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Delmas MV, Soan M, Khirikoekkong N, Aung KK, Ler Wah S, Htun WPP, Maung B, Mukaka M, Cheah PY. Under the Mask: A Film on Tuberculosis at the Thai-Myanmar Border. Front Public Health 2022; 10:795503. [PMID: 35530731 PMCID: PMC9068961 DOI: 10.3389/fpubh.2022.795503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
In this paper, we describe the development of the film, “Under the Mask,” which follows the lives of three fictional characters who live on the Thai-Myanmar border as they journey from diagnosis of tuberculosis (TB) to completion of treatment. Under the Mask was filmed on location on the Thai-Myanmar border by local filmmakers and former refugee populations. Cast members were chosen from communities living along the border. This paper describes the script development process, filming, and screening in the community. We also report the findings from the pre- and post-screening questionnaires and post-film focus group discussions. A total of 77 screening events took place between March 2019 and March 2020 to 9,510 audience members in community venues such as village squares, temples and monasteries (N = 21), schools/migrant learning centers (N = 49), and clinics (N = 4). The pre-and post-screen questionnaires showed a significant gain in self-perceived TB knowledge on prevention, transmission, signs and symptoms, and related discrimination. Our findings from 18 post-screening focus group discussions conducted with 188 participants showed that there were improvements in knowledge and awareness of the disease and treatment, as well as in the awareness of stigma, and the burdens of tuberculosis on patients and their families.
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Affiliation(s)
- Michele Vincenti Delmas
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mary Soan
- Sermpanya (FilmAid) Foundation, Mae Sot, Thailand
| | - Napat Khirikoekkong
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ko Ko Aung
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Saw Ler Wah
- Sermpanya (FilmAid) Foundation, Mae Sot, Thailand
| | - Win Pa Pa Htun
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Banyar Maung
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Population Health, The Ethox Centre, Oxford, United Kingdom
- *Correspondence: Phaik Yeong Cheah
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Garg T, Panibatla V, Carel JP, Shanta A, Bhardwaj M, Brouwer M. Can Patient Navigators Help Potential TB Patients Navigate the Diagnostic and Treatment Pathways? An Implementation Research from India. Trop Med Infect Dis 2021; 6:tropicalmed6040200. [PMID: 34842840 PMCID: PMC8628981 DOI: 10.3390/tropicalmed6040200] [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: 09/03/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/22/2022] Open
Abstract
Navigating the Indian health system is a challenge for people with tuberculosis (TB) symptoms. The onus of organizing care is on the patient and their families alone. Factors like gender discrimination and opportunity costs further aggravate this. As a result, people may not complete the diagnostic and treatment pathway even though they experience poor health. Navigators can aid in the pathway’s completion. We implemented two projects in India—a public sector intervention in Bihar, with a population of 1.02 million, and a private sector intervention in Andhra Pradesh (AP), with a population of 8.45 million. Accredited Social Health Activists (ASHAs) of the public health system in Bihar and local field officers in AP facilitated the patients’ navigation through the health system. In Bihar, ASHAs accompanied community-identified presumptive TB patients to the nearest primary health center, assisted them through the diagnostic process, and supported the patients throughout the TB treatment. In AP, the field officers liaised with the private physicians, accompanied presumptive patients through the diagnosis, counseled and started treatment, and followed-up with the patients during the treatment. Both projects recorded case-based data for all of the patients, and used the yield and historical TB notifications to evaluate the intervention’s effect. Between July 2017 and December 2018, Bihar confirmed 1650 patients, which represented an increase of 94% in public notifications compared to the baseline. About 97% of them started treatment. During the same period in AP, private notifications increased by 147% compared to the baseline, and all 5765 patients started treatment. Patient navigators support the patients in the diagnostic and treatment pathways, and improve their health system experience. This novel approach of involving navigators in TB projects can improve the completion of the care cascade and reduce the loss to follow-up at various stages.
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Affiliation(s)
- Tushar Garg
- Innovators In Health, Patna 800001, India;
- Correspondence:
| | | | - Joseph P. Carel
- Independent Consultant, New Delhi 110001, India; (J.P.C.); (A.S.)
| | - Achanta Shanta
- Independent Consultant, New Delhi 110001, India; (J.P.C.); (A.S.)
