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Paradkar MS, Pradhan NN, Balaji S, Gaikwad SN, Chavan A, Dharmashale SN, Sahasrabudhe T, Lokhande R, Deshmukh SA, Barthwal M, Atre S, Raskar SS, Sawant TU, Gupte AN, Kakrani A, Golub J, Padmapriyadarsini C, Gupta A, Gupte NA, Mave V. Early Microbiologic Markers of Pulmonary Tuberculosis Treatment Outcomes. Ann Am Thorac Soc 2023; 20:1760-1768. [PMID: 38038600 PMCID: PMC10704230 DOI: 10.1513/annalsats.202302-144oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/26/2023] [Indexed: 12/02/2023] Open
Abstract
Rationale: Earlier biomarkers of pulmonary tuberculosis (PTB) treatment outcomes are critical to monitor shortened anti-TB treatment (ATT). Objectives: To identify early microbiologic markers of unfavorable TB treatment outcomes. Methods: We performed a subanalysis of 2 prospective TB cohort studies conducted from 2013 to 2019 in India. We included participants aged ⩾18 years who initiated 6-month ATT for clinically or microbiologically diagnosed drug-sensitive PTB and completed at least one follow-up visit. Sputum specimens were subjected to a baseline Xpert Mycobacterium tuberculosis/rifampin (MTB/RIF) assay, acid-fast bacilli (AFB) microscopy and liquid and solid cultures, and serial AFB microscopy and liquid and solid cultures at weeks 2, 4, and 8. Poisson regression was used to assess the impact of available microbiologic markers (test positivity, smear grade, time to detection, and time to conversion) on a composite outcome of failure, recurrence, or death by 18 months after the end of treatment. Models were adjusted for age, sex, nutritional status, diabetes, smoking, alcohol consumption, and regimen type. Results: Among 1,098 eligible cases, there were 251 (22%) adverse TB treatment outcomes: 127 (51%) treatment failures, 73 (29%) recurrences, and 51 (20%) deaths. The primary outcome was independently associated with the Xpert MTB/RIF assay (medium-positive adjusted incidence rate ratio [aIRR], 1.91; 95% confidence interval [CI], 1.07-3.40; high-positive aIRR, 2.51; 95% CI, 1.41-4.46), positive AFB smear (aIRR, 1.48; 95% CI, 1.06-2.06), and positive liquid culture (aIRR, 1.98; 95% CI, 1.21-3.23) at baseline; Week 2 positive liquid culture (aIRR, 1.47; 95% CI, 1.04-2.09); and Week 8 positive AFB smear (aIRR, 1.63; 95% CI, 1.06-2.50) and positive liquid culture (aIRR, 1.54; 95% CI, 1.07-2.22). There was no evidence of Mycobacterium tuberculosis growth in the Mycobacterium Growth Indicator Tube at Week 4 conferring a higher risk of adverse outcomes (aIRR, 1.25; 95% CI, 0.89-1.75). Conclusions: Our analysis identifies Week 2 respiratory mycobacterial culture as the earliest microbiologic marker of unfavorable PTB treatment outcomes.
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Affiliation(s)
- Mandar Sudhir Paradkar
- BJ Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins Center for Infectious Diseases in India, Pune, India
| | - Neeta Nitin Pradhan
- BJ Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins Center for Infectious Diseases in India, Pune, India
| | | | | | - Amol Chavan
- BJ Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins Center for Infectious Diseases in India, Pune, India
| | | | | | | | - Sona Anil Deshmukh
- BJ Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins Center for Infectious Diseases in India, Pune, India
| | | | - Sachin Atre
- Johns Hopkins Center for Infectious Diseases in India, Pune, India
- Department of Respiratory Medicine and
| | - Swapnil Suresh Raskar
- BJ Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins Center for Infectious Diseases in India, Pune, India
| | | | - Akshay N. Gupte
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- School of Public Health, Boston University, Boston, Massachusetts
| | - ArjunLal Kakrani
- Department of Medicine, Dr. D.Y. Patil Medical College, Hospital & Research Centre, Pune, India
| | - Jonathan Golub
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Amita Gupta
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nikhil Anil Gupte
- BJ Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins Center for Infectious Diseases in India, Pune, India
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vidya Mave
- BJ Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins Center for Infectious Diseases in India, Pune, India
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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2
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Lombardo AR, Materi J, Caturegli G, Milovanovic M, Martinson N, Calver A, Nonyane BAS, Golub J, Hoffmann CJ, Variava E. Brief Report: Changing Characteristics Among In-Hospital HIV Deaths: An 11-Year Retrospective Review of a Regional Hospital in South Africa. J Acquir Immune Defic Syndr 2023; 94:185-189. [PMID: 37757855 DOI: 10.1097/qai.0000000000003249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/05/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Elevated HIV-associated mortality persists, despite a notable decline with the expansion of antiretroviral therapy (ART). In South Africa, the relative majority of deaths occur in health facilities, providing an opportunity to track decedent characteristics. SETTING We analyzed data from 14,870 adult patients who died between 2008 and 2018 at Klerksdorp/Tshepong Hospital Complex in South Africa. METHODS Recorded data included demographics, causes of death, HIV status, ART, and tuberculosis (TB) history. We present summary statistics and results from linear, log-binomial, and multinomial regressions to quantify changes over time. RESULTS Over the study period, the median age of decedents with HIV in the hospital increased from 39.3 to 43.4 years, and there was a switch to male predominance (46%-54%). Those who died at a younger age (<40 years) remained more likely to be HIV-positive than the older age group, despite the overall proportion of HIV-positivity decreasing over time. The proportion of decedents with HIV ever started on ART increased from 21% to 67%. The proportion of HIV patients dying from TB and AIDS-defining illnesses decreased from 31% to 22%. CONCLUSIONS We noted a shift in deaths over time to more men and older individuals, whereas the burden of HIV was heaviest on the younger age groups. Advanced HIV disease remained an important cause of mortality. We also observed an increase in less-traditional opportunistic illnesses among those with HIV, including malignancy, cardiovascular disease, and kidney disease. The high proportion of patients on ART who died prematurely requires further research and interventions.
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Affiliation(s)
| | - Joshua Materi
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | | | - Jonathan Golub
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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3
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Malhotra A, Nonyane BAS, Shirey E, Mulder C, Hippner P, Mulatu F, Ratshinanga A, Mitiku P, Cohn S, Conradie G, Chihota V, Chaisson RE, Churchyard GJ, Golub J, Dowdy D, Sohn H, Charalambous S, Bedru A, Salazar-Austin N. Pragmatic cluster-randomized trial of home-based preventive treatment for TB in Ethiopia and South Africa (CHIP-TB). Trials 2023; 24:475. [PMID: 37491264 PMCID: PMC10367260 DOI: 10.1186/s13063-023-07514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/16/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Each year, 1 million children develop TB resulting in over 200,000 child deaths. TB preventive treatment (TPT) is highly effective in preventing TB but remains poorly implemented for household child contacts. Home-based child contact management and TPT services may improve access to care. In this study, we aim to evaluate the effectiveness and cost-effectiveness of home-based contact management with TPT initiation in two TB high-burden African countries, Ethiopia and South Africa. METHODS This pragmatic cluster randomized trial compares home-based versus facility-based care delivery models for contact management. Thirty-six clinics with decentralized TB services (18 in Ethiopia and 18 in South Africa) were randomized in a 1:1 ratio to conduct either home-based or facility-based contact management. The study will attempt to enroll all eligible close child contacts of infectious drug-sensitive TB index patients diagnosed and treated for TB by one of the study clinics. Child TB contact management, including contact tracing, child evaluation, and TPT initiation and follow-up, will take place in the child's home for the intervention arm and at the clinic for the control arm. The primary outcome is the cluster-level ratio of the number of household child contacts less than 15 years of age in Ethiopia and less than 5 years of age in South Africa initiated on TPT per index patient, comparing the intervention to the control arm. Secondary outcomes include child contact identification and the TB prevention continuum of care. Other implementation outcomes include acceptability, feasibility, fidelity, cost, and cost-effectiveness of the intervention. DISCUSSION This implementation research trial will determine whether home-based contact management identifies and initiates more household child contacts on TPT than facility-based contact management. TRIAL REGISTRATION NCT04369326 . Registered on April 30, 2020.
