1
|
Bhargava A, Bhargava M, Meher A, Benedetti A, Velayutham B, Sai Teja G, Watson B, Barik G, Pathak RR, Prasad R, Dayal R, Madhukeshwar AK, Chadha V, Pai M, Joshi R, Menzies D, Swaminathan S. Nutritional supplementation to prevent tuberculosis incidence in household contacts of patients with pulmonary tuberculosis in India (RATIONS): a field-based, open-label, cluster-randomised, controlled trial. Lancet 2023; 402:627-640. [PMID: 37567200 DOI: 10.1016/s0140-6736(23)01231-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND In India, tuberculosis and undernutrition are syndemics with a high burden of tuberculosis coexisting with a high burden of undernutrition in patients and in the population. The aim of this study was to determine the effect of nutritional supplementation on tuberculosis incidence in household contacts of adults with microbiologically confirmed pulmonary tuberculosis. METHODS In this field-based, open-label, cluster-randomised controlled trial, we enrolled household contacts of 2800 patients with microbiologically confirmed pulmonary tuberculosis across 28 tuberculosis units of the National Tuberculosis Elimination Programme in four districts of Jharkhand, India. The tuberculosis units were randomly allocated 1:1 by block randomisation to the control group or the intervention group, by a statistician using computer-generated random numbers. Although microbiologically confirmed pulmonary tuberculosis patients in both groups received food rations (1200 kcal, 52 grams of protein per day with micronutrients) for 6 months, only household contacts in the intervention group received monthly food rations and micronutrients (750 kcal, 23 grams of protein per day with micronutrients). After screening all household contacts for co-prevalent tuberculosis at baseline, all participants were followed up actively until July 31, 2022, for the primary outcome of incident tuberculosis (all forms). The ascertainment of the outcome was by independent medical staff in health services. We used Cox proportional hazards model and Poisson regression via the generalised estimating equation approach to estimate unadjusted hazard ratios, adjusted hazard ratios (aHRs), and incidence rate ratios (IRRs). This study is registered with CTRI-India, CTRI/2019/08/020490. FINDINGS Between Aug 16, 2019, and Jan 31, 2021, there were 10 345 household contacts, of whom 5328 (94·8%) of 5621 household contacts in the intervention group and 4283 (90·7%) of 4724 household contacts in the control group completed the primary outcome assessment. Almost two-thirds of the population belonged to Indigenous communities (eg, Santhals, Ho, Munda, Oraon, and Bhumij) and 34% (3543 of 10 345) had undernutrition. We detected 31 (0·3%) of 10 345 household contact patients with co-prevalent tuberculosis disease in both groups at baseline and 218 (2·1%) people were diagnosed with incident tuberculosis (all forms) over 21 869 person-years of follow-up, with 122 of 218 incident cases in the control group (2·6% [122 of 4712 contacts at risk], 95% CI 2·2-3·1; incidence rate 1·27 per 100 person-years) and 96 incident cases in the intervention group (1·7% [96 of 5602], 1·4-2·1; 0·78 per 100 person-years), of whom 152 (69·7%) of 218 were patients with microbiologically confirmed pulmonary tuberculosis. Tuberculosis incidence (all forms) in the intervention group had an adjusted IRR of 0·61 (95% CI 0·43-0·85; aHR 0·59 [0·42-0·83]), with an even greater decline in incidence of microbiologically confirmed pulmonary tuberculosis (0·52 [0·35-0·79]; 0·51 [0·34-0·78]). This translates into a relative reduction of tuberculosis incidence of 39% (all forms) to 48% (microbiologically confirmed pulmonary tuberculosis) in the intervention group. An estimated 30 households (111 household contacts) would need to be provided nutritional supplementation to prevent one incident tuberculosis. INTERPRETATION To our knowledge, this is the first randomised trial looking at the effect of nutritional support on tuberculosis incidence in household contacts, whereby the nutritional intervention was associated with substantial (39-48%) reduction in tuberculosis incidence in the household during 2 years of follow-up. This biosocial intervention can accelerate reduction in tuberculosis incidence in countries or communities with a tuberculosis and undernutrition syndemic. FUNDING Indian Council of Medical Research-India TB Research Consortium.
Collapse
Affiliation(s)
- Anurag Bhargava
- Department of Medicine, Yenepoya Medical College, Mangalore, India; Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, India; Department of Medicine, McGill University, Montreal, QC, Canada.
