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1.
JNMA J Nepal Med Assoc ; 59(234): 217-219, 2021 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-34506467

RESUMEN

Globally, childhood tuberculosis constitutes up to 10% of overall tuberculosis cases. In Nepal, childhood tuberculosis has remained around 5.5% of overall tuberculosis cases and has remained stagnant over the years. Moreover, our health system is focused on adult tuberculosis. Childhood tuberculosis has recently got its attention both at the national and international levels. National Tuberculosis Program has been a successful program; however, more has to be done to track childhood tuberculosis progress. In this viewpoint, we discuss current initiatives taken by the government and the way forward for case detection and management of childhood tuberculosis in Nepal.


Asunto(s)
Tuberculosis , Adulto , Humanos , Nepal/epidemiología , Tuberculosis/diagnóstico , Tuberculosis/epidemiología
2.
JNMA J Nepal Med Assoc ; 59(238): 531-536, 2021 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-34508414

RESUMEN

INTRODUCTION: Tuberculosis has high burden in developing countries like Nepal. This study aims to determine the prevalence of tuberculosis among patients admitted in the department of medicine of a tertiary hospital. METHODS: A descriptive cross-sectional study of all the patients admitted to the tertiary care hospital from 1st January 2017 to 31st December 2019 was done. Ethical approval was obtained from Institutional Review Committee (Ref: drs2006181387). Convenience sampling method was used. A descriptive analysis of demographic, clinical and laboratory profile of patients was made using Microsoft Excel version 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Among 6829 patients admitted to the department of medicine, 209 (3.06%) (2.65-3.47 at 95% CI) patients were diagnosed with tuberculosis. Among them, 147 (70.33%) were males and the mean age was 49.77 years. Pulmonary and extra-pulmonary tuberculosis were present in 153 (73.20%) and 56 (26.79%) patients, respectively. Bacteriological confirmation was limited to 107 (70%) of pulmonary tuberculosis and 3 (5%) of extrapulmonary tuberculosis. Fever was the commonest presentation in 166 (79.42%) followed by cough in 164 (78.46%), anorexia in 108 (51.67%), weight loss 104 (49.76%), and others. CONCLUSIONS: The study showed that the prevalence of tuberculosis among admitted patients was higher than national prevalence.


Asunto(s)
Tuberculosis , Estudios Transversales , Humanos , Masculino , Persona de Mediana Edad , Nepal/epidemiología , Prevalencia , Centros de Atención Terciaria , Tuberculosis/diagnóstico , Tuberculosis/epidemiología
3.
Georgian Med News ; (316-317): 129-135, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34511459

RESUMEN

Tuberculosis is one of the main problems of medicine in Kazakhstan. Kazakhstan is on the list of 30 countries with high rates of multidrug resistant tuberculosis in the world. Aim of this study is to conduct genotyping by MIRU-VNTR method to get preliminary data on M. tuberculosis genotypes distributed among the clinical isolates in Kazakhstan. 271 M. tuberculosis clinical isolates were gathered from new cases of tuberculosis from different regions of Kazakhstan in this study. Genotyping was done using 15 MIRU-VNTR (12 MIRU+3 ETR) loci. Obtained digital profiles of the clinical isolates were analyzed using the database on miru-vntrplus.org. Phylogenetic tree was built by UPGMA method. 97 genotypes were identified, 70 (25.8%) of them were unique and were determined in one isolate in the sample collection. The rest 201 (74.2%) isolates were grouped into 27 clusters, that contained from 2 to 102 isolates. According to genotyping results M. tuberculosis Beijing family strains were found in 65.3% cases. 121 out of 177 Beijing isolates (68.4%) were drug-resistant. Prevalence of MDR-TB was detected among drug-resistant Beijing (58.7% - 71/121) and LAM family (50% - 10/20) isolates.


