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1.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48259

RESUMO

A tuberculose é um grave problema de saúde pública que, por séculos, permanece entre as doenças infecciosas que mais matam no mundo.


Assuntos
Tuberculose/prevenção & controle , Brasil , Organização Mundial da Saúde/organização & administração , Tuberculose/mortalidade
2.
Pan Afr Med J ; 38: 253, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104301

RESUMO

Introduction: proper tuberculosis (TB) infection control (TBIC) practice of health professionals is one of the effective TB prevention approaches. Despite this reality, the TBIC practice of health care workers was not been well studied. This study assessed the TBIC practice of health professionals and associated factors in Mizan Tepi University Teaching Hospital, southwest Ethiopia. Methods: an institution based quantitative cross-sectional study was conducted from September 1 to 30, 2019, by including all health professionals in the hospital. Participants who answered at least 50% of TBIC practice questions correctly were categorized as having good TBIC practice. Binary logistic regression was used to identify factors associated with the practice of the participants. The odds ratio with a 95% confidence interval and p-value was used to measure the strength of association; the significant association was declared at a p-value less than 0.05. Results: the study found that 64.1% (95% CI: 56.6%, 70.7%) of the participants had good TBIC practice. More than half, 102(51.5 %) of study participants have service years of greater than or equal to five years. Only the service year of health professionals was significantly associated [95%CI (AOR= 2.43; 95%CI: 1.28, 4.6)] with the respondents´ TBIC practice. Conclusion: only less than two-third of health professionals had good TBIC practice which is inadequate. And also experienced staff had significantly better TBIC practice. As a result, health professionals in MTUTH should be supported to practice TBIC as routine activity and opportunities should be made for senior staffs to share their TBIC experiences with others.


Assuntos
Pessoal de Saúde/estatística & dados numéricos , Controle de Infecções/métodos , Tuberculose/prevenção & controle , Adulto , Estudos Transversais , Etiópia , Feminino , Hospitais Universitários , Humanos , Masculino , Inquéritos e Questionários , Fatores de Tempo
3.
Pan Afr Med J ; 38: 243, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104291

RESUMO

The first COVID-19 case was reported in Ethiopia on 13th March 2020 and series of announcements of set of measures, proclamation and directives have been enacted to fight the coronavirus pandemic. These have implications for the regular health services including the TB control program. This brief communication assesses the impact of the COVID-19 response on the TB control activities of Addis Ababa health centers based on research project data. We compared the patient flows in pre-COVID-19 period (quarter 1, Q1) and during COVID-19 (quarter 2, Q2 and quarter 3, Q3) of 2020 at 56 health centers in Addis Ababa from all 10 sub-cities per sub-city. The patient flow declined from 3,473 in Q1 to 1,062 in Q2 and 1,074 in Q3, which is a decrease by 62-76% and 52-80% in Q2 and Q3 respectively as compared to that of Q1. In Q2, Kolfe keranio and Kirkos sub-cities recorded the biggest decline (76 and 75% respectively) whereas Yeka sub-city had the least decline (62%). In Q3, Kirkos sub-city had the biggest decline (80%) and Addis ketema sub-city had the lowest (52%). We conclude that the series of measures, state of emergency proclamation and government directives issued to counter the spread of COVID-19 and the public response to these significantly affected the TB control activities in Addis Ababa city as attested by the decrease in the patient flow at the clinics. Health authorities may inform the public that essential health services are still available and open to everyone in need of these services.


Assuntos
COVID-19 , Atenção à Saúde/organização & administração , Tuberculose/prevenção & controle , Etiópia , Humanos
4.
BMC Infect Dis ; 21(1): 511, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074268

