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Garcia-Basteiro AL, Ehrlich J, Bonnet M, Calnan M, Graham SM, Hermans S, Jarrett A, Lewa R, Mandalakas A, Martinez L, Migliori GB, Ong CWM, Otero L, Rangaka MX, Raviglione MCB, Seaworth B, Ssengooba W, Theron G, Trajman A, Behr MA. A Global Tuberculosis Dictionary: unified terms and definitions for the field of tuberculosis. Lancet Glob Health 2024; 12:e737-e739. [PMID: 38527468 DOI: 10.1016/s2214-109x(24)00083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Alberto L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça, Manhiça 1121, Mozambique; Instituto de Salud Global de Barcelona, Barcelona, Spain.
| | - Joanna Ehrlich
- Instituto de Salud Global de Barcelona, Barcelona, Spain
| | - Maryline Bonnet
- TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | | | - Stephen M Graham
- University of Melbourne Department of Paediatrics, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sabine Hermans
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, Amsterdam, Netherlands; Department of Infectious Diseases, Centre for Tropical Medicine and Travel Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Adriana Jarrett
- We Are TB, National Tuberculosis Controllers Association, Smyrna, GA, USA
| | | | - Anna Mandalakas
- Department of Pediatrics, Baylor College of Medicine-Texas Children's Hospital, Houston, TX, USA
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Tradate, Italy
| | - Catherine W M Ong
- Infectious Diseases Translational Research Programme and Division of Infectious Diseases, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Larissa Otero
- School of Medicine and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Molebogeng Xheedha Rangaka
- Institute for Global Health & Medical Research Council Clinical Trials Unit, University College London, London, UK; School of Public Health and Clinical Infectious Disease Research Institute-AFRICA, University of Cape Town, Cape Town, South Africa
| | - Mario C B Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Barbara Seaworth
- University of Texas at Tyler Health Science Center, Tyler, Texas, USA
| | - Willy Ssengooba
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anete Trajman
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; McGill International TB Centre, Montreal, QC, Canada
| | - Marcel A Behr
- McGill International TB Centre, Montreal, QC, Canada
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Olbrich L, Verghese VP, Franckling-Smith Z, Sabi I, Ntinginya NE, Mfinanga A, Banze D, Viegas S, Khosa C, Semphere R, Nliwasa M, McHugh TD, Larsson L, Razid A, Song R, Corbett EL, Nabeta P, Trollip A, Graham SM, Hoelscher M, Geldmacher C, Zar HJ, Michael JS, Heinrich N. Diagnostic accuracy of a three-gene Mycobacterium tuberculosis host response cartridge using fingerstick blood for childhood tuberculosis: a multicentre prospective study in low-income and middle-income countries. Lancet Infect Dis 2024; 24:140-149. [PMID: 37918414 PMCID: PMC10808504 DOI: 10.1016/s1473-3099(23)00491-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Childhood tuberculosis remains a major cause of morbidity and mortality in part due to missed diagnosis. Diagnostic methods with enhanced sensitivity using easy-to-obtain specimens are needed. We aimed to assess the diagnostic accuracy of the Cepheid Mycobacterium tuberculosis Host Response prototype cartridge (MTB-HR), a candidate test measuring a three-gene transcriptomic signature from fingerstick blood, in children with presumptive tuberculosis disease. METHODS RaPaed-TB was a prospective diagnostic accuracy study conducted at four sites in African countries (Malawi, Mozambique, South Africa, and Tanzania) and one site in India. Children younger than 15 years with presumptive pulmonary or extrapulmonary tuberculosis were enrolled between Jan 21, 2019, and June 30, 2021. MTB-HR was performed at baseline and at 1 month in all children and was repeated at 3 months and 6 months in children on tuberculosis treatment. Accuracy was compared with tuberculosis status based on standardised microbiological, radiological, and clinical data. FINDINGS 5313 potentially eligible children were screened, of whom 975 were eligible. 784 children had MTB-HR test results, of whom 639 had a diagnostic classification and were included in the analysis. MTB-HR differentiated children with culture-confirmed tuberculosis from those with unlikely tuberculosis with a sensitivity of 59·8% (95% CI 50·8-68·4). Using any microbiological confirmation (culture, Xpert MTB/RIF Ultra, or both), sensitivity was 41·6% (34·7-48·7), and using a composite clinical reference standard, sensitivity was 29·6% (25·4-34·2). Specificity for all three reference standards was 90·3% (95% CI 85·5-94·0). Performance was similar in different age groups and by malnutrition status. Among children living with HIV, accuracy against the strict reference standard tended to be lower (sensitivity 50·0%, 15·7-84·3) compared with those without HIV (61·0%, 51·6-69·9), although the difference did not reach statistical significance. Combining baseline MTB-HR result with one Ultra result identified 71·2% of children with microbiologically confirmed tuberculosis. INTERPRETATION MTB-HR showed promising diagnostic accuracy for culture-confirmed tuberculosis in this large, geographically diverse, paediatric cohort and hard-to-diagnose subgroups. FUNDING European and Developing Countries Clinical Trials Partnership, UK Medical Research Council, Swedish International Development Cooperation Agency, Bundesministerium für Bildung und Forschung; German Center for Infection Research (DZIF).