Asunto(s)
Mycobacterium tuberculosis , Tuberculosis Resistente a Múltiples Medicamentos , Tuberculosis , Genotipo , Humanos , Kazajstán/epidemiología , Repeticiones de Minisatélite/genética , Mycobacterium tuberculosis/genética , Filogenia , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología
4.
Rev Peru Med Exp Salud Publica ; 38(2): 254-260, 2021.
Artículo en Español, Inglés | MEDLINE | ID: mdl-34468572

RESUMEN

OBJECTIVE: To describe the characteristics of adult patients with tuberculosis (TB) and diabetes mellitus (DM) in Peru, and to explore the association of DM and mortality in people with TB. MATERIALS AND METHODS: We carried out a secondary analysis of the database of the Management Information System of Tuberculosis of the Tuberculosis Prevention and Control Directorate of the Ministry of Health of Peru. Adult patients who started treatment with the scheme for drug-sensitive TB in 2016, 2017 and 2018 were included. We carried out a descriptive analysis of patients with TB and DM, and an exploratory analysis to assess the association of DM with mortality using a Poisson regression to determine the relative risk (RR). RESULTS: We registered 67,524 adults with drug-sensitive TB, of which 6,529 (9.7%) people were reported as having TB and DM; and 4,048 (6.0%) had HIV infection. Of the patients reported with TB and DM, most were men (60.2%) with a median age of 53 years. Regarding mortality, people with TB and DM had a higher frequency of death compared to those with TB without DM (7.2% vs 5.4%). In the exploratory analysis of factors associated with mortality, DM had a crude RR of 1.32 (95% CI: 1.20-1.50); however, this association varied in the adjusted model with a RR of 0.93 (95% CI: 0.84-1.04). CONCLUSIONS: DM is the most frequent comorbidity in patients with TB in Peru, although no association with higher mortality was found.


Asunto(s)
Diabetes Mellitus , Infecciones por VIH , Tuberculosis , Adulto , Comorbilidad , Diabetes Mellitus/epidemiología , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Perú/epidemiología , Factores de Riesgo , Tuberculosis/complicaciones , Tuberculosis/epidemiología
5.
Rev Peru Med Exp Salud Publica ; 38(2): 318-325, 2021.
Artículo en Español | MEDLINE | ID: mdl-34468583

RESUMEN

Reports of infection and/or disease caused by non-tuberculous mycobacteria (NTM) are becoming increasingly frequent. This scope review describes the epidemiological and clinical trend of infection/disease caused by NTM in Latin America. OVID MEDLINE, Embase and LILACS databases were explored for relevant articles. After filtering, we included 44 articles, representing an overall population of 2,826 subjects diagnosed with NTM infection and disease; the majority of the publications included subjects from Brazil and Colombia (75%), cross-sectional studies were the most common (36.6%), most subjects were male (61.3%) and the median age of subjects was 40.1 years. Disease by NTM was reported in 37 publications, extrapulmonary presentation was the most frequent (54%), main comorbidities were other pulmonary diseases, HIV, cystic fibrosis, diabetes and malnutrition, as reported in 13 studies; tuberculosis diagnosis previous to NTM disease was reported in 15 articles. Aesthetic procedures were reported in 12 articles while clinical procedures were reported in 3 articles. Several NTM species were reported, being Mycobacterium avium (52%), M. abscessus (34%), M. chelonae (18%), M. fortuitum (16%) and M. kansasii (9.1%) the most frequent. Culture and molecular testing were the main methods for diagnosis and identification. Scientific literature on NTM from Latin American countries is scarce. There is an urgent need to conduct studies on the frequency and clinical impact of NTM infections, in order to accurately identify the current morbidity and mortality associated with NTM in Latin American. It is also important to strengthen the local diagnostic capacity and the existing networks focused on studying NTM.


Asunto(s)
Infecciones por Mycobacterium no Tuberculosas , Tuberculosis , Adulto , Estudios Transversales , Humanos , América Latina/epidemiología , Masculino , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Micobacterias no Tuberculosas , Tuberculosis/diagnóstico , Tuberculosis/epidemiología
6.
Rev Assoc Med Bras (1992) ; 67(3): 406-410, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34468606

RESUMEN

OBJECTIVE: More than 20% of tuberculosis (TB) cases worldwide are attributable to smoking, and it is associated with an increased risk of latent and active TB, recurrence, and mortality. The aim of this study is to assess the smoking prevalence and the effects on treatment outcomes in TB patients. METHODS: A prospective cohort study was conducted in patients with a recent TB diagnosis. The smoking status was defined, in addition to the patients' knowledge and attitudes toward smoking. The patients were followed up until the end of the treatment, and the treatment result was recorded. RESULTS: Ninety-two patients were included in this study. The prevalence of active smoking was 31.5%. Active smokers had less chance for cure (62.1% versus 82.5%; p=0.032) and more treatment dropout (31.0% versus 12.7%; p=0.035) than non-active smokers. Patients demonstrated positive attitudes and good knowledge about smoking. CONCLUSIONS: Active smokers had less chance for cure and more abandonment than non-active smokers. These results can be useful for the proper planning of actions that impact TB control, especially in the treatment results, such as cognitive-behavioral approaches to smoking cessation.


