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Benjumea-Bedoya D, Villegas Arbeláez E, Martínez-Peñaloza D, Beltrán-Arroyave CP, Restrepo Gouzy AV, Marín D, Cadavid Álvarez LM, Molinares B, Montes Zuluaga FN, Pulido Duarte H, Suárez Parra PM, Alzate Ángel JC, Vélez-Parra G, Realpe T, Vásquez Villa M, Ríos Buitrago SY, Puerta Zapata J, Arango García LM, Perea Torres Y, Pérez Doncel N, Arbeláez Montoya MP, Robledo J. Implementation of an integrated care strategy for child contacts of tuberculosis patients: a quasi-experimental study protocol. BMC Pediatr 2023; 23:28. [PMID: 36653768 PMCID: PMC9850583 DOI: 10.1186/s12887-022-03798-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/12/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Childhood tuberculosis continues to be a major public health problem. Although the visibility of the epidemic in this population group has increased, further research is needed. OBJECTIVE To design, implement and evaluate an integrated care strategy for children under five years old who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients in Medellín and the Metropolitan Area. METHODS A quasi-experimental study in which approximately 300 children who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients from Medellín and the Metropolitan Area will be evaluated and recruited over one year. A subgroup of these children, estimated at 85, who require treatment for latent tuberculosis, will receive an integrated care strategy that includes: some modifications of the current standardized scheme in Colombia, with rifampicin treatment daily for four months, follow-up under the project scheme with nursing personnel, general practitioners, specialists, professionals from other disciplines such as social work, psychology, and nutritionist. Additionally, transportation and food assistance will be provided to encourage treatment compliance. This strategy will be compared with isoniazid treatment received by a cohort of children between 2015 and 2018 following the standardized scheme in the country. The study was approved by the CIB Research Ethics Committee and UPB. CLINICALTRIALS gov identifier NCT04331262. DISCUSSION This study is expected to contribute to the development of integrated care strategies for the treatment of latent tuberculosis in children. The results will have a direct impact on the management of childhood tuberculosis contributing to achieving the goals proposed by the World Health Organization's End TB Strategy. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04331262 . Implementation of an Integrated Care Strategy for Children Contacts of Patients with Tuberculosis. Registered 2 April 2020.
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Affiliation(s)
- Dione Benjumea-Bedoya
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia ,grid.441797.80000 0004 0418 3449Grupo de Investigación en Salud Familiar y Comunitaria, School of Health Sciences, Corporación Universitaria Remington, Medellín, Colombia ,grid.412881.60000 0000 8882 5269Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Esteban Villegas Arbeláez
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Daniela Martínez-Peñaloza
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Claudia Patricia Beltrán-Arroyave
- grid.412881.60000 0000 8882 5269Grupo Pediaciencias, Medicine School, Universidad de Antioquia, Medellín, Colombia ,Clínica El Rosario, Medellín, Colombia ,Clínica del Prado, Medellín, Colombia
| | | | - Diana Marín
- grid.412249.80000 0004 0487 2295Grupo de Investigación en Salud Pública, School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | - Beatriz Molinares
- grid.413124.10000 0004 1784 5448Hospital Pablo Tobón Uribe, Medellín, Colombia
| | | | | | | | - Juan Carlos Alzate Ángel
- grid.412881.60000 0000 8882 5269Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Guillermo Vélez-Parra
- grid.411140.10000 0001 0812 5789Hospital General de Medellín, Professor Universidad CES, Medellín, Colombia
| | - Teresa Realpe
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Marisol Vásquez Villa
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Stefani Yamile Ríos Buitrago
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Jenifer Puerta Zapata
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Lisandra María Arango García
