Impact of Isoniazid Preventive Therapy on Tuberculosis Incidence and Predictors of Tuberculosis Among People Living With HIV/AIDS at Debre Tabor General Hospital, Northwest Ethiopia.

Background: The World Health Organization (WHO) recommended isoniazid preventive therapy (IPT) to decrease the effects of tuberculosis (TB) on human immunodeficiency virus (HIV) patients. However, not enough research has been conducted to determine the impact of IPT on TB incidence and their predictors. Therefore, the goal of this study was to evaluate how IPT affects the incidence of TB and identify factors that are predictive of TB among HIV/AIDS patients. Methods: A total of 588 patients at Debre Tabor General Hospital (DTGH) who had taken IPT between December 2009 and January 2016 participated in the current study, which then followed them for 3 years and compared them to patients who did not receive IPT during the study period. The data were gathered from patient registries and charts. IPT users' and nonusers' TB-free survival curves were compared using log-rank testing. Predictors were identified using bivariate and multivariate Cox proportional hazards models. Results: In this study, 1656 person-years (PYs) follow-ups on 588 patients found 82 additional TB cases, with an overall incidence rate (IR) of 4.95/100 PY. When compared to individuals who were not on IPT, the TB IR among patients living with human immunodeficiency virus (PLHIV) on IPT was significantly lower (1.94/100 PY vs. 8.32/100 PY). A baseline CD4 cell count < 200 cells/uL, history of TB, Hgb level < 10 g/dL, BMI < 18.5 kg/m2, and not receiving IPT are independent predictors of TB among HIV/AIDS patients. Conclusion: The frequency of TB was high among PLHIV patients who did not receive IPT. It was discovered that a low CD4 cell count at baseline, a history of TB, IPT status, Hgb level, and BMI independently predicted the presence of TB. Therefore, addressing the independent predictors that are connected to a higher risk of TB in PLHIV as well as isoniazid (INH) prophylaxis has a significant impact on reducing the incidence of TB.

Leveraging Google Trends to identify Indonesian tuberculosis trends before and after the implementation of a national mandatory notification system.

BACKGROUND: Tuberculosis (TB) burden and the underreporting of TB remain major health challenges in Indonesia. Interest in the internet is growing extensively, and the introduction of the TB mandatory electronic notification system in 2017 engaged the public's interest to leverage digital traces regarding TB information in Indonesia. OBJECTIVE: To quantify the correlation between Google Trends data and Indonesian TB surveillance data before and after the implementation of a mandatory TB notification system. METHODS: Google Trends searches on TB information were used. We used two sets of time series data, including before and after the launch of the TB notification system. Pearson's correlation was used to measure the correlation between TB search terms and official TB reports. RESULTS: The moving average graph showed a linear pattern of TB information with TB reports after 2017. Pearson's correlation estimated a high correlation for TB definition, TB symptoms, and official TB reports with an R-value range of 0.97 to -1.00 (p ≤ 0.05) and showed an increasing trend in TB information searching after 2016. CONCLUSION: Google Trends data can depict public interest in the TB epidemic. Validation of information-searching behavior is required to advocate the implementation of Google Trends for TB digital surveillance in Indonesia.

Tuberculosis in Poland in 2021. / Gruzlica w Polsce w 2021 r.

AIM OF THE STUDY: To evaluate the main features of epidemiology of tuberculosis (TB) in 2021 in Poland and to compare with the situation in the European Union and European Economic Area (EU/EEA) countries. MATERIAL AND METHODS: Analysis of case-based data on TB patients from National TB Register, data on anti-TB drug susceptibility in cases notified in 2021, data from Statistics Poland on deaths from tuberculosis in 2020, data from National Institute of Public Health NIH - National Research Institute (NIPH NIH - NRI) on HIV-positive subjects for whom TB was an AIDS-defining disease, data from the report "European Centre for Disease Prevention and Control, WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2022 - 2021 data. Copenhagen: WHO Regional Office for Europe and Stockholm: European Centre for Disease Prevention and Control; 2022." RESULTS: In 2021, 3704 TB cases were reported in Poland. The incidence rate was 9.7 cases per 100,000 with large variability between voivodeships from 5.4 to 12.6 per 100,000. A decrease in the incidence with respect to 2020 was found in 8 voivodeships, the most significant in lubuskie voivodship (42.6%). The number of all pulmonary tuberculosis cases was 3,553 i.e. 9.3 per 100,000. Pulmonary cases represented 95.9% of all TB cases. In 2021, 151 extrapulmonary TB cases were notified (4.1% of all TB cases). Pulmonary tuberculosis was bacteriologically confirmed in 2,970 cases (83.6% of all pulmonary TB cases, the incidence rate 7.8 per 100,000). The number of smear-positive pulmonary TB cases was 2,085 i.e. 5.5 per 100,000 (58.7% of all pulmonary TB cases). In 2021, there were 54 cases (25 of foreign origin) with multidrug resistant TB (MDR-TB) representing 1.9% of cases with known drug sensitivity. The incidence rates of tuberculosis were growing along with the age group from 0.6 per 100,000 among children (0-14 years) to 15.8 per 100,000 among subjects in the age group 45-64 years, the incidence rate in the age group ≥65 years was 11.7 per 100,000. There were 37 cases in children up to 14 years of age (1.0% of the total) and 51 cases in adolescents between 15 and 19 years of age - rates 0.6 and 2.8 per 100,000 respectively. In 2021, there were 2,690 cases of tuberculosis in men and 1,014 in women. The TB incidence in men - 14.6 per 100,000 was almost 3.0 times higher than among women - 5.1. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 55-59 years, 30.5 vs. 6.6 and in age group 60 to 64 years, 26.0 vs. 5.7. In 2021, there were 132 patients of foreign origin among all cases of tuberculosis in Poland (3.6%). In 2020, TB was the cause of death for 474 people (mortality rate - 1.2 per 100,000). CONCLUSIONS: The incidence of tuberculosis in Poland in 2021 was 10.2% higher than in 2020. The percentage of tuberculosis cases with bacteriological confirmation was 82.6%, higher than the average in EU/EEA countries (72.0%). The percentage of MDR-TB cases was lower than the average in EU/EEA countries (1.9% vs. 3.8%). The highest incidence rates are found in Poland in the older age groups (in EU/EEA countries in people aged 25 to 44). The percentage of children up to 14 years of age among the total number of TB patients was 1.0%, the average in the EU/EEA countries was 3.5%. The incidence of tuberculosis in men was nearly three times higher than in women in Poland. The impact of migration on the epidemiological situation of tuberculosis in Poland in 2021 was smaller than in the EU/EEA countries (in Poland, the percentage of foreigners among all TB patients was 3.6 vs. 33.8% in the EU/EEA).