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Affiliation(s)
- Akash Malhotra
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bareng Aletta Sanny Nonyane
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Evan Shirey
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christiaan Mulder
- Department of TB Elimination and Health System Innovations, KNCV Tuberculosis Foundation, The Hague, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Piotr Hippner
- The Aurum Institute, Parktown, Johannesburg, South Africa
| | | | | | | | - Silvia Cohn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Violet Chihota
- The Aurum Institute, Parktown, Johannesburg, South Africa
| | - Richard E Chaisson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gavin J Churchyard
- The Aurum Institute, Parktown, Johannesburg, South Africa
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Jonathan Golub
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hojoon Sohn
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Salome Charalambous
- The Aurum Institute, Parktown, Johannesburg, South Africa
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
- Yale School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA
| | - Ahmed Bedru
- KNCV Tuberculosis Foundation, Addis Ababa, Ethiopia
| | - Nicole Salazar-Austin
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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4
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Sabet NL, Milovanovic M, Hlongwane K, Golub J, Abraham P, Lebina L, Otwombe K, Martinson NA. Prevalence of tobacco smoking and cannabis use in young men in South Africa. Int J Tuberc Lung Dis 2022; 26:1080-1082. [DOI: 10.5588/ijtld.22.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- N. L. Sabet
- Perinatal HIV Research Unit, South African Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa, Department of Internal Medicine, Klerksdorp Tshepong Hospital
Complex, Klerksdorp, South Africa
| | - M. Milovanovic
- Perinatal HIV Research Unit, South African Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - K. Hlongwane
- Perinatal HIV Research Unit, South African Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - J. Golub
- Johns Hopkins University Center for TB Research, Baltimore, MD, USA
| | - P. Abraham
- Perinatal HIV Research Unit, South African Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - L Lebina
- Perinatal HIV Research Unit, South African Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa, Africa Health Research Institute, Nelson R. Mandela School
for Medicine, Durban, South Africa
| | - K. Otwombe
- Perinatal HIV Research Unit, South African Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa, School of Public Health, Faculty of Health Sciences, University
of Witwatersrand, Johannesburg, South Africa
| | - N. A. Martinson
- Perinatal HIV Research Unit, South African Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa, Johns Hopkins University Center for TB Research, Baltimore,
MD, USA
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5
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Atre S, Barthwal M, Gaikwad S, Sawant T, Sahasrabudhe T, Kakrani A, Lokhande R, Deshmukh S, Raskar S, Hodgar B, Jadhav V, Gupte N, Gupta A, Golub J, Mave V. Cascade of care for people with TB and diabetes in India. Int J Tuberc Lung Dis 2022; 26:787-788. [PMID: 35898132 DOI: 10.5588/ijtld.22.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- S Atre
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - M Barthwal
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - S Gaikwad
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - T Sawant
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - T Sahasrabudhe
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - A Kakrani
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - R Lokhande
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - S Deshmukh
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - S Raskar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | | | | | - N Gupte
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - A Gupta
- Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J Golub
- Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - V Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, Johns Hopkins School of Medicine, Baltimore, MD, USA
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6
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Dixit A, Kagal A, Ektefaie Y, Freschi L, Lokhande R, Groeschel M, Tornheim JA, Gupte N, Pradhan NN, Kadam D, Gupta A, Golub J, Farhat M, Mave V. 1397. Modern Lineages of Mycobacterium tuberculosis Were Recently Introduced in Western India and Demonstrate Increased Transmissibility. Open Forum Infect Dis 2021. [PMCID: PMC8643855 DOI: 10.1093/ofid/ofab466.1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Mycobacterium tuberculosis (Mtb) transmissibility may vary between lineages (or variants) and this may contribute to the slow decline of tuberculosis incidence. The objective of our study was to compare transmissibility across four major lineages (L1-4) of Mtb in Pune, India. Methods We performed whole-genome sequencing (WGS) of Mtb isolated from sputum culture of adult patients with pulmonary TB. We performed genotypic susceptibility testing for both first- and second-line drugs using a previously validated random forest predictor. We identified single nucleotide polymorphisms and generated a multiple sequence alignment excluding drug resistance conferring mutations to avoid skewing the phylogeny due to convergent evolution in these regions. We used Bayesian molecular dating to generate phylogenies and compared tree characteristics using a two-sample Kolmogorov-Smirnov (KS) test. Results Of the 642 isolates from distinct study participants that underwent WGS, 612 met quality criteria. The median age of participants was 31 years (range 18-74), the majority were male (64.7%) and sputum smear-positive (83.3%), and 6.7% had co-infection with HIV (Table 1). There was no significant difference in baseline characteristics between lineages. The majority of isolates belonged to L3 (44.6%). The majority (61.1%) of multidrug-resistant (MDR, resistant to isoniazid and rifampin) isolates belonged to L2. In phylogenetic analysis, we found evidence of higher transmissibility of L2 as indicated by shorter branch lengths (i.e., less time had elapsed between transmission and sampling) and more genetic similarity (smaller pairwise single nucleotide polymorphism [SNP] distances) among L2 isolates as compared to other lineages (Figure 1). Branching times for L2 and L4 were smaller than L1 and L3 indicating recent introduction into the region (p < 0.001 [KS test]). ![]()
Figure 1: Lineage-wise distribution of A) phylogenetic tree branch lengths (log) and B) pairwise single nucleotide polymorphism (SNP) distance, using 612 tuberculosis isolates from Pune, India. P values calculated using two-sample Kolmogorov-Smirnov test. ![]()
Table 1: Demographic characteristics of study participants included in the study, by lineage. Conclusion Modern Mtb lineages (L2 and L4) were relatively recently introduced in western India, as compared to older lineages (L1 and L3), with the more drug-resistant L2 showing higher transmissibility. These findings highlight the need for early detection and treatment initiation to interrupt transmission with important implications for antimicrobial stewardship and heightened surveillance of TB resistance rates. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Avika Dixit
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anju Kagal
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Pune, Maharashtra, India
| | | | | | - Rahul Lokhande
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Pune, Maharashtra, India
| | | | | | - Nikhil Gupte
- Johns Hopkins University, Pune, Maharashtra, India
| | | | - Deelip Kadam
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Pune, Maharashtra, India
| | | | | | - Maha Farhat
- Harvard Medical School, Boston, Massachusetts
| | - Vidya Mave
- Johns Hopkins University, Pune, Maharashtra, India
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7
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Gupte AN, Kumar P, Araújo-Pereira M, Kulkarni V, Paradkar M, Pradhan N, Menon P, Chandrasekaran PD, Hanna LE, Yogendra Shivakumar SVB, Rockwood N, Du Bruyn E, Karyakarte R, Gaikwad S, Bollinger R, Golub J, Gupte N, Viswanathan V, Wilkinson RJ, Mave V, Babu S, Kornfeld H, Andrade BB, Gupta A. Baseline IL-6 is a biomarker for unfavorable tuberculosis treatment outcomes: a multi-site discovery and validation study. Eur Respir J 2021; 59:13993003.00905-2021. [PMID: 34711538 PMCID: PMC7612881 DOI: 10.1183/13993003.00905-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022]
Abstract
Background Biomarkers of unfavorable tuberculosis treatment outcomes are needed to accelerate new drug and regimen development. Whether plasma cytokine levels can predict unfavorable tuberculosis treatment outcomes is unclear. Methods We identified and internally validated the association between 20 a-priori selected plasma inflammatory markers and unfavorable treatment outcomes of failure, recurrence and all-cause mortality among adults with drug-sensitive pulmonary tuberculosis in India. We externally validated these findings in two independent cohorts of predominantly diabetic and HIV coinfected tuberculosis patients in India and South Africa, respectively. Results Pre-treatment IFN-γ, IL-13 and IL-6 were associated with treatment failure in the discovery analysis. Internal validation confirmed higher pre-treatment IL-6 concentrations among failure cases compared to controls. External validation among predominantly diabetic tuberculosis patients found an association between pre-treatment IL-6 concentrations and subsequent recurrence and death. Similarly, external validation among predominantly HIV coinfected tuberculosis patients found an association between pre-treatment IL-6 concentrations and subsequent treatment failure and death. In a pooled analysis of 363 tuberculosis cases from the Indian and South African validation cohorts, high pre-treatment IL-6 concentrations were associated with higher risk of failure (adjusted odds ratio [aOR]=2.16, 95%CI 1.08-4.33, p=0.02), recurrence (aOR=5.36, 95%CI 2.48-11.57, p<0.001) and death (aOR=4.62, 95%CI 1.95-10.95, p<0.001). Adding baseline IL-6 to a risk-prediction model comprising of low BMI, high smear grade and cavitation improved model performance by 15 percent (C-statistic of 0.66 versus 0.76, p=0.02). Conclusion Pre-treatment IL-6 is a biomarker for unfavorable tuberculosis treatment outcomes. Future studies should identify optimal IL-6 concentrations for point-of-care risk prediction.
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Affiliation(s)
- Akshay N Gupte
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA .,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Pavan Kumar
- National Institute for Research in Tuberculosis, Chennai, India
| | - Mariana Araújo-Pereira
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Vandana Kulkarni
- Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA.,Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins India Private Limited, Pune, India
| | - Mandar Paradkar
- Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA.,Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins India Private Limited, Pune, India
| | - Neeta Pradhan
- Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA.,Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins India Private Limited, Pune, India
| | - Pradeep Menon
- National Institute for Research in Tuberculosis, Chennai, India
| | | | | | | | - Neesha Rockwood
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa.,Department of Microbiology, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka.,Department of Infectious Diseases, Imperial College London, United Kingdom
| | - Elsa Du Bruyn
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa.,Department of Infectious Diseases, University of Cape Town, Observatory, South Africa
| | - Rajesh Karyakarte
- Department of Microbiology, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Sanjay Gaikwad
- Department of Pulmonary Medicine, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Robert Bollinger
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jonathan Golub
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Tuberculosis Research, Johns Hopkins University, Baltimore, USA
| | - Nikhil Gupte
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Robert J Wilkinson
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa.,Department of Infectious Diseases, Imperial College London, United Kingdom.,Department of Infectious Diseases, University of Cape Town, Observatory, South Africa.,The Francis Crick Institute, London, UK
| | - Vidya Mave
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Subash Babu
- National Institutes of Health - National Institute for Research in Tuberculosis - International Center for Excellence in Research, Chennai, India
| | - Hardy Kornfeld
- Division of Pulmonary Medicine, University of Massachusetts Medical School, Worcester, USA
| | - Bruno B Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Amita Gupta
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
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8
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Sinkovic A, Krasevec M, Golub J, Suran D, Marinsek M, Markota A. STEMI patients in the first and second wave of COVID-19 pandemic in Slovenia. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Countries, severly hit by COVID-19 pandemic in spring 2020, reported reduced admissions and increased mortality of STEMI patients. The first wave of COVID-19 pandemic in Slovenia was mild, but in the second wave (October to December 2020) COVID-19 cases and fatalities significantly increased. To overcome the pandemic, restrictions to full lockdown, rapid redeployment and mobilization of healthcare resources, as well as reduction or delayed hospital admissions for acute non-communicable conditions were were undertaken.
Purpose
To evaluate STEMI admissions, the delay in treatment, complications and mortality of STEMI patients in the first and second wave of COVID-19 pandemic and comparison of data to 3 months (March-May) in 2019.
Methods
We retrospectively analysed the data of STEMI patients, admitted in March to May 2019 and in the first (March-May) and in the second wave (October-December) of the COVID-19 pandemic in 2020. We compared STEMI admissions, age, gender, comorbidities, time to primary coronary intervention (PPCI), the rate of PPCI, TIMI III flow after PPCI, prior resuscitations, hospital complications such as heart failure, arrhythmias, bleedings, acute kidney injury and mortality between 2019 and both waves of COVID-19 pandemic.
Results
Between STEMI patients in 2019 and patients in the first and the second wave of COVID-19 pandemic there were nonsignificant differences in STEMI admissions (90 patients vs 96 patients vs 81 patients), in gender, age, comorbidities, the rate of primary percutaneous intervention (PPCI, 94.4% vs 94.8% vs 91.4%), TIMI III flow after PPCI, anterior STEMI, in prior resuscitations (10% vs 10.4% vs 16%). Compared to 2019, admission acute heart failure was nonsignificantly increased in COVID-19 pandemic (30% vs 34.4% vs 39.5%). Within the first 3 hours of STEMI PPCI was performed nonsignificantly less likely in the first wave and significantly less likely in the second wave (35.5%* vs 30.2% vs 19.8%*, *p=0.037) in comparison to 2019. The incidence of acute kidney injury was similar in the first wave, but nonsignificantly increased in the second wave (6.6% vs 5.2% vs 9.8%), compared to 2019 and hospital infection was nonsignificantly increased in both COVID-19 periods (15.6% vs 20.8% vs 27.2%). In hospital heart failure was nonsignificantly increased in the first wave and significantly increased in the second one (23.3%* vs 27.1% vs 42%*, *p=0.015), as well as mitral regurgitation (10%* vs 18.8% vs 26.9%*, *p=0.008). Hospital mortality was nonsignificantly increased in bothe waves of the pandemic (8.9% vs 9.4% vs 13.6%).
