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Mvo S, Bokop C, Longo-Mbenza B, Vasaikar SD, Apalata T. Prolongation of Acid-Fast Bacilli Sputum Smear Positivity in Patients with Multidrug-Resistant Pulmonary Tuberculosis. Pathogens 2023; 12:1133. [PMID: 37764941 PMCID: PMC10537881 DOI: 10.3390/pathogens12091133] [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: 07/07/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The study sought to determine factors associated with prolonged smear positivity in multidrug-resistant tuberculosis (MDR-TB) patients following appropriate management. Newly diagnosed patients were enrolled between June 2017 and May 2018. Sputum samples were collected for Xpert® MTB/RIF and line probe assays (LiPAs). Microscopic tests were performed at baseline and 4, 8, and 12 weeks post-anti-TB therapy. Of the 200 patients, 114 (57%) were HIV-positive. After 12 weeks of treatment, there was a significant microscopy conversion rate among DS-TB patients compared to MDR-TB patients irrespective of their HIV status (p = 0.0013). All MDR-TB patients who had a baseline smear grade ranging from scanty to +1 converted negative, while 25% ranging from +2 to +3 remained positive until the end of 12 weeks (p = 0.014). Factors associated with smear positivity included age <35 years (p = 0.021), initial CD4+ T-cell count ≥200 cells/mm3 (p = 0.010), and baseline smear grade ≥2+ (p = 0.014). Cox regression showed that only the baseline smear grade ≥2+ was independently associated with prolonged smear positivity in MDR-TB patients (p = 0.011) after adjusting for HIV status, CD4+ T-cell count, and age. Baseline sputum smear grade ≥2+ is a key determinant for prolonged smear positivity beyond 12 weeks of effective anti-TB therapy in MDR-TB patients.
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Affiliation(s)
- Sidwell Mvo
- Division of Medical Microbiology, Department of Pathology & Laboratory Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (S.M.); (C.B.); (B.L.-M.)
| | - Carine Bokop
- Division of Medical Microbiology, Department of Pathology & Laboratory Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (S.M.); (C.B.); (B.L.-M.)
- Vaccine and Infectious Disease Analytics Research Unit, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Benjamin Longo-Mbenza
- Division of Medical Microbiology, Department of Pathology & Laboratory Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (S.M.); (C.B.); (B.L.-M.)
| | - Sandeep D. Vasaikar
- Department of Medical Microbiology, National Health Laboratory Services, Nelson Mandela Academic Complex, Mthatha 5100, South Africa;
| | - Teke Apalata
- Division of Medical Microbiology, Department of Pathology & Laboratory Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (S.M.); (C.B.); (B.L.-M.)
- Department of Medical Microbiology, National Health Laboratory Services, Nelson Mandela Academic Complex, Mthatha 5100, South Africa;
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Duedu KO, Aninagyei E, Akila DA, Kweku M. Active tuberculosis case findings in Ghanaian health facilities: effectiveness and sensitivity of the symptoms-based screening tool. Pan Afr Med J 2021; 40:111. [PMID: 34887985 PMCID: PMC8627140 DOI: 10.11604/pamj.2021.40.111.28798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/26/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction the National Tuberculosis Programme (NTP), Ghana, introduced Symptoms-Based Screening (SBS) Tool for TB case finding. This study aimed to determine the challenges and limitations associated with the use of the SBS Tool for active tuberculosis case finding in Ghanaian health facility settings. Methods this study targeted suspected TB patients attending two health facilities in the Ho Municipality, Ghana. Initially, suspected TB patients were screened with the SBS tool and presumptive patients subsequently tested for M. tuberculosis using microscopy and geneXpert assay. Additionally, health personnel were interviewed to assess the user-friendliness, challenges, and limitations associated with the tool. Results of 636 presumptive TB patients identified, 1.73% had tuberculosis. Coughing for > 2 weeks (χ2=24.8; p<0.05); chest pain (χ2=28.3; p<0.01) and night sweat (χ2=34.8; p<0.05) associated significantly with M. tuberculosis infection status. The health personnel found the tool to be not user-friendly and it also lacked indicators to identify other vulnerable individuals such as diabetics, cigarette smokers, alcoholics, immunocompromised, and malnourished individuals. Therefore, the SBS tool was found not to be sensitive enough to identify probable cases. Conclusion the SBS tool is useful for detecting active TB cases, however, it must be improved to identify vulnerable individuals such as diabetics, immunosuppressed, and malnourished.
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Affiliation(s)
- Kwabena Obeng Duedu
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Hohoe, Ghana
| | - Enoch Aninagyei
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Hohoe, Ghana
| | - Diana Ayinpokbila Akila
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Margaret Kweku
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
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Kerkhoff AD, Kagujje M, Nyangu S, Mateyo K, Sanjase N, Chilukutu L, Eshun-Wilson I, Geng EH, Havlir DV, Muyoyeta M. Pathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment. PLoS One 2021; 16:e0252095. [PMID: 34464392 PMCID: PMC8407587 DOI: 10.1371/journal.pone.0252095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/21/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Delays in the diagnosis of tuberculosis (TB) contribute to a substantial proportion of TB-related mortality, especially among people living with HIV (PLHIV). We sought to characterize the diagnostic journey for HIV-positive and HIV-negative patients with a new TB diagnosis in Zambia, to understand drivers of delay, and characterize their preferences for service characteristics to inform improvements in TB services. METHODS We assessed consecutive adults with newly microbiologically-confirmed TB at two public health treatment facilities in Lusaka, Zambia. We administered a survey to document critical intervals in the TB care pathway (time to initial care-seeking, diagnosis and treatment initiation), identify bottlenecks and their reasons. We quantified patient preferences for a range of characteristics of health services using a discrete choice experiment (DCE) that assessed 7 attributes (distance, wait times, hours of operation, confidentiality, sex of provider, testing incentive, TB test speed and notification method). RESULTS Among 401 patients enrolled (median age of 34 years, 68.7% male, 46.6% HIV-positive), 60.9% and 39.1% were from a first-level and tertiary hospital, respectively. The median time from symptom onset to receipt of TB treatment was 5.0 weeks (IQR: 3.6-8.0) and was longer among HIV-positive patients seeking care at a tertiary hospital than HIV-negative patients (6.4 vs. 4.9 weeks, p = 0.002). The time from symptom onset to initial presentation for evaluation accounted for the majority of time until treatment initiation (median 3.0 weeks, IQR: 1.0-5.0)-an important minority of 11.0% of patients delayed care-seeking ≥8 weeks. The DCE found that patients strongly preferred same-day TB test results (relative importance, 37.2%), facilities close to home (18.0%), and facilities with short wait times (16.9%). Patients were willing to travel to a facility up to 7.6 kilometers further away in order to access same-day TB test results. Preferences for improving current TB services did not differ according to HIV status. CONCLUSIONS Prolonged intervals from TB symptom onset to treatment initiation were common, especially among PLHIV, and were driven by delayed health-seeking. Addressing known barriers to timely diagnosis and incorporating patients' preferences into TB services, including same-day TB test results, may facilitate earlier TB care engagement in high burden settings.
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Affiliation(s)
- Andrew D. Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center University of California, San Francisco, California, United States of America
| | - Mary Kagujje
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sarah Nyangu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Kondwelani Mateyo
- University Teaching Hospital, Department of Internal Medicine, Lusaka, Zambia
| | - Nsala Sanjase
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Elvin H. Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Diane V. Havlir
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center University of California, San Francisco, California, United States of America
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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Phiri MM, Makepeace E, Nyali M, Kumwenda M, Corbett L, Fielding K, Choko A, MacPherson P, MacPherson EE. Improving pathways to care through interventions cocreated with communities: a qualitative investigation of men's barriers to tuberculosis care-seeking in an informal settlement in Blantyre, Malawi. BMJ Open 2021; 11:e044944. [PMID: 34193484 PMCID: PMC8246363 DOI: 10.1136/bmjopen-2020-044944] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Men have a higher prevalence of undiagnosed tuberculosis (TB) than women and can spend up to a year longer contributing to ongoing transmission in the community before receiving treatment. Health outcomes are often worse for patients with TB living in informal settlements especially men. This study aimed to understand the barriers preventing men from seeking care for TB and cocreate interventions to address these barriers. METHODS We used qualitative research methods including in-depth interviews and participatory workshops. Researchers worked with women and men living in Bangwe, an informal settlement in Blantyre, Malawi to develop interventions that reflected their lived realities. The study took place over two phases, in the first phase we undertook interviews with men and women to explore barrier to care seeking, in the second phase we used participatory workshops to cocreate interventions to address barriers and followed up on issues emerging from the workshops with further interviews. In total, 30 interviews were conducted, and 23 participants joined participatory workshops. The team used a thematic analysis to analyse the data. RESULTS Three interconnected thematic areas shaped men's health TB seeking behaviour: precarious socioeconomic conditions; gendered social norms; and constraints in the health system. Insecurity of day labour with no provision for sick leave; pressure to provide for the household and a gendered desire not to appear weak and a severely under-resourced health system all contributed to men delaying care in this context. Identified interventions included improved patient-provider relations within the health-system, improved workers' health rights and broader social support for households. CONCLUSION Improving mens' pathways to care requires interventions that consider contextual issues by addressing individual level socioeconomic factors but also broader structural factors of gendered social dynamics and health systems environment.
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Affiliation(s)
| | - Effie Makepeace
- Media, Arts and Humanities, University of Sussex, Brighton, UK
| | - Margaret Nyali
- Department of Public Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Moses Kumwenda
- Social Science Department, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Public Health, University of Malawi College of Medicine, Blantyre, Malawi
- TB/HIV, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Liz Corbett
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Augustine Choko
- TB/HIV, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Peter MacPherson
- TB/HIV, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Eleanor Elizabeth MacPherson
- Social Science Department, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Endsley JJ, Huante MB, Naqvi KF, Gelman BB, Endsley MA. Advancing our understanding of HIV co-infections and neurological disease using the humanized mouse. Retrovirology 2021; 18:14. [PMID: 34134725 PMCID: PMC8206883 DOI: 10.1186/s12977-021-00559-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/09/2021] [Indexed: 11/15/2022] Open
Abstract
Humanized mice have become an important workhorse model for HIV research. Advances that enabled development of a human immune system in immune deficient mouse strains have aided new basic research in HIV pathogenesis and immune dysfunction. The small animal features facilitate development of clinical interventions that are difficult to study in clinical cohorts, and avoid the high cost and regulatory burdens of using non-human primates. The model also overcomes the host restriction of HIV for human immune cells which limits discovery and translational research related to important co-infections of people living with HIV. In this review we emphasize recent advances in modeling bacterial and viral co-infections in the setting of HIV in humanized mice, especially neurological disease, and Mycobacterium tuberculosis and HIV co-infections. Applications of current and future co-infection models to address important clinical and research questions are further discussed.
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Affiliation(s)
- Janice J Endsley
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555, USA.
| | - Matthew B Huante
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Kubra F Naqvi
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Benjamin B Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Mark A Endsley
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555, USA.
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6
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van Heerden J, Hendricks M, Poole J, Büchner A, Naidu G, du Plessis J, van Emmenes B, van Zyl A, Uys R, Johani J, Hadley GP, Harrison D, Rowe B, Bassingthwaighte M, Moonsamy N, Kruger M. The implementation of a national paediatric oncology protocol for neuroblastoma in South Africa. Cancer Causes Control 2021; 32:725-737. [PMID: 33881651 PMCID: PMC8058747 DOI: 10.1007/s10552-021-01424-2] [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: 12/15/2020] [Accepted: 03/23/2021] [Indexed: 11/25/2022]
Abstract
Purpose The aim of the World Health Organization-International Paediatric Oncology Society is to improve childhood cancer survival in low- and middle-income countries to 60% by 2030. This can be achieved using standardised evidence-based national treatment protocols for common childhood cancers. The aim of the study was to describe the development and implementation of the SACCSG NB-2017 neuroblastoma (NB) treatment protocol as part of the treatment harmonisation process of the South African Children’s Cancer Study Group. Methods The Consolidated Framework for Implementation Research was used to identify factors that could influence the implementation of the national NB protocol as a health care intervention. The evaluation was done according to five interactive domains for implementation: intervention characteristics, inner setting, outer setting, individual or team characteristics and the implementation process. Results The protocol was developed over 26 months by 26 physicians involved in childhood cancer management. The process included an organisational phase, a resource identification phase, a development phase and a research ethics approval phase. Challenges included nationalised inertia, variable research ethical approval procedures with delays and uncoordinated clinical trial implementation. Conclusion The implementation of the national NB protocol demonstrated the complexity of the implementation of a national childhood cancer treatment protocol. However, standardised paediatric cancer treatment protocols based on local expertise and resources in limited settings are feasible. Supplementary Information The online version contains supplementary material available at 10.1007/s10552-021-01424-2.
