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Wong YJ, Ng KY, Lee SWH. How can we improve latent tuberculosis infection management using behaviour change wheel: a systematic review. J Public Health (Oxf) 2023; 45:e447-e466. [PMID: 37147919 PMCID: PMC10470485 DOI: 10.1093/pubmed/fdad051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 01/08/2023] [Accepted: 04/05/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND To ensure the effective delivery of latent tuberculosis infection (LTBI) care, it is vital to overcome potential challenges in LTBI management. This systematic review aims to identify the barriers and interventions to improve LTBI management using the Capability, Opportunity, and Motivation-Behaviour (COM-B) model and Behaviour Change Wheel (BCW). METHODS A systematic literature search was performed on five electronic databases from database inception to 3 November 2021. A two-step technique was used in the data synthesis process: (i) the barriers of LTBI management were identified using the COM-B model, followed by (ii) mapping of intervention functions from BCW to address the identified barriers. RESULTS Forty-seven eligible articles were included in this review. The findings highlighted the need for a multifaceted approach in tackling the barriers in LTBI management across the public, provider and system levels. The barriers were summarized into suboptimal knowledge and misperception of LTBI, as well as stigma and psychosocial burden, which could be overcome with a combination of intervention functions, targeting education, environment restructuring, persuasion, modelling, training, incentivization and enablement. CONCLUSIONS The remedial strategies using BCW to facilitate policy reforms in LTBI management could serve as a value-added initiative in the global tuberculosis control and prevention program.
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Affiliation(s)
- Yen Jun Wong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Subang Jaya, Selangor, Malaysia
| | - Khuen Yen Ng
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Subang Jaya, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Subang Jaya, Selangor, Malaysia
- School of Pharmacy, Taylor’s University Lakeside Campus, Jalan Taylors, 47500 Subang Jaya, Selangor, Malaysia
- Center of Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Kawatsu L, Kaneko N, Imahashi M, Kamada K, Uchimura K. Practices and attitudes towards tuberculosis and latent tuberculosis infection screening in people living with HIV/AIDS among HIV physicians in Japan. AIDS Res Ther 2022; 19:60. [DOI: 10.1186/s12981-022-00487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022] Open
Abstract
Abstract
Background
Tuberculosis (TB) continues to be the leading cause of death for people living with HIV/AIDS (PLHIV), and HIV is the strongest known risk factor for progression to active TB disease for persons with latent TB infection (LTBI). Screening for active TB and LTBI, and TB preventive therapy (TPT) is recommended, however, clinical practices regarding LTBI screening for HIV positive population have not been uniform, resulting in low rates of LTBI screening and TPT uptake, in both low and high TB-burden countries. We sought to explore the practices and attitudes towards TB and LTBI screening in PLHIV among HIV physicians in Japan.
Methods
We conducted a cross-sectional survey whereby an on-line questionnaire was administered to physicians who are currently, or have the experience of, providing care and treatment for PLHIV in Japan.
Results
The questionnaire was sent to a total of 83 physicians, of which 59 responded (response rate; 71.1%). 52.5% (31/59) conducted routine screening and 44.0% (26/59) conducted selectively screening for active TB among HIV/AIDS patients. As for LTBI, 54.2% (32/59) conducted routine screening and 35.6% (21/59) conducted selective screening for LTBI among PLHIV. “T-SPOT only” was the most frequently used method of screening (n = 33), followed by “QFT only” (n = 11). Criteria for LTBI screening included TB burden in the country of birth of the patient, previous contact with a TB patient, and CD4+ cell count. 83.1% (49/59) either “always” or “selectively” offered TPT to PLHIV diagnosed with LTBI, and among the 49 respondents who did provide TPT, 77.6% (38/49) chose 9-months isoniazid as their first choice. None chose regimen including rifampicin.
Conclusions
Our study revealed that practices regarding TB and LTBI screening and treatment for PLHIV among HIV physicians were mixed and not necessarily in accordance with the various published guidelines. Building and disseminating scientific evidence that takes into consideration the local epidemiology of TB and HIV in Japan is urgently needed to assist physicians make decisions.
