Magnitude, associated risk factors, and trend comparisons of identified tuberculosis types among prisons in Ethiopia: A systematic review and meta-analysis

Global perspectives on tuberculosis in prisons and incarceration centers - Risk factors, priority needs, challenges for control and the way forward

Tuberculosis (TB) remains a prominent cause of illness and mortality worldwide. Prisons are hotspots for TB transmission worldwide. We reviewed the literature on TB in prisons worldwide, including TB risk factors, delays in diagnosis including drug resistance, the treatment accorded, and operational and logistical issues of TB care in prison. The quantity and quality of data on TB in prisons varies worldwide. The TB incidence rate in prisons varies by World Health Organization region, with African countries having the highest rates of TB and TB/HIV co-infection. Its incidence rate among inmates is about 10 times higher than that of the general population. The growing prevalence of multidrug-resistant TB is particularly concerning, as it may affect high-risk settings and disproportionately affects vulnerable populations, such as prisoners and incarcerated individuals who go undiagnosed for extended periods of time. Factors that drive the high TB rates in prisons include limited access to health services such as TB care, overcrowding, poor ventilation, malnutrition, HIV, alcohol use disorders, illegal drug use, smoking, and other comorbidities, compounded by limited access to healthcare. Addressing TB in prisons requires a multifaceted approach, that includes improving living conditions, enhancing healthcare services, and developing innovative detection methods. The ongoing conflicts in Europe, the Middle East, Asia, and Africa further complicated TB prevention and control efforts in prisons, emphasizing the need for targeted interventions to address TB in these high-risk settings. Structured interventions tailored to the specific risk factors present in each environment should be investigated to effectively focus measures aimed at diminishing the overall burden of TB in prisons. Electronic record-keeping worldwide will allow for accurate data to be collected and shared.

Prevalence of Opportunistic Infections and Determinants Among HIV-Positive Patients in Ethiopia: A Systematic Review and Meta-Analysis

Background and Aims

Opportunistic infections (OIs) associated with HIV are the primary cause of morbidity and mortality among individuals living with HIV/AIDS. Evaluating the extent of OIs at the national level is essential for developing targeted interventions and effective control measures. Therefore, the aim of this study was to evaluate the pooled prevalence and identify the associated factors of OIs among HIV-positive individuals across all age groups.

Methods

This systematic review and meta-analysis was conducted following the PRISMA guidelines. It included studies published in English, research articles conducted in Ethiopia, and articles released between 2013 and 2023. A systematic search of articles on the prevalence and determinants of OIs among patients living with HIV in Ethiopia was conducted across four databases (PubMed, ScienceDirect, Scopus, and the Cochrane Library). To evaluate heterogeneity and publication bias, the study employed Cochran's Q, inverse variance (I2), sensitivity analysis, funnel plots, and Begg and Egger regression tests. The meta-analysis was executed using STATA software, version 14.

Results

Of the 207 articles examined, only 26 met the inclusion requirements. The overall prevalence of OIs among HIV-positive patients was 42.71% (95% CI: 36.87-48.56). OIs among HIV-positive individuals were significantly associated with baseline WHO clinical stage II and above (OR: 2.83; 95% CI: 1.93-3.73), khat chewers (OR: 1.94; 95% CI: 1.21-2.66), poor adherence to ART (OR: 2.32; 95% CI: 1.51-3.13), and individuals with an initial CD4 number less than 200 cells/mm3 (OR: 2.32; 95% CI: 1.55-3.09).

Conclusion

Chewing khat, poor adherence, low CD4 count, and WHO stage II and above were found to be predictors of OIs. A constant state of awareness is required for healthcare providers to improve decisions about the proper diagnosis and management of OIs among HIV-positive individuals.

Prevalence of pulmonary tuberculosis among key and vulnerable populations in hotspot settings of Ethiopia. A systematic review and meta-analysis

BACKGROUND

Despite the decline in tuberculosis (TB) incidence across many regions worldwide, including Ethiopia, the disease remains highly concentrated among vulnerable or socially marginalized populations and in high-risk settings. This systematic review and meta-analysis aims to estimate the pooled prevalence of pulmonary tuberculosis (PTB) among key and vulnerable populations (KVPs) residing in hotspot settings in Ethiopia.

METHODS

Potential papers were searched systematically in PubMed, Scopus, ScienceDirect databases, Google Scholar search engine, and institutional electronic repositories/registrars. A total of 34 potential articles that provide necessary information on the prevalence of PTB were reviewed and data were analyzed to determine the pooled prevalence of PTB among KVPs. The relevant data were recorded and analyzed using STATA 17.0. Cohen's kappa was computed to determine the agreement between reviewers, the Inverse of variance (I2) to evaluate heterogeneity across studies, and Egger's test to identify publication bias. A random effect model was used to determine the pooled prevalence of PTB, subgroup analysis was computed by types of hotspot settings and year of publication.