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Yesenia Perea Torres
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Natalia Pérez Doncel
- grid.412249.80000 0004 0487 2295School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - María Patricia Arbeláez Montoya
- grid.412881.60000 0000 8882 5269Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Jaime Robledo
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
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Assefa DG, Zeleke ED, Bekele D, Ejigu DA, Molla W, Woldesenbet TT, Aynalem A, Abebe M, Mebratu A, Manyazewal T. Isoniazid Preventive Therapy for Prevention of Tuberculosis among People Living with HIV in Ethiopia: A Systematic Review of Implementation and Impacts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:621. [PMID: 36612942 PMCID: PMC9819739 DOI: 10.3390/ijerph20010621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Tuberculosis (TB) is a major cause of morbidity and mortality in people living with HIV (PLWHIV). Isoniazid preventive therapy (IPT) prevents TB in PLWHIV, but estimates of its effects and actual implementation vary across countries. We reviewed studies that examined the impact of IPT on PLHIV and the factors influencing its implementation in Ethiopia. METHODS We searched PubMed/MEDLINE, Embase, and the Cochrane Central Register of Clinical Controlled Trials from their inception to 1 April 2021 for studies of any design that examined the impact of IPT on PLHIV and the factors influencing its implementation. The protocol was registered in PROSPERO, ID: CRD42021256579. RESULT Of the initial 546 studies identified, 13 of which enrolled 12,426 participants, 15,640 PLHIV and 62 HIV clinical care providers were included. PLHIV who were on IPT, independently or simultaneously with ART, were less likely to develop TB than those without IPT. IPT interventions had a significant association with improved CD4 count and reduced all-cause mortality. IPT was less effective in people with advanced HIV infection. The major factors influencing IPT implementation and uptake were stock-outs, fear of developing isoniazid-resistant TB, patient's refusal and non-adherence, and improper counseling and low commitment of HIV clinical care providers. CONCLUSION IPT alone or in combination with ART significantly reduces the incidence of TB and mortality in PLHIV in Ethiopia than those without IPT. More research on safety is needed, especially on women with HIV who receive a combination of IPT and ART. Additionally, studies need to be conducted to investigate the efficacy and safety of the new TPT (3 months combination of isoniazid and rifapentine) in children and people living with HIV.
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Affiliation(s)
- Dawit Getachew Assefa
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 3880, Ethiopia
- Department of Nursing, College of Medicine and Health Sciences, Dilla University, Dilla P.O. Box 419, Ethiopia
| | - Eden Dagnachew Zeleke
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 3880, Ethiopia
- Department of Midwifery, College of Health Science, Bule-Hora University, Bule-Hora P.O. Box 144, Ethiopia
| | - Delayehu Bekele
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 3880, Ethiopia
- Department of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa P.O. Box 3880, Ethiopia
| | - Dawit A. Ejigu
- Department of Pharmacology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa P.O. Box 3880, Ethiopia
| | - Wondwosen Molla
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla P.O. Box 419, Ethiopia
| | - Tigist Tekle Woldesenbet
- Department of Public Health, School of Graduate Studies, Pharma College, Hawassa P.O. Box 5, Ethiopia
| | - Amdehiwot Aynalem
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 1560, Ethiopia
| | - Mesfin Abebe
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla P.O. Box 419, Ethiopia
| | - Andualem Mebratu
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla P.O. Box 419, Ethiopia
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 3880, Ethiopia
