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Medina-Marino A, Bezuidenhout D, Bezuidenhout C, Facente SN, Fourie B, Shin SS, Penn-Nicholson A, Theron G. In-home TB Testing Using GeneXpert Edge is Acceptable, Feasible, and Improves the Proportion of Symptomatic Household Contacts Tested for TB: A Proof-of-Concept Study. Open Forum Infect Dis 2024; 11:ofae279. [PMID: 38868309 PMCID: PMC11167660 DOI: 10.1093/ofid/ofae279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 05/13/2024] [Indexed: 06/14/2024] Open
Abstract
Background Household contact investigations are effective for finding tuberculosis (TB) cases but are hindered by low referral uptake for clinic-based evaluation and testing. We assessed the acceptability and feasibility of in-home testing of household contacts (HHC) using the GeneXpert Edge platform. Methods We conducted a 2-arm, randomized study in Eastern Cape, South Africa. HHCs were verbally assessed using the World Health Organization-recommended 4-symptom screen. Households with ≥1 eligible symptomatic contact were randomized. Intervention households received in-home GeneXpert MTB/RIF molecular testing. GeneXpert-positive HHCs were referred for clinic-based treatment. Standard-of-care households were referred for clinic-based sputum collection and testing. We defined acceptability as agreeing to in-home testing and feasibility as generation of valid Xpert MTB/RIF results. The proportion and timeliness of test results received was compared between groups. Results Eighty-four households were randomized (n = 42 per arm). Of 100 eligible HHCs identified, 98/100 (98%) provided consent. Of 51 HHCs allocated to the intervention arm, all accepted in-home testing; of those, 24/51 (47%) were sputum productive and 23/24 (96%) received their test results. Of 47 HCCs allocated to standard-of-care, 7 (15%) presented for clinic-based TB evaluation, 6/47 (13%) were tested, and 4/6 (67%) returned for their results. The median (interquartile range) number of days from screening to receiving test results was 0 (0) and 16.5 (11-15) in the intervention and standard-of-care arms, respectively. Conclusions In-home testing for TB was acceptable, feasible, and increased HHCs with a molecular test result. In-home testing mitigates a major limitation of household contact investigations (dependency on clinic-based referral), revealing new strategies for enhancing early case detection.
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Affiliation(s)
- Andrew Medina-Marino
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dana Bezuidenhout
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | | | - Shelley N Facente
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Bernard Fourie
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Sanghyuk S Shin
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
| | | | - Grant Theron
- NRF-DSI Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
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Mafirakureva N, Tchounga BK, Mukherjee S, Tchakounte Youngui B, Ssekyanzi B, Simo L, Okello RF, Turyahabwe S, Kuate Kuate A, Cohn J, Vasiliu A, Casenghi M, Atwine D, Bonnet M, Dodd PJ. Cost-effectiveness of community-based household tuberculosis contact management for children in Cameroon and Uganda: a modelling analysis of a cluster-randomised trial. Lancet Glob Health 2023; 11:e1922-e1930. [PMID: 37918416 DOI: 10.1016/s2214-109x(23)00451-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/22/2023] [Accepted: 09/12/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND WHO recommends household contact management (HCM) including contact screening and tuberculosis-preventive treatment (TPT) for eligible children. The CONTACT trial found increased TPT initiation and completion rates when community health workers were used for HCM in Cameroon and Uganda. METHODS We did a cost-utility analysis of the CONTACT trial using a health-system perspective to estimate the health impact, health-system costs, and cost-effectiveness of community-based versus facility-based HCM models of care. A decision-analytical modelling approach was used to evaluate the cost-effectiveness of the intervention compared with the standard of care using trial data on cascade of care, intervention effects, and resource use. Health outcomes were based on modelled progression to tuberculosis, mortality, and discounted disability-adjusted life-years (DALYs) averted. Health-care resource use, outcomes, costs (2021 US$), and cost-effectiveness are presented. FINDINGS For every 1000 index patients diagnosed with tuberculosis, the intervention increased the number of TPT courses by 1110 (95% uncertainty interval 894 to 1227) in Cameroon and by 1078 (796 to 1220) in Uganda compared with the control model. The intervention prevented 15 (-3 to 49) tuberculosis deaths in Cameroon and 10 (-20 to 33) in Uganda. The incremental cost-effectiveness ratio was $620 per DALY averted in Cameroon and $970 per DALY averted in Uganda. INTERPRETATION Community-based HCM approaches can substantially reduce child tuberculosis deaths and in our case would be considered cost-effective at willingness-to-pay thresholds of $1000 per DALY averted. Their impact and cost-effectiveness are likely to be greatest where baseline HCM coverage is lowest. FUNDING Unitaid and UK Medical Research Council.
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Affiliation(s)
| | | | | | | | | | - Leonie Simo
- Elizabeth Glaser Pediatric AIDS Foundation, Yaounde, Cameroon
| | | | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Program, Ministry of Health, Kampala, Uganda
| | - Albert Kuate Kuate
- National Tuberculosis Control Program, Ministry of Health, Yaounde, Cameroon
| | - Jennifer Cohn
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Anca Vasiliu
- Baylor College of Medicine, Department of Pediatrics, Global TB Program, Houston, TX, USA; University Montpellier, TransVIHMI, IRD, Inserm, Montpellier, France
| | | | - Daniel Atwine
- Epicentre, Mbarara, Uganda; Mbarara University of Science and Technology, Mbarara, Uganda
| | - Maryline Bonnet
- University Montpellier, TransVIHMI, IRD, Inserm, Montpellier, France
| | - Peter J Dodd
- Health Economics and Decision Science, University of Sheffield, Sheffield, UK
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Quang Vo LN, Forse RJ, Tran J, Dam T, Driscoll J, Codlin AJ, Creswell J, Sidney-Annerstedt K, Van Truong V, Thi Minh HD, Huu LN, Nguyen HB, Nguyen NV. Economic evaluation of a community health worker model for tuberculosis care in Ho Chi Minh City, Viet Nam: a mixed-methods Social Return on Investment Analysis. BMC Public Health 2023; 23:945. [PMID: 37231468 DOI: 10.1186/s12889-023-15841-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND There is extensive evidence for the cost-effectiveness of programmatic and additional tuberculosis (TB) interventions, but no studies have employed the social return on investment (SROI) methodology. We conducted a SROI analysis to measure the benefits of a community health worker (CHW) model for active TB case finding and patient-centered care. METHODS This mixed-method study took place alongside a TB intervention implemented in Ho Chi Minh City, Viet Nam, between October-2017 - September-2019. The valuation encompassed beneficiary, health system and societal perspectives over a 5-year time-horizon. We conducted a rapid literature review, two focus group discussions and 14 in-depth interviews to identify and validate pertinent stakeholders and material value drivers. We compiled quantitative data from the TB program's and the intervention's surveillance systems, ecological databases, scientific publications, project accounts and 11 beneficiary surveys. We mapped, quantified and monetized value drivers to derive a crude financial benefit, which was adjusted for four counterfactuals. We calculated a SROI based on the net present value (NPV) of benefits and investments using a discounted cash flow model with a discount rate of 3.5%. A scenario analysis assessed SROI at varying discount rates of 0-10%. RESULTS The mathematical model yielded NPVs of US$235,511 in investments and US$8,497,183 in benefits. This suggested a return of US$36.08 for each dollar invested, ranging from US$31.66-US39.00 for varying discount rate scenarios. CONCLUSIONS The evaluated CHW-based TB intervention generated substantial individual and societal benefits. The SROI methodology may be an alternative for the economic evaluation of healthcare interventions.