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Affiliation(s)
- Jaques van Heerden
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa. .,Paediatric Haematology and Oncology, Department of Paediatrics, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium.
| | - Marc Hendricks
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Paediatric Haematology and Oncology Service, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Janet Poole
- Faculty of Health Sciences, Division of Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Ané Büchner
- Paediatric Haematology and Oncology, Department of Paediatrics, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Gita Naidu
- Faculty of Health Sciences, Division of Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Jan du Plessis
- Division of Paediatric Haematology and Oncology, Department of Paediatrics, Faculty of Health Sciences, Universitas Hospital, University of the Free State, Bloemfontein, South Africa
| | - Barry van Emmenes
- Division of Paediatric Haematology and Oncology Hospital, Department of Paediatrics, Frere Hospital, East London, South Africa
| | - Anel van Zyl
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Ronelle Uys
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Johani Johani
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Port Elizabeth Provincial Hospital, Walter Sisulu University, Port Elizabeth, South Africa
| | - G P Hadley
- Department of Paediatric Surgery, Faculty of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Derek Harrison
- Faculty of Health Sciences, Department of Paediatric Surgery, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Biance Rowe
- Faculty of Health Sciences, Division of Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Mairi Bassingthwaighte
- Faculty of Health Sciences, Division of Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Nicolene Moonsamy
- Department of Paediatric Haematology and Oncology, Faculty of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Inkosi Albert Luthuli Academic Hospital, Durban, South Africa
| | - Mariana Kruger
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
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Hodges J, Zhdanova S, Koshkina O, Suzdalnitsky A, Waldman AL, Schwendinger J, Vitko S, Plenskey A, Plotnikova Y, Moiseeva E, Koshcheyev M, Sebekin S, Ogarkov O, Dillingham R, Heysell S. Implementation of a Mobile Health Strategy to Improve Linkage to and Engagement with HIV Care for People Living with HIV, Tuberculosis, and Substance Use in Irkutsk, Siberia. AIDS Patient Care STDS 2021; 35:84-91. [PMID: 33538649 PMCID: PMC7987354 DOI: 10.1089/apc.2020.0233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In Irkutsk, Siberia, there is a high prevalence of HIV and tuberculosis (TB) coinfection. Mobile health (mHealth) strategies have shown promise for increasing linkage to and engagement in care for people living with HIV (PLWH) in other contexts. We evaluated outcomes for a cohort of PLWH, TB, and substance use in Irkutsk after participation in a multi-feature mHealth intervention called MOCT. Sixty patients were enrolled during hospitalization for TB. We evaluated participant app usage, linkage to HIV care postdischarge, perception of self-efficacy related to HIV care, and HIV-related clinical outcomes at 6 months. We also performed an exploratory analysis to compare a subset of 49 patients with a pre-intervention cohort matched for age and gender. Participants demonstrated engagement with app features examined at 6 months. The majority linked to HIV care by 6 months (83%). Self-scoring of confidence in ability to communicate with HIV providers improved from baseline (median score 8, scale 1-10) to 6 months (10, p = 0.004). A higher proportion of the MOCT subset refilled antiretroviral therapy (69% vs. 43% in pre-intervention cohort, p = 0.01), with fewer deaths in the MOCT subset at 6 months (1 death vs. 10 deaths in pre-intervention cohort, p = 0.02) and a decreased likelihood of developing the composite outcome of death/failure to achieve viral suppression at 6 months (adjusted odds ratio = 0.33, p = 0.029). This study demonstrates preliminary intervention uptake and improvement in short-term outcomes for an urban cohort of PLWH, TB, and substance use enrolled in a multi-feature mHealth intervention, a novel strategy for the context. Clinical Trial Registration Number: NCT03819374.
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Affiliation(s)
- Jacqueline Hodges
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.,Address correspondence to: Jacqueline Hodges, MD, MPH, Division of Infectious Diseases and International Health, University of Virginia, 1215 Lee Street, Charlottesville, VA 22902, USA
| | - Svetlana Zhdanova
- Department of Epidemiology and Microbiology, Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation
| | - Olga Koshkina
- Irkutsk Regional Tuberculosis Referral Hospital, Irkutsk, Russian Federation
| | - Alexey Suzdalnitsky
- Irkutsk Regional Tuberculosis Referral Hospital, Irkutsk, Russian Federation
| | - Ava Lena Waldman
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Jason Schwendinger
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Serhiy Vitko
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Elena Moiseeva
- Irkutsk Regional Tuberculosis Referral Hospital, Irkutsk, Russian Federation
| | - Mikhail Koshcheyev
- Irkutsk Regional Tuberculosis Referral Hospital, Irkutsk, Russian Federation
| | - Sergey Sebekin
- Irkutsk Regional AIDS Centre, Irkutsk, Russian Federation
| | - Oleg Ogarkov
- Department of Epidemiology and Microbiology, Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Scott Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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8
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Letang E, Ellis J, Naidoo K, Casas EC, Sánchez P, Hassan-Moosa R, Cresswell F, Miró JM, García-Basteiro AL. Tuberculosis-HIV Co-Infection: Progress and Challenges After Two Decades of Global Antiretroviral Treatment Roll-Out. Arch Bronconeumol 2020; 56:446-454. [PMID: 35373756 DOI: 10.1016/j.arbr.2019.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/02/2019] [Indexed: 06/14/2023]
Abstract
Despite wide antiretroviral scale-up during the past two decades resulting in declining new infections and mortality globally, HIV-associated tuberculosis remains as a major public health concern. Tuberculosis is the leading HIV-associated opportunistic infection and the main cause of death globally and, particularly, in resource-limited settings. Several challenges exist regarding diagnosis, global implementation of latent tuberculosis treatment, management of active tuberculosis, delivery of optimal patient-centered TB and HIV prevention and care in high burden countries. In this article we review the advances on pathogenesis, diagnosis, and treatment after nearly two decades of global roll-out of antiretroviral therapy and discuss the current challenges for the global control of tuberculosis-HIV co-infection.
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Affiliation(s)
- Emilio Letang
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Infectious Diseases Department, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain.
| | - Jayne Ellis
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Hospital for Tropical Diseases, University College London, London, UK
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
| | - Esther C Casas
- Southern Africa Medical Unit, Médecins sans Frontières, Cape Town, South Africa
| | - Paquita Sánchez
- Infectious Diseases Department, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain
| | - Razia Hassan-Moosa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
| | - Fiona Cresswell
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; MRC-UVRI-London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Jose M Miró
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alberto L García-Basteiro
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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9
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Letang E, Ellis J, Naidoo K, Casas EC, Sánchez P, Hassan-Moosa R, Cresswell F, Miró JM, García-Basteiro AL. Tuberculosis-HIV Co-Infection: Progress and Challenges After Two Decades of Global Antiretroviral Treatment Roll-Out. Arch Bronconeumol 2020. [PMID: 31932150 DOI: 10.1016/j.arbres.2019.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite wide antiretroviral scale-up during the past two decades resulting in declining new infections and mortality globally, HIV-associated tuberculosis remains as a major public health concern. Tuberculosis is the leading HIV-associated opportunistic infection and the main cause of death globally and, particularly, in resource-limited settings. Several challenges exist regarding diagnosis, global implementation of latent tuberculosis treatment, management of active tuberculosis, delivery of optimal patient-centered TB and HIV prevention and care in high burden countries. In this article we review the advances on pathogenesis, diagnosis, and treatment after nearly two decades of global roll-out of antiretroviral therapy and discuss the current challenges for the global control of tuberculosis-HIV co-infection.
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Affiliation(s)
- Emilio Letang
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Infectious Diseases Department, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain.
| | - Jayne Ellis
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Hospital for Tropical Diseases, University College London, London, UK
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
| | - Esther C Casas
- Southern Africa Medical Unit, Médecins sans Frontières, Cape Town, South Africa
| | - Paquita Sánchez
- Infectious Diseases Department, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain
| | - Razia Hassan-Moosa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
| | - Fiona Cresswell
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; MRC-UVRI-London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Jose M Miró
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alberto L García-Basteiro
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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10
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Zheng Z, Lin J, Lu Z, Su J, Li J, Tan G, Zhou C, Geng W. Mortality risk in the population of HIV-positive individuals in Southern China: A cohort study. PLoS One 2019; 14:e0210856. [PMID: 30742626 PMCID: PMC6370196 DOI: 10.1371/journal.pone.0210856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/03/2019] [Indexed: 12/22/2022] Open
Abstract
To evaluate the mortality risk in the HIV-positive population, we conducted an observational cohort study involving routine data collection of HIV-positive patients who presented at HIV clinics and multiple treatment centers throughout Guangxi province, Southern China in 2011. The patients were screened for tuberculosis (TB) and tested for hepatitis B (HBV) and C (HCV) virus infections yearly. Following the registration, the cohort was followed up for a 60-month period till the end-point (December 31, 2015). Univariable and multivariable Cox proportional hazards regression models were used to analyze the hazard ratio (HR) and 95% confidence interval (95% CI) for mortality after adjusting for confounding factors stratified by patients’ sociodemographic and behavioral characteristics. HRs were compared within risk-factor levels. With the median follow-up of 3.7-person years for each individual, 5,398 (37.8%) (of 14,293 patients with HIV/AIDS) died; among whom, 78.4% were antiretroviral therapy (ART)-naïve; 43.6% presented late; and 12.2% and 3.3% of patients had Mycobacterium tuberculosis (MTB) and HBV and HCV co-infection, respectively. Of individuals with CD4 counts, those with CD4 count >350 cells/μL formed 14.0% of those who died. Furthermore, gender [multivariable HR (95% CI):1.94 (1.68–2.25)], Han ethnicity [2.15 (1.07–4.32)], illiteracy [3.28 (1.96–5.5)], elementary education [2.91 (1.8–4.72)], late presentation [2.89 (2.46–3.39)], and MTB co-infection [1.28 (1.10–1.49)] strongly increased the all-cause mortality risk of HIV-positive individuals. The HR for ART-based stratification was 0.08 (0.07–0.09); and for HBV and HCV co-infection, HR was 1.02 (0.86–1.21). The findings emphasized that accessibility to HIV testing among high-risk populations and screening for viral hepatitis and TB co-infection are important for the survival of HIV-positive individuals. Initiating early ART, even for individuals with higher CD4 counts, is advisable to help increase the prolongation of lives within the community.
