Video-observed therapy (VOT) vs directly observed therapy (DOT) for tuberculosis treatment: A systematic review on adherence, cost of treatment observation, time spent observing treatment and patient satisfaction.

INTRODUCTION: Tuberculosis (TB) treatment demands strict adherence to multidrug regimens. Directly Observed Therapy (DOT) poses challenges, especially regarding adherence. With the popularization of smartphones, Video-Observed Therapy (VOT) has emerged as a promising alternative, allowing healthcare providers to remotely supervise patients taking their medications via video calls. OBJECTIVES: This systematic review critically assesses VOT's effectiveness compared to DOT, focusing on adherence, treatment costs, time spent supervising treatment, and patient satisfaction, aiming to optimize TB supervision methods worldwide. METHODS: Only studies that met the following criteria were eligible for inclusion in the systematic review: randomized trials; studies that compared VOT to DOT; studies involving patients diagnosed with pulmonary or extrapulmonary tuberculosis; studies that reported any of the desired outcomes; full-text articles available for review; and studies conducted in the English language. We excluded studies with the following attributes: studies that lacked a control group; case series or case reports; and previous systematic reviews. The search engines and databases MEDLINE, Embase, and Cochrane were used to find studies comparing Video-Observed Therapy (VOT) to Directly Observed Therapy (DOT). The following search phrases were used to look for papers that contained them in their title or abstract: ("Electronic Directly Observed Therapy" OR "Video-observed therapy" OR "Telemedicine" OR "Wirelessly observed therapy" OR "Smartphone-enabled video-observed") AND ("TUBERCULOSIS"). RESULTS: A systematic review of the literature revealed the following findings: in all Randomized Controlled Trials (RCTs), video-observed therapy (VOT) demonstrated non-inferiority in terms of treatment adherence compared to traditional directly observed therapy (DOT); VOT reduced costs where these outcomes were assessed in the RCTs; the use of VOT reduced the amount of time healthcare professionals spent supervising treatment in RCTs evaluating this aspect; VOT contributed to higher treatment satisfaction in RCTs where this outcome was measured. CONCLUSION: In this systematic review we emphasize the importance of Video-Observed Therapy (VOT) in the digital age for patients that have access to internet. Our findings show that VOT is comparable to DOT in terms of treatment adherence, but it is also cost-effective, improves patient satisfaction and takes less time for healthcare professionals to supervise.

[Pancreatic tuberculosis]. / Tuberculosis pancreática.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It is currently considered a public health problem due to the socioeconomic conditions of the world population and the increase in other infections such as that due to Human Immunodeficiency Virus (HIV). Pulmonary involvement is the most common form of clinical presentation, although in recent decades extrapulmonary involvement has increased. Among these, digestive disorders represent less than 10%. We present a case of exclusive pancreatic tuberculosis, in the context of an immunocompromised patient. A 43-year-old man with a history of HIV with a low CD4 count and high viral load, without antiretroviral treatment, with one-month history of symptoms characterized by low-grade fever associated with weight loss and nonspecific abdominal pain. An abdominal tomography was performed which showed a collection in the tail of the pancreas; the puncture revealed material with positive culture for M. tuberculosis. Antifimic and antiretroviral treatment was started with a good response. Primary pancreatic tuberculosis is an uncommon extrapulmonary form, given that it is a gland that would be biologically protected by the enzymes it produces. We highlight the rarity of the case and although the prognosis is good with anti-tuberculosis treatment, it could be fatal without correct diagnosis and treatment. The high index of suspicion of pancreatic tuberculosis by the physician and the performance of fine needle aspiration puncture to obtain histopathological evidence are important for a correct diagnosis, especially in HIV patients.