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D’Ambrosio L, Centis R, Dobler CC, Tiberi S, Matteelli A, Denholm J, Zenner D, Al-Abri S, Alyaquobi F, Arbex MA, Belilovskiy E, Blanc FX, Borisov S, Carvalho ACC, Chakaya JM, Cocco N, Codecasa LR, Dalcolmo MP, Dheda K, Dinh-Xuan AT, Esposito SR, García-García JM, Li Y, Manga S, Marchese V, Muñoz Torrico M, Pontali E, Rendon A, Rossato Silva D, Singla R, Solovic I, Sotgiu G, van den Boom M, Nhung NV, Zellweger JP, Migliori GB. Screening for Tuberculosis in Migrants: A Survey by the Global Tuberculosis Network. Antibiotics (Basel) 2021; 10:1355. [PMID: 34827293 PMCID: PMC8615134 DOI: 10.3390/antibiotics10111355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 01/02/2023] Open
Abstract
Tuberculosis (TB) does not respect borders, and migration confounds global TB control and elimination. Systematic screening of immigrants from TB high burden settings and-to a lesser degree TB infection (TBI)-is recommended in most countries with a low incidence of TB. The aim of the study was to evaluate the views of a diverse group of international health professionals on TB management among migrants. Participants expressed their level of agreement using a six-point Likert scale with different statements in an online survey available in English, French, Mandarin, Spanish, Portuguese and Russian. The survey consisted of eight sections, covering TB and TBI screening and treatment in migrants. A total of 1055 respondents from 80 countries and territories participated between November 2019 and April 2020. The largest professional groups were pulmonologists (16.8%), other clinicians (30.4%), and nurses (11.8%). Participants generally supported infection control and TB surveillance established practices (administrative interventions, personal protection, etc.), while they disagreed on how to diagnose and manage both TB and TBI, particularly on which TBI regimens to use and when patients should be hospitalised. The results of this first knowledge, attitude and practice study on TB screening and treatment in migrants will inform public health policy and educational resources.
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Affiliation(s)
- Lia D’Ambrosio
- Public Health Consulting Group, 6900 Lugano, Switzerland;
| | - Rosella Centis
- Servizio di Epidemiologia, Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy;
| | - Claudia C. Dobler
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia;
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW 2107, Australia
| | - Simon Tiberi
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK;
- Blizard Institute, Queen Mary University of London, London E1 2AT, UK
| | - Alberto Matteelli
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, 25123 Brescia, Italy; (A.M.); (V.M.)
- WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, 25123 Brescia, Italy
| | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC 3000, Australia;
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC 3010, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Dominik Zenner
- Centre for Global Public Health, Institute for Population Health Sciences, Queen Mary University, London E1 2AB, UK;
| | - Seif Al-Abri
- Directorate General of Disease Surveillance and Control, Ministry of Health, Muscat 100, Oman; (S.A.-A.); (F.A.)
| | - Fatma Alyaquobi
- Directorate General of Disease Surveillance and Control, Ministry of Health, Muscat 100, Oman; (S.A.-A.); (F.A.)
| | - Marcos Abdo Arbex
- Nestor Goulart Reis Hospital, Health Secretary São Paulo State, Sao Paulo 14801-320, Brazil;
- Faculdade de Medicina, Universidade de Araraquara, Sao Paulo 14801-320, Brazil
| | - Evgeny Belilovskiy
- Moscow Research and Clinical Center for Tuberculosis Control, 107014 Moscow, Russia; (E.B.); (S.B.)
| | - François-Xavier Blanc
- Service de Pneumologie, Centre Hospitalier Universitaire, L’institut du Thorax, F-44093 Nantes, France;
| | - Sergey Borisov
- Moscow Research and Clinical Center for Tuberculosis Control, 107014 Moscow, Russia; (E.B.); (S.B.)
| | - Anna Cristina C. Carvalho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Brazil;
| | - Jeremiah Muhwa Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi P.O. Box 43844-00100, Kenya;
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Nicola Cocco
- ASST Santi Paolo e Carlo—Medicina Penitenziaria, 21100 Milan, Italy;
| | - Luigi Ruffo Codecasa
- TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, 20159 Milan, Italy;
| | - Margareth Pretti Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz), Ministry of Health, Rio de Janeiro 21040-360, Brazil;
| | - Keertan Dheda
- South African MRC Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town 7701, South Africa;
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town 7701, South Africa
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London 400706, UK
| | - Anh Tuan Dinh-Xuan
- Respiratory Physiology Unit, Department of Respiratory Medicine, Cochin Hospital, Université de Paris, 75014 Paris, France;
| | - Susanna R. Esposito
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, 43126 Parma, Italy;
| | | | - Yang Li
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China;
| | - Selene Manga
- Ministry of Health, Direccion General de Gestion de Riesgos en y Desastres en Salud, Lima 15072, Peru;
| | - Valentina Marchese
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, 25123 Brescia, Italy; (A.M.); (V.M.)
- WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, 25123 Brescia, Italy
| | - Marcela Muñoz Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico;
| | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy;
| | - Adrián Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias CIPTIR, University Hospital of Monterrey UANL (Universidad Autonoma de Nuevo Leon), Monterrey 64000, Mexico;
| | - Denise Rossato Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil;
| | - Rupak Singla
- Department of TB & Respiratory Diseases, National Institute of TB & Respiratory Diseases, Sri Aurobindo Marg, New Delhi 110030, India;
| | - Ivan Solovic
- National Institute for TB, Vysne Hagy, Catholic University, 05984 Ruzomberok, Slovakia;
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Martin van den Boom
- WHO Regional Office for the Eastern Mediterranean Region, Cairo 11571, Egypt;
| | | | | | - Giovanni Battista Migliori
- Servizio di Epidemiologia, Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy;
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Turgenbayev KA, Borsynbayeva AM, Plazun AA, Turgenbayev RK. Tuberculosis prevalence in animals and humans in the Republic of Kazakhstan. Vet World 2021; 14:2362-2370. [PMID: 34840455 PMCID: PMC8613783 DOI: 10.14202/vetworld.2021.2362-2370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIM Tuberculosis is an infectious disease that affects humans and animals. This study aimed to review the influence of economic and organizational, veterinary, and sanitary measures on the epizootic situation of animal tuberculosis and the epidemiological situation of human tuberculosis in the Republic of Kazakhstan. MATERIALS AND METHODS The epizootic situation of cattle tuberculosis in Kazakhstan was studied based on the annual statistics of allergy testing of animals with tuberculosis by the Committee for Veterinary Control and Supervision of the Ministry of Agriculture of the Republic of Kazakhstan, according to the results of allergic, clinical, and pathological studies, including laboratory studies of biomaterials from animals that reacted to tuberculin. Tuberculinization of cattle in the country is performed twice in the spring and autumn using tuberculin purified protein derivative for mammals. In addition, mass diagnosis of human tuberculosis is conducted by radiology. RESULTS The authors assessed the epizootic situation of tuberculosis in cattle in Kazakhstan from 1991 to 2019. The analysis results showed that at the beginning, the epizootic situation in cattle tuberculosis was challenging. However, since 2001, there has been a noticeable decrease in tuberculosis in animals in Kazakhstan, which has had a favorable effect on the epidemic situation of human tuberculosis. CONCLUSION According to the analysis results, the measures used in the Republic of Kazakhstan to prevent tuberculosis improved the well-being of livestock farms. The proper conduct by qualified veterinary specialists on allergy testing of animals and differential diagnosis of nonspecific tuberculin reactions allows establishing an accurate epizootic picture of tuberculosis. Furthermore, strict adherence to instructions on the diagnosis and prevention of tuberculosis, implementation of developed veterinary, sanitary, and organization, and economic measures can improve the epizootic picture of tuberculosis, reducing the risk of human tuberculosis.
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Affiliation(s)
| | | | - Aleksandr A. Plazun
- Kazakh Scientific Research Veterinary Institute, 223 Raiymbek St., Almaty, 050016, Kazakhstan
| | - Rauan K. Turgenbayev
- Research and Production Center BioVet, 191-A Karasay batyr St., 191-A, Almaty, 050008, Kazakhstan
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Conroy O, Wurie F, Collin SM, Edmunds M, de Vries G, Lönnroth K, Abubakar I, Anderson SR, Zenner D. Barriers and enablers to implementing tuberculosis control strategies in EU and European Economic Area countries: a systematic review. THE LANCET. INFECTIOUS DISEASES 2021; 21:e272-e280. [PMID: 34450080 DOI: 10.1016/s1473-3099(21)00077-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 11/25/2022]
Abstract
Meeting the 2035 WHO targets of reducing tuberculosis incidence by 90% from 2015 levels requires the implementation of country-specific tuberculosis control strategies. This systematic review aims to identify factors that facilitate or impede the implementation of such strategies in EU and European Economic Area (EEA) settings. Focusing on providers of care, health system constraints, and social and political factors, this Review complements available evidence on the accessibility of tuberculosis services to recipients of care. Databases were searched for EU and EEA articles published between Jan 1, 1997, and Nov 6, 2020, that presented empirical data on tuberculosis policies, strategies, guidelines, or interventions. 2061 articles were screened and 65 were included. The most common barrier to tuberculosis control strategies described the divergence of health-care practices from guidelines, often related to inadequate knowledge or perceived usefulness of the guidelines by clinicians. The most commonly identified enabler to tuberculosis control strategies was the documented positive attitudes of health-care workers towards tuberculosis programmes. Divergence between clinical practice and guidelines was described in most EU and EEA settings, indicating the need for a focused review of guideline adherence. Strengths of this study involve its broad inclusion criteria and wide range of tuberculosis control strategies analysed.