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Affiliation(s)
- Zhigang Zheng
- HIV/AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
- Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
- * E-mail:
| | | | - ZhenZhen Lu
- HIV/AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Jinming Su
- HIV/AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Jianjun Li
- HIV/AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Guangjie Tan
- HIV/AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Chongxing Zhou
- HIV/AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Wenkui Geng
- Guangxi Health and Family Planning Committee, Nanning, China
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11
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MacPherson P, Webb EL, Lalloo DG, Nliwasa M, Maheswaran H, Joekes E, Phiri D, Squire B, Pai M, Corbett EL. Design and protocol for a pragmatic randomised study to optimise screening, prevention and care for tuberculosis and HIV in Malawi (PROSPECT Study). Wellcome Open Res 2018; 3:61. [PMID: 30542662 PMCID: PMC6259593 DOI: 10.12688/wellcomeopenres.14598.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 01/20/2023] Open
Abstract
Background: Adults seeking diagnosis and treatment for tuberculosis (TB) and HIV in low-resource settings face considerable barriers and have high pre-treatment mortality. Efforts to improve access to prompt TB treatment have been hampered by limitations in TB diagnostics, with considerable uncertainty about how available and new tests can best be implemented. Design and methods: The PROSPECT Study is an open, three-arm pragmatic randomised study that will investigate the effectiveness and cost-effectiveness of optimised HIV and TB diagnosis and linkage to care interventions in reducing time to TB diagnosis and prevalence of undiagnosed TB and HIV in primary care in Blantyre, Malawi. Participants (≥ 18 years) attending a primary care clinic with TB symptoms (cough of any duration) will be randomly allocated to one of three groups: (i) standard of care; (ii) optimised HIV diagnosis and linkage; or (iii) optimised HIV and TB diagnosis and linkage. We will test two hypotheses: firstly, whether prompt linkage to HIV care should be prioritised for adults with TB symptoms; and secondly, whether an optimised TB triage testing algorithm comprised of digital chest x-ray evaluated by computer-aided diagnosis software and sputum GeneXpert MTB/Rif can outperform clinician-directed TB screening. The primary trial outcome will be time to TB treatment initiation by day 56, and secondary outcomes will include prevalence of undiagnosed TB and HIV, mortality, quality of life, and cost-effectiveness. Conclusions: The PROSPECT Study will provide urgently-needed evidence under "real-life" conditions to inform clinicians and policy makers on how best to improve TB/HIV diagnosis and treatment in Africa. Clinical trial registration: NCT03519425 (08/05/2018).
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Affiliation(s)
- Peter MacPherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
| | - Emily L Webb
- London School of Hygiene & Tropical Medicine, London, UK
| | - David G. Lalloo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Marriott Nliwasa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
- Helse Nord TB Programme, Department of Microbiology, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Elizabeth Joekes
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Dama Phiri
- Radiology Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Bertie Squire
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal , Canada
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12
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Frimpong-Mansoh RP, Calys-Tagoe BNL, Therson-Coffie EF, Antwi-Agyei KO. Evaluation of the tuberculosis surveillance system in the Ashaiman municipality, in Ghana. Pan Afr Med J 2018; 31:126. [PMID: 31037186 PMCID: PMC6462495 DOI: 10.11604/pamj.2018.31.126.14993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 03/29/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Tuberculosis (TB) was the leading cause of death from an infectious illness globally with an estimated 10.4 million new cases and 1.4 million deaths in 2015. In Ghana, from the 2013 TB prevalence survey conducted by the National Tuberculosis Control Programme, the incidence is estimated as 165 per 100,000 population and a mortality rate of 7.5 per 1,000 infected people. The Tuberculosis surveillance system is part of the general framework of the Integrated Disease Surveillance and Response. This evaluation was to assess whether the system is meeting its set objectives, assess its usefulness and describe its attributes. Methods The TB surveillance system of the Ashaiman municipality was evaluated using Centre for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems 2006. Records review from 2014 to 2016 was done to assess objectives of the system and surveillance data source of 2016 was used to assess attributes. Interviews were conducted at the various levels using semi-structured questionnaire and data analysis done with Epi info 7 and Microsoft Excel to run frequencies and percentages. Results The surveillance system is well structured with standardized data collection tools. The system was found to be useful, though it just partially met its objectives. It was also found to be simple, flexible and fairly stable with average timeliness. It had low acceptability and is not geographically representative. It had low sensitivity of 45/100,000 and a low predictive value positive of 6.6%. Conclusion The surveillance system was found to be useful but partially met its objectives. There is the need to improve the sensitivity, predictive value positive timeliness and acceptability.
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Affiliation(s)
- Rita Patricia Frimpong-Mansoh
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana.,Ashaiman Municipal Health Directorate, Ghana Health Service, Ghana
| | - Benedict Nii Laryea Calys-Tagoe
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana.,Department of Community Health, University of Ghana, School of Public Health-Legon, Ghana
| | - Esi Forewaa Therson-Coffie
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana.,Ashaiman Municipal Health Directorate, Ghana Health Service, Ghana
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13
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Drug targets exploited in Mycobacterium tuberculosis: Pitfalls and promises on the horizon. Biomed Pharmacother 2018; 103:1733-1747. [PMID: 29864964 DOI: 10.1016/j.biopha.2018.04.176] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/24/2018] [Accepted: 04/24/2018] [Indexed: 01/10/2023] Open
Abstract
Tuberculosis is an ever evolving infectious disease that still claims about 1.8 million human lives each year around the globe. Although modern chemotherapy has played a pivotal role in combating TB, the increasing emergence of drug-resistant TB aligned with HIV pandemic threaten its control. This highlights both the need to understand how our current drugs work and the need to develop new and more effective drugs. TB drug discovery is revisiting the clinically validated drug targets in Mycobacterium tuberculosis using whole-cell phenotypic assays in search of better therapeutic scaffolds. Herein, we review the promises of current TB drug regimens, major pitfalls faced, key drug targets exploited so far in M. tuberculosis along with the status of newly discovered drugs against drug resistant forms of TB. New antituberculosis regimens that use lesser number of drugs, require shorter duration of treatment, are equally effective against susceptible and resistant forms of disease, have acceptable toxicity profiles and behave friendly with anti-HIV regimens remains top most priority in TB drug discovery.
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14
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MacPherson P, Webb EL, Lalloo DG, Nliwasa M, Maheswaran H, Joekes E, Phiri D, Squire B, Pai M, Corbett EL. Design and protocol for a pragmatic randomised study to optimise screening, prevention and care for tuberculosis and HIV in Malawi (PROSPECT Study). Wellcome Open Res 2018; 3:61. [PMID: 30542662 PMCID: PMC6259593 DOI: 10.12688/wellcomeopenres.14598.2] [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: 07/24/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Adults seeking diagnosis and treatment for tuberculosis (TB) and HIV in low-resource settings face considerable barriers and have high pre-treatment mortality. Efforts to improve access to prompt TB treatment have been hampered by limitations in TB diagnostics, with considerable uncertainty about how available and new tests can best be implemented. Design and methods: The PROSPECT Study is an open, three-arm pragmatic randomised study that will investigate the effectiveness and cost-effectiveness of optimised HIV and TB diagnosis and linkage to care interventions in reducing time to TB diagnosis and prevalence of undiagnosed TB and HIV in primary care in Blantyre, Malawi. Participants (≥ 18 years) attending a primary care clinic with TB symptoms (cough of any duration) will be randomly allocated to one of three groups: (i) standard of care; (ii) optimised HIV diagnosis and linkage; or (iii) optimised HIV and TB diagnosis and linkage. We will test two hypotheses: firstly, whether prompt linkage to HIV care should be prioritised for adults with TB symptoms; and secondly, whether an optimised TB triage testing algorithm comprised of digital chest x-ray evaluated by computer-aided diagnosis software and sputum GeneXpert MTB/Rif can outperform clinician-directed TB screening. The primary trial outcome will be time to TB treatment initiation by day 56, and secondary outcomes will include prevalence of undiagnosed TB and HIV, mortality, quality of life, and cost-effectiveness. Conclusions: The PROSPECT Study will provide urgently-needed evidence under "real-life" conditions to inform clinicians and policy makers on how best to improve TB/HIV diagnosis and treatment in Africa. Clinical trial registration: NCT03519425 (08/05/2018).
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Affiliation(s)
- Peter MacPherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
| | - Emily L Webb
- London School of Hygiene & Tropical Medicine, London, UK
| | - David G. Lalloo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Marriott Nliwasa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
- Helse Nord TB Programme, Department of Microbiology, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Elizabeth Joekes
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Dama Phiri
- Radiology Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Bertie Squire
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal , Canada
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15
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MacPherson P, Webb EL, Lalloo DG, Nliwasa M, Maheswaran H, Joekes E, Phiri D, Squire B, Pai M, Corbett EL. Design and protocol for a pragmatic randomised study to optimise screening, prevention and care for tuberculosis and HIV in Malawi (PROSPECT Study). Wellcome Open Res 2018; 3:61. [PMID: 30542662 PMCID: PMC6259593 DOI: 10.12688/wellcomeopenres.14598.1] [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] [Accepted: 05/15/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Adults seeking diagnosis and treatment for tuberculosis (TB) and HIV in low-resource settings face considerable barriers and have high pre-treatment mortality. Efforts to improve access to prompt TB treatment have been hampered by limitations in TB diagnostics, with considerable uncertainty about how available and new tests can best be implemented. Design and methods: The PROSPECT Study is an open, three-arm pragmatic randomised study that will investigate the effectiveness and cost-effectiveness of optimised HIV and TB diagnosis and linkage to care interventions in reducing time to TB diagnosis and prevalence of undiagnosed TB and HIV in primary care in Blantyre, Malawi. Participants (≥ 18 years) attending a primary care clinic with TB symptoms (cough of any duration) will be randomly allocated to one of three groups: (i) standard of care; (ii) optimised HIV diagnosis and linkage; or (iii) optimised HIV and TB diagnosis and linkage. We will test two hypotheses: firstly, whether prompt linkage to HIV care should be prioritised for adults with TB symptoms; and secondly, whether an optimised TB triage testing algorithm comprised of digital chest x-ray evaluated by computer-aided diagnosis software and sputum GeneXpert MTB/Rif can outperform clinician-directed TB screening. The primary trial outcome will be time to TB treatment initiation by day 56, and secondary outcomes will include prevalence of undiagnosed TB and HIV, mortality, quality of life, and cost-effectiveness. Conclusions: The PROSPECT Study will provide urgently-needed evidence under "real-life" conditions to inform clinicians and policy makers on how best to improve TB/HIV diagnosis and treatment in Africa. Clinical trial registration: NCT03519425 (08/05/2018).
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Affiliation(s)
- Peter MacPherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
| | - Emily L Webb
- London School of Hygiene & Tropical Medicine, London, UK
| | - David G. Lalloo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Marriott Nliwasa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
- Helse Nord TB Programme, Department of Microbiology, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Elizabeth Joekes
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Dama Phiri
- Radiology Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Bertie Squire
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal , Canada
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16
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Bastard M, Sanchez-Padilla E, du Cros P, Khamraev AK, Parpieva N, Tillyashaykov M, Hayrapetyan A, Kimenye K, Khurkhumal S, Dlamini T, Perez SF, Telnov A, Hewison C, Varaine F, Bonnet M. Outcomes of HIV-infected versus HIV-non-infected patients treated for drug-resistance tuberculosis: Multicenter cohort study. PLoS One 2018. [PMID: 29518098 PMCID: PMC5843270 DOI: 10.1371/journal.pone.0193491] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The emergence of resistance to anti-tuberculosis (DR-TB) drugs and the HIV epidemic represent a serious threat for reducing the global burden of TB. Although data on HIV-negative DR-TB treatment outcomes are well published, few data on DR-TB outcomes among HIV co-infected people is available despite the great public health importance. Methods We retrospectively reported and compared the DR-TB treatment outcomes of HIV-positive and HIV-negative patients treated with an individualized regimen based on WHO guidelines in seven countries: Abkhazia, Armenia, Colombia, Kenya, Kyrgyzstan, Swaziland and Uzbekistan. Results Of the 1,369 patients started DRTB treatment, 809 (59.1%) were multi-drug resistant (MDR-TB) and 418 (30.5%) were HIV-positive. HIV-positive patients were mainly from African countries (90.1%) while HIV-negative originated from Former Soviet Union (FSU) countries. Despite a higher case fatality rate (19.0% vs 9.4%), HIV-positive MDR-TB patients had a 10% higher success rate than HIV-negative patients (64.0% vs 53.2%, p = 0.007). No difference in treatment success was found among polydrug-resistant (PDR-TB) patients. Overall, lost to follow-up rate was much higher among HIV-negative (22.0% vs. 8.4%). Older age and not receiving ART were the only factors associated with unfavorable treatment outcome among HIV-positive patients. Conclusions As already known for HIV-negative patients, success rate of DR-TB HIV-positive patients remains low and requires more effective DR-TB regimen using new drugs also suitable to HIV-infected patients on ART. The study also confirms the need of ART introduction in HIV co-infected patients.