Pre-sensitization with tuberculosis and non-tuberculosis mycobacteria and its impact on TB incidence in different age groups: Chengalpattu BCG trial revisited.

Individuals pre-sensitized with Mycobacterium tuberculosis (MTB), non-tuberculosis mycobacteria, and its impact on TB incidence are relatively unexplored in a high TB burden setting. We conducted secondary data analysis of a double-blind, randomized Chengalpattu BCG trial, India. Induration to Purified Protein Derivative (PPD)-S and PPD-B were proxies for exposures to MTB and M. intracellulare respectively. Optimum cut-off for PPD-S and B were determined using Receiver-Operating Characteristic curves and induration ≥12 mm for PPD-S and ≥10 mm for PPD-B were considered strong reaction. Incidence rates of culture positive pulmonary TB per 100,000 person-years (PY) were calculated. Of 270,043 individuals with skin test results, children <14 years (n = 109,383, 64% showed strong-reaction to PPD-B and 17% to PPD-S) and adults between 25 and 34 years (n = 40,292, 98% were strong reactors to PPD-B and 73% to PPD-S). Overall incidence rate was lower in individuals with PPD-S < PPD-B (136, 95% CI: 130-141/100,000 PY) compared to individuals with PPD-S > PPD-B (447, 95% CI: 427-468/100,000 PY). Incidence rates of culture positive pulmonary TB was affected by early age of exposure to cross-reactive mycobacterial antigens represented by PPD-B and exposure to MTB represented by PPD-S during adolescence and early adulthood.

Revisiting the Chingleput BCG vaccination trial for the impact of BCG revaccination on the incidence of tuberculosis disease.

Background & objectives: Vaccines play a crucial role in the prevention of tuberculosis (TB). Revaccination with Bacille Calmette-Guerin (BCG) for the prevention of TB is an important strategy that is currently gaining interest. The objective of this study was to reanalyze the community-based Chingleput BCG vaccination trial for protective efficacy of BCG revaccination against incident TB disease. Methods: A retrospective analysis of the Chingleput BCG vaccination trial (conducted in 1968) data was carried out. Data on participants with evidence of prior BCG vaccination at trial intake and randomized to BCG vaccine [low dose (0.01 mg), high dose (0.1 mg)] and placebo arms were analyzed. The incidence of TB disease, which was based on sputum culture and/or chest X-ray was compared between the BCG and placebo arms over a 15 yr follow up period. Results: Of the 269,727 individuals randomized in the trial; 263,158 had no evidence of TB at baseline, of which 4436 (1.68%) had evidence of BCG vaccination at trial intake (2890 in the BCG vaccine and 1546 in the placebo arms, respectively). There were 77 (190 per 100,000) and 64 (296 per 100,000) incident TB cases in the BCG and placebo arm, respectively, at 15 yr post-vaccination. The incidence of TB disease was significantly lower in the BCG arm [Hazard ratio of BCG arm (95% confidence interval): 0.64 (0.46-0.89)]. Interpretation & conclusions: Retrospective data analysis of this community-based trial revealed that BCG revaccination in a community offered modest protection against the development of TB disease at the end of 15 years which, however, requires further evaluation.

Applying SARIMA, ETS, and hybrid models for prediction of tuberculosis incidence rate in Taiwan.