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Loesch RBR, Ribeiro RM, Conceição C. Tuberculosis contact investigation in African Portuguese-speaking countries at End TB Strategy era: a scoping review. BMJ Open 2022; 12:e056761. [PMID: 35379632 PMCID: PMC8981322 DOI: 10.1136/bmjopen-2021-056761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The contact investigation of tuberculosis (TB) index case is one of the critical elements pointed by the WHO to reach the end of the TB epidemic. The scoping review aimed to map out the recommended and the adopted processes applied to active contact investigation of TB index case in African Portuguese-speaking countries (PALOP). DESIGN Scoping review. DATA SOURCES We searched B-on, Cochrane Library, PubMed, Web of Science, Scopus, WHOLIS, IRIS, OKR, each country's Ministry of Health websites, WHO, Global Fund, World Bank and bibliographic reference lists from February to May 2020. ELIGIBILITY CRITERIA All available literature on TB contact investigation in each country part of PALOP (Angola, Cape Verde, Guinea-Bissau, Mozambique and Sao Tome and Principe) published from 1 January 2010 to 31 January2020. DATA EXTRACTION AND SYNTHESIS A data-charting form was developed to extract data on documents' characteristics and variables pertinent to the TB contact investigation process. Before qualitative analysis, we thematically synthesised findings and converted them into appropriate text units. RESULTS Fifteen documents were included in the scoping review. The recommended processes for TB contact investigation were identified only for Cape Verde and Mozambique. It included clinical evaluation, counselling and testing for HIV, chest radiography, tuberculin skin test, sputum smear microscopy or Xpert MTB/RIF. The adopted processes were detected only in research studies from Angola, Guinea-Bissau and Mozambique. Therefore, they cannot be assumed as adopted within the scope of the national programmes of the respective countries. CONCLUSION This review highlights the scarcity of references on TB contact investigation in PALOP at the End TB Strategy era. Furthermore, it is well clear the importance of an information system that provides actual data for assessing the real impact of such interventions in controlling the disease in African Portuguese-speaking countries.
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Affiliation(s)
| | - Rafaela M Ribeiro
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Cláudia Conceição
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
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Thysen SM, Benn CS, Gomes VF, Rudolf F, Wejse C, Roth A, Kallestrup P, Aaby P, Fisker A. Neonatal BCG vaccination and child survival in TB-exposed and TB-unexposed children: a prospective cohort study. BMJ Open 2020; 10:e035595. [PMID: 32114478 PMCID: PMC7050365 DOI: 10.1136/bmjopen-2019-035595] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To assess the association between neonatal BCG vaccination and mortality between 28 days and 3 years of age among tuberculosis (TB)-exposed and TB-unexposed children. DESIGN Prospective cohort study. SETTING Bandim Health Project runs an urban Health and Demographic Surveillance site in Guinea-Bissau with registration of mortality, vaccination status and TB cases. PARTICIPANTS Children entered the analysis when their vaccination card was inspected after 28 days of age and remained under surveillance to 3 years of age. Children residing in the same house as a TB case were classified as TB-exposed from 3 months prior to case registration to the end of follow-up. METHODS Using Cox-proportional hazards models with age as underlying time scale, we compared mortality of children with and without neonatal BCG between October 2003 and September 2017. MAIN OUTCOME MEASURE HR for neonatal BCG compared with no neonatal BCG by TB-exposure status. RESULTS Among the 39 421 children who entered the analyses, 3022 (8%) had observation time as TB-exposed. In total, 84% of children received neonatal BCG. Children with neonatal BCG had lower mortality both in TB-exposed (adjusted HR: 0.57 (0.26 to 1.27)) and in TB-unexposed children (HR: 0.57 (95% CI 0.47 to 0.69)) than children without neonatal BCG. Children exposed to TB had higher mortality than TB-unexposed children if they had not received neonatal BCG. CONCLUSION Neonatal BCG vaccination was associated with lower mortality among both TB-exposed and TB-unexposed children, consistent with neonatal BCG vaccination having beneficial non-specific effects. Interventions to increase timely BCG vaccination are urgently warranted.