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Affiliation(s)
- Luan Nguyen Quang Vo
- Friends for International TB Relief, 6th Floor, 1/21 Le Van Luong St., Nhan Chinh Ward, Thanh Xuan District, Ha Noi, Viet Nam.
| | - Rachel Jeanette Forse
- Friends for International TB Relief, 6th Floor, 1/21 Le Van Luong St., Nhan Chinh Ward, Thanh Xuan District, Ha Noi, Viet Nam
| | - Jacqueline Tran
- Friends for International TB Relief, 6th Floor, 1/21 Le Van Luong St., Nhan Chinh Ward, Thanh Xuan District, Ha Noi, Viet Nam
| | - Thu Dam
- Friends for International TB Relief, 6th Floor, 1/21 Le Van Luong St., Nhan Chinh Ward, Thanh Xuan District, Ha Noi, Viet Nam
| | - Jenny Driscoll
- Friends for International TB Relief, 6th Floor, 1/21 Le Van Luong St., Nhan Chinh Ward, Thanh Xuan District, Ha Noi, Viet Nam
| | - Andrew James Codlin
- Friends for International TB Relief, 6th Floor, 1/21 Le Van Luong St., Nhan Chinh Ward, Thanh Xuan District, Ha Noi, Viet Nam
| | | | - Kristi Sidney-Annerstedt
- Department of Global Public Health, WHO Collaboration Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Solna, Sweden
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Mertaniasih NM, Soedarsono S, Pakasi TT, Nuha Z, Ato M. Proposed Algorithm for Integrated Management of TB-SARS-CoV-2 Co-Infection in a TB-Endemic Country. Trop Med Infect Dis 2022; 7:367. [PMID: 36355911 PMCID: PMC9694243 DOI: 10.3390/tropicalmed7110367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Tuberculosis (TB) and COVID-19 have become significant health problems globally, especially in countries with high prevalence. Therefore, this research aims to examine all possibilities and predict the impact of TB-SARS-CoV-2 co-infection to anticipate the cascade effect of both diseases in all sectors. The conceptual strategy of the algorithm in TB-COVID-19 is needed to create an integrated management system. It includes the stages of early detection with accurate and effective methods, as well as the synchronization of TB-COVID-19 health services, starting from primary health facilities to secondary and tertiary referral centers. The algorithm in TB-COVID-19 is crucial to prepare future strategies for PTB co-infection viral respiratory infections other than SARS-CoV-2, ILI, ARI, and SARI. Since the implementation involves all health services, there is a need to integrate the governance of TB-COVID-19 and other comorbidities in good health services based on research and multicentre design.
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Affiliation(s)
- Ni Made Mertaniasih
- Department of Medical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya 60131, Indonesia
- Sub-Pulmonology Department of Internal Medicine, Faculty of Medicine, Hang Tuah University, Surabaya 57600, Indonesia
| | - Soedarsono Soedarsono
- Sub-Pulmonology Department of Internal Medicine, Faculty of Medicine, Hang Tuah University, Surabaya 57600, Indonesia
- Tuberculosis Laboratory, Institute of Tropical Disease, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Tiffany Tiara Pakasi
- National TB Program, Directorate of Communicable Disease Prevention and Control, Ministry of Health Indonesia, Jakarta 10710, Indonesia
| | - Zakiyathun Nuha
- Tuberculosis Laboratory, Institute of Tropical Disease, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Manabu Ato
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Tokyo 162-0052, Japan
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Haq MU, Hinderaker SG, Fatima R, Qadeer E, Habib H, Hussain K, Khan AW. Are pulmonary tuberculosis patients identified by active and by passive case detection different? A cross sectional study in Pakistan. Int J Infect Dis 2022; 121:39-46. [PMID: 35489633 DOI: 10.1016/j.ijid.2022.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Active tuberculosis (TB) case finding by 'extended contact screening' (ECS), was tested during 2013-15. OBJECTIVES Our objective was to compare the characteristics of pulmonary TB patients detected by ECS with patients detected by routine passive case finding (PCF). METHODS This cross sectional study was based on data collected through ECS and routine program data in Lahore, Faisalabad and Rawalpindi districts and Islamabad in 2015. Characteristics of patients detected by ECS and PCF were compared. RESULTS In 12114 patients with pulmonary TB in the study, 4604 (38%) were detected by ECS, 4052 (88%) had bacteriological confirmation. Males represented 56.2%(95%CI 54.8-57.6) in ESC and 49.7%(95%CI 48.6-50.8) in PCF; bacteriologically confirmed cases was 88.0%(95%CI 87.1-88.9) in ECS and 50.3%(95%CI 49.2-51.4). By regression analysis we found that compared to adults aged 15-44 years, children under 15 had higher chance of being detected by ECS (adjusted odds ratio (OR) 2.69; 95%CI 2.21-3.28). There was a higher chance of being detected by ECS in Faisalabad (adjusted OR 2.57; 95%CI 2.01-3.29) compared to Islamabad. CONCLUSION Extended contact screening detected a higher proportion of men and children than routine case finding; both these groups are more often undetected by routine TB control.
