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Magodoro IM, Guerrero-Chalela CE, Myer L, Jao J, Ntsekhe M, Wilkinson KA, Wilkinson RJ, Zar H, Ntusi NA. Effect of prior tuberculosis on cardiovascular status in perinatally HIV-1-infected adolescents. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.09.24303989. [PMID: 38559174 PMCID: PMC10980126 DOI: 10.1101/2024.03.09.24303989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Whether, and how, co-occurring HIV-1 infection (HIV) and tuberculosis (TB) impact cardiovascular status, especially in adolescents with perinatally acquired HIV (APHIV), have not been examined. We hypothesized that APHIV with previous active TB have worse cardiac efficiency than APHIV without TB, which is mediated by increased inflammation. Arterial elastance (Ea) and ventricular end-systolic elastance (Ees) were assessed by cardiovascular magnetic resonance, and ventriculoarterial coupling (VAC) estimated as Ea/Ees ratio. Inflammation was measured by high sensitivity C-reactive protein (hsCRP). Previous TB in APHIV was associated with reduced cardiac efficiency, related to an altered ventriculoarterial coupling. However, we did not find evidence of hsCRP mediated effects in the association between prior TB and cardiac efficiency. The clinical significance of these findings requires further study, including a wider range of biomarkers of specific immune pathways.
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2
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Belard S, Taccari F, Kumwenda T, Huson MA, Wallrauch C, Heller T. Point-of-care ultrasound for tuberculosis and HIV-revisiting the focused assessment with sonography for HIV-associated tuberculosis (FASH) protocol and its differential diagnoses. Clin Microbiol Infect 2024; 30:320-327. [PMID: 37923216 DOI: 10.1016/j.cmi.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/10/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The 'Focused assessment with sonography for HIV-associated tuberculosis' (FASH) protocol has been applied and researched for over a decade in HIV-infected patients with suspected extra-pulmonary tuberculosis. Interpretation of target FASH features may be challenging as they can also indicate alternative opportunistic diseases. OBJECTIVES The primary aim of the review was summarizing the accumulated evidence on the diagnostic accuracy of the FASH protocol including description of diagnoses of target FASH features. SOURCES Literature was searched using PubMed, Google Scholar, and publications referencing the original FASH publications; data from identified studies were compiled with data from studies identified by a preceding Cochrane review. A meta-analysis was performed based on a generalized linearized mixed model. Data on differential diagnoses were compiled by literature review and retrospective evaluation of clinical data. CONTENT We identified ten studies; abdominal target FASH features were most studied. Sensitivity and specificity estimates were 39% (95% CI 25-54) and 89% (95% CI 83-96) for enlarged lymph nodes (ten studies), and 30% (95% CI 16-45%) and 93% (95% CI 89-98%) for hypoechoic spleen lesions (eight studies). In people living with HIV differential diagnoses of target FASH features are multiple and primarily include other opportunistic infections and malignancies such as non-tuberculous mycobacterial infection, bacillary angiomatosis, hepato-splenic brucellosis, meliodiosis, visceral leishmaniasis, invasive fungal infections, and lymphoma as well as Kaposi sarcoma. Ultrasound-guided diagnostic sampling may assist obtention of a definitive diagnosis. IMPLICATIONS On the basis of current evidence, although limited by methodology, and personal experience, we recommend basic ultrasound training, including the FASH protocol and ultrasound-guided diagnostic interventions, for all healthcare providers working with people living with HIV in resource-limited settings.
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Affiliation(s)
- Sabine Belard
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Partner Site Tübingen, German Center for Infection Research (DZIF), Tübingen, Germany.
| | - Francesco Taccari
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Michaëla Am Huson
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Tom Heller
- Lighthouse Clinic Trust, Lilongwe, Malawi; International Training and Education Center for Health, University of Washington, Seattle, WA, USA
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3
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Konstantinidis I, Crothers K, Kunisaki KM, Drummond MB, Benfield T, Zar HJ, Huang L, Morris A. HIV-associated lung disease. Nat Rev Dis Primers 2023; 9:39. [PMID: 37500684 PMCID: PMC11146142 DOI: 10.1038/s41572-023-00450-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/29/2023]
Abstract
Lung disease encompasses acute, infectious processes and chronic, non-infectious processes such as chronic obstructive pulmonary disease, asthma and lung cancer. People living with HIV are at increased risk of both acute and chronic lung diseases. Although the use of effective antiretroviral therapy has diminished the burden of infectious lung disease, people living with HIV experience growing morbidity and mortality from chronic lung diseases. A key risk factor for HIV-associated lung disease is cigarette smoking, which is more prevalent in people living with HIV than in uninfected people. Other risk factors include older age, history of bacterial pneumonia, Pneumocystis pneumonia, pulmonary tuberculosis and immunosuppression. Mechanistic investigations support roles for aberrant innate and adaptive immunity, local and systemic inflammation, oxidative stress, altered lung and gut microbiota, and environmental exposures such as biomass fuel burning in the development of HIV-associated lung disease. Assessment, prevention and treatment strategies are largely extrapolated from data from HIV-uninfected people. Smoking cessation is essential. Data on the long-term consequences of HIV-associated lung disease are limited. Efforts to continue quantifying the effects of HIV infection on the lung, especially in low-income and middle-income countries, are essential to advance our knowledge and optimize respiratory care in people living with HIV.