RESUMO

INTRODUCTION: Discontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death. DTT in children is understudied in Uganda. We examined the level and factors associated with DTT among children at four large health facilities in Kampala Capital City Authority and documented the reasons for DTT from treatment supporters and healthcare provider perspectives. METHODS: We conducted a retrospective analysis of records for children < 15 years diagnosed and treated for TB between January 2018 and December 2019. We held focus group discussions with treatment supporters and key informant interviews with healthcare providers. We defined DTT as the stoppage of TB treatment for 30 or more consecutive days. We used a stepwise generalized linear model to assess factors independently associated with DTT and content analysis for the qualitative data reported using sub-themes. RESULTS: Of 312 participants enrolled, 35 (11.2%) had discontinued TB treatment. The reasons for DTT included lack of privacy at healthcare facilities for children with TB and their treatment supporters, the disappearance of TB symptoms following treatment initiation, poor implementation of the community-based directly observed therapy short-course (CB-DOTS) strategy, insufficient funding to the TB program, and frequent stock-outs of TB drugs. DTT was more likely during the continuation phase of TB treatment compared to the intensive phase (Adjusted odds ratio (aOR), 5.22; 95% Confidence Interval (CI), 1.76-17.52) and when the treatment supporter was employed compared to when the treatment supporter was unemployed (aOR, 3.60; 95% CI, 1.34-11.38). CONCLUSION: Many children with TB discontinue TB treatment and this might exacerbate TB morbidity and mortality. To mitigate DTT, healthcare providers should ensure children with TB and their treatment supporters are accorded privacy during service provision and provide more information about TB symptom resolution and treatment duration versus the need to complete treatment. The district and national TB control programs should address gaps in funding to TB care, the supply of TB drugs, and the implementation of the CB-DOTS strategy.


Assuntos
Tuberculose/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Terapia Diretamente Observada , Feminino , Grupos Focais , Instalações de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Razão de Chances , Estudos Retrospectivos , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Uganda/epidemiologia
5.
BMC Res Notes ; 14(1): 217, 2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059138

RESUMO

OBJECTIVES: To explore the mechanisms of collaboration between the stakeholders, including National Tuberculosis Control Program (NTP) and the Non-Communicable Disease Control and Prevention Program (NCDCP) at the national, regional, and local (health facility) levels of the health care system in Ghana. This is one of the objectives in a study on the "Barriers and Facilitators to the Implementation of the Collaborative Framework for the Care and Control of Tuberculosis and Diabetes in Ghana" RESULTS: The data analysis revealed 4 key themes. These were (1) Increased support for communicable diseases (CDs) compared to stagnant support for non-communicable diseases (NCDs), (2) Donor support, (3) Poor collaboration between NTP and NCDCP, and (4) Low Tuberculosis-Diabetes Mellitus (TB-DM) case detection.


Assuntos
Doenças Transmissíveis , Diabetes Mellitus , Tuberculose , Comorbidade , Diabetes Mellitus/epidemiologia , Gana/epidemiologia , Humanos , Tuberculose/epidemiologia , Tuberculose/prevenção & controle
8.
Int J Tuberc Lung Dis ; 25(5): 367-372, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33977904

RESUMO

BACKGROUND: TB is the leading cause of mortality among people living with HIV (PLHIV), for whom isoniazid preventive therapy (IPT) has a proven mortality benefit. Despite WHO recommendations, countries have been slow in scaling up IPT. This study describes processes, challenges, solutions, outcomes and lessons learned during IPT scale-up in Kenya.METHODS: We conducted a desk review and analyzed aggregated Ministry of Health (MOH) IPT enrollment data from 2014 to 2018 to determine trends and impact of program activities. We further analyzed IPT completion reports for patients initiated from 2015 to 2017 in 745 MOH sites in Nairobi, Central, Eastern and Western Kenya.RESULTS: IPT was scaled up 75-fold from 2014 to 2018: the number of PLHIV covered increased from 9,981 to 749,890. The highest percentage increases in the cumulative number of PLHIV on IPT were seen in the quarters following IPT pilot projects in 2014 (49%), national launch in 2015 (54%), and HIV treatment acceleration in 2016 (158%). Among 250,069 patients initiating IPT from 2015 to 2017, 97.5% completed treatment, 0.2% died, 0.8% were lost to follow-up, 1.0% were not evaluated, and 0.6% discontinued treatment.CONCLUSIONS: IPT can be scaled up rapidly and effectively among PLHIV. Deliberate MOH efforts, strong leadership, service delivery integration, continuous mentorship, stakeholder involvement, and accountability are critical to program success.