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Affiliation(s)
| | | | | | - Atadjan Karimovich Khamraev
- Teaching Assistant of the Department of Public Health Administration, Nukus branch of Tashkent Pediatric Medical Institute, Nukus, Uzbekistan
| | | | | | | | - Kamene Kimenye
- Programmatic Management of Drug resistant Tuberculosis, Nairobi, Kenya
| | | | - Themba Dlamini
- MoH-TB National Control Program National Manager, Mbanane, Swaziland
| | - Santiago Fadul Perez
- National Public Health Institute, Respiratory disease department, Bogota, Colombia
| | - Alex Telnov
- Médecins Sans Frontières, Geneva, Switzerland
| | | | | | - Maryline Bonnet
- Epicentre, Paris, France
- Unité Mixte Internationale UMI233-U1175, Institute of Research for Development, Montpelier, France
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Tonganibeia A, Harries AD, Merilles OEA, Tarataake T, Tiira T, Kienene T. Impact of Laboratory Practice Changes on the Diagnosis of Tuberculosis with the Introduction of Xpert MTB/RIF in Kiribati. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2018; 77:30-34. [PMID: 29435388 PMCID: PMC5801526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Republic of Kiribati, Central Pacific, has the largest tuberculosis epidemic in the region. There is a national tuberculosis control program, which has used smear microscopy for acid-fast bacilli as the main diagnostic tool for many years. In 2015, an Xpert MTB/RIF machine was procured and became functional within the tuberculosis hospital. The aim of this cross-sectional study, using routinely collected data, was to determine the effects of introducing Xpert MTB/RIF on laboratory smear microscopy practices and the pattern of registered tuberculosis cases. Between February 2015 and January 2016, there were 220 Xpert MTB/RIF assays performed with 6.4% errors and 15% detection of Mycobacterium tuberculosis: one patient showed rifampicin-resistance. One year before and after introducing Xpert MTB/RIF, the number of presumptive tuberculosis patients increased by 9% from 2,138 to 2,322. There were no changes in demographic characteristics, smear-positive results, or acid-fast bacilli grade between the two periods. The number of specimens cultured for Mycobacterium tuberculosis significantly declined from 638 to zero, with 76 positive MTB cultures before and none after introducing Xpert MTB/RIF. There was a significant change in the profile of registered tuberculosis cases with more children (34% versus 21%) and fewer bacteriologically-confirmed cases (29% versus 43%) - P < .001. Since the deployment of Xpert MTB/RIF in Kiribati, there have been a small number of assays performed and this has been associated with no adverse effects on smear microscopy, a stoppage in mycobacterial cultures, and a change in the types and categories of diagnosed tuberculosis.
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Affiliation(s)
- Alfred Tonganibeia
- Ministry of Health and Medical Services, Kiribati (AT, TTarataake, TTiira, TK)
- International Union Against Tuberculosis and Lung Disease, Paris, France and London School of Hygiene and Tropical Medicine, London, UK (ADH)
- London School of Hygiene and Tropical Medicine, London, UK
- The Pacific Community, Noumea, New Caledonia (OEAM)
| | - Anthony D Harries
- Ministry of Health and Medical Services, Kiribati (AT, TTarataake, TTiira, TK)
- International Union Against Tuberculosis and Lung Disease, Paris, France and London School of Hygiene and Tropical Medicine, London, UK (ADH)
- London School of Hygiene and Tropical Medicine, London, UK
- The Pacific Community, Noumea, New Caledonia (OEAM)
| | - Onofre Edwin A Merilles
- Ministry of Health and Medical Services, Kiribati (AT, TTarataake, TTiira, TK)
- International Union Against Tuberculosis and Lung Disease, Paris, France and London School of Hygiene and Tropical Medicine, London, UK (ADH)
- London School of Hygiene and Tropical Medicine, London, UK
- The Pacific Community, Noumea, New Caledonia (OEAM)
| | - Tekaibeti Tarataake
- Ministry of Health and Medical Services, Kiribati (AT, TTarataake, TTiira, TK)
- International Union Against Tuberculosis and Lung Disease, Paris, France and London School of Hygiene and Tropical Medicine, London, UK (ADH)
- London School of Hygiene and Tropical Medicine, London, UK
- The Pacific Community, Noumea, New Caledonia (OEAM)
| | - Teatao Tiira
- Ministry of Health and Medical Services, Kiribati (AT, TTarataake, TTiira, TK)
- International Union Against Tuberculosis and Lung Disease, Paris, France and London School of Hygiene and Tropical Medicine, London, UK (ADH)
- London School of Hygiene and Tropical Medicine, London, UK
- The Pacific Community, Noumea, New Caledonia (OEAM)
| | - Takeieta Kienene
- Ministry of Health and Medical Services, Kiribati (AT, TTarataake, TTiira, TK)
- International Union Against Tuberculosis and Lung Disease, Paris, France and London School of Hygiene and Tropical Medicine, London, UK (ADH)
- London School of Hygiene and Tropical Medicine, London, UK
- The Pacific Community, Noumea, New Caledonia (OEAM)
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18
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Ng'ambi W, Gugsa S, Tweya H, Girma B, Kanyerere H, Dambe I, Babaye Y, Mpunga J, Phiri S. Characteristics and management of presumptive tuberculosis in public health facilities in Malawi, 2014-2016. Public Health Action 2017; 7:282-288. [PMID: 29584793 PMCID: PMC5753781 DOI: 10.5588/pha.17.0050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/29/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Public health facilities providing tuberculosis (TB) and human immunodeficiency virus (HIV) services in Malawi. Objectives: Using routinely collected health service delivery data to describe trends in HIV ascertainment and use of the Xpert® MTB/RIF assay to diagnose TB among HIV-positive presumptive TB cases. Design: This was an implementation study of presumptive TB cases who sought care from 21 facilities between April 2014 and June 2016. Descriptive statistics were used to summarise patient, facility and service level characteristics. Results: Of 28 567 presumptive TB cases analysed, 23 198 (81%) had known HIV status. The proportion of ascertained HIV status in presumptive TB cases increased over the study period. HIV prevalence was 49%, with 73% of HIV-positive presumptive TB cases on antiretroviral therapy. Access to Xpert ranged between 37% and 63% per quarter among HIV-positive presumptive TB patients with smear-negative sputum results. Of 7829 patients with documented Xpert results, 68% were HIV-positive. Conclusion: After the introduction of registers with HIV-related variables, HIV ascertainment among presumptive TB cases increased over time. Access to Xpert was suboptimal among HIV-positive presumptive TB cases. Further collaboration between national TB and HIV programmes may facilitate increased use of Xpert for HIV-positive patients with presumptive TB who seek care in public health facilities.
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Affiliation(s)
- W Ng'ambi
- International Training and Education Center for Health (I-TECH), Lilongwe, Malawi
- Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
| | - S Gugsa
- Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
- I-TECH, Seattle, Washington, USA
| | - H Tweya
- Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - B Girma
- International Training and Education Center for Health (I-TECH), Lilongwe, Malawi
- National Tuberculosis Control Programme, Lilongwe, Malawi
| | - H Kanyerere
- National Tuberculosis Control Programme, Lilongwe, Malawi
| | - I Dambe
- National Tuberculosis Control Programme, Lilongwe, Malawi
| | - Y Babaye
- International Training and Education Center for Health (I-TECH), Lilongwe, Malawi
| | - J Mpunga
- National Tuberculosis Control Programme, Lilongwe, Malawi
| | - S Phiri
- Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Public Health, College of Medicine, School of Public Health and Family Medicine, University of Malawi, Blantyre, Malawi
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19
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Pinto CM, Carvalho AR. The HIV/TB coinfection severity in the presence of TB multi-drug resistant strains. ECOLOGICAL COMPLEXITY 2017. [DOI: 10.1016/j.ecocom.2017.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Reduction of HIV-associated excess mortality by antiretroviral treatment among tuberculosis patients in Kenya. PLoS One 2017; 12:e0188235. [PMID: 29145454 PMCID: PMC5690617 DOI: 10.1371/journal.pone.0188235] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/05/2017] [Indexed: 12/01/2022] Open
Abstract
Background Mortality from TB continues to be a global public health challenge. TB ranks alongside Human Immunodeficiency Virus (HIV) as the leading infectious causes of death globally. HIV is a major driver of TB related morbidity and mortality while TB is the leading cause of mortality among people living with HIV/AIDS. We sought to determine excess mortality associated with HIV and the effect of antiretroviral therapy on reducing mortality among tuberculosis patients in Kenya. Methods We conducted a retrospective analysis of Kenya national tuberculosis program data of patients enrolled from 2013 through 2014. We used direct standardization to obtain standardized mortality ratios for tuberculosis patients compared with the general population. We calculated the population attributable fraction of tuberculosis deaths due to HIV based on the standardized mortality ratio for deaths among TB patients with HIV compared to TB patients without HIV. We used Cox proportional hazards regression for assessing risk factors for mortality. Results Of 162,014 patients included in the analysis, 6% died. Mortality was 10.6 (95% CI: 10.4–10.8) times higher among TB patients than the general population; 42% of deaths were attributable to HIV infection. Patients with HIV who were not receiving ART had an over four-fold risk of death compared to patients without HIV (aHR = 4.2, 95% CI 3.9–4.6). In contrast, patients with HIV who were receiving ART had only 2.6 times the risk of death (aHR = 2.6, 95% CI 2.5–2.7). Conclusion HIV was a significant contributor to TB-associated deaths in Kenya. Mortality among HIV-infected individuals was higher among those not on ART than those on ART. Early initiation of ART among HIV infected people (a “test and treat” approach) should further reduce TB-associated deaths.
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Baghaei P, Tabarsi P, Moniri A, Marjani M, Farnia P, Jabbehdari S, Velayati AA. Distribution scheme of antituberculosis drug resistance among HIV patients in a referral centre over 10 years. J Glob Antimicrob Resist 2017; 11:116-119. [PMID: 28739225 DOI: 10.1016/j.jgar.2017.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 04/18/2017] [Accepted: 06/29/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Antituberculosis drug resistance is increasing among tuberculosis (TB) patients globally, particularly in those who are human immunodeficiency virus (HIV)-positive. The aim of this study was to determine the pattern of anti-TB drug resistance in these patients in an effort to improve successful treatment outcomes with a proper regimen. METHODS A cross-sectional study was conducted on adult TB/HIV co-infected patients from 2005-2015. The pattern of anti-TB drug resistance was evaluated among HIV-positive patients with and without a history of TB treatment. Categorisation was made as follows: isoniazid (INH)-resistant; rifampicin (RIF)-resistant; or multidrug-resistant (MDR). RESULTS A total of 52 patients were enrolled in this study (median age 38 years). Among the 52 patients, 18 (34.6%) were MDR-TB patients and the rest were monoresistant TB (resistant either to INH or RIF). INH resistance was the most common resistance pattern (36.5%) noted among patients and was significantly associated with new TB cases (69% vs. 31%; P=0.01). During TB treatment, 3/48 patients (6.3%) failed treatment and 11/48 (22.9%) died. Patients with MDR-TB were more likely to die during treatment (44.4% vs. 10%; P=0.011). CONCLUSIONS Any drug resistance in previously treated TB cases among HIV-infected patients remains high. The risk of death is increasing in MDR-TB/HIV co-infected patients.