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Affiliation(s)
- Mahboob Ul Haq
- University of Bergen, Norway; Management Unit (HIV/AIDS, TB & Malaria), Islamabad, Pakistan.
| | | | - Razia Fatima
- Management Unit (HIV/AIDS, TB & Malaria), Islamabad, Pakistan
| | - Ejaz Qadeer
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan; Ministry of National Health Services Regulations and Coordination Islamabad, Pakistan
| | - Hammad Habib
- Management Unit (HIV/AIDS, TB & Malaria), Islamabad, Pakistan
| | - Kashif Hussain
- Ministry of National Health Services Regulations and Coordination Islamabad, Pakistan
| | - Abdul Wali Khan
- Management Unit (HIV/AIDS, TB & Malaria), Islamabad, Pakistan; Ministry of National Health Services Regulations and Coordination Islamabad, Pakistan
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Household contact investigation for the detection of active tuberculosis and latent tuberculosis: a comprehensive evaluation in two high-burden provinces in Iran. New Microbes New Infect 2022; 45:100958. [PMID: 35242336 PMCID: PMC8861284 DOI: 10.1016/j.nmni.2022.100958] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 09/09/2021] [Accepted: 01/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background Systematic evaluation of household contacts of persons with pulmonary tuberculosis (TB) in low- and middle-income countries is recommended by the World Health Organization (WHO). This study recruited adult household contacts of diagnosed TB patients in two high burden provinces of Iran to estimate the prevalence and incidence of active disease and latent TB infection (LTBI) among individuals exposed to TB cases. Methods We conducted a cohort study among adults in household contact with a pulmonary TB index case. All subjects were assessed for active disease through evaluation of symptoms. Tuberculin skin test (TST) and QuantiFERON®-TB Gold Plus (QFT-Plus) were used to define LTBI. These tests were performed at the time of the index TB case diagnosis and repeated if the previous result was negative, at three-, 12-, and 18-months post recruitment. In addition, interferon-γ-induced protein-10 (IP-10) concentrations were measured in QFT-Plus supernatants for all participants three months after diagnosing the index case. Results A total of 451 individuals who had close contact with 95 active TB patients were enrolled in this study. Five (1.1%) contacts were diagnosed with active TB and 285 (63.2%) were identified with LTBI during our study. The incidence rate of LTBI among adult household contacts of TB index cases was 0.44 per person per year. Conclusion The overall rate of LTBI was high. Systematic screening of all household contacts of pulmonary TB should be expanded in Iran to make the timely achievement of the global end TB strategy feasible.
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Teo AKJ, Prem K, Wang Y, Pande T, Smelyanskaya M, Gerstel L, Chry M, Tuot S, Yi S. Economic Evaluation of Community Tuberculosis Active Case-Finding Approaches in Cambodia: A Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312690. [PMID: 34886416 PMCID: PMC8656683 DOI: 10.3390/ijerph182312690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to estimate the costs and incremental cost-effectiveness of two community-based tuberculosis (TB) active case-finding (ACF) strategies in Cambodia. We also assessed the number needed to screen and test to find one TB case. Program and national TB notification data from a quasi-experimental study of a cohort of people with TB in 12 intervention operational districts (ODs) and 12 control ODs between November 2018 and December 2019 were analyzed. Two ACF interventions (ACF seed-and-recruit (ACF SAR) model and one-off roving (one-off) ACF) were implemented concurrently. The matched control sites included PCF only. We estimated costs using the program and published data in Cambodia. The primary outcome was disability-adjusted life years (DALY) averted over 14 months. We considered the gross domestic product per capita of Cambodia in 2018 as the cost-effectiveness threshold. ACF SAR needed to test 7.7 people with presumptive TB to identify one all-forms TB, while one-off ACF needed to test 22.4. The costs to diagnose one all-forms TB were USD 458 (ACF SAR) and USD 191 (one-off ACF). The incremental cost per DALY averted was USD 257 for ACF SAR and USD 204 for one-off ACF. Community-based ACF interventions that targeted key populations for TB in Cambodia were highly cost-effective.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore 117549, Singapore; (A.K.J.T.); (K.P.); (Y.W.)
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore 117549, Singapore; (A.K.J.T.); (K.P.); (Y.W.)
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore 117549, Singapore; (A.K.J.T.); (K.P.); (Y.W.)
| | - Tripti Pande
- McGill International TB Centre, Montreal, QC H4A 3S5, Canada;
| | | | - Lisanne Gerstel
- KIT Royal Tropical Institute, 1092 AD Amsterdam, The Netherlands;
| | - Monyrath Chry
- Cambodia Anti-Tuberculosis Association, Phnom Penh 12303, Cambodia;
| | - Sovannary Tuot
- KHANA Centre for Population Health Research, Phnom Penh 12301, Cambodia;
- Faculty of Social Sciences and Humanity, Royal University of Phnom Penh, Phnom Penh 12150, Cambodia
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore 117549, Singapore; (A.K.J.T.); (K.P.); (Y.W.)
- KHANA Centre for Population Health Research, Phnom Penh 12301, Cambodia;
- Center for Global Health Research, Touro University California, Vallejo, CA 94592, USA
- Correspondence:
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Ross JM, Xie Y, Wang Y, Collins JK, Horst C, Doody JB, Lindstedt P, Ledesma JR, Shapiro AE, Hay PSI, Kyu HH, Flaxman AD. Estimating the population at high risk for tuberculosis through household exposure in high-incidence countries: a model-based analysis. EClinicalMedicine 2021; 42:101206. [PMID: 34870135 PMCID: PMC8626652 DOI: 10.1016/j.eclinm.2021.101206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Household contacts of people with pulmonary tuberculosis (TB) have greater risk of developing TB. Recent guidelines conditionally recommended TB preventive treatment (TPT) for household contacts of any age living in TB high-incidence countries, expanding earlier guidance to provide TPT to household contacts under five. The all-age population of household contacts has not been estimated. METHODS Our model-based estimation included 20 countries with >80% of incident TB globally in 2019. We developed country-specific distributions of household composition by age and sex using bootstrap resampling from health surveys and census data. We incorporated age-, sex-, year-, and location-specific estimates of pulmonary TB incidence from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 to estimate the population in each country sharing a household with someone with incident pulmonary TB, and quantified uncertainty using a Monte Carlo approach. FINDINGS We estimate that 38 million [95% uncertainty interval (UI) 33- 43 million] individuals lived in a household with someone with incident pulmonary TB in 2019 in these 20 countries. Children under five made up 12% of the population with household exposure, while adults were 65%. Zimbabwe, Mozambique, Zambia, and Pakistan had the highest proportion of the population with household exposure, while India had the highest number of contacts (11·4 million, 95% UI 9·7-13·4 million). INTERPRETATION Expanding TPT evaluation to household contacts of all ages in high-incidence countries could include a population more than 7-times larger than the under-5 contacts previously prioritized. This would substantially increase the impact of household contact investigation on reducing TB morbidity and mortality. FUNDING JMR is supported by the National Institute of Allergy and Infectious Diseases (K01 AI138620). This research was funded in part by a 2020 developmental grant from the University of Washington / Fred Hutch Center for AIDS Research, an NIH funded program under award number AI027757 which is supported by the following NIH Institutes and Centers: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA, NIGMS, NIDDK. This work was funded in part by the National Science Foundation (DMS-1839116).