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Affiliation(s)
- Laura Olbrich
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany; Fraunhofer Institute ITMP, Immunology, Infection and Pandemic Research, Munich, Germany; Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Valsan P Verghese
- Pediatric Infectious Diseases, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Zoe Franckling-Smith
- Department of Paediatrics and Child Health, SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Issa Sabi
- Mbeya Medical Research Centre, National Institute for Medical Research, Mbeya, Tanzania
| | - Nyanda E Ntinginya
- Mbeya Medical Research Centre, National Institute for Medical Research, Mbeya, Tanzania
| | - Alfred Mfinanga
- Mbeya Medical Research Centre, National Institute for Medical Research, Mbeya, Tanzania
| | - Denise Banze
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Sofia Viegas
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Celso Khosa
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Robina Semphere
- Helse Nord Tuberculosis Initiative, Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Marriott Nliwasa
- Helse Nord Tuberculosis Initiative, Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Timothy D McHugh
- Centre for Clinical Microbiology, University College London, London, UK
| | - Leyla Larsson
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Alia Razid
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Rinn Song
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Elizabeth L Corbett
- Helse Nord Tuberculosis Initiative, Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi; Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Pamela Nabeta
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Andre Trollip
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Stephen M Graham
- Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany; CIHLMU Center for International Health, LMU University Hospital, LMU Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany; Fraunhofer Institute ITMP, Immunology, Infection and Pandemic Research, Munich, Germany; Unit Global Health, Helmholtz Zentrum München, German Research Center for Environmental Health (HMGU), Neuherberg, Germany
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany; Fraunhofer Institute ITMP, Immunology, Infection and Pandemic Research, Munich, Germany
| | - Heather J Zar
- Department of Paediatrics and Child Health, SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | | | - Norbert Heinrich
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany; CIHLMU Center for International Health, LMU University Hospital, LMU Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany; Fraunhofer Institute ITMP, Immunology, Infection and Pandemic Research, Munich, Germany.
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Boast A, How JA, Lau C, Sett A, Gilby D, Burke A, McWhinney B, Wright C, Tramontana A, Globan M, Denholm J, Graham SM, Osowicki J. Pre-extensively Drug-Resistant Congenital Tuberculosis in an Extremely Premature Baby. Clin Infect Dis 2024; 78:149-153. [PMID: 37681559 PMCID: PMC10810709 DOI: 10.1093/cid/ciad540] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/06/2023] [Accepted: 09/05/2023] [Indexed: 09/09/2023] Open
Abstract
We describe a case of congenital tuberculosis in an extremely premature baby, with rapid molecular detection of a pre-extensively drug-resistant (XDR) pattern of drug resistance. The baby was treated successfully with a regimen including bedaquline and delamanid, drugs not previously described in the treatment of congenital tuberculosis (TB).