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Affiliation(s)
- Parvaneh Baghaei
- Clinical Tuberculosis and Epidemiology Research Center (CTERC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center (CTERC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Afshin Moniri
- Clinical Tuberculosis and Epidemiology Research Center (CTERC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center (CTERC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parissa Farnia
- Mycobacteriology Research Center (MRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sayena Jabbehdari
- Students' Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Velayati
- Clinical Tuberculosis and Epidemiology Research Center (CTERC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; Mycobacteriology Research Center (MRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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22
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Shenoi SV, Moll AP, Brooks RP, Kyriakides T, Andrews L, Kompala T, Upadhya D, Altice FL, Eksteen FJ, Friedland G. Integrated Tuberculosis/Human Immunodeficiency Virus Community-Based Case Finding in Rural South Africa: Implications for Tuberculosis Control Efforts. Open Forum Infect Dis 2017; 4:ofx092. [PMID: 28695145 PMCID: PMC5499582 DOI: 10.1093/ofid/ofx092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/02/2017] [Indexed: 11/18/2022] Open
Abstract
Background Intensive case finding is endorsed for tuberculosis (TB) control in high-risk populations. Novel case-finding strategies are needed in hard-to-reach rural populations with high prevalence of TB and human immunodeficiency virus (HIV). Methods We performed community-based integrated HIV and TB intensive case finding in a rural South African subdistrict from March 2010 to June 2012. We offered TB symptom screening, sputum collection for microbiologic diagnosis, rapid fingerstick HIV testing, and phlebotomy for CD4 cell count. We recorded number of cases detected and calculated population-level rates and number needed to screen (NNS) for drug-susceptible and -resistant TB. Results Among 5615 persons screened for TB at 322 community sites, 91.2% accepted concurrent HIV testing, identifying 510 (9.9%) HIV-positive individuals with median CD4 count of 382 cells/mm3 (interquartile range = 260–552). Tuberculosis symptoms were reported by 2049 (36.4%), and sputum was provided by 1033 (18.4%). Forty-one (4.0%) cases of microbiologically confirmed TB were detected for an overall case notification rate of 730/100000 (NNS = 137); 11 (28.6%) were multidrug-resistant or extensively drug-resistant TB. Only 5 (12.2%) TB cases were HIV positive compared with an HIV coinfection rate of 64% among contemporaneously registered TB cases (P = .001). Conclusion Community-based integrated intensive case finding is feasible and is high yield for drug-susceptible and -resistant TB and HIV in rural South Africa. Human immunodeficiency virus–negative tuberculosis predominated in this community sample, suggesting a distinct TB epidemiology compared with cases diagnosed in healthcare facilities. Increasing HIV/TB integrated community-based efforts and other strategies directed at both HIV-positive and HIV-negative tuberculosis may contribute to TB elimination in high TB/HIV burden regions.
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Affiliation(s)
- Sheela V Shenoi
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, and
| | - Anthony P Moll
- Church of Scotland Hospital, and.,Philanjalo NGO, Tugela Ferry, South Africa
| | - Ralph P Brooks
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, and
| | - Tassos Kyriakides
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Laurie Andrews
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, and
| | - Teja Kompala
- Department of Internal Medicine, University of California, San Francisco; and
| | - Devesh Upadhya
- Department of Internal Medicine, Baylor University School of Medicine, Texas
| | - Frederick L Altice
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, and
| | | | - Gerald Friedland
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, and
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Oren E, Bell ML, Garcia F, Perez-Velez C, Gerald LB. Promoting adherence to treatment for latent TB infection through mobile phone text messaging: study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2017; 3:15. [PMID: 28293431 PMCID: PMC5346839 DOI: 10.1186/s40814-017-0128-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/02/2017] [Indexed: 12/31/2022] Open
Abstract
Background An estimated two billion people, over one third of the world’s population, have latent infection with Mycobacterium tuberculosis (LTBI). Patient adherence to LTBI treatment is currently poor given that individuals show no symptoms of illness and may not feel that they are at risk of developing active tuberculosis (TB). Short text messages can serve as a simple reminder to take medications and address barriers to adherence such as forgetfulness and lack of social support. Methods/design We aim to determine the feasibility and acceptability of text reminders for improving adherence in latent TB patients using a randomized controlled single-blinded trial, measuring adherence through an increase in treatment completion rates. Forty adult LTBI participants will be randomized to either text messages plus phone call reminders or phone call reminders only (usual care). Recruitment, retention, and study acceptability will be assessed as primary outcomes. Discussion This pilot study will examine the feasibility of using text messaging for increasing adherence to treatment for latent tuberculosis infection. The study will allow for evaluation of process measures and challenges and development of a model for scaling up an effectiveness trial for increasing treatment adherence. Trial registration NCT02690818 (Clinical Trials.gov) Electronic supplementary material The online version of this article (doi:10.1186/s40814-017-0128-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eyal Oren
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, 1295 N. Martin Avenue, P.O. Box 245211, Tucson, AZ 85724 USA.,Asthma and Airways Disease Research Center, University of Arizona Health Sciences, Tucson, AZ USA
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, 1295 N. Martin Avenue, P.O. Box 245211, Tucson, AZ 85724 USA
| | - Francisco Garcia
- Department of Health Promotion Sciences, College of Public Health, University of Arizona, 1295 N. Martin Avenue, P.O. Box 245211, Tucson, AZ 85724 USA.,Pima County Health Department, University of Arizona Health Sciences, Tucson, AZ USA
| | - Carlos Perez-Velez
- Pima County Health Department, University of Arizona Health Sciences, Tucson, AZ USA
| | - Lynn B Gerald
- Department of Health Promotion Sciences, College of Public Health, University of Arizona, 1295 N. Martin Avenue, P.O. Box 245211, Tucson, AZ 85724 USA.,Asthma and Airways Disease Research Center, University of Arizona Health Sciences, Tucson, AZ USA
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Belete W, Demissie M, Gebreegziabher A, Kassa D, Gebre-Michael G, Mesfin G, Kebede A, Kumsa A, Fekadu L, Kebede B, Mikru F, Hailu K, Yilma A, Kebede E, Hassen I, Bekele A, Wondimagegne G, Abate K, Fiseha D, Shimeles E, Assefa Y. Assessment of national tuberculosis and HIV collaborative program implementation status in health care settings of Ethiopia. ETHIOPIAN JOURNAL OF PUBLIC HEALTH AND NUTRITION 2017; 1:93-98. [PMID: 31531414 PMCID: PMC6748620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Ethiopia has adopted the World Health Organization recommendation for TB and HIV collaborative activities since 2004. These collaborative activities have been scaled up in a phased manner and covered large number of health facilities across the nation. However, there is scarcity of information on implementation of these collaborative activities in Ethiopia. OBJECTIVE To assess the status of implementation of TB and HIV collaborative activities in health facility settings of Ethiopia. METHODS A cross sectional study mainly quantitative supplemented by qualitative methods was undertaken from May 10 to July 10, 2014 in 132 selected health facilities. Statistical analysis was performed using SPSS version 20. RESULT About 81% of the respondents in the selected health facilities reported the screening of People Living with HIV in care for TB at every follow up visit, whereas, only 28.7% of those health facilities reported the screening of PLWHIV for TB at enrolment to HIV chronic care. About half of the public health facilities assessed were not implementing Isoniazid Preventive Therapy and only 18.2% of eligible clients were getting this Preventive Therapy. Among the co-infected patients, 32% were not linked to chronic care services and 45.3% were not getting ART during TB treatment. On the other hand, about two thirds of the co-infected patients are getting the Cotrimoxazole Prophylaxis Therapy. CONCLUSION Most of anti-TB and HIV collaborative activities were not implemented as expected in the health facilities. Thus it needs integration from the ministry to the health facilities level in order to improve the collaborative activities.
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Affiliation(s)
- Wudinesh Belete
- Ethiopian Public Health Institute, P.O. Box 1242, Addis
Ababa
| | | | | | - Desta Kassa
- Ethiopian Public Health Institute, P.O. Box 1242, Addis
Ababa
| | | | - Getnet Mesfin
- Ethiopian Public Health Institute, P.O. Box 1242, Addis
Ababa
| | - Abebaw Kebede
- Ethiopian Public Health Institute, P.O. Box 1242, Addis
Ababa
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yibeltal Assefa
- Ethiopian Public Health Institute, P.O. Box 1242, Addis
Ababa
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Oren E, Fiero MH, Barrett E, Anderson B, Nuῆez M, Gonzalez-Salazar F. Detection of latent tuberculosis infection among migrant farmworkers along the US-Mexico border. BMC Infect Dis 2016; 16:630. [PMID: 27809805 PMCID: PMC5096297 DOI: 10.1186/s12879-016-1959-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/25/2016] [Indexed: 12/22/2022] Open
Abstract
Background Migrant farmworkers are among the highest-risk populations for latent TB infection (LTBI) in the United States with numerous barriers to healthcare access and increased vulnerability to infectious diseases. LTBI is usually diagnosed on the border using the tuberculin skin test (TST). QuantiFERON-TB Gold In-Tube (QFT-GIT) also measures immune response against specific Mycobacterium tuberculosis antigens. The objective of this study is to assess the comparability of TST and QFT-GIT to detect LTBI among migrant farmworkers on the border, as well as to examine the effects of various demographic and clinical factors on test positivity. Methods Participants were recruited using mobile clinics on the San Luis US-Mexico border and tested with QFT-GIT and TST. Demographic profiles and clinical histories were collected. Kappa coefficients assessed agreement between TST and QFT-GIT using various assay cutoffs. Logistic regression examined factors associated with positive TST or QFT-GIT results. Results Of 109 participants, 59 of 108 (55 %) were either TST (24/71, 34 %) or QFT-GIT (52/106, 50 %) positive. Concordance between TST and QFT-GIT was fair (71 % agreement, ĸ = 0.38, 95 % CI: 0.15, 0.61). Factors associated with LTBI positivity included smoking (OR = 1.26, 95 % CI–1.01–1.58) and diabetes/high blood sugar (OR = 0.70, 95 % CI = 0.51–0.98). Discussion Test concordance between the two tests was fair, with numerous discordant results observed. Greater proportion of positives detected using QFT-GIT may help avoid LTBI under-diagnosis. Assessment of LTBI status on the border provides evidence whether QFT-GIT should replace the TST in routine practice, as well as identifies risk factors for LTBI among migrant populations. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1959-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Oren
- Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., P.O. Box 245211, Tucson, AZ, 85724, USA.
| | - M H Fiero
- Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., P.O. Box 245211, Tucson, AZ, 85724, USA
| | - E Barrett
- Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., P.O. Box 245211, Tucson, AZ, 85724, USA
| | - B Anderson
- Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., P.O. Box 245211, Tucson, AZ, 85724, USA
| | - M Nuῆez
- Yuma County Health Services District, 2200 W 28th St, Yuma, AZ, 85364, USA
| | - F Gonzalez-Salazar
- Mexican Social Security Institute, Juárez, México City, Mexico.,University of Monterrey, Avenida Ignacio Morones Prieto 4500 Pte., Jesús M. Garza, 66238, San Pedro Garza García, NL, Mexico
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Mueller-Using S, Feldt T, Sarfo FS, Eberhardt KA. Factors associated with performing tuberculosis screening of HIV-positive patients in Ghana: LASSO-based predictor selection in a large public health data set. BMC Public Health 2016; 16:563. [PMID: 27412114 PMCID: PMC4944423 DOI: 10.1186/s12889-016-3239-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/28/2016] [Indexed: 01/20/2023] Open
Abstract
Background The purpose of this study is to propose the Least Absolute Shrinkage and Selection Operators procedure (LASSO) as an alternative to conventional variable selection models, as it allows for easy interpretation and handles multicollinearities. We developed a model on the basis of LASSO-selected parameters in order to link associated demographical, socio-economical, clinical and immunological factors to performing tuberculosis screening in HIV-positive patients in Ghana. Methods Applying the LASSO method and multivariate logistic regression analysis on a large public health data set, we selected relevant predictors related to tuberculosis screening. Results One Thousand Ninety Five patients infected with HIV were enrolled into this study with 691 (63.2 %) of them having tuberculosis screening documented in their patient folders. Predictors found to be significantly associated with performance of tuberculosis screening can be classified into factors related to the clinician’s perception of the clinical state, as well as those related to PLHIV’s awareness. These factors include newly diagnosed HIV infections (n = 354 (32.42 %), aOR 1.84), current CD4+ T cell count (aOR 0.92), non-availability of HIV type (n = 787 (72.07 %), aOR 0.56), chronic cough (n = 32 (2.93 %), aOR 5.07), intake of co-trimoxazole (n = 271 (24.82 %), aOR 2.31), vitamin supplementation (n = 220 (20.15 %), aOR 2.64) as well as the use of mosquito bed nets (n = 613 (56.14 %), aOR 1.53). Conclusions Accelerated TB screening among newly diagnosed HIV-patients indicates that application of the WHO screening form for intensifying tuberculosis case finding among HIV-positive individuals in resource-limited settings is increasingly adopted. However, screening for TB in PLHIV is still impacted by clinician’s perception of patient’s health state and PLHIV’s health awareness. Education of staff, counselling of PLHIV and sufficient financing are needed for further improvement in implementation of TB screening for all PLHIV. The LASSO approach proved a convenient method for automatic variable selection in a large public health data set that requires efficient and fast algorithms. Trials registration ClinicalTrials.gov NCT01897909 (July 5, 2013).
