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Meghji J, Msukwa-Panje W, Mkutumula E, Kamchedzera W, Banda NPK, MacPherson P, Engel N. Respiratory symptoms after TB treatment completion: A qualitative study of patient and provider experiences in urban Blantyre, Malawi. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003436. [PMID: 39331642 PMCID: PMC11433068 DOI: 10.1371/journal.pgph.0003436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/28/2024] [Indexed: 09/29/2024]
Abstract
Pulmonary tuberculosis (PTB) survivors experience a high burden of residual and recurrent respiratory symptoms after TB treatment completion. However, guidelines for the investigation and care of symptomatic TB-survivors are limited. We used qualitative methods to explore patient and provider understandings, experience and practice around respiratory symptoms in the post-TB period. We conducted in-depth interviews with PTB-survivors who had experienced respiratory symptoms (cough, chest pain, breathlessness) after successful TB treatment completion in Blantyre, Malawi (n = 23). We completed focus group discussions with TB-Officers (n = 12), and in-depth interviews with health care workers (n = 18) from primary and tertiary health facilities. Interviews were conducted in Chichewa, and thematic analysis was used to identify common themes. Our data highlight that TB survivors have negative experiences of respiratory symptoms after TB treatment completion, with anxiety about the cause of symptoms, uncertainty about if and how to return to care, and fear of recurrent TB disease. Our findings suggest four critical practices which shape this experience including: limited counselling at TB treatment completion; the lack of clear health seeking pathways to return to care; the use of TB-focused investigations for those returning to care; and heterogeneous approaches to TB retreatment decisions. This study highlights that the post-TB period is a critical part of the patient's experience of TB disease. Current practices create a negative patient experience, and carry clinical and public health risks including delayed diagnosis of TB relapse, missed diagnosis of cardio-respiratory disease, and misuse of antimicrobials and TB retreatment. Formative guidelines are needed to improve the care of symptomatic TB-survivors.
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Affiliation(s)
- Jamilah Meghji
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | | | | | - Ndaziona P. K. Banda
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Department of Medicine, Kamuzu University of Health Sciences and Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Peter MacPherson
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nora Engel
- Department of Health, Ethics & Society, Maastricht University, Maastricht, Netherlands
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Milburn J, Ntwayagae O, Suresh R, Ngoni K, Northcott C, Penney J, Kinsella M, Mechie I, Ensor S, Thamae G, Leeme T, Lawrence DS, Chebani T, Grint D, Tenforde MW, Avalos A, Ramaabya D, Ogando J, Mokomane M, Mine M, Jarvis JN. Tracking Cryptococcal Meningitis to Monitor HIV Program Success During the Treat All Era: An Analysis of National Data in Botswana. Clin Infect Dis 2024; 79:462-468. [PMID: 38330295 PMCID: PMC11327789 DOI: 10.1093/cid/ciae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Cryptococcal meningitis (CM) causes substantial mortality in African countries with a high prevalence of human immunodeficiency virus (HIV), despite advances in disease management and increasing antiretroviral therapy (ART) coverage. Reliable diagnosis of CM is cheap and more accessible than other indicators of advanced HIV disease burden such as CD4 testing or investigation for disseminated tuberculosis; therefore, monitoring CM incidence has the potential to serve as a valuable metric of HIV programmatic success. METHODS Botswana national meningitis surveillance data from 2015 to 2022 were obtained from electronic health records. All electronic laboratory records from cerebrospinal fluid samples analyzed within government healthcare facilities in Botswana were extracted from a central online repository. Adjustments for missing data were made through triangulation with prospective cohort study datasets. CM case frequency was enumerated using a case definition and incidence calculated using national census data. RESULTS A total of 1744 episodes of CM were identified; incidence declined from 15.0 (95% confidence interval [CI], 13.4-16.7) cases/100 000 person-years in 2015 to 7.4 (95% CI, 6.4-8.6) cases/100 000 person-years in 2022. However, the rate of decline slowed following the introduction of universal treatment in 2016. The highest incidence was observed in men and individuals aged 40-44 years. The proportion of cases diagnosed through cryptococcal antigen testing increased from 35.5% to 86.3%. CONCLUSIONS CM incidence has decreased in Botswana following expansion of ART coverage but persists at a stubbornly high incidence. Most cases are now diagnosed through the cheap and easy-to-use cryptococcal antigen test, highlighting the potential of using CM as key metric of program success in the Treat All era.
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Affiliation(s)
- James Milburn
- Botswana Harvard Health Partnership, Gaborone, Botswana
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | | | | | | | | | - James Penney
- Botswana Harvard Health Partnership, Gaborone, Botswana
| | | | - Imogen Mechie
- Botswana Harvard Health Partnership, Gaborone, Botswana
| | - Samuel Ensor
- Botswana Harvard Health Partnership, Gaborone, Botswana
| | | | - Tshepo Leeme
- Botswana Harvard Health Partnership, Gaborone, Botswana
| | - David S Lawrence
- Botswana Harvard Health Partnership, Gaborone, Botswana
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Tony Chebani
- Botswana Ministry of Health and Wellness, Gaborone
| | - Daniel Grint
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | | | - Ava Avalos
- Botswana Harvard Health Partnership, Gaborone, Botswana
| | | | | | - Margaret Mokomane
- School of Allied Health Professions, University of Botswana, Gaborone, Botswana
| | - Madisa Mine
- National Health Laboratory, Ministry of Health and Wellness, Gaborone, Botswana
| | - Joseph N Jarvis
- Botswana Harvard Health Partnership, Gaborone, Botswana
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
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Kamchedzera W, Quaife M, Msukwa-Panje W, Burke RM, Macpherson L, Kumwenda M, Twabi HH, Quartagno M, MacPherson P, Esmail H. Treatment preferences among people at risk of developing tuberculosis: A discrete choice experiment. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002804. [PMID: 39028696 PMCID: PMC11259259 DOI: 10.1371/journal.pgph.0002804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/01/2024] [Indexed: 07/21/2024]
Abstract
Diagnosing and treating people with bacteriologically-negative but radiologically-apparent tuberculosis (TB) may contribute to more effective TB care and reduce transmission. However, optimal treatment approaches for this group are unknown. It is important to understand peoples' preferences of treatment options for effective programmatic implementation of people-centred treatment approaches. We designed and implemented a discrete choice experiment (DCE) to solicit treatment preferences among adults (≥18 years) with TB symptoms attending a primary health clinic in Blantyre, Malawi. Treatment attributes included in the DCE were as follows: duration of treatment; number of tablets per dose; reduction in the risk of being unwell with TB disease; likelihood of infecting others; adverse effects from the treatment; frequency of follow up; and the annual travel cost to access care. Quantitative choice modelling with multinomial logit models estimated through frequentist and Bayesian approaches investigated preferences for the management of bacteriologically-negative, but radiographically-apparent TB. 128 participants were recruited (57% male, 43.8% HIV-positive, 8.6% previously treated for TB). Participants preferred to take any treatment compared to not taking treatment (odds ratio [OR] 5.78; 95% confidence interval [CI]: 2.40, 13.90). Treatments that reduced the relative risk of developing TB disease by 80% were preferred (OR: 2.97; 95% CI: 2.09, 4.21) compared to treatments that lead to a lower reduction in risk of 50%. However, there was no evidence for treatments that are 95% effective being preferred over those that are 80% effective. Participants strongly favoured the treatments that could completely stop transmission (OR: 7.87, 95% CI: 5.71, 10.84), and prioritised avoiding side effects (OR: 0.19, 95% CI: 0.12, 0.29). There was no evidence of an interaction between perceived TB disease risk and treatment preferences. In summary, participants were primarily concerned with the effectiveness of TB treatments and strongly preferred treatments that removed the risk of onward transmission. Person-centred approaches of preferences for treatment should be considered when designing new treatment strategies. Understanding treatment preferences will ensure that any recommended treatment for probable early TB disease is well accepted and utilized by the public.
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Affiliation(s)
- Wala Kamchedzera
- Public Health Research Group, Malawi-Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Matthew Quaife
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England, United Kingdom
| | - Wezi Msukwa-Panje
- Public Health Research Group, Malawi-Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Rachael M. Burke
- Faculty of Infectious and Tropical Disease, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, England, United Kingdom
| | - Liana Macpherson
- MRC Clinical Trials Unit at University College London, London, England, United Kingdom
| | - Moses Kumwenda
- Public Health Research Group, Malawi-Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Hussein H. Twabi
- Public Health Research Group, Malawi-Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
- Helse-Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Matteo Quartagno
- MRC Clinical Trials Unit at University College London, London, England, United Kingdom
| | - Peter MacPherson
- Public Health Research Group, Malawi-Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
- Faculty of Infectious and Tropical Disease, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, England, United Kingdom
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Hanif Esmail
- MRC Clinical Trials Unit at University College London, London, England, United Kingdom
- WHO Collaborating Centre on Tuberculosis Research and Innovation, Institute for Global Health, University College London, London, United Kingdom
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Marco MH, Ahmedov S, Castro KG. The global impact of COVID-19 on tuberculosis: A thematic scoping review, 2020-2023. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003043. [PMID: 38959278 PMCID: PMC11221697 DOI: 10.1371/journal.pgph.0003043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/25/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND This thematic scoping review of publications sought to understand the global impact of COVID-19 on tuberculosis (TB), interpret the scope of resonating themes, and offer policy recommendations to stimulate TB recovery and future pandemic preparedness. DATA SOURCES Publications were captured from three search engines, PubMed, EBSCO, and Google Scholar, and applicable websites written in English from January 1, 2020, to April 30, 2023. STUDY SELECTION Our scoping review was limited to publications detailing the impact of COVID-19 on TB. Original research, reviews, letters, and editorials describing the deleterious and harmful--yet sometimes positive--impact of COVID-19 (sole exposure) on TB (sole outcome) were included. The objective was to methodically categorize the impacts into themes through a comprehensive review of selected studies to provide significant health policy guidance. DATA EXTRACTION Two authors independently screened citations and full texts, while the third arbitrated when consensus was not met. All three performed data extraction. DATA SYNTHESIS/RESULTS Of 1,755 screened publications, 176 (10%) covering 39 countries over 41 months met the inclusion criteria. By independently using a data extraction instrument, the three authors identified ten principal themes from each publication. These themes were later finalized through a consensus decision. The themes encompassed TB's care cascade, patient-centered care, psychosocial issues, and health services: 1) case-finding and notification (n = 45; 26%); 2) diagnosis and laboratory systems (n = 19; 10.7%) 3) prevention, treatment, and care (n = 22; 12.2%); 4) telemedicine/telehealth (n = 12; 6.8%); 5) social determinants of health (n = 14; 8%); 6) airborne infection prevention and control (n = 8; 4.6%); 7) health system strengthening (n = 22; 13%); 8) mental health (n = 13; 7.4%); 9) stigma (n = 11; 6.3%); and 10) health education (n = 10; 5.7%). LIMITATIONS Heterogeneity of publications within themes. CONCLUSIONS We identified ten globally generalizable themes of COVID-19's impact on TB. The impact and lessons learned from the themed analysis propelled us to draft public health policy recommendations to direct evidence-informed guidance that strengthens comprehensive global responses, recovery for TB, and future airborne pandemic preparedness.
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Affiliation(s)
- Michael H. Marco
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
- Global Health Technical Assistance and Mission Support, Vienna, Virginia, United States of America
| | - Sevim Ahmedov
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
| | - Kenneth G. Castro
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
- Rollins School of Public Health, School of Medicine, Emory/Georgia TB Research Advancement Center, Atlanta, Georgia, United States of America
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Deng H, Liu Y, Lv F, Li X, Qi M, Bo Y, Qiu S, He X, Ji F, Zeng QL, Gao N. Sex disparities of the effect of the COVID-19 pandemic on mortality among patients living with tuberculosis in the United States. Front Public Health 2024; 12:1413604. [PMID: 38957204 PMCID: PMC11217309 DOI: 10.3389/fpubh.2024.1413604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/03/2024] [Indexed: 07/04/2024] Open
Abstract
Background We aimed to determine the trend of TB-related deaths during the COVID-19 pandemic. Methods TB-related mortality data of decedents aged ≥25 years from 2006 to 2021 were analyzed. Excess deaths were estimated by determining the difference between observed and projected mortality rates during the pandemic. Results A total of 18,628 TB-related deaths were documented from 2006 to 2021. TB-related age-standardized mortality rates (ASMRs) were 0.51 in 2020 and 0.52 in 2021, corresponding to an excess mortality of 10.22 and 9.19%, respectively. Female patients with TB demonstrated a higher relative increase in mortality (26.33 vs. 2.17% in 2020; 21.48 vs. 3.23% in 2021) when compared to male. Female aged 45-64 years old showed a surge in mortality, with an annual percent change (APC) of -2.2% pre-pandemic to 22.8% (95% CI: -1.7 to 68.7%) during the pandemic, corresponding to excess mortalities of 62.165 and 99.16% in 2020 and 2021, respectively; these excess mortality rates were higher than those observed in the overall female population ages 45-64 years in 2020 (17.53%) and 2021 (33.79%). Conclusion The steady decline in TB-related mortality in the United States has been reversed by COVID-19. Female with TB were disproportionately affected by the pandemic.
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Affiliation(s)
- Huan Deng
- National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yishan Liu
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fan Lv
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, China
| | - Xiaofeng Li
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Center for Infectious Diseases, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Mingyan Qi
- Department of Clinical Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yajing Bo
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Sikai Qiu
- Department of Clinical Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinyuan He
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fanpu Ji
- National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Provincial Research Center, Shaanxi Provincial Clinical Medical Research Center of Infectious Diseases, Xi'an, China
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, Xi'an, China
| | - Qing-Lei Zeng
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ning Gao
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Shapiro AN, Dolynska M, Chiang SS, Rybak N, Petrenko V, Horsburgh CR, Kobe J, Terleieva I, Sakalska O, Jenkins HE. The impact of the COVID-19 pandemic on TB notifications in Ukraine in 2020. IJTLD OPEN 2024; 1:258-265. [PMID: 39021447 PMCID: PMC11249659 DOI: 10.5588/ijtldopen.24.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/08/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND We assessed the impact of the COVID-19 pandemic on TB notifications in Ukraine, stratified by multiple subgroups. DESIGN/METHODS We analyzed data from Ukraine's National TB Program from January 2015 to December 2020 using interrupted time series models. We compared observed cases to counterfactual estimated cases had the pandemic not occurred and estimated trends through December 2020 nationally and by various demographics. We compared the proportions of individuals who underwent drug susceptibility testing (DST) in February 2020 and April 2020 to assess the pandemic impact on drug resistance testing. RESULTS In April 2020, there were 39% (95% CI 36-42) fewer TB notifications than the estimated counterfactual (3,060 estimated; 95% CI 2,918-3,202; 1,872 observed). We observed a greater decrease in notifications among refugees/migrants compared with non-refugees/migrants (64%, 95% CI 60-67 vs. 39%, 95% CI 36-42), and individuals aged <15 years compared with those aged ≥15 years (60%, 95% CI 57-64 vs. 38%, 95% CI 36-41). We also observed a decrease in the proportion of individuals receiving DST for several drugs. CONCLUSIONS These findings underscore the challenges to TB prevention and care during disruption and may be generalizable to the current wartime situation, especially considering the substantial increase in refugees within and leaving Ukraine.