| | - Madhavi Bhargava
- Department of Community Medicine, Yenepoya Medical College, Mangalore, India; Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, India
| | - Ajay Meher
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - Andrea Benedetti
- Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, India; Department of Medicine, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Banurekha Velayutham
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - G Sai Teja
- Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, India
| | - Basilea Watson
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - Ganesh Barik
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | | | - Ranjit Prasad
- State TB Cell, National Tuberculosis Elimination Programme, Ranchi, India
| | - Rakesh Dayal
- National Health Mission, Department of Health, Medical Education and Family Welfare, Ranchi, India
| | | | | | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Rajendra Joshi
- National Tuberculosis Elimination Programme, Ministry of Health and Family Welfare, New Delhi, India
| | - Dick Menzies
- Department of Medicine, Yenepoya Medical College, Mangalore, India; Department of Medicine, McGill University, Montreal, QC, Canada; McGill International TB Centre, McGill University, Montreal, QC, Canada
| | | |
Collapse
|
2
|
Mutayoba BK, Ershova J, Lyamuya E, Hoelscher M, Heinrich N, Kilale AM, Range NS, Ngowi BJ, Ntinginya NE, Mfaume SM, Nkiligi E, Doulla B, Lyimo J, Kisonga R, Kingalu A, Lema Y, Kondo Z, Pletschette M. The second national anti-tuberculosis drug resistance survey in Tanzania, 2017-2018. Trop Med Int Health 2022; 27:891-901. [PMID: 36089572 PMCID: PMC9826299 DOI: 10.1111/tmi.13814] [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] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the levels and patterns of resistance to first- and second-line anti-tuberculosis (TB) drugs among new and previously treated sputum smear positive pulmonary TB (PTB) patients. METHODS We conducted a nationally representative cross-sectional facility-based survey in June 2017-July 2018 involving 45 clusters selected based on probability proportional to size. The survey aimed to determine the prevalence of anti-TB drug resistance and associated risk factors among smear positive PTB patients in Tanzania. Sputum samples were examined using smear microscopy, Xpert MTB/RIF, culture and drug susceptibility testing (DST). Logistic regression was used to account for missing data and sampling design effects on the estimates and their standard errors. RESULTS We enrolled 1557 TB patients, including 1408 (90.4%) newly diagnosed and 149 (9.6%) previously treated patients. The prevalence of multidrug-resistant TB (MDR-TB) was 0.85% [95% confidence interval (CI): 0.4-1.3] among new cases and 4.6% (95% CI: 1.1-8.2) among previously treated cases. The prevalence of Mycobacterium tuberculosis strains resistant to any of the four first-line anti-TB drugs (isoniazid, rifampicin, streptomycin and ethambutol) was 1.7% among new TB patients and 6.5% among those previously treated. Drug resistance to all first-line drugs was similar (0.1%) in new and previously treated patients. None of the isolates displayed poly-resistance or extensively drug-resistant TB (XDR-TB). The only risk factor for MDR-TB was history of previous TB treatment (odds ratio = 5.7, 95% CI: 1.9-17.2). CONCLUSION The burden of MDR-TB in the country was relatively low with no evidence of XDR-TB. Given the overall small number of MDR-TB cases in this survey, it will be beneficial focusing efforts on intensified case detection including universal DST.
Collapse
Affiliation(s)
- Beatrice Kemilembe Mutayoba
- Department of Preventive ServicesMinistry of Health National AIDS Control ProgramDodomaTanzania,Department of Infectious Diseases and Tropical MedicineMedical Center of the University of MunichMunichGermany
| | - Julia Ershova
- Division of Global HIV and TB, Global TB BranchUS Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Eligius Lyamuya
- Department of Microbiology and ImmunologyMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Michael Hoelscher
- Department of Infectious Diseases and Tropical MedicineMedical Center of the University of MunichMunichGermany
| | - Norbert Heinrich
- Department of Infectious Diseases and Tropical MedicineMedical Center of the University of MunichMunichGermany
| | - Andrew Martin Kilale
- Muhimbili Medical Research CentreNational Institute for Medical ResearchDar es SalaamTanzania
| | - Nyagosya Segere Range
- Muhimbili Medical Research CentreNational Institute for Medical ResearchDar es SalaamTanzania
| | - Benard James Ngowi
- Mbeya College of Health and Allied SciencesUniversity of Dar es SalaamMbeyaTanzania
| | | | - Saidi Mwinjuma Mfaume
- Muhimbili Medical Research CentreNational Institute for Medical ResearchDar es SalaamTanzania
| | - Emmanuel Nkiligi
- National Tuberculosis and Leprosy Program, Department of Preventive ServicesMinistry of HealthDodomaTanzania
| | - Basra Doulla
- National Tuberculosis and Leprosy ProgramCentral Tuberculosis Reference LaboratoryDar es SalaamTanzania
| | - Johnson Lyimo
- National Tuberculosis and Leprosy Program, Department of Preventive ServicesMinistry of HealthDodomaTanzania
| | - Riziki Kisonga
- Kibong'oto Infectious Diseases HospitalKilimanjaroTanzania
| | - Amri Kingalu
- National Tuberculosis and Leprosy Program, Department of Preventive ServicesMinistry of HealthDodomaTanzania
| | - Yakobo Lema
- Muhimbili Medical Research CentreNational Institute for Medical ResearchDar es SalaamTanzania
| | - Zuwena Kondo
- National Tuberculosis and Leprosy Program, Department of Preventive ServicesMinistry of HealthDodomaTanzania
| | - Michel Pletschette
- Department of Infectious Diseases and Tropical MedicineMedical Center of the University of MunichMunichGermany
| |
Collapse
|
3
|
Hussain H, Malik A, Ahmed JF, Siddiqui S, Amanullah F, Creswell J, Tylleskär T, Robberstad B. Cost-effectiveness of household contact investigation for detection of tuberculosis in Pakistan. BMJ Open 2021; 11:e049658. [PMID: 34686551 PMCID: PMC8543626 DOI: 10.1136/bmjopen-2021-049658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Despite WHO guidelines recommending household contact investigation, and studies showing the impact of active screening, most tuberculosis (TB) programmes in resource-limited settings only carry out passive contact investigation. The cost of such strategies is often cited as barriers to their implementation. However, little data are available for the additional costs required to implement this strategy. We aimed to estimate the cost and cost-effectiveness of active contact investigation as compared with passive contact investigation in urban Pakistan. METHODS We estimated the cost-effectiveness of 'enhanced' (passive with follow-up) and 'active' (household visit) contact investigations compared with standard 'passive' contact investigation from providers and the programme's perspective using a simple decision tree. Costs were collected in Pakistan from a TB clinic performing passive contact investigation and from studies of active contact tracing interventions conducted. The effectiveness was based on the number of patients with TB identified among household contacts screened. RESULTS The addition of enhanced contact investigation to the existing passive mode detected 3.8 times more cases of TB per index patient compared with passive contact investigation alone. The incremental cost was US$30 per index patient, which yielded an incremental cost of US$120 per incremental patient identified with TB. The active contact investigation was 1.5 times more effective than enhanced contact investigation with an incremental cost of US$238 per incremental patient with TB identified. CONCLUSION Our results show that enhanced and active approaches to contact investigation effectively identify additional patients with TB among household contacts at a relatively modest cost. These strategies can be added to the passive contact investigation in a high burden setting to find the people with TB who are missed and meet the End TB strategy goals.