Conclusions
In paralell to the increased severity of COVID-19 pandemic in the second wave there was less STEMI admissions, significantly less timely performed PPCI with significantly increased hospital heart failure, resulting in nonsignificantly increased hospital mortality.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Sinkovic
- University Medical Centre Maribor, Maribor, Slovenia
| | - M Krasevec
- University of Maribor, Medical faculty, Maribor, Slovenia
| | - J Golub
- University Medical Centre Maribor, Maribor, Slovenia
| | - D Suran
- University Medical Centre Maribor, Maribor, Slovenia
| | - M Marinsek
- University Medical Centre Maribor, Maribor, Slovenia
| | - A Markota
- University Medical Centre Maribor, Maribor, Slovenia
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9
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Chaisson RE, Cavalcante SC, Golub J, Durovni B. The impact of contact evaluation and TB preventive therapy on TB incidence. Int J Tuberc Lung Dis 2021; 25:599a-599. [PMID: 34183112 DOI: 10.5588/ijtld.21.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- R E Chaisson
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S C Cavalcante
- Municipal Health Secretariat of Rio de Janeiro, Rio de Janeiro, RJ, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil, Correspondence to: Richard E Chaisson, Center for Tuberculosis Research, Johns Hopkins University, 1550 Orleans Street, Baltimore, MD 21231, USA. ,
| | - J Golub
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - B Durovni
- Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil, Correspondence to: Richard E Chaisson, Center for Tuberculosis Research, Johns Hopkins University, 1550 Orleans Street, Baltimore, MD 21231, USA. ,
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10
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Ealand C, Peters J, Jacobs O, Sewcharran A, Ghoor A, Golub J, Brahmbhatt H, Martinson N, Dangor Z, Lala SG, Kana B. Detection of Mycobacterium tuberculosis Complex Bacilli and Nucleic Acids From Tongue Swabs in Young, Hospitalized Children. Front Cell Infect Microbiol 2021; 11:696379. [PMID: 34195103 PMCID: PMC8238041 DOI: 10.3389/fcimb.2021.696379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/21/2021] [Indexed: 01/24/2023] Open
Abstract
Diagnosis of tuberculosis in pediatric patients remains challenging due to inherent difficulties associated with obtaining respiratory samples for molecular and culture-based testing. To address this, recent studies have highlighted the utility of tongue swabs to detect Mycobacterium tuberculosis genomic DNA in the oral epithelia of tuberculosis infected adults. It is unknown whether tongue swabs have similar utility for diagnosis of childhood tuberculosis and if the presence of DNA in these swabs was associated with whole bacilli. We therefore sought to conduct a preliminary assessment of the utility of tongue swabs to detect tubercle bacilli and their associated genetic material in young children. For this, we recruited hospitalized children with clinically diagnosed tuberculosis (n = 26) or lower respiratory tract infection (LRTI, n = 9). These categories were blinded for downstream laboratory tests, which included PCR, spoligotyping, smear microscopy, and culture. Mtb genomic DNA was detected by PCR only in clinically diagnosed TB cases [11/26 (31.4%)] and not in cases with LRTI. Of these, 5/11 [45.5%] were associated with a spoligotype. Spoligotyping also detected an additional six specimens that were negative by PCR. Using smear microscopy, 19/26 [73.1%] and 4/9 [44.4] were Mtb positive in the tuberculosis or LRTI categories respectively. We noted positive results on all three tests in 5/26 [19.2%] in the tuberculosis category and 0/9 in the LRTI category. All specimens were culture negative. Collectively, these preliminary data present a compelling case for broader testing of tongue swabs to diagnose tuberculosis in children where obtaining standard sputum specimens is not easy.
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Affiliation(s)
- Christopher Ealand
- Department of Science and Innovation/National Research Foundation (DSI/NRF) Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
| | - Julian Peters
- Department of Science and Innovation/National Research Foundation (DSI/NRF) Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
| | - Olivia Jacobs
- Department of Science and Innovation/National Research Foundation (DSI/NRF) Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
| | - Astika Sewcharran
- Department of Science and Innovation/National Research Foundation (DSI/NRF) Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
| | - Azra Ghoor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Golub
- Center for TB Research, Johns Hopkins University, Baltimore, MD, United States
| | - Heena Brahmbhatt
- United States Agency for International Development (USAID), South Africa, Pretoria, South Africa.,Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil Martinson
- Center for TB Research, Johns Hopkins University, Baltimore, MD, United States.,Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bavesh Kana
- Department of Science and Innovation/National Research Foundation (DSI/NRF) Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
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11
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Mave V, Kadam D, Gaikwad S, Kinikar A, Aguilar D, Chavan A, Paradkar M, Yogendra SVB, Bharadwaj R, Kagal A, Suryavanshi N, Golub J, Kulkarni V, Dooley KE, Gupta A, Bacchetti P, Gerona R, Gupte N, Gandhi M. Measuring TB drug levels in the hair in adults and children to monitor drug exposure and outcomes. Int J Tuberc Lung Dis 2021; 25:52-60. [PMID: 33384045 DOI: 10.5588/ijtld.20.0574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION: Testing for anti-TB drugs in small hair samples may serve as a non-invasive tool to measure cumulative drug exposure and/or adherence, as these determine treatment success. We aimed to assess how well hair assays of TB drugs predict TB treatment outcomes.METHODS: A small thatch of hair, ~30 strands, was cut from the occipital region in adults and children from a prospective TB cohort in India. Isoniazid (INH), acetyl-INH and pyrazinamide (PZA) were extracted from the hair samples and quantified using liquid-chromatography-tandem mass spectrometry. The relationship between drug concentrations in hair and time to unfavourable outcomes was assessed using Cox-proportional hazards regression models.RESULTS: A two-fold increase in hair acetyl-INH concentrations in the 264 participants in our cohort with hair assays for TB drugs indicated a lower hazard of unfavourable TB treatment outcomes (aHR 0.67, 95%CI 0.44-1.02) and TB treatment failure (aHR 0.65, 95%CI 0.42-1.01). Higher summed concentrations (a summed measure of INH and acetyl-INH) indicated a lower hazard of treatment failure (aHR 0.69, 95%CI 0.45-1.05)CONCLUSION: Hair levels of INH and its metabolite may predict TB treatment outcomes, indicating the potential utility of this measure to assess and optimise TB treatment outcomes.
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Affiliation(s)
- V Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University School of Medicine, Baltimore, MD
| | - D Kadam
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - S Gaikwad
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - A Kinikar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - D Aguilar
- University of California, San Francisco, CA, USA
| | - A Chavan
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - M Paradkar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - S V B Yogendra
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - R Bharadwaj
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - A Kagal
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - N Suryavanshi
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - J Golub
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - V Kulkarni
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - K E Dooley
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - A Gupta
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University School of Medicine, Baltimore, MD
| | - P Bacchetti
- University of California, San Francisco, CA, USA
| | - R Gerona
- University of California, San Francisco, CA, USA
| | - N Gupte
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Gandhi
- University of California, San Francisco, CA, USA
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12
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Godongwana M, Chewparsad J, Lebina L, Golub J, Martinson N, Jarrett BA. Ethical Implications of eHealth Tools for Delivering STI/HIV Laboratory Results and Partner Notifications. Curr HIV/AIDS Rep 2021; 18:237-246. [PMID: 33772406 PMCID: PMC8057984 DOI: 10.1007/s11904-021-00549-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
Purpose of Review eHealth tools are increasingly utilized for communication with patients. Although efficacious and cost-effective, these tools face several barriers that challenge their ethical use in sexual health. We reviewed literature from the past decade to pick illustrative studies of eHealth tools that deliver results of laboratory tests for sexually transmitted infections, including the human immunodeficiency virus, as well as partner notifications. We describe ethical implications for such technologies. Recent Findings Our review found that despite widespread research on the use of eHealth tools in delivering laboratory results and partner notifications, these studies rarely measured or reported on the ethical implications. Such implications can be organized according to the four major principles in bioethics: beneficence, patient autonomy, non-maleficence, and justice. The beneficence of eHealth typically measures efficacy in comparison to existing standards of care. Patient autonomy includes the ability to opt in or out of eHealth tools, right-based principles of consent, and sovereignty over healthcare data. To adhere to the principle of non-maleficence, relevant harms must be identified and measured—such as unintentional disclosure of illness, sexual orientation, or sexual activity. Justice must also be considered to accommodate all users equally, irrespective of their literacy level, with easy-to-use platforms that provide clear messages. Summary Based on case studies from this review, we developed a list of recommendations for the ethical development and evaluation of eHealth platforms to deliver STI/HIV results to patients and notifications to partners.
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Affiliation(s)
- Motlatso Godongwana
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,Programme in Demography and Population Studies, University of the Witwatersrand, Schools of Public Health and Social Sciences, Johannesburg, South Africa.
| | - Juanita Chewparsad
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Limakatso Lebina
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Golub
- Center for TB Research, Johns Hopkins University, Baltimore, MD, USA
| | - Neil Martinson
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Brooke A Jarrett
- Programme in Demography and Population Studies, University of the Witwatersrand, Schools of Public Health and Social Sciences, Johannesburg, South Africa.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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13
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Ramachandran G, Chandrasekaran P, Gaikwad S, Agibothu Kupparam HK, Thiruvengadam K, Gupte N, Paradkar M, Dhanasekaran K, Sivaramakrishnan GN, Kagal A, Thomas B, Pradhan N, Kadam D, Hanna LE, Balasubramanian U, Kulkarni V, Murali L, Golub J, Gupte A, Shivakumar SVBY, Swaminathan S, Dooley KE, Gupta A, Mave V. Subtherapeutic Rifampicin Concentration Is Associated With Unfavorable Tuberculosis Treatment Outcomes. Clin Infect Dis 2021; 70:1463-1470. [PMID: 31075166 DOI: 10.1093/cid/ciz380] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The relationships between first-line drug concentrations and clinically important outcomes among patients with tuberculosis (TB) remain poorly understood. METHODS We enrolled a prospective cohort of patients with new pulmonary TB receiving thrice-weekly treatment in India. The maximum plasma concentration of each drug was determined at months 1 and 5 using blood samples drawn 2 hours postdose. Subtherapeutic cutoffs were: rifampicin <8 µg/mL, isoniazid <3 µg/mL, and pyrazinamide <20 µg/mL. Factors associated with lower log-transformed drug concentrations, unfavorable outcomes (composite of treatment failure, all-cause mortality, and recurrence), and individual outcomes were examined using Poisson regression models. RESULTS Among 404 participants, rifampicin, isoniazid, and pyrazinamide concentrations were subtherapeutic in 85%, 29%, and 13%, respectively, at month 1 (with similar results for rifampicin and isoniazid at month 5). Rifampicin concentrations were lower with human immunodeficiency virus coinfection (median, 1.6 vs 4.6 µg/mL; P = .015). Unfavorable outcome was observed in 19%; a 1-μg/mL decrease in rifampicin concentration was independently associated with unfavorable outcome (adjusted incidence rate ratio [aIRR], 1.21 [95% confidence interval {CI}, 1.01-1.47]) and treatment failure (aIRR, 1.16 [95% CI, 1.05-1.28]). A 1-μg/mL decrease in pyrazinamide concentration was associated with recurrence (aIRR, 1.05 [95% CI, 1.01-1.11]). CONCLUSIONS Rifampicin concentrations were subtherapeutic in most Indian patients taking a thrice-weekly TB regimen, and low rifampicin and pyrazinamide concentrations were associated with poor outcomes. Higher or more frequent dosing is needed to improve TB treatment outcomes in India.