La tuberculosis es una enfermedad infectocontagiosa producida por el Mycobacterium tuberculosis. Actualmente se considera un problema de salud pública debido a las condiciones socioeconómicas de la población mundial y al incremento de otras infecciones causantes de inmunosupresión, como el virus de la inmunodeficiencia humana (HIV). La afección pulmonar es la forma de presentación clínica más frecuente aunque en las últimas décadas el compromiso extrapulmonar se ha visto incrementado. Dentro de este la afección digestiva representa menos del 10%. Presentamos un caso de localización exclusivamente pancreática en un paciente inmunocomprometido. Varón de 43 años HIV positivo, con bajo recuento de CD4 y alta carga viral, sin tratamiento antirretroviral, consultó por cuadro de un mes de evolución caracterizado por registros subfebriles asociado a pérdida de peso y dolor abdominal inespecífico. Se realizó tomografía de abdomen la cual arrojó colección en cola de páncreas, y posteriormente punción del material con rescate en cultivo de M. tuberculosis. Se inició tratamiento antifímico y antirretroviral con buena respuesta al mismo. La tuberculosis pancreática primaria es una forma extrapulmonar infrecuente, dado que es una glándula que estaría biológicamente protegida por las enzimas que origina. Destacamos la infrecuencia del caso y aunque el pronóstico es bueno con el tratamiento antifímico, podría ser fatal sin un diagnóstico y tratamiento correctos. El alto índice de sospecha de tuberculosis pancreática por parte del médico y la realización de punción aspiración con aguja fina (PAAF) para obtener evidencia histopatológica son importantes para un diagnóstico correcto, especialmente en pacientes HIV.

Factors associated with unsuccessful tuberculosis treatment in Manaus, Amazonas, from 2011 to 2021.

OBJECTIVE: To identify vulnerability factors associated with unsuccessful tuberculosis treatment outcomes between 2011 and 2021 in Manaus, Amazonas. METHOD: Ecological study using tuberculosis case notification data from the Notifiable Diseases Information System, from 2011 to 2021, of residents in Manaus. The variables refer to treatment outcomes and patient vulnerability, according to the theoretical model: individual, programmatic and social. The analysis tested the association between vulnerability and tuberculosis treatment non-success, measured by the occurrence of death, loss to follow-up or treatment default. The Odds Ratio estimate with confidence interval was obtained by logistic regression, according to a hierarchical model. RESULTS: The following factors were more likely to lead to unsuccessful tuberculosis treatment: individual vulnerability (age group 20 to 29 years and over 60 years, indigenous race, HIV+, drug use); programmatic vulnerability (not having an HIV test), social vulnerability (special population). CONCLUSION: Individual vulnerability was more strongly associated with non-success. Intervention is needed to explore the points of greatest individual vulnerability, enabling effective action to prevent unsuccessful tuberculosis treatment.

[Tuberculosis in childhood and adolescence: prevalence and factors associated with treatment abandonment]. / Tuberculose na infância e adolescência: prevalência e fatores associados ao abandono do tratamento.

Tuberculosis (TB) is an infectious disease that remains a serious public health problem worldwide. In the pediatric population, the knowledge about the factors that lead to the abandonment of TB treatment is limited, especially in regions with a high prevalence of the disease. This study aimed to identify the prevalence and risk factors associated with TB treatment abandonment in children and adolescents. A cross-sectional study was carried out using data obtained from TB notifications from the São Paulo State Tuberculosis Patient Control System, Brazil, for individuals aged between 0 and 18 years, from January 2009 to December 2019. The crude and adjusted prevalence ratios were estimated with a 95% confidence interval, using the Poisson regression model to identify associations between the outcome of treatment abandonment and the sociodemographic, clinical-epidemiological, diagnostic and therapeutic factors of TB cases with complete information. Of the 12,256 cases analyzed, 941 individuals abandoned treatment. The highest prevalence rate of treatment abandonment occurs among Black or brown adolescents, those over 11 years of age and those deprived of their liberty. Other characteristics associated with treatment abandonment include: being a person living with HIV/AIDS, having a history of previous TB treatment, using illicit substances and using a self-administered TB treatment regimen. Knowing the profile of the patient most likely to abandon TB treatment makes it possible to devise more effective strategies focused on adherence to drug treatment.