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Affiliation(s)
- Olivia Conroy
- TB Unit, National Infection Service, Public Health England, London, UK.
| | - Fatima Wurie
- TB Unit, National Infection Service, Public Health England, London, UK
| | - Simon M Collin
- TB Unit, National Infection Service, Public Health England, London, UK
| | - Matt Edmunds
- TB Unit, National Infection Service, Public Health England, London, UK
| | | | - Knut Lönnroth
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Sarah R Anderson
- TB Unit, National Infection Service, Public Health England, London, UK
| | - Dominik Zenner
- TB Unit, National Infection Service, Public Health England, London, UK; Institute for Global Health, University College London, London, UK
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Sorry for the delay. Clin Microbiol Infect 2021; 27:941-943. [PMID: 33823271 PMCID: PMC8079284 DOI: 10.1016/j.cmi.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/24/2022]
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Spruijt I, Erkens C, Suurmond J, Huisman E, Koenders M, Kouw P, Toumanian S, Cobelens F, van den Hof S. Implementation of latent tuberculosis infection screening and treatment among newly arriving immigrants in the Netherlands: A mixed methods pilot evaluation. PLoS One 2019; 14:e0219252. [PMID: 31260502 PMCID: PMC6602457 DOI: 10.1371/journal.pone.0219252] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/19/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION To reach pre-elimination levels of tuberculosis (TB) incidence in the Netherlands, prevention of TB among immigrants through diagnosis and treatment of latent TB infection (LTBI) is needed. We studied the feasibility of a LTBI screening and treatment program among newly arriving immigrants for national implementation. METHODS We used mixed methods to evaluate the implementation of LTBI screening and treatment in five Public Health Services (PHS) among immigrants from countries with a TB incidence >50/100,000 population. We used Poisson regression models with robust variance estimators to assess factors associated with LTBI diagnosis and LTBI treatment initiation and reported reasons for not initiating or completing LTBI treatment. We interviewed five PHS teams using a semi-structured method to identify enhancing and impeding factors for LTBI screening and treatment. RESULTS We screened 566 immigrants; 94 (17%) were diagnosed with LTBI, of whom 49 (52%) initiated and 34 (69%) completed LTBI treatment. LTBI diagnosis was associated with male gender, higher age group, higher TB incidence in the country of origin and lower level of education. Treatment initiation was associated with PHS (ranging from 29% to 86%), lower age group, longer intended duration of stay in the Netherlands, and lower level of education. According to TB physicians, clients and their consulted physicians in the home country lacked awareness about benefits of LTBI treatment. Furthermore, TB physicians questioned the individual and public health benefit of clients who return to their country of origin within the foreseeable future. CONCLUSIONS Doubt of physicians in both host country and country of origin about individual and public health benefits of LTBI screening and treatment of immigrants hampered treatment initiation: the high initiation proportion in one PHS shows that if TB physicians are committed, the LTBI treatment uptake can be higher.