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Wademan DT, Mainga T, Gondwe M, Ayles H, Shanaube K, Mureithi L, Bond V, Hoddinott G. 'TB is a disease which hides in the body': Qualitative data on conceptualisations of tuberculosis recurrence among patients in Zambia and South Africa. Glob Public Health 2021; 17:1713-1727. [PMID: 34187320 DOI: 10.1080/17441692.2021.1940235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The WHO estimates 58 million people experienced one or more TB disease episodes between 2000 and 2018. These 'former TB patients' are at greater risk of future TB infection and death than TB naïve people. Additionally, former TB patients experience social, psychological, and physiological difficulties after microbiological cure. Drawing on semi-structured interviews collected with 28 people from communities in Zambia (n = 8) and South Africa (n = 2) between October 2018 and March 2019, we describe their perceptions of having two or more TB episodes. Utilising a discursive analytic approach, we interrogated how participants conceptualise their risk of disease recurrence. Despite being surprised by subsequent TB episodes, participants utilised their bodily experiences of TB signs and symptoms alongside their experiential knowledge of health systems processes to procure timely diagnosis and care. Yet, many participants were unable to resume social and economic participation. Experiences of multiple TB episodes and correlating social, economic, and physiological vulnerabilities, challenged participants biomedical understanding of TBs curability. Through notions of dirt and 'staining', participants conceptualise TB as a sinister, malicious presence they are bound to encounter time and again. Health providers should discuss the risk of TB recurrence with patients and promote prevention, early detection, and diagnosis of TB disease.
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Affiliation(s)
- Dillon T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Tila Mainga
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Melleh Gondwe
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Helen Ayles
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Kwame Shanaube
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Linda Mureithi
- Health Systems Research Unit, Health Systems Trust, Cape Town, South Africa
| | - Virginia Bond
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia.,Department of Global Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Gokmen Y, Baskici C, Ercil Y. The impact of national culture on the increase of COVID-19: A cross-country analysis of European countries. INTERNATIONAL JOURNAL OF INTERCULTURAL RELATIONS : IJIR 2021; 81:1-8. [PMID: 33518841 PMCID: PMC7833793 DOI: 10.1016/j.ijintrel.2020.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/16/2020] [Accepted: 12/24/2020] [Indexed: 05/21/2023]
Abstract
In recent years, countries have been fighting with increasing momentum against outbreaks. This struggle requires the effective implementation of several measures that are required in medical science. However, the cultural characteristics of each society prevent these measures from being applied in the same way globally. One area in which social scientists have not applied much effort is observing the impact of countries' cultural characteristics in the fight against outbreaks. Therefore, this study aims to determine whether cultural differences among countries have an impact on their fight against outbreaks. This study uses the COVID-19 pandemic's total cases and selected European countries' cultural dimension scores as data. Due to the differences in the measurement units of cultural and outbreak variables, a stepwise multiple logarithmic regression analysis is preferred to select the proper regression model. The results have shown that power distance has a significant and negative effect on the increase rate of the total COVID-19 cases per million (IRTCCPM). In addition, the results have demonstrated that both individualism and indulgence have significant and positive effects on IRTCCPM, at the 95 % confidence level. However, the hypotheses concerning the impacts of masculinity, uncertainty avoidance, and long-term orientation on the IRTCCPM are rejected at the α = 0.05 level. In light of the findings of this study, it can be asserted that countries act in harmony with their cultural characteristics in the formal or informal practices of their fight against outbreaks. The contributions of the study can be discussed in academic and practical fields.
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Affiliation(s)
- Yunus Gokmen
- The Department of Industry and System Engineering, National Defence University, Turkish Military Academy, Ankara, Turkey
| | - Cigdem Baskici
- Başkent University, Department of Healthcare Management, Center for Strategy and Technology, Ankara, Turkey
| | - Yavuz Ercil
- Başkent University, Center for Strategy and Technology, Ankara, Turkey
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Heyd A, Heffernan C, Storey K, Wild TC, Long R. Treating latent tuberculosis infection (LTBI) with isoniazid and rifapentine (3HP) in an inner-city population with psychosocial barriers to treatment adherence: A qualitative descriptive study. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000017. [PMID: 36962068 PMCID: PMC10021900 DOI: 10.1371/journal.pgph.0000017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
In Canada, preventive therapy for latent tuberculosis infection (LTBI) has required multiple doses of medication over an extended period of time. Such regimens are associated with poor adherence and completion rates. A shortened treatment regimen of once weekly isoniazid plus rifapentine for 3 months (3HP), is now available, and holds promise in populations facing challenges to treatment adherence. Although many factors impact treatment adherence, a knowledge gap exists in describing these factors in the context of this regimen. We present findings from a qualitative descriptive study, involving semi-structured interviews with unstably housed or homeless individuals in Edmonton and Fort McMurray, Alberta, Canada who were offered directly-observed preventive therapy (DOPT) with 3HP, and their health care providers. Latent content analysis revealed incomplete understandings of LTBI and about the need for preventive therapy. Clients' motivation to be healthy, alongside education, health care outreach, relationships developed in the context of DOPT, ease of treatment regimen, incentives, and collaboration were all described as supporting treatment completion. Competing priorities, difficulty in reaching clients, undesirable aspects of the regimen and difficulties obtaining and initiating 3HP were identified as barriers. Perceptions of stigma related to LTBI and TB were described by clients in addition to feelings of shame related to their diagnosis. Our study provides insight into LTBI and indicates that multiple interacting psychosocial factors influence preventive therapy access, uptake, and adherence. Findings from this study of both client and provider perspectives can be used to inform and address inequities among individuals experiencing homelessness, and ultimately contribute to a diminished reservoir of LTBI.