A tuberculose (TB) é uma doença infectocontagiosa que ainda representa um grave problema de saúde pública no mundo. Na população pediátrica, os fatores que levam ao abandono do tratamento da TB, especialmente em regiões de elevada prevalência da doença, são pouco conhecidos. Portanto, este estudo objetivou identificar a prevalência e os fatores de risco associados ao abandono do tratamento da TB em crianças e adolescentes. Foi realizado um estudo transversal com dados obtidos das notificações de TB provenientes do Sistema de Controle de Pacientes com Tuberculose do Estado de São Paulo, Brasil, em indivíduos com idade entre 0 e 18 anos, no período de janeiro de 2009 a dezembro de 2019. Estimou-se a razão de prevalência bruta e ajustada com intervalo de 95% de confiança, utilizando-se o modelo de regressão de Poisson para identificar associações entre o desfecho abandono do tratamento com os fatores sociodemográficos, clínico-epidemiológicos, diagnósticos e terapêuticos dos casos de TB, contendo informações completas. Dos 12.256 casos analisados, 941 indivíduos abandonaram o tratamento. A maior taxa de prevalência de abandono do tratamento ocorre entre os adolescentes pretos ou pardos, acima de 11 anos e privados de liberdade. Outras características associadas ao abandono do tratamento incluem: serem pessoas vivendo com HIV/aids, ter histórico de tratamento anterior para TB, fazer uso de substâncias ilícitas e utilizar o regime de tratamento de TB autoadministrado. Concluiu-se que conhecer o perfil do paciente com maiores chances para abandonar o tratamento da TB permite elaborar estratégias focadas na adesão ao tratamento medicamentoso mais efetivas.

La tuberculosis (TB) es una enfermedad infectocontagiosa que sigue siendo un grave problema de salud pública mundial. Se sabe poco sobre los factores que conducen al abandono del tratamiento de la TB en la población pediátrica, especialmente en regiones con alta prevalencia de la enfermedad. Por lo tanto, este estudio tuvo como objetivo identificar la prevalencia y los factores de riesgo asociados con el abandono del tratamiento de la TB en niños y adolescentes. Se trató de un estudio transversal realizado a partir de los datos de notificaciones de TB del Sistema de Control de Pacientes con Tuberculosis del Estado de São Paulo, Brasil, recopilados de individuos con edades comprendidas entre 0 y 18 años, en el período de enero de 2009 a diciembre de 2019. La relación de prevalencia bruta y ajustada se estimó con un intervalo de 95% de confianza; y se utilizó el modelo de regresión de Poisson para identificar las asociaciones entre el resultado del abandono del tratamiento y los factores sociodemográficos, clínico-epidemiológicos, diagnósticos y terapéuticos de los casos de TB que contienen información completa. De los 12.256 casos analizados, 941 individuos habían abandonado el tratamiento. La mayor tasa de prevalencia de abandono del tratamiento se dio entre adolescentes negros o pardos, mayores de 11 años y los privados de libertad. Otras características asociadas con el abandono del tratamiento fueron personas que viven con VIH/sida, tener antecedentes de tratamiento previo de TB, usar sustancias ilícitas y utilizar el régimen de tratamiento de TB autoadministrado. Se concluyó que conocer el perfil de los pacientes con mayor tendencia a abandonar el tratamiento de la TB nos permite desarrollar estrategias efectivas enfocadas en una adherencia al tratamiento farmacológico.

DRESS syndrome and tuberculosis: Implementation of a desensitization and re-desensitization protocol to recover antituberculosis drugs in a case series at a specialized TB Unit in Lima, Peru.