Assuntos
Infecções por HIV , Tuberculose , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Isoniazida/uso terapêutico , Quênia/epidemiologia , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle
9.
Int J Tuberc Lung Dis ; 25(5): 382-387, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33977906

RESUMO

In September 2018, all countries made a commitment at the first ever United Nations High-Level Meeting (UNHLM) on TB, to provide TB preventive treatment (TPT) to at least 30 million people at high-risk of TB disease between 2018 and 2022. In the WHO South-East Asia Region (SEA Region), which accounts for 44% of the global TB burden, only 1.2 million high-risk individuals (household contacts and people living with HIV) were provided TPT (11% of the 10.8 million regional UNHLM TPT target) in 2018 and 2019. By 2020, almost all 11 countries of the SEA Region had revised their policies on TPT target groups and criteria to assess TPT eligibility, and had adopted at least one shorter TPT regimen recommended in the latest WHO TPT guidelines. The major challenges for TPT scale-up in the SEA Region are resource shortages, knowledge and service delivery/uptake gaps among providers and service recipients, and the lack of adequate quantities of rifapentine for use in shorter TPT regimens. There are several regional opportunities to address these gaps and countries of the SEA Region must make use of these opportunities to scale up TPT services rapidly to reduce the TB burden in the SEA Region.


Assuntos
Tuberculose , Ásia Sudeste/epidemiologia , Extremo Oriente , Humanos , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Nações Unidas , Organização Mundial da Saúde
10.
Int J Tuberc Lung Dis ; 25(5): 388-394, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33977907

RESUMO

BACKGROUND: The WHO recommends TB symptom screening and TB preventive therapy (TPT) for latent TB infection (LTBI) in persons living with HIV (PLWH). However, TPT uptake remains limited. We aimed to characterize and contextualize gaps in the TPT care cascade among persons enrolling for antiretroviral therapy (ART).SETTING: Four PEPFAR-supported facilities in Uganda.METHODS: We studied a proportionate stratified random sample of persons registering for ART when TPT was available. Patient-level data on eligibility, initiation, and completion were obtained from registers to determine proportion of eligible patients completing each cascade step. We interviewed providers and administrators and used content analysis to identify barriers to guideline-concordant TPT practices.RESULTS: Of 399 study persons, 309 (77%) were women. Median age was 29 (IQR 25-34), CD4 count 405 cells/µL (IQR 222-573), and body mass 23 kg/m² (IQR 21-25). Of 390 (98%) screened, 372 (93%) were TPT-eligible. Only 62 (17%) eligible PLWH initiated and 36 (58%) of 62 completed TPT. Providers reported hesitating to prescribe TPT because they lacked confidence excluding TB by symptom screening alone and feared promoting drug resistance. Although isoniazid was available, past experience of irregular supply discouraged TPT initiation. Providers pointed to insufficient TB-dedicated staff, speculated that patients discounted TB risk, and worried TPT pill burden and side effects depressed ART adherence.CONCLUSIONS: While screening was nearly universal, most eligible PLWH did not initiate TPT. Only about half of those who initiated completed treatment. Providers feared promoting drug resistance, harbored uncertainty about continued availability, and worried TPT could antagonize ART adherence. Our findings suggest urgent need for stakeholder engagement in TPT provision.


Assuntos
Infecções por HIV , Tuberculose , Adulto , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Isoniazida , Masculino , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/prevenção & controle , Uganda
11.
Pan Afr Med J ; 38: 197, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33995803

RESUMO

Introduction: isoniazid preventive therapy for people living with HIV is an essential public health intervention in low-income countries with high tuberculosis and HIV burden. Despite available evidence that it is efficacious, its implementation is still low in many countries. This study was designed to determine its implementation coverage and explore barriers for suboptimal implementation in Songea municipality in Tanzania. Methods: a cross-sectional descriptive study design using both quantitative and qualitative approaches of data collection was employed. A review of 2148 records of people living with HIV eligible for isoniazid preventive therapy (IPT) was done to determine its implementation coverage. Twenty-one (21) in-depth interviews and 5 observations were conducted to explore barriers in the implementation. Quantitative data was analyzed using Statistical Package for the Social Science (SPSS) for windows version 20 statistical software. Descriptive statistics (frequencies and percentage) were employed and data were visualized using tables and bar graphs. All interviews were audio-recorded and analyzed using thematic analysis approach. Results: overall, isoniazid preventive therapy coverage at Songea municipality was estimated to be 45%. Insufficient drug supply and stock out, shortage of staff, lack of service privacy, long waiting time, drug side effects, pills burden, distance and cost of transport were the main reported barriers hindering full scale implementation of isoniazid preventive therapy. Conclusion: implementation of isoniazid preventive therapy in Songea municipality had low coverage. The study recommends that tuberculosis and HIV stakeholders must be part of the solutions by ensuring that the identified barriers are addressed.