Collapse
Affiliation(s)
- Hamidah Hussain
- Centre for International Health, Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Norway
- Interactive Research and Development (IRD) Global, Singapore
| | - Amyn Malik
- Interactive Research and Development (IRD) Global, Singapore
| | - Junaid F Ahmed
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Sara Siddiqui
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | | | | | - Thorkild Tylleskär
- Centre for International Health, Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Norway
| | - Bjarne Robberstad
- Centre for International Health, Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Norway
- Section for Ethics and Health Economics, Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Norway
| |
Collapse
|
4
|
Nguyen HV, Nguyen HB, Nguyen NV, Cobelens F, Finlay A, Dao CH, Mirtskhulava V, Glaziou P, Pham HTT, de Haas P, Tiemersma E. Decline of Tuberculosis Burden in Vietnam Measured by Consecutive National Surveys, 2007-2017. Emerg Infect Dis 2021; 27:872-879. [PMID: 33622491 PMCID: PMC7920672 DOI: 10.3201/eid2703.204253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Vietnam, a high tuberculosis (TB) burden country, conducted national TB prevalence surveys in 2007 and 2017. In both surveys participants were screened by using a questionnaire and chest radiograph; sputum samples were then collected to test for Mycobacterium tuberculosis by smear microscopy and Löwenstein-Jensen culture. Culture-positive, smear-positive, and smear-negative TB cases were defined by laboratory results, and the prevalence of tuberculosis was compared between the 2 surveys. The results showed prevalence of culture-positive TB decreased by 37% (95% CI 11.5%–55.4%), from 199 (95% CI 160–248) cases/100,000 adults in 2007 to 125 (95% CI 98–159) cases/100,000 adults in 2017. Prevalence of smear-positive TB dropped by 53% (95% CI 27.0%–69.7%), from 99 (95% CI 78–125) cases/100,000 adults to 46 (95% CI 32–68) cases/100,000 adults; smear-negative TB showed no substantial decrease. Replacing microscopy with molecular methods for primary diagnostics might enhance diagnosis of pulmonary TB cases and further lower TB burden.
Collapse
|
5
|
Nguyen HV, Nguyen HB, Nguyen NV, Cobelens F, Finlay A, Dao CH, Mirtskhulava V, Glaziou P, Pham HT, de Haas P, Tiemersma E. Decline of Tuberculosis Burden in Vietnam Measured by Consecutive National Surveys, 2007–2017. Emerg Infect Dis 2021. [DOI: 10.3201/2703.204253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
6
|
Velen K, Nhung NV, Anh NT, Cuong PD, Hoa NB, Cuong NK, Dung NH, Sy DN, Britton WJ, Marks GB, Fox GJ. Risk factors for TB among household contacts of patients with smear-positive TB in eight provinces of Vietnam: a nested case-control study. Clin Infect Dis 2020; 73:e3358-e3364. [PMID: 33215197 DOI: 10.1093/cid/ciaa1742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) continues to account for significant morbidity and mortality annually. Household contacts (HHCs) of persons with TB are a key population for targeting prevention and control interventions. We aimed to identify risk factors associated with developing TB among HHCs. METHODS We conducted a nested case-control study among HHCs in eight provinces in Vietnam who were enrolled in a randomized control trial of active case finding for TB. Cases were any HHCs diagnosed and registered with TB within the Vietnam National TB programme during two years of follow-up. Controls were selected by simple random sampling from the remaining HHCs. Risk factor data were collected at enrolment and during follow-up. A logistic regression model was developed to determine predictors of TB among HHCs. RESULTS We selected 1,254 HHCs for the analysis; 214 cases and 1,040 controls. Underlying characteristics varied between both groups; cases were older, more likely to be male, higher proportion of reported previous TB and diabetes. Risk factors associated with a TB diagnosis included being male (aOR 1.4; 95% CI: 1.03-2.0), residing in an urban setting (aOR 1.8; 1.3-2.5), prior TB (aOR 4.6; 95% CI: 2.5-8.7), history of diabetes (aOR 3.1; 95% CI: 1.7-5.8), current smoking (aOR 3.1; 95% CI: 2.2-4.4) and prolonged history of coughing in the source case at enrolment (OR 1.6; 95% CI: 1.1-2.3). CONCLUSIONS Household contacts remain and important key population for TB prevention and control. TB programmes should ensure effective contact investigations are implemented for household contacts, particularly those with additional risk factors for developing tuberculosis.