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Affiliation(s)
- Sanne M Thysen
- Bandim Health Project, OPEN, University of Southern Denmark, Odense, Syddanmark, Denmark
- Bandim Health Project, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Christine Stabell Benn
- Bandim Health Project, OPEN, University of Southern Denmark, Odense, Syddanmark, Denmark
- Bandim Health Project, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | | | - Frauke Rudolf
- Bandim Health Project, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Wejse
- Bandim Health Project, Bissau, Guinea-Bissau
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Adam Roth
- Department of Communicable Disease Control and Health Protection, Public Health Agency of Sweden, Solna, Stockholm, Sweden
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Per Kallestrup
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Ane Fisker
- Bandim Health Project, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
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Does Isoniazid Preventive Therapy Provide Better Treatment Outcomes in HIV-Infected Individuals in Northern Ethiopia? A Retrospective Cohort Study. AIDS Res Treat 2020; 2020:7025738. [PMID: 32411454 PMCID: PMC7204289 DOI: 10.1155/2020/7025738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/26/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives Early antiretroviral therapy (ART), isoniazid preventive therapy (IPT), and isoniazid-rifapentine (3HP) are effective strategies for preventing tuberculosis (TB) among people living with HIV (PLHIV). The study aimed to determine the effect of IPT on the TB incidence, follow-up CD4+ T cells, and all-cause mortality rate. Participants. Eligible patients on ART (n = 1, 863) were categorized into one-to-two ratios of exposed groups to IPT (n = 621) and nonexposed groups to IPT (n = 1, 242). Exposed groups entered the cohort at their first prescription of IPT, and unexposed groups entered into the study at the first prescription of ART and then followed until the occurrence of the outcome or date of administrative censoring (June 30, 2017). The outcome endpoints were TB incidence, follow-up CD4+ T cells, and all-cause mortality rate. Results The follow-up CD4+ T cells for the exposed and nonexposed groups were 405.74 and 366.95 cells/mm (World Health Organization (WHO), 2017), respectively, a statistically significant finding (t 1861 = -3.770, p < 0.0001; Cohen's d = 0.186). Nine percent of the exposed patients (620 incidence of TB per 100,000 person-years (PYs)) and 21.9% of the nonexposed patients (3160 incidence of TB per 100,000 PYs) developed TB. Mortality rate (per 100,000 PYs) was 440 for the exposed and 1490 for the unexposed patients. Statistically significant determinants of the all-cause mortality were unscheduled follow-up (AHR = 1.601; 95% CI: 1.154-2.222) and unable to work properly (AHR = 2.324; 95% CI: 1.643-3.288). Conclusion This study demonstrates the effect of IPT in reducing incidence of TB and all-cause mortality rate and improving follow-up CD4+ T cells. Promoting IPT use can help to achieve the TB eradicating national agenda in Ethiopia.
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Sekadde MP, Kay AW. Tuberculosis Prevention: an Under Prioritized yet Critical Intervention to Reduce Child Tuberculosis Morbidity and Mortality. CURRENT TROPICAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40475-018-0139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Qualitative Assessment of Challenges in Tuberculosis Control in West Gojjam Zone, Northwest Ethiopia: Health Workers' and Tuberculosis Control Program Coordinators' Perspectives. Tuberc Res Treat 2016; 2016:2036234. [PMID: 27066271 PMCID: PMC4811263 DOI: 10.1155/2016/2036234] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/11/2016] [Accepted: 02/18/2016] [Indexed: 11/30/2022] Open
Abstract
Background. Weak health systems pose many barriers to effective tuberculosis (TB) control. This study aimed at exploring health worker's and TB control program coordinator's perspectives on health systems challenges facing TB control in West Gojjam Zone, Amhara Region, Ethiopia. Methods. This was a qualitative descriptive study. Eight in-depth interviews with TB control program coordinators and two focus group discussions among 16 health workers were conducted. Purposive sampling was used to recruit study participants. Thematic analysis was used to identify and analyse main themes. Results. We found that intermittent interruptions of laboratory reagents and anti-TB drugs supplies, absence of trained and motivated health workers, poor TB data documentation, lack of adherence to TB treatment guideline, and lack of access to TB diagnostic tools at peripheral health institutions were challenges facing the TB control program performance in the study zone. Conclusions. Ensuring uninterrupted supply of anti-TB drugs and laboratory reagents to all health institutions is essential. Continuous refresher training of health workers on standard TB care and data handling and developing and implementing a sound retention strategy to attract and motivate health professionals to work in rural areas are necessary interventions to improve the TB control program performance in the study zone.
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