Assuntos
Antituberculosos/administração & dosagem , Infecções por HIV/complicações , Isoniazida/administração & dosagem , Tuberculose/prevenção & controle , Adulto , Idoso , Antituberculosos/provisão & distribuição , Estudos Transversais , Feminino , Humanos , Isoniazida/provisão & distribuição , Masculino , Pessoa de Meia-Idade , Tanzânia
12.
F1000Res ; 10: 257, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33976866

RESUMO

The only currently available approach to early efficacy testing of tuberculosis (TB) vaccine candidates is in vivo preclinical challenge models. These typically include mice, guinea pigs and non-human primates (NHPs), which must be exposed to virulent M.tb in a 'challenge' experiment following vaccination in order to evaluate protective efficacy. This procedure results in disease development and is classified as 'Moderate' in severity under EU legislation and UK ASPA licensure. Furthermore, experiments are relatively long and animals must be maintained in high containment level facilities, making them relatively costly. We describe an in vitro protocol for the direct mycobacterial growth inhibition assay (MGIA) for use in the macaque model of TB vaccine development with the aim of overcoming some of these limitations. Importantly, using an in vitro assay in place of in vivo M.tb challenge represents a significant refinement to the existing procedure for early vaccine efficacy testing. Peripheral blood mononuclear cell and autologous serum samples collected from vaccinated and unvaccinated control animals are co-cultured with mycobacteria in a 48-well plate format for 96 hours. Adherent monocytes are then lysed to release intracellular mycobacteria which is quantified using the BACTEC MGIT system and colony-forming units determined relative to an inoculum control and stock standard curve. We discuss related optimisation and characterisation experiments, and review evidence that the direct NHP MGIA provides a biologically relevant model of vaccine-induced protection. The potential end-users of the NHP MGIA are academic and industry organisations that conduct the assessment of TB vaccine candidates and associated protective immunity using the NHP model. This approach aims to provide a method for high-throughput down-selection of vaccine candidates going forward to in vivo efficacy testing, thus expediting the development of a more efficacious TB vaccine and offering potential refinement and reduction to the use of NHPs for this purpose.


Assuntos
Mycobacterium tuberculosis , Vacinas contra a Tuberculose , Tuberculose , Animais , Cobaias , Leucócitos Mononucleares , Camundongos , Primatas , Tuberculose/prevenção & controle
13.
BMC Infect Dis ; 21(1): 486, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34039304

RESUMO

BACKGROUND: In countries with a high tuberculosis incidence such as Gabon, healthcare workers are at enhanced risk to become infected with tuberculosis due to their occupational exposure. In addition, transmission can occur between patients and visitors, if a tuberculosis infection is not suspected in time. Knowledge about tuberculosis and correct infection control measures are therefore highly relevant in healthcare settings. METHODS: We conducted an interviewer-administered knowledge, attitude and practice survey amongst healthcare workers in 20 healthcare facilities at all levels in the Moyen-Ogooué province, Gabon. Correctly answered knowledge questions were scored and then categorised into four knowledge levels. Additionally, factors associated with high knowledge levels were identified. Fisher's Exact test was used to identify factors associated with high knowledge levels. RESULTS: A total of 103 questionnaires were completed by various healthcare personnel. The most-frequently scored category was 'intermediate knowledge', which was scored by 40.8% (42/103), followed by 'good knowledge' with 28.2% (29/103) and 'poor knowledge' with 21.4% (22/103) of participating healthcare workers, respectively. 'Excellent knowledge' was achieved by 9.7% (10/103) of the interviewees. Apart from the profession, education level, type of employing healthcare facility, as well as former training on tuberculosis were significantly associated with high knowledge scores. Attitudes were generally positive towards tuberculosis infection control efforts. Of note, healthcare workers reported that infection control measures were not consistently practiced; 72.8% (75/103) of the participants were scared of becoming infected with tuberculosis, and 98.1% saw a need for improvement of local tuberculosis control. CONCLUSIONS: The survey results lead to the assumption that healthcare workers in the Moyen-Ogooué province are at high risk to become infected with tuberculosis. There is an urgent need for improvement of tuberculosis infection control training for local healthcare personnel, particularly for less trained staff such as assistant nurses. Furthermore, the lack of adequate infection control measures reported by staff could possibly be correlated with a lack of adequate facility structures and protective equipment and requires further investigation.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Tuberculose/prevenção & controle , Adulto , Estudos Transversais , Feminino , Gabão/epidemiologia , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Humanos , Controle de Infecções/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/prevenção & controle , Inquéritos e Questionários , Tuberculose/epidemiologia , Tuberculose/transmissão
14.
Stud Health Technol Inform ; 279: 130-135, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33965929