Asunto(s)
Fumar , Tuberculosis , Humanos , Prevalencia , Estudios Prospectivos , Fumar/efectos adversos , Resultado del Tratamiento , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología
7.
Medicine (Baltimore) ; 100(35): e27125, 2021 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-34477155

RESUMEN

ABSTRACT: We aimed to investigate the genetic and demographic differences and interactions between areas where observed genomic variations in Mycobacterium tuberculosis (M. tb) were distributed uniformly in cold and hot spots.The cold and hot spot areas were identified using the reported incidence of TB over the previous 5 years. Whole genome sequencing was performed on 291 M. tb isolates between January and June 2018. Analysis of molecular variance and a multifactor dimensionality reduction (MDR) model was applied to test gene-gene-environment interactions. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were computed to test the extent to which genetic mutation affects the TB epidemic using a multivariate logistic regression model.The percentage of the Beijing family strain in hot spots was significantly higher than that in cold spots (64.63% vs 50.69%, P = .022), among the elderly, people with a low BMI, and those having a history of contact with a TB patient (all P < .05). Individuals from cold spot areas had a higher frequency of out-of-town traveling (P < .05). The mutation of Rv1186c, Rv3900c, Rv1508c, Rv0210, and an Intergenic Region (SNP site: 3847237) showed a significant difference between cold and hot spots. (P < .001). The MDR model displayed a clear negative interaction effect of age groups with BMI (interaction entropy: -3.55%) and mutation of Rv0210 (interaction entropy: -2.39%). Through the mutations of Rv0210 and BMI had a low independent effect (interaction entropy: -1.46%).Our data suggests a statistically significant role of age, BMI and the polymorphisms of Rv0210 genes in the transmission and development of M. tb. The results provide clues for the study of susceptibility genes of M. tb in different populations. The characteristic strains showed a local epidemic. Strengthening genotype monitoring of strains in various regions can be used as an early warning signal of epidemic spillover.


Asunto(s)
Interacciones Huésped-Patógeno/genética , Mycobacterium tuberculosis/genética , Tuberculosis/microbiología , Adulto , China/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tuberculosis/epidemiología
8.
J Assoc Physicians India ; 69(8): 11-12, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34472801

RESUMEN

OBJECTIVES: The purpose of this study was to identify the relationship between socio-psychological factors and TB patients as well as to determine whether the association differs from treated and untreated persons. METHODS: This was a prospective study in a municipal corporation hospital in Pune district. A total 104 patient sample were selected from the population; criteria covered age group of 25 to 60 years along with their education and economic background. Trained study nurses then collected baseline information from consenting participants using a questionnaire. RESULTS: After being cured from the disease, patients share clothes or utensils with their family members. For a few patients psychological improvements were observed after some period of treatment whereas as in majority of patients psychological support by their family and friends was not received. This caused increase in emotional stress despite patients got cured off the TB infection. CONCLUSION: The important point noticed about the cured patients was augmented fighting spirit against this deadly disease. Recovered patients want to live more with the same joy and happiness after treatment.


Asunto(s)
Tuberculosis , Adulto , Consejo , Humanos , India/epidemiología , Persona de Mediana Edad , Estudios Prospectivos , Tuberculosis/epidemiología
11.
BMJ Open ; 11(8): e048449, 2021 08 25.
Artículo en Inglés | MEDLINE | ID: mdl-34433597

