1
|
Pei X, Zhong T, Yang C, Sun L, Chen M, Xu M. Cost-Effectiveness of Community-Based Active Case Finding Strategy for Tuberculosis: Evidence From Shenzhen, China. J Infect Dis 2024; 229:1866-1877. [PMID: 38262678 DOI: 10.1093/infdis/jiae024] [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: 06/09/2023] [Revised: 01/13/2024] [Accepted: 01/22/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Active case finding (ACF) is a potentially promising approach for the early identification and treatment of tuberculosis patients. However, evidence on its cost-effectiveness, particularly in low- and middle-income countries, remains limited. This study evaluates the cost-effectiveness of a community-based ACF practice in Shenzhen, China. METHODS We employed a Markov model-based decision analytic method to assess the costs and effectiveness of 3 tuberculosis detection strategies: passive case finding (PCF), basic ACF, and advanced ACF. The analysis was conducted from a societal perspective on a dynamic cohort over a 20-year horizon, focusing on active tuberculosis (ATB) prevalence and the incremental cost-effectiveness ratio (ICER). RESULTS Compared to the PCF strategy, the basic and advanced ACF strategies effectively reduced ATB cases by 6.8 and 10.2 per 100 000 population, respectively, by the final year of this 20-year period. The ICER for the basic and advanced ACF strategies were ¥14 757 and ¥8217 per quality-adjusted life-year, respectively. Both values fell below the cost-effectiveness threshold. CONCLUSIONS Our findings indicate that the community-based ACF screening strategy, which targets individuals exhibiting tuberculosis symptoms, is cost-effective. This underscores the potential benefits of adopting similar community-based ACF strategies for symptomatic populations in tuberculosis-endemic areas.
Collapse
Affiliation(s)
- Xingtong Pei
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, China
| | - Tao Zhong
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Chongguang Yang
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, China
| | - Li Sun
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Meiru Chen
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, China
| | - Mingming Xu
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, China
| |
Collapse
|
2
|
Ding C, Ji Z, Zheng L, Jin X, Ruan B, Zhang Y, Li L, Xu K. Population-based active screening strategy contributes to the prevention and control of tuberculosis. Zhejiang Da Xue Xue Bao Yi Xue Ban 2022; 51:669-678. [PMID: 36915974 PMCID: PMC10262001 DOI: 10.3724/zdxbyxb-2022-0426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/10/2022] [Indexed: 12/24/2022]
Abstract
Despite the achievements obtained worldwide in the control of tuberculosis in recent years, many countries and regions including China still face challenges such as low diagnosis rate, high missed diagnosis rate, and delayed diagnosis of the disease. The discovery strategy of tuberculosis in China has changed from "active discovery by X-ray examination" to "passive discovery by self-referral due to symptoms", and currently the approach is integrated involving self-referral due to symptoms, active screening, and physical examination. Active screening could help to identify early asymptomatic and untreated cases. With the development of molecular biology and artificial intelligence-assisted diagnosis technology, there are more options for active screening among the large-scale populations. Although the implementation cost of a population-based active screening strategy is high, it has great value in social benefits, and active screening in special populations can obtain better benefits. Active screening of tuberculosis is an important component of the disease control. It is suggested that active screening strategies should be optimized according to the specific conditions of the regions to ultimately ensure the benefit of the tuberculosis control.
Collapse
Affiliation(s)
- Cheng Ding
- 1. The First Affiliated Hospital, Zhejiang University School of Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Zhongkang Ji
- 1. The First Affiliated Hospital, Zhejiang University School of Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Lin Zheng
- 1. The First Affiliated Hospital, Zhejiang University School of Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Xiuyuan Jin
- 1. The First Affiliated Hospital, Zhejiang University School of Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Bing Ruan
- 1. The First Affiliated Hospital, Zhejiang University School of Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Ying Zhang
- 1. The First Affiliated Hospital, Zhejiang University School of Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
- 2. Jinan Microecological Biomedicine Shandong Laboratory, Jinan 250117, China
| | - Lanjuan Li
- 1. The First Affiliated Hospital, Zhejiang University School of Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
- 2. Jinan Microecological Biomedicine Shandong Laboratory, Jinan 250117, China
| | - Kaijin Xu
- 1. The First Affiliated Hospital, Zhejiang University School of Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| |
Collapse
|
3
|
Mohd Hassan NZA, Razali A, Mohd Nor Sham Kunusagaran MSJ, Aminuddin F. A symptomatic approach to tuberculosis screening for high-risk groups in Malaysia: Cost-effectiveness and budget impact analysis. J Clin Tuberc Other Mycobact Dis 2022; 29:100334. [PMID: 36262308 PMCID: PMC9574700 DOI: 10.1016/j.jctube.2022.100334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND One of the crucial areas of eliminating TB is the early detection of cases through the screening programme. This study's focal point is to measure the relative cost-effectiveness and budget impact of the symptomatic approach compared to the existing approach of TB screening (consisted of both symptomatic and asymptomatic screening) among high-risk groups in Malaysia. METHOD The Cost-Effectiveness Analysis (CEA) was measured using a decision tree model and the outcome is presented in terms of cost per TB case detected and the ICER. Analysis was conducted using secondary data collected from the Disease Control Division, Sabah and Sarawak State Health Departments. The robustness of the model is determined by Deterministic and Probabilistic Sensitivity Analysis. Subsequently, Budget impact over 5 years period, from 2018 to 2022 was estimated for both approaches. RESULTS The symptomatic approach was more cost-effective than the existing approach with ICER of MYR 424.71. The cost of conducting Sputum for Acid Fast Bacilli (SAFB) was found as the key driver for ICER. Budget Impact Analysis showed that switching from the existing approach towards the symptomatic approach would result in a cost-saving of MYR 65.5 million over 5 years. However, this would lead to 4473 TB cases being undetected over the same duration. CONCLUSION This study suggests that the policymakers have to weigh the trade-off between cost-saving and TB case detection. This cost-saving can be channelled to new TB intervention programme with a higher chance of TB case detection. Nevertheless, any decision made must be in concordance to the objectives of the country's TB programme.