Collapse
Affiliation(s)
- Kavindhran Velen
- Sydney Medical School, The University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sydney, Australia
| | | | - Nguyen Thu Anh
- Woolcock Institute of Medical Research, Sydney, Australia
| | - Pham Duc Cuong
- Woolcock Institute of Medical Research, Sydney, Australia
| | - Nguyen Binh Hoa
- National Lung Hospital, Hanoi, Vietnam.,Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Nguyen Kim Cuong
- National Lung Hospital, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | | | | | - Warwick John Britton
- Centenary Institute of Cancer Medicine and Cell Biology, University of Sydney, Sydney, Australia.,Department of Clinical Immunology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Guy Barrington Marks
- Woolcock Institute of Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Greg James Fox
- Sydney Medical School, The University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sydney, Australia
| |
Collapse
|
7
|
Lung T, Marks GB, Nhung NV, Anh NT, Hoa NLP, Anh LTN, Hoa NB, Britton WJ, Bestrashniy J, Jan S, Fox GJ. Household contact investigation for the detection of tuberculosis in Vietnam: economic evaluation of a cluster-randomised trial. LANCET GLOBAL HEALTH 2020; 7:e376-e384. [PMID: 30784638 DOI: 10.1016/s2214-109x(18)30520-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/18/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Active case finding is recommended as an important strategy to control tuberculosis, particularly in low-income and middle-income countries with a high prevalence of the disease. However, the costs and cost-effectiveness of active case finding are unclear due to the absence of evidence from randomised trials. We assessed the costs and cost-effectiveness of an active case finding strategy in Vietnam, where there is a high prevalence of tuberculosis. METHODS We conducted an economic evaluation alongside the Active Case Finding in Tuberculosis (ACT2) trial-a pragmatic cluster-randomised controlled trial in 70 districts across eight provinces of Vietnam. Patients aged 15 years and older with smear-positive pulmonary tuberculosis were recruited to the trial if they lived with one or more other household members. Household contacts were verbally invited to the clinic by the index patient with tuberculosis. ACT2 compared a combination of active and passive case finding with usual care (passive case finding) of household contacts of patients with tuberculosis from a health system perspective. Clustering occurred at the district and household level. Districts were the unit of randomisation, and we used minimisation to ensure balance of intervention and control districts within each province. In the intervention group, participants were invited to attend screening at baseline, 6 months, 12 months, and 24 months. We determined health-care costs with a standardised national costing survey and reported results in 2017 $US. The primary outcome of our study was disability-adjusted life years (DALYs) averted over a 24-month period. ACT2 was registered prospectively with the Australian and New Zealand Clinical Trials Registry, number ACTRN126.100.00600044. FINDINGS Between Aug 11, 2010, and Aug 11, 2015, 10 964 index patients and 25 707 household contacts completed the ACT2 study. There were 10 069 household contacts in the intervention group and 15 638 household contacts in the control group. The incremental cost-effectiveness ratio per DALY averted was $544 (330-1375). INTERPRETATION Active case finding was shown to be highly cost-effective in a setting with a high prevalence of tuberculosis. Investment in the wide-scale implementation of this programme in Vietnam should be strongly supported. FUNDING Australian National Health and Medical Research Council.
Collapse
Affiliation(s)
- Thomas Lung
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia.