RESUMO

BACKGROUND: Intensified research and innovation and rapid uptake of new tools, interventions, and strategies are crucial to fight Tuberculosis, the world's deadliest infectious disease. The sharing of health data remains a significant challenge. Data consumers must be able to verify the consistency and integrity of data. Solutions based on distributed ledger technologies may be adequate, where each member in a network holds a unique credential and stores an identical copy of the ledger and contributes to the collective process of validating and certifying digital transactions. OBJECTIVES: This work proposes a mechanism and presents a use case in Digital Health to allow the verification of integrity and immutability of TB electronic health records. METHODS: IOTA was selected as a supporting tool due to its data immutability, traceability and tamper-proof characteristics. RESULTS: A mechanism to verify the integrity of data through hash functions and the IOTA network is proposed. Then, a set of TB related information systems was integrated with the network. CONCLUSION: IOTA technology offers performance and flexibility to enable a reliable environment for electronic health records.


Assuntos
Registros Eletrônicos de Saúde , Tuberculose , Atenção à Saúde , Humanos , Tecnologia , Tuberculose/prevenção & controle
15.
Immunol Rev ; 301(1): 98-121, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33955564

RESUMO

BCG turns 100 this year and while it might not be the perfect vaccine, it has certainly contributed significantly towards eradication and prevention of spread of tuberculosis (TB). The search for newer and better vaccines for TB is an ongoing endeavor and latest results from trials of candidate TB vaccines such as M72AS01 look promising. However, recent encouraging data from BCG revaccination trials in adults combined with studies on mucosal and intravenous routes of BCG vaccination in non-human primate models have renewed interest in BCG for TB prevention. In addition, several well-demonstrated non-specific effects of BCG, for example, prevention of viral and respiratory infections, give BCG an added advantage. Also, BCG vaccination is currently being widely tested in human clinical trials to determine whether it protects against SARS-CoV-2 infection and/or death with detailed analyses and outcomes from several ongoing trials across the world awaited. Through this review, we attempt to bring together information on various aspects of the BCG-induced immune response, its efficacy in TB control, comparison with other candidate TB vaccines and strategies to improve its efficiency including revaccination and alternate routes of administration. Finally, we discuss the future relevance of BCG use especially in light of its several heterologous benefits.


Assuntos
Vacina BCG/imunologia , Mycobacterium tuberculosis/imunologia , Tuberculose/imunologia , Tuberculose/prevenção & controle , Vacinação , Imunidade Adaptativa , Vacina BCG/administração & dosagem , Humanos , Imunidade Heteróloga , Imunidade Inata , Imunogenicidade da Vacina , Memória Imunológica
16.
BMC Public Health ; 21(1): 859, 2021 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947361