Collapse
Affiliation(s)
- Nor Zam Azihan Mohd Hassan
- Center for Health Economics Research, Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Shah Alam, Selangor Darul Ehsan, Malaysia
- Corresponding author.
| | - Asmah Razali
- Disease Control Division, Ministry of Health Malaysia, Wilayah Persekutuan Putrajaya, Malaysia
| | | | - Farhana Aminuddin
- Center for Health Economics Research, Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Shah Alam, Selangor Darul Ehsan, Malaysia
| |
Collapse
|
4
|
Samade R, Voskuil RT, Scharschmidt TJ. Two-stage TKA for tuberculosis septic arthritis of the knee masquerading as pigmented villonodular synovitis: A case report. Knee 2022; 38:30-35. [PMID: 35872480 DOI: 10.1016/j.knee.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 05/31/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023]
Abstract
A 25-year-old female presented with left knee pain following arthroscopic synovectomy for presumed pigmented villonodular synovitis (PVNS). Radiographs and magnetic resonance imaging demonstrated tricompartmental arthritic changes. She underwent a two-stage procedure first involving antibiotic spacer implantation, followed 1 week later by spacer removal and definitive total knee arthroplasty (TKA) once initial intraoperative culture results were negative. Subsequent cultures confirmed tuberculosis septic arthritis. Repeat evaluation 1 year postoperatively showed no complications and patient satisfaction with left knee function. This is a unique case report in the United States describing 1-year outcomes following staged TKA for tuberculosis septic arthritis masquerading as PVNS.
Collapse
Affiliation(s)
- Richard Samade
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Ryan T Voskuil
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Thomas J Scharschmidt
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
| |
Collapse
|
5
|
Naufal F, Chaisson LH, Robsky KO, Delgado-Barroso P, Alvarez-Manzo HS, Miller CR, Shapiro AE, Golub JE. Number needed to screen for TB in clinical, structural or occupational risk groups. Int J Tuberc Lung Dis 2022; 26:500-508. [PMID: 35650693 PMCID: PMC9202999 DOI: 10.5588/ijtld.21.0749] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND: Screening for active TB using active case-finding (ACF) may reduce TB incidence, prevalence, and mortality; however, yield of ACF interventions varies substantially across populations. We systematically reviewed studies reporting on ACF to calculate the number needed to screen (NNS) for groups at high risk for TB.METHODS: We conducted a literature search for studies reporting ACF for adults published between November 2010 and February 2020. We determined active TB prevalence detected through various screening strategies and calculated crude NNS for - TB confirmed using culture or Xpert® MTB/RIF, and weighted mean NNS stratified by screening strategy, risk group, and country-level TB incidence.RESULTS: We screened 27,223 abstracts; 90 studies were included (41 in low/moderate and 49 in medium/high TB incidence settings). High-risk groups included inpatients, outpatients, people living with diabetes (PLWD), migrants, prison inmates, persons experiencing homelessness (PEH), healthcare workers, and miners. Screening strategies included symptom-based screening, chest X-ray and Xpert testing. NNS varied widely across and within incidence settings based on risk groups and screening methods. Screening tools with higher sensitivity (e.g., Xpert, CXR) were associated with lower NNS estimates.CONCLUSIONS: NNS for ACF strategies varies substantially between adult risk groups. Specific interventions should be tailored based on local epidemiology and costs.