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Affiliation(s)
- Jennifer M. Ross
- Department of Global Health, University of Washington, Seattle, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, USA
- Correspondence to: Jennifer M. Ross, MD, MPH, International Clinical Research Center, University of Washington, HMC Box #359927, 325 9th Ave, Seattle, WA USA, Tel: 206-543-9192
| | - Yongquan Xie
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Yaqi Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - James K. Collins
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Cody Horst
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Jessie B. Doody
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Paulina Lindstedt
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Jorge R. Ledesma
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Adrienne E. Shapiro
- Department of Global Health, University of Washington, Seattle, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, USA
| | - Prof. Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | - Hmwe H. Kyu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | - Abraham D. Flaxman
- Department of Global Health, University of Washington, Seattle, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
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Fuady A. Call for more investment in cost-effective tuberculosis care. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 11:100157. [PMID: 34327362 PMCID: PMC8315399 DOI: 10.1016/j.lanwpc.2021.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Ahmad Fuady
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Chin DP. The COVID-19 Pandemic and Elimination of Tuberculosis in China. China CDC Wkly 2021; 3:260-264. [PMID: 34594862 PMCID: PMC8392955 DOI: 10.46234/ccdcw2021.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022] Open
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Jo Y, Gomes I, Flack J, Salazar-Austin N, Churchyard G, Chaisson RE, Dowdy DW. Cost-effectiveness of scaling up short course preventive therapy for tuberculosis among children across 12 countries. EClinicalMedicine 2021; 31:100707. [PMID: 33554088 PMCID: PMC7846666 DOI: 10.1016/j.eclinm.2020.100707] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/12/2020] [Accepted: 12/18/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While household contact investigation is widely recommended as a means to reduce the burden of tuberculosis (TB) among children, only 27% of eligible pediatric household contacts globally received preventive treatment in 2018. We assessed the cost-effectiveness of household contact investigation for TB treatment and short-course preventive therapy provision for children under 15 years old across 12 high TB burden countries. METHODS We used decision analysis to compare the costs and estimated effectiveness of three intervention scenarios: (a) status quo (existing levels of coverage with isoniazid preventive therapy), (b) contact investigation with treatment of active TB but no additional preventive therapy, and (c) contact investigation with TB treatment and provision of short-course preventive therapy. Using country-specific demographic, epidemiological and cost data from the literature, we estimated annual costs (in 2018 USD) and the number of TB cases and deaths averted across 12 countries. Incremental cost effectiveness ratios were assessed as cost per death and per disability-adjusted life year [DALY] averted. FINDINGS Our model estimates that contact investigation with treatment of active TB and provision of preventive therapy could be highly cost-effective compared to the status quo (ranging from $100 per DALY averted in Malawi to $1,600 in Brazil; weighted average $383 per DALY averted [uncertainty range: $248 - $1,130]) and preferred to contact investigation without preventive therapy (weighted average $751 per DALY averted [uncertainty range: $250 - $1,306]). Key drivers of cost-effectiveness were TB prevalence, sensitivity of TB diagnosis, case fatality for untreated TB, and cost of household screening. INTERPRETATION Based on this modeling analysis of available published data, household contact investigation with provision of short-course preventive therapy for TB has a value-for-money profile that compares favorably with other interventions. FUNDING Unitaid (2017-20-IMPAACT4TB).
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Affiliation(s)
- Youngji Jo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Corresponding author.
| | - Isabella Gomes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph Flack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicole Salazar-Austin
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gavin Churchyard
- The Aurum Institute, Parktown, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Richard E. Chaisson
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David W. Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Shah L, Rojas Peña M, Mori O, Zamudio C, Kaufman JS, Otero L, Gotuzzo E, Seas C, Brewer TF. A pragmatic stepped-wedge cluster randomized trial to evaluate the effectiveness and cost-effectiveness of active case finding for household contacts within a routine tuberculosis program, San Juan de Lurigancho, Lima, Peru. Int J Infect Dis 2020; 100:95-103. [DOI: 10.1016/j.ijid.2020.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 11/25/2022] Open
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Garg T, Bhardwaj M, Deo S. Role of community health workers in improving cost efficiency in an active case finding tuberculosis programme: an operational research study from rural Bihar, India. BMJ Open 2020; 10:e036625. [PMID: 33004390 PMCID: PMC7536783 DOI: 10.1136/bmjopen-2019-036625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Cost-efficient active case finding (ACF) approaches are needed for their large-scale adoption in national tuberculosis (TB) programmes. Our aim was to assess if community health workers' (CHW) knowledge about families' health status can improve the cost efficiency of the ACF programme without adversely affecting the delivery of other health services for which they are responsible. DESIGN Quasi-experimental design. INTERVENTIONS We evaluated an ACF programme in the Samastipur district in Bihar, India, between July 2017 and June 2018. CHWs called Accredited Social Health Activists generated referrals of individuals at risk of TB and conducted symptom-based screening to identify patients with presumptive TB. They also helped them undergo testing and provided treatment support for confirmed TB cases. PRIMARY AND SECONDARY OUTCOME MEASURES We compared the notification rate from the intervention region with that from a control region in the same district with similar characteristics. We analysed operational data to calculate the cost per TB case diagnosed. We used routine programmatic data from the public health system to estimate the impact on other services provided by CHWs. FINDINGS CHWs identified 9895 patients with presumptive TB. Of these, 5864 patients were tested for TB, and 1236 were confirmed as TB cases. Annual public case notification rate increased sharply in the intervention region from 45.8 to 105.8 per 100 000 population, whereas it decreased from 50.7 to 45.3 in the control region. There was no practically or statistically significant impact on other output indicators of the CHWs, such as institutional deliveries (-0.04%). The overall cost of the intervention was about US$134 per diagnosed case. Main cost drivers were human resources, and commodities (drugs and diagnostics), which contributed 37.4% and 32.5% of the cost, respectively. CONCLUSIONS ACF programmes that use existing CHWs in the health system are feasible, cost efficient and do not adversely affect other healthcare services delivered by CHWs.