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Affiliation(s)
- Ioannis Konstantinidis
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kristina Crothers
- Veterans Affairs Puget Sound Healthcare System and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ken M Kunisaki
- Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - M Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Heather J Zar
- Department of Paediatrics & Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Laurence Huang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alison Morris
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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4
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Cranmer LM, Cotton MF, Day CL, Nemes E. What's Old and New in Tuberculosis Vaccines for Children. J Pediatric Infect Dis Soc 2022; 11:S110-S116. [PMID: 36314550 PMCID: PMC9620432 DOI: 10.1093/jpids/piac078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tuberculosis (TB) is a leading cause of global child mortality. Until the turn of the 21st century, Mycobacterium bovis bacille Calmette-Guerin (BCG) was the only vaccine to prevent TB. The pediatric TB vaccine pipeline has advanced in the past decade to include the evaluation of novel whole cell vaccines to replace infant BCG and investigation of subunit and whole cell vaccines to boost TB immunity during adolescence. We describe the history of BCG, current TB vaccine candidates in clinical trials, and the challenges and opportunities for future TB vaccine research in children. Children are a critical target population for TB vaccines, and expansion of the pediatric TB vaccine pipeline is urgently needed to end the TB pandemic.
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Affiliation(s)
- Lisa M Cranmer
- Department of Pediatrics, Division of Pediatric Infectious Disease, Emory School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Mark F Cotton
- Department of Pediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - Cheryl L Day
- Department of Microbiology & Immunology, Emory School of Medicine, Atlanta, Georgia, USA
- Emory Vaccine Center, Atlanta, Georgia, USA
| | - Elisa Nemes
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
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5
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Kay A, Mendez-Reyes J, Devezin T, Bakaya M, Steffy T, Dlamini S, Msekandiana A, Ness T, Bacha J, Amuge P, Matshaba M, Chodota M, Nyasulu P, Thahane L, Mwita L, Kekitiinwa A, DiNardo A, Lukhele B, Kirchner HL, Mandalakas A. Optimal Timing of Antiretroviral Therapy Initiation in Children and Adolescents With Human Immunodeficiency Virus-Associated Pulmonary Tuberculosis. Clin Infect Dis 2022; 76:10-17. [PMID: 36097966 PMCID: PMC9825818 DOI: 10.1093/cid/ciac765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/29/2022] [Accepted: 09/09/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There is insufficient evidence in children and adolescents with human immunodeficiency virus (CAHIV) to guide the timing of antiretroviral treatment (ART) initiation after starting treatment for pulmonary tuberculosis (pTB). To address this knowledge gap, we evaluated the risk of mortality associated with timing of ART initiation in ART-naive CAHIV treated for pTB. METHODS Data were extracted from electronic medical records of ART-naive patients, aged 0-19 years, who were treated for HIV-associated pTB at Baylor Centers of Excellence in Botswana, Eswatini, Malawi, Lesotho, Tanzania, or Uganda between 2013 and 2020. Data were analyzed against a primary outcome of all-cause mortality with unadjusted Kaplan-Meier curves and Cox proportional hazard models. RESULTS The study population included 774 CAHIV with variable intervals to ART initiation after starting TB treatment: <2 weeks (n = 266), 2 weeks to 2 months (n = 398), >2 months (n = 66), and no ART initiated (n = 44). Adjusted Cox proportional hazards models demonstrated increased mortality 1 year from TB treatment initiation in children never starting ART (adjusted HR [aHR]: 2.67; 95% CI: 1.03, 6.94) versus children initiating ART between 2 weeks and 2 months from TB treatment initiation. Mortality risk did not differ for the <2-weeks group (aHR: 1.02; 95% CI: .55, 1.89) versus the group initiating ART between 2 weeks and 2 months. CONCLUSIONS This retrospective study demonstrated no increase in mortality among CAHIV initiating ART <2 weeks from TB treatment initiation. Given the broad health benefits of ART, this evidence supports the recent WHO recommendation for CAHIV to initiate ART within 2 weeks of initiating TB treatment.