Collapse
Affiliation(s)
- F Naufal
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - L H Chaisson
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - K O Robsky
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - P Delgado-Barroso
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - H S Alvarez-Manzo
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - C R Miller
- World Health Organization, Geneva, Switzerland
| | - A E Shapiro
- Departments of Global Health and Medicine, University of Washington, Seattle, WA
| | - J E Golub
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA, Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
6
|
Malaisamy M, Nagarajan K, Kirti T, Malkeet S, Venkatesan P, Senthilkumar S, Sananthya K, Rajendran K, Kavitha R, Vivekanandan S, Selvavinayagam TS. Economic Evaluation of Implementing a Rapid Point-of-Care Screening Test for the Identification of Hepatitis C Virus under National Viral Hepatitis Control Programme in Tamil Nadu, South India. J Glob Infect Dis 2021; 13:126-132. [PMID: 34703152 PMCID: PMC8491813 DOI: 10.4103/jgid.jgid_394_20] [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: 11/02/2020] [Revised: 11/27/2020] [Accepted: 01/30/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction: Viral hepatitis is a crucial public health problem in India. Hepatitis C virus (HCV) elimination is a national priority and a key strategy has been adopted to strengthen the HCV diagnostics services to ensure early and accurate diagnosis. Methods: To conduct an economic evaluation of implementing a rapid point-of-care screening test for the identification of HCV among the selected key population under the National Viral Hepatitis Control Programme in Tamil Nadu, South India. Economic evaluation of a point-of-care screening test for HCV diagnosis among the key population attending the primary health care centers. A combination of decision tree and Markov model was developed to estimate cost-effectiveness of point-of-care screening test for HCV diagnosis at the primary health care centers. Total costs, quality-adjusted life years (QALYs) of the intervention and comparator, and incremental cost-effectiveness ratio (ICER) were calculated. The model parameter uncertainties which would influence the cost-effectiveness outcome has been evaluated by one-way sensitivity analysis and probabilistic sensitivity analysis. Results: When compared to the tertiary level diagnostic strategy for HCV, the point-of-care screening for selected key population at primary health care level results in a gain of 57 undiscounted QALYs and 38 discounted QALYs, four undiscounted life years and two discounted life years. The negative ICER of the new strategy indicates that it is less expensive and more effective compared with the current HCV diagnosis strategy. Conclusions: The proposed strategy for HCV diagnosis in the selected key population in Tamil Nadu is dominant and cost-saving compared to the current strategy.
Collapse
Affiliation(s)
- Muniyandi Malaisamy
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Karikalan Nagarajan
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Tyagi Kirti
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Singh Malkeet
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Prakash Venkatesan
- Department of Public Health and Preventive Medicine, Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, Tamil Nadu, India
| | - S Senthilkumar
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Karthikeyan Sananthya
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Krishnan Rajendran
- Department of Statistics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Rajsekar Kavitha
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | | | - T S Selvavinayagam
- Department of Public Health and Preventive Medicine, Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, Tamil Nadu, India
| |
Collapse
|
7
|
Mohd Hassan NZA, Razali A, Shahari MR, Mohd Nor Sham Kunusagaran MSJ, Halili J, Zaimi NA, Bahari MS, Aminuddin F. Cost-Effectiveness Analysis of High-Risk Groups Tuberculosis Screening in Malaysia. Front Public Health 2021; 9:699735. [PMID: 34322473 PMCID: PMC8310930 DOI: 10.3389/fpubh.2021.699735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022] Open
Abstract
Screening of high-risk groups for Tuberculosis (TB) is considered as the cornerstone for TB elimination but the measure of cost-effectiveness is also crucial in deciding the strategy for TB screening. This study aims to measure the cost-effectiveness of TB screening between the various high-risk groups in Malaysia. A decision tree model was developed to assess the cost-effectiveness of TB screening among the high-risk groups from a provider perspective using secondary data from the year 2016 to 2018. The results are presented in terms of an Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per TB case detected. Deterministic and Probabilistic Sensitivity Analysis was also performed to measure the robustness of the model. TB screening among Person Living with Human Immunodeficiency Virus (PL HIV) was the most cost-effective strategy, with MYR 2,597.00 per TB case detected. This was followed by elderly, prisoners and smokers with MYR 2,868.62, MYR 3,065.24, and MYR 4,327.76 per one TB case detected, respectively. There was an incremental cost of MYR 2.49 per screening, and 3.4 TB case detection per 1,000 screening for TB screening among PL HIV in relation to TB screening among prisoners. The probability of symptomatic cases diagnosed as TB was the key driver for increasing cost-effectiveness efficacy among PL HIV. Results of the study suggest prioritization of high-risk group TB screening program by focusing on the most cost-effective strategy such as screening among PL HIV, prisoners and elderly, which has a lower cost per TB case detected.