| | - Guy B Marks
- South Western Sydney Clinical School, University of New South Wales, Kensington, NSW, Australia; Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - Nguyen Viet Nhung
- National Lung Hospital, Ba Dinh, Hanoi, Vietnam; Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Thu Anh
- Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | | | - Le Thi Ngoc Anh
- Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - Nguyen Binh Hoa
- National Lung Hospital, Ba Dinh, Hanoi, Vietnam; Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Warwick John Britton
- Faculty of Medicine and Health, University of Sydney, NSW, Australia; Centenary Institute of Cancer Medicine and Cell Biology, University of Sydney, Camperdown, NSW, Australia
| | | | - Stephen Jan
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Gregory J Fox
- Faculty of Medicine and Health, University of Sydney, NSW, Australia; Woolcock Institute of Medical Research, Glebe, NSW, Australia
| |
Collapse
|
8
|
Nguyen HV, Tiemersma EW, Nguyen HB, Cobelens FGJ, Finlay A, Glaziou P, Dao CH, Mirtskhulava V, Nguyen HV, Pham HTT, Khieu NTT, de Haas P, Do NH, Nguyen PD, Cung CV, Nguyen NV. The second national tuberculosis prevalence survey in Vietnam. PLoS One 2020; 15:e0232142. [PMID: 32324806 PMCID: PMC7179905 DOI: 10.1371/journal.pone.0232142] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/07/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Tuberculosis (TB) remains a significant cause of morbidity and mortality in Vietnam. The current TB burden is unknown as not all individuals with TB are diagnosed, recorded and notified. The second national TB prevalence survey was conducted in 2017–2018 to assess the current burden of TB disease in the country. Method Eighty-two clusters were selected using a multistage cluster sampling design. Adult (≥15 years of age) residents having lived for 2 weeks or more in the households of the selected clusters were invited to participate in the survey. The survey participants were screened for TB by a questionnaire and digital chest X-ray after providing written informed consent. Individuals with a positive symptom screen and/or chest X-ray suggestive of TB were asked to provide sputum samples to test for Mycobacterium tuberculosis by Ziehl-Neelsen direct light microscopy, Xpert MTB/RIF G4, BACTEC MGIT960 liquid culture and Löwenstein-Jensen solid culture. Bacteriologically confirmed TB cases were defined by an expert panel following a standard decision tree. Result Of 87,207 eligible residents, 61,763 (70.8%) participated, and 4,738 (7.7%) screened positive for TB. Among these, 221 participants were defined as bacteriologically confirmed TB cases. The estimated prevalence of bacteriologically confirmed adult pulmonary TB was 322 (95% CI: 260–399) per 100,000, and the male-to-female ratio was 4.0 (2.8–5.8, p<0.001). In-depth interviews with the participants with TB disease showed that only 57.9% (95% CI: 51.3–64.3%) reported cough for 2 weeks or more and 32.1% (26.3–38.6%) did not report any symptom consistent with TB, while their chest X-ray results showed that 97.7% (95% CI: 94.6–99.1) had abnormal chest X-ray images suggesting TB. Conclusion With highly sensitive diagnostics applied, this survey showed that the TB burden in Vietnam remains high. Half of the TB cases were not picked up by general symptom-based screening and were identified by chest X-ray only. Our results indicate that improving TB diagnostic capacity and access to care, along with reducing TB stigma, need to be top priorities for TB control and elimination in Vietnam.
Collapse
Affiliation(s)
- Hai Viet Nguyen
- National Tuberculosis Programme, Hanoi, Vietnam
- Department of Global Health and Amsterdam Institute of Global Health and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Edine W. Tiemersma
- Department of Global Health and Amsterdam Institute of Global Health and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- KNCV Tuberculosis Foundation, The Hague, the Netherlands
| | | | - Frank G. J. Cobelens
- Department of Global Health and Amsterdam Institute of Global Health and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Alyssa Finlay
- Centers for Disease Control Vietnam Office, Hanoi, Vietnam
| | - Philippe Glaziou
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Cu Huy Dao
- National Tuberculosis Programme, Hanoi, Vietnam
| | | | | | | | | | - Petra de Haas
- KNCV Tuberculosis Foundation, The Hague, the Netherlands
| | | | | | | | | |
Collapse
|
9
|
Reid MJA, Arinaminpathy N, Bloom A, Bloom BR, Boehme C, Chaisson R, Chin DP, Churchyard G, Cox H, Ditiu L, Dybul M, Farrar J, Fauci AS, Fekadu E, Fujiwara PI, Hallett TB, Hanson CL, Harrington M, Herbert N, Hopewell PC, Ikeda C, Jamison DT, Khan AJ, Koek I, Krishnan N, Motsoaledi A, Pai M, Raviglione MC, Sharman A, Small PM, Swaminathan S, Temesgen Z, Vassall A, Venkatesan N, van Weezenbeek K, Yamey G, Agins BD, Alexandru S, Andrews JR, Beyeler N, Bivol S, Brigden G, Cattamanchi A, Cazabon D, Crudu V, Daftary A, Dewan P, Doepel LK, Eisinger RW, Fan V, Fewer S, Furin J, Goldhaber-Fiebert JD, Gomez GB, Graham SM, Gupta D, Kamene M, Khaparde S, Mailu EW, Masini EO, McHugh L, Mitchell E, Moon S, Osberg M, Pande T, Prince L, Rade K, Rao R, Remme M, Seddon JA, Selwyn C, Shete P, Sachdeva KS, Stallworthy G, Vesga JF, Vilc V, Goosby EP. Building a tuberculosis-free world: The Lancet Commission on tuberculosis. Lancet 2019; 393:1331-1384. [PMID: 30904263 DOI: 10.1016/s0140-6736(19)30024-8] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 12/20/2018] [Accepted: 12/25/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Michael J A Reid
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Nimalan Arinaminpathy
- School of Public Health, Imperial College London, London, UK; Faculty of Medicine, Imperial College London, London, UK
| | - Amy Bloom
- Tuberculosis Division, United States Agency for International Development, Washington, DC, USA
| | - Barry R Bloom
- Department of Global Health and Population, Harvard University, Cambridge, MA, USA
| | | | - Richard Chaisson
- Departments of Medicine, Epidemiology, and International Health, Johns Hopkins School of Medicine, Baltimore, MA, USA
| | | | | | - Helen Cox
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Mark Dybul
- Department of Medicine, Centre for Global Health and Quality, Georgetown University, Washington, DC, USA
| | | | - Anthony S Fauci
- National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Maryland, MA, USA
| | | | - Paula I Fujiwara
- Department of Tuberculosis and HIV, The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Timothy B Hallett
- School of Public Health, Imperial College London, London, UK; Faculty of Medicine, Imperial College London, London, UK
| | | | | | - Nick Herbert
- Global TB Caucus, Houses of Parliament, London, UK
| | - Philip C Hopewell
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Chieko Ikeda
- Department of GLobal Health, Ministry of Heath, Labor and Welfare, Tokyo, Japan
| | - Dean T Jamison
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Aamir J Khan