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Affiliation(s)
- Tushar Garg
- Research, Innovators In Health, Patna, Bihar, India
| | | | - Sarang Deo
- Operations Management, Indian School of Business, Hyderabad, Telangana, India
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Osei E, Oppong S, Der J. Trends of tuberculosis case detection, mortality and co-infection with HIV in Ghana: A retrospective cohort study. PLoS One 2020; 15:e0234878. [PMID: 32579568 PMCID: PMC7313972 DOI: 10.1371/journal.pone.0234878] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/03/2020] [Indexed: 12/23/2022] Open
Abstract
Background In an era of renewed commitment to accelerate the declines in Tuberculosis (TB) incidence and mortality, there is the need for National Tuberculosis Programmes (NTPs) to monitor trends in key indicators across a geographical location and to provide reliable data for direct measurement of TB incidence and mortality. In this context, we explored the trends of TB case detection, mortality and HIV co-infection, and examined the predictors of TB deaths in Ten districts of the Volta region of Ghana. Methods We conducted a retrospective cohort study of all TB cases registered from 2013 to 2017 in 10 districts of the Volta Region of Ghana. Case detection rate (CDR) was computed as the ratio of the number of new and relapse TB case notified to NTP to the number of estimated incident TB cases in a given year. Case fatality rates were estimated using data from 2012–2016 cohort of TB patients. Simple and multiple logistic regression were used to identify predictors of TB deaths with odds ratios and 95% confidence intervals estimated. Results Overall, there were 3,735 new and relapse TB patients who commenced anti-TB treatment during the period, representing the case detection rate of 40.1% with district variations. The CDR remained stable during the 5 years. Of the total cases, HIV status was documented for 3,144 (84.2%), among whom, 712 (22.6%) were HIV positive. The TB/HIV co-infection was more prevalent among children under 15 years of age (30.1%), males (30.6%), treatment after lost to follow-up patients (33.3%), and smear-negative pulmonary TB patients (29.1%). The prevalence of TB/HIV co-infection did not significantly change over the years. The overall case fatality rate was 13% (n = 486), with considerable variation among HIV-positives and HIV-negative TB patients (21.8% and 11% respectively) (p<0.001) and among districts. TB/HIV co-infection, sputum smear-negative pulmonary TB and district of anti-TB treatment predicted TB mortality. Conclusion TB case detection rate was low and remained stable during the study period, whereas co-infection with HIV and mortality rates were quite high, indicating the need for feasible strategies such as active case finding to improve case detection, and improved case management to reduce mortality.
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Affiliation(s)
- Eric Osei
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
- Department of Public Health Graduate School, Yonsei University, Seoul, Republic of Korea
- * E-mail:
| | - Samuel Oppong
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Joyce Der
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
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15
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Oo MM, Tassanakijpanich N, Phyu MH, Safira N, Kandel S, Chumchuen K, Zhang LM, Kyu HA, Sriwannawit P, Bilmumad B, Cao L, Guo Y, Sukmanee J, Cuong VM, Chongsuvivatwong V, McNeil EB. Coverage of tuberculosis and diabetes mellitus screening among household contacts of tuberculosis patients: a household-based cross-sectional survey from Southern Thailand. BMC Public Health 2020; 20:957. [PMID: 32552712 PMCID: PMC7301490 DOI: 10.1186/s12889-020-09090-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/11/2020] [Indexed: 01/07/2023] Open
Abstract
Background The comorbid presence of tuberculosis and diabetes mellitus has become an increasingly important public health threat to the prevention and control of both diseases. Thus, household contact investigation may serve a dual purpose of screening for both tuberculosis and diabetes mellitus among household contacts. We therefore aimed to evaluate the coverage of screening for tuberculosis and diabetes mellitus among household contacts of tuberculosis index cases and to determine predictors of tuberculosis screening. Methods A household-based survey was conducted in February 2019 in Muang district of Phatthalung Province, Thailand where 95 index tuberculosis patients were newly diagnosed with pulmonary or pleural tuberculosis between October 2017 and September 2018. Household contacts of the index patients were interviewed using a structured questionnaire to ascertain their past-year history of tuberculosis screening and, if appropriate, diabetes mellitus screening. For children, the household head or an adult household member was interviewed as a proxy. Coverage of tuberculosis screening at the household level was regarded as households having all contacts screened for tuberculosis. Logistic regression and mixed-effects logistic regression models were used to determine predictors of tuberculosis screening at the household and individual levels, respectively, with the strengths of association presented as adjusted odds ratios (AOR) and 95% confidence intervals (CI). Results Of 61 responding households (64%), complete coverage of tuberculosis screening at the household level was 34.4% and among the 174 household contacts was 46.6%. About 20% of contacts did not receive any recommendation for tuberculosis screening. Households were more likely to have all members screened for tuberculosis if they were advised to be screened by a healthcare professional rather than someone else. At the individual level, contacts aged ≥35 years (AOR: 30.6, 95% CI: 2.0–466.0), being an employee (AOR: 0.1, 95% CI: 0.0–0.8) and those who had lived more than 5 years in the same household (AOR: 0.1, 95% CI: 0.0–0.8) were independent predictors for tuberculosis screening. Coverage of diabetes mellitus screening was 80.6% with lack of awareness being the main reason for not being screened. Conclusions Compared to diabetes screening, the coverage of tuberculosis screening was low. A better strategy to improve coverage of tuberculosis contact screening is needed.
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Affiliation(s)
- Myo Minn Oo
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | | | - Moe Hnin Phyu
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.,National TB Programme, Department of Public Health, Nay Pi Taw, Myanmar
| | - Nanda Safira
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Shashi Kandel
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Kemmapon Chumchuen
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Li Mei Zhang
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.,People's Hospital of Chuxiong Prefecture, Yunnan, China
| | - Hnin Aye Kyu
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Porraporn Sriwannawit
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Bintinee Bilmumad
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Li Cao
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Yingwu Guo
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Jarawee Sukmanee
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Vu Manh Cuong
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | | | - Edward B McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
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16
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Abstract
PURPOSE OF REVIEW The present review focuses on recent advances and current challenges in screening, diagnosis and management of tuberculosis (TB) in children, encompassing TB infection and TB disease, and public health priorities for screening and family engagement. RECENT FINDINGS Although awareness has improved in recent years that children in TB endemic areas suffer a huge disease burden, translation into better prevention and care remains challenging. Recent WHO guidelines have incorporated screening of all household contacts of pulmonary TB cases, but implementation in high incidence settings remains limited. Improved tests using noninvasive samples, such as the lateral flow urinary lipoarabinomannan assay and the new Xpert Ultra assay applied to induced sputum or stool in young children, are showing promise and further assessment is eagerly awaited. From a treatment perspective, child-friendly dispersible fixed dose combination tablets are now widely available with excellent acceptability and tolerance reported in young children. SUMMARY High-level government commitment to TB control as a public health priority and feasible strategies to achieve this are required to contain the global epidemic, whereas strong engagement of local TB clinics and affected families in TB prevention is essential to limit secondary cases and protect exposed children.