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Affiliation(s)
- Alison Boast
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Antimicrobials Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jeu Ann How
- Newborn Services, Joan Kirner Women's and Children's Hospital, St Albans, Victoria, Australia
| | - Charis Lau
- Newborn Services, Joan Kirner Women's and Children's Hospital, St Albans, Victoria, Australia
- Pharmacy Department, Joan Kirner Women's and Children's Hospital, St Albans, Victoria, Australia
| | - Arun Sett
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
- Centre of Research Excellence in Newborn Medicine, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Damien Gilby
- Newborn Services, Joan Kirner Women's and Children's Hospital, St Albans, Victoria, Australia
| | - Andrew Burke
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Brett McWhinney
- Department of Chemical Pathology, Pathology Queensland, Queensland Health, Herston, Australia
| | - Connor Wright
- Department of Infectious Diseases, Western Health, St Albans, Victoria, Australia
| | - Adrian Tramontana
- Department of Infectious Diseases, Western Health, St Albans, Victoria, Australia
| | - Maria Globan
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
| | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health, Parkville, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Stephen M Graham
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Joshua Osowicki
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Bonnet M, Vasiliu A, Tchounga BK, Cuer B, Fielding K, Ssekyanzi B, Tchakounte Youngui B, Cohn J, Dodd PJ, Tiendrebeogo G, Tchendjou P, Simo L, Okello RF, Kuate Kuate A, Turyahabwe S, Atwine D, Graham SM, Casenghi M. Effectiveness of a community-based approach for the investigation and management of children with household tuberculosis contact in Cameroon and Uganda: a cluster-randomised trial. Lancet Glob Health 2023; 11:e1911-e1921. [PMID: 37918417 DOI: 10.1016/s2214-109x(23)00430-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/13/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Globally, the uptake of tuberculosis-preventive treatment (TPT) among children with household tuberculosis contact remains low, partly due to the necessity of bringing children to health facilities for investigations. This study aimed to evaluate the effect on TPT initiation and completion of community-based approaches to tuberculosis contact investigations in Cameroon and Uganda. METHODS We did a parallel, cluster-randomised, controlled trial across 20 clusters (consisting of 25 district hospitals and primary health centres) in Cameroon and Uganda, which were randomised (1:1) to receive a community-based approach (intervention group) or standard-of-care facility-based approach to contact screening and management (control group). The community-based approach consisted of symptom-based tuberculosis screening of all household contacts by community health workers at the household, with referral of symptomatic contacts to local facilities for investigations. Initiation of TPT (3-month course of rifampicin-isoniazid) was done by a nurse in the household, and home visits for TPT follow-up were done by community health workers. Index patients were people aged 15 years or older with bacteriologically confirmed, drug-susceptible, pulmonary tuberculosis diagnosed less than 1 month before inclusion and who declared at least one child or young adolescent (aged 0-14 years) household contact. The primary endpoint was the proportion of declared child contacts in the TPT target group (those aged <5 years irrespective of HIV status, and children aged 5-14 years living with HIV) who commenced and completed TPT, assessed in the modified intention-to-treat population (excluding enrolled index patients and their contacts who did not fit the eligibility criteria). Descriptive cascade of care assessment and generalised linear mixed modelling were used for comparison. This study is registered with ClinicalTrials.gov (NCT03832023). FINDINGS The study included nine clusters in the intervention group (after excluding one cluster that did not enrol any index patients for >2 months) and ten in the control group. Between Oct 14, 2019 and Jan 13, 2022, 2894 child contacts were declared by 899 index patients with bacteriologically confirmed tuberculosis. Among all child contacts declared, 1548 (81·9%) of 1889 in the intervention group and 475 (47·3%) of 1005 in the control group were screened for tuberculosis. 1400 (48·4%) child contacts were considered to be in the TPT target group: 941 (49·8%) of 1889 in the intervention group and 459 (45·7%) of 1005 in the control group. In the TPT target group, TPT was commenced and completed in 752 (79·9%) of 941 child contacts in the intervention group and 283 (61·7%) of 459 in the control group (odds ratio 3·06 [95% CI 1·24-7·53]). INTERPRETATION A community-based approach using community health workers can significantly increase contact investigation coverage and TPT completion among eligible child contacts in a tuberculosis-endemic setting. FUNDING Unitaid. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Maryline Bonnet
- TransVIHMI, University Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France.
| | - Anca Vasiliu
- TransVIHMI, University Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | - Benjamin Cuer
- TransVIHMI, University Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France
| | | | | | | | - Jennifer Cohn
- Department of Innovation and New Technology, Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland
| | - Peter J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Georges Tiendrebeogo
- University Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France
| | | | - Leonie Simo
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | | | | | | | - Daniel Atwine
- Clinical Research Department, Epicentre Mbarara Research Centre, Mbarara, Uganda
| | - Stephen M Graham
- Royal Children's Hospital, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Melbourne, Australia; International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Martina Casenghi
- Department of Innovation and New Technology, Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland
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Trauer JM, Tiberi S, Graham SM, Blackbourn HD. Literature Highlights. Int J Tuberc Lung Dis 2023; 27:721-723. [PMID: 37749840 PMCID: PMC10519380 DOI: 10.5588/ijtld.23.9910] [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] [Indexed: 09/27/2023] Open
Abstract
Literature Highlights is a digest of notable papers recently published in the leading respiratory journals, allowing our readers to stay up-to-date with research advances. Coverage in this issue includes time to smear and culture conversion during TB treatment; probability of diagnosing ventilator-associated pneumonia in intensive care and use of antimicrobials; optimising computer-aided chest X-ray to diagnose intra-thoracic TB in children; and clinical standards for asthma in low- and middle-income countries.