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Affiliation(s)
- Ineke Spruijt
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Connie Erkens
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Jeanine Suurmond
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Huisman
- Department tuberculosis control, Public Health Service Haaglanden, The Hague, The Netherlands
| | - Marga Koenders
- Department tuberculosis control, Public Health Service Gelderland Zuid, Nijmegen, The Netherlands
| | - Peter Kouw
- Department tuberculosis control, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Sophie Toumanian
- Department tuberculosis control, Public Health Service Twente, Enschede, The Netherlands
| | - Frank Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Aadnanes O, Wallis S, Harstad I. A cross-sectional survey of the knowledge, attitudes and practices regarding tuberculosis among general practitioners working in municipalities with and without asylum centres in eastern Norway. BMC Health Serv Res 2018; 18:987. [PMID: 30572893 PMCID: PMC6302494 DOI: 10.1186/s12913-018-3792-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of tuberculosis (TB) cases in Norway is increasing due to immigration from countries with high TB prevalence and few studies have been conducted on general practitioners' (GPs) knowledge of TB in low incidence countries. The main purpose of this study was to explore knowledge, attitudes and practices of TB among Norwegian GPs using a modified Knowledge Attitude Practice (KAP) survey template. METHODS A cross-sectional survey of 30 questions was distributed by email using SurveyMonkey to GPs working in municipalities either with or without an asylum reception centre in Eastern Norway (GPwAS or GPw/oAS). The questionnaire assessed demographic data and had 14 questions on TB knowledge and 7 questions on attitudes and practices. Descriptive and inferential analysis of the data was carried out using SPSS 18. RESULTS One hundred ninety five GPs responded and 42% worked in a municipality with an asylum reception centre. There was no significant difference between the two GP groups in relation to demographic variables (all p-values > 0.2). GPwAS were more experienced in diagnosing TB patients compared to GPw/oAS (63.4% vs 44.2%, p = 0.008). There was no significant differences in participation in TB training between the two groups (8.5% vs 7.6%, p = 0.71). The majority of GPs (69%) did not consider TB as a major public health threat and misconceptions of TB epidemiology were identified. Overall, 97 (49.7%) GPs had good TB knowledge level and good TB knowledge level was associated with experience in diagnosing TB patients (p = 0.001) and recent TB training (p = 0.015). CONCLUSION Gaps in TB knowledge and awareness among GPs in Norway need to be addressed if GPs are to be more involved in TB management and prevention in the future. TB training had an effect on the GPs knowledge level and GPwAS had more experience with TB patients but our survey revealed no major differences in KAP between GPwAS and GPw/oAS.
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Affiliation(s)
- Oddvar Aadnanes
- Present Address: Legehuset Nova, Torggata 1, N-2317, Hamar, Norway. .,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7489, Trondheim, NO, Norway.
| | - Selina Wallis
- Public Health Institute, John Moores University, Liverpool, UK
| | - Ingunn Harstad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7489, Trondheim, NO, Norway.,Department of Pulmonary Medicine, St Olavs University Hospital, Po Box3250 Sluppen, N-7006, Trondheim, Norway
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Basybekov SZ, Bazarbayev MB, Yespembetov BA, Mussaeva A, Kanatbayev SG, Romashev KM, Dossanova AK, Yelekeyev TA, Akmatova EK, Syrym NS. Diagnostics of tuberculosis and differentiation of nonspecific tuberculin reactions in animals. Braz J Microbiol 2017; 49:329-335. [PMID: 29153452 PMCID: PMC5913827 DOI: 10.1016/j.bjm.2017.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 05/17/2017] [Accepted: 07/17/2017] [Indexed: 11/28/2022] Open
Abstract
Tuberculosis is a serious disease of humans and animals, caused by bacteria of the Mycobacterium genus. This leads to complications in the life of the sick person, and subsequently to death. The cattle, who have been diagnosed with this bacterium, are usually sent to the slaughter, with the result that their livestock is reduced. Mycobacteriosis is also a disease, after determining which cattle are most often sent to slaughter. Such a reduction in livestock numbers has a negative effect on the economy. Of the 300 samples from the animals, 25 cultures of atypical bacteria responding to tuberculin were isolated. A series of tests – intravenous tuberculin test, ophthalmic test, palpebral test, “ZhAT” test, showed that most of the tuberculosis changes in cattle were found in regional lymph nodes more often than in internal organs. In healthy for tuberculosis cows, at the age of 4–9 years, seasonal nonspecific sensitivity to tuberculin is observed. Implementation of the developed express method of glutaraldehyde test on farms in healthy tuberculosis will speed up the diagnosis of tuberculosis and mycobacteriosis in animals that reacted to tuberculin and will exclude short-term nonspecific sensitization of their organism to tuberculin. The introduction of this methodology can be used to diagnose and clearly differentiate the diagnoses of “tuberculosis” and “mycobacteriosis” in cattle. This will cure part of the livestock and reduce the amount of slaughter.
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Affiliation(s)
| | | | | | - Assiya Mussaeva
- Kazakh Research Veterinary Institute, Gvardeiskiy, Kazakhstan
| | | | | | | | - Tokseiit A Yelekeyev
- Kyrgyz Research Institute of Veterinary named after A. Duysheev, Bishkek, Kyrgyzstan
| | - Elmira K Akmatova
- Kyrgyz Research Institute of Veterinary named after A. Duysheev, Bishkek, Kyrgyzstan
| | - Nazym S Syrym
- Research Institute of Biological Safety Problems, Gvardeiskiy, Kazakhstan.