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Affiliation(s)
| | - Ben J Marais
- Department of Infectious Diseases & Microbiology, The Children's Hospital at Westmead, Westmead.,Discipline of Child and Adolescent Health.,Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney, Sydney, New South Wales, Australia
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17
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Paryani RH, Gupta V, Singh P, Verma M, Sheikh S, Yadav R, Mansoor H, Kalon S, Selvaraju S, Das M, Laxmeshwar C, Ferlazzo G, Isaakidis P. Yield of Systematic Longitudinal Screening of Household Contacts of Pre-Extensively Drug Resistant (PreXDR) and Extensively Drug Resistant (XDR) Tuberculosis Patients in Mumbai, India. Trop Med Infect Dis 2020; 5:tropicalmed5020083. [PMID: 32466438 PMCID: PMC7344454 DOI: 10.3390/tropicalmed5020083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 01/16/2023] Open
Abstract
While risk of tuberculosis (TB) is high among household contacts (HHCs) of pre-extensively drug resistant (pre-XDR) TB and XDR-TB, data on yield of systematic longitudinal screening are lacking. We aim to describe the yield of systematic longitudinal TB contact tracing among HHCs of patients with pre-XDR-TB and XDR-TB. At the Médecins Sans Frontières (MSF) clinic, Mumbai, India a cohort comprising 518 HHCs of 109 pre-XDR and XDR index cases was enrolled between January 2016 and June 2018. Regular HHC follow-ups were done till one year post treatment of index cases. Of 518 HHCs, 23 had TB (21 on TB treatment and two newly diagnosed) at the time of first visit. Of the rest, 19% HHCs had no follow-ups. Fourteen (3.5%) TB cases were identified among 400 HHCs; incidence rate: 2072/100,000 person-years (95% CI: 1227-3499). The overall yield of household contact tracing was 3% (16/518). Of 14 who were diagnosed with TB during follow-up, six had drug susceptible TB (DSTB); six had pre-XDR-TB and one had XDR-TB. Five of fourteen cases had resistance patterns concordant with their index case. In view of the high incidence of TB among HHCs of pre-XDR and XDR-TB cases, follow-up of HHCs for at least the duration of index cases' treatment should be considered.
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Affiliation(s)
- Roma Haresh Paryani
- Médecins Sans Frontières (MSF)/Doctors Without Borders, Mumbai 400088, India; (R.H.P.); (P.S.); (S.S.); (R.Y.); (H.M.); (S.K.); (C.L.)
| | - Vivek Gupta
- Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India;
| | - Pramila Singh
- Médecins Sans Frontières (MSF)/Doctors Without Borders, Mumbai 400088, India; (R.H.P.); (P.S.); (S.S.); (R.Y.); (H.M.); (S.K.); (C.L.)
| | - Madhur Verma
- Department of Community & Family Medicine, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab 151001, India;
| | - Sabira Sheikh
- Médecins Sans Frontières (MSF)/Doctors Without Borders, Mumbai 400088, India; (R.H.P.); (P.S.); (S.S.); (R.Y.); (H.M.); (S.K.); (C.L.)
| | - Reeta Yadav
- Médecins Sans Frontières (MSF)/Doctors Without Borders, Mumbai 400088, India; (R.H.P.); (P.S.); (S.S.); (R.Y.); (H.M.); (S.K.); (C.L.)
| | - Homa Mansoor
- Médecins Sans Frontières (MSF)/Doctors Without Borders, Mumbai 400088, India; (R.H.P.); (P.S.); (S.S.); (R.Y.); (H.M.); (S.K.); (C.L.)
| | - Stobdan Kalon
- Médecins Sans Frontières (MSF)/Doctors Without Borders, Mumbai 400088, India; (R.H.P.); (P.S.); (S.S.); (R.Y.); (H.M.); (S.K.); (C.L.)
| | - Sriram Selvaraju
- National Institute for Research in Tuberculosis, Chennai 600031, India;
| | - Mrinalini Das
- Médecins Sans Frontières (MSF)/Doctors Without Borders, Mumbai 400088, India; (R.H.P.); (P.S.); (S.S.); (R.Y.); (H.M.); (S.K.); (C.L.)
- Correspondence: ; Tel.: +91-8010261984
| | - Chinmay Laxmeshwar
- Médecins Sans Frontières (MSF)/Doctors Without Borders, Mumbai 400088, India; (R.H.P.); (P.S.); (S.S.); (R.Y.); (H.M.); (S.K.); (C.L.)
| | - Gabriella Ferlazzo
- Southern Africa Medical Unit (SAMU), Médecins Sans Frontières, Cape Town 7925, South Africa; (G.F.); (P.I.)
| | - Petros Isaakidis
- Southern Africa Medical Unit (SAMU), Médecins Sans Frontières, Cape Town 7925, South Africa; (G.F.); (P.I.)
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18
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Yassin MA, Yirdaw KD, Datiko DG, Cuevas LE, Yassin MA. Yield of household contact investigation of patients with pulmonary tuberculosis in southern Ethiopia. BMC Public Health 2020; 20:737. [PMID: 32434507 PMCID: PMC7238661 DOI: 10.1186/s12889-020-08879-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Household Contacts (HHCs) of patients with pulmonary tuberculosis (PTB) have a higher risk of developing TB. Contact investigation is recommended to reach this group and identify undiagnosed cases. In this study, we have determined the yield of contact investigation among HHCs of patients with smear-positive PTB, and estimated TB burden. METHODS We conducted retrospective record review for the occurrence of TB among HHCs of Index PTB+ cases treated between November 2010 and April 2013 in 12 public health facilities in Boricha district. HHCs were followed up monthly and revisited between March and June 2015. Information on additional TB cases diagnosed and treated among HHCs were documented. HHCs who were diagnosed as having TB after the index cases were diagnosed and treated were considered as 'incident cases'. Presumptive TB case was defined as those having cough for ≥2 weeks or enlarged lymph node. Diagnosis of TB among HHCs were made using smear-microscopy and/or X-rays, and clinically for Extra-pulmonary TB (EPTB). RESULTS One thousand five hundred and seventeenth HHCs of 344 index cases were visited and screened for TB and followed up for a median of 37 months. 77 (5.1% - 72 with PTB and 5 with EPTB) HHCs developed TB during 4713 person-years of follow-up with an estimated incidence of 1634 (95% CI: 1370-2043) per 100,000 person-years follow-up which is much higher than the estimated TB incidence for the general population in Ethiopia of 210/100,000. Half (41/77) of incident TB cases were diagnosed within the first year of diagnosis of the index cases and 88% (68/77) were adults (Hazard Ratio: 4.03; 95% CI: 2.00-8.12). CONCLUSION HHCs of index PTB+ cases have high risk of developing active TB. Long term follow-up of HHCs could help improve TB case finding depending on country contexts. Further studies on effectiveness and feasibility of the approach and integration in routine settings are needed.