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Affiliation(s)
- Amber Heyd
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Courtney Heffernan
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kate Storey
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Richard Long
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Mac TH, Phan TH, Nguyen VV, Dong TTT, Le HV, Nguyen QD, Nguyen TD, Codlin AJ, Mai TDT, Forse RJ, Nguyen LP, Luu THT, Nguyen HB, Nguyen NV, Pham XT, Tran PN, Khan A, Vo LNQ, Creswell J. Optimizing Active Tuberculosis Case Finding: Evaluating the Impact of Community Referral for Chest X-ray Screening and Xpert Testing on Case Notifications in Two Cities in Viet Nam. Trop Med Infect Dis 2020; 5:tropicalmed5040181. [PMID: 33265972 PMCID: PMC7709663 DOI: 10.3390/tropicalmed5040181] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022] Open
Abstract
To accelerate the reduction in tuberculosis (TB) incidence, it is necessary to optimize the use of innovative tools and approaches available within a local context. This study evaluated the use of an existing network of community health workers (CHW) for active case finding, in combination with mobile chest X-ray (CXR) screening events and the expansion of Xpert MTB/RIF testing eligibility, in order to reach people with TB who had been missed by the current system. A controlled intervention study was conducted from January 2018 to March 2019 in five intervention and four control districts of two low to medium TB burden cities in Viet Nam. CHWs screened and referred eligible persons for CXR to TB care facilities or mobile screening events in the community. The initial diagnostic test was Xpert MTB/RIF for persons with parenchymal abnormalities suggestive of TB on CXR or otherwise on smear microscopy. We analyzed the TB care cascade by calculating the yield and number needed to screen (NNS), estimated the impact on TB notifications and conducted a pre-/postintervention comparison of TB notification rates using controlled, interrupted time series (ITS) analyses. We screened 30,336 individuals in both cities to detect and treat 243 individuals with TB, 88.9% of whom completed treatment successfully. All forms of TB notifications rose by +18.3% (95% CI: +15.8%, +20.8%). The ITS detected a significant postintervention step-increase in the intervention area for all-form TB notification rates (IRR(β6) = 1.221 (95% CI: 1.011, 1.475); p = 0.038). The combined use of CHWs for active case findings and mobile CXR screening expanded the access to and uptake of Xpert MTB/RIF testing and resulted in a significant increase in TB notifications. This model could serve as a blueprint for expansion throughout Vietnam. Moreover, the results demonstrate the need to optimize the use of the best available tools and approaches in order to end TB.
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Affiliation(s)
- Tuan Huy Mac
- Hai Phong Lung Hospital, Hai Phong 180000, Vietnam; (T.H.M.); (T.D.N.)
| | - Thuc Huy Phan
- Provincial Department of Health, Hai Phong 180000, Vietnam; (T.H.P.); (Q.D.N.); (X.T.P.)
| | - Van Van Nguyen
- Provincial Department of Health, Quang Nam 560000, Vietnam;
| | - Thuy Thu Thi Dong
- Friends for International TB Relief, Ha Noi 100000, Vietnam; (T.T.T.D.); (A.J.C.); (T.D.T.M.); (R.J.F.); (L.P.N.)
| | - Hoi Van Le
- Viet Nam National Lung Hospital, Ha Noi 100000, Vietnam; (H.V.L.); (H.B.N.); (N.V.N.)
| | - Quan Duc Nguyen
- Provincial Department of Health, Hai Phong 180000, Vietnam; (T.H.P.); (Q.D.N.); (X.T.P.)
| | - Tho Duc Nguyen
- Hai Phong Lung Hospital, Hai Phong 180000, Vietnam; (T.H.M.); (T.D.N.)
| | - Andrew James Codlin
- Friends for International TB Relief, Ha Noi 100000, Vietnam; (T.T.T.D.); (A.J.C.); (T.D.T.M.); (R.J.F.); (L.P.N.)
| | - Thuy Doan To Mai
- Friends for International TB Relief, Ha Noi 100000, Vietnam; (T.T.T.D.); (A.J.C.); (T.D.T.M.); (R.J.F.); (L.P.N.)
| | - Rachel Jeanette Forse
- Friends for International TB Relief, Ha Noi 100000, Vietnam; (T.T.T.D.); (A.J.C.); (T.D.T.M.); (R.J.F.); (L.P.N.)
| | - Lan Phuong Nguyen
- Friends for International TB Relief, Ha Noi 100000, Vietnam; (T.T.T.D.); (A.J.C.); (T.D.T.M.); (R.J.F.); (L.P.N.)