Collapse
Affiliation(s)
| | - Asmah Razali
- Disease Control Division, Ministry of Health Malaysia, Wilayah Persekutuan Putrajaya, Malaysia
| | - Mohd Ridzwan Shahari
- Medical Development Division, Ministry of Health Malaysia, Wilayah Persekutuan Putrajaya, Malaysia
| | | | - Juanita Halili
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Nur Amalina Zaimi
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Mohd Shahri Bahari
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Farhana Aminuddin
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Malaysia
| |
Collapse
|
8
|
Godoy P. Guidelines on controlling latent tuberculosis infection to support tuberculosis elimination. ACTA ACUST UNITED AC 2021; 23:28-36. [PMID: 33847703 PMCID: PMC8278168 DOI: 10.18176/resp.00028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 01/08/2021] [Indexed: 01/01/2023]
Abstract
Objectives Latent TB infection (LTBI) affects 25% of the world’s population. As long as this reservoir exists, the elimination of TB will not be feasible. The Assembly of the World Health Organization adopted the “Global End TB” strategy for the elimination of TB in 2014. The objective of this review is to present strategies for risk groups that are candidates for the detection and treatment of LTBI. Material and method There is sufficient evidence of screening in: immunocompromised people (HIV-infected, biological therapies, alternative renal therapy, organ transplantation), recent immigrants, inmates in prison, people injecting drugs and homeless people, and workers from at-risk settings. Tests to diagnose LTBI include tuberculin skin test (TST) and gamma release assay interferon (IGRA). There is no reference test and the choice of one or the other will depend on logistical considerations, such as avoiding injection (TST) or not needing a second visit (IGRA). Treatment of LTBI is based on the use of isoniazide and rifampicin in short period of 3 or 4 months, using associations of rifampicin and isoniazide or rifampicin alone. Discussion Given the estimated high prevalence of LTBI, renewed efforts are required to reduce the number of people with LTBI that includes a registration and monitoring system to observer progress, increased testing, and the use of short treatment guidelines.
Collapse
Affiliation(s)
- P Godoy
- Public Health Emergencies Epidemiological Monitoring and Response Service in Lleida and Alto Pirineo and Aran. Public Health Agency of Catalonia.,Biomedical Research Centre Network of Epidemiology and Public Health (CIBERESP). Carlos III Health Institute.,Lleida Biomedical Research Institute (IRBLleida)
| |
Collapse
|
9
|
Jia D, Li H, Xu Y. Awareness and Mental Health of Male Drug Addicts With Tuberculosis During the COVID-19 Pandemic. Front Psychiatry 2021; 12:697508. [PMID: 34483992 PMCID: PMC8416263 DOI: 10.3389/fpsyt.2021.697508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/09/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: At present, the COVID-19 pandemic remains the most pressing global health issue. Given the significant amount of public awareness, the infection rate and rehabilitation efforts are governed not only by the compliance of transmission mitigation strategies but also by the understanding of coexisting diseases and COVID-19 in patients with chronic infectious diseases. The main goal of this study was to evaluate the differences in demographics, as well as awareness, risk perception, and emotional reactions, among imprisoned drug addicts with and without tuberculosis (TB) regarding their perceptions of and feelings toward the COVID-19 pandemic. The secondary goal of the study was also to measure how the psychological health and nutritional indices of the drug addicts with TB changed during their ongoing rehabilitation. Methods: A total of 265 male drug addicts, 45 of which were positive for TB and another 220 who were negative, were selected as subjects from a mandatory detoxification and rehabilitation center (MDRC). Data were collected through a combination of questionnaires (questions regarding COVID-19 awareness, emotional knowledge and responses, and SCL-90 tests), anthropometric examination, and laboratory blood tests, with which inferential and descriptive statistical analyses were performed. Results: During a period of 1 week in early 2021, the differences in the accuracy of the responses from the questions probing the awareness of COVID-19 symptoms, transmission, susceptible populations, what kind of mask should be worn, and preventive measures between TB addicts to non-TB addicts were 11.11 vs. 60.45%, 57.78 vs. 77.27%, 66.67 vs. 78.64%, 97.98 vs. 97.73%, and 93.33 vs. 65.91%, respectively. In the risk perception and emotional reaction sections of the questionnaire, there was a significant difference in the responses to "What you were more worried about was?" (p < 0.001) and "Alteration in your mood since the outbreak?" (p = 0.002) between the two cohorts. In the section assessing the 10 dimensions of the SCL-90 scale, there were significant differences between the TB addicts and the Chinese norm. In addition, the BMI (21.06 ± 2.65 kg/m2) and total serum protein (77.14 ± 6.12 g/L) levels of the TB addicts were normal, but the serum hemoglobin (117.02 ± 4.97 g/L) and albumin (42.08 ± 1.81 g/L) levels were significantly lower in the TB addicts compared to the norm (p < 0.001). Conclusion: The COVID-19 pandemic we are facing is both an epidemiologic and a psychological crisis. However, while the COVID-19 epidemic will eventually disappear (or become manageable, similar to the flu), the TB epidemic may still persist. To avoid the deleterious consequences of multiple simultaneous epidemics, complementary response measures to COVID-19 and TB can help curb the exacerbation of both situations and, therefore, save lives. Imprisoned drug addicts, especially those with TB, can master relevant knowledge on COVID-19.