Background: Tuberculosis (TB) remained one of the world's most deadly chronic communicable diseases. Future TB incidence prediction is a benefit for intervention options and resource-allocation planning. We aimed to develop rapid univariate prediction models for epidemics forecasting employment. Methods: The surveillance data regarding Taiwan monthly TB incidence rates which from January 2005 to June 2017 were utilized for simulation modelling and from July 2017 to December 2020 for model validation. The modeling approaches including the Seasonal Autoregressive Integrated Moving Average (SARIMA), the Exponential Smoothing (ETS), and SARIMA-ETS hybrid algorithms were constructed and compared. The modeling performance of in-sample simulating training sets and pseudo-out-of-sample validating sets were evaluated by metrics of the root mean square error (RMSE), mean absolute percentage error (MAPE), mean absolute error (MAE), and mean absolute scaled error (MASE). Results: A total of 191,526 TB cases with a highest incidence rate in 2005 (72.5 per 100,000 person-year) and lowest in 2020 (33.2 per 100,000 person-year), from January-2005 to December-2020 showed a seasonality and steadily declining trend in Taiwan. The monthly incidence rates data were utilized to formulate these forecasting models. Through stepwise screening and assessing of the accuracy metrics, the optimized SARIMA(3,0,0)(2,1,0)12, ETS(A,A,A) and SARIMA-ETS-hybrid models were respectively selected as the candidate models. Regarding the outcome assessment of model performance, the SARIMA-ETS-hybrid model outperformed the ARIMA and ETS in the short term prediction with metrics of RMSE, MAE MAPE, and MASE of 0.084%, 0.067%, 0.646%, and 0.870%, during the pseudo-out-of-sample forecasting period. After projecting ahead to the long term forecasting TB incidence rates, ETS model showed the best performance resulting as a 41.69% (range: 22.1-56.38%) reduction of TB epidemics in 2025 and a 54.48% (range: 33.7-68.7%) reduction in 2030 compared with the 2015 levels. Conclusion: This time series modeling might offer us a rapid surveillance tool for facilitating WHO's future TB elimination milestone. Our proposed SARIMA-ETS or ETS model outperformed the SARIMA in predicting less or 12-30 months ahead of epidemics, and all models showed better in short or medium-term forecasting than long-term forecasting.

Towards building a tuberculosis free world.

The Honourable Prime Minister of India set a target of year 2025 for elimination of TB from the country, 5 years ahead of the Sustainable Development Goal of 2030. Last few years, India has made significant improvements, towards elimination of tuberculosis from the country in the form of bold policies and unprecedented political commitment. While COVID-19 has resulted in setbacks for TB elimination efforts, it has also offered an opportunity to revisit and structurally redesign the public health infrastructure/system in our country. The dream of TB elimination is possible with active participation of all stakeholders and community at large coupled with accelerated development of new diagnostics, drugs, and development of a new TB vaccine. COVID-19 pandemic has shown that vaccines can be developed in a year, contrarily, the lack of a TB vaccine is deterrent in the efforts towards a TB free world. A progress towards TB elimination would require potential contribution of novel TB vaccine. Now, is the time for mobilization towards a TB vaccine to make an impact towards our end TB goal.

Dynamics of Mycobacterium tuberculosis Lineages in Oman, 2009 to 2018.

Study aim. Effective Tuberculosis (TB) control measures in Oman have reduced the annual incidence of tuberculosis cases by 92% between 1981 and 2016. However, the current incidence remains above the program control target of <1 TB case per 100,000 population. This has been partly attributed to a high influx of migrants from countries with high TB burdens. The present study aimed to elucidate Mycobacterium tuberculosis infection dynamics among nationals and foreigners over a period of 10 years. Methods. The study examined TB cases reported between 2009 and 2018 and examined the spatial heterogeneity of TB cases and the distribution of M. tuberculosis genotypes defined by spoligotypes and MIRU-VNTR among Omanis and foreigners. Results. A total of 484 spoligoprofiles were detected among the examined isolates (n = 1295). These include 943 (72.8%) clustered and 352 (27.2%) unique isolates. Diverse M. tuberculosis lineages exist in all provinces in Oman, with most lineages shared between Omanis and foreigners. The most frequent spoligotypes were found to belong to EAI (318, 30.9%), CAS (310, 30.1%), T (154, 14.9%), and Beijing (88, 8.5%) lineages. However, the frequencies of these lineages differed between Omanis and foreigners. Of the clustered strains, 192 MTB isolates were further analysed via MIRU-VNTR. Each isolate exhibited a unique MIRU-VNTR profile, indicative of absence of ongoing transmission. Conclusions. TB incidence exhibits spatial heterogeneity across Oman, with high levels of diversity of M. tuberculosis lineages among Omanis and foreigners and sub-lineages shared between the two groups. However, MIRU-VNTR analysis ruled out ongoing transmission.

Importance of Tuberculosis Screening of Resident Visa Applicants in Low TB Incidence Settings: Experience from Oman.

INTRODUCTION: For Oman, a country targeting tuberculosis (TB) elimination, TB among expatriates is a major challenge. Thus, screening for active TB using chest X-ray was made mandatory for expatriates' residency renewals. OBJECTIVE: To estimate the incidence of bacteriologically confirmed TB and assess impact of chest X-ray based TB screening among expatriates in Muscat Governorate. METHODS: Applicants for residency and renewals were mandated for chest X-ray-based TB screening in 2018. We collected data of screened subjects with radiological suspicion of TB who were subjected to further bacteriological evaluation. RESULTS: Of 501,290 applicants screened during the study period, 436 (0.09%) had X-ray findings suggestive of TB. Among the 436, TB was confirmed in 53 (12.2%; 95% CI 9.2-15.6), giving an overall prevalence of 10.6 (95% CI 8-13.9) per 100,000 applicants (number needed to be screened 9458). Among renewals, the point prevalence of TB was 10.5 per 100,000 expatriates screened (95% CI 6.9-14.04 per 100,000), with a mean follow-up period of 11.8 years. CONCLUSION: Our findings are consistent with the recommendation for utilization of chest X-ray as a preferred tool for active case finding in the setting of expatriate screening. Our findings are also suggestive of the need for latent TB screening and ruling out TB prior to latent TB treatment.

Incidence and factors associated with active tuberculosis among people living with HIV after long-term antiretroviral therapy in Thailand: a competing risk model.

