The impact of COVID-19 on TB: a review of the data.

Early in the COVID-19 pandemic, models predicted hundreds of thousands of additional TB deaths as a result of health service disruption. To date, empirical evidence on the effects of COVID-19 on TB outcomes has been limited. Here we summarise the evidence available at a country level, identifying broad mechanisms by which COVID-19 may modify TB burden and mitigation efforts. From the data, it is clear that there have been substantial disruptions to TB health services and an increase in vulnerability to TB. Evidence for changes in Mycobacterium tuberculosis transmission is limited, and it remains unclear how the resources required and available for the TB response have changed. To advocate for additional funding to mitigate the impact of COVID-19 on the global TB burden, and to efficiently allocate resources for the TB response, requires a significant improvement in the TB data available.

Reducing stigma and discrimination associated with COVID-19: early stage pandemic rapid review and practical recommendations.

AIMS: To develop recommendations for strategies and interventions to reduce stigma and discrimination related to coronavirus disease 2019 (COVID-19), through reviewing and synthesising evidence in relation to COVID-19 and other disease outbreaks and infectious/stigmatised conditions from systematic reviews and primary studies and recommendations from additional materials. METHODS: Rapid review, drawing on the World Health Organization's (WHO) methodology for developing interim guidelines during health emergencies. PubMed/MEDLINE, PsycINFO, Cochrane Central and Campbell Collaboration searched up to mid-April 2020. Searches were supplemented by reference-searching and expert recommendations. Searches were designed to identify: (1) systematic reviews (<10 years), or (2) primary intervention studies (no date limit) reporting evidence on anti-stigma interventions (in relation to COVID-19 or other infectious/stigmatised conditions) or (3) additional relevant materials. Data were extracted on population, intervention, outcome and results. These data were compiled into evidence summary tables and narrative overviews. Recommendations on strategies for COVID-19 stigma-reduction were developed using the WHO 'Evidence to Decision' framework approach. The review protocol was registered with PROSPERO (registration ID: CRD42020177677). RESULTS: The searches identified a total of 4150 potentially relevant records, from which 12 systematic reviews and 29 additional articles were included. Overarching considerations and specific recommendations focus on: (1) language/words used in relation to COVID-19 and affected people; (2) media/journalistic practices; (3) public health interventions; (4) targeted public health interventions for key groups and (5) involving communities and key stakeholders. CONCLUSIONS: These recommendations represent the first consolidated evidence-based guidance on stigma and discrimination reduction in relation to COVID-19. Mitigating the impact of stigma is critical in reducing distress and negative experiences, and strengthening communities' resolve to work together during exceptional circumstances. Ultimately, reducing stigma helps addressing structural inequalities that drive marginalisation and exacerbate both health risks and the impact of stigma. Administrations and decision makers are urged to consider integrating these recommendations into the ongoing COVID-19 response.

Latent tuberculosis infection and the EndTB Strategy: ethical tensions and imperatives.

Latent tuberculosis infection (LTBI) is increasingly recognised as central to programmatic TB activity, and a critical element in global progress towards TB elimination. LTBI affects a much larger group of people than active disease, who by definition are asymptomatic. Furthermore, while LTBI represents a state of risk, there remains significant uncertainty regarding which individuals will progress to active disease. Therefore, the development and implementation of LTBI management policies within the End TB Strategy requires careful ethical consideration. This article reviews ethical issues related to developments in LTBI diagnosis and management, including new tools and emerging policies and practice. Implications of LTBI management practices in specific settings are discussed, including healthcare worker infection and management of likely multidrug-resistant (MDR) LTBI. Better prediction of progression to active disease and less burdensome treatments would allow ethically appropriate expansion of testing programmes in future. However, even with existing tools there is a strong ethical imperative to provide the most effective and least burdensome therapy possible to those with LTBI, particularly those at highest risk of progression and/or poor outcomes from active disease. Greater community engagement is required in designing optimal LTBI management programmes, and ensure harms and benefits are appropriately balanced in specific settings.

Change in attitudes and knowledge of problem drug use and harm reduction among a community cohort in Kabul, Afghanistan.

This pre-post evaluation aimed to measure changes in knowledge and attitudes towards drug users among community representatives in Kabul, Afghanistan, over a period of expansion of harm reduction and drug dependence programming. A convenience sample of 160 professionals aged 18+ years completed interview questionnaires in 2007 and 2009. Views endorsing programme quality and the provision of condoms, infection counselling/testing and needle/syringe distribution increased significantly over the 2-year period. In 13 of 38 statements, there was a substantial (> 10%) change in agreement level, most commonly among men and medical professionals. Attitudes concerning support of drug users remained largely positive, with substantial attitude changes in some subgroups of the population. Further community education through the media and a more cohesive government drug policy may be needed to strengthen community support for harm reduction/drug treatment in Afghanistan.