Collapse
Affiliation(s)
- Dongming Jia
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.,Zhejiang Police Vocational College, Hangzhou, China
| | - Hai Li
- Qiongshan Mandatory Detoxification and Rehabilitation Center, Haikou, China
| | - Yuming Xu
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| |
Collapse
|
10
|
Staerke NB, Smidt-Hansen T, Oldenborg L, Jensen TT, Weinreich UM, Shakar S, Wejse C, Hilberg O, Fløe A. High yield from repeated testing for tuberculosis among high-risk citizens in Denmark. Int J Infect Dis 2020; 102:352-356. [PMID: 33130208 DOI: 10.1016/j.ijid.2020.10.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Screening for TB (tuberculosis) among socially marginalized citizens has been implemented in many urban areas in countries with a low incidence of TB, including Denmark. This study aims to describe the findings of the screening programs for TB and latent tuberculosis (LTBI) used in the western part of Denmark in the period 2014-2019. METHODS Data was collected retrospectively on test results from interferon-gamma release assays (IGRA), spot sputum tests and chest X-rays performed as part of TB and LTBI screening among 1024 socially marginalized citizens in urban areas of western Denmark in 2014-2019. RESULTS The overall TB incidence was 2148/100.000 and number needed to screen to find one TB case was 39. The incidence of LTBI in the group screened using IGRA was 17.500/100.000. TB incidence when using spot sputum test was 2.5, while TB incidence when using IGRA as the primary screening test was 2.7. In total, 38.9% of TB diagnoses were obtained after the second or third round of screening. CONCLUSION We demonstrated a high incidence of TB and LTBI among socially marginalized citizens in Denmark. Screening with spot sputum testing and IGRA generated comparable results in diagnosing TB in this setting.
Collapse
Affiliation(s)
- Nina Breinholt Staerke
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.
| | - Torben Smidt-Hansen
- Department of Pulmonary Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Leni Oldenborg
- Department of Pulmonary Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Torben Tranborg Jensen
- Department of Pulmonary Medicine, Sydvestjysk Sygehus, Finsensgade 35, 6700 Esbjerg, Denmark
| | - Ulla Møller Weinreich
- Department of Pulmonary Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Shakil Shakar
- Department of Pulmonary Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark; Department of Internal Medicine, North Denmark Regional Hospital, Bispensgade 37, 9800 Hjoerring, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Sygehus Lillebælt, Beriderbakken 4, 7100 Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Andreas Fløe
- Department of Pulmonary Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| |
Collapse
|
11
|
Kerr EM, Vonnahme LA, Goswami ND. Impact of Targeted Local Interventions on Tuberculosis Awareness and Screening Among Persons Experiencing Homelessness During a Large Tuberculosis Outbreak in Atlanta, Georgia, 2015-2016. Public Health Rep 2020; 135:90S-99S. [PMID: 32735200 PMCID: PMC7407052 DOI: 10.1177/0033354920932644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Tuberculosis (TB) outbreaks disproportionately affect persons experiencing homelessness (PEH) in the United States. During 2014-2016, a resurgent TB outbreak occurred among PEH in Atlanta, Georgia. To control the outbreak, citywide policies and educational interventions were implemented in January 2015. Policy changes standardized and enforced TB screening requirements for PEH in homeless shelters. Educational campaigns informed PEH of the outbreak and encouraged TB screening. We evaluated factors associated with, and the effect policy changes and educational interventions had on, TB screening and awareness among PEH in Atlanta. METHODS Questions related to TB screening and awareness of the outbreak were added to an annual US Department of Housing and Urban Development survey of PEH in Atlanta in 2015 (n = 296 respondents) and 2016 (n = 1325 respondents). We analyzed the 2016 survey data to determine characteristics associated with outcomes. RESULTS From 2015 to 2016, reported TB screening increased from 81% to 86%, and awareness of the TB outbreak increased from 68% to 75%. In 2016, sheltered PEH were significantly more likely than unsheltered PEH to report being evaluated for TB in the previous 6 months (prevalence odds ratio [pOR] = 3.18; 95% confidence interval [CI], 2.28-4.47) and to report being aware of the TB outbreak (pOR = 4.00; 95% CI, 2.89-5.55). CONCLUSIONS Implementation of required TB screening and educational interventions may reduce the incidence and severity of TB outbreaks among PEH in other communities. Furthermore, the annual survey of PEH offers an opportunity to collect data to better inform practices and policies.
