred for clinical evaluation and free chest X-ray and bacteriological tests. Children with TB were started on treatment and their care givers asked to bring household members to the hospital for screening. RESULTS: Over 105 000 children were verbally screened and 5880 presumptive childhood TB patients were identified; 1417 children (prevalence 1.3%) were diagnosed with TB; 43% were female. The median age was 5 years; 82% had pulmonary TB. An additional 390 children with TB were diagnosed through contact tracing. These activities resulted in a three-fold increase in pediatric TB case notifications. CONCLUSION: Systematic verbal screening with clinical evaluation and free diagnostics can identify children with TB who may otherwise be missed in rural health settings.
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Trazado de Contacto/métodos , Tamizaje Masivo/métodos , Tuberculosis/diagnóstico , Adolescente , Niño , Preescolar , Composición Familiar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Tamizaje Masivo/economía , Pakistán/epidemiología , Radiografía Torácica/economía , Población Rural , Tuberculosis/epidemiologíaRESUMEN
SETTING: Electronic diagnostic tests, such as the Xpert® MTB/RIF assay, are being implemented in low- and middle-income countries (LMICs). However, timely information from these tests available via remote monitoring is underutilized. The failure to transmit real-time, actionable data to key individuals such as clinicians, patients, and national monitoring and evaluation teams may negatively impact patient care. OBJECTIVE: To describe recently developed applications that allow for real-time, remote monitoring of Xpert results, and initial implementation of one of these products in central Mozambique. DESIGN: In partnership with the Mozambican National Tuberculosis Program, we compared three different remote monitoring tools for Xpert and selected one, GxAlert, to pilot and evaluate at five public health centers in Mozambique. RESULTS: GxAlert software was successfully installed on all five Xpert computers, and test results are now uploaded daily via a USB internet modem to a secure online database. A password-protected web-based interface allows real-time analysis of test results, and 1200 positive tests for tuberculosis generated 8000 SMS result notifications to key individuals. CONCLUSION: Remote monitoring of diagnostic platforms is feasible in LMICs. While promising, this effort needs to address issues around patient data ownership, confidentiality, interoperability, unique patient identifiers, and data security.
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Consulta Remota/métodos , Programas Informáticos , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Antibióticos Antituberculosos/uso terapéutico , Países en Desarrollo , Farmacorresistencia Bacteriana Múltiple , Estudios de Factibilidad , Humanos , Internet , Mozambique , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/aislamiento & purificación , Proyectos Piloto , Rifampin/uso terapéutico , Esputo/microbiologíaRESUMEN
BACKGROUND: Nomadic populations are often isolated and have difficulty accessing health care, leading to increased morbidity and mortality. Although Nigeria has one of the highest tuberculosis (TB) burdens in Africa, case detection rates remain relatively low. METHODS: Active case finding for TB among nomadic populations was implemented over a 2-year period in Adamawa State. A total of 378 community screening days were organised with local leaders; community volunteers provided treatment support. Xpert(®) MTB/RIF was available for nomads with negative smear results. RESULTS: Through active case finding, 96 376 nomads were verbally screened, yielding 1310 bacteriologically positive patients. The number of patients submitting sputum for smear microscopy statewide increased by 112% compared with the 2 years before the intervention. New smear-positive notifications increased by 49.5%, while notifications of all forms of TB increased by 24.5% compared with expected notifications based on historical trends. Nomads accounted for respectively 31.4% and 26.0% of all smear-positive and all forms TB notifications. Pre-treatment loss to follow-up and treatment outcomes were similar among nomads and non-nomads. DISCUSSION: Nomads in Nigeria have high TB rates, and active case-finding approaches may be useful in identifying and successfully treating them. Large-scale interventions in vulnerable populations can improve TB case detection.
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Rifampin/uso terapéutico , Migrantes/estadística & datos numéricos , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/etnología , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/etnología , Coinfección/diagnóstico , Femenino , Infecciones por VIH/diagnóstico , Humanos , Masculino , Microscopía , Mycobacterium tuberculosis , Nigeria/epidemiología , Esputo/microbiología , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológicoRESUMEN
SETTING: The Xpert(®) MTB/RIF assay is a highly sensitive molecular test with the potential to improve tuberculosis (TB) case detection. However, evidence supporting this potential at a programme level is minimal. METHODS: Xpert testing following smear microscopy and chest X-ray was implemented as part of routine case finding in 16 districts of Eastern Nepal. Changes in TB case notification were evaluated based on a pre/post analysis, as were expected notifications based on linear trend. RESULTS: A total of 9723 Xpert tests were performed, resulting in the identification of 1662 Mycobacterium tuberculosis-positive patients. Despite a previous declining trend in notifications, annual bacteriologically positive TB notifications increased by 15.2% during the intervention, from 3390 to 3906. However, annual notifications of pulmonary TB dropped by 8.5% overall, from 5123 to 4688. Both observations were significantly different from expected notifications based on historical trends. Treatment initiation for drug-resistant TB almost doubled. DISCUSSION: Xpert testing significantly increased bacteriologically positive TB notifications, but large reductions in empiric treatment of smear-negative disease reduced the number of pulmonary TB notifications overall. While better diagnostics remain critical, focusing solely on superior test sensitivity may not increase TB case notifications. Additional interventions are required to reach the millions of people with TB who are missed by routine services.
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Antituberculosos/administración & dosificación , Control de Enfermedades Transmisibles/organización & administración , Notificación de Enfermedades/estadística & datos numéricos , Técnicas de Diagnóstico Molecular/métodos , Tuberculosis Pulmonar/diagnóstico , Adolescente , Antituberculosos/farmacología , Niño , Preescolar , Intervalos de Confianza , ADN Bacteriano/análisis , Notificación de Enfermedades/métodos , Femenino , Humanos , Masculino , Nepal/epidemiología , Reacción en Cadena de la Polimerasa/métodos , Mejoramiento de la Calidad , Radiografía Torácica/métodos , Sensibilidad y Especificidad , Esputo/microbiología , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Adulto JovenRESUMEN
Transmission of hepatitis C (HCV) in Pakistan is a continuing public health problem; 15 years ago it was linked to the practice of reusing therapeutic instruments in healthcare settings. We sought to examine current risk factors for HCV transmission in a hospital population in Karachi, Pakistan. We enrolled 300 laboratory-confirmed HCV-positive participants and 300 laboratory confirmed HCV-negative participants from clinics at Indus Hospital. Independent and significant risk factors for both men and women were: receiving o12 injections in the past year, blood transfusions, having had dental work performed, and delivery in hospital or transfusion for women. Interestingly, being of Mohajir origin or born in Sindh province were protective.Encouragingly, a strong protective effect was observed for those that reported bringing their own needle for injections (59%). The widespread reuse of therapeutic needles in healthcare settings in Karachi remains a major driver of the HCV epidemic.