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Affiliation(s)
- A N Shapiro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - M Dolynska
- NGO Infection Control Ukraine, Kyiv, Ukraine
| | - S S Chiang
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Center for International Health Research, Rhode Island Hospital, Providence, RI, USA
| | - N Rybak
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - V Petrenko
- Bogomolets National Medical University, Kyiv, Ukraine
| | - C R Horsburgh
- Departments of Global Health, Epidemiology, Biostatistics and Medicine, Boston University, Boston, MA, USA
| | - J Kobe
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - I Terleieva
- Public Health Center of the Ministry of Health, Kyiv City, Ukraine
| | - O Sakalska
- Public Health Center of the Ministry of Health, Kyiv City, Ukraine
| | - H E Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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Rickman HM, Phiri MD, Feasey HRA, Mbale H, Nliwasa M, Semphere R, Chagaluka G, Fielding K, Mwandumba HC, Horton KC, Nightingale ES, Henrion MYR, Mbendera K, Mpunga JA, Corbett EL, MacPherson P. Tuberculosis Immunoreactivity Surveillance in Malawi (Timasamala)-A protocol for a cross-sectional Mycobacterium tuberculosis immunoreactivity survey in Blantyre, Malawi. PLoS One 2024; 19:e0291215. [PMID: 38787869 PMCID: PMC11125513 DOI: 10.1371/journal.pone.0291215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/28/2024] [Indexed: 05/26/2024] Open
Abstract
Tuberculosis (TB) transmission and prevalence are dynamic over time, and heterogeneous within populations. Public health programmes therefore require up-to-date, accurate epidemiological data to appropriately allocate resources, target interventions, and track progress towards End TB goals. Current methods of TB surveillance often rely on case notifications, which are biased by access to healthcare, and TB disease prevalence surveys, which are highly resource-intensive, requiring many tens of thousands of people to be tested to identify high-risk groups or capture trends. Surveys of "latent TB infection", or immunoreactivity to Mycobacterium tuberculosis (Mtb), using tests such as interferon-gamma release assays (IGRAs) could provide a way to identify TB transmission hotspots, supplementing information from disease notifications, and with greater spatial and temporal resolution than is possible to achieve in disease prevalence surveys. This cross-sectional survey will investigate the prevalence of Mtb immunoreactivity amongst young children, adolescents and adults in Blantyre, Malawi, a high HIV-prevalence city in southern Africa. Through this study we will estimate the annual risk of TB infection (ARTI) in Blantyre and explore individual- and area-level risk factors for infection, as well as investigating geospatial heterogeneity of Mtb infection (and its determinants), and comparing these to the distribution of TB disease case-notifications. We will also evaluate novel diagnostics for Mtb infection (QIAreach QFT) and sampling methodologies (convenience sampling in healthcare settings and community sampling based on satellite imagery), which may increase the feasibility of measuring Mtb infection at large scale. The overall aim is to provide high-resolution epidemiological data and provide new insights into methodologies which may be used by TB programmes globally.
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Affiliation(s)
- Hannah M. Rickman
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Mphatso D. Phiri
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helena R. A. Feasey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Hannah Mbale
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Marriott Nliwasa
- Helse Nord TB Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Robina Semphere
- Helse Nord TB Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - George Chagaluka
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Henry C. Mwandumba
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Katherine C. Horton
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emily S. Nightingale
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marc Y. R. Henrion
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kuzani Mbendera
- Malawi National Tuberculosis and Leprosy Control Programme, Lilongwe, Malawi
| | - James A. Mpunga
- Malawi National Tuberculosis and Leprosy Control Programme, Lilongwe, Malawi
| | - Elizabeth L. Corbett
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Peter MacPherson
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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8
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Faust L, Caceres-Cardenas G, Martinez L, Huddart S, Vidal JR, Corilloclla-Torres R, Ayllon MC, Benedetti A, Pai M, Ugarte-Gil C. Tuberculosis case notifications and outcomes in Peruvian prisons prior to and during the COVID-19 pandemic: a national-level interrupted time series analysis. LANCET REGIONAL HEALTH. AMERICAS 2024; 33:100723. [PMID: 38800646 PMCID: PMC11117008 DOI: 10.1016/j.lana.2024.100723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 05/29/2024]
Abstract
Background The COVID-19 pandemic has significantly disrupted tuberculosis (TB) programs, making it urgent to focus TB elimination efforts on key populations. People experiencing incarceration are at high risk for TB, however, how COVID-19-related disruptions have impacted incarcerated populations with TB is unknown. Methods Using Peruvian National TB Program data from Jan 2018 to Dec 2021, an interrupted time series of drug-susceptible (DS) TB case notifications pre- and during COVID-19 was conducted (cut-off date: COVID-19 emergency declaration in Peru, 16 March 2020). The effect of TB care occurring pre-vs. during COVID-19 on TB treatment success in the incarcerated and non-incarcerated populations was explored using logistic regression. Findings DS-TB cases notified in prisons from Jan 2018 to Dec 2021 (n = 10,134) represented 10% of all cases notified in the country (n = 101,507). In the first week of COVID-19, DS-TB case notifications dropped by 61.2% (95% CI: 59.9-62.7%) in the non-incarcerated population and 17.7% (95% CI: 17.5-17.9%) among the incarcerated population. TB treatment success was significantly lower in people receiving TB care entirely during the COVID-19 pandemic vs. before COVID-19 in the non-incarcerated population (OR: 0.81, 95% CI: 0.78-0.85), but not statistically significantly lower in the incarcerated population (OR: 0.88, 95% CI: 0.76-1.01). Incarceration status was not found to modify the effect of COVID-19 period on TB treatment outcomes (OR: 1.07, 95% CI: 0.92-1.25), although treatment success was higher in the incarcerated population (OR [incarcerated vs. not incarcerated, pre-COVID]: 1.52, 95% CI: 1.39-1.67). Interpretation Both incarcerated and non-incarcerated populations experienced a large drop in DS-TB case notifications (although higher in the non-incarcerated population). Lower TB treatment success among those receiving care during COVID-19 indicates significant TB service disruptions in the overall population. The finding that incarceration at time of diagnosis was associated with treatment success is plausible in Peru given increased screening and stricter treatment monitoring in prisons. Funding Canadian Institutes of Health Research (Funding Reference Number: 179418) .
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Affiliation(s)
- Lena Faust
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
- McGill International TB Centre, McGill University, Montréal, Canada
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Sophie Huddart
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, USA
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, USA
| | - Julia Rios Vidal
- Dirección De Control y Prevención de la Tuberculosis (DPCT), Ministerio de Salud, Lima, Perú
| | | | | | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
- McGill International TB Centre, McGill University, Montréal, Canada
| | - César Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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9
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Weary TE, Tusiime P, Tuhaise S, Mandujano Reyes JF, Ross E, Gern JE, Goldberg TL. Respiratory disease patterns in rural Western Uganda, 2019-2022. Front Pediatr 2024; 12:1336009. [PMID: 38650995 PMCID: PMC11033374 DOI: 10.3389/fped.2024.1336009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Respiratory disease is a major cause of morbidity and mortality in the developing world, but prospective studies of temporal patterns and risk factors are rare. Methods We studied people in rural Western Uganda, where respiratory disease is pervasive. We followed 30 adults (ages 22-51 years; 534 observations) and 234 children (ages 3-11 years; 1,513 observations) between May 2019 and July 2022 and collected monthly data on their respiratory symptoms, for a total of 2,047 case records. We examined associations between demographic and temporal factors and respiratory symptoms severity. Results The timing of our study (before, during, and after the emergence of COVID-19) allowed us to document the effects of public health measures instituted in the region. Incidence rates of respiratory symptoms before COVID-19 lockdown were 568.4 cases per 1,000 person-months in children and 254.2 cases per 1,000 person-months in adults. These rates were 2.6 times higher than the 2019 global average for children but comparable for adults. Younger children (ages 3-6 years) had the highest frequencies and severities of respiratory symptoms. Study participants were most likely to experience symptoms in February, which is a seasonal pattern not previously documented. Incidence and severity of symptoms in children decreased markedly during COVID-19 lockdown, illustrating the broad effects of public health measures on the incidence of respiratory disease. Discussion Our results demonstrate that patterns of respiratory disease in settings such as Western Uganda resemble patterns in developed economies in some ways (age-related factors) but not in others (increased incidence in children and seasonal pattern). Factors such as indoor air quality, health care access, timing of school trimesters, and seasonal effects (rainy/dry seasons) likely contribute to the differences observed.
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Affiliation(s)
- Taylor E. Weary
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, United States
| | | | | | | | | | - James E. Gern
- Department of Pediatrics, University of Wisconsin Hospital and Clinics, Madison, WI, United States
| | - Tony L. Goldberg
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, United States
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10
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Konu YR, Dogo F, Dagnra CA, Atcha-Oubou T, Gbeasor-Komlanvi FA, Afanvi KA, Diallo FBT, Teouri M, Mijiyawa M, Ekouevi DK. Effect of the COVID-19 pandemic on HIV, malaria and tuberculosis indicators in Togo: an interrupted time series analysis. BMJ Glob Health 2024; 9:e013679. [PMID: 38569659 PMCID: PMC11002417 DOI: 10.1136/bmjgh-2023-013679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Limited data are available on the effects of the COVID-19 pandemic on health-related indicators in sub-Saharan Africa. This study aimed to estimate the effect of the COVID-19 pandemic on nine indicators of HIV, malaria and tuberculosis (TB) in Togo. METHODS For this interrupted time series analysis, national health information system data from January 2019 to December 2021 and TB programmatic data from the first quarter of 2018 to the fourth quarter of 2022 were analysed. Nine indicators were included. We used Poisson segmented regression to estimate the immediate impact of the pandemic and per-pandemic period trends through incidence rate ratios (IRRs) with 95% CIs. RESULTS Overall, there was a decrease in six of the nine indicators, ranging from 19.3% (IRR 0.807, 95% CI 0.682 to 0.955, p=0.024) for the hospitalisation of patients for malaria to 36.9% (IRR 0.631, 95% CI 0.457 to 0.871, p=0.013) for TB diagnosis by Mycobacterium tuberculosis Xpert immediately after the declaration of the COVID-19 pandemic. A comparison of the observed and predicted trends showed that the trend remained constant between the prepandemic and pandemic periods of COVID-19 for all malaria indicators. A significant downward monthly trend was observed in antiretroviral therapy initiation (IRR 0.909, 95% CI 0.892 to 0.926, p<0.001) and positive TB microscopy (IRR 0.919, 95% CI 0.880 to 0.960, p=0.002). CONCLUSION HIV, malaria and TB services were generally maintained over time in Togo despite the COVID-19 pandemic. However, given the decline in levels immediately after the onset of the pandemic, there is an urgent need to improve the preparedness of the healthcare system.
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Affiliation(s)
- Yao Rodion Konu
- Département de Santé Publique, Université de Lomé, Lome, Togo
- Centre Africain de Recherche en Epidemiologie et en Santé Publique (CARESP), Lomé, Togo
- Global Health in the Global South (Inserm UMR 1219, IRD EMR 271), Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
| | - Fall Dogo
- Programme national de lutte contre la tuberculose (PNLT), Lomé, Togo
| | - Claver Anoumou Dagnra
- Programme national de lutte contre le sida, les hépatites virales et les infections sexuellement transmissibles (PNLS-HV-IST), Lomé, Togo
| | | | - Fifonsi Adjidossi Gbeasor-Komlanvi
- Département de Santé Publique, Université de Lomé, Lome, Togo
- Centre Africain de Recherche en Epidemiologie et en Santé Publique (CARESP), Lomé, Togo
| | | | | | - Mahmoud Teouri
- Direction du système national d'information sanitaire et l'informatique (DSNSI), Lomé, Togo
| | - Moustafa Mijiyawa
- Ministère de la Santé, de l'Hygiène Publique et de l'Accès Universel aux Soins, Lomé, Togo
| | - Didier Koumavi Ekouevi
- Département de Santé Publique, Université de Lomé, Lome, Togo
- Centre Africain de Recherche en Epidemiologie et en Santé Publique (CARESP), Lomé, Togo
- Global Health in the Global South (Inserm UMR 1219, IRD EMR 271), Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
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11
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Feasey HRA, Khundi M, Soko RN, Bottomley C, Chiume L, Burchett HED, Nliwasa M, Twabi HH, Mpunga JA, MacPherson P, Corbett EL. Impact of active case-finding for tuberculosis on case-notifications in Blantyre, Malawi: A community-based cluster-randomised trial (SCALE). PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002683. [PMID: 38051717 PMCID: PMC10697577 DOI: 10.1371/journal.pgph.0002683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023]
Abstract
Active case-finding (ACF) for tuberculosis can help find the "missing millions" with undiagnosed tuberculosis. In a cluster-randomised trial, we investigated impact of ACF on case-notifications in Blantyre, Malawi, where ACF has been intensively implemented following 2014 estimates of ~1,000 per 100,000 adults with undiagnosed TB. Following a pre-intervention prevalence survey (May 2019 to March 2020), constrained randomisation allocated neighbourhoods to either door-to-door ACF (sputum microscopy for reported cough >2 weeks) or standard-of-care (SOC). Implementation was interrupted by COVID-19. Cluster-level bacteriologically-confirmed case-notification rate (CNR) ratio within 91 days of ACF was our redefined primary outcome; comparison between arms used Poisson regression with random effects. Secondary outcomes were 91-day CNR ratios comparing all tuberculosis registrations and all non-ACF registrations. Interrupted time series (ITS) analysis of CNRs in the SOC arm examined prevalence survey impact. (ISRCTN11400592). 72 clusters served by 10 study-supported tuberculosis registration centres were randomised to ACF (261,244 adults, 58,944 person-years follow-up) or SOC (256,713 adults, 52,805 person-years). Of 1,192 ACF participants, 13 (1.09%) were smear-positive. Within 91 days, 113 (42 bacteriologically-confirmed) and 108 (33 bacteriologically-confirmed) tuberculosis patients were identified as ACF or SOC cluster residents, respectively. There was no difference by arm, with adjusted 91-day CNR ratios 1.12 (95% CI: 0.61-2.07) for bacteriologically-confirmed tuberculosis; 0.93 (95% CI: 0.68-1.28) for all tuberculosis registrations; and 0.86 (95%CI: 0.63-1.16) for non-ACF (routinely) diagnosed. Of 7,905 ACF and 7,992 SOC pre-intervention survey participants, 12 (0.15%) and 17 (0.21%), respectively, had culture/Xpert-confirmed tuberculosis. ITS analysis showed no survey impact on SOC CNRs. Despite residual undiagnosed tuberculosis of 150 per 100,000 population, there was no increase in tuberculosis notifications from this previously successful approach targeting symptomatic disease, likely due to previous TB ACF and rapid declines in TB burden. In such settings, future ACF should focus on targeted outreach and demand creation, alongside optimised facility-based screening. Trial Registration: ISRCTN11400592.