RESUMO

BACKGROUND: The Ministry of Health Zambia recommends tuberculosis preventive treatment (TPT) with 6 months daily isoniazid for all people living with human immunodeficiency virus (HIV) after ruling out active tuberculosis disease. We sought to estimate the percentage of people living with HIV who progress through each stage of the tuberculosis case-finding and prevention cascade in two provinces with the highest tuberculosis burden in Zambia. METHODS: In this cross-sectional survey, we used a two-stage cluster sampling method. We sampled 12 healthcare facilities with probability proportional to size. Patient volume determined facility cluster size. During October 2018, from each facility we systematically sampled medical records of adults and children living with HIV. Our primary outcome of interest was TPT initiation rate among eligible people living with HIV, weighted for complex survey design. The Rao-Scott adjusted chi-square test was used to test for differences in TPT initiation rate and other indicators from the tuberculosis prevention cascade by age group and province of residence. Additionally, we conducted semi-structured interviews with healthcare workers at each facility to assess TPT knowledge and identify challenges to its implementation. RESULTS: We sampled 482 records of people living with HIV (including 128 children living with HIV). Excluding two people diagnosed with tuberculosis disease before enrollment in HIV care, 93.4% underwent tuberculosis symptom screening. Of those, 4.7% were diagnosed with tuberculosis disease and 95.3% were TPT-eligible, of whom 24.7% initiated TPT. TPT initiation was lower among eligible children (7.7%) compared with adults (25.2%, p = 0.03) and Copperbelt residents (3.1%) compared with Lusaka residents (35.8%, p < 0.01). TPT completion rate was 38.4% among people living with HIV who initiated the 6-month course. Among interviewed healthcare workers, 58.3% (unweighted) incorrectly relayed the number of symptoms needed for a positive tuberculosis symptom screen, 83.3% (unweighted) reported insufficient isoniazid stockpile for completion at the time of TPT initiation, and only 27.3% (unweighted) reported receiving TPT-specific training. CONCLUSIONS: TPT uptake among people living with HIV in Zambia is challenged by inconsistent tuberculosis screening, lack of TPT training for healthcare workers, and supply chain inefficiencies. Addressing these barriers may increase TPT initiations and improve outcomes among people living with HIV.


Assuntos
Infecções por HIV , Tuberculose , Adulto , Antituberculosos/uso terapêutico , Criança , Estudos Transversais , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Zâmbia/epidemiologia
17.
J Infect Public Health ; 14(5): 588-597, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33848888

RESUMO

BACKGROUND: Healthcare workers (HCWs) in high tuberculosis (TB) burden countries are at increased risk of TB infection due to increased exposures to TB patients and inadequate implementation of TB infection prevention and control (TB IPC) measures in health settings. While various guidelines on TB IPC exist, there is little understanding of the content of these guidelines, whether they are relevant to the context and are being appropriately implemented in low-and middle-income high TB burden countries. This study aimed to critically examine the implementation of TB IPC guidelines, along with factors impacting TB IPC implementation in health settings in seven high TB burden countries. METHODS: The WHO 2009 and national level TB IPC guidelines and the published literature from seven TB high burden countries were reviewed and relevant information extracted. Eleven key-stakeholders from the case study countries were interviewed to elucidate further facilitators and barriers impacting TB IPC guidelines implementation. RESULTS: Our study identified that all the study countries adopted the WHO 2009 guidelines with no or minimal modifications for the local context. Therefore, the subsequent translation of the TB IPC recommendations into practice has been limited and impaired in some settings. Poor infrastructure, inadequate space for isolation, lack of TB IPC training, limited supply of personal protective equipment, the discomfort of using N95 respirators, and a high number of TB patients were some of the factors impacting the implementation of TB IPC guidelines. CONCLUSION: The implementation of TB IPC guidelines in all seven countries was limited. It was affected by the diverse context where each of the countries and each of the facilities had a different health infrastructure and TB disease burdens. The findings warrant re-assessment of the current context prevailing in these high TB burden countries and subsequent revisions of national guidelines based to account for local context and evidence.


Assuntos
Tuberculose Latente , Tuberculose , Antibioticoprofilaxia , Pessoal de Saúde , Humanos , Controle de Infecções , Equipamento de Proteção Individual , Tuberculose/prevenção & controle
18.
Vaccine ; 39(20): 2736-2745, 2021 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-33810902

RESUMO

INTRODUCTION: Revaccination with Bacillus Calmette-Guérin (BCG) vaccine is not generally recommended due to a lack of proven efficacy of repeat doses for protection against tuberculosis. However, there is a growing interest in the use of BCG vaccine for its 'off-target' effects which might involve revaccination. We did a systematic review of the safety of BCG revaccination. METHODS: MEDLINE (1946 to March 2020) and the BCG World Atlas (updated 2017) were searched, limiting to studies of BCG administration by the intradermal or percutaneous route. Adverse events as well as patient and vaccine characteristics were reviewed. RESULTS: The search identified 388 articles, of which 24 met the inclusion criteria. These reported 22 studies comprising eight randomised trials, four case-control studies, four observational studies and six case series or reports. Overall, there was evidence for a small increase in the rate of mild local and systemic reactions. No serious adverse events were reported in immunocompetent individuals. CONCLUSIONS: Evidence to date suggests that revaccination with BCG vaccine carries minimal risk. Future studies of BCG vaccine for novel applications should report adverse event data stratified by prior BCG vaccination status.