BACKGROUND: Antiretroviral therapy (ART) is known to reduce tuberculosis (TB) incidence among people living with HIV (PLWH). However, studies describing the impact of long-term ART and CD4 count recovery on TB incidence remain scarce due to limited follow up in previous studies. We evaluated TB incidence in a long-term cohort of PLWH on ART in Thailand. METHODS: We conducted an analysis of PLWH aged ≥ 18 years who started ART between 1996 and December 2020. Participants were followed up every 6 months for routine HIV care. TB risk factors, body mass index (BMI), physical examination and full differential blood counts were evaluated at each clinic visit, and CD4 cell counts and HIV RNA every 12 months. Participants diagnosed with TB > 3 months after starting ART were classified as incident cases. Time to event models with death as a competing risk, were used to derive the TB cumulative incidence function (CIF) after ART initiation, and assess time-updated factors associated with incident TB using a six month lag. RESULTS: A total of 2,636 PLWH contributing 24,229 person years (PY) of follow-up on ART were analysed. Median age was 32.0 (IQR 27.4-37.6) years; 67.5% were male. Median CD4 cell count at ART initiation was 264 (IQR 167-379) cells/mm3 and median follow-up duration was 7.6 (IQR 1.9-15.7) years. During follow-up, 113 PLWH developed TB. The probability of incident TB was 0.7%, 1.7%, 3.3% and 4.3%, at 1, 2, 5 and 7 years after ART initiation, respectively. TB CIF was highest among participants with CD4 < 50 cells/mm3. The overall crude incidence of TB was 4.66 (95% CI 3.87-5.60) per 1000 PY. Low CD4 count, BMI < 18 kg/m2, and substance use in the previous six months were significantly associated with incident TB. Incidence declined with time on suppressive ART, but remained higher than the Thai general population 7 years after ART initiation (2.2 vs 1.5/1000 PY, respectively). CONCLUSION: Despite a marked reduction in TB incidence following ART, ongoing TB risk remains high among PLWH, despite long-term suppressive ART. Those with low CD4 cell counts, who are underweight, or currently having substance abuse should be carefully monitored.

Tuberculosis in Poland in 2020.

AIM OF THE STUDY: To evaluate the main features of epidemiology of tuberculosis (TB) in 2020 in Poland and to compare with the situation in the European Union and European Economic Area (EU/EEA) countries. MATERIAL AND METHODS: Analysis of case-based data on TB patients from National TB Register, data on anti-TB drug susceptibility in cases notified in 2020, data from Statistics Poland on deaths from tuberculosis in 2019, data from National Institute of Public Health NIH - National Research Institute (NIPH NIH - NRI) on HIV-positive subjects for whom TB was an AIDS-defining disease, data from the report "European Centre for Disease Prevention and Control, WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2022 - 2020 data. Copenhagen: WHO Regional Office for Europe and Stockholm: European Centre for Disease Prevention and Control; 2022." RESULTS: In 2020, 3,388 TB cases were reported in Poland. The incidence rate was 8.8 cases per 100,000 with large variability between voivodeships from 5.5 to 13.3 per 100,000. A decrease in the incidence was found in 15 voivodeships, the most significant in Slaskie voivodship (63.9%). The number of all pulmonary tuberculosis cases was 3,237 i.e. 8.4 per 100,000. Pulmonary cases represented 95.5% of all TB cases. In 2020, 151 extrapulmonary TB cases were notified (4.5% of all TB cases). Pulmonary tuberculosis was bacteriologically confirmed in 2,573 cases (79.5% of all pulmonary TB cases, the incidence rate 6.7 per 100,000). The number of smear-positive pulmonary TB cases was 1,771 i.e. 4.6 per 100,000 (54.7% of all pulmonary TB cases). In 2020, there were 38 cases (15 of foreign origin) with multidrug resistant TB (MDR-TB) representing 1.6% of cases with known drug sensitivity. The incidence rates of tuberculosis were growing along with increasing age from 0.7 per 100,000 among children (0-14 years) to 15.0 per 100,000 among subjects in the age group 45-64 years, the incidence rate in the age group ≥65 years was 12.1 per 100,000. There were 39 cases in children up to 14 years of age (1.2% of the total) and 49 cases in adolescents between 15 and 19 years of age - rates 0.7 and 2.7 per 100,000 respectively. In 2020, there were 2,506 cases of tuberculosis in men and 882 in women. The TB incidence in men - 13.5 per 100,000 was 3.0 times higher than among women - 4.5. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 50-54 years - 26.8 vs. 4.1 and in age group 55 to 59 years - 28.7 vs. 4.8. In 2020, there were 116 patients of foreign origin among all cases of tuberculosis in Poland (3.4%). In 2019, TB was the cause of death for 456 people (mortality rate - 1.2 per 100,000). CONCLUSIONS: TB incidence in Poland in 2020 was 36.7% lower than in 2019. Such significant declines in the incidence have not been observed in the last two decades. As in previous years, there were differences in incidence rates between voivodeships with an unexpectedly sharp decrease in incidence in Silesia (Slaskie voivodeship). The percentage of tuberculosis cases with bacteriological confirmation exceeded 78%, more than in EU/EEA countries (67.3%). The percentage of MDR-TB cases was still lower than the average in EU/EEA countries (1.6% vs. 3.8%). The highest incidence rates were found in Poland in the older age groups (EU/EEAaged 25 to 44). The percentage of children up to 14 years of age among the total number of TB patients was 1.2%, less than the average in EU/EEA countries (3.8%). The incidence of tuberculosis in men was three times higher than in women in Poland, and six times higher in patients aged 50 to 59. The impact of migration on the TB pattern in Poland has not yet become significant in 2020. The percentage of foreigners among TB patients was 3.4% (33% in EU/EEA countries).