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Affiliation(s)
| | | | | | - Luis E Cuevas
- Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
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19
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Wingfield T, Verguet S. Active case finding in tuberculosis-affected households: time to scale up. LANCET GLOBAL HEALTH 2020; 7:e296-e298. [PMID: 30784625 DOI: 10.1016/s2214-109x(19)30015-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Tom Wingfield
- LIV-TB Collaboration, Department of Clinical Sciences and Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; Tropical and Infectious Diseases Unit, Royal Liverpool Hospital, Liverpool, UK; Social Medicine, Infectious Diseases and Migration Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
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20
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Zellweger JP. Is the EU model for contact investigation applicable to high TB burden settings? Int J Infect Dis 2020; 92S:S55-S59. [DOI: 10.1016/j.ijid.2020.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 11/16/2022] Open
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21
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Yang J, Lee S, Oh S, Han S, Park SY, Kim Y, Kim J, Park MS. The risk of active tuberculosis among individuals living in tuberculosis-affected households in the Republic of Korea, 2015. PLoS One 2019; 14:e0225744. [PMID: 31846466 PMCID: PMC6917288 DOI: 10.1371/journal.pone.0225744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/11/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In the Republic of Korea (ROK), compared to other high-income countries, tuberculosis (TB) prevalence is relatively high. Active TB and latent TB infection (LTBI) surveillance of individuals living in TB-affected households has been conducted for several years. Although active case finding is an important strategy in low-prevalence, high-income countries, its effectiveness in a high prevalence setting is unclear. This study evaluated the risk of TB in household contact by calculating the incidence of TB among household contacts and comparing it with the general population of the ROK. METHODS A retrospective cohort study, including 36,133 household-contacts of 17,958 TB patients reported in 2015, was conducted. The data was extracted from the Korean National TB Surveillance System (web-based TB cases notification system, KNTSS). The Cox proportional hazard regression model was used to evaluate risk factors for incidence of TB. A P-value < .05 was considered statistically significant. RESULTS In this study, 319 (0.9%) of 36,133 household-contacts were reported as having TB within 1 year, which is a higher rate than the rate for the general population in the ROK. The rate of TB reported for contacts that had completed LTBI treatment (0.6%) was lower than for the LTBI group without treatment (4.6%). In multivariate analysis, age older than 65 (p < .001), being a spouse of a TB patient (p = .007), and LTBI without treatment (p = .013) were each a risk factor for TB incidence among contacts. Younger age (p < .001), presence of a cough (p < .001), testing positive for acid-fast bacilli (AFB; p < .001), and cavity on radiograph (p < .001) of the index patient were also statistically significant risk factors. CONCLUSIONS Individuals living in TB-affected households are at high risk of developing TB in the ROK and active case finding among them is a strategy effective in the early detection and prevention of TB.
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Affiliation(s)
- Jiyeon Yang
- Korea Centers for Disease Control & Prevention, Cheongju, Republic of Korea
| | - Sodam Lee
- Korea Centers for Disease Control & Prevention, Cheongju, Republic of Korea
| | - Suhyeon Oh
- Korea Centers for Disease Control & Prevention, Cheongju, Republic of Korea
| | - Sunmi Han
- Korea Centers for Disease Control & Prevention, Cheongju, Republic of Korea
| | - Shin Young Park
- Korea Centers for Disease Control & Prevention, Cheongju, Republic of Korea
| | - Youngman Kim
- Korea Centers for Disease Control & Prevention, Cheongju, Republic of Korea
| | - Jieun Kim
- Korea Centers for Disease Control & Prevention, Cheongju, Republic of Korea
| | - Mi-sun Park
- Korea Centers for Disease Control & Prevention, Cheongju, Republic of Korea
- * E-mail:
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22
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Gafar F, Van't Boveneind-Vrubleuskaya N, Akkerman OW, Wilffert B, Alffenaar JWC. Nationwide analysis of treatment outcomes in children and adolescents routinely treated for tuberculosis in the Netherlands. Eur Respir J 2019; 54:13993003.01402-2019. [PMID: 31515410 DOI: 10.1183/13993003.01402-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/06/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND As a vulnerable population, children and adolescents with tuberculosis (TB) are faced with many challenges, even those who live in low TB incidence countries. We aimed to evaluate factors associated with TB treatment outcomes allowing more focused interventions to support this population once diagnosed. METHODS A retrospective cohort study using a nationwide surveillance database was performed in children and adolescents (aged 0-18 years) treated for TB in the Netherlands from 1993 to 2018. Logistic regression analyses were used to estimate adjusted odds ratios (aOR) for associated factors of mortality and loss to follow-up (LTFU). RESULTS Among 3253 eligible patients with known outcomes, 94.4% (95.9% children and 92.8% adolescents) were cured or completed treatment, 0.7% died during treatment and 4.9% were LTFU. There were no reported treatment failures. Risk factors of death included children aged 2-4 years (aOR 10.42), central nervous system TB (aOR 5.14), miliary TB (aOR 10.25), HIV co-infection (aOR 8.60), re-treated TB cases (aOR 10.12) and drug-induced liver injury (aOR 6.50). Active case-finding was a protective factor of death (aOR 0.13). Risk factors of LTFU were adolescents aged 15-18 years (aOR 1.91), illegal immigrants (aOR 4.28), urban domicile (aOR 1.59), unknown history of TB contact (aOR 1.99), drug-resistant TB (aOR 2.31), single adverse drug reaction (aOR 2.12), multiple adverse drug reactions (aOR 7.84) and treatment interruption >14 days (aOR 6.93). Treatment in recent years (aOR 0.94) and supervision by public health nurses (aOR 0.14) were protective factors of LTFU. CONCLUSION Highly successful treatment outcomes were demonstrated in children and adolescents routinely treated for TB. Special attention should be given to specific risk groups to improve treatment outcomes.