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Affiliation(s)
- J M Trauer
- Monash University, Melbourne, VIC, Australia
| | - S Tiberi
- Blizard Institute, Queen Mary University, London, UK
| | | | - H D Blackbourn
- International Union Against Tuberculosis and Lung Disease, Paris, France
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Simpson G, Philip M, Vogel JP, Scoullar MJL, Graham SM, Wilson AN. The clinical presentation and detection of tuberculosis during pregnancy and in the postpartum period in low- and middle-income countries: A systematic review and meta-analysis. PLOS Glob Public Health 2023; 3:e0002222. [PMID: 37611006 PMCID: PMC10446195 DOI: 10.1371/journal.pgph.0002222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/10/2023] [Indexed: 08/25/2023]
Abstract
For women infected with Mycobacterium tuberculosis, pregnancy is associated with an increased risk of developing or worsening TB disease. TB in pregnancy increases the risk of adverse maternal and neonatal outcomes, however the detection of TB in pregnancy is challenging. We aimed to identify and summarise the findings of studies regarding the clinical presentation and diagnosis of TB during pregnancy and the postpartum period (within 6 months of birth) in low-and middle-income countries (LMICs). A systematic review was conducted searching Ovid MEDLINE, Embase, CINAHL and Global Index Medicus databases. We included any primary research study of women diagnosed with TB during pregnancy or the postpartum period in LMICs that described the clinical presentation or method of diagnosis. Meta-analysis was used to determine pooled prevalence of TB clinical features and health outcomes, as well as detection method yield. Eighty-seven studies of 2,965 women from 27 countries were included. 70.4% of women were from South Africa or India and 44.7% were known to be HIV positive. For 1,833 women where TB type was reported, pulmonary TB was most common (79.6%). Most studies did not report the prevalence of presenting clinical features. Where reported, the most common were sputum production (73%) and cough (68%). Having a recent TB contact was found in 45% of women. Only six studies screened for TB using diagnostic testing for asymptomatic antenatal women and included mainly HIV-positive women ‒ 58% of women with bacteriologically confirmed TB did not report symptoms and only two were in HIV-negative women. Chest X-ray had the highest screening yield; 60% abnormal results of 3036 women tested. Screening pregnant women for TB-related symptoms and risk factors is important but detection yields are limited. Chest radiography and bacteriological detection methods can improve this, but procedures for optimal utilisation remain uncertain in this at-risk population. Trial registration: Prospero registration number: CRD42020202493.
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Affiliation(s)
- Grace Simpson
- Maternal Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Moira Philip
- Maternal Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Joshua P. Vogel
- Maternal Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Michelle J. L. Scoullar
- Maternal Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Stephen M. Graham
- Maternal Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
- Centre for International Health, University of Melbourne Department of Paediatrics, Melbourne, Australia
| | - Alyce N. Wilson
- Maternal Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
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Maleche-Obimbo E, Attia E, Were F, Jaoko W, Graham SM. Prevalence, clinical presentation and factors associated with chronic lung disease among children and adolescents living with HIV in Kenya. PLoS One 2023; 18:e0289756. [PMID: 37556423 PMCID: PMC10411792 DOI: 10.1371/journal.pone.0289756] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Children and adolescents with HIV (CAHIV) may experience recurrent and severe respiratory disease and are at risk of residual lung sequelae, and long-term morbidity from chronically damaged lungs. With improved survival due to increased access to effective antiretroviral therapy there is an increasing population of CAHIV who require optimal life-long care. Chronic lung disease in CAHIV is an under-recognised problem in African settings. We sought to determine the prevalence, clinical presentation and factors associated with chronic lung disease (CLD) among CAHIV in Kenya. METHODS CAHIV aged ≤19 years in care at a public hospital in Nairobi were enrolled into a longitudinal cohort study. Sociodemographic and clinical information were obtained through interview, medical record review, physical examination and six-minute walk test. CD4 counts and viral load were determined. Enrolment data was analysed to determine baseline sociodemographic and clinical characteristics. Prevalence of CLD defined as presence of ≥2 respiratory symptoms or signs at enrolment