Tuberculosis incidence in country of origin is a key determinant of the risk of active tuberculosis in people living with HIV: Data from a 30-year observational cohort study.

INTRODUCTION: People living with HIV (PLWH) are at high risk of active tuberculosis (TB) but this risk in the era of antiretroviral treatment (ART) remains unclear. It is critical to identify the groups who should be prioritised for latent TB (LTBI) screening. In this study we identified the risk factors associated with developing incident TB disease, by analysing a 30-year observational cohort. METHODS: We evaluated PLWH in Leicester, UK, between 1983 and 2017 to ascertain those who developed active TB and the timing of this in relation to HIV diagnosis; whether before, concurrently with, or more than 3 months after the diagnosis of HIV (incident TB). Predictors of incident TB were ascertained using Cox proportional hazards models. RESULTS: In all, 325 out of 2158 (15.1%) PLWH under care had had active TB; 64/325 (19.7%) prior to HIV diagnosis, 161/325 (49.5%) concurrently with/within 3 months of HIV diagnosis and 100/325 (30.8%) had incident TB. Incident TB risk was 4.57/1000 person-years. Increased TB incidence in the country of birth was associated with an increased risk of developing incident TB [50-149/100 000 population, adjusted hazard ratio (AHR) = 3.10, 95% CI: 0.94-10.20; 150-249/100 000 population, AHR = 7.14, 95% CI: 3.46-14.74; 250-349/100 000 population, AHR = 5.90, 95% CI: 2.32-14.99; ≥ 350/100 000 population, AHR = 3.96, 95% CI: 1.39-11.26]. CONCLUSIONS: Tuberculosis risk remains high among PLWH and is related to TB incidence in the country of birth. Further work is required to determine whether specific groups of PLWH should be targeted for programmatic LTBI screening, and whether it will result in high uptake and completion of chemoprophylaxis and is cost-effective for widespread implementation.

The Relationship Between Socio-Demographic Factors and Tuberculosis Mortality in the Republic of Korea During 2008-2017.

The Republic of Korea has a high incidence of tuberculosis (TB) and TB-specific mortality rate. In 2019, it had the second highest TB-specific mortality among Organization for Economic Co-operation and Development countries. Understanding the factors associated with TB-specific deaths may help eradicate the disease. Therefore, we aimed to identify the general characteristics associated with TB-specific mortality among Koreans. Using Causes of Death Statistics data from Statistics Korea, we assessed the year of death, sex, age, occupation, area of residence, marital status, and education level reported between 2008 and 2017. Patient characteristics associated with TB-specific deaths were analyzed using the Chi-squared test, while influencing factors of TB-specific mortality were analyzed using logistic regression analysis to calculate adjusted odds ratios (AOR). Female (AOR: 0.509, 95% CI: 0.493-0.526), those with a graduate degree or higher (AOR: 0.559, 95% CI: 0.474-0.660) had lower TB-specific mortality rates than those of their counterparts. Conversely, those aged ≥70 years (AOR: 1.239, 95% CI: 1.199-1.280), single (AOR: 1.355, 95% CI: 1.315-1.396), and skilled agricultural, forestry, and fishery workers (AOR: 1.441, 95% CI: 1.359-1.529) had higher TB-specific mortality rates than those of their counterparts. In conclusion, TB-specific mortality rates differed according to the characteristics of the deceased patients. In order to establish effective TB control, multisectoral action on broader determinants should be strengthened.

Tuberculosis in Poland in 2019.

AIM OF THE STUDY: To evaluate the main features of epidemiology of tuberculosis (TB) in 2019 in Poland and to compare with the situation in the European Union and European Economic Area (EU/EEA) countries. MATERIAL AND METHODS: Analysis of case-based data on TB patients from National TB Register, data on anti-TB drug susceptibility in cases notified in 2019, data from Central Statistical Office on deaths from tuberculosis in 2018, data from National Institute of Public Health - National Institute of Hygiene on HIV-positive subjects for whom TB was an AIDS-defining disease, data from the report "European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2021 - 2019 data". RESULTS: In 2019, 5321 TB cases were reported in Poland. The incidence rate was 13.9 cases per 100,000 with large variability between voivodeships from 8.0 to 20.0 per 100,000. The number of all pulmonary tuberculosis cases was 5075 i.e. 13.2 per 100,000. Pulmonary cases represented 95.4% of all TB cases. In 2019, 246 extrapulmonary TB cases were notified (4.6% of all TB cases). Pulmonary tuberculosis was bacteriologically confirmed in 3926 cases (77.4% of all pulmonary TB cases, the incidence rate 10.2 per 100,000). The number of smear-positive pulmonary TB cases was 2565 i.e. 6.7 per 100,000 ( 48.2% of all pulmonary TB cases). In 2019, there were 41 cases (18 of foreign origin) with multidrug resistant TB (MDR-TB) representing 1.1% of cases with known drug sensitivity. The incidence rates of tuberculosis were growing along with the age group from 1.4 per 100,000 among children (0-14 years) to 23.9 per 100,000 among subjects in the age group 45-64 years, the incidence rate in the age group ≥65 years was 19.8 per 100,000. There were 81 cases in children up to 14 years of age (1.5% of the total) and 48 cases in adolescents between 15 and 19 years of age - rates 1.4 and 2.6 per 100,000 respectively. In 2019, there were 3897 cases of tuberculosis in men and 1424 in women. The TB incidence in men - 21.0 per 100,000 was 2.9 times higher than among women - 7.2. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 50-54 years - 40.2 vs. 8.1 and in age group 55 to 59 years - 45.1 vs. 9.0. In 2019, there were 121 patients of foreign origin among all cases of tuberculosis in Poland (2.3%). In 2018, TB was the cause of death for 519 people (mortality rate - 1.4 per 100,000). CONCLUSIONS: TB incidence in Poland in 2019 was lower than in the previous year. Differences in incidence between voivodships persist. The percentage of TB cases with bacteriological confirmation exceeded 75%, more than in EU/EEA countries (67.1%). In Poland, MDR-TB is less common than the average in the EU/EEA countries. In Poland, the highest incidence rates are found in older age groups. The percentage of children up to 14 years of age among all TB patients was 1.5%, lower than the average in EU/EEA countries (3.9%). The incidence of tuberculosis in men is nearly three times as high as in women. The impact of migration on the characteristics of tuberculosis in Poland is not substantial. The percentage of foreign-born persons among TB patients is low.