RATIONALE: Antituberculosis drugs (ATDs) could cause severe and rare reactions, such as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. Recovering ATDs might guarantee a higher cure rate for tuberculosis patients. Our aim was to evaluate the results of desensitization and re-desensitization to recover ATDs in a case series of patients with DRESS syndrome. PATIENT CONCERNS AND DIAGNOSES: A retrospective case series study was conducted on patients with DRESS syndrome due to therapy with ATDs from 2021 to 2023. Desensitization and re-desensitization protocols, designed with an algorithm proposed by the Tuberculosis Specialized Unit of the Dos de Mayo National Hospital in Lima, Peru, were implemented. INTERVENTIONS AND OUTCOMES: A total of 18 patients underwent desensitization or re-desensitization protocols, achieving an overall success rate of 72.2%. The average time for the development of DRESS syndrome due to ATDs was 19 days. Rifampicin (84.2%), isoniazid (68.4%), and pyrazinamide (26.3%) were identified as the main drugs responsible for this adverse reaction. All patients presented with fever and skin rash, with an average eosinophil percentage of 16.7% (interquartile range: 4.5-28.8). Organ involvement (liver, kidney, and heart) was observed in 8 patients, but only 2 patients experienced severe complications due to DRESS syndrome. A significant association was found between the number of ATDs used and eosinophil levels (P =.03). LESSONS: The study introduced a desensitization and re-desensitization algorithm for the treatment of DRESS syndrome, notable for its safety, adaptability, and high success rate. This advancement provided healthcare professionals with safer and more effective therapeutic approaches for managing this complex condition.

Benzohydroxamate and nitrobenzohydroxamate affect membrane order: Correlations between spectroscopic and molecular dynamics to approach tuberculosis.

This work correlates the effects of benzohydroxamate (BH) and nitrobenzohydroxamate (NBH) anions in two membrane models which may be used for anti-tuberculosis (anti-TB) spectroscopic studies and/or computational studies. Firstly, the BH and NBH influence in the physico-chemical properties of soy asolectin (ASO)-based large multilamellar vesicles (MLVs) were evaluated by spectroscopic and calorimetric studies. In parallel, the BH and NBH interaction with a Mycobacterium tuberculosis (Mtb) inner membrane model, composed of phosphatidyl-myo-inositol-dimannoside (PIM2), was investigated by molecular dynamics (MD) simulations. Spectroscopic data showed a localization of BH close to the lipid phosphate group, while NBH was found close to the choline region. The BH ordered the ASO choline, phosphate and carbonyl regions and disrupted the acyl methylenes, reducing the membrane packing of the lipid hydrophobic region. On the other hand, NBH showed an ordering effect in all the lipid groups (polar, interface and hydrophobic ones). By MD studies, it was found that NBH enhanced the stability of the PIM2 membrane more than BH, while also being positioned closer to its mannosyl oxygens. As in ASO MLVs, BH was localized close to the PIM2 phosphate group and disrupted its acyl chains. However, higher values of lateral diffusion were observed for NBH than BH. Despite this, BH and NBH increased the membrane thickness by 35 %, which suggests a global ordering effect of both drugs. Findings of this work reinforce the accordance and complementarity between MLVs based on ASO and the PIM2 MD model results to study the drug effects in Mtb membrane properties.

Cost-effectiveness and health impact of screening and treatment of Mycobacterium tuberculosis infection among formerly incarcerated individuals in Brazil: a Markov modelling study.

BACKGROUND: Individuals who were formerly incarcerated have high tuberculosis incidence, but are generally not considered among the risk groups eligible for tuberculosis prevention. We investigated the potential health impact and cost-effectiveness of Mycobacterium tuberculosis infection screening and tuberculosis preventive treatment (TPT) for individuals who were formerly incarcerated in Brazil. METHODS: Using published evidence for Brazil, we constructed a Markov state transition model estimating tuberculosis-related health outcomes and costs among individuals who were formerly incarcerated, by simulating transitions between health states over time. The analysis compared tuberculosis infection screening and TPT, to no screening, considering a combination of M tuberculosis infection tests and TPT regimens. We quantified health effects as reductions in tuberculosis cases, tuberculosis deaths, and disability-adjusted life-years (DALYs). We assessed costs from a tuberculosis programme perspective. We report intervention cost-effectiveness as the incremental costs per DALY averted, and tested how results changed across subgroups of the target population. FINDINGS: Compared with no intervention, an intervention incorporating tuberculin skin testing and treatment with 3 months of isoniazid and rifapentine would avert 31 (95% uncertainty interval 14-56) lifetime tuberculosis cases and 4·1 (1·4-5·8) lifetime tuberculosis deaths per 1000 individuals, and cost US$242 per DALY averted. All test and regimen combinations were cost-effective compared with no screening. Younger age, longer incarceration, and more recent prison release were each associated with significantly greater health benefits and more favourable cost-effectiveness ratios, although the intervention was cost-effective for all subgroups examined. INTERPRETATION: M tuberculosis infection screening and TPT for individuals who were formerly incarcerated appears cost-effective, and would provide valuable health gains. FUNDING: National Institutes of Health. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.