- Interactive Research & Development, Karachi, Pakistan
| | - Irene Koek
- Global Health Bureau, United States Agency for International Development, Washington, DC, USA
| | - Nalini Krishnan
- Resource Group for Education and Advocacy for Community Health, Chennai, India
| | - Aaron Motsoaledi
- South African National Department of Health, Pretoria, South Africa
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; McGill International TB Center, McGill University, Montreal, QC, Canada
| | - Mario C Raviglione
- University of Milan, Milan, Italy; Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Almaz Sharman
- Academy of Preventive Medicine of Kazakhstan, Almaty, Kazakhstan
| | - Peter M Small
- Global Health Institute, School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | | | - Zelalem Temesgen
- Department of Infectious Diseases, Mayo Clinic, Rochester, MI, USA
| | - Anna Vassall
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Bruce D Agins
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Sofia Alexandru
- Institutul de Ftiziopneumologie Chiril Draganiuc, Chisinau, Moldova
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Naomi Beyeler
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Stela Bivol
- Center for Health Policies and Studies, Chisinau, Moldova
| | - Grania Brigden
- Department of Tuberculosis and HIV, The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Adithya Cattamanchi
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Danielle Cazabon
- McGill International TB Center, McGill University, Montreal, QC, Canada
| | - Valeriu Crudu
- Center for Health Policies and Studies, Chisinau, Moldova
| | - Amrita Daftary
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; McGill International TB Center, McGill University, Montreal, QC, Canada
| | - Puneet Dewan
- Bill & Melinda Gates Foundation, New Delhi, India
| | - Laurie K Doepel
- National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Maryland, MA, USA
| | - Robert W Eisinger
- National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Maryland, MA, USA
| | - Victoria Fan
- T H Chan School of Public Health, Harvard University, Cambridge, MA, USA; Office of Public Health Studies, University of Hawaii, Mānoa, HI, USA
| | - Sara Fewer
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Furin
- Division of Infectious Diseases & HIV Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jeremy D Goldhaber-Fiebert
- Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Gabriela B Gomez
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen M Graham
- Department of Tuberculosis and HIV, The International Union Against Tuberculosis and Lung Disease, Paris, France; Department of Paediatrics, Center for International Child Health, University of Melbourne, Melbourne, VIC, Australia; Burnet Institute, Melbourne, VIC, Australia
| | - Devesh Gupta
- Revised National TB Control Program, New Delhi, India
| | - Maureen Kamene
- National Tuberculosis, Leprosy and Lung Disease Program, Ministry of Health, Nairobi, Kenya
| | | | - Eunice W Mailu
- National Tuberculosis, Leprosy and Lung Disease Program, Ministry of Health, Nairobi, Kenya
| | | | - Lorrie McHugh
- Office of the Secretary-General's Special Envoy on Tuberculosis, United Nations, Geneva, Switzerland
| | - Ellen Mitchell
- International Institute of Social Studies, Erasmus University Rotterdam, The Hague, Netherland
| | - Suerie Moon
- Department of Global Health and Population, Harvard University, Cambridge, MA, USA; Global Health Centre, The Graduate Institute Geneva, Geneva, Switzerland
| | | | - Tripti Pande
- McGill International TB Center, McGill University, Montreal, QC, Canada
| | - Lea Prince
- Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | | | - Raghuram Rao
- Ministry of Health and Family Welfare, New Delhi, India
| | - Michelle Remme
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - James A Seddon
- Department of Medicine, Imperial College London, London, UK; Faculty of Medicine, Imperial College London, London, UK; Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Casey Selwyn
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Priya Shete
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Juan F Vesga
- School of Public Health, Imperial College London, London, UK; Faculty of Medicine, Imperial College London, London, UK
| | | | - Eric P Goosby
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
10
|
Bestrashniy JRBM, Nguyen VN, Nguyen TL, Pham TL, Nguyen TA, Pham DC, Nghiem LPH, Le TNA, Nguyen BH, Nguyen KC, Nguyen HD, Buu TN, Le TN, Nguyen VH, Dinh NS, Britton WJ, Marks GB, Fox GJ. Recurrence of tuberculosis among patients following treatment completion in eight provinces of Vietnam: A nested case-control study. Int J Infect Dis 2018; 74:31-37. [PMID: 29944930 DOI: 10.1016/j.ijid.2018.06.013] [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] [Received: 03/13/2018] [Revised: 06/06/2018] [Accepted: 06/17/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Patients completing treatment for tuberculosis (TB) in high-prevalence settings face a risk of developing recurrent disease. This has important consequences for public health, given its association with drug resistance and a poor prognosis. Previous research has implicated individual factors such as smoking, alcohol use, HIV, poor treatment adherence, and drug resistant disease as risk factors for recurrence. However, little is known about how these factors co-act to produce recurrent disease. Furthermore, perhaps factors related to the index disease means higher burden/low resource settings may be more prone to recurrent disease that could be preventable. METHODS We conducted a case-control study nested within a cohort of consecutively enrolled adults who were being treated for smear positive pulmonary TB in 70 randomly selected district clinics in Vietnam. Cases were patients with recurrent TB, identified by follow-up from the parent cohort study. Controls were selected from the cohort by random sampling. Information on demographic, clinical and disease-related characteristics was obtained by interview. Treatment information was extracted from clinic registries. Logistic regression, with stepwise selection, was used to develop a fully adjusted model for the odds of recurrence of TB. RESULTS We recruited 10,964 patients between October 2010 and July 2013. Median follow-up was 988 days. At the end of follow-up, 505 patients (4.7%) with recurrence were identified as cases and 630 other patients were randomly selected as controls. Predictors of recurrence included multidrug-resistant (MDR)-TB (adjusted odds ratio 79.6; 95% CI: 25.1-252.0), self-reported prior TB therapy (aOR=2.5; 95% CI: 1.7-3.5), and incomplete adherence (aOR=1.9; 95% CI 1.1-3.1). CONCLUSIONS Index disease treatment history is a leading determinant of relapse among patients with TB in Vietnam. Further research is required to identify interventions that will reduce the risk of recurrent disease and enhance its early detection within high-risk populations.