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Affiliation(s)
| | - McEwen Khundi
- African Institute for Development Policy, Lilongwe, Malawi
| | - Rebecca Nzawa Soko
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Lingstone Chiume
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Marriott Nliwasa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Hussein H. Twabi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Peter MacPherson
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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12
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Spruijt I, Alam Y, Nguyen H, Myrzaliev B, Ahmatov M, Odume B, Mtei L, Gebhard A, Gidado M, Jerene D. Digital health solutions and integrated COVID-19 and TB services to help recover TB care and prevention services in the COVID-19 pandemic: A descriptive study in four high TB burden countries. PLoS One 2023; 18:e0293964. [PMID: 37983209 PMCID: PMC10659175 DOI: 10.1371/journal.pone.0293964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The measures undertaken to control COVID-19 have disrupted many platforms including tuberculosis (TB) healthcare services. Consequently, declines in TB notifications have been observed in various countries. We visualized changes over time in TB and SARS-CoV-2 infection notifications and reported on country-specific strategies to retain TB care and prevention services in Kyrgyzstan, Nigeria, Tanzania, and Vietnam. METHODS We collected and visualized quarterly, retrospective, and country-specific data (Quarter (Q) 1 2018- Q1 2021) on SARS-CoV-2 infection and TB notifications. Additionally, we conducted a country-specific landscape assessment on COVID-19 measures, including lockdowns, operational level strategy of TB care and prevention services, and strategies employed to recover and retain those services. We used negative binomial regression models to assess the association between the installation of COVID-19 measures and changes in TB notifications. RESULTS TB notifications declined in Kyrgyzstan and Vietnam, and (slightly) increased in Nigeria and Tanzania. The changes in TB notifications were associated with the installation of various COVID-19 prevention measures for Kyrgyzstan and Vietnam (declines) and Nigeria (increases). All countries reported reduced TB screening and testing activities. Countries reported the following strategies to retain TB prevention and care services: digital solutions for treatment adherence support, capacity building, and monitor & evaluation activities; adjustment in medication supply/delivery & quantity, including home delivery, pick up points, and month supply; integrated TB/COVID-19 screening & diagnostic platform; and the use of community health care workers. CONCLUSION Following the COVID-19 pandemic, we did not observe consistent changes in TB notifications across countries. However, all countries reported lower operating levels of TB prevention and care services. Digital health solutions, community-based interventions, and the integration of COVID-19 and TB testing services were employed to recover and retain those services.
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Affiliation(s)
- Ineke Spruijt
- Technical Division, KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Yalda Alam
- Technical Division, KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Huong Nguyen
- Technical Division, KNCV Vietnam, Hanoi, Vietnam
| | | | | | | | - Lillian Mtei
- Technical Division, KNCV Tanzania, Dar es Salaam, Tanzania
| | - Agnes Gebhard
- Technical Division, KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Mustapha Gidado
- Technical Division, KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Degu Jerene
- Technical Division, KNCV Tuberculosis Foundation, The Hague, The Netherlands
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13
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Feasey HRA, Khundi M, Nzawa Soko R, Nightingale E, Burke RM, Henrion MYR, Phiri MD, Burchett HE, Chiume L, Nliwasa M, Twabi HH, Mpunga JA, MacPherson P, Corbett EL. Prevalence of bacteriologically-confirmed pulmonary tuberculosis in urban Blantyre, Malawi 2019-20: Substantial decline compared to 2013-14 national survey. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001911. [PMID: 37862284 PMCID: PMC10588852 DOI: 10.1371/journal.pgph.0001911] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/21/2023] [Indexed: 10/22/2023]
Abstract
Recent evidence shows rapidly changing tuberculosis (TB) epidemiology in Southern and Eastern Africa, with need for subdistrict prevalence estimates to guide targeted interventions. We conducted a pulmonary TB prevalence survey to estimate current TB burden in Blantyre city, Malawi. From May 2019 to March 2020, 115 households in middle/high-density residential Blantyre, were randomly-selected from each of 72 clusters. Consenting eligible participants (household residents ≥ 18 years) were interviewed, including for cough (any duration), and offered HIV testing and chest X-ray; participants with cough and/or abnormal X-ray provided two sputum samples for microscopy, Xpert MTB/Rif and mycobacterial culture. TB disease prevalence and risk factors for prevalent TB were calculated using complete-case analysis, multiple imputation, and inverse probability weighting. Of 20,899 eligible adults, 15,897 (76%) were interviewed, 13,490/15,897 (85%) had X-ray, and 1,120/1,394 (80%) sputum-eligible participants produced at least one specimen, giving 15,318 complete cases (5,895, 38% men). 29/15,318 had bacteriologically-confirmed TB (189 per 100,000 complete-case (cc) / 150 per 100,000 with inverse weighting (iw)). Men had higher burden (cc: 305 [95% CI:144-645] per 100,000) than women (cc: 117 [95% CI:65-211] per 100,000): cc adjusted odds ratio (aOR) 2.70 (1.26-5.78). Other significant risk factors for prevalent TB on complete-case analysis were working age (25-49 years) and previous TB treatment, but not HIV status. Multivariable analysis of imputed data was limited by small numbers, but previous TB and age group 25-49 years remained significantly associated with higher TB prevalence. Pulmonary TB prevalence for Blantyre was considerably lower than the 1,014 per 100,000 for urban Malawi in the 2013-14 national survey, at 150-189 per 100,000 adults, but some groups, notably men, remain disproportionately affected. TB case-finding is still needed for TB elimination in Blantyre, and similar urban centres, but should focus on reaching the highest risk groups, such as older men.
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Affiliation(s)
| | - McEwen Khundi
- African Institute for Development Policy, Lilongwe, Malawi
| | - Rebecca Nzawa Soko
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Emily Nightingale
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rachael M. Burke
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marc Y. R. Henrion
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mphatso D. Phiri
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helen E. Burchett
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lingstone Chiume
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Marriott Nliwasa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Hussein H. Twabi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Peter MacPherson
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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14
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Zhang Y, Zhang L, Gao W, Li M, Luo Q, Xiang Y, Bao K. The impact of COVID-19 pandemic on reported tuberculosis incidence and mortality in China: An interrupted time series analysis. J Glob Health 2023; 13:06043. [PMID: 37824176 PMCID: PMC10569365 DOI: 10.7189/jogh.13.06043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Background The reported number of cases and deaths from common infectious diseases can change during major public health crises. We explored whether the coronavirus disease 2019 (COVID-19) had an impact on tuberculosis (TB) incidence and mortality in China based on routinely reported TB data. Methods We used TB data used from the monthly national notifiable infectious disease reports in China from January 2015 to January 2023. Based on an interrupted time series (ITS) design, we applied Poisson and negative binomial regression models to assess the changes of reported TB incidence and mortality before and during the COVID-19 pandemic. Results We found a significant and immediate decrease in the levels of both reported TB incidence (relative risk (RR) = 0.887; 95% confidence interval (CI) = 0.810-0.973) and mortality (RR = 0.448; 95% CI = 0.351-0.572) at the start of COVID-19 outbreak. During the pandemic, the slope of reported incidence decreased significantly (RR = 0.994; 95% CI = 0.989-0.999), while the slope of reported mortality increased sharply (RR = 1.032; 95% CI = 1.022-1.041) owing to an abrupt rise in reported mortality after January 2022. Conclusions Both TB incidence and mortality decreased immediately at the start of the COVID-19 pandemic. Over a longer period, the COVID-19 pandemic had contributed to a sustained and more significant decrease in reported incidence, and a delayed but sharp increase in reported mortality.
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Affiliation(s)
- Yuqi Zhang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Li Zhang
- TB Prevention and Control Institute, Lanzhou Municipal Center for Disease Control and Prevention, Lanzhou, Gansu, China
| | - Wenlong Gao
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ming Li
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Qiuxia Luo
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Yuanyuan Xiang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Kai Bao
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
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15
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Dlangalala T, Musekiwa A, Mashamba-Thompson T. Impact of COVID-19 on TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa. Sci Rep 2023; 13:16645. [PMID: 37789034 PMCID: PMC10547754 DOI: 10.1038/s41598-023-43589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023] Open
Abstract
We assessed the impact of the pandemic on TB diagnostics at primary healthcare clinics (PHCs) during the different stages of COVID-19 in eThekwini district, South Africa. Data from the District Health Information System (DHIS) were used to conduct an interrupted time series analysis that assessed the changes in TB investigations and confirmed TB cases during four pandemic periods: lockdown and the subsequent three peaks of infection compared to the two years prior (2018-2022). The initial lockdown resulted in - 45% (95% CI - 55 to - 31) and - 40% (95% CI - 59 to - 28) immediate declines in TB investigations and confirmed cases, respectively. Both indicators showed substantial recovery in the months after the first wave (p < 0.05). However, while TB investigations sustained smaller declines throughout the pandemic, they rebounded and surpassed pre-COVID-19 levels by the end of the investigation period. On the other hand, confirmed cases experienced reductions that persisted until the end of the investigation period. TB diagnostic services at PHCs were considerably disrupted by COVID-19, with the confirmation of cases being the most adversely affected throughout the pandemic. The reasons for these persistent declines in TB detection must be determined to inform the development of sustainable diagnostic systems that are capable of withstanding future pandemics.
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Affiliation(s)
- Thobeka Dlangalala
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, 0002, South Africa.
| | - Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, 0002, South Africa
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16
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Mndala L, Chapuma C, Riches J, Gadama L, Kachale F, Bilesi R, Mbewe M, Likaka A, Kumwenda M, Makuluni R, Maseko B, Ndamala C, Kuyere A, Munthali L, Phiri D, Monk EJM, Henrion MYR, Odland ML, Lissauer D. Effects of COVID-19 on Maternal and Neonatal Outcomes and Access to Antenatal and Postnatal Care, Malawi. Emerg Infect Dis 2023; 29:1990-1998. [PMID: 37640377 PMCID: PMC10521614 DOI: 10.3201/eid2910.230003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
We used national facility-level data from all government hospitals in Malawi to examine the effects of the second and third COVID-19 waves on maternal and neonatal outcomes and access to care during September 6, 2020-October 31, 2021. The COVID-19 pandemic affected maternal and neonatal health not only through direct infections but also through disruption of the health system, which could have wider indirect effects on critical maternal and neonatal outcomes. In an interrupted time series analysis, we noted a cumulative 15.4% relative increase (63 more deaths) in maternal deaths than anticipated across the 2 COVID-19 waves. We observed a 41% decrease in postnatal care visits at the onset of the second COVID-19 wave and 0.2% by the third wave, cumulative to 36,809 fewer visits than anticipated. Our findings demonstrate the need for strengthening health systems, particularly in resource-constrained settings, to prepare for future pandemic threats.
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17
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de Souza CDF, Neto ERD, Matos TS, Ferreira ACF, Bezerra-Santos M, da Silva Junior AG, do Carmo RF. Bridging the Gaps: Investigating the Complex Impact of the COVID-19 Pandemic on Tuberculosis Records in Brazil. Trop Med Infect Dis 2023; 8:454. [PMID: 37755915 PMCID: PMC10534437 DOI: 10.3390/tropicalmed8090454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND This study aimed to analyze the temporal evolution, spatial distribution, and impact of the COVID-19 pandemic on tuberculosis records in a northeastern state of Brazil. METHODS This is an ecological study involving all diagnoses of Tuberculosis (TB) in residents of the state of Pernambuco/Brazil. Data were extracted from the National System of Notifiable Diseases. A pre-pandemic COVID-19 temporal analysis (2001-2019), a spatial analysis before (2015-2019) and during the first two pandemic years (2020-2021), and the impact of the COVID-19 pandemic on cases of TB diagnoses in Pernambuco in the years 2020 and 2021 were performed. Inflection point regression models, Global and Local Moran's statistics, and spatial scan statistics were used. RESULTS In the period from 2001 to 2019, 91,225 cases of TB were registered in Pernambuco (48.40/100,000 inhabitants), with a tendency of growth starting in 2007 (0.7% per year; p = 0.005). In the pre-pandemic period (2015-2019), 10.8% (n = 20) of Pernambuco municipalities had TB incidence rates below 10/100,000. In 2020, this percentage reached 27.0% (n = 50) and in 2021 it was 17.8% (n = 33). Risk clusters were identified in the eastern region of the state, with five clusters in the pre-pandemic period and in 2021 and six in 2020. In the first year of the pandemic, an 8.5% reduction in the number of new TB cases was observed. In 2021, the state showed a slight increase (1.1%) in the number of new TB cases. CONCLUSIONS The data indicate that the COVID-19 pandemic may have caused a reduction in the number of new TB case reports in the state of Pernambuco, Brazil.
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Affiliation(s)
- Carlos Dornels Freire de Souza
- Department of Medicine, Federal University of Vale do São Francisco (UNIVASF), Petrolina 56304-205, Brazil; (E.R.D.N.); (A.C.F.F.)
| | - Epaminondas Ribeiro Dias Neto
- Department of Medicine, Federal University of Vale do São Francisco (UNIVASF), Petrolina 56304-205, Brazil; (E.R.D.N.); (A.C.F.F.)
| | - Thais Silva Matos
- Department of physiotherapy, University of Pernambuco (UPE), Petrolina 56328-900, Brazil;
| | - Ana Carolina Furtado Ferreira
- Department of Medicine, Federal University of Vale do São Francisco (UNIVASF), Petrolina 56304-205, Brazil; (E.R.D.N.); (A.C.F.F.)
| | - Márcio Bezerra-Santos
- Department of Medicine, Federal University of Alagoas (UFAL), Arapiraca 57309-005, Brazil;
| | | | - Rodrigo Feliciano do Carmo
- Postgraduate Program in Health and Biological Sciences, Federal University of Vale do São Francisco (UNIVASF), Petrolina 56304-205, Brazil;
- Postgraduate Program in Biosciences, Federal University of Vale do São Francisco (UNIVASF), Petrolina 56304-205, Brazil
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18
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Mancuso G, Midiri A, De Gaetano S, Ponzo E, Biondo C. Tackling Drug-Resistant Tuberculosis: New Challenges from the Old Pathogen Mycobacterium tuberculosis. Microorganisms 2023; 11:2277. [PMID: 37764122 PMCID: PMC10537529 DOI: 10.3390/microorganisms11092277] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Antibiotics have played a crucial role in the reduction in the incidence of TB globally as evidenced by the fact that before the mid-20th century, the mortality rate within five years of the onset of the disease was 50%. The use of antibiotics has eliminated TB as a devastating disease, but the challenge of resistance to anti-TB drugs, which had already been described at the time of the introduction of streptomycin, has become a major global issue in disease management. Mismanagement of multidrug-resistant tuberculosis (MDR-TB) cases, resulting from intermittent drug use, prescription errors, and non-compliance of patients, has been identified as a critical risk factor for the development of extensively drug-resistant tuberculosis (XDR-TB). Antimicrobial resistance (AMR) in TB is a multi-factorial, complex problem of microbes evolving to escape antibiotics, the gradual decline in antibiotic development, and different economic and social conditions. In this review, we summarize recent advances in our understanding of how Mycobacterium tuberculosis evolves drug resistance. We also highlight the importance of developing shorter regimens that rapidly reach bacteria in diverse host environments, eradicating all mycobacterial populations and preventing the evolution of drug resistance. Lastly, we also emphasize that the current burden of this ancient disease is driven by a combination of complex interactions between mycobacterial and host factors, and that only a holistic approach that effectively addresses all the critical issues associated with drug resistance will limit the further spread of drug-resistant strains throughout the community.