| | | | - Hoa Binh Nguyen
- Viet Nam National Lung Hospital, Ha Noi 100000, Vietnam; (H.V.L.); (H.B.N.); (N.V.N.)
| | - Nhung Viet Nguyen
- Viet Nam National Lung Hospital, Ha Noi 100000, Vietnam; (H.V.L.); (H.B.N.); (N.V.N.)
| | - Xanh Thu Pham
- Provincial Department of Health, Hai Phong 180000, Vietnam; (T.H.P.); (Q.D.N.); (X.T.P.)
| | - Phap Ngoc Tran
- Pham Ngoc Thach Quang Nam Hospital, Quang Nam 560000, Vietnam;
| | - Amera Khan
- Stop TB Partnership, 1218 Geneva, Switzerland; (A.K.); (J.C.)
| | - Luan Nguyen Quang Vo
- Friends for International TB Relief, Ha Noi 100000, Vietnam; (T.T.T.D.); (A.J.C.); (T.D.T.M.); (R.J.F.); (L.P.N.)
- Interactive Research and Development, Singapore 189677, Singapore
- Correspondence: ; Tel.: +84-902-908004
| | - Jacob Creswell
- Stop TB Partnership, 1218 Geneva, Switzerland; (A.K.); (J.C.)
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Investigating the risk factors for contraction and diagnosis of human tuberculosis in Indonesia using data from the fifth wave of RAND's Indonesian Family Life Survey (IFLS-5). J Biosoc Sci 2020; 53:577-589. [PMID: 32799940 DOI: 10.1017/s0021932020000395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tuberculosis (TB) is a globally widespread disease, with approximately a quarter of the world's population currently infected (WHO, 2018). Some risk factors, such as HIV status, nutrition and body mass index, have already been thoroughly investigated. However, little attention has been given to behavioural and/or psychological risk factors such as stress and education level. This study investigated the risk factors for TB diagnosis by statistical analyses of publicly available data from the most recent wave of the Indonesian Family Life survey (IFLS-5) conducted in 2015. Out of 34,249 respondents there were 328 who reported having TB. For comparison and completeness, variables were divided into levels: individual-, household- and community-level variables. The most prominent and interesting variables found to influence TB diagnosis status (on each level) were investigated, and a logistic regression was subsequently developed to understand the extent to which each risk factor acts as a predictor for being diagnosed with TB. Age, health benefit or insurance, stress at work and living in a rural area all showed significant association with TB diagnosis status. This study's findings suggest that suitable control measures, such as schemes for improving mental health/stress reduction and improved access to health care in rural areas should be implemented in Indonesia to address each of the key factors identified.
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Madjid A, Syafar M, Arsunan A, Maria IL. Social determinants and tuberculosis incidents on empowerment case finding in Majene district. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rodrigo T, García-García JM, Caminero JA, Ruiz-Manzano J, Anibarro L, García-Clemente MM, Gullón JA, Jiménez-Fuentes MÁ, Medina JF, Mir I, Penas A, Sánchez F, Souza-Galvão MLD, Caylà JA. Evaluation of the Integrated Tuberculosis Research Program Sponsored by the Spanish Society of Pulmonology and Thoracic Surgery: 11 Years on. Arch Bronconeumol 2019; 56:483-492. [PMID: 31780285 DOI: 10.1016/j.arbres.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/16/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to determine the trend of variables related to tuberculosis (TB) from the Integrated Tuberculosis Research Program (PII-TB) registry of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), and to evaluate the PII-TB according to indicators related to its scientific objectives. METHOD Cross-sectional, population-based, multicenter study of new TB cases prospectively registered in the PII-TB between 2006 and 2016. The time trend of quantitative variables was calculated using a lineal regression model, and qualitative variables using the χy test for lineal trend. RESULTS A total of 6,892 cases with an annual median of 531 were analyzed. Overall, a significant downward trend was observed in women, immigrants, prisoners, and patients initially treated with 3 drugs. Significant upward trends were observed in patients aged 40-50 and > 50 years, first visit conducted by a specialist, hospitalization, diagnostic delay, disseminated disease and single extrapulmonary location, culture(+), sensitivity testing performed, drug resistance, directly observed treatment, prolonged treatment, and death from another cause. The scientific objectives of the PII-TB that showed a significant upward trend were publications, which reached a maximum of 8 in 2016 with a total impact factor of 49,664, numbers of projects initiated annually, presentations at conferences, and theses. CONCLUSIONS PII-TB provides relevant information on TB and its associated factors in Spain. A large team of researchers has been created; some scientific aspects of the registry were positive, while others could have been improved.