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Affiliation(s)
- Alexander Kay
- Correspondence: A. Kay, Baylor College of Medicine, Associate Director of the Baylor College of Medicine Global TB Program, Baylor College of Medicine Children's Foundation Eswatini, PO Box 110, Mbabane H-100, Eswatini or Baylor College of Medicine, 1102 Bates St, FC-630, Houston, TX 77030, USA ()
| | - Jose Mendez-Reyes
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Tara Devezin
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Meenakshi Bakaya
- Baylor College of Medicine Children's Foundation–Lesotho, Maseru, Lesotho
| | - Teresa Steffy
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Baylor College of Medicine Children's Foundation–Lesotho, Maseru, Lesotho
| | - Sandile Dlamini
- Baylor College of Medicine Children's Foundation–Swaziland, Mbabane, Eswatini
| | - Amos Msekandiana
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Tara Ness
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Jason Bacha
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Baylor College of Medicine Children’s Foundation–Tanzania, Mbeya, Tanzania
| | - Pauline Amuge
- Baylor College of Medicine Children's Foundation–Uganda, Kampala, Uganda
| | - Mogomotsi Matshaba
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Moses Chodota
- Baylor College of Medicine Children’s Foundation–Tanzania, Mbeya, Tanzania
| | - Phoebe Nyasulu
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Lineo Thahane
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Baylor College of Medicine Children's Foundation–Lesotho, Maseru, Lesotho
| | - Lumumbwa Mwita
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Baylor College of Medicine Children's Foundation–Tanzania, Mwanza, Tanzania
| | - Adeodata Kekitiinwa
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Baylor College of Medicine Children's Foundation–Uganda, Kampala, Uganda
| | - Andrew DiNardo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Bhekumusa Lukhele
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Baylor College of Medicine Children's Foundation–Swaziland, Mbabane, Eswatini
| | - H Lester Kirchner
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Anna Mandalakas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA,Research Center Borstel, Clinical Infectious Diseases, Borstel, Germany
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Kay AW, Rabie H, Maleche-Obimbo E, Sekadde MP, Cotton MF, Mandalakas AM. HIV-Associated Tuberculosis in Children and Adolescents: Evolving Epidemiology, Screening, Prevention and Management Strategies. Pathogens 2021; 11:33. [PMID: 35055981 PMCID: PMC8780758 DOI: 10.3390/pathogens11010033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Children and adolescents living with HIV continue to be impacted disproportionately by tuberculosis as compared to peers without HIV. HIV can impact TB screening and diagnosis by altering screening and diagnostic test performance and can complicate prevention and treatment strategies due to drug-drug interactions. Post-tuberculosis lung disease is an underappreciated phenomenon in children and adolescents, but is more commonly observed in children and adolescents with HIV-associated tuberculosis. This review presents new data related to HIV-associated TB in children and adolescents. Data on the epidemiology of HIV-associated TB suggests that an elevated risk of TB in children and adolescents with HIV persists even with broad implementation of ART. Recent guidance also indicates the need for new screening strategies for HIV-associated TB. There have been major advances in the availability of new antiretroviral medications and also TB prevention options for children, but these advances have come with additional questions surrounding drug-drug interactions and dosing in younger age groups. Finally, we review new approaches to manage post-TB lung disease in children living with HIV. Collectively, we present data on the rapidly evolving field of HIV-associated child tuberculosis. This evolution offers new management opportunities for children and adolescents living with HIV while also generating new questions for additional research.
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Affiliation(s)
- Alexander W. Kay
- Global Tuberculosis Program, Department of Pediatrics, Baylor College of Medicine and Texas Chidlren’s Hospital, Houston, TX 77030, USA;
| | - Helena Rabie
- Department of Pediatrics and Child Health and FAMCRU, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa;
| | | | | | - Mark F. Cotton
- Children’s Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Anna M. Mandalakas
- Global Tuberculosis Program, Department of Pediatrics, Baylor College of Medicine and Texas Chidlren’s Hospital, Houston, TX 77030, USA;
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7
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Moscibrodzki P, Enane LA, Hoddinott G, Brooks MB, Byron V, Furin J, Seddon JA, Meyersohn L, Chiang SS. The Impact of Tuberculosis on the Well-Being of Adolescents and Young Adults. Pathogens 2021; 10:1591. [PMID: 34959546 PMCID: PMC8706072 DOI: 10.3390/pathogens10121591] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 01/26/2023] Open
Abstract
The health needs of adolescents and young adults (AYAs) have been neglected in tuberculosis (TB) care, control, and research. AYAs, who are distinct from younger children and older adults, undergo dynamic physical, psychological, emotional, cognitive, and social development. Five domains of adolescent well-being are crucial to a successful transition between childhood and adulthood: (1) Good health; (2) connectedness and contribution to society; (3) safety and a supportive environment; (4) learning, competence, education, skills, and employability; and (5) agency and resilience. This review summarizes the evidence of the impact of TB disease and treatment on these five domains of AYA well-being.