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Affiliation(s)
- Susanne Mueller-Using
- Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359, Hamburg, Germany.,Hamburg Institute of International Economics, Heimhuder Str. 71, 20148, Hamburg, Germany
| | - Torsten Feldt
- Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359, Hamburg, Germany.,Clinic of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of the Heinrich Heine University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Fred Stephen Sarfo
- Kwame Nkrumah University of Science and Technology, University Post Office - KNUST, Kumasi, Ghana.,Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana
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Mchunu G, van Griensven J, Hinderaker SG, Kizito W, Sikhondze W, Manzi M, Dlamini T, Harries AD. High mortality in tuberculosis patients despite HIV interventions in Swaziland. Public Health Action 2016; 6:105-10. [PMID: 27358803 PMCID: PMC4913672 DOI: 10.5588/pha.15.0081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/23/2016] [Indexed: 12/12/2022] Open
Abstract
SETTING All health facilities providing tuberculosis (TB) care in Swaziland. OBJECTIVE To describe the impact of human immunodeficiency virus (HIV) interventions on the trend of TB treatment outcomes during 2010-2013 in Swaziland; and to describe the evolution in TB case notification, the uptake of HIV testing, antiretroviral therapy (ART) and cotrimoxazole preventive therapy (CPT), and the proportion of TB-HIV co-infected patients with adverse treatment outcomes, including mortality, loss to follow-up and treatment failure. DESIGN A retrospective descriptive study using aggregated national TB programme data. RESULTS Between 2010 and 2013, TB case notifications in Swaziland decreased by 40%, HIV testing increased from 86% to 96%, CPT uptake increased from 93% to 99% and ART uptake among TB patients increased from 35% to 75%. The TB-HIV co-infection rate remained around 70% and the proportion of TB-HIV cases with adverse outcomes decreased from 36% to 30%. Mortality remained high, at 14-16%, over the study period, and anti-tuberculosis treatment failure rates were stable over time (<5%). CONCLUSION Despite high CPT and ART uptake in TB-HIV patients, mortality remained high. Further studies are required to better define high-risk patient groups, understand the reasons for death and design appropriate interventions.
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Affiliation(s)
- G. Mchunu
- National TB Control Programme, Ministry of Health, Manzini, Swaziland
| | | | | | - W. Kizito
- Médecins Sans Frontières (MSF), Operational Centre Brussels, Kenya Mission, Nairobi, Kenya
| | - W. Sikhondze
- National TB Control Programme, Ministry of Health, Manzini, Swaziland
| | - M. Manzi
- MSF, Medical Department, Operational Research Unit, Luxembourg
| | - T. Dlamini
- National TB Control Programme, Ministry of Health, Manzini, Swaziland
| | - A. D. Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
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Baghaei P, Esmaeili S, Farshidpour M, Javanmard P, Marjani M, Moniri A, Nemati K, Tabarsi P. Diagnosing active and latent tuberculosis among Iranian HIV-infected patients. CLINICAL RESPIRATORY JOURNAL 2016; 12:62-67. [PMID: 27059900 DOI: 10.1111/crj.12479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 02/06/2016] [Accepted: 03/31/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To screen for Tuberculosis (TB) in human immunodeficiency virus (HIV) people in an effort to improve early TB diagnosis and reduce TB transmission. METHODS A prospective study was conducted on adult HIV people from 2008 to 2011. Three samples of sputum, cell blood count, tuberculin skin test (TST) and chest X-ray were obtained from all patients. The characteristics of HIV patients with TB and HIV patients without TB were compared to each other. RESULTS Of the 154 HIV patients included, 58 (38%) had tuberculosis with a mean CD4 cell count of 68 cells/mm3 . Active TB was found in 56 (47%) patients with a history of intravenous drug use. Cough (OR = 3.1, 95% CI 1.2-7.79), positive TST (OR = 8.15, 95% CI 3.28-20.25) and an abnormal chest X-ray (OR = 5.1, 95% CI 1.84-14.2) were the predicting factors for detecting active TB among HIV patients. The sensitivity and specificity of a combination of any symptoms with chest X-ray, smear, TST or all of these were 96.5% and 86.5%, respectively. CD4 cell count <100 (OR = 2.67; 95% CI 1.23-5.78) and smoking (OR = 13.4; 95% CI 3.04-59.4) remained independently associated with TB in a multivariate analysis. CONCLUSION There was a high prevalence of TB within the HIV population. Screening for TB among these patients can be carried out at every clinic or health facility using a combination of symptoms, TST, chest X-ray and smear sample.
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Affiliation(s)
- Parvaneh Baghaei
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahrbanou Esmaeili
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maham Farshidpour
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pedram Javanmard
- Department of Internal Medicine, SUNY Stony Brook University, Stony Brook, NY, USA
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Moniri
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kambiz Nemati
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nusbaum RJ, Calderon VE, Huante MB, Sutjita P, Vijayakumar S, Lancaster KL, Hunter RL, Actor JK, Cirillo JD, Aronson J, Gelman BB, Lisinicchia JG, Valbuena G, Endsley JJ. Pulmonary Tuberculosis in Humanized Mice Infected with HIV-1. Sci Rep 2016; 6:21522. [PMID: 26908312 PMCID: PMC4808832 DOI: 10.1038/srep21522] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/26/2016] [Indexed: 11/09/2022] Open
Abstract
Co-infection with HIV increases the morbidity and mortality associated with tuberculosis due to multiple factors including a poorly understood microbial synergy. We developed a novel small animal model of co-infection in the humanized mouse to investigate how HIV infection disrupts pulmonary containment of Mtb. Following dual infection, HIV-infected cells were localized to sites of Mtb-driven inflammation and mycobacterial replication in the lung. Consistent with disease in human subjects, we observed increased mycobacterial burden, loss of granuloma structure, and increased progression of TB disease, due to HIV co-infection. Importantly, we observed an HIV-dependent pro-inflammatory cytokine signature (IL-1β, IL-6, TNFα, and IL-8), neutrophil accumulation, and greater lung pathology in the Mtb-co-infected lung. These results suggest that in the early stages of acute co-infection in the humanized mouse, infection with HIV exacerbates the pro-inflammatory response to pulmonary Mtb, leading to poorly formed granulomas, more severe lung pathology, and increased mycobacterial burden and dissemination.
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Affiliation(s)
| | | | | | - Putri Sutjita
- University of Texas Medical Branch, Galveston, TX 77555, USA
| | | | | | - Robert L Hunter
- University of Texas-Houston Health Science Center, Houston, TX 77030, USA
| | - Jeffrey K Actor
- University of Texas-Houston Health Science Center, Houston, TX 77030, USA
| | | | - Judith Aronson
- University of Texas Medical Branch, Galveston, TX 77555, USA
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Oren E, Alatorre-Izaguirre G, Vargas-Villarreal J, Moreno-Treviño MG, Garcialuna-Martinez J, Gonzalez-Salazar F. Interferon Gamma-Based Detection of Latent Tuberculosis Infection in the Border States of Nuevo Leon and Tamaulipas, Mexico. Front Public Health 2015; 3:220. [PMID: 26484340 PMCID: PMC4588115 DOI: 10.3389/fpubh.2015.00220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 09/17/2015] [Indexed: 01/26/2023] Open
Abstract
Nearly one-third of the world’s population is infected with latent tuberculosis (LTBI). Tuberculosis (TB) rates in the border states are higher than national rates in both the US and Mexico, with the border accounting for 30% of total registered TB cases in both countries. However, LTBI rates in the general population in Mexican border states are unknown. In this region, LTBI is diagnosed using the tuberculin skin test (TST). New methods of detection more specific than TST have been developed, although there is currently no gold standard for LTBI detection. Our objective is to demonstrate utility of the Quantiferon TB gold In-Tube (QFT-GIT) test compared with the TST to detect LTBI among border populations. This is an observational, cross-sectional study carried out in border areas of the states of Nuevo Leon and Tamaulipas, Mexico. Participants (n = 210) provided a TST and blood sample for the QFT-GIT. Kappa coefficients assessed the agreement between TST and QFT-GIT. Participant characteristics were compared using Fisher exact tests. Thirty-eight percent of participants were diagnosed with LTBI by QFT-GIT. The proportion of LTBI detected using QFT-GIT was almost double [38% (79/210)] that found by TST [19% (39/210)] (P < 0.001). Concordance between TST and QFT-GIT was low (kappa = 0.37). We recommend further studies utilizing the QFT-GIT test to detect LTBI among border populations.
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Affiliation(s)
- Eyal Oren
- Division of Epidemiology and Biostatistics, University of Arizona , Tucson, AZ , USA
| | | | | | | | | | - Francisco Gonzalez-Salazar
- Health Division, Basic Sciences, University of Monterrey , San Pedro Garza Garcia , Mexico ; Northeast Biomedical Research, Mexican Social Security Institute , Monterrey , Mexico
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Zenner D, Abubakar I, Conti S, Gupta RK, Yin Z, Kall M, Kruijshaar M, Rice B, Thomas HL, Pozniak A, Lipman M, Delpech V. Impact of TB on the survival of people living with HIV infection in England, Wales and Northern Ireland. Thorax 2015; 70:566-73. [PMID: 25805209 DOI: 10.1136/thoraxjnl-2014-206452] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 02/18/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The impact of TB disease on survival in people living with HIV in high resource settings is not well documented in the antiretroviral treatment (ART) era. We calculated TB incidence rates and compared the mortality of persons with and without HIV-TB in a UK HIV cohort in the post-ART era, to determine the impact of HIV-TB on survival in the UK. METHODS We linked the national cohort of persons (aged ≥15 years) diagnosed with HIV between 2000 and 2008 in England, Wales and Northern Ireland with the national TB register and deaths from the Office of National Statistics. We compared all-cause and AIDS-specific mortality in patients with and without TB by estimating HRs using Cox regression modelling allowing for potential predictors. RESULTS Overall, 3188 (7.2%) individuals developed TB infection among a cohort of 44 050 HIV-diagnosed persons and 149 663 person-years. The cumulative TB incidence rate was 2.13 per 100 person-years with a spike within the first 6 months after HIV diagnosis. TB coinfected patients comprised 18% of the 1880 deaths during follow-up and 79% of deaths (n=967) in the year following HIV diagnosis. TB coinfection (HR 4.77, 95% CI 4.11 to 5.54) was significantly associated with increased all-cause mortality. Analysis of AIDS-related survival showed similar results. DISCUSSION The unexpected high mortality in patients with HIV-TB in a population with good healthcare access and ART availability highlights the importance of improving active and latent TB case-finding among patients with HIV, and HIV-testing among patients with TB, to ensure appropriate and prompt treatment initiation for both diseases.
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Affiliation(s)
- Dominik Zenner
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK Research Department of Infection and Population Health, University College London, London, UK
| | - Ibrahim Abubakar
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK Research Department of Infection and Population Health, University College London, London, UK
| | - Stefano Conti
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Rishi K Gupta
- Division of Medicine, University College London, London, UK
| | - Zheng Yin
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Meaghan Kall
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Michelle Kruijshaar
- Erasmus MC University Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Brian Rice
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - H Lucy Thomas
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Anton Pozniak
- Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK
| | - Marc Lipman
- Division of Medicine, University College London, London, UK
| | - Valerie Delpech
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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Mycobacterium tuberculosis-specific CD8+ T cell recall in convalescing TB subjects with HIV co-infection. Tuberculosis (Edinb) 2014; 93 Suppl:S60-5. [PMID: 24388651 DOI: 10.1016/s1472-9792(13)70012-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Memory T cell populations recover following phase I chemotherapy for tuberculosis (TB) and augment the effectiveness of antibiotics during the continuation phase of treatment. For those with human immunodeficiency virus (HIV), the CD8(+)T cells may have an especially important role in host defense to Mycobacterium tuberculosis (M.tb) as CD4(+)T cell function and/or numbers decline. Here we performed a preliminary study to investigate the impact of HIV infection status on CD8(+)T cell effector function during the convalescent TB period. Peripheral blood samples from convalescent HIV(+) and HIV(-) TB subjects were used to determine CD4(+)T cell count and monitor antigen-specific CD8(+) T cell activation of effector function (lymphoproliferation, IFN-γ, granulysin) in response to M.tb antigen. Our preliminary results suggest that HIV co-infection is associated with moderate suppression of the M.tb-specific memory CD8(+)T cell compartment in many subjects convalescent for TB. Interestingly, highly activated CD8(+)T cells were observed in recall experiments using peripheral blood from several HIV+ subjects that had low (<200 cells/mm(3)) CD4(+)T cell counts. Further investigation may provide important information for development of novel approaches to target M.tb-specific CD8(+)T cell memory to protect against TB in HIV-endemic regions.