Change in attitudes and knowledge of problem drug use and harm reduction among a community cohort in Kabul, Afghanistan

هذا التقييم لما قبل ومابعد تطبيق البرنامج يهدف الى قياس التغيرات التي طرأت على المعارف والاتجاهات تجاه متعاطي المخدرات لدي ممثلين عن المجتمع في كابول بافغانستان خلال فتره من فترات التوسع في تطبيق برنامج لمعالجه ادمان المخدرات والحد من اضرارها فقد قامت عينه ملائمه تضم 160 مهنيا اعمارهم 18 سنه فما فوق بملء استبيانات مقابله في عامي 2007 و 2009 فتبين ان الآراء المؤيدة لجودة البرنامج ولتوفير الواقي الذكري وتقديم المشورة والاختبارات الخاصة بالعدوي وتوزيع الابر والمحاقن قد ازدادت زيادة ملحوظة خلال هذين العامين وكان هناك تغير جوهري في مستوي القبول ( اكثر من 10%)في 13 بيانا من اصل 38 لاسيما لدي الرجال واصحاب المهن الطبيه المتعلقه بدعم متعاطي المخدرات ايجابيه الى حد كبير مع تغيرات كبيره في مواقف بعض المجموعات السكانيه الفرعيه ربما تكون هناك حاجة الى مزيد من تثقيف المجتمع عن طريق وسائل الاعلام والى سياسه حكوميه اكثر تماسكا بشأن المخدرات تعزز دعم المجتمع لمعالجة تعاطي المخدرات والحد من اضرارها في افغانستان

La presente evaluation pre-post visait a mesurer ['acquisition de connaissances et les changements d'attitudes a I'egard des toxicomanes parmi les representants d'une communaute a Kaboul [Afghanistan]au cours d'une periode d'elargissement des programmes de reduction des effets nocifs et de traitement de la clependance aux drogues.Un echantillon de commodite de 160 professionnels ages de plus de 18 ans a rempli des questionnaires dans le cadre d'entretiens en 2007 et en 2009.Les opinions au sujet de ['application de programmes de qualite et de la fourniture de preservatifs,du conseil et du depistage en matiere defections,ainsi que de la distribution d/aiguilles/de seringues se sont considerablement ameliorees au cours de ces deux annees.Dans 13 des 38 declarations,on a pu noter un changement notable [>10 %]dans le niveau d'acceptation,le plus souvent parmi les hommes et les professionnels de sante.Les attitudes concernant le soutien a apporter aux toxicomanes sont restees positives dans une large mesure,avec des changements d'attitude notables dans certains sous-groupes de la population.Une education plus poussee des communautes par le biais des medias et des politiques gouvernementales de lutte contre la drogue plus coherentes sont necessaires pour renforcer le soutien communautaire a la reduction des effets nocifs/au traitement des toxicomanies en Afghanistan

This pre-post evaluation aimed to measure changes in knowledge and attitudes towards drug users among community representatives in Kabul,Afghanistan,over a period of expansion of harm reduction and drug dependence programming.A convenience sample of 160 professionals aged 18+ years completed interview questionnaires in 2007 and 2009.Views endorsing programme quality and the provision of condoms,infection counselling/testing and needle/syringe distribution increased significantly over the 2-year period.In 13 of 38 statements,there was a substantial [>10%]change in agreement level,most commonly among men and medical professionals.Attitudes concerning support of drug users remained largely positive,with substantial attitude changes in some subgroups of the population.further community education through the media and a more cohesive government drug policy may be needed to strengthen community support for harm reduction/drug treatment in Afghanistan

A tuberculin skin test survey among Afghan children in Kabul.

SETTING: Kabul, Afghanistan, October to November 2000. OBJECTIVE: To determine the prevalence and the average annual risk of infection with Mycobacterium tuberculosis (ARTI). METHODS: A cluster sampling method was selected to carry out the survey. Sub-divisions of Kabul's districts were chosen, and door-to-door visits were carried out to register the children. The prevalence of tuberculous infection was determined using a cut-off point to denote infection and mixture analysis. The average ARTI was derived algebraically from the prevalence estimates. RESULTS: The tuberculin skin test was administered and read in 89% of registered children. Utilising a cut-off point of > or = 8 mm in duration, the estimated prevalence of tuberculous infection was 4.3% and the calculated average ARTI was 0.61%. Using mixture analysis, the average ARTI was estimated to be 0.34% (95% credibility interval 0.23-0.54). This indicates a substantial decrease from the estimated ARTI of 2.55% calculated in the 1963 survey. CONCLUSIONS: There has been a large decrease in the risk of tuberculous infection in Kabul since the last assessment. The adverse situation in the past decades does not appear to have severely affected the epidemiological situation.