Tuberculosis treatment loss to follow-up in children exposed at home: A prospective cohort study.

Background: Loss to follow-up (LTFU) from tuberculosis (TB) treatment and care is a significant public health problem. It is important to understand what drives LTFU in children - a population whose treatment and management depend on an adult caregiver - to better provide support services to families affected by TB. Methods: We conducted a prospective cohort study of household contacts in Lima, Peru (2009-12). Using multilevel logistic regression analysis, we explored individual-level characteristics of children and their adult household members with TB disease to identify risk factors for LTFU among children initiated on treatment for TB. Results: A total of 154 child (0-14 years) household contacts were diagnosed with TB and initiated on treatment. While most (n = 133, 86.4%) had a successful outcome, 20 (13.0%) children were LTFU. Six (30.0%) children were LTFU within three months, nine (45.0%) between five to seven months, and three (15.0%) after seven months of treatment being initiated. In univariable analysis, children with index patients above 25 years of age had decreased odds of being LTFU (odds ratio = 0.26; 95% confidence interval = 0.08-0.84) compared to children with index patients 25 years or younger. Conclusions: In this cohort, more than 10% of children sick with TB who were exposed to the disease at home were LTFU. An integrated, family-centred TB prevention and management approach may reduce barriers to a child completing their course of TB treatment.

Barriers That Interfere with Access to Tuberculosis Diagnosis and Treatment across Countries Globally: A Systematic Review.

This study evaluated the barriers that interfere with access to diagnosis and treatment of tuberculosis (TB) from the perspective of the patient and health professionals globally. Using the PICo acronym, the question we asked was "What are the barriers that interfere with access to tuberculosis diagnosis and treatment (I) from the perspective of patients and/or health professionals (P) across countries globally (Co)?". We searched the following databases: EMBASE, Scopus, MEDLINE, Latin American and Caribbean Literature in Health Sciences (LILACS), and Web of Science. On Rayyan, duplicates were removed and extraction was done afterward by two authors independently, followed by a tiebreaker. Using a Critical Appraisal Tool proposed by the Joanna Briggs Institute, the methodological quality of the article was assessed. From 36 published articles, the barriers to tuberculosis diagnosis as obtained from our study include information scarcity/low TB knowledge, exorbitant cost of transport, sample collection challenges, long distance to health facility, gender limitations, lack of decentralized diagnostic services, payment for diagnosis and testing, medication side effects, multiple visits during therapy, delayed diagnosis, poor human resources, low knowledge of medical practitioners, concerns regarding the efficacy of treatment, poor facility coordination, poor socioeconomic factors, fear and stigmatization of TB, and wrong initial diagnosis. The review of studies on TB diagnosis and treatment barriers evidences the diverse barriers to the eradication of tuberculosis. Eliminating these barriers is an onus that lies on policy makers, citizens, and health workers alike, with the joint aim of reducing the global TB burden.

Multi-target Compounds against Trypanosomatid Parasites and Mycobacterium tuberculosis.