Collapse
Affiliation(s)
| | | | - Thi Loi Nguyen
- Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia
| | - Thi Lieu Pham
- Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia
| | - Thu Anh Nguyen
- Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia
| | - Duc Cuong Pham
- Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia
| | | | | | - Binh Hoa Nguyen
- National Lung Hospital, Ba Dinh, Hanoi, Vietnam; Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Kim Cuong Nguyen
- National Lung Hospital, Ba Dinh, Hanoi, Vietnam; Hanoi Medical University, Hanoi, Vietnam
| | | | - Tran Ngoc Buu
- Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia
| | - Thi Nhung Le
- Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia
| | - Viet Hung Nguyen
- Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia
| | | | - Warwick John Britton
- Centenary Institute of Cancer Medicine and Cell Biology, University of Sydney, Camperdown, NSW, 2050, Australia; Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia
| | - Guy Barrington Marks
- Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Greg James Fox
- Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia; Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia.
| |
Collapse
|
11
|
Fox GJ, Nhung NV, Sy DN, Hoa NLP, Anh LTN, Anh NT, Hoa NB, Dung NH, Buu TN, Loi NT, Nhung LT, Hung NV, Lieu PT, Cuong NK, Cuong PD, Bestrashniy J, Britton WJ, Marks GB. Household-Contact Investigation for Detection of Tuberculosis in Vietnam. N Engl J Med 2018; 378:221-229. [PMID: 29342390 DOI: 10.1056/nejmoa1700209] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Active case finding is a top priority for the global control of tuberculosis, but robust evidence for its effectiveness in high-prevalence settings is lacking. We sought to evaluate the effectiveness of household-contact investigation, as compared with standard, passive measures alone, in Vietnam. METHODS We performed a cluster-randomized, controlled trial at clinics in 70 districts (local government areas with an average population of approximately 500,000 in urban areas and 100,000 in rural areas) in eight provinces of Vietnam. Health workers at each district clinic or hospital were assigned to perform either household-contact intervention plus standard passive case finding (intervention group) or passive case finding alone (control group). In the intervention districts, household contacts of patients with positive results for tuberculosis on sputum smear microscopy (smear-positive tuberculosis) were invited for clinical assessment and chest radiography at baseline and at 6, 12, and 24 months. The primary outcome was the cumulative incidence of registered cases of tuberculosis among household contacts of patients with tuberculosis during a 2-year period. RESULTS In 70 selected districts, we enrolled 25,707 household contacts of 10,964 patients who had smear-positive pulmonary tuberculosis. In the 36 districts that were included in the intervention group, 180 of 10,069 contacts were registered as having tuberculosis (1788 cases per 100,000 population), as compared with 110 of 15,638 contacts (703 per 100,000) in the control group (relative risk of the primary outcome in the intervention group, 2.5; 95% confidence interval [CI], 2.0 to 3.2; P<0.001); the relative risk of smear-positive disease among household contacts in the intervention group was 6.4 (95% CI, 4.5 to 9.0; P<0.001). CONCLUSIONS Household-contact investigation plus standard passive case finding was more effective than standard passive case finding alone for the detection of tuberculosis in a high-prevalence setting at 2 years. (Funded by the Australian National Health and Medical Research Council; ACT2 Australian New Zealand Clinical Trials Registry number, ACTRN12610000600044 .).
Collapse
Affiliation(s)
- Greg J Fox
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nguyen V Nhung
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Dinh N Sy
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nghiem L P Hoa
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Le T N Anh
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nguyen T Anh
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nguyen B Hoa
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nguyen H Dung
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Tran N Buu
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nguyen T Loi
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Le T Nhung
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nguyen V Hung
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Phan T Lieu
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nguyen K Cuong
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Pham D Cuong
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Jessica Bestrashniy
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Warwick J Britton
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Guy B Marks
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| |
Collapse
|
12
|
The effect of delay on contact tracing. Math Biosci 2016; 282:204-214. [PMID: 27793628 DOI: 10.1016/j.mbs.2016.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 10/22/2016] [Accepted: 10/24/2016] [Indexed: 11/22/2022]
Abstract
We consider a model for an infectious disease in the onset of an outbreak. We introduce contact tracing incorporating a tracing delay. The effect of randomness in the delay and the effect of the length of this delay in comparison to the infectious period of the disease respectively to a latency period on the effect of tracing, given e.g. by the change of the reproduction number, is analyzed. We focus particularly on the effect of randomness in the tracing delay.