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Safety and immunogenicity of the M72/AS01 candidate tuberculosis vaccine in HIV-infected adults on combination antiretroviral therapy: a phase I/II, randomized trial. AIDS 2014; 28:1769-81. [PMID: 24911353 DOI: 10.1097/qad.0000000000000343] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Tuberculosis (TB) is highly prevalent among HIV-infected people, including those receiving combination antiretroviral therapy (cART), necessitating a well tolerated and efficacious TB vaccine for these populations. We evaluated the safety and immunogenicity of the candidate TB vaccine M72/AS01 in adults with well controlled HIV infection on cART. DESIGN A randomized, observer-blind, controlled trial (NCT00707967). METHODS HIV-infected adults on cART in Switzerland were randomized 3 : 1 : 1 to receive two doses, 1 month apart, of M72/AS01, AS01 or 0.9% physiological saline (N = 22, N = 8 and N = 7, respectively) and were followed up to 6 months postdose 2 (D210). Individuals with CD4⁺ cell counts below 200 cells/μl were excluded. Adverse events (AEs) including HIV-specific and laboratory safety parameters were recorded. Cell-mediated (ICS) and humoral (ELISA) responses were evaluated before vaccination, 1 month after each dose (D30, D60) and D210. RESULTS Thirty-seven individuals [interquartile range (IQR) CD4⁺ cell counts at screening: 438-872 cells/μl; undetectable HIV-1 viremia] were enrolled; 73% of individuals reported previous BCG vaccination, 97.3% tested negative for the QuantiFERON-TB assay. For M72/AS01 recipients, no vaccine-related serious AEs or cART-regimen adjustments were recorded, and there were no clinically relevant effects on laboratory safety parameters, HIV-1 viral loads or CD4⁺ cell counts. M72/AS01 was immunogenic, inducing persistent and polyfunctional M72-specific CD4⁺ T-cell responses [medians 0.70% (IQR 0.37-1.07) at D60] and 0.42% (0.24-0.61) at D210, predominantly CD40L⁺IL-2⁺TNF-α⁺, CD40L⁺IL-2⁺ and CD40L⁺IL-2⁺TNF-α⁺IFN-γ⁺]. All M72/AS01 vaccines were seropositive for anti-M72 IgG after second vaccination until study end. CONCLUSION M72/AS01 was clinically well tolerated and immunogenic in this population, supporting further clinical evaluation in HIV-infected individuals in TB-endemic settings.
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Yuen CM, Weyenga HO, Kim AA, Malika T, Muttai H, Katana A, Nganga L, Cain KP, De Cock KM. Comparison of trends in tuberculosis incidence among adults living with HIV and adults without HIV--Kenya, 1998-2012. PLoS One 2014; 9:e99880. [PMID: 24937804 PMCID: PMC4061026 DOI: 10.1371/journal.pone.0099880] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/19/2014] [Indexed: 12/16/2022] Open
Abstract
Background In Kenya, the comparative incidences of tuberculosis among persons with and without HIV have not been described, and the differential impact of public health interventions on tuberculosis incidence in the two groups is unknown. Methods We estimated annual tuberculosis incidence stratified by HIV status during 2006–2012 based on the numbers of reported tuberculosis patients with and without HIV infection, the prevalence of HIV infection in the general population, and the total population. We also made crude estimates of annual tuberculosis incidence stratified by HIV status during 1998–2012 by assuming a constant ratio of HIV prevalence among tuberculosis patients compared to the general population. Results Tuberculosis incidence among both adults with HIV and adults without HIV increased during 1998–2004 then remained relatively stable until 2007. During 2007–2012, tuberculosis incidence declined by 28–44% among adults with HIV and by 11–26% among adults without HIV, concurrent with an increase in antiretroviral therapy uptake. In 2012, tuberculosis incidence among adults with HIV (1,839–1,936 cases/100,000 population) was still eight times as high as among adults without HIV (231–238 cases/100,000 population), and approximately one third of tuberculosis cases were attributable to HIV. Conclusions Although tuberculosis incidence has declined among adults with and without HIV, the persistent high incidence of tuberculosis among those with HIV and the disparity between the two groups are concerning. Early diagnosis of HIV, early initiation of antiretroviral therapy, regular screening for tuberculosis, and isoniazid preventive therapy among persons with HIV, as well as tuberculosis control in the general population, are required to address these issues.
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Affiliation(s)
- Courtney M. Yuen
- Epidemic Intelligence Service, assigned to Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Herman O. Weyenga
- Division of Leprosy, Tuberculosis and Lung Disease, Ministry of Health, Nairobi, Kenya
| | - Andrea A. Kim
- Centers for Disease Control and Prevention Kenya, Nairobi, Kenya
| | - Timothy Malika
- Division of Leprosy, Tuberculosis and Lung Disease, Ministry of Health, Nairobi, Kenya
| | - Hellen Muttai
- Centers for Disease Control and Prevention Kenya, Nairobi, Kenya
| | - Abraham Katana
- Centers for Disease Control and Prevention Kenya, Nairobi, Kenya
| | - Lucy Nganga
- Centers for Disease Control and Prevention Kenya, Nairobi, Kenya
| | - Kevin P. Cain
- Centers for Disease Control and Prevention Kenya, Nairobi, Kenya
- * E-mail:
| | - Kevin M. De Cock
- Centers for Disease Control and Prevention Kenya, Nairobi, Kenya
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Kong D, Watt JP, Marks SM, Flood JM. Timely HIV diagnosis and HIV/TB comanagement among California patients in 2008. Public Health Rep 2014; 129:170-7. [PMID: 24587552 DOI: 10.1177/003335491412900211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE National guidelines highlight the roles of early HIV diagnosis and effective comanagement for HIV and tuberculosis (TB) to prevent mortality and morbidity from HIV-related TB. We assessed HIV diagnosis timing and HIV/TB comanagement for California HIV/TB patients. METHODS We reviewed and analyzed public health charts for California HIV/TB patients reported during 2008. HIV diagnoses fewer than three months before TB diagnosis were considered new HIV diagnoses. We determined the proportion of patients with new HIV diagnoses, risk factors for new HIV diagnoses, and proportion of patients receiving recommended CD4 cell count measurements, supervised TB therapy, and antiretroviral therapy (ART). RESULTS Of 130 HIV/TB patients, 51% had new HIV diagnoses. Foreign-born patients were more likely than U.S.-born patients to have new HIV diagnoses. Supervised TB therapy and CD4 cell count measurements followed national recommendations for 91% and 74% of patients, respectively. At least 73% of patients started ART before completing TB therapy. Compared with patients who had previous HIV diagnoses, patients with new HIV diagnoses started ART later and had lower CD4 cell counts and higher viral loads at TB diagnosis. CONCLUSIONS Although most HIV/TB patients received the recommended treatment, half had new HIV diagnoses. Compared with patients who had previous HIV diagnoses, patients with new HIV diagnoses had greater immunosuppression at TB diagnosis. A new diagnosis indicates that HIV could have been diagnosed earlier and ART or treatment for latent TB infection could have been initiated to prevent TB development.
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Affiliation(s)
- Darryl Kong
- California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Tuberculosis Control Branch, Richmond, CA ; Current affiliation: California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Immunization Branch, Richmond, CA
| | - James P Watt
- California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Tuberculosis Control Branch, Richmond, CA
| | - Suzanne M Marks
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, GA
| | - Jennifer M Flood
- California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Tuberculosis Control Branch, Richmond, CA
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Massavon W, Barlow-Mosha L, Mugenyi L, McFarland W, Gray G, Lundin R, Costenaro P, Nannyonga MM, Penazzato M, Bagenda D, Namisi CP, Wabwire D, Mubiru M, Kironde S, Bilardi D, Mazza A, Fowler MG, Musoke P, Giaquinto C. Factors Determining Survival and Retention among HIV-Infected Children and Adolescents in a Community Home-Based Care and a Facility-Based Family-Centred Approach in Kampala, Uganda: A Cohort Study. ISRN AIDS 2014; 2014:852489. [PMID: 25006529 PMCID: PMC4003865 DOI: 10.1155/2014/852489] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 04/01/2014] [Indexed: 12/28/2022]
Abstract
We describe factors determining retention and survival among HIV-infected children and adolescents engaged in two health care delivery models in Kampala, Uganda: one is a community home-based care (CHBC) and the other is a facility-based family-centred approach (FBFCA). This retrospective cohort study reviewed records from children aged from 0 to 18 years engaged in the two models from 2003 to 2010 focussing on retention/loss to follow-up, mortality, use of antiretroviral therapy (ART), and clinical characteristics. Kaplan Meier survival curves with log rank tests were used to describe and compare retention and survival. Overall, 1,623 children were included, 90.0% (1460/1623) from the CHBC. Children completed an average of 4.2 years of follow-up (maximum 7.7 years). Median age was 53 (IQR: 11-109) months at enrolment. In the CHBC, retention differed significantly between patients on ART and those not (log-rank test, adjusted, P < 0.001). Comparing ART patients in both models, there was no significant difference in long-term survival (log-rank test, P = 0.308, adjusted, P = 0.489), while retention was higher in the CHBC: 94.8% versus 84.7% in the FBFCA (log-rank test, P < 0.001, adjusted P = 0.006). Irrespective of model of care, children receiving ART had better retention in care and survival.
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Affiliation(s)
- W. Massavon
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - L. Barlow-Mosha
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - L. Mugenyi
- Infectious Diseases Research Collaboration, Mulago Hospital Complex, Kampala, Uganda
| | - W. McFarland
- Department of Global Health Sciences, University of California San Francisco, 50 Beale Street, 12th Floor, San Francisco, CA 94105, USA
| | - G. Gray
- University of Witwatersrand, 1 Jan Smuts Avenue, Braamfontein 2000, Johannesburg, South Africa
| | - R. Lundin
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - P. Costenaro
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - M. M. Nannyonga
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - M. Penazzato
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - D. Bagenda
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Global Heath and Population, Harvard University School of Public Health, Boston, MA, USA
| | - C. P. Namisi
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - D. Wabwire
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - M. Mubiru
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - S. Kironde
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - D. Bilardi
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - A. Mazza
- Santa Chiara Hospital, Via Largo Gold Medals 9, 38122 Trento, Italy
| | - M. G. Fowler
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pathology, Johns Hopkins School of Medicine 600 N. Wolfe Street/Carnegie 43 Baltimore, MD 21287, USA
| | - P. Musoke
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - C. Giaquinto
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
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Vijayakumar S, Finney John S, Nusbaum RJ, Ferguson MR, Cirillo JD, Olaleye O, Endsley JJ. In vitro model of mycobacteria and HIV-1 co-infection for drug discovery. Tuberculosis (Edinb) 2013; 93 Suppl:S66-70. [PMID: 24388652 PMCID: PMC7337258 DOI: 10.1016/s1472-9792(13)70013-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Tuberculosis (TB) has become a global health threat in the wake of the Human Immunodeficiency Virus (HIV) pandemic and is the leading cause of death in people with HIV/AIDS. Treatment of patients with Mycobacterium tuberculosis (Mtb)/HIV co-infection is complicated by drug interactions and toxicity that present huge challenges for clinical intervention. Discovery efforts to identify novel compounds with increased effectiveness and decreased drug-drug interactions against Mtb, HIV-1, or both, would be greatly aided by the use of a co-infection model for screening drug libraries. Currently, inhibitors of Mtb are screened independently in mycobacterial cell cultures or target based biochemical screens and less often in macrophages or peripheral blood leukocytes. Similarly, HIV-1 drugs are screened in vitro independently from anti-mycobacterial compounds. Here, we describe an in vitro model where primary human peripheral blood mononuclear cells or monocyte-derived macrophages are infected with Mycobacterium bovis BCG and HIV-1, and used to evaluate drug toxicity and activity in a co-infection setting. Our results with standard compounds (e.g. Azidothymidine, Rifampicin) demonstrate the utility of this in vitro model to evaluate drug effectiveness relevant to cellular toxicity, HIV-1 replication, and intracellular mycobacterial growth, through the use of ELISA, bacterial enumeration, and multi-variate flow cytometry. This model and associated assays have great value in accelerating the discovery of compounds for use in Mtb/HIV-1 co-infected patients.