Multi-target drug treatment has become popular as a substitute for traditional monotherapy. Monotherapy can lead to resistance and side effects. Multi-target drug discovery is gaining importance as data on bioactivity becomes more abundant. The design of multi-target drugs is expected to be an important development in the pharmaceutical industry in the near future. This review presents multi-target compounds against trypanosomatid parasites (Trypanosoma cruzi, T. brucei, and Leishmania sp.) and tuberculosis (Mycobacterium tuberculosis), which mainly affect populations in socioeconomically unfavorable conditions. The article analyzes the studies, including their chemical structures, viral strains, and molecular docking studies, when available. The objective of this review is to establish a foundation for designing new multi-target inhibitors for these diseases.

Food Insecurity at Tuberculosis Treatment Initiation Is Associated With Clinical Outcomes in Rural Haiti: A Prospective Cohort Study.

BACKGROUND: Tuberculosis is a leading cause of death worldwide, and food insecurity is known to negatively influence health outcomes through multiple pathways. Few studies have interrogated the relationship between food insecurity and tuberculosis outcomes, particularly independent of nutrition. METHODS: We conducted a prospective cohort study of adults initiating first-line treatment for clinically suspected or microbiologically confirmed drug-sensitive tuberculosis at a rural referral center in Haiti. We administered a baseline questionnaire, collected clinical data, and analyzed laboratory samples. We used logistic regression models to estimate the relationship between household food insecurity (Household Hunger Scale) and treatment failure or death. We accounted for exclusion of patients lost to follow-up using inverse probability of censoring weighting and adjusted for measured confounders and nutritional status using inverse probability of treatment weighting. RESULTS: We enrolled 257 participants (37% female) between May 2020 and March 2023 with a median age (interquartile range) of 35 (25-45) years. Of these, 105 (41%) had no hunger in the household, 104 (40%) had moderate hunger in the household, and 48 (19%) had severe hunger in the household. Eleven participants (4%) died, and 6 (3%) had treatment failure. After adjustment, food insecurity was significantly associated with subsequent treatment failure or death (odds ratio 5.78 [95% confidence interval, 1.20-27.8]; P = .03). CONCLUSIONS: Household food insecurity at tuberculosis treatment initiation was significantly associated with death or treatment failure after accounting for loss to follow-up, measured confounders, and nutritional status. In addition to the known importance of undernutrition, our findings indicate that food insecurity independently affects tuberculosis treatment outcomes in Haiti.

Shedding light on vitamin D in tuberculosis: A comprehensive review of clinical trials and discrepancies.

Over the past few decades, there has been extensive research on the use of vitamin D as an adjunctive therapy in the treatment and prevention of tuberculosis. In vitro studies have provided valuable insights into the mechanisms by which vitamin D activates the immune response to combat Mycobacterium tuberculosis. These encouraging findings have spurred clinical investigations globally to assess the effectiveness of vitamin D as a preventive measure and as an adjunctive treatment for tuberculosis. However, the results from these clinical studies have been contradictory, with some demonstrating clear efficacy while others report only modest or no activity. In this review, we aim to analyze the clinical studies on vitamin D and examine the possible discrepancies observed in their outcomes.

Predictors of unsuccessful tuberculosis treatment outcomes in Brazil: an analysis of 259,484 patient records.