Collapse
|
13
|
Dobler CC. Screening strategies for active tuberculosis: focus on cost-effectiveness. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:335-47. [PMID: 27418848 PMCID: PMC4934456 DOI: 10.2147/ceor.s92244] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
In recent years, there has been renewed interest in screening for active tuberculosis (TB), also called active case-finding (ACF), as a possible means to achieve control of the global TB epidemic. ACF aims to increase the detection of TB, in order to diagnose and treat patients with TB earlier than if they had been diagnosed and treated only at the time when they sought health care because of symptoms. This will reduce or avoid secondary transmission of TB to other people, with the long-term goal of reducing the incidence of TB. Here, the history of screening for active TB, current screening practices, and the role of TB-diagnostic tools are summarized and the literature on cost-effectiveness of screening for active TB reviewed. Cost-effectiveness analyses indicate that community-wide ACF can be cost-effective in settings with a high incidence of TB. ACF among close TB contacts is cost-effective in settings with a low as well as a high incidence of TB. The evidence for cost-effectiveness of screening among HIV-infected persons is not as strong as for TB contacts, but the reviewed studies suggest that the intervention can be cost-effective depending on the background prevalence of TB and test volume. None of the cost-effectiveness analyses were informed by data from randomized controlled trials. As the results of randomized controlled trials evaluating different ACF strategies will become available in future, we will hopefully gain a better understanding of the role that ACF can play in achieving global TB control.
Collapse
Affiliation(s)
- Claudia Caroline Dobler
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
14
|
Fox GJ, Loan LP, Nhung NV, Loi NT, Sy DN, Britton WJ, Marks GB. Barriers to adherence with tuberculosis contact investigation in six provinces of Vietnam: a nested case-control study. BMC Infect Dis 2015; 15:103. [PMID: 25886411 PMCID: PMC4377211 DOI: 10.1186/s12879-015-0816-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/10/2015] [Indexed: 12/03/2022] Open
Abstract
Background Close contacts of patients with tuberculosis (TB) have a substantial risk of developing the disease, particularly during the first year after exposure. Household contact investigation has recently been recommended as a strategy to enhance case detection in high-burden countries. However the barriers to its implementation in these settings remain poorly understood. Methods A nested case–control study was conducted in Vietnam within the context of a large cluster randomised controlled trial of active screening for TB in household contacts of patients with pulmonary TB. The study population comprised contacts (and their index patients) from 12 Districts in six provinces throughout the country. Cases were contacts (and their index patients) that did not attend the scheduled screening appointment. Controls were those who did attend. We assessed relevant knowledge, attitudes and practices in cases and controls. Results The acceptability of contact investigation was high among both cases (n = 109) and controls (n = 194). Both cases (47%) and controls (36%) commonly reported discrimination against people with TB. Cases were less likely than controls to understand that sharing sleeping quarters with a TB patient increased their risk of disease (OR 0.46, 0.27 – 0.78) or recognise TB as an infectious disease (OR 0.65, 0.39 – 1.08). A higher proportion of cases than controls held the mistaken traditional belief that a non-infectious form of TB caused the disease (OR 1.69, 1.02 – 2.78). Conclusions The knowledge, attitudes and practices of contacts and TB patients influence their ongoing participation in contact investigation. TB case detection policies in high-prevalence settings can be strengthened by systematically evaluating and addressing locally important barriers to attendance. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12610000600044. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0816-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Gregory James Fox
- Woolcock Institute of Medical Research, University of Sydney, 431 Glebe Point Road, Glebe, Sydney, 2037, Australia. .,Sydney Medical School, University of Sydney, Sydney, 2006, Australia.
| | - Le Phuong Loan
- Woolcock Institute of Medical Research, University of Sydney, 431 Glebe Point Road, Glebe, Sydney, 2037, Australia.
| | - Nguyen Viet Nhung
- National Lung Hospital, 463 Hoang Hoa Tham Street, Ba Dinh, Hanoi, Vietnam.
| | - Nguyen Thi Loi
- Woolcock Institute of Medical Research, University of Sydney, 431 Glebe Point Road, Glebe, Sydney, 2037, Australia.
| | - Dinh Ngoc Sy
- National Lung Hospital, 463 Hoang Hoa Tham Street, Ba Dinh, Hanoi, Vietnam.
| | - Warwick John Britton
- Sydney Medical School, University of Sydney, Sydney, 2006, Australia. .,Centenary Institute of Cancer Medicine and Cell Biology, University of Sydney, Missenden Road Camperdown, Sydney, 2050, Australia.
| | - Guy Barrington Marks
- Woolcock Institute of Medical Research, University of Sydney, 431 Glebe Point Road, Glebe, Sydney, 2037, Australia. .,South Western Sydney Clinical School, University of New South Wales, Sydney, 2052, Australia.
| |
Collapse
|