Joint Modeling of Incidence of Tuberculosis and Change in Viral Load Over Time Among Adult HIV/AIDS Patients on Anti-Retroviral Therapy at Zewditu Memorial Hospital in Addis Ababa, Ethiopia.

BACKGROUND: Globally, approximately 37.9 million people were living with HIV and one-third of these people are co-infected with tuberculosis (TB). However, little is known about predictors of tuberculosis incidence and its association with viral load. Thus, this study was aimed at assessing the incidence of tuberculosis and its predictors and its association with the longitudinal change in viral load over time among adult HIV/AIDS patients at Zewditu memorial hospital, Addis Ababa Ethiopia. METHODS: A retrospective follow-up study was conducted among 471 HIV patients. The proportional hazard assumption was checked for the survival sub-model and the longitudinal sub-model. Νormality assumption was checked. Then the joint model with time-dependent lagged parameterizations was fitted. The goodness of fit was checked using the Cox-Snell residual test and Akaike Information Criteria (AIC) was used for model selection. Finally, the hazard ratio with a 95% confidence interval (CI) with a corresponding P-value <0.05 was used. RESULTS: A total of 471 patients were followed for a minimum of 12 and a maximum of 48 months with a median follow-up time of 44 months [IQR (33, 46)]. The incidence rate was 3.08/1000 person-years (PY) with a 95% CI of [0.0023788, 0.003998). Age above 65 years adjusted hazard ratio (AHR) = 2.07, 95% CI: 1.06, 4.06), underweight at baseline (AHR = 2.29, 95% CI: 1.20, 4.35), past opportunistic infection (AHR = 2.98, CI: 1.23, 7.17) and 6th month lagged value of the viral load were significant predictors for being co-infected with TB. CONCLUSION: The incidence of TB among HIV/AIDS patients in Zewditu memorial hospital was low. Older age, underweight at baseline, and past opportunistic infection were significant predictors of time to TB co-infection. Thus, addressing significant predictors and strengthening continuous follow-up are highly recommended in the study setting.

Tuberculosis in Poland in 2018.

AIM OF THE STUDY: To evaluate the main features of tuberculosis (TB) epidemiology in 2018 in Poland and to compare with the situation in the EU/EEA countries. METHODS: Analysis of case- based data on TB patients from National TB Register, data on anti-TB drug susceptibility testing results in cases notified in 2018, data from National Institute of Public Health- National Institute of Hygiene on HIV-positive subjects for whom TB was an AIDS-defining disease, data from Central Statistical Office on deaths from tuberculosis based on death certificates, data from the report " European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2020- 2018 data. Stockholm: European Centre for Disease Prevention and Control, 2020". RESULTS: In 2018, 5487 TB cases were reported in Poland. The incidence rate was 14.3 cases per 100000, with large variability between voivodeships from 7.3 to 23.4 per 100 000. The mean annual decrease of TB incidence in 2014- 2018 was 3.8%. In 2018, 4852 cases were newly diagnosed with no history of previous treatment i.e. 12.6 per 100 000. 635 cases i.e. 1.7 per 100 000 - 11.6% of all registered subjects were previously treated for tuberculosis. In 2018, the number of all pulmonary tuberculosis cases was 5224 i.e. 13.7 per 100000. Pulmonary cases represented 95.2% of all TB cases. In 2018, 243 extrapulmonary TB cases were found i.e. 0.6 per 100 000. In the whole country there were 52 pediatric cases of tuberculosis. TB in children represented 0.9% of all cases notified in Poland in 2018. The incidence rates of tuberculosis were growing along with the age group from 0.9 per 100 000 among children to 24.7 per 100 000 among subjects in the age group 45-64 years (the highest incidence rate). In 2018, the incidence rate in the age group ≥65 years was 21.3 per 100 000. The TB incidence among men i.e. 21.0 per 100 000 was 2.6 times higher than among women i.e. 8.0 per 100 000. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 55 to 59 years - 44.9 vs. 9.8 and in age group 60- 64 years - 43.7 vs. 10.2. The TB incidence in rural population was lower than in urban, respectively 13.4 per 100 000 and 14.9 per 100 000. The number of all registered culture positive TB cases was 4075. Pulmonary tuberculosis was bacteriologically confirmed in 3935 subjects. Cases confirmed by culture represented 74.3% of all TB cases and 75.3% of all pulmonary TB cases. The number of smear-positive pulmonary TB cases reported in 2018 was 2324 i.e. 6.1 per 100 000 accounting for 44.3% of all pulmonary TB cases and 59.1% of pulmonary TB cases confirmed by culture. In all patients with tuberculosis in Poland in 2018 there were 48 cases with MDR-TB (among them 14 foreigners) and 83 patients with resistance to isoniazid only, representing respectively 1.3% and 2.2% of cases with known DST results (DSTs were available in 90.7% of all culture-confirmed TB cases). In 2018, there were 97 patients of foreign origin among all cases of tuberculosis in Poland. TB was AIDS-indicative disease in 14 subjects with HIV co-infection. There were 490 deaths due to tuberculosis reported in 2017 - 1.3 per 100 000; 468 people died from pulmonary and 22 from extrapulmonary tuberculosis. Mortality among males - 2.1 per 100 000 - was 3.6 X higher than among females - 0.5. 40.2% of all TB deaths were cases 65 years old and older - 3.1 per 100 000. In 2017, there was no death from tuberculosis in children and no deaths in adolescents. In 2017, tuberculosis represented 0.1% of total mortality in Poland and 25.4% of mortality from infectious and parasitic diseases. CONCLUSIONS: In 2018, the incidence of tuberculosis in Poland was lower than in 2017. Despite a continuous decline it is still higher than the average in the EU/EEA countries. The highest incidence rates were observed in older age groups. The participation of pediatric cases is smaller than average in the EU/EEA countries. The incidence in males was more than 2 times higher than in females. The impact of migration on the characteristics of tuberculosis in Poland is not substantial. In Poland, MDR-TB is less common than the average in the EU/EEA countries.

