ABSTRACT
Subject(s)
Tuberculin Test , Tuberculosis , Humans , Incidence , Male , Uganda/epidemiology , Adult , Female , Prospective Studies , Tuberculosis/epidemiology , Young Adult , Middle Aged , Adolescent , Mycobacterium tuberculosis/isolation & purification , Prevalence , Endemic Diseases , Cohort StudiesABSTRACT
BACKGROUND: It is very difficult to observe tuberculosis (TB) transmission chains and thus, identify superspreaders. We investigate cough duration as a proxy measure of transmission to assess the presence of potential TB superspreaders.DESIGN: We analyzed six studies from China, Peru, The Gambia and Uganda, and determined the distribution of cough duration and compared it with several theoretical distributions. To determine factors associated with cough duration, we used linear regression and boosted regression trees to examine the predictive power of patient, clinical and environmental characteristics.RESULTS: We found within-study heterogeneity in cough duration and strong similarities across studies. Approximately 20% of patients contributed 50% of total cough days, and around 50% of patients contributed 80% of total cough days. The cough duration distribution suggested an initially increasing, and subsequently, decreasing hazard of diagnosis. While some of the exposure variables showed statistically significant associations with cough duration, none of them had a strong effect. Multivariate analyses of different model types did not produce a model that had good predictive power.CONCLUSION: We found consistent evidence for the presence of supercoughers, but no characteristics predictive of such individuals.
Subject(s)
Cough/physiopathology , Tuberculosis, Pulmonary/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , China/epidemiology , Cohort Studies , Cough/etiology , Female , Gambia/epidemiology , Humans , Male , Middle Aged , Peru/epidemiology , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/transmission , Uganda/epidemiology , Young AdultABSTRACT
OBJECTIVE: To examine quality of life (QOL) in perinatally HIV-infected (PHIV) or HIV-exposed uninfected (PHEU) vs. healthy HIV-unexposed uninfected (HUU) children during school-age/adolescence. METHODS: PHIV infection was diagnosed via DNA PCR. Current HIV status was confirmed by HIV rapid diagnostic test. Three HIV groups were defined: PHIV, PHEU, and HUU. QOL was assessed with proxy and self-report versions of the PedsQL™ 4.0 instrument at 6-18 years of age. QOL scores ranged from zero (least QOL) to 100 (highest QOL) in the following dimensions: combined QOL inventory (CQOLI), multi-dimensional vigor (MDV), general wellbeing (GWB), present functioning, and general cognitive functioning (CF). Multivariable linear regression models estimated HIV-related percent differences (ß) in QOL scores and 95% confidence intervals (CI). FINDINGS: Compared to HUU CQOLI deficits ranged from 6.5 to 9.2% (95% CI -15.4, -1.6), GWB deficit ranged from 6.5 to 10.5% (95% CI -16.0, -1.3), MDV deficit ranged from 6.8 to 11.6% (95% CI -14.5, 0.9), and CF deficit ranged from 9.7 to 13.1% for PHIV children. QOL deficits of similar magnitude and direction in most domains were observed for PHIV compared to PHEU. However, self-reported indicators of GWB (ß = -3.5; 95% CI -9.0, 2.0) and present functioning (ß = 4.0; 95% CI -4.6, 12.5) were similar for PHIV compared to PHEU. QOL scores were generally similar for PHEU compared to HUU. CONCLUSION: PHEU and HUU had similar QOL profile but PHIV predicted sustained deficits in multiple QOL domains. PHIV and PHEU children were similar with respect to general wellbeing and present functioning. Psychosocial and scholastic interventions in combination with HIV care are likely to improve QOL in PHIV.