INTRODUCTION: Tuberculosis (TB) causes over 1 million deaths annually. Providing effective treatment is a key strategy for reducing TB deaths. In this study, we identified factors associated with unsuccessful treatment outcomes among individuals treated for TB in Brazil. METHODS: We obtained data on individuals treated for TB between 2015 and 2018 from Brazil's National Disease Notification System (SINAN). We excluded patients with a history of prior TB disease or with diagnosed TB drug resistance. We extracted information on patient-level factors potentially associated with unsuccessful treatment, including demographic and social factors, comorbid health conditions, health-related behaviors, health system level at which care was provided, use of directly observed therapy (DOT), and clinical examination results. We categorized treatment outcomes as successful (cure, completed) or unsuccessful (death, regimen failure, loss to follow-up). We fit multivariate logistic regression models to identify factors associated with unsuccessful treatment. RESULTS: Among 259,484 individuals treated for drug susceptible TB, 19.7% experienced an unsuccessful treatment outcome (death during treatment 7.8%, regimen failure 0.1%, loss to follow-up 11.9%). The odds of unsuccessful treatment were higher with older age (adjusted odds ratio (aOR) 2.90 [95% confidence interval: 2.62-3.21] for 85-100-year-olds vs. 25-34-year-olds), male sex (aOR 1.28 [1.25-1.32], vs. female sex), Black race (aOR 1.23 [1.19-1.28], vs. White race), no education (aOR 2.03 [1.91-2.17], vs. complete high school education), HIV infection (aOR 2.72 [2.63-2.81], vs. no HIV infection), illicit drug use (aOR 1.95 [1.88-2.01], vs. no illicit drug use), alcohol consumption (aOR 1.46 [1.41-1.50], vs. no alcohol consumption), smoking (aOR 1.20 [1.16-1.23], vs. non-smoking), homelessness (aOR 3.12 [2.95-3.31], vs. no homelessness), and immigrant status (aOR 1.27 [1.11-1.45], vs. non-immigrants). Treatment was more likely to be unsuccessful for individuals treated in tertiary care (aOR 2.20 [2.14-2.27], vs. primary care), and for patients not receiving DOT (aOR 2.35 [2.29-2.41], vs. receiving DOT). CONCLUSION: The risk of unsuccessful TB treatment varied systematically according to individual and service-related factors. Concentrating clinical attention on individuals with a high risk of poor treatment outcomes could improve the overall effectiveness of TB treatment in Brazil.

Exploring the Role of the Private Sector in Tuberculosis Detection and Management in Lima, Peru: A Mixed-Methods Patient Pathway Analysis.

In Latin America, little is known about the involvement of private health-care providers in tuberculosis (TB) detection and management. We sought to gain a better understanding of current and potential roles of the private sector in delivering TB services in Peru. We conducted a mixed-methods study in North Lima, Peru. The quantitative component comprised a patient pathway analysis assessing the alignment of TB services with patient care-seeking behavior. The qualitative component comprised in-depth interviews with 18 private health-care providers and 5 key informants. We estimated that 77% of patients sought care initially at a facility with TB diagnostic capacity and 59% at a facility with TB treatment capacity. Among private facilities, 43% offered smear microscopy, 13% offered radiography, and none provided TB treatment. Among public-sector facilities, 100% offered smear microscopy, 26% offered radiography, and 99% provided TB treatment. Private providers believed they offered shorter wait times and a faster diagnosis, but they struggled with a lack of referral systems and communication with the public sector. Nonrecognition of private-sector tests by the public sector led to duplicate testing of referred patients. Although expressing willingness to collaborate with public-sector programs for diagnosis and referral, private providers had limited interest in treating TB. This study highlights the role of private providers in Peru as an entry point for TB care. Public-private collaboration is necessary to harness the potential of the private sector as an ally for early diagnosis.

Machine learning algorithms using national registry data to predict loss to follow-up during tuberculosis treatment.