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Affiliation(s)
| | | | | | | | - Carmelo Biondo
- Mycobacteriology Unit, Department of Human Pathology, University of Messina, 98125 Messina, Italy; (G.M.); (A.M.); (S.D.G.); (E.P.)
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19
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Daniel OJ, Bamidele JO, Alabi AD, Tijani MA, Akinleye CA, Oritogun KS, Soyinka FO, Adejumo OA. The effect of the Covid-19 pandemic on Tuberculosis (TB) case notification in Ogun State, Nigeria. Afr Health Sci 2023; 23:376-383. [PMID: 38357178 PMCID: PMC10862610 DOI: 10.4314/ahs.v23i3.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Introduction COVID-19 pandemic has resulted in disruptions in delivery of Tuberculosis services especially, in resource-limited settings. Provisional data by the WHO from 84 countries indicates that about 1.4 million fewer people received care for tuberculosis in 2020 than in 2019. This study assessed the effect of COVID-19 pandemic on tuberculosis case notification rates in Ogun state, Nigeria. Methods A retrospective review of presumptive TB and diagnosed TB cases that were notified in 2019 and 2020. Analysis was done using Epi-info version 7.2.3.1. Level of statistical significance was p < 0.05. Results A total of 3102 and 3326 confirmed cases were reported in 2019 and 2020 respectively with an increase of 7.2%. There was significant decline in total number of cases notified in Q2, 2020 compared to 2019 (p=0.001) with a significant increase in proportion of TB cases notified by private facilities from 11.65% in 2019 to 20.27% in 2020. Conclusion Total TB cases notified in Ogun state increased during the covid-19 pandemic. There was significant decline in TB cases during the lockdown but an increase in proportion of TB cases notified by private facilities demonstrating that private facilities can withstand disruptions to TB case notifications due to the Covid-19 pandemic.
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Affiliation(s)
- Olusoji J Daniel
- Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State
- Department of Community Medicine and Primary Care, Faculty of Clinical Sciences, Olabisi Onabanjo University Sagamu Campus, Ogun State
| | - Janet O Bamidele
- Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State
| | - Adekunle D Alabi
- Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State
- Department of Community Medicine and Primary Care, Faculty of Clinical Sciences, Olabisi Onabanjo University Sagamu Campus, Ogun State
| | - Musibau A Tijani
- State Tuberculosis, Leprosy & Buruli Ulcer Control Programme, Department of Public Health, Ministry of Health, Abeokuta, Ogun State
| | | | - Kolawole S Oritogun
- Department of Community Medicine and Primary Care, Faculty of Clinical Sciences, Olabisi Onabanjo University Sagamu Campus, Ogun State
| | - Festus O Soyinka
- State Tuberculosis, Leprosy & Buruli Ulcer Control Programme, Department of Public Health, Ministry of Health, Abeokuta, Ogun State
| | - Olusola A Adejumo
- Department of Community Health, Lagos State University Teaching Hospital Ikeja, Lagos
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20
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Ledesma JR, Basting A, Chu HT, Ma J, Zhang M, Vongpradith A, Novotney A, Dalos J, Zheng P, Murray CJL, Kyu HH. Global-, Regional-, and National-Level Impacts of the COVID-19 Pandemic on Tuberculosis Diagnoses, 2020-2021. Microorganisms 2023; 11:2191. [PMID: 37764035 PMCID: PMC10536333 DOI: 10.3390/microorganisms11092191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Evaluating cross-country variability on the impact of the COVID-19 pandemic on tuberculosis (TB) may provide urgent inputs to control programs as countries recover from the pandemic. We compared expected TB notifications, modeled using trends in annual TB notifications from 2013-2019, with observed TB notifications to compute the observed to expected (OE) ratios for 170 countries. We applied the least absolute shrinkage and selection operator (LASSO) method to identify the covariates, out of 27 pandemic- and tuberculosis-relevant variables, that had the strongest explanatory power for log OE ratios. The COVID-19 pandemic was associated with a 1.55 million (95% CI: 1.26-1.85, 21.0% [17.5-24.6%]) decrease in TB diagnoses in 2020 and a 1.28 million (0.90-1.76, 16.6% [12.1-21.2%]) decrease in 2021 at a global level. India, Indonesia, the Philippines, and China contributed the most to the global declines for both years, while sub-Saharan Africa achieved pre-pandemic levels by 2021 (OE ratio = 1.02 [0.99-1.05]). Age-stratified analyses revealed that the ≥ 65-year-old age group experienced greater relative declines in TB diagnoses compared with the under 65-year-old age group in 2020 (RR = 0.88 [0.81-0.96]) and 2021 (RR = 0.88 [0.79-0.98]) globally. Covariates found to be associated with all-age OE ratios in 2020 were age-standardized smoking prevalence in 2019 (β = 0.973 [0.957-990]), school closures (β = 0.988 [0.977-0.998]), stay-at-home orders (β = 0.993 [0.985-1.00]), SARS-CoV-2 infection rate (β = 0.991 [0.987-0.996]), and proportion of population ≥65 years (β = 0.971 [0.944-0.999]). Further research is needed to clarify the extent to which the observed declines in TB diagnoses were attributable to disruptions in health services, decreases in TB transmission, and COVID-19 mortality among TB patients.
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Affiliation(s)
- Jorge R. Ledesma
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Epidemiology, Brown University School of Public Health, 121 S Main St, Providence, RI 02912, USA
| | - Ann Basting
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Huong T. Chu
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA
| | - Jianing Ma
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, 1800 Cannon Drive, Columbus, OH 43210, USA;
| | - Meixin Zhang
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Avina Vongpradith
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Amanda Novotney
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Jeremy Dalos
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA
| | - Christopher J. L. Murray
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA
| | - Hmwe H. Kyu
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA
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21
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Gordon SB, Sichone S, Chirwa AE, Hazenberg P, Kafuko Z, Ferreira DM, Flynn J, Fortune S, Balasingam S, Biagini GA, McShane H, Mwandumba HC, Jambo K, Dheda K, Raj Sharma N, Robertson BD, Walker NF, Morton B. Practical considerations for a TB controlled human infection model (TB-CHIM); the case for TB-CHIM in Africa, a systematic review of the literature and report of 2 workshop discussions in UK and Malawi. Wellcome Open Res 2023; 8:71. [PMID: 37007907 PMCID: PMC10064019 DOI: 10.12688/wellcomeopenres.18767.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/23/2023] Open
Abstract
Background: Tuberculosis (TB) remains a major challenge in many domains including diagnosis, pathogenesis, prevention, treatment, drug resistance and long-term protection of the public health by vaccination. A controlled human infection model (CHIM) could potentially facilitate breakthroughs in each of these domains but has so far been considered impossible owing to technical and safety concerns. Methods: A systematic review of mycobacterial human challenge studies was carried out to evaluate progress to date, best possible ways forward and challenges to be overcome. We searched MEDLINE (1946 to current) and CINAHL (1984 to current) databases; and Google Scholar to search citations in selected manuscripts. The final search was conducted 3 rd February 2022. Inclusion criteria: adults ≥18 years old; administration of live mycobacteria; and interventional trials or cohort studies with immune and/or microbiological endpoints. Exclusion criteria: animal studies; studies with no primary data; no administration of live mycobacteria; retrospective cohort studies; case-series; and case-reports. Relevant tools (Cochrane Collaboration for RCTs and Newcastle-Ottawa Scale for non-randomised studies) were used to assess risk of bias and present a narrative synthesis of our findings. Results: The search identified 1,388 titles for review; of these 90 were reviewed for inclusion; and 27 were included. Of these, 15 were randomised controlled trials and 12 were prospective cohort studies. We focussed on administration route, challenge agent and dose administered for data extraction. Overall, BCG studies including fluorescent BCG show the most immediate utility, and genetically modified Mycobacteria tuberculosis is the most tantalising prospect of discovery breakthrough. Conclusions: The TB-CHIM development group met in 2019 and 2022 to consider the results of the systematic review, to hear presentations from many of the senior authors whose work had been reviewed and to consider best ways forward. This paper reports both the systematic review and the deliberations. Registration: PROSPERO ( CRD42022302785; 21 January 2022).
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Affiliation(s)
- Stephen B. Gordon
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Simon Sichone
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Anthony E. Chirwa
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | | | - Daniela M. Ferreira
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - JoAnne Flynn
- Centre for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah Fortune
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | | | | | - Helen McShane
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Henry C Mwandumba
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Kondwani Jambo
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Keertan Dheda
- Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | | | | | - Naomi F Walker
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Ben Morton
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - TB Controlled Human Infection Model Development Group
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- 1Day Africa, 1Day Sooner, Lusaka Province, Zambia
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- Centre for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Wellcome Trust, London, UK
- The Jenner Institute, University of Oxford, Oxford, UK
- Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
- Imperial College London, London, UK
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22
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Jackson PD, Muyanja SZ, Sekitoleko I, Bbuye M, Helwig M, Padalkar R, Hammad M, Hopkinson D, Siddharthan T. Risk factors for disruptions in tuberculosis care in Uganda during the COVID-19 pandemic. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001573. [PMID: 37267249 DOI: 10.1371/journal.pgph.0001573] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/22/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, TB mortality increased while diagnoses decreased, likely due to care disruption. In March, 2020, Uganda-a country with high TB burden, implemented a COVID-19 lockdown with associated decrease in TB diagnoses. This study aims to examine patient level risk factors for disruption in TB care during the COVID-19 pandemic in Uganda. This retrospective cross-sectional cohort study included six TB clinics in Uganda. Clustered sampling included phases of TB care and three time-periods: pre-lockdown, lockdown and post-lockdown. Characteristics of patients with TB care disruption (TBCD), defined as those with > 2 months of symptoms prior to diagnosis or who missed a TB clinic, and those without TB care disruption (non-TBCD) were analyzed between time-periods. 1,624 charts were reviewed; 1322 were contacted, 672 consented and completed phone interview; pre-lockdown (n = 213), lockdown (n = 189) and post-lockdown (n = 270). TBCD occurred in 57% (385/672) of patients. There was an increase in the proportion of urban patients in the TBCD and non-TBCD groups during post-lockdown (p <0.001). There was no difference in demographics, HIV co-infection, socioeconomic status, or distance to TB clinic between TBCD and non-TBCD groups or within TBCD by time-period. There were few differences amongst TBCD and all TB patients by time-period. The increase in urban patients' post-lockdown may represent a portion of urban patients who delayed care until post-lockdown. Insignificant trends suggesting more TBCD amongst those who lived further from clinics and those without HIV-coinfection require more investigation.
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Affiliation(s)
- Peter D Jackson
- Division of Pulmonary and Critical Care, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Stella Zawedde Muyanja
- Infectious Disease Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Isaac Sekitoleko
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, England
| | - Mudarshiru Bbuye
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Madeline Helwig
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Roma Padalkar
- Rowan University School of Osteopathic Medicine, Glassboro, New Jersey, United States of America
| | - Mariam Hammad
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Dennis Hopkinson
- Division of Pulmonary and Critical Care, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Division of Pulmonary and Critical Care, Department of Medicine, Duke University, Durham, North Carolina
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care, Department of Medicine, University of Miami, Miami, Florida, United States of America
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23
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Gordon SB, Sichone S, Chirwa AE, Hazenberg P, Kafuko Z, Ferreira DM, Flynn J, Fortune S, Balasingam S, Biagini GA, McShane H, Mwandumba HC, Jambo K, Dheda K, Raj Sharma N, Robertson BD, Walker NF, Morton B. Practical considerations for a TB controlled human infection model (TB-CHIM); the case for TB-CHIM in Africa, a systematic review of the literature and report of 2 workshop discussions in UK and Malawi. Wellcome Open Res 2023; 8:71. [PMID: 37007907 PMCID: PMC10064019 DOI: 10.12688/wellcomeopenres.18767.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/12/2023] Open
Abstract
Background: Tuberculosis (TB) remains a major challenge in many domains including diagnosis, pathogenesis, prevention, treatment, drug resistance and long-term protection of the public health by vaccination. A controlled human infection model (CHIM) could potentially facilitate breakthroughs in each of these domains but has so far been considered impossible owing to technical and safety concerns. Methods: A systematic review of mycobacterial human challenge studies was carried out to evaluate progress to date, best possible ways forward and challenges to be overcome. We searched MEDLINE (1946 to current) and CINAHL (1984 to current) databases; and Google Scholar to search citations in selected manuscripts. The final search was conducted 3 rd February 2022. Inclusion criteria: adults ≥18 years old; administration of live mycobacteria; and interventional trials or cohort studies with immune and/or microbiological endpoints. Exclusion criteria: animal studies; studies with no primary data; no administration of live mycobacteria; retrospective cohort studies; case-series; and case-reports. Relevant tools (Cochrane Collaboration for RCTs and Newcastle-Ottawa Scale for non-randomised studies) were used to assess risk of bias and present a narrative synthesis of our findings. Results: The search identified 1,388 titles for review; of these 90 were reviewed for inclusion; and 27 were included. Of these, 15 were randomised controlled trials and 12 were prospective cohort studies. We focussed on administration route, challenge agent and dose administered for data extraction. Overall, BCG studies including fluorescent BCG show the most immediate utility, and genetically modified Mycobacteria tuberculosis is the most tantalising prospect of discovery breakthrough. Conclusions: The TB-CHIM development group met in 2019 and 2022 to consider the results of the systematic review, to hear presentations from many of the senior authors whose work had been reviewed and to consider best ways forward. This paper reports both the systematic review and the deliberations. Registration: PROSPERO ( CRD42022302785; 21 January 2022).