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Affiliation(s)
- Patricia Moscibrodzki
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Leslie A. Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (G.H.); (J.A.S.)
| | - Meredith B. Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.B.B.); (V.B.); (J.F.)
| | - Virginia Byron
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.B.B.); (V.B.); (J.F.)
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.B.B.); (V.B.); (J.F.)
- Sentinel Project on Pediatric Drug-Resistant Tuberculosis, Boston, MA 02115, USA
| | - James A. Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (G.H.); (J.A.S.)
- Department of Infectious Diseases, Imperial College London, London W2 1NY, UK
| | - Lily Meyersohn
- Center for International Health Research, Rhode Island Hospital, Providence, RI 02903, USA; (L.M.); (S.S.C.)
| | - Silvia S. Chiang
- Center for International Health Research, Rhode Island Hospital, Providence, RI 02903, USA; (L.M.); (S.S.C.)
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI 02903, USA
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8
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Muttamba W, Bbuye M, Baruch Baluku J, Kyaligonza S, Nalunjogi J, Kimuli I, Kirenga B. Perceptions of Adolescents and Health Workers Towards Adolescents' TB Diagnosis in Central Uganda: A Cross-Sectional Qualitative Study. Risk Manag Healthc Policy 2021; 14:4823-4832. [PMID: 34876864 PMCID: PMC8643211 DOI: 10.2147/rmhp.s340112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Prompt diagnosis of TB among adolescents may reduce transmission and improve individual outcomes. However, TB diagnosis in adolescents is challenging. This study sought to understand challenges to adolescent TB diagnosis. METHODS We conducted qualitative focus group discussions (FGDs) to explore adolescents' and health workers' perspectives on challenges to TB diagnosis among adolescents seeking care at four secondary health care facilities in Uganda. Eight FGDs were conducted: four with 32 adolescents consulting for medical care and four with 34 health workers involved in TB care. RESULTS Adolescents were aware of TB and associated risk factors and believed behaviours like smoking and alcohol use are risk factors for TB. They reported school schedules limit them from seeking TB care and have to miss school or wait for holidays to seek TB diagnosis. They noted school nurses do not take much interest in diagnosing TB and do not refer them to hospitals for further evaluation when they present with TB symptoms. Furthermore, adolescents reported cross-cutting issues like loss of trust in public health systems, encountering unfriendly, judgmental and uncooperative health workers. Health workers mentioned the school environment exposes adolescents to TB as the dormitories they sleep in are overcrowded. They indicated that it was difficult to make a diagnosis of TB in adolescents as the adolescents do not disclose health information. They reported fellow health workers perceive adolescents as being at low risk of TB as they believe most often adolescents are HIV negative and thus have reduced risk of TB. CONCLUSION Adolescents present unique challenges that need to be addressed if TB diagnosis is to improve. These challenges could be handled by interventions that lead to minimal disruptions on school schedules, provision of adolescent-friendly services and intervention to build capacity of health care workers in the provision of adolescent-friendly services.
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Affiliation(s)
- Winters Muttamba
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mudarshiru Bbuye
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Baruch Baluku
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | - Stephen Kyaligonza
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joanitah Nalunjogi
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ivan Kimuli
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bruce Kirenga
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Division of Pulmonary Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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9
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Sant'Anna CC, de Oliveira MCB. The long-running issues of tuberculosis. LANCET GLOBAL HEALTH 2021; 9:e1339-e1340. [PMID: 34534470 DOI: 10.1016/s2214-109x(21)00401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Clemax Couto Sant'Anna
- Pediatrics Department, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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10
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Laycock KM, Enane LA, Steenhoff AP. Tuberculosis in Adolescents and Young Adults: Emerging Data on TB Transmission and Prevention among Vulnerable Young People. Trop Med Infect Dis 2021; 6:148. [PMID: 34449722 PMCID: PMC8396328 DOI: 10.3390/tropicalmed6030148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 02/01/2023] Open
Abstract
Adolescents and young adults (AYA, ages 10-24 years) comprise a uniquely important but understudied population in global efforts to end tuberculosis (TB), the leading infectious cause of death by a single agent worldwide prior to the COVID-19 pandemic. While TB prevention and care strategies often overlook AYA by grouping them with either children or adults, AYA have particular physiologic, developmental, and social characteristics that require dedicated approaches. This review describes current evidence on the prevention and control of TB among AYA, including approaches to TB screening, dynamics of TB transmission among AYA, and management challenges within the context of unique developmental needs. Challenges are considered for vulnerable groups of AYA such as migrants and refugees; AYA experiencing homelessness, incarceration, or substance use; and AYA living with HIV. We outline areas for needed research and implementation strategies to address TB among AYA globally.
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Affiliation(s)
- Katherine M. Laycock
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Leslie A. Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Andrew P. Steenhoff
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
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