BACKGROUND: Identifying patients at increased risk of loss to follow-up (LTFU) is key to developing strategies to optimize the clinical management of tuberculosis (TB). The use of national registry data in prediction models may be a useful tool to inform healthcare workers about risk of LTFU. Here we developed a score to predict the risk of LTFU during anti-TB treatment (ATT) in a nationwide cohort of cases using clinical data reported to the Brazilian Notifiable Disease Information System (SINAN). METHODS: We performed a retrospective study of all TB cases reported to SINAN between 2015 and 2022; excluding children (< 18 years-old), vulnerable groups or drug-resistant TB. For the score, data before treatment initiation were used. We trained and internally validated three different prediction scoring systems, based on Logistic Regression, Random Forest, and Light Gradient Boosting. Before applying our models we splitted our data into training (~ 80% data) and test (~ 20%) sets, and then compared the model metrics using the test data set. RESULTS: Of the 243,726 cases included, 41,373 experienced LTFU whereas 202,353 were successfully treated. The groups were different with regards to several clinical and sociodemographic characteristics. The directly observed treatment (DOT) was unbalanced between the groups with lower prevalence in those who were LTFU. Three models were developed to predict LTFU using 8 features (prior TB, drug use, age, sex, HIV infection and schooling level) with different score composition approaches. Those prediction scoring systems exhibited an area under the curve (AUC) ranging between 0.71 and 0.72. The Light Gradient Boosting technique resulted in the best prediction performance, weighting specificity and sensitivity. A user-friendly web calculator app was developed ( https://tbprediction.herokuapp.com/ ) to facilitate implementation. CONCLUSIONS: Our nationwide risk score predicts the risk of LTFU during ATT in Brazilian adults prior to treatment commencement utilizing schooling level, sex, age, prior TB status, and substance use (drug, alcohol, and/or tobacco). This is a potential tool to assist in decision-making strategies to guide resource allocation, DOT indications, and improve TB treatment adherence.

Tuberculosis treatment during the COVID-19 pandemic: actions offered and case profile.

OBJECTIVE: To analyze the association between the provision of tuberculosis treatment actions and the sociodemographic and clinical characteristics of cases during the COVID-19 pandemic. METHOD: Cross-sectional study conducted with data from secondary sources of 134 tuberculosis cases that underwent treatment in 2020 in the city of Pelotas, RS, Brazil. Data were analyzed using descriptive statistics, Chi-square test, and Fisher's exact test. RESULTS: The least frequently offered actions in the period were: three or more control smear microscopies (12.7%), smear microscopy at the end of treatment (16.7%), chest X-ray at sixth month (48.5%) and sputum culture (49%). The number of medical and nursing consultations did not reach six in 52.9% and 83.3% of cases, respectively. The lower offer of treatment actions was associated with: retreatment (p<0.001); comorbidities (p=0.023); HIV infection (p<0.001); mental disorder (p=0.013); illicit substance use (p=0.018); normal chest X-ray (p=0.024); and special treatment regimen (p=0.009). CONCLUSION: After the COVID-19 pandemic, it is essential to invest in cases follow-up, especially those undergoing retreatment, with comorbidities, drug use, normal chest X-ray results, and special treatment regimens.

A Mathematical Model for the Impact of 3HP and Social Programme Implementation on the Incidence and Mortality of Tuberculosis: Study in Brazil.

In this paper, we presented a mathematical model for tuberculosis with treatment for latent tuberculosis cases and incorporated social implementations based on the impact they will have on tuberculosis incidence, cure, and recovery. We incorporated two variables containing the accumulated deaths and active cases into the model in order to study the incidence and mortality rate per year with the data reported by the model. Our objective is to study the impact of social program implementations and therapies on latent tuberculosis in particular the use of once-weekly isoniazid-rifapentine for 12 weeks (3HP). The computational experimentation was performed with data from Brazil and for model calibration, we used the Markov Chain Monte Carlo method (MCMC) with a Bayesian approach. We studied the effect of increasing the coverage of social programs, the Bolsa Familia Programme (BFP) and the Family Health Strategy (FHS) and the implementation of the 3HP as a substitution therapy for two rates of diagnosis and treatment of latent at 1% and 5%. Based of the data obtained by the model in the period 2023-2035, the FHS reported better results than BFP in the case of social implementations and 3HP with a higher rate of diagnosis and treatment of latent in the reduction of incidence and mortality rate and in cases and deaths avoided. With the objective of linking the social and biomedical implementations, we constructed two different scenarios with the rate of diagnosis and treatment. We verified with results reported by the model that with the social implementations studied and the 3HP with the highest rate of diagnosis and treatment of latent, the best results were obtained in comparison with the other independent and joint implementations. A reduction of the incidence by 36.54% with respect to the model with the current strategies and coverage was achieved, and a greater number of cases and deaths from tuberculosis was avoided.