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Affiliation(s)
- Stephen B. Gordon
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Simon Sichone
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Anthony E. Chirwa
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | | | - Daniela M. Ferreira
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - JoAnne Flynn
- Centre for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah Fortune
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | | | | | - Helen McShane
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Henry C Mwandumba
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Kondwani Jambo
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Keertan Dheda
- Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | | | | | - Naomi F Walker
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Ben Morton
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - TB Controlled Human Infection Model Development Group
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- 1Day Africa, 1Day Sooner, Lusaka Province, Zambia
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- Centre for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Wellcome Trust, London, UK
- The Jenner Institute, University of Oxford, Oxford, UK
- Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
- Imperial College London, London, UK
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24
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Elfiyunai NN, Nursalam N, Sukartini T, Efendi F. A systematic review on telenursing as a solution in improving the treatment compliance of tuberculosis patients in the COVID-19 pandemic. HEALTHCARE IN LOW-RESOURCE SETTINGS 2023. [DOI: 10.4081/hls.2023.11194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Introduction: The COVID-19 pandemic had made patients scared of coming to clinics or hospitals, and this could affect the treatment of TB. Therefore, one type of service that can be used by nurses to improve compliance to TB treatment is Telenursing. This article aims to ascertain whether telenursing could be a solution in improving the compliance of TB patients to treatments in the COVID-19 pandemic.
Design and Method: This research was conducted using the Randomised Controlled Trial design as well as PRISMA. Furthermore, useful research articles were sourced from the database using the keywords, “Message Reminder and Tuberculosis OR Medication Adherence”. The databases used are Scopus, Science Direct, PubMed, and SAGE, all in English text and from 2015 to 2021, with inclusion criteria. 277 articles were obtained, and then filtered to select 3 articles by reading the main focus of the write-up, with regard to the topic of study.
Result: Telenursing can be a solution to reduce the spread of COVID-19, and a substitute for remotely motivating individuals, as social support. Furthermore, it could be used as a reminder to patients to be obedient in carrying out treatments, and as a means of educating and improving good relationships with providers.
Conclusions: Telenursing is a fairly effective solution in helping TB patients improve treatment compliance, reduce drug dropout rates and missed doses, as well as, raise awareness about the importance of health in the COVID-19 pandemic.
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25
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Semitala FC, Katwesigye R, Kalibbala D, Mbuliro M, Lalitha R, Owachi D, Atine E, Nassazi J, Turyahabwe S, Sekadde M. Integration of COVID-19 and TB screening in Kampala, Uganda: healthcare provider perspectives. Implement Sci Commun 2023; 4:8. [PMID: 36650596 PMCID: PMC9844180 DOI: 10.1186/s43058-023-00391-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 12/27/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Following the first wave of the COVID-19 outbreak, Uganda experienced a 40% drop in tuberculosis (TB) screening by June 2020. We sought to identify barriers to and facilitators of integrated COVID-19 and TB screening from the perspective of healthcare providers (HCPs) at a National Referral Hospital in Kampala, Uganda. DESIGN/METHODS We conducted a cross-sectional study using in-depth interviews with 12 HCPs involved in TB activities in the outpatient and emergency departments at Kiruddu National Referral Hospital, Kampala, Uganda. We explored the HCP experiences at work in the setting of COVID-19, HCP perceived effect of COVID-19 on TB screening activities at the hospital, and perceptions about social and contextual factors that might influence the willingness of HCP to integrate screening of COVID-19 and TB. We analyzed the data using an inductive thematic approach and we denoted the emergent themes as barriers to and facilitators of COVID-19/TB integrated screening. We then mapped the themes to the Capability, Opportunity, Motivation, and Behavior (COM-B) model. RESULTS The facilitators to integrated COVID-19 and TB screening included the availability of TB focal persons and already existing training forums at the hospital that could be utilized to strengthen the capacity of HCP to integrate COVID-19 and TB screening. The barriers included HCP's inadequate knowledge on how to integrate screening of COVID-19 and TB, the absence of simple easy-to-use standard operating procedures and data collection tools for integrated screening, inconsistent supply of personal protective equipment (PPE), understaffing, and fear of contracting COVID-19 infection. The identified intervention functions to address the facilitators or barriers included education, persuasion, enablement, and training. CONCLUSIONS These findings provided a basis for designing contextually appropriate interventions targeting factors that are likely to influence HCP decisions and willingness to conduct TB screening in the context of COVID-19. Future studies should evaluate the effect of addressing these barriers to the integration of COVID-19 and TB as well as the effect of this on TB case finding in high-burden TB settings.
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Affiliation(s)
- Fred C. Semitala
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Rodgers Katwesigye
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Dennis Kalibbala
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Mary Mbuliro
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Rejani Lalitha
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Darius Owachi
- grid.513250.0Kiruddu National Referral Hospital, Kampala, Uganda
| | - Edgar Atine
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Josephine Nassazi
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Stavia Turyahabwe
- grid.415705.2Ministry of Health Uganda, National Tuberculosis and Leprosy Program, Kampala, Uganda
| | - Moorine Sekadde
- grid.415705.2Ministry of Health Uganda, National Tuberculosis and Leprosy Program, Kampala, Uganda
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Agadjanian V. The COVID-19 Pandemic, Social Ties, and Psychosocial Well-Being of Middle-Aged Women in Rural Africa. SOCIUS : SOCIOLOGICAL RESEARCH FOR A DYNAMIC WORLD 2023; 9:23780231231171868. [PMID: 37234471 PMCID: PMC10201067 DOI: 10.1177/23780231231171868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The study contributes to the understanding of the societal impact of the coronavirus disease 2019 pandemic in the Global South by examining longer term implications of pandemic-induced disruptions and deprivations for social ties and psychosocial well-being. Using data from a survey of middle-aged women in rural Mozambique, the author finds a negative association between the pandemic-triggered household economic decline and perceived changes in the quality of relations with marital partners, non-coresident children, and relatives, but not with generally more distant actors, such as coreligionists and neighbors. In turn, multivariable analyses detect a positive association of changes in the quality of family and kin ties with participants' life satisfaction, regardless of other factors. Yet women's expectations for changes in their household living conditions in the near future show a significant association only with changes in the quality of relations with marital partners. The author situates these findings within the context of women's enduring vulnerabilities in low-income patriarchal settings.
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Romano ER, Sleeman K, Hall-Eidson P, Zeh C, Bhairavabhotla R, Zhang G, Adhikari A, Alemnji G, Cardo YR, Pinheiro A, Pocongo B, Eno LT, Shang JD, Ndongmo CB, Rosario H, Moreno O, De León LADLC, Fonjungo P, Kabwe C, Ahuke-Mundeke S, Gama D, Dlamini S, Maphalala G, Abreha T, Purfield A, Gebrehiwot YT, Desalegn DM, Basiye F, Mwangi J, Bowen N, Mengistu Y, Lecher S, Kampira E, Kaba M, Bitilinyu-Bangoh J, Masamha G, Viegas SO, Beard RS, van Rooyen G, Shiningavamwe AN, I J M, Iriemenam NC, Mba N, Okoi C, Katoro J, Kenyi DL, Bior BK, Mwangi C, Nabadda S, Kaleebu P, Yingst SL, Chikwanda P, Veri L, Simbi R, Alexander H. Contribution of PEPFAR-Supported HIV and TB Molecular Diagnostic Networks to COVID-19 Testing Preparedness in 16 Countries. Emerg Infect Dis 2022; 28:S59-S68. [PMID: 36502414 PMCID: PMC9745242 DOI: 10.3201/eid2813.220789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The US President's Emergency Plan for AIDS Relief (PEPFAR) supports molecular HIV and tuberculosis diagnostic networks and information management systems in low- and middle-income countries. We describe how national programs leveraged these PEPFAR-supported laboratory resources for SARS-CoV-2 testing during the COVID-19 pandemic. We sent a spreadsheet template consisting of 46 indicators for assessing the use of PEPFAR-supported diagnostic networks for COVID-19 pandemic response activities during April 1, 2020, to March 31, 2021, to 27 PEPFAR-supported countries or regions. A total of 109 PEPFAR-supported centralized HIV viral load and early infant diagnosis laboratories and 138 decentralized HIV and TB sites reported performing SARS-CoV-2 testing in 16 countries. Together, these sites contributed to >3.4 million SARS-CoV-2 tests during the 1-year period. Our findings illustrate that PEPFAR-supported diagnostic networks provided a wide range of resources to respond to emergency COVID-19 diagnostic testing in 16 low- and middle-income countries.
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Alemu A, Bitew ZW, Seid G, Diriba G, Gashu E, Berhe N, Mariam SH, Gumi B. Tuberculosis in individuals who recovered from COVID-19: A systematic review of case reports. PLoS One 2022; 17:e0277807. [PMID: 36441785 PMCID: PMC9704624 DOI: 10.1371/journal.pone.0277807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The emergence of COVID-19 overwhelmed tuberculosis (TB) prevention and control, resulting in a decrease in TB detection rate and an increase in TB deaths. Furthermore, the temporary immunosuppressive effects, lung inflammation, and the corticosteroids used to treat COVID-19, may play a direct role in immunosuppression, leading to reactivation of either previous infection or latent TB or the development of new TB. Thus, the aim of this study was to review TB incidence in individuals who recovered from COVID-19. METHODS We conducted a systematic search of available databases for previously published studies that reported TB in COVID-19 survivors. The PRISMA checklist was used to guide the review, and the JBI checklist was used to evaluate the study's quality. The descriptive data were summarized. RESULTS Data were extracted from 21 studies conducted in 13 countries having 33 cases. The median age was 44 years (range; 13.5-80), and more than half (18, 54.5%) were males. Twelve patients immigrated from TB endemic settings. All 17 patients assessed for HIV were seronegative, and all 11 patients assessed for BCG vaccination status were vaccinated. The majority (20, 69%) of patients had some type of comorbidity with diabetes (12/29) and hypertension (9/29) being the most common. Four patients (30.77%) had a history of TB. Corticosteroids were used to treat COVID-19 in 62.5% (10) of individuals. Dexamethasone, remdesivir, azithromycin, hydroxychloroquine, and enoxaparin were the most commonly used drugs to treat COVID-19. The most common TB symptoms were fever, cough, weight loss, dyspnea, and fatigue. Twenty, eleven, and two patients developed pulmonary, extrapulmonary, and disseminated/miliary TB respectively. It may take up to seven months after COVID-19 recovery to develop tuberculosis. Data on the final treatment outcome was found for 24 patients, and five patients died during the anti-TB treatment period. CONCLUSION Tuberculosis after recovering from COVID-19 is becoming more common, potentially leading to a TB outbreak in the post-COVID-19 era. The immunosuppressive nature of the disease and its treatment modalities may contribute to post COVID-19 TB. Thus, we recommend a further study with a large sample size. Furthermore, we recommend feasibility studies to assess and treat latent TB in COVID-19 patients residing in TB endemic counties since treatment of latent TB is done only in TB non-endemic countries.
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Affiliation(s)
- Ayinalem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail: ,
| | | | - Getachew Seid
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getu Diriba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Emebet Gashu
- Addis Ababa Health Bureau, Addis Ababa, Ethiopia
| | - Nega Berhe
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon H. Mariam
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Balako Gumi
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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The Effect of the COVID-19 Pandemic on Pulmonary Tuberculosis Control in the Selected Upazila Health Complexes of Dhaka Division, Bangladesh. Trop Med Infect Dis 2022; 7:tropicalmed7110385. [DOI: 10.3390/tropicalmed7110385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Despite the enormous disruption of tuberculosis (TB) services reported globally, Bangladesh’s impact is not well documented. We aimed to assess the effect of the COVID-19 pandemic on the TB control program in Bangladesh from patients’ and service providers’ perspectives. We conducted a cross-sectional study from November–December 2021 at six conveniently selected Upazila Health Complexes (UHC) of the Dhaka division, Bangladesh. We conducted face-to-face interviews among 180 pulmonary TB service recipients and all TB service providers working in the selected UHC. We also reviewed TB registries from each UHC. All data were summarized using descriptive statistics tools. We found a 31% reduction in presumptive TB cases during 2021 compared to 2020. Other TB services, such as testing, were reduced by 16–36% during the same period. Service receivers reported a lack of transportation (95%), and a lack of adequate human resources (89%) as critical barriers to receiving and providing TB service, respectively. The findings of our study showed substantial interruption of TB service delivery during the COVID-19 pandemic, threatening the recent progress and pushback from achieving the 2035 End TB targets. Early mitigation of TB service delivery through adopting remote follow-ups using digital health technology and integrating COVID-19 and TB screening is essential for the continuity of essential TB services and achieving global TB targets.
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McQuaid CF, Henrion MYR, Burke RM, MacPherson P, Nzawa-Soko R, Horton KC. Inequalities in the impact of COVID-19-associated disruptions on tuberculosis diagnosis by age and sex in 45 high TB burden countries. BMC Med 2022; 20:432. [PMID: 36372899 PMCID: PMC9660190 DOI: 10.1186/s12916-022-02624-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Tuberculosis remains a major public health priority and is the second leading cause of mortality from infectious disease worldwide. TB case detection rates are unacceptably low for men, the elderly and children. Disruptions in TB services due to the COVID-19 pandemic may have exacerbated these and other inequalities. METHODS We modelled trends in age- and sex- disaggregated case notifications for all forms of new and relapse TB reported to the World Health Organization for 45 high TB, TB/HIV and MDR-TB burden countries from 2013 to 2019. We compared trend predicted notifications to observed notifications in 2020 to estimate the number of people with TB likely to have missed or delayed diagnosis. We estimated the risk ratio (RR) of missed or delayed TB diagnosis for children (aged < 15 years) or the elderly (aged ≥ 65 years) compared to adults (aged 15-64 years) and women compared to men (both aged ≥ 15 years) using a random-effects meta-analysis. RESULTS An estimated 195,449 children (95% confidence interval, CI: 189,673-201,562, 37.8% of an expected 517,168), 1,126,133 adults (CI: 1,107,146-1,145,704, 21.8% of an expected 5,170,592) and 235,402 elderly (CI: 228,108-243,202, 28.5% of an expected 826,563) had a missed or delayed TB diagnosis in 2020. This included 511,546 women (CI: 499,623-523,869, 22.7%, of an expected 2,250,097) and 863,916 men (CI: 847,591-880,515, 23.0% of an expected 3,763,363). There was no evidence globally that the risk of having TB diagnosis missed or delayed was different for children and adults (RR: 1.09, CI: 0.41-2.91), the elderly and adults (RR: 1.40, CI: 0.62-3.16) or men and women (RR: 0.59, CI: 0.25-1.42). However, there was evidence of disparities in risk by age and/or sex in some WHO regions and in most countries. CONCLUSIONS There is no evidence at an aggregate global level of any difference by age or sex in the risk of disruption to TB diagnosis as a result of the COVID-19 pandemic. However, in many countries, disruptions in TB services have been greater for some groups than others. It is important to recognise these context-specific inequalities when prioritising key populations for catch-up campaigns.