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Affiliation(s)
| | | | - Sanjay Gaikwad
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | | | - Nikhil Gupte
- Johns Hopkins School of Medicine, Baltimore, Maryland.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | | | | | - Anju Kagal
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Beena Thomas
- National Institute for Research in Tuberculosis, Chennai
| | - Neeta Pradhan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - Dileep Kadam
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | - Usha Balasubramanian
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | | | - Jonathan Golub
- Johns Hopkins School of Medicine, Baltimore, Maryland.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Akshay Gupte
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | | | - Amita Gupta
- Johns Hopkins School of Medicine, Baltimore, Maryland.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Vidya Mave
- Johns Hopkins School of Medicine, Baltimore, Maryland.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
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14
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Deshmukh S, Atre S, Chavan A, Raskar S, Sawant T, Mave V, Gupte N, Gaikwad S, Sahasrabudhe T, Barthwal M, Kakrani A, Kagal A, Gupta A, Bharadwaj R, Pradhan N, Dharmshale S, Golub J. Assessment of the Xpert assay among adult pulmonary tuberculosis suspects with and without diabetes mellitus. Int J Tuberc Lung Dis 2020; 24:113-117. [DOI: 10.5588/ijtld.19.0239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Pune and Pimpri-Chinchwad Municipal Corporation area, Maharashtra State, India.OBJECTIVE: To assess the sensitivity and specificity of the Xpert® MTB/RIF assay among adults with suspected pulmonary tuberculosis (PTB) and with or without diabetes
(DM).DESIGN: As part of a prospective cohort study, we screened 2359 adults presumed to have PTB with no history of TB. All individuals underwent testing for two sputum smears, culture, Xpert, glycated haemoglobin and fasting blood sugar. We calculated sensitivity and specificity
of Xpert by comparing it with TB sputum culture result as a gold standard.RESULTS: Among screened individuals, 483 (20%) were diagnosed with DM and 1153 (49%) with pre-DM; 723 (31%) had no DM. Overall sensitivity of Xpert was 96% (95%CI 95–97) and specificity was 91% (95%CI
89–93). Xpert sensitivity was significantly higher among DM group (98%) than in the ‘No DM' (95%; P < 0.01) and pre-DM (96%; P < 0.05) groups. Among sputum smear-negative individuals, Xpert sensitivity was higher in the DM group than in the No DM (92% vs. 82%;
P = 0.054) and pre-DM group (92% vs. 82%; P = 0.037).CONCLUSION: High sensitivity and specificity of Xpert underscores the need for its rapid scale up for the early detection of TB in settings with a high dual burden of TB and DM.
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Affiliation(s)
- S. Deshmukh
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India, Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, USA
| | - S. Atre
- Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, USA, Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - A. Chavan
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India
| | - S. Raskar
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India
| | - T. Sawant
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - V. Mave
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - N. Gupte
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - S. Gaikwad
- Byramjee-Jeejeebhoy Government Medical College, Pune India
| | - T. Sahasrabudhe
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - M. Barthwal
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - A. Kakrani
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - A. Kagal
- Byramjee-Jeejeebhoy Government Medical College, Pune India
| | - A. Gupta
- Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, USA, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - R. Bharadwaj
- Byramjee-Jeejeebhoy Government Medical College, Pune India
| | - N. Pradhan
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India
| | - S. Dharmshale
- Byramjee-Jeejeebhoy Government Medical College, Pune India
| | - J. Golub
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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15
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Gupte AN, Paradkar M, Selvaraju S, Thiruvengadam K, Shivakumar SVBY, Sekar K, Marinaik S, Momin A, Gaikwad A, Natrajan P, Prithivi M, Shivaramakrishnan G, Pradhan N, Kohli R, Raskar S, Jain D, Velu R, Karthavarayan B, Lokhande R, Suryavanshi N, Gupte N, Murali L, Salvi S, Checkley W, Golub J, Bollinger R, Mave V, Padmapriyadarasini C, Gupta A. Correction: Assessment of lung function in successfully treated tuberculosis reveals high burden of ventilatory defects and COPD. PLoS One 2019; 14:e0226389. [PMID: 31805169 PMCID: PMC6894794 DOI: 10.1371/journal.pone.0226389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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16
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Gupte AN, Kadam D, Sangle S, Rewari BB, Salvi S, Chavan A, Nimkar S, Golub J, Gupte N, Gupta A, Marbaniang I, Mave V. Incidence of tuberculosis in HIV-infected adults on first- and second-line antiretroviral therapy in India. BMC Infect Dis 2019; 19:914. [PMID: 31664933 PMCID: PMC6820927 DOI: 10.1186/s12879-019-4569-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/16/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Programmatic data on the baseline risk of tuberculosis in people living with HIV (PLHIV) are needed to evaluate long-term effectiveness of the ongoing isoniazid preventive therapy (IPT) roll-out in India. METHODS We estimated the incidence rate and risk factors of tuberculosis disease in adult PLHIV initiating first- and second-line anti-retroviral therapy (ART) prior to widespread IPT in a public ART center in Pune, India. RESULTS 4067 participants contributing 5205.7 person-years of follow-up on first-line ART and 871 participants contributing 1031.7 person-years of follow-up on second-line ART were included in the analysis. The incidence rate of tuberculosis was 4.39 cases (95%CI 3.86-5.00) per 100 person-years on first-line ART and 1.64 cases (95%CI 1.01-2.63) per 100 person-years on second-line ART (p < 0.001). After adjusting for competing risks, male sex (aSHR = 1.33, 95%CI 1.02-1.74, p = 0.03), urban residence (aSHR = 1.53, 95%CI 1.13-2.07, p = 0.006) and CD4+ counts < 350 cells/mm3 (aSHR = 3.06 vs CD4 > 350 cells/mm3, 95%CI 1.58-5.94, p < 0.001) at ART initiation were associated with higher risk of tuberculosis independent of ART regimen. CONCLUSION Risk of tuberculosis was lower in PLHIV receiving second-line ART compared to first-line ART. Prioritizing IPT in PLHIV with low CD4+ counts, urban residence and in males may further mitigate the risk of tuberculosis during ART.
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Affiliation(s)
- Akshay N Gupte
- Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 521, Baltimore, MD, 21287, USA.
| | - Dileep Kadam
- Byramjee-Jeejeebhoy Medical College, Pune, India
| | | | - Bharat B Rewari
- Former National Programme Office, National AIDS Control Organization, New Delhi, India
| | - Sonali Salvi
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - Amol Chavan
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - Smita Nimkar
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - Jonathan Golub
- Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 521, Baltimore, MD, 21287, USA
| | - Nikhil Gupte
- Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 521, Baltimore, MD, 21287, USA
| | - Amita Gupta
- Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 521, Baltimore, MD, 21287, USA
| | - Ivan Marbaniang
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - Vidya Mave
- Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 521, Baltimore, MD, 21287, USA
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Belgaumkar V, Chandanwale A, Valvi C, Pardeshi G, Lokhande R, Kadam D, Joshi S, Gupte N, Jain D, Dhumal G, Deluca A, Golub J, Gupta A, Kinikar A, Bollinger RC. Barriers to screening and isoniazid preventive therapy for child contacts of tuberculosis patients. Int J Tuberc Lung Dis 2019; 22:1179-1187. [PMID: 30236186 DOI: 10.5588/ijtld.17.0848] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND India's guidelines recommend tuberculosis (TB) screening of household contacts aged <6 years and isoniazid preventive therapy (IPT) for children without active disease. We evaluated the current status and barriers to screening and IPT provision among the child contacts of TB patients. METHODS Questionnaire and health record data were collected from index cases and health care providers (HCPs) at Sassoon General Hospital, Pune, India. RESULTS Of 80 adult TB cases, 24 (30%) reported that an HCP recommended TB screening of their child contacts; 49/178 (28%) child contacts were screened. Sixteen (33%) children had active TB, and 28 (85%) of those who screened negative were prescribed IPT. Nineteen (76%) HCPs reported recommending child contact screening. Only 8 (32%) reported ever prescribing IPT. Lack of TB screening and IPT provision for child contacts was associated with inadequate HCP counseling (aOR 19.5, P < 0.001), a non-parent index case (aOR 3.72, P = 0.008) and lack of postgraduate HCP qualification (aOR 19.12, P = 0.04). CONCLUSIONS TB screening and IPT provision for child contacts of adults with TB were infrequent. Many screened children had active TB. Universal, timely TB screening and IPT for exposed children are urgently needed to reduce pediatric TB in India.
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Affiliation(s)
- V Belgaumkar
- Byramjee Jeejeebhoy Government Medical College/Sassoon General Hospital, Pune
| | - A Chandanwale
- Byramjee Jeejeebhoy Government Medical College/Sassoon General Hospital, Pune
| | - C Valvi
- Byramjee Jeejeebhoy Government Medical College/Sassoon General Hospital, Pune
| | - G Pardeshi
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi
| | - R Lokhande
- Byramjee Jeejeebhoy Government Medical College/Sassoon General Hospital, Pune
| | - D Kadam
- Byramjee Jeejeebhoy Government Medical College/Sassoon General Hospital, Pune
| | - S Joshi
- Byramjee Jeejeebhoy Government Medical College/Sassoon General Hospital, Pune
| | - N Gupte
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - D Jain
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - G Dhumal
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - A Deluca
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - J Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Gupta
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Kinikar
- Byramjee Jeejeebhoy Government Medical College/Sassoon General Hospital, Pune
| | - R C Bollinger
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Shivakumar SVBY, Chandrasekaran P, Kumar AMV, Paradkar M, Dhanasekaran K, Suryavarshini N, Thomas B, Kohli R, Thiruvengadam K, Kulkarni V, Hannah LE, Sivaramakrishnan GN, Pradhan N, Dolla C, Gupte A, Ramachandran G, DeLuca A, Meshram S, Bhardawaj R, Bollinger RC, Golub J, Selvaraj K, Gupte N, Swaminathan S, Mave V, Gupta A. Diabetes and pre-diabetes among household contacts of tuberculosis patients in India: is it time to screen them all? Int J Tuberc Lung Dis 2019; 22:686-694. [PMID: 29862955 DOI: 10.5588/ijtld.17.0598] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Pre-diabetes mellitus (pre-DM) and DM increase the risk of developing tuberculosis (TB). Screening contacts of TB patients for pre-DM/DM and linking them to care may mitigate the risk of developing TB and improve DM management. OBJECTIVE To measure the prevalence of pre-DM/DM and associated factors among the adult household contacts (HHCs) of pulmonary TB patients. METHODS Between August 2014 and May 2017, adult HHCs of newly diagnosed adult PTB patients in Pune and Chennai, India, had single blood samples tested for glycosylated haemoglobin (HbA1c) at enrolment. DM was defined as previously diagnosed, self-reported DM or HbA1c 6.5%, and pre-DM as HbA1c between 5.7% and 6.4%. Latent tuberculous infection (LTBI) was defined as a positive tuberculin skin test (5 mm induration) or QuantiFERON® Gold In-Tube (0.35 international units/ml). RESULTS Of 652 adult HHCs, 175 (27%) had pre-DM and 64 (10%) had DM. Forty (64%) HHCs were newly diagnosed with DM and 48 (75%) had poor glycaemic control (HbA1c 7.0%). Sixty-eight (22%) pre-DM cases were aged 18-34 years. Age 35 years, body mass index 25 kg/m2, chronic disease and current tobacco smoking were significantly associated with DM among HHCs. CONCLUSIONS Adult HHCs of TB patients in India have a high prevalence of undiagnosed DM, pre-DM and LTBI, putting them at high risk for developing TB. Routine DM screening should be considered among all adult HHCs of TB.