RESUMEN

INTRODUCTION: In the past three decades, China has made great strides in the prevention and treatment of tuberculosis (TB). However, the TB burden remains high. In 2019, China accounted for 8.4% of global incident cases of TB, the third highest in the world, with a higher prevalence in rural areas. The Healthy China 2030 highlights the gate-keeping role of primary healthcare (PHC). However, the impact of PHC reforms on the future TB burden is unclear. We propose to use mathematical models to project and evaluate the impacts of different gate-keeping policies. METHODS AND ANALYSIS: We will develop a deterministic, population-level, compartmental model to capture the dynamics of TB transmission within adult rural population. The model will incorporate seven main TB statuses, and each compartment will be subdivided by service providers. The parameters involving preference for healthcare seeking will be collected using discrete choice experiment (DCE) method. We will solve the deterministic model numerically over a 20-year (2021-2040) timeframe and predict the TB prevalence, incidence and cumulative new infections under the status quo or various policy scenarios. We will also conduct an analysis following standard protocols to calculate the average cost-effectiveness for each policy scenario relative to the status quo. A numerical calibration analysis against the available published TB prevalence data will be performed using a Bayesian approach. ETHICS AND DISSEMINATION: Most of the data or parameters in the model will be obtained based on secondary data (eg, published literature and an open-access data set). The DCE survey has been reviewed and approved by the Ethics Committee of the School of Public Health, Sun Yat-sen University. The approval number is SYSU [2019]140. Results of the study will be disseminated through peer-reviewed journals, media and conference presentations.


Asunto(s)
Tuberculosis , Adulto , Teorema de Bayes , China/epidemiología , Reforma de la Atención de Salud , Humanos , Modelos Teóricos , Atención Primaria de Salud , Tuberculosis/epidemiología , Tuberculosis/prevención & control
12.
BMC Infect Dis ; 21(1): 822, 2021 Aug 16.
Artículo en Inglés | MEDLINE | ID: mdl-34399706

RESUMEN

BACKGROUND: We aimed to determine how emerging evidence over the past decade informed how Ugandan HIV clinicians prescribed protease inhibitors (PIs) in HIV patients on rifampicin-based tuberculosis (TB) treatment and how this affected HIV treatment outcomes. METHODS: We reviewed clinical records of HIV patients aged 13 years and above, treated with rifampicin-based TB treatment while on PIs between1st-January -2013 and 30th-September-2018 from twelve public HIV clinics in Uganda. Appropriate PI prescription during rifampicin-based TB treatment was defined as; prescribing doubled dose lopinavir/ritonavir- (LPV/r 800/200 mg twice daily) and inappropriate PI prescription as prescribing standard dose LPV/r or atazanavir/ritonavir (ATV/r). RESULTS: Of the 602 patients who were on both PIs and rifampicin, 103 patients (17.1% (95% CI: 14.3-20.34)) received an appropriate PI prescription. There were no significant differences in the two-year mortality (4.8 vs. 5.7%, P = 0.318), loss to follow up (23.8 vs. 18.9%, P = 0.318) and one-year post TB treatment virologic failure rates (31.6 vs. 30.7%, P = 0.471) between patients that had an appropriate PI prescription and those that did not. However, more patients on double dose LPV/r had missed anti-retroviral therapy (ART) days (35.9 vs 21%, P = 0.001). CONCLUSION: We conclude that despite availability of clinical evidence, double dosing LPV/r in patients receiving rifampicin-based TB treatment is low in Uganda's public HIV clinics but this does not seem to affect patient survival and viral suppression.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Coinfección/tratamiento farmacológico , Guías como Asunto , Infecciones por VIH/tratamiento farmacológico , Prescripción Inadecuada/prevención & control , Inhibidores de Proteasas/uso terapéutico , Rifampin/uso terapéutico , Tuberculosis/tratamiento farmacológico , Adolescente , Adulto , Anciano , Quimioterapia Combinada , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Inhibidores de la Proteasa del VIH/uso terapéutico , Humanos , Lopinavir/uso terapéutico , Persona de Mediana Edad , Ritonavir/uso terapéutico , Resultado del Tratamiento , Tuberculosis/complicaciones , Tuberculosis/epidemiología , Uganda/epidemiología , Adulto Joven
13.
Rev Esc Enferm USP ; 55: e20200538, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-34464433

RESUMEN

OBJECTIVE: To analyze the spatiality of completeness of the Information System on Diseases of Compulsory Declaration of tuberculosis in Paraná state, focusing on the border region. METHOD: A study composed by the notified cases of the disease treated in Paraná between 2008 and 2017. The variable completeness was classified as excellent (<5% of incompleteness), good (5 to <10%), regular (10 to <20%), poor (20% to 50%), and very poor (>50%). Moran global was used for the spatial correlation and local association was analyzed. Logistic regression was employed to assess the spatial association of the variables with the border and, for the significant variables, multiple logistic regression was used. The study abides by the resolution 510/2016 of the National Health Council. RESULTS: There was a "high-high" correlation for education level, 2- and 6-month sputum smear in the Eastern health macroregional and "high-high" correlation in the Northwestern macroregional for 2-month sputum smear and antibiotic sensitivity testing. There was no spatial association with the border. CONCLUSION: Unsatisfactory completeness was identified in the database and conglomerates, indicating spatial association of incompleteness of some variables, but with no relation with the border. There was no worsening of completeness nor of the case outcomes related to these regions.