RESULTS

This meta-analysis demonstrates that the pooled prevalence of PTB among populations residing in hotspot settings in Ethiopia was 11.7% (95% confidence interval (95CI): 7.97-15.43) with an I2 of 99.91% and a p< 0.001. Furthermore, the subgroup analysis unveiled the pooled prevalence of PTB among KVPs residing in different hotspot settings as follows: Prison inmates 8.8% (95CI: 5.00-12.55%), University students 23.1% (95CI: 15.81-30.37%), Refugees 28.4% (95CI: -1.27-58.15%), Homeless peoples 5.8% (95CI: -0.67-12.35%), Healthcare settings 11.1% (95CI: 0.58-21.63%), Spiritual holy water sites attendees 12.3% (95CI: -6.26-30.80%), and other high-risk settings 4.3% (95CI: 0.47-8.09%). Besides, the subgroup analysis revealed that the pooled prevalence of PTB post-2015 was 10.79% (95CI: 5.94-15.64%), whereas it stood at 14.04% (95CI: 10.27-17.82%) before 2015.

CONCLUSION

The prevalence of PTB among KVPs residing in the hotspot settings in Ethiopia remains significant, with a weighted pooled prevalence of 11.7%. Thus, the national TB control programs should give due attention and appropriate control measures should be instituted that include regular systematic TB screening, compulsory TB testing for presumptive TB cases among KVPs, and tightened infection control at hotspot settings.

Patterns and profiles of drug resistance-conferring mutations in Mycobacterium tuberculosis genotypes isolated from tuberculosis-suspected attendees of spiritual holy water sites in Northwest Ethiopia

Purpose

This study examined the patterns and frequency of genetic changes responsible for resistance to first-line (rifampicin and isoniazid), fluoroquinolones, and second-line injectable drugs in drug-resistant Mycobacterium tuberculosis (MTB) isolated from culture-positive pulmonary tuberculosis (PTB) symptomatic attendees of spiritual holy water sites (HWSs) in the Amhara region.

Patients and methods

From June 2019 to March 2020, a cross-sectional study was carried out. A total of 122 culture-positive MTB isolates from PTB-suspected attendees of HWSs in the Amhara region were evaluated for their drug resistance profiles, and characterized gene mutations conferring resistance to rifampicin (RIF), isoniazid (INH), fluoroquinolones (FLQs), and second-line injectable drugs (SLIDs) using GenoType®MTBDRplus VER2.0 and GenoType®MTBDRsl VER2.0. Drug-resistant MTB isolates were Spoligotyped following the manufacturer's protocol.

Results

Genetic changes (mutations) responsible for resistance to RIF, INH, and FLQs were identified in 15/122 (12.3%), 20/122 (16.4%), and 5/20 (25%) of MTB isolates, respectively. In RIF-resistant, rpoB/Ser531Lue (n = 12, 80%) was most frequent followed by His526Tyr (6.7%). Amongst INH-resistant isolates, katG/Ser315Thr1 (n = 19, 95%) was the most frequent. Of 15 MDR-TB, the majority (n = 12, 80%) isolates had mutations at both rpoB/Ser531Leu and katG/Ser315Thr1. All 20 INH and/or RIF-resistant isolates were tested with the MTBDRsl VER 2.0, yielding 5 FLQs-resistant isolates with gene mutations at rpoB/Ser531Lue, katG/Ser315Thr1, and gyrA/Asp94Ala genes. Of 20 Spoligotyped drug-resistant MTB isolates, the majority (n = 11, 55%) and 6 (30%) were SIT149/T3-ETH and SIT21/CAS1-Kili sublineages, respectively; and they were any INH-resistant (mono-hetero/multi-). Of 15 RIF-resistant (RR/MDR-TB) isolates, 7 were SIT149/T3-ETH, while 6 were SIT21/CAS1-Kili sublineages. FLQ resistance was detected in four SIT21/CAS1-Kili lineages.

Conclusion

In the current study, the most common gene mutations responsible for resistance to INH, RIF, and FLQs were identified. SIT149/T3-ETH and SIT21/CAS1-Kili constitute the majority of drug-resistant TB (DR-TB) isolates. To further understand the complete spectrum of genetic changes/mutations and related genotypes, a sequencing technology is warranted.