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Affiliation(s)
| | - P Chandrasekaran
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - M Paradkar
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India
| | - K Dhanasekaran
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - N Suryavarshini
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India
| | - B Thomas
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - R Kohli
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India
| | - K Thiruvengadam
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - V Kulkarni
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India
| | - L E Hannah
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | | | - N Pradhan
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India
| | - C Dolla
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - A Gupte
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - G Ramachandran
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - A DeLuca
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - S Meshram
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - R Bhardawaj
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - R C Bollinger
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - J Golub
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - K Selvaraj
- Pondicherry Institute of Medical Sciences (PIMS), Puducherry
| | - N Gupte
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - S Swaminathan
- Indian Council of Medical Research, New Delhi, India
| | - V Mave
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - A Gupta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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19
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Mave V, Chandrasekaran P, Chavan A, Shivakumar SVBY, Danasekaran K, Paradkar M, Thiruvengadam K, Kinikar A, Murali L, Gaikwad S, Hanna LE, Kulkarni V, Pattabiraman S, Suryavanshi N, Thomas B, Kohli R, Sivaramakrishnan GN, Pradhan N, Bhanu B, Kagal A, Golub J, Gandhi N, Gupte A, Gupte N, Swaminathan S, Gupta A. Infection free "resisters" among household contacts of adult pulmonary tuberculosis. PLoS One 2019; 14:e0218034. [PMID: 31318864 PMCID: PMC6638997 DOI: 10.1371/journal.pone.0218034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/23/2019] [Indexed: 02/01/2023] Open
Abstract
Despite substantial exposure to infectious pulmonary tuberculosis (TB) cases, some household contacts (HHC) never acquire latent TB infection (LTBI). Characterizing these “resisters” can inform who to study immunologically for the development of TB vaccines. We enrolled HHCs of culture-confirmed adult pulmonary TB in India who underwent LTBI testing using tuberculin skin test (TST) and QuantiFERON TB Gold Test-in-tube (QFT-GIT) at baseline and, if negative by both (<5mm TST and <0.35IU/mL QFT-GIT), underwent follow-up testing at 4–6 and/or 12 months. We defined persons with persistently negative LTBI tests at both baseline and followup as pLTBI- and resisters as those who had a high exposure to TB using a published score and remained pLTBI-. We calculated the proportion of resisters overall and resisters with complete absence of response to LTBI tests (0mm TST and/or QFT-GIT <0.01 IU/ml). Using random effects Poisson regression, we assessed factors associated with pLTBI-. Of 799 HHCs in 355 households, 67 (8%) were pLTBI- at 12 months; 52 (6.5%) pLTBI- in 39 households were resisters. Complete absence of response to LTBI tests was found in 27 (53%) resisters. No epidemiological characteristics were associated with the pLTBI- phenotype. LTBI free resisters among HHC exist but are uncommon and are without distinguishing epidemiologic characteristics. Assessing the genetic and immunologic features of such resister individuals is likely to elucidate mechanisms of protective immunity to TB.
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Affiliation(s)
- Vidya Mave
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | | | - Amol Chavan
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | | | | | - Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | | | - Aarti Kinikar
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Lakshmi Murali
- District Tuberculosis Officer, State Tuberculosis Office, Thiruvallur, Tamil Nadu, India
| | - Sanjay Gaikwad
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | | | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | | | - Nishi Suryavanshi
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Beena Thomas
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Rewa Kohli
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | | | - Neeta Pradhan
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Brindha Bhanu
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Anju Kagal
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Jonathan Golub
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Neel Gandhi
- Emory University, Atlanta, Georgia, United States of America
| | - Akshay Gupte
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | | | - Amita Gupta
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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20
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Kinikar A, Chandanwale A, Kadam D, Joshi S, Basavaraj A, Pardeshi G, Girish S, Shelke S, DeLuca A, Dhumal G, Golub J, Lokhande N, Gupte N, Gupta A, Bollinger R, Mave V. High risk for latent tuberculosis infection among medical residents and nursing students in India. PLoS One 2019; 14:e0219131. [PMID: 31283794 PMCID: PMC6613683 DOI: 10.1371/journal.pone.0219131] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/17/2019] [Indexed: 11/18/2022] Open
Abstract
Defining occupational latent tuberculosis infection (LTBI) risk among healthcare workers is needed to support implementation of prevention guidelines. Prospective cohort study of 200 medical residents and nursing students in India was conducted May 2016—December 2017. Tuberculin skin test (TST) and QuantiFERON TB Gold Test-in-tube (QFT-GIT) were performed at study entry and 12 months. Primary outcome was incident LTBI (≥10mm TST induration and/or ≥0.35IU/mL QFT-GIT) at 12 months; secondary outcomes included baseline LTBI prevalence and risk factors for incident and prevalent LTBI using Poisson regression. Among 200, [90 nursing students and 110 medical residents], LTBI prevalence was 30% (95% CI, 24–37); LTBI incidence was 26.8 (95% CI, 18.6–37.2) cases per 100 person-years and differed by testing method (28.7 [95% CI, 20.6–38.9] vs 17.4 [95% CI, 11.5–25.4] cases per 100 person-years using TST and QFT-GIT, respectively). Medical residents had two-fold greater risk of incident LTBI than nursing students (Relative Risk, 2.16; 95% CI, 1.05–4.42). During study period 6 (3%) HCWs were diagnosed with active TB disease. Overall, median number of self-reported TB exposures was 5 (Interquartile Range, 1–15). Of 60 participants with prevalent and incident LTBI who were offered free isoniazid preventive therapy (IPT), only 2 participants initiated and completed IPT. High risk for LTBI was noted among medical residents compared to nursing students. Self-reported TB exposure is underreported, and uptake of LTBI prevention therapy remains low. New approaches are needed to identify HCWs at highest risk for LTBI.
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Affiliation(s)
- Aarti Kinikar
- Department of Pediatrics, BJGMC-JHU Clinical Trial Unit, Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India
- * E-mail:
| | - Ajay Chandanwale
- Department of Orthopedics, BJGMC-JHU Clinical Trial Unit, Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Dileep Kadam
- Department of Medicine, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Samir Joshi
- Department of ENT, BJGMC-JHU Clinical Trial Unit, Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Anita Basavaraj
- Department of Medicine, Government Medical College, Miraj, Maharashtra, India
| | - Geeta Pardeshi
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sunita Girish
- Department of Biochemistry, BJGMC-JHU Clinical Trial Unit, Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Sangeeta Shelke
- Department of Community Medicine, BJGMC-JHU Clinical Trial Unit, Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Andrea DeLuca
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Gauri Dhumal
- BJGMC-JHU Clinical Trial Unit, Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Jonathan Golub
- Department of Medicine, Epidemiology and International Health, Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nilima Lokhande
- BJGMC-JHU Clinical Trial Unit, Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Nikhil Gupte
- BJGMC-JHU Clinical Trial Unit, Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Amita Gupta
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Robert Bollinger
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Vidya Mave
- BJGMC-JHU Clinical Trial Unit, Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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21
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Huangfu P, Ugarte-Gil C, Golub J, Pearson F, Critchley J. The effects of diabetes on tuberculosis treatment outcomes: an updated systematic review and meta-analysis. Int J Tuberc Lung Dis 2019; 23:783-796. [DOI: 10.5588/ijtld.18.0433] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- P. Huangfu
- Population Health Research Institute, St George's University of London, London, UK
| | - C. Ugarte-Gil
- Facultad de Medicina Alberto Hurtado and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University,
Baltimore, MD
| | - J. Golub
- Centre for Tuberculosis Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - F. Pearson
- Population Health Research Institute, St George's University of London, London, UK
| | - J. Critchley
- Population Health Research Institute, St George's University of London, London, UK
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22
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Kim HY, Dowdy DW, Martinson NA, Kerrigan D, Tudor C, Golub J, Bridges JFP, Hanrahan CF. Maternal Motivation to Take Preventive Therapy in Antepartum and Postpartum Among HIV-Positive Pregnant Women in South Africa: A Choice Experiment. AIDS Behav 2019; 23:1689-1697. [PMID: 30415430 DOI: 10.1007/s10461-018-2324-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HIV-positive pregnant women who are initiated on lifelong antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) have lower adherence rates after delivery. We quantified maternal motivation to take preventive therapy before and after delivery among pregnant women newly diagnosed with HIV. We enrolled pregnant women (≥ 18 years) with a recent HIV diagnosis (< 6 months) at 14 public primary health clinics in Matlosana, South Africa and followed them in the postpartum period. Participants received eight choice tasks comparing two mutually exclusive sub-sets of seven possible benefits related to preventive therapy identified through literature reviews and key informant interviews. Data was analyzed using conditional logit regression in the antepartum versus postpartum periods. Coefficients are reported with 95% confidence intervals (CI). Sixty-five women completed surveys both at enrollment and in the postpartum period. All women were already on ART, while 21 (32%) were receiving IPT at enrollment. The mean CD4 count was 436 (± 246) cells/mm3. In the antepartum period, preventing HIV transmission to partners was the most important benefit (coefficients (ß) = 0.87, 95% CI 0.64, 1.11), followed by keeping healthy for family (ß = 0.75, 95% CI 0.52, 0.97). Such prioritization significantly decreased in the postpartum period (p < 0.001). Compared to other motivators, keeping a high CD4 count was least prioritized in the antepartum period (ß = 0.19, 95% CI - 0.04, 0.43) but was most prioritized in the postpartum period (ß = 0.39, 95% CI 0.21, 0.57). These results highlight that messages on family might be particularly salient in the antepartum period, and keeping CD4 count high in the postpartum period. Understanding maternal motivation may help to design targeted health promotion messages to HIV-positive women around the time of delivery.
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Affiliation(s)
- Hae-Young Kim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
- Africa Health Research Institute, Kwazulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Kwazulu-Natal, South Africa
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neil A Martinson
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - Deanna Kerrigan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie Tudor
- International Council of Nurses, Geneva, Switzerland
| | - Jonathan Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - John F P Bridges
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colleen F Hanrahan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
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23
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Gupte AN, Paradkar M, Selvaraju S, Thiruvengadam K, Shivakumar SVBY, Sekar K, Marinaik S, Momin A, Gaikwad A, Natrajan P, Prithivi M, Shivaramakrishnan G, Pradhan N, Kohli R, Raskar S, Jain D, Velu R, Karthavarayan B, Lokhande R, Suryavanshi N, Gupte N, Murali L, Salvi S, Checkley W, Golub J, Bollinger R, Mave V, Padmapriyadarasini C, Gupta A. Assessment of lung function in successfully treated tuberculosis reveals high burden of ventilatory defects and COPD. PLoS One 2019; 14:e0217289. [PMID: 31120971 PMCID: PMC6532904 DOI: 10.1371/journal.pone.0217289] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/08/2019] [Indexed: 12/17/2022] Open
Abstract
Background Burden, phenotype and risk-factors of lung function defects in successfully treated tuberculosis cases are unclear. Methods We performed spirometry with bronchodilators in new drug-sensitive adult (≥18 years) pulmonary tuberculosis cases during the 12 months following successful treatment in India. Airflow obstruction was defined as pre-bronchodilator FEV1/FVC<5th percentile of Global Lung Initiative mixed-ethnicity reference (lower limit of normal [LLN]). Chronic obstructive pulmonary disease (COPD) was defined as post-bronchodilator FEV1/FVC<LLN among participants with obstruction. Restrictive spirometry pattern was defined as FVC<LLN among participants without obstruction. Multivariable logistic and linear regression was used to identify risk-factors for obstruction, restriction and low lung function despite successful treatment. Results Of the 172 participants included in the analysis, 82 (48%) were female, 22 (13%) had diabetes and 34 (20%) ever-smoked with a median (IQR) exposure of 3.5 (0.2–9.9) pack-years. Median (IQR) age and body-mass index (BMI) at enrollment was 32 (23–39) years and 18.1 (16.0–20.5) kg/m2 respectively. Airflow obstruction was detected in 42 (24%) participants; of whom 9 (21%) responded to short-acting bronchodilators and 25 (56%) had COPD; and was associated with duration of illness prior to treatment (aOR = 1.32 per 30-days, 95%CI 1.04–1.68, p = 0.02). A restrictive spirometry pattern was detected in 89 (52%) participants and was associated with female sex (aOR = 3.73, 95%CI 1.51–9.17, p = 0.004) and diabetes (aOR = 4.06, 95%CI 1.14–14.42, p = 0.03). Higher HbA1c at treatment initiation was associated with greater odds of a restrictive spirometry pattern (aOR = 1.29 per unit higher HbA1c, 95%CI 1.04 to 1.60, p = 0.02). Conclusion We found a high burden of lung function defects and COPD in tuberculosis cases who successfully completed treatment. Screening for chronic lung diseases following treatment and linkage to respiratory health clinics should be included in the routine management plan of all tuberculosis cases in India, regardless of conventional COPD risk-factors such as older age and smoking.