was computed. Logistic regression analysis was performed to evaluate for association between various factors and presence or absence of CLD. RESULTS We enrolled 320 CAHIV of median age 13 (IQR 10-16) years, 80 (25%) were <10 years, 46% were female, 31% lived in a one-room house and 51% used polluting cooking fuel. Antiretroviral therapy (ART) was initiated after age five years in 56%, 43% had prior pneumonia or tuberculosis, 11% had low CD4 count and 79% were virologically suppressed. Common respiratory symptoms and signs were exertional breathlessness (40%), chronic cough (23%), chest problems in the preceding year (24%), tachypnoea (52%), finger clubbing (6%), exercise limitation (59%) and oxygen desaturation during exercise (7%). CLD was present in 82 (26%) participants, and adding the six-minute walk distance <70% of predicted (exercise limitation) identified an additional 28 (9%) CAHIV with CLD. CLD was more common among older teenagers (odds ratio (OR) 1.95), those who had prior TB or pneumonia (OR 2.04), delayed initiation of ART (OR 2.60), cotrimoxazole prophylaxis (OR 3.35) or TB preventive therapy (OR 2.81). CLD was associated with viraemia (OR 2.7), lower quality of life (OR 12.7), small houses (OR 2.05), caregiver having fewer years of education (OR 2.46), outdoor pollution exposure (OR 3.31) and lower use of polluting cooking fuel indoors (OR 0.26). Adjusted analysis revealed CLD to be associated with prior tuberculosis or pneumonia (adjusted OR (aOR) [95%CI] 2.15 [1.18-3.91]), small house (aOR 1.95 [1.02-3.73]), lower use of polluting cooking fuel (aOR 0.35 [0.13-0.94]) and negative impact on health-related quality of life (aOR 6.91 [3.66-13.03]). CONCLUSIONS CLD is highly prevalent across the age spectrum of CAHIV, and most are symptomatic with cough or exertional breathlessness. CLD is associated with prior tuberculosis or pneumonia, socio-environmental factors, and lower quality of life. Structured interventions are needed to provide optimal care specific to their needs.
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Affiliation(s)
- Elizabeth Maleche-Obimbo
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
- Division of Paediatrics, Kenyatta National Hospital, Nairobi, Kenya
| | - Engi Attia
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Fredrick Were
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | - Walter Jaoko
- Department of Medical Microbiology & Immunology, University of Nairobi, Nairobi, Kenya
| | - Stephen M. Graham
- Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Melbourne, Australia
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Chiang SS, Graham SM, Schaaf HS, Marais BJ, Sant'Anna CC, Sharma S, Starke JR, Triasih R, Achar J, Amanullah F, Armitage LY, Aurilio RB, Buck WC, Centis R, Chabala C, Cruz AT, Demers AM, du Preez K, Enimil A, Furin J, Garcia-Prats AJ, Gonzalez NE, Hoddinott G, Isaakidis P, Jaganath D, Kabra SK, Kampmann B, Kay A, Kitai I, Lopez-Varela E, Maleche-Obimbo E, Malaspina FM, Velásquez JN, Nuttall JJC, Oliwa JN, Andrade IO, Perez-Velez CM, Rabie H, Seddon JA, Sekadde MP, Shen A, Skrahina A, Soriano-Arandes A, Steenhoff AP, Tebruegge M, Tovar MA, Tsogt B, van der Zalm MM, Welch H, Migliori GB. Clinical standards for drug-susceptible TB in children and adolescents. Int J Tuberc Lung Dis 2023; 27:584-598. [PMID: 37491754 PMCID: PMC10365562 DOI: 10.5588/ijtld.23.0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND: These clinical standards aim to provide guidance for diagnosis, treatment, and management of drug-susceptible TB in children and adolescents.METHODS: Fifty-two global experts in paediatric TB participated in a Delphi consensus process. After eight rounds of revisions, 51/52 (98%) participants endorsed the final document.RESULTS: Eight standards were identified: Standard 1, Age and developmental stage are critical considerations in the assessment and management of TB; Standard 2, Children and adolescents with symptoms and signs of TB disease should undergo prompt evaluation, and diagnosis and treatment initiation should not depend on microbiological confirmation; Standard 3, Treatment initiation is particularly urgent in children and adolescents with presumptive TB meningitis and disseminated (miliary) TB; Standard 4, Children and adolescents should be treated with an appropriate weight-based regimen; Standard 5, Treating TB infection (TBI) is important to prevent disease; Standard 6, Children and adolescents should receive home-based/community-based treatment support whenever possible; Standard 7, Children, adolescents, and their families should be provided age-appropriate support to optimise engagement in care and clinical outcomes; and Standard 8, Case reporting and contact tracing should be conducted for each child and adolescent.CONCLUSION: These consensus-based clinical standards, which should be adapted to local contexts, will improve the care of children and adolescents affected by TB.