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Affiliation(s)
- C Finn McQuaid
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Marc Y R Henrion
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Rachael M Burke
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter MacPherson
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Katherine C Horton
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Mertaniasih NM, Soedarsono S, Pakasi TT, Nuha Z, Ato M. Proposed Algorithm for Integrated Management of TB-SARS-CoV-2 Co-Infection in a TB-Endemic Country. Trop Med Infect Dis 2022; 7:367. [PMID: 36355911 PMCID: PMC9694243 DOI: 10.3390/tropicalmed7110367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Tuberculosis (TB) and COVID-19 have become significant health problems globally, especially in countries with high prevalence. Therefore, this research aims to examine all possibilities and predict the impact of TB-SARS-CoV-2 co-infection to anticipate the cascade effect of both diseases in all sectors. The conceptual strategy of the algorithm in TB-COVID-19 is needed to create an integrated management system. It includes the stages of early detection with accurate and effective methods, as well as the synchronization of TB-COVID-19 health services, starting from primary health facilities to secondary and tertiary referral centers. The algorithm in TB-COVID-19 is crucial to prepare future strategies for PTB co-infection viral respiratory infections other than SARS-CoV-2, ILI, ARI, and SARI. Since the implementation involves all health services, there is a need to integrate the governance of TB-COVID-19 and other comorbidities in good health services based on research and multicentre design.
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Affiliation(s)
- Ni Made Mertaniasih
- Department of Medical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya 60131, Indonesia
- Sub-Pulmonology Department of Internal Medicine, Faculty of Medicine, Hang Tuah University, Surabaya 57600, Indonesia
| | - Soedarsono Soedarsono
- Sub-Pulmonology Department of Internal Medicine, Faculty of Medicine, Hang Tuah University, Surabaya 57600, Indonesia
- Tuberculosis Laboratory, Institute of Tropical Disease, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Tiffany Tiara Pakasi
- National TB Program, Directorate of Communicable Disease Prevention and Control, Ministry of Health Indonesia, Jakarta 10710, Indonesia
| | - Zakiyathun Nuha
- Tuberculosis Laboratory, Institute of Tropical Disease, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Manabu Ato
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Tokyo 162-0052, Japan
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Dadi LS, Kefeni BD, Kadi H, Kifle E, Yesuf EA, Hailemariam G, Edosa ZK, Befekadu T. Household Readiness to Care for Mild and Asymptomatic COVID-19 Cases at Home, Southwest Ethiopia: A Community-based Cross-Sectional Study. Ethiop J Health Sci 2022; 32:1071-1082. [PMID: 36475246 PMCID: PMC9692155 DOI: 10.4314/ejhs.v32i6.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/19/2022] [Indexed: 12/13/2022] Open
Abstract
Background Corona virus disease (COVID-19) continued with its notorious effects overwhelming health institutions. Thus, home-based identification and care for asymptomatic and mild cases of COVID-19 has been recommended. Therefore, the objective of this study was to assess the level of household readiness for caring asymptomatic and mild cases of COVID-19 at home. Methods A community-based cross-sectional study was conducted from March-June 2021 on randomly selected 778 households. Data entry and analysis were carried out using EpiData and SPSS version 25, respectively. Multivariable logistic regression was modeled to identify independent predictors of community readiness. Results Overall readiness of the community was very low (43.8%). Factors positively affecting household readiness were male household heads (AOR = 1.6; 95%CI: 1.05, 2.45), primary (AOR=2.0; CI:.62, 1.59) and higher (AOR = 1.90; 95%CI: 1.04, 3.45) educational level of the respondents, number of rooms within household (AOR = 1.22; CI: 1.03, 1.46), having additionally house (AOR = 2.61; CI: 1.35, 5.03), availability of single use eating utensils (AOR = 2.76; 95%CI: 1.66, 4.56), availability of community water supply (AOR = 8.21; 95% CI: 5.02, 13.43), and community participation and engagement (AOR = 2.81; 95% CI: 1.93, 4.08) in accessing transport, water and sanitation. Conclusions The community was less prepared in terms of housing, infection prevention, water and sanitation. Considering alternative options including universal coverage of vaccine is important; designed behavioral change communications can enhance community participation and engagement in improving access to transport, water and sanitation to reduce risk of infections.
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Affiliation(s)
- Lelisa Sena Dadi
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | | | - Hanan Kadi
- Jimma University Medical Center, Jimma, Ethiopia
| | - Enku Kifle
- Jimma University Medical Center, Jimma, Ethiopia
| | - Elias Ali Yesuf
- Department of Health Policy and management, Faculty of Public Health, Jimma University, Ethiopia
| | - Gelaw Hailemariam
- Department of Emergency medicine, Jimma University Medical Center, Jimma, Ethiopia
| | - Zerihun Kura Edosa
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Marti M, Zürcher K, Enane LA, Diero L, Marcy O, Tiendrebeogo T, Yotebieng M, Twizere C, Khusuwan S, Yunihastuti E, Reubenson G, Shah NS, Egger M, Ballif M, Fenner L. Impact of the COVID-19 pandemic on TB services at ART programmes in low- and middle-income countries: a multi-cohort survey. J Int AIDS Soc 2022; 25:e26018. [PMID: 36285602 PMCID: PMC9597377 DOI: 10.1002/jia2.26018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/21/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION COVID-19 stretched healthcare systems to their limits, particularly in settings with a pre-existing high burden of infectious diseases, including HIV and tuberculosis (TB). We studied the impact of COVID-19 on TB services at antiretroviral therapy (ART) clinics in low- and middle-income countries. METHODS We surveyed ART clinics providing TB services in the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium in Africa and the Asia-Pacific until July 2021 (TB diagnoses until the end of 2021). We collected site-level data using standardized questionnaires. RESULTS Of 46 participating ART clinics, 32 (70%) were in Africa and 14 (30%) in the Asia-Pacific; 52% provided tertiary care. Most clinics (85%) reported disrupted routine HIV care services during the pandemic, both in Africa (84%) and the Asia-Pacific (86%). The most frequently reported impacts were on staff (52%) and resource shortages (37%; protective clothing, face masks and disinfectants). Restrictions in TB health services were observed in 12 clinics (26%), mainly reduced access to TB diagnosis and postponed follow-up visits (6/12, 50% each), and restrictions in TB laboratory services (22%). Restrictions of TB services were addressed by dispensing TB drugs for longer periods than usual (7/12, 58%), providing telehealth services (3/12, 25%) and with changes in directly observed therapy (DOT) (e.g. virtual DOT, 3/12). The number of TB diagnoses at participating clinics decreased by 21% in 2020 compared to 2019; the decline was more pronounced in tertiary than primary/secondary clinics (24% vs. 12%) and in sites from the Asia-Pacific compared to Africa (46% vs. 14%). In 2021, TB diagnoses continued to decline in Africa (-8%) but not in the Asia-Pacific (+62%) compared to 2020. During the pandemic, new infection control measures were introduced or intensified at the clinics, including wearing face masks, hand sanitation and patient triage. CONCLUSIONS The COVID-19 pandemic led to staff shortages, reduced access to TB care and delays in follow-up visits for people with TB across IeDEA sites in Africa and the Asia-Pacific. Increased efforts are needed to restore and secure ongoing access to essential TB services in these contexts.
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Affiliation(s)
- Mariana Marti
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Kathrin Zürcher
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Leslie A. Enane
- The Ryan White Center for Pediatric Infectious Disease and Global HealthDepartment of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Lameck Diero
- Department of MedicineMoi University School of MedicineEldoretKenya
- Department of MedicineMoi Teaching and Referral HospitalEldoretKenya
| | - Olivier Marcy
- University of Bordeaux, Inserm U1219IRD EMR271BordeauxFrance
| | | | - Marcel Yotebieng
- Division of General Internal MedicineDepartment of MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Christelle Twizere
- Centre National de Référence en matière de VIH/SIDA Burundi (CNR)BujumburaBurundi
| | | | - Evy Yunihastuti
- Faculty of Medicine Universitas IndonesiaDr. Cipto Mangunkusumo General HospitalJakartaIndonesia
| | - Gary Reubenson
- Rahima Moosa Mother and Child HospitalDepartment of Paediatrics and Child HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - N. Sarita Shah
- Emory Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Matthias Egger
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Centre for Infectious Disease Epidemiology and ResearchFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Marie Ballif
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Lukas Fenner
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
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Diallo A, Combary A, Veronese V, Dahourou DL, Ouédraogo S, Traoré IT, Merle CS. Delays in TB Diagnosis and Treatment Initiation in Burkina Faso during the COVID-19 Pandemic. Trop Med Infect Dis 2022; 7:237. [PMID: 36136648 PMCID: PMC9500868 DOI: 10.3390/tropicalmed7090237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/21/2022] [Accepted: 09/01/2022] [Indexed: 02/07/2023] Open
Abstract
The COVID-19 pandemic has significantly disrupted TB services, particularly in low resource settings. In Burkina Faso, a cross-sectional ‘before and after’ study was conducted to assess the impact of COVID-19 on access to TB services. Data was collected in two phases (Phase 1: December 2017−March 2018, and 2: October−December 2020) to estimate and compare various patient and system delays among TB patients before and during COVID-19 and explore changes in treatment seeking behaviors and practices. 331 TB patients were recruited across the two phases. A significant increase in median time between first symptom and contact with TB service (45 days vs. 26 days; p < 0.01) and decrease in median time between first contact and diagnosis, and treatment initiation, respectively, during COVID-19 compared to before. Fewer patients reported using public health centers and more patients reporting using private facilities as the point of first contact following TB symptom onset during the COVID-19 period compared to before. These findings suggest that COVID-19 has created barriers to TB service access and health seeking among symptomatic individuals, yet also led to some efficiencies in TB diagnostic and treatment services. Our findings can be help target efforts along specific points of the TB patient pathway to minimize the overall disruption of COVID-19 and future public health emergencies on TB control in Burkina Faso.
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Affiliation(s)
- Adama Diallo
- National Tuberculosis Control Program, Ouagadougou P.O. Box 6632, Burkina Faso
| | - Adjima Combary
- National Tuberculosis Control Program, Ouagadougou P.O. Box 6632, Burkina Faso
| | - Vanessa Veronese
- Special Programme for Research & Training in Tropical Diseases (TDR), World Health Organization, 1211 Geneva, Switzerland
| | - Désiré Lucien Dahourou
- Département Biomédical/Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou P.O. Box 7192, Burkina Faso
| | - Salifou Ouédraogo
- National Tuberculosis Control Program, Ouagadougou P.O. Box 6632, Burkina Faso
| | - Isidore Tiandiogo Traoré
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso P.O. Box 1091, Burkina Faso
| | - Corinne Simone Merle
- Special Programme for Research & Training in Tropical Diseases (TDR), World Health Organization, 1211 Geneva, Switzerland
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V V, Munjal SK, Jain S, Abdullah V Y, M A, Iyer SS. To investigate the knowledge, attitude and practices regarding tuberculosis case notification among public and private doctors practicing of modern medicine in South Delhi. Monaldi Arch Chest Dis 2022; 93. [PMID: 36062991 DOI: 10.4081/monaldi.2022.2374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/23/2022] [Indexed: 11/22/2022] Open
Abstract
In India, tuberculosis (TB) notification has been required since 2012. Notwithstanding, notification rates remain low. Non-reporting of tuberculosis cases not only results in an underestimation of cases, but also impedes the country's TB control strategy. Our research aims to assess practitioners' awareness, perception, and practice of tuberculosis case notification, as these factors can help reduce the TB burden. A cross-sectional study of 142 physicians was conducted between August 2018 and December 2019. Doctors were interviewed and given evaluation forms. Seventy-seven percent of the 142 physicians polled worked in medicine-related specialties, while 33% worked in surgery. Public sector physicians (64.7%) knew more about the Nikshay App than private practitioners (40.8%). The vast majority of public-sector doctors were only notified through their hospital's National Tuberculosis Elimination Programme (NTEP) center. However, the majority of private practitioners (47.8%) notified cases directly through the hospital, the local District Tuberculosis Officer (DTO) or NTEP medical officer (24 percent), or the Nikshay portal (28%), whereas the majority of public sector doctors notified only through the hospital NTEP center (85.9%). The primary reasons for non-notification are the high patient load on doctors, a lack of understanding about Nikshay App and its functionality, technological difficulties in using the Nikshay App, and the stigma associated with tuberculosis. The Nikshay App must be popularized as a notification mechanism through the NTEP program. To increase notification rates, practitioners must overcome the challenges they face. In terms of notification, more seminars and training, particularly hands-on training, should be held on a regular basis.
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Thindwa D, Jambo KC, Ojal J, MacPherson P, Dennis Phiri M, Pinsent A, Khundi M, Chiume L, Gallagher KE, Heyderman RS, Corbett EL, French N, Flasche S. Social mixing patterns relevant to infectious diseases spread by close contact in urban Blantyre, Malawi. Epidemics 2022; 40:100590. [PMID: 35691100 PMCID: PMC9176177 DOI: 10.1016/j.epidem.2022.100590] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/08/2022] [Accepted: 05/30/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Understanding human mixing patterns relevant to infectious diseases spread through close contact is vital for modelling transmission dynamics and optimisation of disease control strategies. Mixing patterns in low-income countries like Malawi are not well known. METHODOLOGY We conducted a social mixing survey in urban Blantyre, Malawi between April and July 2021 (between the 2nd and 3rd wave of COVID-19 infections). Participants living in densely-populated neighbourhoods were randomly sampled and, if they consented, reported their physical and non-physical contacts within and outside homes lasting at least 5 min during the previous day. Age-specific mixing rates were calculated, and a negative binomial mixed effects model was used to estimate determinants of contact behaviour. RESULTS Of 1201 individuals enroled, 702 (58.5%) were female, the median age was 15 years (interquartile range [IQR] 5-32) and 127 (10.6%) were HIV-positive. On average, participants reported 10.3 contacts per day (range: 1-25). Mixing patterns were highly age-assortative, particularly those within the community and with skin-to-skin contact. Adults aged 20-49 y reported the most contacts (median:11, IQR: 8-15) of all age groups; 38% (95%CI: 16-63) more than infants (median: 8, IQR: 5-10), who had the least contacts. Household contact frequency increased by 3% (95%CI: 2-5) per additional household member. Unemployed participants had 15% (95%CI: 9-21) fewer contacts than other adults. Among long range (>30 m away from home) contacts, secondary school children had the largest median contact distance from home (257 m, IQR 78-761). HIV-positive status in adults >=18 years-old was not associated with changed contact patterns (rate ratio: 1.01, 95%CI: (0.91-1.12)). During this period of relatively low COVID-19 incidence in Malawi, 301 (25.1%) individuals stated that they had limited their contact with others due to COVID-19 precautions; however, their reported contacts were 8% (95%CI: 1-13) higher. CONCLUSION In urban Malawi, contact rates, are high and age-assortative, with little reported behavioural change due to either HIV-status or COVID-19 circulation. This highlights the limits of contact-restriction-based mitigation strategies in such settings and the need for pandemic preparedness to better understand how contact reductions can be enabled and motivated.