How Far Does Highly Active Antiretroviral Treatment Reduce TB Incidence among Children? A Marginal Structural Modeling Analysis, Southwest Ethiopia.

BACKGROUND: Children younger than 15 years, carry almost 80% of the global burden of HIV/AIDS. HIV worsens the progression of latent TB to active TB disease. Although antiretroviral treatment has shown marked reduction in Tuberculosis incidence, TB continues to occur in Sub-Saharan countries including Ethiopia. The aim of this study was to investigate the impact of HAART on the incidence of tuberculosis among children infected with HIV in Southwest Ethiopia. METHODS: A retrospective cohort study was conducted between 2009 to 2014. We used chi-square test, and Mann-Whitney U test to compare non-HAART and HAART cohort. We estimated the effect of HAART on TB incidence using marginal structural model after adjusting for time-dependent confounders affected by exposure. RESULT: A total of 844 children were followed. We observed them for a median of 51 months (IQR 31) and a total of 2942.99 child-years. The overall TB incidence rate was 7.917 per 100 child years (95% CI, 6.933-9.002). TB incidence for specific HAART and non-HAART cohort were 7.67 per 100 child-years (95% CI, 6.318-9.217) and 8.17 per 100 child-years (95% CI, 6.772-9.767) respectively. From marginal structural modeling, children on HAART were 36% (HR=0.642, 95% CI 0.442-0.931, p<0.02) less likely to develop TB compared to those who were not. CONCLUSION: HAART reduced the hazard of TB in HIV-infected children by 36%. This is by far less than what is expected.

Effect of isoniazid preventive therapy on tuberculosis incidence and associated risk factors among HIV infected adults in Tanzania: a retrospective cohort study.

BACKGROUND: Tuberculosis (TB) continues to be the leading cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals in Sub Saharan Africa including Tanzania. Provision of isoniazid preventive therapy (IPT) is one of the public health interventions to reduce the burden of TB among HIV infected persons. However there is limited information about the influence of IPT on TB incidence in Tanzania. This study aimed at ascertaining the effect of IPT on TB incidence and to determine risk factors for TB among HIV positive adults in Dar es Salaam region. METHODS: A retrospective cohort study was conducted using secondary data of HIV positive adults receiving care and treatment services in Dar es Salaam region from 2011 to 2014. TB incidence rate among HIV positive adults on IPT was compared to those who were not on IPT during the follow up period. Risk factors for incident TB were estimated using multivariate Cox proportional hazards regression model. RESULTS: A total of 68,378 HIV positive adults were studied. The median follow up time was 3.4 (IQR = 1.9-3.8) years for patients who ever received IPT and 1.3 (IQR = 0.3-1.3) years among those who never received IPT. A total of 3124 TB cases occurred during 114,926 total person-years of follow up. The overall TB incidence rate was 2.7/100 person-years (95%CI; 2.6-2.8). Patients on IPT had 48% lower TB incidence rate compared to patients who were not on IPT (IRR = 0.52, 95%CI; 0.46-0.59). Factors associated with higher risk for incident TB included; being male (aHR = 1.8, 95% CI; 1.6-2.0), WHO stage III (aHR = 2.7, 95% CI; 2.3-3.3) and IV (aHR = 2.4, 95% CI; 1.9-3.1),being underweight (aHR = 1.7, 95% CI; 1.5-1.9) while overweight (aHR = 0.7, 95% CI; 0.6-0.8), obese (aHR = 0.5, 95% CI; 0.4-0.7), having baseline CD4 cell count between 200 and 350 cells/µl (aHR = 0.7, 95% CI; 0.6-0.8) and CD4 count above 350 cells/µl (aHR = 0.5, 95% CI; 0.4-0.6) were associated with lower risk of developing TB. CONCLUSION: Isoniazid preventive therapy (IPT) has shown to be effective in reducing TB incidence among HIV infected adults in Dar es Salaam. More efforts are needed to increase the provision and coverage of IPT.