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Ernst SA, Brand T, Lhachimi SK, Zeeb H. Combining Internet-Based and Postal Survey Methods in a Survey among Gynecologists: Results of a Randomized Trial. Health Serv Res 2017; 53:879-895. [PMID: 28217941 DOI: 10.1111/1475-6773.12664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess whether a combination of Internet-based and postal survey methods (mixed-mode) compared to postal-only survey methods (postal-only) leads to improved response rates in a physician survey, and to compare the cost implications of the different recruitment strategies. DATA SOURCES/STUDY SETTING All primary care gynecologists in Bremen and Lower Saxony, Germany, were invited to participate in a cross-sectional survey from January to July 2014. STUDY DESIGN The sample was divided into two strata (A; B) depending on availability of an email address. Within each stratum, potential participants were randomly assigned to mixed-mode or postal-only group. PRINCIPAL FINDINGS In Stratum A, the mixed-mode group had a lower response rate compared to the postal-only group (12.5 vs. 20.2 percent; RR = 0.61, 95 percent CI: 0.44-0.87). In stratum B, no significant differences were found (15.6 vs. 16.2 percent; RR = 0.95, 95 percent CI: 0.62-1.44). Total costs (in €) per valid questionnaire returned (Stratum A: 399.72 vs. 248.85; Stratum B: 496.37 vs. 455.15) and per percentage point of response (Stratum A: 1,379.02 vs. 861.02; Stratum B 1,116.82 vs. 1,024.09) were higher, whereas variable costs were lower in mixed-mode compared to the respective postal-only groups (Stratum A cost ratio: 0.47, Stratum B cost ratio: 0.71). CONCLUSIONS In this study, primary care gynecologists were more likely to participate by traditional postal-only than by mixed-mode survey methods that first offered an Internet option. However, the lower response rate for the mixed-mode method may be partly due to the older age structure of the responding gynecologists. Variable costs per returned questionnaire were substantially lower in mixed-mode groups and indicate the potential for cost savings if the sample population is sufficiently large.
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Affiliation(s)
| | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Stefan K Lhachimi
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany.,Collaborative Research Group for Evidence-Based Public Health, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
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11
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Dobler CC. Unwarranted prescription variations for treatment of latent tuberculosis infection. THE LANCET. INFECTIOUS DISEASES 2017; 17:134. [PMID: 28134105 DOI: 10.1016/s1473-3099(17)30004-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Claudia C Dobler
- Department of Respiratory Medicine, Liverpool Hospital, Liverpool, Sydney, NSW 2034, Australia; Woolcock Institute of Medical Research, University of Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.
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12
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Herzmann C, Sotgiu G, Bellinger O, Diel R, Gerdes S, Goetsch U, Heykes-Uden H, Schaberg T, Lange C. Risk for latent and active tuberculosis in Germany. Infection 2016; 45:283-290. [PMID: 27866367 PMCID: PMC5488071 DOI: 10.1007/s15010-016-0963-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/07/2016] [Indexed: 11/28/2022]
Abstract
Purpose Few individuals that are latently infected with M. tuberculosis latent tuberculosis infection(LTBI) progress to active disease. We investigated risk factors for LTBI and active pulmonary tuberculosis (PTB) in Germany. Methods Healthy household contacts (HHCs), health care workers (HCWs) exposed to M. tuberculosis and PTB patients were recruited at 18 German centres. Interferon-γ release assay (IGRA) testing was performed. LTBI risk factors were evaluated by comparing IGRA-positive with IGRA-negative contacts. Risk factors for tuberculosis were evaluated by comparing PTB patients with HHCs. Results From 2008–2014, 603 HHCs, 295 HCWs and 856 PTBs were recruited. LTBI was found in 34.5% of HHCs and in 38.9% of HCWs. In HCWs, care for coughing patients (p = 0.02) and longstanding nursing occupation (p = 0.04) were associated with LTBI. In HHCs, predictors for LTBI were a diseased partner (odds ratio 4.39), sexual contact to a diseased partner and substance dependency (all p < 0.001). PTB was associated with male sex, low body weight (p < 0.0001), alcoholism (15.0 vs 5.9%; p < 0.0001), glucocorticoid therapy (7.2 vs 2.0%; p = 0.004) and diabetes (7.8 vs. 4.0%; p = 0.04). No contact developed active tuberculosis within 2 years follow-up. Conclusions Positive IGRA responses are frequent among exposed HHCs and HCWs in Germany and are poor predictors for the development of active tuberculosis. Electronic supplementary material The online version of this article (doi:10.1007/s15010-016-0963-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian Herzmann
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,Center for Clinical Studies, Research Center Borstel, Borstel, Germany
| | - Giovanni Sotgiu
- Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Oswald Bellinger
- DAHW German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | - Roland Diel
- Institute of Epidemiology, University Medical Hospital Schleswig-Holstein, Campus Kiel, Germany.,LungenClinic Grosshansdorf, Airway Research Center North, Großhansdorf, Germany
| | - Silke Gerdes
- Municipal Health Authority Hannover, Hanover, Germany
| | - Udo Goetsch
- Municipal Health Authority Frankfurt, Frankfurt, Germany
| | | | - Tom Schaberg
- Center of Pneumology, Agaplesion Deaconess Hospital Rotenburg, Rotenburg, Germany
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany. .,German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Germany. .,International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany. .,Department of Medicine, Karolinska Institute, Stockholm, Sweden.