Collapse
Affiliation(s)
- Eleanor M Kerr
- 25798 Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Laura A Vonnahme
- 1242 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Neela D Goswami
- 25798 Emory University Rollins School of Public Health, Atlanta, GA, USA
- 1242 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
12
|
Rastoder E, Shaker SB, Naqibullah M, Wille MMW, Lund M, Wilcke JT, Seersholm N, Jensen SG. Chest x-ray findings in tuberculosis patients identified by passive and active case finding: A retrospective study. J Clin Tuberc Other Mycobact Dis 2019; 14:26-30. [PMID: 31720415 PMCID: PMC6830123 DOI: 10.1016/j.jctube.2019.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Chest x-ray is central in screening and diagnosis of tuberculosis. However, sputum culture remains gold standard for diagnosis. Aim To establish the rate of normal chest x-rays in tuberculosis patients found by spot sputum culture screening, and compare them to a group identified through passive case finding. Method Chest x-rays from 39 culture-positive patients, identified by spot sputum culture screening in Copenhagen from 2012 to 2014, were included in the study (spot sputum culture group(SSC)). 39 normal chest x-rays from persons screened by mobile x-ray, and 39 chest x-rays from tuberculosis-patients identified through passive case finding(PCF) were anonymised and randomised. Two respiratory physicians and two radiologists assessed the chest x-rays. Results The normal chest x-ray rate was higher in the non-tuberculosis control group (median = 32 (82.1%), range = 74.4% – 100%), compared to the SSC group (median = 7 (17.9%), range = 10.3% – 33.3%), and the PCF controls (median = 3(7.7%), range = 2.6% – 15.4%). In the SSC group 14 (35.9%) were categorized as normal by at least one study participant. Conclusion A substantial minority of patients diagnosed with tuberculosis by spot sputum culture screening, and through passive case finding would not have been identified with chest x-ray alone, highlighting that a normal chest x-ray does not exclude pulmonary tuberculosis.
Collapse
Affiliation(s)
- Ema Rastoder
- Department of Respiratory Medicine, Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Copenhagen, Denmark
| | - Saher Burhan Shaker
- Department of Respiratory Medicine, Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Copenhagen, Denmark
| | - Matiullah Naqibullah
- Department of Respiratory Medicine, Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Copenhagen, Denmark
| | | | - Mette Lund
- Department of Radiology, Hillerød Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Jon Torgny Wilcke
- Department of Respiratory Medicine, Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Copenhagen, Denmark
| | - Niels Seersholm
- Department of Respiratory Medicine, Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Copenhagen, Denmark
| | - Sidse Graff Jensen
- Department of Respiratory Medicine, Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Copenhagen, Denmark
| |
Collapse
|
13
|
Ranzani OT, Rodrigues LC, Waldman EA, Prina E, Carvalho CRR. Who are the patients with tuberculosis who are diagnosed in emergency facilities? An analysis of treatment outcomes in the state of São Paulo, Brazil. J Bras Pneumol 2018; 44:125-133. [PMID: 29791555 PMCID: PMC6044664 DOI: 10.1590/s1806-37562017000000384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/11/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Early tuberculosis diagnosis and treatment are determinants of better outcomes and effective disease control. Although tuberculosis should ideally be managed in a primary care setting, a proportion of patients are diagnosed in emergency facilities (EFs). We sought to describe patient characteristics by place of tuberculosis diagnosis and determine whether the place of diagnosis is associated with treatment outcomes. A secondary objective was to determine whether municipal indicators are associated with the probability of tuberculosis diagnosis in EFs. METHODS We analyzed data from the São Paulo State Tuberculosis Control Program database for the period between January of 2010 and December of 2013. Newly diagnosed patients over 15 years of age with pulmonary, extrapulmonary, or disseminated tuberculosis were included in the study. Multiple logistic regression models adjusted for potential confounders were used in order to evaluate the association between place of diagnosis and treatment outcomes. RESULTS Of a total of 50,295 patients, 12,696 (25%) were found to have been diagnosed in EFs. In comparison with the patients who had been diagnosed in an outpatient setting, those who had been diagnosed in EFs were younger and more socially vulnerable. Patients diagnosed in EFs were more likely to have unsuccessful treatment outcomes (adjusted OR: 1.54; 95% CI: 1.42-1.66), including loss to follow-up and death. At the municipal level, the probability of tuberculosis diagnosis in EFs was associated with low primary care coverage, inequality, and social vulnerability. In some municipalities, more than 50% of the tuberculosis cases were diagnosed in EFs. CONCLUSIONS In the state of São Paulo, one in every four tuberculosis patients is diagnosed in EFs, a diagnosis of tuberculosis in EFs being associated with poor treatment outcomes. At the municipal level, an EF diagnosis of tuberculosis is associated with structural and socioeconomic indicators, indicating areas for improvement.