Asunto(s)
Tuberculosis , Brasil/epidemiología , Bases de Datos Factuales , Humanos , Sistemas de Información , Análisis Espacial , Tuberculosis/epidemiología
14.
PLoS One ; 16(8): e0256033, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34388206

RESUMEN

BACKGROUND: Tuberculosis (TB) household contact tracing is a form of targeted active case-finding for which community health workers ('outreach teams') in South Africa are primarily responsible for its implementation. We conducted an exploratory qualitative study to understand the role of outreach teams in delivering TB household contact tracing. METHODS: The study took place in three districts of South Africa between May 2016 and February 2017. We conducted 78 in-depth interviews (IDI) (comprising 35 key stakeholders, 31 TB index patients and 12 HHCs) and five focus group discussions (FGD) (40 outreach team members in four FGDs and 12 community stakeholders in one FGD). RESULTS: Outreach teams contributed positively by working across health-related programmes, providing home-based care and assisting with tracing of persons lost to TB care. However, outreach teams had a limited focus on TB household contact tracing activities, likely due to the broad scope of their work and insufficient programmatic support. Outreach teams often confused TB household contact tracing activities with finding persons lost to TB care. The community also had some reservations on the role of outreach teams conducting TB household contact tracing activities. CONCLUSIONS: Creating awareness among outreach workers and clinic personnel about the importance of and activities related to TB household contact tracing would be required to strengthen the delivery of TB household contact tracing through the community-based primary health care teams. We need better monitoring and evaluation systems, stronger integration within a realistic scope of work, adequate training on TB household contact tracing and TB infection prevention control measures. Involving the community and educating them on the role of outreach teams could improve acceptance of future activities. These timely results and lessons learned should inform contact tracing approaches in the context of COVID-19.


Asunto(s)
Trazado de Contacto , Conocimientos, Actitudes y Práctica en Salud , Profesionales para Control de Infecciones/psicología , Tuberculosis/prevención & control , Adulto , Actitud del Personal de Salud , Relaciones Comunidad-Institución , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Sudáfrica , Tuberculosis/epidemiología
15.
BMC Health Serv Res ; 21(1): 861, 2021 Aug 23.
Artículo en Inglés | MEDLINE | ID: mdl-34425809

RESUMEN

BACKGROUND: Over the past decade, global health policy has increased its focus on measures to halt further increase in tuberculosis (TB) incidence and management of diabetes mellitus (DM). However, the vertical management of these two diseases have not achieved much in addressing the adverse effects of the rising tuberculosis-diabetes co-epidemic. This necessitated the World Health Organisation and the International Union Against Tuberculosis and Lung Disease to develop a framework to manage this dual disease burden. TB-DM co-epidemic is a public health concern in Ghana, adversely threatening the country's fragile health systems. Since frontline healthcare workers are critical in health policy implementation, this study used Lipsky's theoretical framework of street-level bureaucracy to explore their experiences in implementing the collaborative framework at the health facility level in Ghana. METHODS: This qualitative study was conducted between July to September 2019 using an exploratory design. Data was generated using a semi-structured interview guide designed to elicit information on knowledge of TB-DM comorbidity as well as systems for co-management. Twenty-three in-depth interviews were conducted among purposively selected frontline healthcare workers (doctors, nurses, TB task- shifting officers, TB institutional coordinators and hospital managers) from three health facilities in the Northern Region of Ghana. The lead author also conducted observations and document reviews, in order to fully address the study objectives. Thematic analysis was guided by the Lipsky's theoretical framework of street level bureaucracy. RESULTS: The findings revealed three main themes and six sub-themes. Main themes were Prioritisation of TB/HIV co-infection while negating TB-DM comorbidity, Poor working conditions, and Coping mechanisms, whereas sub-themes were Low knowledge and awareness of TB-DM comorbidity, Limited awareness of the collaborative framework, High workload in TB & DM Clinics, Multiple roles, Inadequate training, and Space shortage. CONCLUSIONS: Frontline healthcare workers had limited knowledge of TB-DM comorbidity and the collaborative framework, which, in turn adversely affected the effectiveness in implementing the framework. The effective implementation of the framework begins with raising awareness about the framework through in service training amongst the frontline healthcare workers. Additionally, an integrated screening tool to detect both TB and DM would help achieve early detection of TB-DM comorbidity.