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Affiliation(s)
- Teresa Rodrigo
- Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Fundación Unidad de Investigación en Tuberculosis (fuiTB), Barcelona, España.
| | - José-María García-García
- Servicio de Neumología, Hospital Universitario San Agustín, Avilés, Asturias, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - José A Caminero
- Servicio de Neumología, Hospital General Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España; International Union Against Tuberculosis and Lung Disease, París, Francia; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Juan Ruiz-Manzano
- Servicio de Neumología, Hospital Universitario Germans Trials i Pujol, Badalona, Barcelona, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Luis Anibarro
- Unidad de Tuberculosis, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Marta M García-Clemente
- Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - José A Gullón
- Servicio de Neumología, Hospital Universitario San Agustín, Avilés, Asturias, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - M Ángeles Jiménez-Fuentes
- Unidad de Prevención y Control de Tuberculosis, Hospital Universitario Vall d'Hebrón, Barcelona, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Juan F Medina
- Unidad de Tuberculosis, Hospitales Universitarios Virgen del Rocío, Sevilla, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Isabel Mir
- Servicio de Neumología, Hospital Son Llàtzer, Palma de Mallorca, Baleares, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Antón Penas
- Unidad de Tuberculosis, Hospital Universitario Lucus Augusti, Lugo, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Francisca Sánchez
- Servicio de Medicina Interna, Hospital del Mar, Barcelona, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Maria Luiza De Souza-Galvão
- Unidad de Prevención y Control de Tuberculosis, Hospital Universitario Vall d'Hebrón, Barcelona, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Joan A Caylà
- Fundación Unidad de Investigación en Tuberculosis (fuiTB), Barcelona, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
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10
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Community Knowledge about Tuberculosis and Perception about Tuberculosis-Associated Stigma in Pakistan. SOCIETIES 2019. [DOI: 10.3390/soc9010009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Tuberculosis- (TB) associated stigma is a well-documented phenomenon with various factors, both individual and societal, manifesting its role in shaping health-seeking behavior and contributing to suboptimal TB care in Pakistan. The objective of this study was to assess TB-related knowledge and perceived stigma among community members. This was a cross-sectional survey using a convenience sample of 183 individuals recruited between October and December 2017. A validated stigma measurement tool developed by Van Rie et al. was adapted. Data was analyzed using SPSS version 20.0. A clear majority was aware that TB is curable disease and that it is transmitted by coughing. However, respondents also thought that TB spread through contaminated food, sharing meals, sharing utensils, and by having sexual intercourse with a TB patient. In addition, females, unemployed, and persons having less than six years of education were also more likely to associate stigma with TB. We found an association between the lack of knowledge about TB and perceived stigma. This study highlights the need for improved TB-related education among communities.
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EXPERIENCING SYNDEMIC: DISENTANGLING THE BIOSOCIAL COMPLEXITY OF TUBERCULOSIS THROUGH QUALITATIVE RESEARCH. J Biosoc Sci 2018; 51:403-417. [PMID: 30296952 DOI: 10.1017/s0021932018000263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Tuberculosis (TB) remains a major global public health problem that has become a crisis fuelled by HIV and the increasing occurrence of antimicrobial resistance. What has been termed the biosocial nature of TB challenges effective control of the disease. Yet, biosocial interactions involved in the persistence of TB in diverse settings are difficult to systematically account for. The recently developed framework of syndemics provides a way to capture how complex health problems result from the interactions between diseases such as HIV and TB, and harmful social conditions such as unemployment, malnutrition and substance abuse. This article advances the syndemics scholarship by examining health conditions that cluster together with TB in the Russian Federation, by eliciting a set of social processes that precipitate this clustering and exacerbate health outcomes, and by analysing interactions between these health conditions and social processes. To provide an account of this complexity, the article takes a qualitative approach and draws on the perspectives and experiences of people with TB. The results demonstrate emergence of a syndemic of stress, substance abuse, TB and HIV that is sustained by poverty, occupational insecurity, marginalization and isolation. Frictions between the narrow focus of the health care system on TB and the wider syndemic processes in which the lives of many persons with TB are embedded, contribute to poorer health outcomes and increase the risks of developing drug resistance. Finally, the article argues that the large-scale and impersonal forces become embodied as individual pathology through the crucial interface of the ways in which persons experience and make sense of these forces and pathologies. Qualitative research is needed for the adequate analysis of this biosocial complexity in order to provide a solid basis for responses to TB-centred syndemics in various settings.