Collapse
Affiliation(s)
- Otavio Tavares Ranzani
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Eliseu Alves Waldman
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Elena Prina
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | |
Collapse
|
14
|
Jiménez-Fuentes MÁ, Rodrigo T, Altet MN, Jiménez-Ruiz CA, Casals M, Penas A, Mir I, Solano Reina S, Riesco-Miranda JA, Caylá JA. Factors associated with smoking among tuberculosis patients in Spain. BMC Infect Dis 2016; 16:486. [PMID: 27629062 PMCID: PMC5024488 DOI: 10.1186/s12879-016-1819-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 09/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the prevalence of smoking and analyze associated factors in a cohort of patients diagnosed with tuberculosis (TB) in Spain between 2006 and 2013. METHODS Multicenter, cross-sectional, descriptive, observational study using a national database of TB patients, using logistic regression to calculate odds ratios (OR) and confidence intervals (CI). RESULTS We analyzed 5,846 cases (62 % men, mean age 39 years, 33 % foreigners). 23.4 % were alcohol abuser, 1.3 % were injected drug users (IDU), 4.6 % were co-infected with HIV, and 7.5 % had a history of TB treatment. 6.6 % and 0.8 % showed resistance to one and multiple drugs, respectively. The predominant clinical presentation was pulmonary (71 %) with a cavitary radiological pattern in 32.8 % of cases. 82 % of cases were confirmed microbiologically, and 54 % were smear-positive microscopy. 2,300 (39.3 %) patients were smokers. The following factors were associated with smoking: male sex (OR = 2.26;CI:1.97;2.60), Spanish origin (OR = 2.79;CI:2.40-3.24), alcoholism (OR = 2.85;CI:2.46;3.31), IDU (OR = 2.78;CI:1.48;5.52), homelessness (OR = 1.99;CI:1.14-3.57), pulmonary TB (OR = 1.61;CI:1.16;2.24), cavitary radiological pattern (OR = 1.99;CI:1.43;2.79) and a smear-positive microscopy at the time of diagnosis (OR = 1.39;CI:1.14;1.17). CONCLUSIONS The prevalence of smoking among TB patients is high. Smokers with TB have a distinct sociodemographic, clinical, radiological and microbiological profile to non-smokers.
Collapse
Affiliation(s)
- María Ángeles Jiménez-Fuentes
- Unidad de Tuberculosis Valle de Hebrón-Drassanes. Programa Especial de Enfermedades Infecciosas, Hospital Universitario Valle de Hebrón, Av Drassanes, 17-21, 08001, Barcelona, Spain. .,Programa Integrado de Investigación en Tuberculosis (PII TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain. .,Unidad de Investigación de Tuberculosis de Barcelona, Barcelona, Spain.
| | - Teresa Rodrigo
- Programa Integrado de Investigación en Tuberculosis (PII TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain.,Unidad de Investigación de Tuberculosis de Barcelona, Barcelona, Spain.,Fundación Respira de la SEPAR, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Neus Altet
- Programa Integrado de Investigación en Tuberculosis (PII TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain.,Unidad de Investigación de Tuberculosis de Barcelona, Barcelona, Spain.,Serveis Clínics S.A., Barcelona, Spain
| | | | - Martí Casals
- Programa Integrado de Investigación en Tuberculosis (PII TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Servicio de Epidemiología de la Agencia de Salud Pública de Barcelona, Barcelona, Spain
| | - Antón Penas
- Programa Integrado de Investigación en Tuberculosis (PII TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain.,Hospital Lucus Augusti, Lugo, Spain
| | - Isabel Mir
- Programa Integrado de Investigación en Tuberculosis (PII TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain.,Hospital Son Llàtzer, Palma de Mallorca, Spain
| | | | - Juan Antonio Riesco-Miranda
- Complejo Hospitalario de Cáceres, Cáceres, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Joan A Caylá
- Programa Integrado de Investigación en Tuberculosis (PII TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain.,Unidad de Investigación de Tuberculosis de Barcelona, Barcelona, Spain.,Fundación Respira de la SEPAR, Barcelona, Spain.,Servicio de Epidemiología de la Agencia de Salud Pública de Barcelona, Barcelona, Spain.,Departamento de Salud Pública, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | |
Collapse
|
15
|
Schepisi MS, Gualano G, Piselli P, Mazza M, D’Angelo D, Fasciani F, Barbieri A, Rocca G, Gnolfo F, Olivani P, Ferrarese M, Codecasa LR, Palmieri F, Girardi E. Active Tuberculosis Case Finding Interventions Among Immigrants, Refugees and Asylum Seekers in Italy. Infect Dis Rep 2016; 8:6594. [PMID: 27403270 PMCID: PMC4927939 DOI: 10.4081/idr.2016.6594] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/11/2016] [Indexed: 11/23/2022] Open
Abstract
In Italy tuberculosis (TB) is largely concentrated in vulnerable groups such as migrants and in urban settings. We analyzed three TB case finding interventions conducted at primary centers and mobile clinics for regular/irregular immigrants and refugees/asylum seekers performed over a four-year period (November 2009-March 2014) at five different sites in Rome and one site in Milan, Italy. TB history and presence of symptoms suggestive of active TB were investigated by verbal screening through a structured questionnaire in migrants presenting for any medical condition to out-patient and mobile clinics. Individuals reporting TB history or symptoms were referred to a TB clinic for diagnostic workup. Among 6347 migrants enrolled, 891 (14.0%) reported TB history or symptoms suggestive of active TB and 546 (61.3%) were referred to the TB clinic. Of them, 254 (46.5%) did not present for diagnostic evaluation. TB was diagnosed in 11 individuals representing 0.17% of those screened and 3.76% of those evaluated. The overall yield of this intervention was in the range reported for other TB screening programs for migrants, although we recorded an unsatisfactory adherence to diagnostic workup. Possible advantages of this intervention include low cost and reduced burden of medical procedures for the screened population.