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13
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Salzer HJF, Wassilew N, Köhler N, Olaru ID, Günther G, Herzmann C, Kalsdorf B, Sanchez-Carballo P, Terhalle E, Rolling T, Lange C, Heyckendorf J. Personalized Medicine for Chronic Respiratory Infectious Diseases: Tuberculosis, Nontuberculous Mycobacterial Pulmonary Diseases, and Chronic Pulmonary Aspergillosis. Respiration 2016; 92:199-214. [PMID: 27595540 DOI: 10.1159/000449037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Chronic respiratory infectious diseases are causing high rates of morbidity and mortality worldwide. Tuberculosis, a major cause of chronic pulmonary infection, is currently responsible for approximately 1.5 million deaths per year. Although important advances in the fight against tuberculosis have been made, the progress towards eradication of this disease is being challenged by the dramatic increase in multidrug-resistant bacilli. Nontuberculous mycobacteria causing pulmonary disease and chronic pulmonary aspergillosis are emerging infectious diseases. In contrast to other infectious diseases, chronic respiratory infections share the trait of having highly variable treatment outcomes despite longstanding antimicrobial therapy. Recent scientific progress indicates that medicine is presently at a transition stage from programmatic to personalized management. We explain current state-of-the-art management concepts of chronic pulmonary infectious diseases as well as the underlying methods for therapeutic decisions and their implications for personalized medicine. Furthermore, we describe promising biomarkers and techniques with the potential to serve future individual treatment concepts in this field of difficult-to-treat patients. These include candidate markers to improve individual risk assessment for disease development, the design of tailor-made drug therapy regimens, and individualized biomarker-guided therapy duration to achieve relapse-free cure. In addition, the use of therapeutic drug monitoring to reach optimal drug dosing with the smallest rate of adverse events as well as candidate agents for future host-directed therapies are described. Taken together, personalized medicine will provide opportunities to substantially improve the management and treatment outcome of difficult-to-treat patients with chronic respiratory infections.
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Affiliation(s)
- Helmut J F Salzer
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
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14
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A Low Cost/Low Power Open Source Sensor System for Automated Tuberculosis Drug Susceptibility Testing. SENSORS 2016; 16:s16060942. [PMID: 27338406 PMCID: PMC4934367 DOI: 10.3390/s16060942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/11/2016] [Accepted: 06/16/2016] [Indexed: 11/20/2022]
Abstract
In this research an open source, low power sensor node was developed to check the growth of mycobacteria in a culture bottle with a nitrate reductase assay method for a drug susceptibility test. The sensor system reports the temperature and color sensor output frequency change of the culture bottle when the device is triggered. After the culture process is finished, a nitrite ion detecting solution based on a commercial nitrite ion detection kit is injected into the culture bottle by a syringe pump to check bacterial growth by the formation of a pigment by the reaction between the solution and the color sensor. Sensor status and NRA results are broadcasted via a Bluetooth low energy beacon. An Android application was developed to collect the broadcasted data, classify the status of cultured samples from multiple devices, and visualize the data for the end users, circumventing the need to examine each culture bottle manually during a long culture period. The authors expect that usage of the developed sensor will decrease the cost and required labor for handling large amounts of patient samples in local health centers in developing countries. All 3D-printerable hardware parts, a circuit diagram, and software are available online.