Asunto(s)
Diabetes Mellitus , Tuberculosis , Ghana/epidemiología , Personal de Salud , Humanos , Investigación Cualitativa , Tuberculosis/epidemiología , Tuberculosis/terapia
16.
BMJ Open ; 11(8): e044867, 2021 08 10.
Artículo en Inglés | MEDLINE | ID: mdl-34376439

RESUMEN

OBJECTIVE: Tuberculosis (TB) remains a leading cause of morbidity and mortality in Zambia, especially for people living with HIV (PLHIV). We undertook a care cascade analysis to quantify gaps in care and align programme improvement measures with areas of need. DESIGN: Retrospective, population-based analysis. SETTING: We derived national-level estimates for each step of the TB care cascade in Zambia. Estimates were informed by WHO incidence estimates, nationally aggregated laboratory and notification registers, and individual-level programme data from four provinces. PARTICIPANTS: Participants included all individuals with active TB disease in Zambia in 2018. We characterised the overall TB cascade and disaggregated by drug susceptibility results and HIV status. RESULTS: In 2018, the total burden of TB in Zambia was estimated to be 72 495 (range, 40 495-111 495) cases. Of these, 43 387 (59.8%) accessed TB testing, 40 176 (55.4%) were diagnosed with TB, 36 431 (50.3%) were started on treatment and 32 700 (45.1%) completed treatment. Among all persons with TB lost at any step along the care cascade (n=39 795), 29 108 (73.1%) were lost prior to accessing diagnostic services, 3211 (8.1%) prior to diagnosis, 3745 (9.4%) prior to initiating treatment and 3731 (9.4%) prior to treatment completion. PLHIV were less likely than HIV-negative individuals to successfully complete the care cascade (42.8% vs 50.2%, p<0.001). Among those with rifampicin-resistant TB, there was substantial attrition at each step of the cascade and only 22.8% were estimated to have successfully completed treatment. CONCLUSIONS: Losses throughout the care cascade resulted in a large proportion of individuals with TB not completing treatment. Ongoing health systems strengthening and patient-centred engagement strategies are needed at every step of the care cascade; however, scale-up of active case finding strategies is particularly critical to ensure individuals with TB in the population reach initial stages of care. Additionally, a renewed focus on PLHIV and individuals with drug-resistant TB is urgently needed to improve TB-related outcomes in Zambia.


Asunto(s)
Infecciones por VIH , Tuberculosis Resistente a Múltiples Medicamentos , Tuberculosis , Programas de Gobierno , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Estudios Retrospectivos , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Zambia/epidemiología
18.
Med Sci Monit ; 27: e934292, 2021 Aug 09.
Artículo en Inglés | MEDLINE | ID: mdl-34366429

RESUMEN

The World Health Organization (WHO) estimated that in 2019, 10.0 million people worldwide developed tuberculosis (TB), with 1.4 million deaths from TB in that year. Infection with Mycobacterium tuberculosis that is resistant to at least isoniazid and rifampin and an additional chemotherapeutic agent is known as multidrug-resistant TB (MDR TB). Until recently, the prevalence of drug resistance in patients with TB has been poorly understood due to a lack of infection surveillance and molecular testing. Countries with the highest prevalence of TB, including MDR TB, are also those most affected by the COVID-19 pandemic. The identification of MDR TB requires careful monitoring and resources for molecular testing. Previous treatment regimens have required intravenous treatments of long duration and high cost. The 2020 and 2021 recommendations from the WHO for the management of drug-susceptible TB and MDR TB have included oral treatment regimens and reduced treatment duration. This Editorial aims to present the rationale for the 2020 and 2021 recommendations from the WHO for the management of drug-susceptible TB and MDR TB.