Assuntos
Mycobacterium bovis , Tuberculose , Vacina BCG/efeitos adversos , Humanos , Imunização Secundária , Tuberculose/prevenção & controle , Vacinação
19.
BMC Health Serv Res ; 21(1): 295, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794878

RESUMO

BACKGROUND: Nepal has a high burden of undetected tuberculosis (TB). In line with the World Health Organization's End TB Strategy, the National TB Programme promotes active case-finding (ACF) as one strategy to find people with TB who are unreached by existing health services. The IMPACT TB (Implementing proven community-based active TB case-finding intervention) project was implemented in four districts in Nepal, generating a substantial yield of previously undetected TB. We aimed to identify the facilitators and barriers linked to the implementation of ACF within IMPACT TB, as well as how those facilitators and barriers have been or could be addressed. METHODS: This was an exploratory qualitative study based on 17 semi-structured key-informant interviews with people with TB who were identified through ACF, and community health workers who had implemented ACF. Thematic analysis was applied in NVivo 11, using an implementation science framework developed by Grol and Wensing to classify the data. RESULTS: We generated five main themes from the data: (1) ACF addressed the social determinants of TB by providing timely access to free healthcare, (2) knowledge and awareness about TB among people with TB, communities and community health workers were the 'oil' in the ACF 'machine', (3) trust in community health workers was fundamental for implementing ACF, (4) community engagement and support had a powerful influence on ACF implementation and (5) improved working conditions and enhanced collaboration with key stakeholders could further facilitate ACF. These themes covered a variety of facilitators and barriers, which we divided into 22 categories cutting across five framework levels: innovation, individual professional, patient, social context and organizational context. CONCLUSIONS: This study provides new insights into facilitators and barriers for the implementation of ACF in Nepal and emphasizes the importance of addressing the social determinants of TB. The main themes reflect key ingredients which are required for successful ACF implementation, while the absence of these factors may convert them from facilitators into barriers for ACF. As this study outlined "how-to" strategies for ACF implementation, the findings can furthermore inform the planning and implementation of ACF in Nepal and similar contexts in low- and middle-income countries.


Assuntos
Agentes Comunitários de Saúde , Tuberculose , Saúde Global , Humanos , Nepal/epidemiologia , Pesquisa Qualitativa , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle
20.
J Neurol Sci ; 425: 117447, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-33878657

RESUMO

Data regarding the risk of tuberculosis (TB) in myasthenia gravis (MG) patients receiving immunosuppressive therapy is limited, and the benefit of TB preventative therapy in these patients is uncertain. We audited observational data collected at an MG clinic in South Africa over a ~ 10-year period, of cases who received immunosuppressive therapy. The total time that the cohort was at risk (patient-years) was used as the denominator to calculate TB incidence after immunosuppressive therapy initiation. Multivariate logistic regression analysis was performed to identify differences between patients who did, and those who did not, develop TB. Of 480 cases, only two received TB preventative therapy when starting immunotherapy. Seventeen of 282 (6%) patients tested, were HIV-infected. With a median follow-up of 3.6 years (interquartile range 1;7.5), 13 (3%) patients (all HIV-uninfected) developed TB (38% within 12 months of starting immunosuppressive therapy). The incidence rate of TB in the study population (≤401/100000 person-years) was not higher than that for the hospital's catchment area during the same period (>500/100000 population). The maximum dose of prescribed prednisone was higher in patients who developed TB compared to those who did not (median: 0.6 mg/kg/day vs 0.4; 0.002); Odds ratio for TB increased 1.26-fold for every 0.1 mg/kg/day increase in maximum dose (p = 0.001). In our TB endemic setting, receiving immunosuppressive therapy was not associated with excess TB in MG patients. Preventative therapy may be considered in those who are at greatest risk of developing TB and receiving high-dose prednisone.


Assuntos
Infecções por HIV , Miastenia Gravis , Tuberculose , Antituberculosos/efeitos adversos , Estudos de Coortes , Infecções por HIV/tratamento farmacológico , Humanos , Incidência , Miastenia Gravis/tratamento farmacológico , Miastenia Gravis/epidemiologia , África do Sul/epidemiologia , Tuberculose/epidemiologia , Tuberculose/prevenção & controle
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