Quantifying the beliefs of key players in the UK sheep industry on the efficacy of two treatments for footrot.

Clinical trials have demonstrated that sheep with footrot treated with parenteral and topical antibiotics without foot trimming (treatment A), cure faster than sheep treated with foot trimming and topical antibiotics (treatment B). We investigated how key players in the UK sheep industry recommended treating footrot, and tested whether reviewing the evidence surrounding treatment of footrot changed their beliefs. Eight key players attended a workshop to investigate their current practices, and their perceived efficacy of treatments, using probabilistic elicitation. At the start of the study, all participants recommended use of antibiotic injection but only four recommended not foot trimming feet with footrot. Initial beliefs in the difference in cure rate within five days of treatment ranged from 30 to 97% in favour of treatment A (true difference 60%); this heterogeneity reduced after reviewing the evidence. Participants who believed the cure rate differed by >60% over-estimated the cure rate of treatment A whilst participants who believed the difference was <60% over-estimated the efficacy of treatment B. During discussions, participants stated that parenteral antibiotics had always been recommended as a treatment for footrot but that the new research clarified when to use them. In contrast, it was highly novel to hear that foot trimming was detrimental to recovery, and key players and farmers are taking longer to accept this evidence. Three months after the workshop, two participants stated that they now placed greater emphasis on rapid individual antibiotic treatment of lame sheep and one was no longer recommending trimming feet.

Tuberculosis infection and disease in people living with HIV in countries with low tuberculosis incidence.

In countries with low tuberculosis (TB) incidence, TB is concentrated in vulnerable populations, including people living with the human immunodeficiency virus (PLHIV), who have a substantially greater risk of TB than people without HIV. We searched PubMed, EMBASE and Web of Science for studies evaluating the risk factors for latent tuberculous infection (LTBI) or active TB in PLHIV in countries with TB incidence 10 per 100 000 population. Due to the number of risk factors evaluated and heterogeneity in study designs, we present summary data and a narrative synthesis. We included 45 studies: 17 reported data on the risk factors for LTBI and 32 on active TB. Black, Asian or Hispanic ethnicity, birth or long-term residence in a country with high TB incidence, and HIV acquisition via injecting drug use (IDU) or heterosexual sex were strong predictors of both LTBI and active TB. History of contact, a greater degree of immunosuppression at diagnosis or higher viral load increased the TB risk. Early HIV diagnosis to allow timely initiation of antiretroviral therapy is essential for the prevention of TB in PLHIV. Screening and treating PLHIV for LTBI to reduce the risk of progression to active TB disease should also be considered to further reduce the burden of active TB in low TB incidence settings. Research to support the expansion of TB and HIV prevention and treatment globally is essential to eliminate TB in low-incidence settings.