Collapse
Affiliation(s)
- Monica Sañé Schepisi
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, Department of Clinical Research, National Institute for Infectious Diseases, L. Spallanzani, Rome, Italy
| | - Pierluca Piselli
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | | | | | | | | | - Giorgia Rocca
- Salute per i migranti forzati (SaMiFo) Centro Astalli, Local Health Unit AUSL RM A, Rome, Italy
| | - Filippo Gnolfo
- Salute per i migranti forzati (SaMiFo) Centro Astalli, Local Health Unit AUSL RM A, Rome, Italy
| | | | - Maurizio Ferrarese
- Regional Reference Center for TB -Villa Marelli Institute, Niguarda Ca’ Granda Hospital, Milan, Italy
| | - Luigi Ruffo Codecasa
- Regional Reference Center for TB -Villa Marelli Institute, Niguarda Ca’ Granda Hospital, Milan, Italy
| | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, Department of Clinical Research, National Institute for Infectious Diseases, L. Spallanzani, Rome, Italy
| | - Enrico Girardi
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| |
Collapse
|
16
|
Ranzani OT, Carvalho CRR, Waldman EA, Rodrigues LC. The impact of being homeless on the unsuccessful outcome of treatment of pulmonary TB in São Paulo State, Brazil. BMC Med 2016; 14:41. [PMID: 27006009 PMCID: PMC4804546 DOI: 10.1186/s12916-016-0584-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major public health problem requiring complex treatment, the success of which depends on biological, social, and institutional factors. São Paulo State (SPS), in Brazil, has a high TB burden. Because of high socioeconomic heterogeneity and chaotic urbanisation, homelessness might play an important role in the TB burden in SPS. Our aim was to determine the association between homelessness and outcome of treatment of pulmonary TB (PTB) in SPS. METHODS A historical cohort from the routine SPS TB database for 2009-2013 was analysed. The study population was newly diagnosed adult patients with PTB. Homelessness was ascertained at notification or when treatment started. Our outcome was unsuccessful outcome of treatment. We used logistic regression to adjust for potential confounders and multiple imputation for missing data. RESULTS We analysed 61,817 patients; 1726 (2.8 %, 95%CI 2.7-2.9 %) were homeless. Homeless patients were concentrated in bigger cities, were more frequently middle-aged males, had black/brown skin colour, and had received less education (P < 0.001, for all). Alcohol and drug use was three times more frequent in homeless patients (43.2 % vs 14.4 %, 30.2 % vs. 9.4 %, P < 0.001, respectively). HIV testing was less common among the homeless, of whom 17.3 % were HIV positive compared with 8.5 % among the not homeless population (P < 0.001). Microbiologic confirmation was more frequent among the homeless (91.6 % vs. 84.8 %, P < 0.001). Unsuccessful outcome of treatment was 57.3 % among the homeless and 17.5 % among the not homeless (OR = 6.32, 95%CI 5.73-6.97, P < 0.001), mainly due to loss to follow-up (39 %) and death (10.5 %). After full-adjustment for potential confounders, homelessness remained strongly associated with lower treatment success (aOR = 4.96, 95 % CI 4.27-5.76, P < 0.001). HIV status interacted with homelessness: among HIV-infected patients, the aOR was 2.45 (95%CI 1.90-3.16, Pinteraction < 0.001). The population attributable fraction for the joint effect of homelessness, alcohol and drug use was almost 20 %. CONCLUSIONS Confirming our hypothesis, homelessness led to a marked reduction in the successful treatment of newly diagnosed pulmonary tuberculosis. Homelessness and associated conditions were important contributors to lack of treatment success in pulmonary tuberculosis in São Paulo. A multifaceted intervention must be implemented to target this vulnerable population.
Collapse
Affiliation(s)
- Otavio T Ranzani
- Pulmonary Division, Heart Institute (InCor), Medical School, University of São Paulo, Av. Dr. Arnaldo, 455, 2° andar, sala 2144, Post-code 01246903, São Paulo, Brazil. .,London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, Room G9a, Post-code WC1E 7HT, London, UK.
| | - Carlos R R Carvalho
- Pulmonary Division, Heart Institute (InCor), Medical School, University of São Paulo, Av. Dr. Arnaldo, 455, 2° andar, sala 2144, Post-code 01246903, São Paulo, Brazil
| | - Eliseu A Waldman
- Department of Epidemiology, Faculty of Public Health, University of Sao Paulo, Av. Dr. Arnaldo, 715, Post-code 01246904, São Paulo, Brazil
| | - Laura C Rodrigues
- London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, Room G9a, Post-code WC1E 7HT, London, UK
| |
Collapse
|
17
|
Jensen SG, Olsen NW, Seersholm N, Lillebaek T, Wilcke T, Pedersen MK, Kok-Jensen A. Screening for TB by sputum culture in high-risk groups in Copenhagen, Denmark: a novel and promising approach. Thorax 2015; 70:979-83. [DOI: 10.1136/thoraxjnl-2015-207162] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/18/2015] [Indexed: 11/04/2022]
|