Asunto(s)
Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis/tratamiento farmacológico , Antituberculosos/uso terapéutico , Protocolos Clínicos/normas , Salud Global , Humanos , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Pulmonar/epidemiología , Organización Mundial de la Salud
19.
BMJ Open ; 11(8): e045289, 2021 08 24.
Artículo en Inglés | MEDLINE | ID: mdl-34429305

RESUMEN

OBJECTIVE: To implement and assess the mobile X-ray unit (MXU) equipped with digital radiography, computer-aided detection (CAD) software and molecular point of care tests to improve early tuberculosis (TB) diagnosis in vulnerable populations in a TB outreach screening programme in Romania. DESIGN: Descriptive study. SETTINGS: Prisons in Bucharest and other cities in the southern part of Romania, homeless shelters and services for problem drug users in Bucharest, and Roma populations in Bucharest and Craiova. PARTICIPANTS: 5510 individuals attended the MXU service; 5003 persons were radiologically screened, 61% prisoners, 15% prison staff, 11% Roma population, 10% homeless persons and/or problem drug users and 3% other. INTERVENTIONS: Radiological digital chest X-ray (CXR) screening of people at risk for TB, followed by CAD and human reading of the CXRs, and further TB diagnostics when the pulmonologist classified the CXR as suggestive for TB. PRIMARY AND SECONDARY OUTCOME MEASURES: Ten bacteriologically confirmed TB cases were identified translating into an overall yield of 200 per 100 000 persons screened (95% CIs of 109 to 368 per 100 000). Prevalence rates among homeless persons and/or problem drug users (826/100 000; 95% CI 326 to 2105/100 000) and the Roma population (345/100 000; 95% CI 95 to 1251/100 000) were particularly high. RESULTS: The human reader classified 6.4% (n=317) of the CXRs as suspect for TB (of which 32 were highly suggestive for TB); 16.3% of all CXRs had a CAD4TB version 6 score >50. All 10 diagnosed TB patients had a CAD4TB score >50; 9 had a CAD4TB score >60. CONCLUSIONS: Given the high TB prevalence rates found among homeless persons and problem drug users and in the Roma population, targeted active case finding has the potential to deliver a major contribution to TB control in Romania.


Asunto(s)
Tuberculosis , Computadores , Humanos , Rumanía/epidemiología , Programas Informáticos , Tuberculosis/diagnóstico por imagen , Tuberculosis/epidemiología , Rayos X
20.
BMC Health Serv Res ; 21(1): 798, 2021 Aug 12.
Artículo en Inglés | MEDLINE | ID: mdl-34384439

RESUMEN

BACKGROUND: The COVID-19 pandemic has caused major disruption to healthcare services globally and has impacted on tuberculosis (TB) patients and TB diagnosis and treatment services both in low- and high-income countries. We therefore explored the perspectives of members of regional and international TB control and research networks to further understand TB service disruptions and compared the experiences of members from West African and European countries. METHODS: This cross-sectional, explorative descriptive study was conducted from May to July 2020 using an open online survey with target respondents from both West African and European countries. The survey comprised discrete questions exploring challenges faced with TB screening, diagnosis, treatment, prevention, and changes implemented. Additionally, respondents were asked to provide recommendations for remedial actions. RESULTS: We analysed responses from 124 respondents based in 29 countries located in Europe and West Africa. About half of the respondents reported challenges in delivering routine TB services during the COVID-19 pandemic, with over one third reporting having some form of guidance issued regarding maintaining delivery of routine TB services. Respondents emphasised the need for strengthening TB services especially in light of COVID-19 pandemic. Considerable similarities were found between the challenges experienced by TB professionals in both West African and European settings. Responses also highlighted the hidden challenges faced in some countries prior to the COVID-19 pandemic, especially in some West African settings where staff shortages and laboratory issues predated COVID-19. CONCLUSIONS: TB control and research professionals in West African and European settings experienced similar challenges to the delivery of TB diagnosis and treatment services due to the COVID-19 pandemic, and highlighted the need for clear communication of guidelines, prioritisation of routine TB service delivery, ongoing health education, and possible integration of TB and COVID-19 services to ensure that TB services are more resilient against the impact of the pandemic.


Asunto(s)
COVID-19 , Tuberculosis , Estudios Transversales , Humanos , Pandemias , SARS-CoV-2 , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Tuberculosis/prevención & control
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