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Affiliation(s)
- Deus Thindwa
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.
| | - Kondwani C Jambo
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - John Ojal
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; KEMRI-Wellcome Research Programme, Geographic Medicine Centre, Kilifi, Kenya
| | - Peter MacPherson
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Mphatso Dennis Phiri
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - McEwen Khundi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Lingstone Chiume
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Katherine E Gallagher
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; KEMRI-Wellcome Research Programme, Geographic Medicine Centre, Kilifi, Kenya
| | - Robert S Heyderman
- NIHR Global Health Research Unit on Mucosal Pathogens, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
| | - Elizabeth L Corbett
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil French
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, UK
| | - Stefan Flasche
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Kiarie H, Temmerman M, Nyamai M, Liku N, Thuo W, Oramisi V, Nyaga L, Karimi J, Wamalwa P, Gatheca G, Mwenda V, Ombajo LA, Thumbi SM. The COVID-19 pandemic and disruptions to essential health services in Kenya: a retrospective time-series analysis. Lancet Glob Health 2022; 10:e1257-e1267. [PMID: 35961349 PMCID: PMC9363041 DOI: 10.1016/s2214-109x(22)00285-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Public health emergencies can disrupt the provision of and access to essential health-care services, exacerbating health crises. We aimed to assess the effect of the COVID-19 pandemic on essential health-care services in Kenya. METHODS Using county-level data routinely collected from the health information system from health facilities across the country, we used a robust mixed-effect model to examine changes in 17 indicators of essential health services across four periods: the pre-pandemic period (from January, 2018 to February, 2020), two pandemic periods (from March to November 2020, and February to October, 2021), and the period during the COVID-19-associated health-care workers' strike (from December, 2020 to January, 2021). FINDINGS In the pre-pandemic period, we observed a positive trend for multiple indicators. The onset of the pandemic was associated with statistically significant decreases in multiple indicators, including outpatient visits (28·7%; 95% CI 16·0-43·5%), cervical cancer screening (49·8%; 20·6-57·9%), number of HIV tests conducted (45·3%; 23·9-63·0%), patients tested for malaria (31·9%; 16·7-46·7%), number of notified tuberculosis cases (26·6%; 14·7-45·1%), hypertension cases (10·4%; 6·0-39·4%), vitamin A supplements (8·7%; 7·9-10·5%), and three doses of the diphtheria, tetanus toxoid, and pertussis vaccine administered (0·9%; 0·5-1·3%). Pneumonia cases reduced by 50·6% (31·3-67·3%), diarrhoea by 39·7% (24·8-62·7%), and children attending welfare clinics by 39·6% (23·5-47·1%). Cases of sexual violence increased by 8·0% (4·3-25·0%). Skilled deliveries, antenatal care, people with HIV infection newly started on antiretroviral therapy, confirmed cases of malaria, and diabetes cases detected were not significantly affected negatively. Although most of the health indicators began to recover during the pandemic, the health-care workers' strike resulted in nearly all indicators falling to numbers lower than those observed at the onset or during the pre-strike pandemic period. INTERPRETATION The COVID-19 pandemic and the associated health-care workers' strike in Kenya have been associated with a substantial disruption of essential health services, with the use of outpatient visits, screening and diagnostic services, and child immunisation adversely affected. Efforts to maintain the provision of these essential health services during a health-care crisis should target the susceptible services to prevent the exacerbation of associated disease burdens during such health crises. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Helen Kiarie
- Division of Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Mutono Nyamai
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Nzisa Liku
- Division of Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Wangari Thuo
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Violet Oramisi
- National AIDS and STIs Control Programme, Ministry of Health, Nairobi, Kenya
| | - Lilly Nyaga
- Division of Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Janette Karimi
- Division of Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | | | - Gladwell Gatheca
- Division of Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Valerian Mwenda
- Division of Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Loice Achieng Ombajo
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - S M Thumbi
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA; Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, UK.
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Kim B, Kang YA, Lee J. Heterogeneous impact of Covid-19 response on tuberculosis burden by age group. Sci Rep 2022; 12:13773. [PMID: 35962020 PMCID: PMC9374296 DOI: 10.1038/s41598-022-18135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/05/2022] [Indexed: 11/09/2022] Open
Abstract
Apart from the incidence and mortality caused by it, Coronavirus disease (COVID-19) has had a significant impact on other diseases. This study aimed to estimate the influences of COVID-19 pandemic on the incidence of tuberculosis (TB) and the number of TB-associated deaths in Republic of Korea. A dynamic compartment model incorporating age-structure was developed for studying TB transmission and progression using the Korean population data. After calibration with notification of incidence data from South Korea, the TB burden over 6 years (2020-2025) was predicted under the nine different scenarios. Under the scenario of strong social distancing and low-level health service disruption, new TB cases were reduced by 761 after 1 year in comparison to the baseline. However, in the elderly population, social distancing had little impact on TB incidence. On the other hand, the number of TB-related deaths mainly depends on the level of health service disruption for TB care. It was predicted that with a high degree of health service disruption, the number of TB-related deaths would increase up to 155 in 1 year and 80 percent of the TB-related deaths would be in the elderly population. The decrease of tuberculosis incidence is significantly affected by social distancing, which is owing to reduction of contacts. The impact of health service disruption is dominant on TB-related deaths, which occurs mainly in the elderly. It suggests that it is important to monitor TB-related deaths by COVID-19 because the TB burden of the elderly is high in the Republic of Korea.
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Affiliation(s)
- Boyeon Kim
- School of Mathematics and Computing (Mathematics), Yonsei University, Seoul, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. .,Institute of Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jeehyun Lee
- School of Mathematics and Computing (Mathematics), Yonsei University, Seoul, Republic of Korea.
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Chen L, Liu C, Liang T, Ye Z, Huang S, Chen J, Sun X, Yi M, Zhou C, Jiang J, Chen T, Li H, Chen W, Guo H, Chen W, Yao Y, Liao S, Yu C, Wu S, Fan B, Gan Z, Zhan X. Mechanism of COVID-19-Related Proteins in Spinal Tuberculosis: Immune Dysregulation. Front Immunol 2022; 13:882651. [PMID: 35720320 PMCID: PMC9202521 DOI: 10.3389/fimmu.2022.882651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of this article was to investigate the mechanism of immune dysregulation of COVID-19-related proteins in spinal tuberculosis (STB). Methods Clinical data were collected to construct a nomogram model. C-index, calibration curve, ROC curve, and DCA curve were used to assess the predictive ability and accuracy of the model. Additionally, 10 intervertebral disc samples were collected for protein identification. Bioinformatics was used to analyze differentially expressed proteins (DEPs), including immune cells analysis, Gene Ontology (GO) and KEGG pathway enrichment analysis, and protein-protein interaction networks (PPI). Results The nomogram predicted risk of STB ranging from 0.01 to 0.994. The C-index and AUC in the training set were 0.872 and 0.862, respectively. The results in the external validation set were consistent with the training set. Immune cells scores indicated that B cells naive in STB tissues were significantly lower than non-TB spinal tissues. Hub proteins were calculated by Degree, Closeness, and MCC methods. The main KEGG pathway included Coronavirus disease-COVID-19. There were 9 key proteins in the intersection of COVID-19-related proteins and hub proteins. There was a negative correlation between B cells naive and RPL19. COVID-19-related proteins were associated with immune genes. Conclusion Lymphocytes were predictive factors for the diagnosis of STB. Immune cells showed low expression in STB. Nine COVID-19-related proteins were involved in STB mechanisms. These nine key proteins may suppress the immune mechanism of STB by regulating the expression of immune genes.
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Affiliation(s)
- Liyi Chen
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Chong Liu
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Tuo Liang
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Zhen Ye
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Shengsheng Huang
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Jiarui Chen
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Xuhua Sun
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Ming Yi
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Chenxing Zhou
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Jie Jiang
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Tianyou Chen
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Hao Li
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Wuhua Chen
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Hao Guo
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Wenkang Chen
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Yuanlin Yao
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Shian Liao
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Chaojie Yu
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Shaofeng Wu
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Binguang Fan
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Zhaoping Gan
- Department of Hematology, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Xinli Zhan
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, China
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40
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Phiri MM, MacPherson EE, Panulo M, Chidziwisano K, Kalua K, Chirambo CM, Kawalazira G, Gundah Z, Chunda P, Morse T. Preparedness for and impact of COVID-19 on primary health care delivery in urban and rural Malawi: a mixed methods study. BMJ Open 2022; 12:e051125. [PMID: 35688583 PMCID: PMC9189546 DOI: 10.1136/bmjopen-2021-051125] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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
OBJECTIVE Across Africa, the impact of COVID-19 continues to be acutely felt. This includes Malawi, where a key component of health service delivery to mitigate against COVID-19 are the primary healthcare facilities, strategically placed throughout districts to offer primary and maternal healthcare. These facilities have limited infrastructure and capacity but are the most accessible and play a crucial role in responding to the COVID-19 pandemic. This study assessed health facility preparedness for COVID-19 and the impact of the pandemic on health service delivery and frontline workers. SETTING Primary and maternal healthcare in Blantyre District, Malawi. PARTICIPANTS We conducted regular visits to 31 healthcare facilities and a series of telephone-based qualitative interviews with frontline workers (n=81 with 38 participants) between August 2020 and May 2021. RESULTS Despite significant financial and infrastructural constraints, health centres continued to remain open. The majority of frontline health workers received training and access to preventative COVID-19 materials. Nevertheless, we found disruptions to key services and a reduction in clients attending facilities. Key barriers to implementing COVID-19 prevention measures included periodic shortages of resources (soap, hand sanitiser, water, masks and staff). Frontline workers reported challenges in managing physical distancing and in handling suspected COVID-19 cases. We found discrepancies between reported behaviour and practice, particularly with consistent use of masks, despite being provided. Frontline workers felt COVID-19 had negatively impacted their lives. They experienced fatigue and stress due to heavy workloads, stigma in the community and worries about becoming infected with and transmitting COVID-19. CONCLUSION Resource (human and material) inadequacy shaped the health facility capacity for support and response to COVID-19, and frontline workers may require psychosocial support to manage the impacts of the COVID-19 pandemic.
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Affiliation(s)
| | - Eleanor Elizabeth MacPherson
- Social Science Department, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mindy Panulo
- Department of Enviromental Health and WASHTED Centre, Polytechnic, University of Malawi, Blantyre, Malawi
| | - Kondwani Chidziwisano
- Department of Environmental Health, Polytechnic, University of Malawi, Blantyre, Malawi
- Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, UK
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | | | | | | | | | - Tracy Morse
- Civil and Environmental Engineering, University of Strathclyde, Glasgow, UK
- WASHTED Center, Polytechnic, University of Malawi, Blantyre, Malawi
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Semitala FC, Katwesigye R, Kalibbala D, Mbuliro M, Opio R, Owachi D, Atine E, Nassazi J, Turyahabwe S, Sekadde M. Integration of COVID-19 and TB screening in Kampala, Uganda - Healthcare provider perspectives. RESEARCH SQUARE 2022:rs.3.rs-1448831. [PMID: 35702151 PMCID: PMC9196119 DOI: 10.21203/rs.3.rs-1448831/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Following the first wave of COVID-19 outbreak, Uganda experienced a 40% drop in Tuberculosis (TB) screening by June 2020. We sought to identify barriers to and facilitators of integrated COVID-19 and TB screening from the perspective of healthcare providers (HCP) at a National Referral Hospital in Kampala, Uganda. Design/Methods: We conducted a cross sectional study using in-depth interviews with 12 HCP involved in TB activities in the outpatient and emergency departments at Kiruddu National Referral hospital Kampala, Uganda. We explored the HCP experiences at work in the setting of COVID-19, HCP perceived effect of COVID-19 on TB screening activities at the Hospital, and perceptions about social and contextual factors that might influence the willingness of HCP to integrate screening of COVID-19 and TB. We analyzed the data using an inductive thematic approach and the emergent themes were denoted as barriers to and facilitators of COVID-19-TB integrated screening. We then mapped the themes to the Capability, Opportunity, Motivation and Behavior (COM-B) model. Results: The facilitators to integrated COVID-19 and TB screening included; HCP knowledge of how to separately screen for TB and COVID-19, availability of TB focal persons and interest in learning how to provide integrated screening for TB and COVID-19. The barriers included; HCP inadequate knowledge on how to integrate screening of TB and COVID-19, absence of simple standard operating procedures and data collection tools for integrated screening, inconsistent supply of personal protective equipment (PPE), under staffing, and fear of contracting COVID-19 infection. The identified intervention functions to address the facilitators or barriers included education, persuasion, enablement, and training. Conclusions: These findings provide a basis for designing contextually appropriate interventions targeting factors that are likely to influence HCP decisions and willingness to conduct TB screening in the context of COVID-19.
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Affiliation(s)
| | | | | | | | - Rejani Opio
- Makerere University Faculty of Medicine: Makerere University College of Health Sciences
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Khundi M, Carpenter JR, Corbett EL, Feasey HRA, Soko RN, Nliwasa M, Twabi H, Chiume L, Burke RM, Horton KC, Dodd PJ, Cohen T, MacPherson P. Neighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in Blantyre, Malawi. PLoS One 2022; 17:e0268749. [PMID: 35605004 PMCID: PMC9126376 DOI: 10.1371/journal.pone.0268749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
Abstract
Local information is needed to guide targeted interventions for respiratory infections such as tuberculosis (TB). Case notification rates (CNRs) are readily available, but systematically underestimate true disease burden in neighbourhoods with high diagnostic access barriers. We explored a novel approach, adjusting CNRs for under-notification (P:N ratio) using neighbourhood-level predictors of TB prevalence-to-notification ratios. We analysed data from 1) a citywide routine TB surveillance system including geolocation, confirmatory mycobacteriology, and clinical and demographic characteristics of all registering TB patients in Blantyre, Malawi during 2015-19, and 2) an adult TB prevalence survey done in 2019. In the prevalence survey, consenting adults from randomly selected households in 72 neighbourhoods had symptom-plus-chest X-ray screening, confirmed with sputum smear microscopy, Xpert MTB/Rif and culture. Bayesian multilevel models were used to estimate adjusted neighbourhood prevalence-to-notification ratios, based on summarised posterior draws from fitted adult bacteriologically-confirmed TB CNRs and prevalence. From 2015-19, adult bacteriologically-confirmed CNRs were 131 (479/371,834), 134 (539/415,226), 114 (519/463,707), 56 (283/517,860) and 46 (258/578,377) per 100,000 adults per annum, and 2019 bacteriologically-confirmed prevalence was 215 (29/13,490) per 100,000 adults. Lower educational achievement by household head and neighbourhood distance to TB clinic was negatively associated with CNRs. The mean neighbourhood P:N ratio was 4.49 (95% credible interval [CrI]: 0.98-11.91), consistent with underdiagnosis of TB, and was most pronounced in informal peri-urban neighbourhoods. Here we have demonstrated a method for the identification of neighbourhoods with high levels of under-diagnosis of TB without the requirement for a prevalence survey; this is important since prevalence surveys are expensive and logistically challenging. If confirmed, this approach may support more efficient and effective targeting of intensified TB and HIV case-finding interventions aiming to accelerate elimination of urban TB.