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Affiliation(s)
- Sudhamathi Vijayakumar
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Sarah Finney John
- Department of Pharmaceutical Sciences, Texas Southern University, Houston, TX, USA
| | - Rebecca J Nusbaum
- Institute for Translational Science, University of Texas Medical Branch, Galveston, TX, USA
| | - Monique R Ferguson
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX, USA
| | - Jeffrey D Cirillo
- Department of Microbial Pathogenesis and Immunology Texas A&M Health Sciences Center, College Station, TX, USA
| | - Omonike Olaleye
- Department of Pharmaceutical Sciences, Texas Southern University, Houston, TX, USA
| | - Janice J Endsley
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA; Institute for Human Infections and Immunity, Center for Tropical Diseases, Sealy Center for Vaccine Development, and Center for Biodefense and Emerging Infectious Diseases, UTMB, Galveston, TX, USA.
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MacPherson P, Houben RMGJ, Glynn JR, Corbett EL, Kranzer K. Pre-treatment loss to follow-up in tuberculosis patients in low- and lower-middle-income countries and high-burden countries: a systematic review and meta-analysis. Bull World Health Organ 2013; 92:126-38. [PMID: 24623906 DOI: 10.2471/blt.13.124800] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the magnitude of loss to follow-up in smear- or culture-positive tuberculosis patients before treatment initiation and outcomes among patients who were traced. METHODS Ovid Medline and Global Health databases were searched for studies published between 1994 and January 2013 that described pre-treatment loss to follow-up in patients with smear- or culture-positive tuberculosis in routine national tuberculosis programmes (NTPs) in low- and lower-middle-income countries and in countries with a high burden of tuberculosis. Data on the proportion of patients who did not initiate treatment after their tuberculosis diagnosis were extracted from studies meeting inclusion criteria. Where available, data on causes and outcomes, including initiation of tuberculosis treatment at another facility, were investigated. Heterogeneity and publication bias were assessed and random-effects meta-analyses by subgroup (region) were performed. FINDINGS Twenty-three eligible studies were identified, with a total of 34 706 smear- or culture-positive tuberculosis patients from 14 countries (8 in Africa, 5 in Asia and 1 in the western Pacific). Most studies were retrospective and linked laboratory and treatment registers to identify pre-treatment loss to follow-up. Pre-treatment loss to follow-up varied from 4 to 38% and was common in studies from Africa (random-effects weighted proportion, WP: 18%; 95% confidence interval, CI: 13-22) and Asia (WP: 13%; 95% CI: 10-15). CONCLUSION Pre-treatment loss to follow-up, common in most settings, can hinder tuberculosis control efforts. By not counting individuals who are lost to follow-up before treatment when reporting standard programme indicators, NTPs underestimate case detection rates and mortality and overestimate cure rates.
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Affiliation(s)
- Peter MacPherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Rein M G J Houben
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England
| | - Judith R Glynn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England
| | - Elizabeth L Corbett
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, England
| | - Katharina Kranzer
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, England
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The journey to antiretroviral therapy in Karnataka, India: who was lost on the road? J Int AIDS Soc 2013; 16:18502. [PMID: 23985346 PMCID: PMC3756231 DOI: 10.7448/ias.16.1.18502] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 06/18/2013] [Accepted: 07/29/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction One important operational challenge facing antiretroviral treatment (ART) programmes in low- and middle-income countries is the loss to follow-up between diagnosis of human immunodeficiency virus (HIV) and initiation of ART. This is a major obstacle to achieving universal access to ART. This study from Karnataka, India, tried to measure such losses by determining the number of HIV-positive individuals diagnosed, the number of them reaching ART centres, the number initiated on ART and the reasons for non-initiation of ART. Methods A review of records routinely maintained under the National AIDS Control Programme (NACP) was carried out in six districts of Karnataka. HIV-positive persons diagnosed during the months from January to June 2011 in 233 public HIV-testing sites were followed up until December 2011 based on the pre-ART registers. A chi-square test was used to assess statistical significance. Results Of 2291 HIV-positive persons diagnosed (52% male; mean age of 35 years), 1829 (80%) reached ART centres. Of the latter, 1166 (64%) were eligible for ART, and 959 (82%) were initiated on treatment. Overall losses (attrition) on the road between HIV diagnosis and ART initiation were 669 (29%). Deaths, migration and not willing to go to the ART centres were cited as the main known reasons for not reaching ART centres. For ART-eligible individuals who did not initiate ART, the most common known reasons for non-initiation included dying before initiation of ART and not being willing to start ART. Conclusions In a large state of India, eight in ten HIV-positive persons reached ART centres, and of those found ART eligible, 82% start treatment. Although this is an encouraging achievement, the programme needs to take further steps to improve the current performance by further reducing pre-ART attrition. We recommend online registering of diagnosed HIV-positive patients to track the patients more efficiently.
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Rinaldo CR. HIV-1 Trans Infection of CD4(+) T Cells by Professional Antigen Presenting Cells. SCIENTIFICA 2013; 2013:164203. [PMID: 24278768 PMCID: PMC3820354 DOI: 10.1155/2013/164203] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/09/2013] [Indexed: 06/02/2023]
Abstract
Since the 1990s we have known of the fascinating ability of a complex set of professional antigen presenting cells (APCs; dendritic cells, monocytes/macrophages, and B lymphocytes) to mediate HIV-1 trans infection of CD4(+) T cells. This results in a burst of virus replication in the T cells that is much greater than that resulting from direct, cis infection of either APC or T cells, or trans infection between T cells. Such APC-to-T cell trans infection first involves a complex set of virus subtype, attachment, entry, and replication patterns that have many similarities among APC, as well as distinct differences related to virus receptors, intracellular trafficking, and productive and nonproductive replication pathways. The end result is that HIV-1 can sequester within the APC for several days and be transmitted via membrane extensions intracellularly and extracellularly to T cells across the virologic synapse. Virus replication requires activated T cells that can develop concurrently with the events of virus transmission. Further research is essential to fill the many gaps in our understanding of these trans infection processes and their role in natural HIV-1 infection.
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Affiliation(s)
- Charles R. Rinaldo
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261, USA
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Choun K, Pe R, Thai S, Lorent N, Lynen L, van Griensven J. Timing of antiretroviral therapy in Cambodian hospital after diagnosis of tuberculosis: impact of revised WHO guidelines. Bull World Health Organ 2012; 91:195-206. [PMID: 23476092 DOI: 10.2471/blt.12.111153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/14/2012] [Accepted: 11/16/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine if implementation of 2010 World Health Organization (WHO) guidelines on antiretroviral therapy (ART) initiation reduced delay from tuberculosis diagnosis to initiation of ART in a Cambodian urban hospital. METHODS A retrospective cohort study was conducted in a nongovernmental hospital in Phnom Penh that followed new WHO guidelines in patients with human immunodeficiency virus (HIV) and tuberculosis. All ART-naïve, HIV-positive patients initiated on antituberculosis treatment over the 18 months before and after guideline implementation were included. A competing risk regression model was used. FINDINGS After implementation of the 2010 WHO guidelines, 190 HIV-positive patients with tuberculosis were identified: 53% males; median age, 38 years; median baseline CD4+ T-lymphocyte (CD4+ cell) count, 43 cells/µL. Before implementation, 262 patients were identified; 56% males; median age, 36 years; median baseline CD4+ cell count, 59 cells/µL. With baseline CD4+ cell counts ≤ 50 cells/µL, median delay to ART declined from 5.8 weeks (interquartile range, IQR: 3.7-9.0) before to 3.0 weeks (IQR: 2.1-4.4) after implementation (P < 0.001); with baseline CD4+ cell counts > 50 cells/µL, delay dropped from 7.0 (IQR: 5.3-11.3) to 3.6 (IQR: 2.9-5.3) weeks (P < 0.001). The probability of ART initiation within 4 and 8 weeks after tuberculosis diagnosis rose from 23% and 65%, respectively, before implementation, to 62% and 90% after implementation. A non-significant increase in 6-month retention and antiretroviral substitution was seen after implementation. CONCLUSION Implementation of 2010 WHO recommendations in a routine clinical setting shortens delay to ART. Larger studies with longer follow-up are needed to assess impact on patient outcomes.
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Affiliation(s)
- Kimcheng Choun
- Sihanouk Hospital Centre of Hope, St. 134, Sangkat Vealvong, Khan 7 Makara, Phnom Penh, Cambodia
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Peltzer K, Mchunu G, Tutshana B, Naidoo P, Matseke G, Louw J. Predictors of non-uptake of human immunodeficiency virus testing by tuberculosis public primary patients in three districts, South Africa. IRANIAN JOURNAL OF PUBLIC HEALTH 2012; 41:19-26. [PMID: 23304672 PMCID: PMC3521882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 09/12/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND The acceptance of HIV testing among patients with tuberculosis (TB) is low in South Africa. The aim of this study was to assess the prevalence, associated factors and reasons of non-uptake of human immunodeficiency virus (HIV) testing by tuberculosis public primary care patients in three districts, South Africa. METHODS In May-October 2011, this cross-sectional survey was conducted amongst 4726 TB patients across 42 primary health care facilities in three districts in South Africa. All new TB and new retreatment patients (N=4726) were consecutively interviewed within one month of anti-tuberculosis treatment. The outcome was self-reported HIV testing after TB diagnosis, validated using clinic registers. RESULTS Almost one in ten (9.6%) of the 4726 participants had not undergone HIV testing, with the most often offered explanation being that they were not knowing where to get tested (21.3%), followed by believing not to have or at risk for HIV (24.3%), emotional concerns (not ready for test: 13.2%; afraid to get to know: 12.1%; concerns over confidentiality: 6.3%) and concerns about stigma (3.3%) and losing the job (2.0%). In multivariable analysis being male, severe psychological distress, having sex with someone HIV negative or unknown and frequency of sex without a condom were associated with not having been tested for HIV. CONCLUSIONS The level of HIV testing among TB public primary care patients was suboptimal, as per policy all patients should be tested. The South African Department of Health should continue to scale-up HIV testing and other collaborative TB-HIV services at health facilities.
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Affiliation(s)
- K Peltzer
- HIV/STI and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, South Africa,Dept. of Psychology, University of Limpopo, Turfloop, South Africa,Corresponding Author:
| | - G Mchunu
- HIV/STI and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, South Africa
| | - B Tutshana
- HIV/STI and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, South Africa
| | - P Naidoo
- HIV/STI and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, South Africa,Department of Psychology, University of the Western Cape, Cape Town, South Africa
| | - G Matseke
- HIV/STI and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, South Africa
| | - J Louw
- HIV/STI and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, South Africa
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Kumar AMV, Gupta D, Gupta RS, Satyanarayana S, Wilson N, Zachariah R, Lawn SD, Harries AD. HIV testing in people with presumptive tuberculosis: time for implementation. THE LANCET RESPIRATORY MEDICINE 2012; 1:7-9. [PMID: 24321791 DOI: 10.1016/s2213-2600(12)70050-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Ajay M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South East Asia Office, C-6, Qutub Institutional Area, New Delhi, 110016, India.
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