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Affiliation(s)
- Akshay N. Gupte
- Johns Hopkins University School of Medicine, Baltimore, United States of America
- * E-mail:
| | - Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | | | | | | | - Krithikaa Sekar
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Ayesha Momin
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Archana Gaikwad
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | | | | | | | - Neeta Pradhan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Rewa Kohli
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Swapnil Raskar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Divyashri Jain
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Rani Velu
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Rahul Lokhande
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Nishi Suryavanshi
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Nikhil Gupte
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Lakshmi Murali
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - William Checkley
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Jonathan Golub
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Robert Bollinger
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Vidya Mave
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | | | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, United States of America
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Little KM, Msandiwa R, Martinson N, Golub J, Chaisson R, Dowdy D. Yield of household contact tracing for tuberculosis in rural South Africa. BMC Infect Dis 2018; 18:299. [PMID: 29973140 PMCID: PMC6030742 DOI: 10.1186/s12879-018-3193-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 06/18/2018] [Indexed: 01/24/2023] Open
Abstract
Background Efficient and effective strategies for identifying cases of active tuberculosis (TB) in rural sub-Saharan Africa are lacking. Household contact tracing offers a potential approach to diagnose more TB cases, and to do so earlier in the disease course. Methods Adults newly diagnosed with active TB were recruited from public clinics in Vhembe District, South Africa. Study staff visited index case households and collected sputum specimens for TB testing via smear microscopy and culture. We calculated the yield and the number of households needed to screen (NHNS) to find one additional case. Predictors of new TB among household contacts were evaluated using multilevel logistic regression. Results We recruited 130 index cases and 282 household contacts. We identified 11 previously undiagnosed cases of bacteriologically-confirmed TB, giving a prevalence of 3.9% (95% CI: 2.0–6.9%) among contacts, a yield of 8.5 per 100 (95% CI: 4.2–15.1) index cases traced, and NHNS of 12 (95% CI: 7–24). The majority of new TB cases (10/11, 90.9%) were smear negative, culture positive. The presence of TB symptoms was not associated with an increased odds of active TB (aOR: 0.3, 95% CI: 0.1–1.4). Conclusions Household contacts of recently diagnosed TB patients in rural South Africa have high prevalence of TB and can be feasibly detected through contact tracing, but more sensitive tests than sputum smear are required. Symptom screening among household contacts had low sensitivity and specificity for active TB in this study.
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Affiliation(s)
- Kristen M Little
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Reginah Msandiwa
- Perinatal HIV Research Unit, Nurses Residence, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit, Nurses Residence, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Jonathan Golub
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - David Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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25
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Boccia D, Rudgard W, Shrestha S, Lönnroth K, Eckhoff P, Golub J, Sanchez M, Maciel E, Rasella D, Shete P, Pedrazzoli D, Houben R, Chang S, Dowdy D. Modelling the impact of social protection on tuberculosis: the S-PROTECT project. BMC Public Health 2018; 18:786. [PMID: 29940906 PMCID: PMC6020219 DOI: 10.1186/s12889-018-5539-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 05/03/2018] [Indexed: 11/21/2022] Open
Abstract
Background Tackling the social determinants of Tuberculosis (TB) through social protection is a key element of the post-2015 End TB Strategy. However, evidence informing policies are still scarce. Mathematical modelling has the potential to contribute to fill this knowledge gap, but existing models are inadequate. The S-PROTECT consortium aimed to develop an innovative mathematical modelling approach to better understand the role of social protection to improve TB care, prevention and control. Methods S-PROTECT used a three-steps approach: 1) the development of a conceptual framework; 2) the extraction from this framework of three high-priority mechanistic pathways amenable for modelling; 3) the development of a revised version of a standard TB transmission model able to capture the structure of these pathways. As a test case we used the Bolsa Familia Programme (BFP), the Brazilian conditional cash transfer scheme. Results Assessing one of these pathways, we estimated that BFP can reduce TB prevalence by 4% by improving households income and thus their nutritional status. When looking at the direct impact via malnutrition (not income mediated) the impact was 33%. This variation was due to limited data availability, uncertainties on data transformation and the pathway approach taken. These results are preliminary and only aim to serve as illustrative example of the methodological challenges encountered in this first modelling attempt, nonetheless they suggest the potential added value of integrating TB standard of care with social protection strategies. Conclusions Results are to be confirmed with further analysis. However, by developing a generalizable modelling framework, S-PROTECT proved that the modelling of social protection is complex, but doable and allowed to draw the research road map for the future in this field. Electronic supplementary material The online version of this article (10.1186/s12889-018-5539-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Boccia
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - W Rudgard
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - S Shrestha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - K Lönnroth
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - P Eckhoff
- Institute for Disease Modeling, Bellevue, USA
| | - J Golub
- Department of Medicine, Epidemiology & International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - M Sanchez
- Federal University of Brasilia, Brasilia, Brazil
| | - E Maciel
- Federal University of Espírito Santo, Maruipe, Vitória, Brazil
| | - D Rasella
- Oswaldo Cruz Foundation (FIOCRUZ), Brasília, DF, Brazil
| | - P Shete
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland.,Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, USA
| | - D Pedrazzoli
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - R Houben
- TB Modelling Group, TB Centre and CMMID, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | - S Chang
- Institute for Disease Modeling, Bellevue, USA
| | - D Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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26
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Shivakoti R, Ewald ER, Gupte N, Yang WT, Kanyama C, Cardoso SW, Santos B, Supparatpinyo K, Badal-Faesen S, Lama JR, Lalloo U, Zulu F, Pawar JS, Riviere C, Kumarasamy N, Hakim J, Pollard R, Detrick B, Balagopal A, Asmuth DM, Semba RD, Campbell TB, Golub J, Gupta A. Effect of baseline micronutrient and inflammation status on CD4 recovery post-cART initiation in the multinational PEARLS trial. Clin Nutr 2018; 38:1303-1309. [PMID: 29885777 DOI: 10.1016/j.clnu.2018.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/06/2018] [Accepted: 05/22/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Nutritional deficiency and inflammation may impact CD4+ T cell recovery during combination antiretroviral therapy (cART), particularly in resource-limited settings where malnutrition is prevalent. The aim of this study was to investigate the relationship of micronutrient and inflammation biomarkers to CD4 recovery after cART initiation. METHODS We conducted a secondary analysis of a random sub-cohort sample (n = 270) from a multinational randomized trial of cART regimen efficacy among 1571 cART-naïve adults. We measured pre-cART serum levels of micronutrients (Vitamin A, B6, B12, D, total carotenoids, selenium, and iron) and inflammation (C-reactive protein, soluble CD14 (sCD14), IFNγ, TNFα, Interleukin-6, and C-X-C motif chemokine 10 (CXCL10/IP10), EndoCab (IgM)) biomarkers. Biomarker status (i.e. micronutrient deficiency vs. sufficiency and elevated vs. low inflammation) was defined using established cutoffs or quartiles. Mixed-effects linear regression models were used to determine the association of baseline (pre-cART) concentrations of individual biomarkers with CD4 recovery through 96 weeks post-cART initiation. RESULTS In models adjusting for time-dependent viral load and baseline CD4 count, age, sex, body mass index, country, treatment regimen, anemia and hypoalbuminemia status, pre-cART vitamin D deficiency was associated with lower CD4 recovery (-14.9 cells/mm3, 95% CI: -27.9, -1.8) compared to sufficiency. In contrast, baseline selenium deficiency (20.8 cells/mm3, 95% CI: 3.3, 38.3), vitamin A deficiency (35.9 cells/mm3, 95% CI: 17.6, 54.3) and high sCD14 (23.4 cells/mm3, 95% CI: 8.9, 37.8) were associated with higher CD4 recovery compared to sufficient/low inflammation status. CONCLUSIONS In summary, baseline vitamin D deficiency was associated with diminished CD4 recovery after cART initiation; impaired CD4 recovery may contribute to the poor clinical outcomes recently observed in individuals with vitamin D deficiency. Vitamin A, selenium and sCD14 were associated with CD4 recovery but future studies are needed to further explore these relationships.
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Affiliation(s)
- Rupak Shivakoti
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Erin R Ewald
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Nikhil Gupte
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Wei-Teng Yang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
| | | | - Sandra W Cardoso
- STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clinica Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.
| | - Breno Santos
- Hospital Nossa Senhora de Conceição, Porto Alegre, Brazil.
| | | | - Sharlaa Badal-Faesen
- Department of Medicine, University of Witwatersrand, Johannesburg, South Africa.
| | - Javier R Lama
- IMPACT PERU Clinical Trials Unit, Asociacion Civil Impacta Salud y Educacion, Lima, Peru.
| | - Umesh Lalloo
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa.
| | - Fatima Zulu
- Malawi College of Medicine - Johns Hopkins Research Project, Kachere Rehabilitation Centre, Blantyre, Malawi.
| | | | | | | | | | - Richard Pollard
- Department of Medicine, University of California Davis, Sacramento, CA, USA.
| | - Barbara Detrick
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Ashwin Balagopal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - David M Asmuth
- Department of Medicine, University of California Davis, Sacramento, CA, USA.
| | - Richard D Semba
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Thomas B Campbell
- Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Jonathan Golub
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Amita Gupta
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
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27
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Kim HY, Hanrahan CF, Dowdy DW, Martinson N, Golub J, Bridges JFP. The effect of partner HIV status on motivation to take antiretroviral and isoniazid preventive therapies: a conjoint analysis. AIDS Care 2018; 30:1298-1305. [PMID: 29595060 DOI: 10.1080/09540121.2018.1455958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are important to reduce morbidity and mortality among people newly diagnosed of HIV. The successful uptake of ART and IPT requires a comprehensive understanding of patients' motivation to take such therapies. Partners also play an important role in the decision to be initiated and retained in care. We quantified patients' motivation to take preventive therapies (ART and IPT) and compared by partner HIV status among people newly diagnosed of HIV. We enrolled and surveyed adults (≥18 years) with a recent HIV diagnosis (<6 months) from 14 public primary care clinics in Matlosana, South Africa. Participants received eight forced-choice tasks comparing two mutually exclusive sub-sets of seven possible benefits related to preventive therapies. A linear probability model was fitted to estimate the probability of prioritizing each benefit. Tests of concordance were conducted across partner HIV status (no partner, HIV- or unknown, or HIV+). A total of 424 people completed surveys. At the time of interview, 272 (64%) were on ART and 334 (79%) had a partner or spouse. Keeping themselves healthy for their family was the most important motivator to take preventive therapies (p < 0.001). Preventing HIV transmission to partners was also highly prioritized among participants with current partners independent of partner's HIV status (p < 0.001), but it was least prioritized among those without current partners (p = 0.72). Keeping themselves healthy was less prioritized. We demonstrate that social responsibility such as supporting family and preventing HIV transmission to partners may pose greater motivation for ART and IPT initiation and adherence compared to individual health benefits. These messages should be emphasized to provide effective patient-centered care and counseling.