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Affiliation(s)
- McEwen Khundi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James R. Carpenter
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Elizabeth L. Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helena R. A. Feasey
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rebecca Nzawa Soko
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marriott Nliwasa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Helse Nord TB Initiative, College of Medicine, University of Malawi, Zomba, Malawi
| | - Hussein Twabi
- Helse Nord TB Initiative, College of Medicine, University of Malawi, Zomba, Malawi
| | - Lingstone Chiume
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rachael M. Burke
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Peter J. Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Ted Cohen
- Yale School of Public Health, New Haven, CT, United States of America
| | - Peter MacPherson
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Manhiça I, Augusto O, Sherr K, Cowan J, Cuco RM, Agostinho S, Macuacua BC, Ramiro I, Carimo N, Matsinhe MB, Gloyd S, Chicumbe S, Machava R, Tembe S, Fernandes Q. COVID-19-related healthcare impacts: an uncontrolled, segmented time-series analysis of tuberculosis diagnosis services in Mozambique, 2017-2020. BMJ Glob Health 2022; 7:bmjgh-2021-007878. [PMID: 35443938 PMCID: PMC9021460 DOI: 10.1136/bmjgh-2021-007878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/27/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Currently, COVID-19 dominates the public health agenda and poses a permanent threat, leading to health systems’ exhaustion and unprecedented service disruption. Primary healthcare services, including tuberculosis services, are at increased risk of facing severe disruptions, particularly in low-income and middle-income countries. Indeed, corroborating model-based forecasts, there is increasing evidence of the COVID-19 pandemic’s negative impact on tuberculosis case detection. Methods Applying a segmented time-series analysis, we assessed the effects of COVID-19-related measures on tuberculosis diagnosis service across districts in Mozambique. Ministry health information system data were used from the first quarter of 2017 to the end of 2020. The model, performed under the Bayesian premises, was estimated as a negative binomial with random effects for districts and provinces. Results A total of 154 districts were followed for 16 consecutive quarters. Together, these districts reported 96 182 cases of all forms of tuberculosis in 2020. At baseline (first quarter of 2017), Mozambique had an estimated incidence rate of 283 (95% CI 200 to 406) tuberculosis cases per 100 000 people and this increased at a 5% annual rate through the end of 2019. We estimated that 17 147 new tuberculosis cases were potentially missed 9 months after COVID-19 onset, resulting in a 15.1% (95% CI 5.9 to 24.0) relative loss in 2020. The greatest impact was observed in the southern region at 40.0% (95% CI 30.1 to 49.0) and among men at 15% (95% CI 4.0 to 25.0). The incidence of pulmonary tuberculosis increased at an average rate of 6.6% annually; however, an abrupt drop (15%) was also observed immediately after COVID-19 onset in March 2020. Conclusion The most significant impact of the state of emergency was observed between April and June 2020, the quarter after COVID-19 onset. Encouragingly, by the end of 2020, clear signs of health system recovery were visible despite the initial shock.
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Affiliation(s)
| | - Orvalho Augusto
- Saude da Comunidade, Faculdade de Medicina, Cidade de Maputo, Mozambique.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - James Cowan
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | | | - Isaías Ramiro
- Comité para a Saúde de Moçambique, Maputo City, Mozambique
| | - Naziat Carimo
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Stélio Tembe
- Ministerio da Saude, Maputo, Mozambique.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Quinhas Fernandes
- Ministerio da Saude, Maputo, Mozambique .,Department of Global Health, University of Washington, Seattle, Washington, USA
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Formenti B, Gregori N, Crosato V, Marchese V, Tomasoni LR, Castelli F. The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review. LE INFEZIONI IN MEDICINA 2022; 30:30-40. [PMID: 35350264 DOI: 10.53854/liim-3001-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/20/2022] [Indexed: 01/06/2023]
Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) has disproportionately impacted global human health, economy, and security. Because of weaker health-care systems, existing comorbidities burden (HIV, malaria, tuberculosis, and non-communicable conditions), and poor socioeconomic determinants, initial predictive models had forecast a disastrous impact of COVID-19 in Africa in terms of transmission, severity, and deaths. Nonetheless, current epidemiological data seem not to have matched expectations, showing lower SARS-CoV-2 infection and fatality rates compared to Europe, the Americas and Asia. However, only few studies were conducted in low- and middle-income African settings where high poverty and limited access to health services worsen underlying health conditions, including endemic chronic infectious diseases such as HIV and tuberculosis. Furthermore, limited, and heterogeneous research was conducted to evaluate the indirect impact of the pandemic on general health services and on major diseases across African countries. International mitigation measures, such as resource reallocation, lockdowns, social restrictions, and fear from the population have had multi-sectoral impacts on various aspects of everyday life, that shaped the general health response. Despite the vast heterogeneity of data across African countries, available evidence suggests that the COVID-19 pandemic has severely impacted the control and prevention programs, the diagnosis capacity and the adherence to treatment of major infectious diseases (HIV, TB, and Malaria) - including neglected diseases - and non-communicable diseases. Future research and efforts are essential to deeply assess the medium- and long-term impact of the pandemic, and to implement tailored interventions to mitigate the standstill on decades of improvement on public health programs.
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Affiliation(s)
- Beatrice Formenti
- UNESCO Training and Empowering Human Resources for Health Development in Resource-Limited Countries, University of Brescia, Italy
| | - Natalia Gregori
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
| | - Verena Crosato
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
| | - Valentina Marchese
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
| | | | - Francesco Castelli
- UNESCO Training and Empowering Human Resources for Health Development in Resource-Limited Countries, University of Brescia, Italy.,Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
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Hashem MK, Hussein AARM, Amin MT, Mahmoud A, Shaddad AM. The burden of COVID-19 pandemic on tuberculosis detection: a single-center study. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [PMCID: PMC8931790 DOI: 10.1186/s43168-022-00117-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Since being declared a global pandemic, Coronavirus disease 2019 (COVID-19) took over healthcare providers and researchers’ interest. However, other epidemic diseases, including tuberculosis (TB), are still a health issue that aggravate under the umbrella of health facilities exhaustion. This study aims to evaluate the impact of the COVID-19 pandemic on tuberculosis management. Methods A retrospective analysis of the quarterly reports issued by a tuberculosis management unit from 2017 to June 2021, including data of 12 subunits. The changes in pulmonary and extrapulmonary tuberculosis incidence trends (new + relapsed cases) throughout the 4 years were reported. The quarterly changed percentages in cases numbers along 2020 and first half of 2021 was compared with that of the same periods in 2019. Results Incidence of extrapulmonary tuberculosis was higher than pulmonary tuberculosis throughout the 4 year study periods (7.69 vs. 4.49, 9.44 vs. 4.33, 7.75 vs. 3.58, and 7.82 vs. 2.94/100.000 population, respectively) with a noticeable decline in the incidence of pulmonary TB during 2020. The second quarter of 2020 showed the lowest tuberculosis incidence rate with a 41.6% decline in the total number of diagnosed cases while 2nd quarter of 2021 showed 21.2% decline. During 2020, only 4 cases of multidrug-resistant TB were reported (compared to an average of 8 cases of MDR-TB yearly before the COVID-19 era). Conclusion There was a noticeable drop in tuberculosis case detection during the COVID-19 pandemic. The lockdown, started in Egypt by the end of March 2020, could contribute to the marked drop in the second quarter. However, a steady partial decline was continued during the first half of 2021, which foretells a growing problem.
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46
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Hasan T, Nguyen VN, Nguyen HB, Nguyen TA, Le HTT, Pham CD, Hoang N, Nguyen PTM, Beardsley J, Marks GB, Fox GJ. Retrospective Cohort Study of Effects of the COVID-19 Pandemic on Tuberculosis Notifications, Vietnam, 2020. Emerg Infect Dis 2022; 28:684-692. [PMID: 35202526 PMCID: PMC8888245 DOI: 10.3201/eid2803.211919] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We evaluated the effects of the coronavirus disease pandemic on diagnosis of and treatment for tuberculosis (TB) in Vietnam. We obtained quarterly notifications for TB and multidrug-resistant/rifampin-resistant (MDR/RR) TB from 2015–2020 and evaluated changes in monthly TB case notifications. We used an interrupted time series to assess the change in notifications and treatment outcomes. Overall, TB case notifications were 8% lower in 2020 than in 2019; MDR/RR TB notifications were 1% lower. TB case notifications decreased by 364 (95% CI −1,236 to 508) notifications per quarter and MDR/RR TB by 1 (95% CI −129 to 132) notification per quarter. The proportion of successful TB treatment outcomes decreased by 0.1% per quarter (95% CI −1.1% to 0.8%) in 2020 compared with previous years. Our study suggests that Vietnam was able to maintain its TB response in 2020, despite the pandemic.
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47
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Dass SA, Balakrishnan V, Arifin N, Lim CSY, Nordin F, Tye GJ. The COVID-19/Tuberculosis Syndemic and Potential Antibody Therapy for TB Based on the Lessons Learnt From the Pandemic. Front Immunol 2022; 13:833715. [PMID: 35242137 PMCID: PMC8886238 DOI: 10.3389/fimmu.2022.833715] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/25/2022] [Indexed: 12/19/2022] Open
Abstract
2020 will be marked in history for the dreadful implications of the COVID-19 pandemic that shook the world globally. The pandemic has reshaped the normality of life and affected mankind in the aspects of mental and physical health, financial, economy, growth, and development. The focus shift to COVID-19 has indirectly impacted an existing air-borne disease, Tuberculosis. In addition to the decrease in TB diagnosis, the emergence of the TB/COVID-19 syndemic and its serious implications (possible reactivation of latent TB post-COVID-19, aggravation of an existing active TB condition, or escalation of the severity of a COVID-19 during TB-COVID-19 coinfection), serve as primary reasons to equally prioritize TB. On a different note, the valuable lessons learnt for the COVID-19 pandemic provide useful knowledge for enhancing TB diagnostics and therapeutics. In this review, the crucial need to focus on TB amid the COVID-19 pandemic has been discussed. Besides, a general comparison between COVID-19 and TB in the aspects of pathogenesis, diagnostics, symptoms, and treatment options with importance given to antibody therapy were presented. Lastly, the lessons learnt from the COVID-19 pandemic and how it is applicable to enhance the antibody-based immunotherapy for TB have been presented.
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Affiliation(s)
- Sylvia Annabel Dass
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Minden, Malaysia
| | - Venugopal Balakrishnan
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Minden, Malaysia
| | - Norsyahida Arifin
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Minden, Malaysia
| | - Crystale Siew Ying Lim
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Fazlina Nordin
- Tissue Engineering Centre (TEC), Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Gee Jun Tye
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Minden, Malaysia
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48
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Savani N, Parikh H. Effect of COVID-19 on tuberculosis care in a District of Western Gujarat. INDIAN JOURNAL OF RESPIRATORY CARE 2022. [DOI: 10.4103/ijrc.ijrc_105_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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49
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Martinson NA, Lebina L, Webb EL, Ratsela A, Varavia E, Kinghorn A, Lala SG, Golub JE, Bosch Z, Motsomi KP, MacPherson P. Household contact tracing with intensified tuberculosis and HIV screening in South Africa: a cluster randomised trial. Clin Infect Dis 2021; 75:849-856. [PMID: 34950944 PMCID: PMC9477445 DOI: 10.1093/cid/ciab1047] [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: 10/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background Household contact tracing for tuberculosis (TB) may facilitate diagnosis and access to TB preventive treatment (TPT). We investigated whether household contact tracing and intensive TB/human immunodeficiency virus (HIV) screening would improve TB-free survival. Methods Household contacts of index TB patients in 2 South African provinces were randomized to home tracing and intensive HIV/TB screening or standard of care (SOC; clinic referral letters). The primary outcome was incident TB or death at 15 months. Secondary outcomes included tuberculin skin test (TST) positivity in children ≤14 years and undiagnosed HIV. Results From December 2016 through March 2019, 1032 index patients (4459 contacts) and 1030 (4129 contacts) were randomized to the intervention and SOC arms. Of intervention arm contacts, 3.2% (69 of 2166) had prevalent microbiologically confirmed TB. At 15 months, the cumulative incidence of TB or death did not differ between the intensive screening (93 of 3230, 2.9%) and SOC (80 of 2600, 3.1%) arms (hazard ratio, 0.90; 95% confidence interval [CI], .66–1.24). TST positivity was higher in the intensive screening arm (38 of 845, 4.5%) compared with the SOC arm (15 of 800, 1.9%; odds ratio, 2.25; 95% CI, 1.07–4.72). Undiagnosed HIV was similar between arms (41 of 3185, 1.3% vs 32 of 2543, 1.3%; odds ratio, 1.02; 95% CI, .64–1.64). Conclusions Household contact tracing with intensive screening and referral did not reduce incident TB or death. Providing referral letters to household contacts of index patients is an alternative strategy to home visits. Clinical Trials Registration ISRCTN16006202.
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Affiliation(s)
- Neil A Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa.,Johns Hopkins University Center for TB Research, Baltimore, MD
| | - Limakatso Lebina
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Emily L Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, UK
| | - Andrew Ratsela
- Department of Internal Medicine, University of Limpopo, Polokwane, South Africa
| | - Ebrahim Varavia
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine. Klerksdorp Tshepong Hospital Complex, North West Provincial Department of Health, and University of the Witwatersrand, South Africa
| | - Anthony Kinghorn
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, University of the Witwatersrand, South Africa
| | | | - Zama Bosch
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Kegaugetswe P Motsomi
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Peter MacPherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, UK.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Malawi.,Clinical Research Department, London School of Hygiene and Tropical Medicine
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50
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Evidence of TB Services at Primary Healthcare Level during COVID-19: A Scoping Review. Diagnostics (Basel) 2021; 11:diagnostics11122221. [PMID: 34943458 PMCID: PMC8700083 DOI: 10.3390/diagnostics11122221] [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: 10/20/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 12/02/2022] Open
Abstract
Tuberculosis (TB) is still a major public health concern, despite the availability of preventative and curative therapies. Significant progress has been made in the past decade towards its control. However, the emergence of the novel coronavirus disease 2019 (COVID-19) has disrupted numerous essential health services, including those for TB. This scoping review maps the available evidence on TB services at the primary healthcare (PHC) level during the COVID-19 period. A comprehensive literature search was conducted in PubMed, Web of Science, Medline OVID, Medline EBSCO, and Scopus. A total of 820 articles were retrieved from the databases and 21 met the eligibility criteria and were used for data extraction. The emerging themes were the effect of the COVID-19 pandemic on TB services, patient and provider experiences, recommendations for TB services during the COVID-19 period, and the implementation of the recommendations. The review found that the mitigation strategies, as well as fear and stigma experienced at the start of the COVID-19 pandemic may have led to TB cases potentially going undetected, which may threaten TB treatment outcomes. Therefore, efforts must be directed at finding these missing cases and ensuring that PHC facilities are equipped to adequately diagnose and treat them.
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