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Lalli M, Hamilton M, Pretorius C, Pedrazzoli D, White RG, Houben RMGJ. Investigating the impact of TB case-detection strategies and the consequences of false positive diagnosis through mathematical modelling. BMC Infect Dis 2018; 18:340. [PMID: 30031378 PMCID: PMC6054844 DOI: 10.1186/s12879-018-3239-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/05/2018] [Indexed: 01/09/2023] Open
Abstract
Background Increasing case notifications is one of the top programmatic priorities of National TB Control Programmes (NTPs). To find more cases, NTPs often need to consider expanding TB case-detection activities to populations with increasingly low prevalence of disease. Together with low-specificity diagnostic algorithms, these strategies can lead to an increasingly high number of false positive diagnoses, which has important adverse consequences. Methods We apply TIME, a widely-used country-level model, to quantify the expected impact of different case-finding strategies under two scenarios. In the first scenario, we compare the impact of implementing two different diagnostic algorithms (higher sensitivity only versus higher sensitivity and specificity) to reach programmatic screening targets. In the second scenario, we examine the impact of expanding coverage to a population with a lower prevalence of disease. Finally, we explore the implications of modelling without taking into consideration the screening of healthy individuals. Outcomes considered were changes in notifications, the ratio of additional false positive to true positive diagnoses, the positive predictive value (PPV), and incidence. Results In scenario 1, algorithm A of prolonged cough and GeneXpert yielded fewer additional notifications compared to algorithm B of any symptom and smear microscopy (n = 4.0 K vs 13.8 K), relative to baseline between 2017 and 2025. However, algorithm A resulted in an increase in PPV, averting 2.4 K false positive notifications thus resulting in a more efficient impact on incidence. Scenario 2 demonstrated an absolute decrease of 11% in the PPV as intensified case finding activities expanded into low-prevalence populations without improving diagnostic accuracy, yielding an additional 23 K false positive diagnoses for an additional 1.3 K true positive diagnoses between 2017 and 2025. Modelling the second scenario without taking into account screening amongst healthy individuals overestimated the impact on cases averted by a factor of 6. Conclusion Our findings show that total notifications can be a misleading indicator for TB programme performance, and should be interpreted carefully. When evaluating potential case-finding strategies, NTPs should consider the specificity of diagnostic algorithms and the risk of increasing false-positive diagnoses. Similarly, modelling the impact of case-finding strategies without taking into account potential adverse consequences can overestimate impact and lead to poor strategic decision-making. Electronic supplementary material The online version of this article (10.1186/s12879-018-3239-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marek Lalli
- Department of Infectious Disease Epidemiology, Keppel Street, WC1E 7HT, London, UK.
| | | | | | - Debora Pedrazzoli
- Department of Infectious Disease Epidemiology, Keppel Street, WC1E 7HT, London, UK
| | - Richard G White
- Department of Infectious Disease Epidemiology, Keppel Street, WC1E 7HT, London, UK
| | - Rein M G J Houben
- Department of Infectious Disease Epidemiology, Keppel Street, WC1E 7HT, London, UK
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Barua M, Van Driel F, Jansen W. Tuberculosis and the sexual and reproductive lives of women in Bangladesh. PLoS One 2018; 13:e0201134. [PMID: 30024977 PMCID: PMC6053219 DOI: 10.1371/journal.pone.0201134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 07/09/2018] [Indexed: 01/23/2023] Open
Abstract
When they do not meet norms related to sexuality and reproduction, Bangladeshi women often face abandonment and are thus deprived of an active sexual life, a marital relationship, and motherhood. Little is known about how a stigmatised disease such as tuberculosis (TB) may constrain the reproductive health and sexual lives of women. This article, derived from a larger study on the impact of TB on women’s sexual and reproductive health and rights in Narsingdi district and Dhaka, Bangladesh, aims to fill this gap. Based on interviews with nine married women who have or had TB, four husbands, and two mothers-in-law, this article highlights that the ways in which TB impedes on the sexual and reproductive lives of women depends on the stigma within their family and community, their relationships with their husbands, motherhood, their living arrangements, their economic contribution to the family and/or their disclosure of their TB diagnosis. Women with children and supportive husbands retain a stronger position among their in-laws and are less likely to be isolated or rejected. The patients’ narratives revealed that the instructions of health workers influenced their decisions about intercourse or abstinence. Future studies should examine the instructions patients receive from health workers regarding their living and sleeping arrangements, sexual intercourse, and pregnancy, as well as policy documents on TB treatment and prevention.