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Affiliation(s)
- Fajri Gafar
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology, and -Economics, Groningen, The Netherlands .,Both authors contributed equally
| | - Natasha Van't Boveneind-Vrubleuskaya
- University of Groningen, University Medical Center Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands.,Dept of Public Health TB Control, Metropolitan Public Health Services, The Hague, The Netherlands.,Both authors contributed equally
| | - Onno W Akkerman
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Tuberculosis Center Beatrixoord, Haren, The Netherlands
| | - Bob Wilffert
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology, and -Economics, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- University of Groningen, University Medical Center Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands.,University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, Australia.,Westmead Hospital, Sydney, Australia
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Gurung SC, Dixit K, Rai B, Caws M, Paudel PR, Dhital R, Acharya S, Budhathoki G, Malla D, Levy JW, van Rest J, Lönnroth K, Viney K, Ramsay A, Wingfield T, Basnyat B, Thapa A, Squire B, Wang D, Mishra G, Shah K, Shrestha A, de Siqueira-Filha NT. The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal. Infect Dis Poverty 2019; 8:99. [PMID: 31791412 PMCID: PMC6889665 DOI: 10.1186/s40249-019-0603-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/23/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has not been determined globally. This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding (PCF), and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal. METHODS The study was conducted in two districts of Nepal: Bardiya and Pyuthan (Province No. 5) between June and August 2018. One hundred patients were included in this study in a 1:1 ratio (PCF: ACF, 25 consecutive ACF and 25 consecutive PCF patients in each district). The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs. Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20% of their annual household income. The intensity of catastrophic costs was calculated using the positive overshoot method. The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs. Meanwhile, the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis. RESULTS Ninety-nine patients were interviewed (50 ACF and 49 PCF). Patients diagnosed through ACF incurred lower costs during the pre-treatment period (direct medical: USD 14 vs USD 32, P = 0.001; direct non-medical: USD 3 vs USD 10, P = 0.004; indirect, time loss: USD 4 vs USD 13, P < 0.001). The cost of the pre-treatment and intensive phases combined was also lower for direct medical (USD 15 vs USD 34, P = 0.002) and non-medical (USD 30 vs USD 54, P = 0.022) costs among ACF patients. The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds. A lower intensity of catastrophic costs was also documented for ACF patients, although the difference was not statistically significant. CONCLUSIONS ACF can reduce patient-incurred costs substantially, contributing to the End TB Strategy target. Other synergistic policies, such as social protection, will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.
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Affiliation(s)
| | | | - Bhola Rai
- Birat Nepal Medical Trust, Kathmandu, Nepal
| | - Maxine Caws
- Birat Nepal Medical Trust, Kathmandu, Nepal
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | | | | | | | - Jens W. Levy
- KNCV Tuberculosis Foundation, The Hague, Netherlands
| | - Job van Rest
- KNCV Tuberculosis Foundation, The Hague, Netherlands
| | - Knut Lönnroth
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Kerri Viney
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Research School of Population Health, Australian National University, Canberra, Australia
| | | | - Tom Wingfield
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- University of Liverpool, Liverpool, UK
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Anil Thapa
- National Tuberculosis Centre, Bhaktapur, Nepal
| | - Bertie Squire
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Gokul Mishra
- Birat Nepal Medical Trust, Kathmandu, Nepal
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Noemia Teixeira de Siqueira-Filha
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Institute for Health Technology Assessment, Porto Alegre, Brazil
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24
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Vesga JF, Hallett TB, Reid MJA, Sachdeva KS, Rao R, Khaparde S, Dave P, Rade K, Kamene M, Omesa E, Masini E, Omale N, Onyango E, Owiti P, Karanja M, Kiplimo R, Alexandru S, Vilc V, Crudu V, Bivol S, Celan C, Arinaminpathy N. Assessing tuberculosis control priorities in high-burden settings: a modelling approach. LANCET GLOBAL HEALTH 2019; 7:e585-e595. [PMID: 30904521 DOI: 10.1016/s2214-109x(19)30037-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/22/2018] [Accepted: 01/11/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND In the context of WHO's End TB strategy, there is a need to focus future control efforts on those interventions and innovations that would be most effective in accelerating declines in tuberculosis burden. Using a modelling approach to link the tuberculosis care cascade to transmission, we aimed to identify which improvements in the cascade would yield the greatest effect on incidence and mortality. METHODS We engaged with national tuberculosis programmes in three country settings (India, Kenya, and Moldova) as illustrative examples of settings with a large private sector (India), a high HIV burden (Kenya), and a high burden of multidrug resistance (Moldova). We collated WHO country burden estimates, routine surveillance data, and tuberculosis prevalence surveys from 2011 (for India) and 2016 (for Kenya). Linking the tuberculosis care cascade to tuberculosis transmission using a mathematical model with Bayesian melding in each setting, we examined which cascade shortfalls would have the greatest effect on incidence and mortality, and how the cascade could be used to monitor future control efforts. FINDINGS Modelling suggests that combined measures to strengthen the care cascade could reduce cumulative tuberculosis incidence by 38% (95% Bayesian credible intervals 27-43) in India, 31% (25-41) in Kenya, and 27% (17-41) in Moldova between 2018 and 2035. For both incidence and mortality, modelling suggests that the most important cascade losses are the proportion of patients visiting the private health-care sector in India, missed diagnosis in health-care settings in Kenya, and drug sensitivity testing in Moldova. In all settings, the most influential delay is the interval before a patient's first presentation for care. In future interventions, the proportion of individuals with tuberculosis who are on high-quality treatment could offer a more robust monitoring tool than routine notifications of tuberculosis. INTERPRETATION Linked to transmission, the care cascade can be valuable, not only for improving patient outcomes but also in identifying and monitoring programmatic priorities to reduce tuberculosis incidence and mortality. FUNDING US Agency for International Development, Stop TB Partnership, UK Medical Research Council, and Department for International Development.
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Affiliation(s)
- Juan F Vesga
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
| | - Timothy B Hallett
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Michael J A Reid
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Raghuram Rao
- Central TB Division, New Delhi, India; Central TB Division, New Delhi, India
| | | | | | - Kiran Rade
- WHO India Country Office, New Delhi, India
| | - Maureen Kamene
- National Tuberculosis, Leprosy and Lung Disease Programme, Nairobi, Kenya
| | - Eunice Omesa
- National Tuberculosis, Leprosy and Lung Disease Programme, Nairobi, Kenya
| | | | - Newton Omale
- National Tuberculosis, Leprosy and Lung Disease Programme, Nairobi, Kenya
| | - Elizabeth Onyango
- National Tuberculosis, Leprosy and Lung Disease Programme, Nairobi, Kenya
| | - Philip Owiti
- National Tuberculosis, Leprosy and Lung Disease Programme, Nairobi, Kenya
| | | | - Richard Kiplimo
- National Tuberculosis, Leprosy and Lung Disease Programme, Nairobi, Kenya
| | - Sofia Alexandru
- National Tuberculosis Programme, 'Chiril Draganiuc' Institute of Phthisiopneumology, Chisinau, Moldova
| | - Valentina Vilc
- National Tuberculosis Programme, 'Chiril Draganiuc' Institute of Phthisiopneumology, Chisinau, Moldova
| | - Valeriu Crudu
- National Tuberculosis Programme, 'Chiril Draganiuc' Institute of Phthisiopneumology, Chisinau, Moldova
| | - Stela Bivol
- Centre for Health Policies and Studies, Chisinau, Moldova
| | - Cristina Celan
- Centre for Health Policies and Studies, Chisinau, Moldova
| | - Nimalan Arinaminpathy
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
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