Subject(s)
Antiretroviral Therapy, Highly Active/methods , HIV Infections/psychology , Quality of Life/psychology , Adolescent , Black People , Child , Female , HIV Infections/pathology , Humans , Male , UgandaABSTRACT
OBJECTIVE: To estimate the levels of adherence to anti-tuberculosis medications and associated risk factors in a pastoral community practising transhumance in North-Eastern Uganda. DESIGN: A cross-sectional retrospective study of a cohort of tuberculosis (TB) patients and their community volunteers registered from August 2008 to July 2009. Self-reported data were collected on doses missed, doses not supervised, sociodemographic situation, drug availability, perceived drug side effects and use of the directly observed treatment (DOT) card. Medication adherence was defined as having ingested at least 90% of doses given, and supervision adherence was defined as direct observation of at least 90% of doses ingested. Independent predictors of medication adherence were identified using binary and multivariate logistic regression. RESULTS: A total of 126 TB patients and an equal number of community volunteers were enrolled in the study. Medication and supervision adherence were estimated at respectively 72% and 63%. Independent predictors of medication adherence were perceived drug side effects (adjusted odds ratio [aOR] 5.0, 95%CI 1.86-13.6), running out of drugs (aOR 5.97, 95%CI 2.27-15.70) and DOT card not filled in (aOR 6.65, 95%CI 2.08-20.66). CONCLUSION: Adherence among pastoralists is less than optimal due to poor institutionalisation of the DOTS strategy in a pastoralist community.
Subject(s)
Antitubercular Agents/therapeutic use , Directly Observed Therapy/methods , Medication Adherence , Tuberculosis/drug therapy , Adult , Animal Husbandry , Antitubercular Agents/administration & dosage , Antitubercular Agents/adverse effects , Cross-Sectional Studies , Female , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Retrospective Studies , Risk Factors , UgandaSubject(s)
Coinfection , HIV Infections/diagnosis , Tuberculosis, Pulmonary/diagnosis , Female , Humans , MaleABSTRACT
OBJECTIVES: To determine the yield of undetected active tuberculosis (TB), TB and human immunodeficiency virus (HIV) coinfection and the number needed to screen (NNS) to detect a case using active case finding (ACF) in an urban community in Kampala, Uganda. METHODS: In a door-to-door survey conducted in Rubaga community from January 2008 to June 2009, residents aged ≥15 years were screened for chronic cough (≥2 weeks) and tested for TB disease using smear microscopy and/or culture. Rapid testing was used to screen for HIV infection. The NNS to detect one case was calculated based on population screened and undetected cases found. RESULTS: Of 5102 participants, 3868 (75.8%) were females; the median age was 24 years (IQR 20-30). Of 199 (4%) with chronic cough, 160 (80.4%) submitted sputum, of whom 39 (24.4%, 95%CI 17.4-31.5) had undetected active TB and 13 (8.1%, 95%CI 6.7-22.9) were TB-HIV co-infected. The NNS to detect one TB case was 131 in the whole study population, but only five among the subgroup with chronic cough. CONCLUSION: ACF obtained a high yield of previously undetected active TB and TB-HIV cases. The NNS in the general population was 131, but the number needed to test in persons with chronic cough was five. These findings suggest that boosting the identification of persons with chronic cough may increase the overall efficiency of TB case detection at a community level.
Subject(s)
Coinfection , HIV Infections/diagnosis , Tuberculosis, Pulmonary/diagnosis , Adolescent , Adult , Chronic Disease , Cough/diagnosis , Cough/epidemiology , Cough/microbiology , Cross-Sectional Studies , Female , HIV Infections/epidemiology , Humans , Male , Middle Aged , Mycobacterium tuberculosis/isolation & purification , Predictive Value of Tests , Sputum/microbiology , Tuberculosis, Pulmonary/epidemiology , Tuberculosis, Pulmonary/microbiology , Uganda/epidemiology , Urban Health , Young AdultABSTRACT
BACKGROUND: Passive case finding (PCF) is the strategy implemented by most developing countries to detect new cases of tuberculosis (TB), but detection rates remain low. Active case finding (ACF) is an alternative strategy, although cost is a barrier to implementation. We estimated the cost-effectiveness of a city-wide ACF programme in Kampala, Uganda, compared to the PCF strategy. METHODS: We developed a decision tree and Markov model to compare ACF vs. PCF across several outcome measures. Parameter estimates for costs, probabilities and utility scores were obtained from published reports and peer-reviewed journal articles. The main outcome measures were TB cases detected, deaths averted, life years saved (LYS) and quality-adjusted life years (QALYs). RESULTS: Our model found that ACF implemented city-wide would result in an additional 1594 TB cases detected in 1 year, 675 deaths averted over a 5-year period, 21,928 LYS, and would cost an additional US$109 per additional QALY. The 25-34 year age group received most health benefits (556 cases detected, 229 deaths averted, 8058 LYS), and the programme was most cost-effective in the 45-54 year age group (US$51/QALY). CONCLUSIONS: ACF is an effective strategy for TB control and improving quality of life and is also cost-effective.