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Affiliation(s)
- Mrittika Barua
- Radboud Gender and Diversity Studies, Radboud University, Nijmegen, The Netherlands
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- * E-mail:
| | - Francien Van Driel
- Anthropology and Development Studies, Radboud University, Nijmegen, The Netherlands
| | - Willy Jansen
- Gender Studies, Radboud University, Nijmegen, The Netherlands
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Diefenbach-Elstob T, Graves P, Dowi R, Gula B, Plummer D, McBryde E, Pelowa D, Siba P, Pomat W, Warner J. The epidemiology of tuberculosis in the rural Balimo region of Papua New Guinea. Trop Med Int Health 2018; 23:1022-1032. [DOI: 10.1111/tmi.13118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tanya Diefenbach-Elstob
- College of Public Health; Medical and Veterinary Sciences; James Cook University; Townsville Australia
- Australian Institute of Tropical Health and Medicine; James Cook University; Townsville Australia
| | - Patricia Graves
- College of Public Health; Medical and Veterinary Sciences; James Cook University; Townsville Australia
| | - Robert Dowi
- Balimo District Hospital; Balimo Western Province Papua New Guinea
| | - Bisato Gula
- Balimo District Hospital; Balimo Western Province Papua New Guinea
| | - David Plummer
- College of Public Health; Medical and Veterinary Sciences; James Cook University; Townsville Australia
| | - Emma McBryde
- Australian Institute of Tropical Health and Medicine; James Cook University; Townsville Australia
| | - Daniel Pelowa
- Balimo District Hospital; Balimo Western Province Papua New Guinea
| | - Peter Siba
- Papua New Guinea Institute of Medical Research; Goroka Eastern Highlands Province Papua New Guinea
| | - William Pomat
- Papua New Guinea Institute of Medical Research; Goroka Eastern Highlands Province Papua New Guinea
| | - Jeffrey Warner
- College of Public Health; Medical and Veterinary Sciences; James Cook University; Townsville Australia
- Australian Institute of Tropical Health and Medicine; James Cook University; Townsville Australia
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Hayward S, Harding RM, McShane H, Tanner R. Factors influencing the higher incidence of tuberculosis among migrants and ethnic minorities in the UK. F1000Res 2018; 7:461. [PMID: 30210785 PMCID: PMC6107974 DOI: 10.12688/f1000research.14476.2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 12/17/2022] Open
Abstract
Migrants and ethnic minorities in the UK have higher rates of tuberculosis (TB) compared with the general population. Historically, much of the disparity in incidence between UK-born and migrant populations has been attributed to differential pathogen exposure, due to migration from high-incidence regions and the transnational connections maintained with TB endemic countries of birth or ethnic origin. However, focusing solely on exposure fails to address the relatively high rates of progression to active disease observed in some populations of latently infected individuals. A range of factors that disproportionately affect migrants and ethnic minorities, including genetic susceptibility, vitamin D deficiency and co-morbidities such as diabetes mellitus and HIV, also increase vulnerability to infection with
Mycobacterium tuberculosis (M.tb) or reactivation of latent infection. Furthermore, ethnic socio-economic disparities and the experience of migration itself may contribute to differences in TB incidence, as well as cultural and structural barriers to accessing healthcare. In this review, we discuss both biological and anthropological influences relating to risk of pathogen exposure, vulnerability to infection or development of active disease, and access to treatment for migrant and ethnic minorities in the UK.
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Affiliation(s)
- Sally Hayward
- St John's College, University of Oxford, Oxford, OX1 3JP, UK
| | | | - Helen McShane
- The Jenner Institute, University of Oxford, Oxford, OX1 3PS, UK
| | - Rachel Tanner
- The Jenner Institute, University of Oxford, Oxford, OX1 3PS, UK
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16
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Hayward S, Harding RM, McShane H, Tanner R. Factors influencing the higher incidence of tuberculosis among migrants and ethnic minorities in the UK. F1000Res 2018; 7:461. [PMID: 30210785 PMCID: PMC6107974 DOI: 10.12688/f1000research.14476.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 09/04/2023] Open
Abstract
Migrants and ethnic minorities in the UK have higher rates of tuberculosis (TB) compared with the general population. Historically, much of the disparity in incidence between UK-born and migrant populations has been attributed to differential pathogen exposure, due to migration from high-incidence regions and the transnational connections maintained with TB endemic countries of birth or ethnic origin. However, focusing solely on exposure fails to address the relatively high rates of progression to active disease observed in some populations of latently infected individuals. A range of factors that disproportionately affect migrants and ethnic minorities, including genetic susceptibility, vitamin D deficiency and co-morbidities such as diabetes mellitus and HIV, also increase vulnerability to infection with Mycobacterium tuberculosis (M.tb) or reactivation of latent infection. Furthermore, ethnic socio-economic disparities and the experience of migration itself may contribute to differences in TB incidence, as well as cultural and structural barriers to accessing healthcare. In this review, we discuss both biological and anthropological influences relating to risk of pathogen exposure, vulnerability to infection or development of active disease, and access to treatment for migrant and ethnic minorities in the UK.