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Affiliation(s)
- Hae-Young Kim
- a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Colleen F Hanrahan
- a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - David W Dowdy
- a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Neil Martinson
- c Perinatal HIV Research Unit , University of Witwatersrand , Johannesburg , South Africa.,d Center for Tuberculosis Research , Johns Hopkins University , Baltimore , MD , USA
| | - Jonathan Golub
- a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,d Center for Tuberculosis Research , Johns Hopkins University , Baltimore , MD , USA
| | - John F P Bridges
- b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,e Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,f Department of Health Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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28
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Nimkar S, Valvi C, Kadam D, Rewari BB, Kinikar A, Gupte N, Suryavanshi N, Deluca A, Shankar A, Golub J, Bollinger R, Gupta A, Marbaniang I, Mave V. Loss to follow-up and mortality among HIV-infected adolescents receiving antiretroviral therapy in Pune, India. HIV Med 2018; 19:395-402. [PMID: 29573312 DOI: 10.1111/hiv.12605] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES India has the highest number of HIV-infected adolescents in Asia, but little is known about their treatment outcomes. We assessed rates and factors associated with loss to follow-up (LTFU) and mortality among Indian adolescents. METHODS The analysis included adolescents (10-19 years old) starting antiretroviral therapy (ART) between 2005 and 2014 at BJ Government Medical College, Pune, India. LTFU was defined as missing more than three consecutive monthly visits. The competing-risks method was used to calculate subdistribution hazard ratios (SHRs) of predictors for LTFU, with death as the competing risk. Cox proportional hazard models were used to identify predictors of mortality. RESULTS Of 717 adolescents starting ART, 402 with complete data were included in the analysis. Of these, 61% were male and 80% were perinatally infected, and the median baseline CD4 count was 174 cells/μL. LTFU and mortality rates were 4.4 and 4.9/100-person years, respectively. Cumulative LTFU incidence increased from 6% to 15% over 6 years. Age ≥ 15 years [adjusted SHR (aSHR) 2.44; 95% confidence interval (CI) 1.18-5.02] was a risk factor for LTFU. Cumulative mortality increased from 9.5% to 17.9% over 6 years. World Health Organization (WHO) stages III and IV [adjusted hazard ratio (aHR) 2.26; 95% CI: 1.14-4.48] and an increase in CD4 count by 100 cells/μL (aHR: 0.59; 95% CI: 0.43-0.83) were associated with mortality. CONCLUSIONS A third of adolescents had been lost to follow-up or died by follow-up year 6. Older age was a risk factor for LTFU and advanced clinical disease for death. Strategies to improve retention counselling for older adolescents and closer clinical monitoring of all adolescents must be considered.
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Affiliation(s)
- S Nimkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - C Valvi
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - D Kadam
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - B B Rewari
- National AIDS Control Organization, New Delhi, India
| | - A Kinikar
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - N Gupte
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - N Suryavanshi
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - A Deluca
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A Shankar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Golub
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - R Bollinger
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Gupta
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - I Marbaniang
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - V Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Milovanovic M, Lebina L, Otwombe K, Hlongwane K, Abraham P, Golub J, Martinson N. Exposure to secondhand smoke as a risk factor for severe tobacco smoking among young healthy men in South Africa. Tob Induc Dis 2018. [DOI: 10.18332/tid/84525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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30
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Majumder A, Carroll B, Bhana S, Tefu D, Syeda S, Martinson N, Golub J. Screening for active tuberculosis in a diabetes mellitus clinic in Soweto, South Africa. Int J Tuberc Lung Dis 2018; 20:992-3. [PMID: 27287661 DOI: 10.5588/ijtld.16.0340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Anwesha Majumder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Bryn Carroll
- Center for Tuberculosis Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sindeep Bhana
- Division of Endocrinology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Dorothy Tefu
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - Sbaa Syeda
- Center for Tuberculosis Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Neil Martinson
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa; DST/NRFCentre of Excellence for Biomedical TB Research, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Golub
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Center for Tuberculosis Research, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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31
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Suryavanshi N, Naik S, Waghmare S, Gupte N, Khan S, Mave V, Deluca A, Gupta A, Golub J, Bollinger RC, Shankar A. Gender-based violence screening methods preferred by women visiting a public hospital in Pune, India. BMC Womens Health 2018; 18:19. [PMID: 29334936 PMCID: PMC5769341 DOI: 10.1186/s12905-018-0515-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/11/2018] [Indexed: 11/17/2022]
Abstract
Background Gender-based violence (GBV) is a major global public health concern and is a risk factor for adverse health outcomes. Early identification of GBV is crucial for improved health outcomes. Interactions with health care providers may provide a unique opportunity for routine GBV screening, if a safe, confidential environment can be established. Methods Between November 2014 and February 2015, a cross-sectional, observational study was conducted where women were interviewed about their opinions concerning GBV screening in a tertiary health care setting in Pune, India. Trained counsellors interviewed 300 women at different out-patient and in-patient departments using a semi-structured questionnaire. Results Twenty-three percent of these women reported experiencing GBV in their life. However, 90% of women said they had never been asked about GBV in a health care setting. Seventy-two percent expressed willingness to be asked about GBV by their health care providers, with the preferred provider being nurses or counsellors. More than half (53%) women reported face-to-face interview as the most preferred method for screening. There were no major differences in these preferences by GBV history status. Conclusions Our study provides evidence for preferred GBV screening methods and optimal provider engagement as perceived by women attending a public hospital. Electronic supplementary material The online version of this article (10.1186/s12905-018-0515-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nishi Suryavanshi
- BJ Government Medical College - Johns Hopikns University Clinical Trial Unit, Jai Prakash Narayan Road, Pune, 411001, India.
| | - Shilpa Naik
- BJ Government Medical College, Department of Obstetrics and Gynaecology, Jai Prakash Narayan Road, Pune, India
| | - Smita Waghmare
- BJ Government Medical College - Johns Hopikns University Clinical Trial Unit, Jai Prakash Narayan Road, Pune, 411001, India
| | - Nikhil Gupte
- BJ Government Medical College - Johns Hopikns University Clinical Trial Unit, Jai Prakash Narayan Road, Pune, 411001, India.,Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Sameer Khan
- BJ Government Medical College - Johns Hopikns University Clinical Trial Unit, Jai Prakash Narayan Road, Pune, 411001, India
| | - Vidya Mave
- BJ Government Medical College - Johns Hopikns University Clinical Trial Unit, Jai Prakash Narayan Road, Pune, 411001, India.,Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Andrea Deluca
- Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Amita Gupta
- Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Jonathan Golub
- Johns Hopkins University, School of Medicine, Baltimore, USA
| | | | - Anita Shankar
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
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32
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Gupte AN, Wong ML, Msandiwa R, Barnes GL, Golub J, Chaisson RE, Hoffmann CJ, Martinson NA. Factors associated with pulmonary impairment in HIV-infected South African adults. PLoS One 2017; 12:e0184530. [PMID: 28902919 PMCID: PMC5597201 DOI: 10.1371/journal.pone.0184530] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/25/2017] [Indexed: 01/08/2023] Open
Abstract
Background HIV-infected individuals have increased risk of developing obstructive lung disease (OLD). Studies from developed countries report high viral load, low CD4 counts, and anti-retroviral therapy (ART) to be associated with OLD; but these findings may not be generalizable to populations in resource-limited settings. Methods We conducted a prospective cohort study of lung function in 730 HIV-infected black South African adults. Pre-bronchodilator spirometry was performed at enrollment and repeated annually for three years. Logistic regression models were used to identify factors associated with OLD, defined as FEV1/FVC<0.70, at enrollment. Excess annual declines in FEV1 and FVC were modelled as the product-term of follow-up time and exposures using random effects regression. Results Median (IQR) age at enrollment was 36 (32–41) years, 85% were female and 30% ever-smoked with a median (IQR) exposure of 3 (1–6) pack-years. Median (IQR) CD4 count and viral load at enrollment were 372 (261–518) cells/mm3 and 2655 (91–13,548) copies/mL respectively. Overall, 25% were receiving ART at enrollment, 16% of whom reported at least 6 months of ART receipt. OLD was found in 35 (5%) at enrollment. Increasing age (aOR = 2.08 per 10-years [95%CI 1.22–3.57], p = 0.007), current smoking (aOR = 3.55 [95%CI 1.20–10.53], p = 0.02), and CRP (aOR = 1.01 per unit-increase [95%CI 1.00–1.03], p = 0.04) were significantly associated with OLD at enrollment; while increasing CD4 count (aOR = 1.02 per-100 cells/mm3 [95%CI 0.85–1.22], p = 0.82), viral load (aOR = 0.67 per log-increase [95%CI 0.43–1.10], p = 0.12) and receipt of ART (aOR = 0.57 [95%CI 0.18–1.75], p = 0.32) were not. The median (IQR) follow-up time was 18 (12–24) months. Participants with a history of tuberculosis (TB) had a 35 mL (95%CI 2–68, p = 0.03) and 57 mL (95%CI 19–96, p = 0.003) per year excess loss of FEV1 and FVC respectively. Conclusion Prevalent OLD was associated with older age, current smoking and higher CRP levels, but not CD4 counts and ART, in HIV-infected South African adults. Better understanding of the long-term effects of TB, smoking and inflammation on lung function in HIV-infected populations is urgently needed.
