Optimising diagnosis and treatment of tuberculosis infection in community and primary care settings in two urban provinces of Viet Nam: a cohort study

Acceptance and Completion Rates of 3-Month Isoniazid-Rifampicin (3HR) Tuberculosis Preventive Treatment (TPT) Among Contacts of Bacteriologically Confirmed TB Patients-Patients' and Healthcare Workers' Perspectives

Providing tuberculosis preventive treatment (TPT) to close contacts of persons with TB is a core strategy recommended by WHO for the prevention and control of TB. Nigeria rolled out the 3-month Isoniazid-Rifampicin (3HR) shorter regimen TPT as a pilot for use among eligible adult and child contacts. This study assesses acceptance and completion rates of 3HR TPT among contacts and determines the perspectives of healthcare workers (HCWs) and contacts on acceptance and completion of 3HR TPT in Nigeria. In this cross-sectional descriptive study using mixed methods, records of TPT-eligible clients were retrospectively reviewed, while 18 purposely selected HCWs and 18 contacts on 3HR were interviewed. Of the 30,012 eligible contacts, 12,040 (40.1%) were initiated on TPT. Among these, 8213 (68%) were enrolled on 3HR, and 6972 (84.7%) of them completed treatment. Perceived facilitators include belief in its effectiveness, training among HCWs, and a good understanding of TPT from HCW counseling sessions. Barriers reported were linked to stockouts, misconceptions about side effects, non-disclosures, and disincentive follow-up strategies. The acceptance and completion rate for 3HR TPT was good. Scaling up 3HR TPT will require redesigning policies towards addressing identified barriers and utilizing interventions linked to capabilities, opportunities, and motivations among contacts of TB patients and HCWs.

Prevalence of non-communicable diseases among household contacts of people with tuberculosis: A systematic review and individual participant data meta-analysis

OBJECTIVE

To investigate the prevalence of non-communicable diseases among household contacts of people with tuberculosis.

METHODS

We conducted a systematic review and individual participant data meta-analysis. We searched Medline, Embase and the Global Index Medicus from inception to 16 May 2023. We included studies that assessed for at least one non-communicable disease among household contacts of people with clinical tuberculosis. We estimated the non-communicable disease prevalence through mixed effects logistic regression for studies providing individual participant data, and compared it with estimates from aggregated data meta-analyses. Furthermore, we compared age and sex-standardised non-communicable disease prevalence with national-level estimates standardised for age and sex.

RESULTS

We identified 39 eligible studies, of which 14 provided individual participant data (29,194 contacts). Of the remaining 25 studies, 18 studies reported aggregated data suitable for aggregated data meta-analysis. In individual participant data analysis, the pooled prevalence of diabetes in studies that undertook biochemical testing was 8.8% (95% confidence interval [CI], 5.1%-14.9%, four studies). Age-and sex-standardised prevalence was higher in two studies (10.4% vs. 6.9% and 11.5% vs. 8.4%) than the corresponding national estimates and similar in two studies. Prevalence of diabetes mellitus based on self-report or medical records was 3.4% (95% CI 2.6%-4.6%, 14 studies). Prevalence did not significantly differ compared to estimates from aggregated data meta-analysis. There were limited data for other non-communicable diseases.

CONCLUSION

The prevalence of diabetes mellitus among household contacts was high while that of known diabetes was substantially lower, suggesting the underdiagnosis. tuberculosis household contact investigation offers opportunities to deliver multifaceted interventions to identify tuberculosis infection and disease, screen for non-communicable diseases and address shared risk factors.