Incidence of tuberculosis and the need of prophylactic treatment in persons living with HIV in Stockholm during the era of anti-retroviral therapy 1996-2013.

BACKGROUND: The aim of this observational cohort study was to determine the incidence and risk factors of active tuberculosis (TB) in persons living with HIV in a low endemic setting over a 17-year time period when combination antiretroviral therapy (ART) has been available. We thereby aimed to understand the usefulness of TB chemoprophylaxis among HIV patients with latent TB. METHODS: All 2127 adult patients diagnosed with HIV January 1996-December 2013 at the Karolinska University Hospital in Stockholm County were eligible. After exclusion of 259 patients transferred to other clinics, 1868 were followed until TB diagnosis, death or end of study period (December 2013). The median follow-up time was 7.9 years (interquartile range, 3.9-11.5). RESULTS: Active TB was diagnosed in 92 patients, corresponding to an incidence rate of 6.2 cases (95% CI 5.1-7.6) per 1000 person-years with a significant decline over time. The majority (52%) of TB cases were diagnosed within 1 month from HIV diagnosis. Being a migrant from a TB-endemic region, was the only patient characteristic associated with significantly higher risk of active TB (Hazard Ration, HR: 8.54, 95% confidence interval, CI: 3.09-23.61 in a multivariate regression analysis controlling for route of HIV transmission, year of HIV diagnosis and CD4-cell count and viral load at HIV diagnosis. The number needed to treat to prevent one case of TB among patients in this high-risk group was 22 (95% CI 26-47). CONCLUSION: The incidence of active TB in persons living with HIV in Stockholm County declined significantly after the introduction of ART but was still 80 times higher than in the general population at the end of the study period. The therapeutic gain of chemoprophylaxis in low endemic settings should be weighed against costs and side effects.

Tuberculosis in Poland in 2016

AIM OF THE STUDY: To evaluate the main features of TB epidemiology in 2016 in Poland and to compare with the situation in the EU/EEA countries. METHODS: Analysis of case- based data on TB patients from National TB Register, data on anti-TB drug susceptibility testing results in cases notified in 2016, data from National Institute of Public Health- National Institute of Hygiene on cases of tuberculosis as AIDS-defining disease, data from Central Statistical Office on deaths from tuberculosis based on death certificates, data from ECDC report " European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2018- 2016 data. Stockholm: European Centre for Disease Prevention and Control, 2018". RESULTS: In 2016, 6 444 TB cases were reported in Poland. The incidence rate was 16.8 cases per 100 000, with large variability between voivodships from 8.1 to 24.3 per 100 000. The average decline of TB incidence was 3.0% per year during 2012- 2016. 5 713 cases were new, never treated i.e. 14.9 per 100 000. 731 cases i.e. 1.9 per 100 000 ­ 11.3% of all registered subjects were previously treated. In 2016, 6 116 pulmonary tuberculosis cases occurred in Poland, equivalent to 15.9 per 100 000. Pulmonary cases represented 94.9% of all TB cases. The number of pulmonary TB cases with bacteriological confirmation was 4475 i.e. 12,0 per 100 000. In 2016, only 328 extrapulmonary TB cases were reported. Pediatric cases represented 1.6% of the total TB cases in Poland; 103 children with TB were notified. The incidence of tuberculosis has been growing along with the age group from 1.8 per 100 000 among children to 27.8 per 100 000 among patients aged 45 to 64 years. In the age group 65 years old and older the incidence was 26.0 per 100 000. The incidence among men i.e. 24.0 per 100 000 was >2 times higher than among women i.e. 10.0 per 100 000. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 55 to 59 years ­ 51.9 vs. 11.5 and in subjects aged 60 to 64 years (45.9 vs. 11.7). The TB incidence in urban population was higher than in rural, respectively 17.3 per 100 000 and 15.9 per 100 000. In 2016, the number of all culture positive TB cases was 4619. Culture-confirmed cases represented 71.7% of all TB cases; culture-confirmed pulmonary TB ­ 73.2% of all pulmonary TB cases. In 2016, the number of smear-positive/culture positive pulmonary TB cases was 2612 (6.8 per 100 000) what represented 42.7% of all pulmonary TB cases. TB was initial AIDS indicative disease in 17 persons. In 2016, 46 cases with MDR-TB (among them 10 foreigners) and 101 patients with resistance solely to isoniazid were reported in Poland, representing respectively 1.1% and 2.4% of cases with known DST results (DSTs were done in 90.7% of all culture-confirmed TB cases). In 2016, there were 92 TB cases of foreign origin. In 2015, there were 537 deaths due to tuberculosis in Poland, which is equivalent to 1.4 deaths per 100 000 population; 520 people died from pulmonary and 17 from extrapulmonary tuberculosis. Mortality among males ­ 2.3 per 100 000 ­ was 3.8 x higher than among females ­ 0.6. The highest mortality rate was observed in subjects 65 years old and older ­ 3.3 per 100 000. There were no deaths from tuberculosis in children and adolescents. In 2015, TB mortality represented 0.14% of total mortality in Poland and 28.0% of mortality from infectious diseases. CONCLUSIONS: In 2016, the incidence of tuberculosis in Poland was slightly higher than in 2015 and higher than the average in the EU/EEA countries. The highest incidence rates were observed in older age groups. The incidence in males was more than 2 times higher than in females. The impact of migration on the characteristics of tuberculosis in Poland is low. In Poland, tuberculosis in children, tuberculosis in persons infected with HIV and MDR-TB is less common than the average in the EU/EEA countries.