Subject(s)
Developing Countries , Health Care Costs/trends , Infection Control/standards , Tuberculosis/prevention & control , Adolescent , Adult , Aged , Child , Cost-Benefit Analysis , Female , Humans , Male , Middle Aged , Morbidity/trends , Quality-Adjusted Life Years , Tuberculosis/economics , Tuberculosis/epidemiology , Uganda/epidemiology , Young AdultABSTRACT
SETTING: One peri-urban and four rural districts in Uganda. OBJECTIVES: To determine the level of and factors associated with human immunodeficiency virus (HIV) testing among tuberculosis (TB) patients. DESIGN: A cross-sectional study was conducted in five selected districts from August to November 2007. Patients aged > or = 18 years returning for TB treatment refills at facilities offering TB and HIV services were included. Patients were excluded if they were very sick or unable to speak English or any of the local study languages. The outcome was self-reported HIV testing after TB diagnosis, validated using clinic registers. RESULTS: Of 261 patients analysed, 169 (65%) had been tested for HIV following TB diagnosis. In a multivariate analysis, age >45 years (OR 0.27, 95%CI 0.08-0.87), not receiving information about the TB-HIV association (OR 0.35, 95%CI 0.15-0.77), not being offered HIV testing by health provider (OR 0.02, 95%CI 0.006-0.042), dissatisfaction with privacy (OR 2.49, 95%CI 1.11-5.55) and spending 30-60 min at the clinic (OR 4.48, 95%CI 1.66-12.10) significantly influenced level of HIV testing. CONCLUSION: The level of HIV testing among TB patients was suboptimal, as per policy all patients should be tested. The Uganda Ministry of Health should continue to scale-up HIV testing and other collaborative TB-HIV services at health facilities.
Subject(s)
HIV Infections/diagnosis , Mass Screening/methods , Tuberculosis/complications , Adolescent , Adult , Cross-Sectional Studies , Data Collection , Female , HIV Infections/complications , HIV Infections/epidemiology , Humans , Male , Middle Aged , Rural Health Services , Uganda , Urban Health Services , Young AdultABSTRACT
SETTING: Kisenyi slum in peri-urban Kampala, Uganda. OBJECTIVES: Using chronic cough (> or = 2 weeks) inquiry as a screening tool to identify undetected smear-positive tuberculosis (TB) cases and to describe the characteristics of smear-positive TB cases detected by active case finding. DESIGN: A house-to-house survey was conducted in five randomly selected villages in Kampala between June and August 2005. A sample of households was visited; adults aged > or = 15 years were consecutively interviewed to identify those with chronic cough. Three sputum specimens were collected and examined by smear microscopy. RESULTS: Among 930 individuals, we identified 189 (20%) chronic coughers. Of these, we found 33 (18%) undiagnosed smear-positive cases. The newly detected cases had an even sex distribution (P = 0.47), a median age of 30 years, a median cough duration of 1 month and 55% had acid-fast bacilli 1+ sputum smear grade. CONCLUSION: These findings suggest that active case finding could supplement DOTS to yield additional smear-positive TB cases, lead to early diagnosis and thus shorten the duration of infectiousness before effective chemotherapy is initiated. In communities such as Kisenyi, this is a feasible strategy that may prove useful for TB control, but its cost-effectiveness needs to be evaluated. Early health care seeking for cough should be emphasized.