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Affiliation(s)
- Sally Hayward
- St John’s College, University of Oxford, Oxford, OX1 3JP, UK
| | | | - Helen McShane
- The Jenner Institute, University of Oxford, Oxford, OX1 3PS, UK
| | - Rachel Tanner
- The Jenner Institute, University of Oxford, Oxford, OX1 3PS, UK
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Maciel EMGDS, Amancio JDS, de Castro DB, Braga JU. Social determinants of pulmonary tuberculosis treatment non-adherence in Rio de Janeiro, Brazil. PLoS One 2018; 13:e0190578. [PMID: 29304100 PMCID: PMC5755789 DOI: 10.1371/journal.pone.0190578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/25/2017] [Indexed: 02/05/2023] Open
Abstract
Success in tuberculosis control depends on the implementation of steps that reduce social inequities, allowing the diagnosis and effective treatment of the disease. Little is known about the conditions affecting antituberculosis treatment non-adherence in areas of great social and economic heterogeneity, such as the municipality of Rio de Janeiro. This study aimed to describe and identify the social determinants of antituberculosis treatment non-adherence in the municipality of Rio de Janeiro between 2008 and 2012. An ecological study was conducted with the districts of Rio de Janeiro as the units of analysis. Analyzes using Poisson regression models allowed us to identify the association between dropout from antituberculosis treatment and the human development index and social development index. The final model showed that economic conditions, infrastructure, and the tuberculosis control quality of surveillance were associated with treatment non-adherence. This study demonstrated that the scenarios of socio-environmental precariousness found in the districts of Rio de Janeiro were able to identify populations with an increased risk of default treatment from antituberculosis.
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Affiliation(s)
| | - Juliana de Souza Amancio
- Sérgio Arouca National School of Public Health (Escola Nacional de Saúde Pública Sérgio Arouca), FIOCRUZ, Rio de Janeiro, Brazil
| | - Daniel Barros de Castro
- Sérgio Arouca National School of Public Health (Escola Nacional de Saúde Pública Sérgio Arouca), FIOCRUZ, Rio de Janeiro, Brazil
- Health Surveillance Foundation (Fundação de Vigilância em Saúde, FVS), Manaus, Brazil
| | - José Ueleres Braga
- Sérgio Arouca National School of Public Health (Escola Nacional de Saúde Pública Sérgio Arouca), FIOCRUZ, Rio de Janeiro, Brazil
- Institute of Social Medicine (Instituto de Medicina Social), Rio de Janeiro State University (Universidade do Estado do Rio de Janeiro, UERJ), Rio de Janeiro, Brazil
- * E-mail:
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Mason PH, Snow K, Asugeni R, Massey PD, Viney K. Tuberculosis and gender in the Asia-Pacific region. Aust N Z J Public Health 2016; 41:227-229. [PMID: 27960224 DOI: 10.1111/1753-6405.12619] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Paul H Mason
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, New South Wales.,Woolcock Institute of Medical Research, University of Sydney, New South Wales.,Department of Anthropology, Macquarie University, New South Wales
| | - Kathryn Snow
- Centre for International Child Health, Department of Paediatrics, University of Melbourne, Victoria.,Melbourne School of Population and Global Health, University of Melbourne, Victoria
| | - Rowena Asugeni
- Atoifi Adventist Hospital, Malaita Province, Solomon Islands
| | | | - Kerri Viney
- National Centre for Epidemiology and Population Health and Department of Global Health, Research School of Population Health, Australian National University, Australian Capital Territory
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RECIPROCITY-BUILDING AND THE IMPORTANCE OF INTERDISCIPLINARY COLLABORATION IN TUBERCULOSIS RESEARCH. J Biosoc Sci 2016; 49:559-562. [DOI: 10.1017/s0021932016000626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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CONSIDERING NEOLIBERALISM, CONTEMPT AND ALLOSTATIC LOAD IN THE SOCIAL DYNAMICS OF TUBERCULOSIS. J Biosoc Sci 2016; 49:557-558. [DOI: 10.1017/s0021932016000614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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22
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Cervantes J. Tuberculosis. Digging deep in the soul of humanity. Respir Med 2016; 119:20-22. [PMID: 27692142 DOI: 10.1016/j.rmed.2016.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/15/2016] [Accepted: 08/17/2016] [Indexed: 11/18/2022]
Abstract
Tuberculosis (TB) is one of the oldest infectious diseases that affected humankind. A quintessential social disease, TB remains one of the world's deadliest communicable diseases, with still a high mortality and burden of disease. Social representations of TB focus on aspects associated to feelings and manifestations awakened by the disease, sometimes reinforcing stigmas and prejudices about the way of perceiving TB. TB is a historic disease now reborn with a deeper social stigma. Despite the modest reduction in TB incidence worldwide, its incidence is still rising in certain crisis-affected populations like refugees, and in those bearing high prevalence of HIV, persisting poverty, especially in the developing world. Fear and stigma may appear justified with the increasing rates of multi-drug resistant (MDR) TB, and now extremely drug resistant (XDR) TB. However, stigmatization of TB poses serious obstacles to current TB control efforts, as socio-cultural aspects can influence adherence to TB treatment.
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Affiliation(s)
- Jorge Cervantes
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, 5001 El Paso Dr., El Paso, TX 79905, United States.
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