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15
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16
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Lange C, Mandalakas AM, Kalsdorf B, Denkinger CM, Sester M. Clinical Application of Interferon-γ Release Assays for the Prevention of Tuberculosis in Countries with Low Incidence. Pathog Immun 2016; 1:308-329. [PMID: 28217762 PMCID: PMC5315027 DOI: 10.20411/pai.v1i2.173] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Despite global efforts to control tuberculosis (TB) the estimated number of people who developed TB worldwide increased to an all-time record of more than 10 million in 2015. The goal of the World Health Organization (WHO) to reduce the global incidence of TB to less than 100 cases per million by 2035, cannot be reached unless TB prevention is markedly improved. There is a need for an improved vaccine that better protects individuals who are exposed to Mycobacterium tuberculosis from infection and active disease compared to the current M. bovis Bacille Calmette Guérin (BCG) vaccine. In the absence of such a vaccine, prevention relies on infection control measures and preventive chemotherapy for people with latent infection with M. tuberculosis (LTBI), who have the highest risk of progression to active TB. During the past decade, interferon-γ release assays (IGRAs) have increasingly replaced the tuberculin skin test as screening tools for the diagnosis of LTBI in countries with a low incidence of TB. Despite recent WHO guidelines on the management of LTBI, the definition of groups at risk for TB remains controversial, and the role of IGRAs for TB prevention in low-incidence countries remains uncertain. We reviewed the scientific literature and provide recommendations for the use of IGRAs for LTBI diagnosis in low-incidence countries. These recommendations are based on the number of patients needing treatment in order to prevent one case of TB. As the positive predictive value of IGRAs for the development of TB is sub-optimal, research must focus on the identification of alternative biomarkers that offer better predictive ability in order to substantially reduce the number needing treatment while improving the prevention of TB and improving the effectiveness of targeted preventive chemotherapy.
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Affiliation(s)
- Christoph Lange
- Division of Clinical Infectious Diseases, Medical Clinic Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Clinical Tuberculosis Center, Borstel, Germany
- International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Internal Medicine, University of Namibia School of Medicine, Windhoek, Namibia
| | - Anna M. Mandalakas
- Global Tuberculosis Program, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
| | - Barbara Kalsdorf
- Division of Clinical Infectious Diseases, Medical Clinic Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Clinical Tuberculosis Center, Borstel, Germany
- International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
| | | | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
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17
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Implementation of latent tuberculosis screening in HIV care centres: evaluation in a low tuberculosis incidence setting. Epidemiol Infect 2015. [PMID: 26211466 DOI: 10.1017/s0950268815001594] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The screening and treatment of latent tuberculosis infection (LTBI) to prevent active tuberculosis (TB) is recommended by the WHO in all HIV-infected patients. The aim of this study was to evaluate its implementation within Belgium's HIV care. A multiple-choice questionnaire was sent to 55 physicians working in the country's AIDS reference centres. Response rate reached 62%. Only 20% screened all their HIV-infected patients for LTBI. Screening methods used and their interpretation vary from one physician to another. The main barriers to the implementation of LTBI screening and treatment, as perceived by the participants, are lack of sensitivity of screening tools, risks associated with polypharmacy and toxicity of treatment. The poor coverage of LTBI screening reported here and the inconsistency in methods used raises concern. However, this was not unexpected as, in low-TB incidence countries, who, when and how to screen for LTBI remains unclear and published guidelines show important disparities. Recently, a targeted approach in which only HIV-infected patients at highest risk of TB are screened has been suggested. Such a strategy would limit unnecessary exposure to LTBI treatment. This methodology was approved by 80% of the participants and could therefore achieve greater coverage. Its clinical validation is still pending.
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Zellweger JP, Sotgiu G, Block M, Dore S, Altet N, Blunschi R, Bogyi M, Bothamley G, Bothe C, Codecasa L, Costa P, Dominguez J, Duarte R, Fløe A, Fresard I, García-García JM, Goletti D, Halm P, Hellwig D, Henninger E, Heykes-Uden H, Horn L, Kruczak K, Latorre I, Pache G, Rath H, Ringshausen FC, Ruiz AS, Solovic I, Souza-Galvão MLD, Widmer U, Witte P, Lange C. Risk Assessment of Tuberculosis in Contacts by IFN-γ Release Assays. A Tuberculosis Network European Trials Group Study. Am J Respir Crit Care Med 2015; 191:1176-84. [DOI: 10.1164/rccm.201502-0232oc] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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