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Affiliation(s)
- Akshay N. Gupte
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Center for Clinical Global Health Education (CCGHE), Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Michelle L. Wong
- Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Reginah Msandiwa
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - Grace L. Barnes
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jonathan Golub
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Richard E. Chaisson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Christopher J. Hoffmann
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Neil A. Martinson
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Gupte A, Meshram S, Selvaraju S, Gupte N, Shivakumar SVBY, Paradkar M, Kohli R, Thiruvengadam K, Suryavanshi N, Chandrasekaran P, Mave V, Swaminathan S, Salvi S, Checkley W, Golub J, Gupta A. Host Factors Associated With Poor Respiratory Health-Related Quality of Life in Pulmonary Tuberculosis. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Akshay Gupte
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Nikhil Gupte
- Johns Hopkins University School of Medicine, Pune, MD
| | | | | | - Rewa Kohli
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | | | | | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | | | - William Checkley
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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34
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Shivakumar SVBY, Chandrasekaran P, Thiruvengadam K, Gupte N, Mave V, Hannah LE, Kulkarni V, Gupte A, Deluca A, N. S. G, P. S, Paradkar M, Kohli R, Meshram S, Kagal A, Suryavanshi N, Ramachandran G, Thomas B, K. DC, Subramanyam B, Golub J, Swaminathan S, Gupta A. Tuberculosis (TB) Infection Prevalence, Incidence and Risk Factors Among Child and Adult Household Contacts of Adult TB Cases in India. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Nikhil Gupte
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vidya Mave
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Akshay Gupte
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Gomathy N. S.
- National Institute for Research in Tuberculosis, Chennai, India
| | - Sathyamurthi P.
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Rewa Kohli
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | - Anju Kagal
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | | | - Beena Thomas
- National Institute for Research in Tuberculosis, Chennai, India
| | - Dolla C. K.
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Jonathan Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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35
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Lebina L, Abraham PM, Milovanovic M, Motlhaoleng K, Chaisson RE, Rakgokong M, Golub J, Variava E, Martinson NA. Latent tuberculous infection in schoolchildren and contact tracing in Matlosana, North West Province, South Africa. Int J Tuberc Lung Dis 2016; 19:1290-2. [PMID: 26467579 DOI: 10.5588/ijtld.15.0370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This is a cross-sectional study to estimate the prevalence of latent tuberculous infection (LTBI) and the annual risk of tuberculous infection (ARTI) among a sample of children aged 5 and 7 years in Matlosana, South Africa. LTBI prevalence was significantly higher in children aged 7 years (n = 704) (19.7%, 95%CI 16.75-22.65) than in those aged 5 years (212/1401, 15.1%, 95%CI 13.23-16.97) (P = 0.0075). The ARI was 2.9% (95%CI 2.2-3.6).
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Affiliation(s)
- L Lebina
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - P M Abraham
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - M Milovanovic
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - K Motlhaoleng
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - R E Chaisson
- Johns Hopkins University Center for TB Research, Baltimore, Maryland, USA
| | - M Rakgokong
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - J Golub
- Johns Hopkins University Center for TB Research, Baltimore, Maryland, USA
| | - E Variava
- Department of Medicine, Klerksdorp-Tshepong Hospital Complex, North West Department of Health, Johannesburg, South Africa
| | - N A Martinson
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Johns Hopkins University Center for TB Research, Baltimore, Maryland, USA; Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research, University of the Witwatersrand, Johannesburg, South Africa; Soweto Matlosana Collaborative Centre for HIV/AIDS & TB, Medical Research Council, Tygerberg, Cape Town, South Africa
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36
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Golub I, Chebbi B, Golub J. Toward the optical "magic carpet": reducing the divergence of a light sheet below the diffraction limit. Opt Lett 2015; 40:5121-4. [PMID: 26512534 DOI: 10.1364/ol.40.005121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In 3D, diffraction-free or Bessel beams are well known and have found applications in diverse fields. An analog in 2D, or pseudonondiffracting (PND) beams, is a nontrivial problem, and existing methods suffer from deficiencies. For example, Airy beams are not highly localized, some PND beams have significant side lobes, and a cosine beam has to be truncated by a very narrow aperture thus discarding most of the energy. We show, both theoretically and experimentally, that it is possible to generate a quasi-nondiffracting 2D light beam in a simple and efficient fashion. This is achieved by placing a mask consisting of a pair of double slits on a cylindrical lens. The applications include light sheet microscopy/optical sectioning and particle manipulation.
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Golub J, Markota A, Stožer A, Prosen G, Bergauer A, Svenšek F, Sinkovič A. Absence of lung sliding is not a reliable indicator of pneumothorax in patients who require high PEEP. Crit Care 2015. [PMCID: PMC4472279 DOI: 10.1186/cc14219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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38
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Lönnroth K, Corbett E, Golub J, Godfrey-Faussett P, Uplekar M, Weil D, Raviglione M. Systematic screening for active tuberculosis: rationale, definitions and key considerations [State of the art series. Active case finding/screening. Number 1 in the series]. Int J Tuberc Lung Dis 2013; 17:289-98. [DOI: 10.5588/ijtld.12.0797] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- K. Lönnroth
- Stop TB Department, World Health Organization, Geneva, Switzerland
| | - E. Corbett
- London School of Hygiene & Tropical Medicine, London, UK
| | - J. Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - M. Uplekar
- Stop TB Department, World Health Organization, Geneva, Switzerland
| | - D. Weil
- Stop TB Department, World Health Organization, Geneva, Switzerland
| | - M. Raviglione
- Stop TB Department, World Health Organization, Geneva, Switzerland
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Pinto V, Espinosa A, Tancredi M, Golub J, Alencar R. P1-S5.28 Cervical cytology and histopathologic abnormalities in women living with AIDS in SAo Paulo, Brazil. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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40
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Motta MCS, Villa TCS, Golub J, Kritski AL, Ruffino-Netto A, Silva DF, Harter RG, Scatena LM. Access to tuberculosis diagnosis in Itaboraí City, Rio de Janeiro, Brazil: the patient's point of view. Int J Tuberc Lung Dis 2009; 13:1137-1141. [PMID: 19723404 PMCID: PMC3697920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
SETTING Itaboraí Municipality in Rio de Janeiro, Brazil. OBJECTIVE To evaluate access to tuberculosis (TB) diagnosis for users of the Family Health Program (FHP) and Reference Ambulatory Units (RAUs). DESIGN A cross-sectional study was conducted in Itaboraí City, Rio de Janeiro, Brazil. Between July and October 2007, a sample of 100 TB patients registered consecutively with the TB Control Program was interviewed using the primary care assessment tool. The two highest scores, describing 'almost always' and 'always', or 'good' and 'very good', were used as a cut-off point to define high quality access to diagnosis. RESULTS FHP patients were older and had less education than RAU interviewees. Sex and overcrowding did not differ in the two groups. Patient groups did not differ with regard to the number of times care was sought at a unit, transport problems, cost of attending units and availability of consultation within 24 h. Adequate access to diagnosis was identified by 62% of the FHP patients and 53% of the RAU patients (P = 0.01). CONCLUSION In Itaboraí, Rio de Janeiro, TB patients believe that the FHP units provide greater access to TB diagnosis than RAUs. These findings will be used by the Department of Health to improve access to diagnosis in Itaboraí.
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Affiliation(s)
- M C S Motta
- Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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41
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Torsuev N, Winnitschenko W, Golub J. Vergleichende Bewertung der Wirksamkeit von Behandlungsmethoden ohne Röntgen bei Mykosen der behaarten Kopfhaut. Mycoses 2009. [DOI: 10.1111/j.1439-0507.1967.tb02884.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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42
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Miller AC, Soares E, Fonseca Z, Cavalcante S, Durovni B, Moulton L, Chaisson R, Golub J. Care-Seeking Behavior for Respiratory Symptoms in a Brazilian Favela (SLUM). Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s35-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dooley K, Golub J, Sterling T. Reply. Clin Infect Dis 2002. [DOI: 10.1086/345303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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44
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Lathan M, Mukasa LN, Hooper N, Golub J, Baruch N, Mulcahy D, Benjamin W, Cronin WA. Cross-jurisdictional transmission of Mycobacterium tuberculosis in Maryland and Washington, D C, 1996-2000, linked to the homeless. Emerg Infect Dis 2002; 8:1249-51. [PMID: 12453350 PMCID: PMC2738544 DOI: 10.3201/eid0811.020245] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
From 1996 to 2000, 23 Maryland and Washington, D.C., tuberculosis cases were identified in one six-band DNA cluster. Cases were clustered on the basis of their Mycobacterium tuberculosis isolates. Medical record reviews and interviews were conducted to identify epidemiologic linkages. Eighteen (78%) of the 23 case-patients with identical restriction fragment length polymorphism patterns were linked to another member; half the patients were associated with a Washington, D.C., homeless shelter. Molecular epidemiology defined the extent of this large, cross-jurisdictional outbreak.
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Affiliation(s)
- Monica Lathan
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA
- American Public Health Association, Washington, D.C., USA
| | | | - Nancy Hooper
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA
| | - Jonathan Golub
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA
| | - Nancy Baruch
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA
| | - Donna Mulcahy
- Alabama Department of Health, Montgomery, Alabama, USA
| | | | - Wendy A. Cronin
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA
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Chaisson RE, Armstrong J, Stafford J, Golub J, Bur S. Safety and tolerability of intermittent rifampin/pyrazinamide for the treatment of latent tuberculosis infection in prisoners. JAMA 2002; 288:165-6. [PMID: 12095379 DOI: 10.1001/jama.288.2.165] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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46
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Dooley KE, Golub J, Goes FS, Merz WG, Sterling TR. Empiric treatment of community-acquired pneumonia with fluoroquinolones, and delays in the treatment of tuberculosis. Clin Infect Dis 2002; 34:1607-12. [PMID: 12032896 DOI: 10.1086/340618] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2001] [Revised: 02/04/2002] [Indexed: 11/04/2022] Open
Abstract
Fluoroquinolones, which are widely used to treat community-acquired pneumonia, also have excellent in vitro activity against Mycobacterium tuberculosis. A retrospective cohort study was conducted among adults with culture-confirmed tuberculosis to assess the effect of empiric fluoroquinolone therapy on delays in the treatment of tuberculosis. Sixteen (48%) of 33 patients received fluoroquinolones for presumed bacterial pneumonia before tuberculosis was diagnosed and treated. There were no differences between the group who did and the group who did not receive fluoroquinolones, except that patients who received fluoroquinolones were more likely to present with shortness of breath. Among patients treated empirically with fluoroquinolones, the median time between presentation to the hospital and initiation of antituberculosis treatment was 21 days (interquartile range, 5-32 days); among those who were not, it was 5 days (interquartile range, 1-16 days; P=.04). Initial empiric therapy with a fluoroquinolone was associated with a delay in the initiation of appropriate antituberculosis treatment.
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Affiliation(s)
- Kelly E Dooley
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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47
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Orlian AI, Schaefer M, Golub J. Multiple bilateral sialoliths of the submandibular ducts. N Y State Dent J 1998; 64:42-3. [PMID: 9785838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A patient with a history of 20 years of intermittent pain and swelling of the floor of the mouth was diagnosed with bilateral multiple sialoliths of the submandibular ducts. Subsequent to the excision of all the sialoliths, the patient was asymptomatic. She will be observed periodically.
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48
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Golub J. Home bleaching may lure new patients. Dentist 1989; 67:1, 36, 43. [PMID: 2630215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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49
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Golub J, Nestor K. CareReview. QRC Advis 1989; 5:5-8. [PMID: 10304327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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50
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Golub J. Esthetic makeovers focus on smile line. Dentist 1989; 67:22, 25-6. [PMID: 2598715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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