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Affiliation(s)
- S S Chiang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, Center for International Health Research, Rhode Island Hospital, Providence, RI, USA
| | - S M Graham
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Burnet Institute, Melbourne, VIC, Australia
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - B J Marais
- Department of Paediatrics and Child Health and the Sydney Infectious Diseases Institute (Sydney ID), Sydney, NSW, Department of Infectious Diseases, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - C C Sant'Anna
- Department of Paediatrics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - S Sharma
- Department of Paediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - J R Starke
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, Section of Infectious Diseases, Texas Children's Hospital, Houston, TX, USA
| | - R Triasih
- Department of Paediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - J Achar
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - F Amanullah
- Department of Paediatrics, The Indus Hospital and Health Network, Karachi, Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan
| | - L Y Armitage
- Heartland National TB Center, University of Texas Health Science Center at Tyler, San Antonio, TX, USA
| | - R B Aurilio
- Department of Paediatrics, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Department of Paediatrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - W C Buck
- Department of Pediatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - R Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italy
| | - C Chabala
- School of Medicine, Department of Paediatrics and Child Health, University of Zambia, Lusaka, Children's Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - A T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - A-M Demers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Division of Microbiology, Department of Laboratory Medicine, CHU Sainte-Justine, Montreal, Canada
| | - K du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Enimil
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
| | - N E Gonzalez
- División Neumotisiología, Hospital de Niños Pedro de Elizalde, Buenos Aires, Dirección General de Posgrado, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - P Isaakidis
- Southern Africa Medical Unit (SAMU), Médecins Sans Frontières, Cape Town, South Africa, Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - D Jaganath
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - S K Kabra
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - B Kampmann
- Charite Centre for Global Health, Charite Universitatsmedizin Berlin, Berlin, Germany, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - A Kay
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - I Kitai
- Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - E Lopez-Varela
- Hospital Clínic and ISGlobal, Universitat de Barcelona, Barcelona, Spain, Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - E Maleche-Obimbo
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | - F Mestanza Malaspina
- Department of Paediatrics, Hospital San Bartólome, Lima, Red Peruana de Tuberculosis Pediátrica, Dirección de Prevención y Control de Tuberculosis, Ministerio de Salud, Lima, Perú
| | - J Niederbacher Velásquez
- Department of Paediatrics, Universidad Industrial de Santander, Bucaramanga, Board of Directors, Asociación Colombiana de Neumología Pediátrica, Bogotá, Colombia
| | - J J C Nuttall
- Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - J N Oliwa
- Faculty of Health Sciences, Department of Paediatrics and Child Health, The University of Nairobi, Nairobi, Health Services Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - I Orozco Andrade
- Center of Diagnosis and Integral Treatment for Tuberculosis, Servicios Médicos de la Frontera, Juárez, Medical Coordination, Juntos Binational Tuberculosis Project, Juárez, México
| | - C M Perez-Velez
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - H Rabie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Infectious Disease, Imperial College London, London, UK
| | - M P Sekadde
- National TB and Leprosy Program, Ministry of Health, Kampala, Uganda
| | - A Shen
- Beijing Paediatric Research Institute, National Centre for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, Pediatric Research Institute, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - A Skrahina
- Clinical Department, The Republican Scientific and Practical Centre for Pulmonology and TB, Minsk, Belarus
| | - A Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Infection and Immunity in Children, Vall d'Hebron Research Institute, Barcelona, Spain
| | - A P Steenhoff
- Global Health Center and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA, Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - M Tebruegge
- Department of Infection, Immunity & Inflammation, University College London, Great Ormond Street Institute of Child Health, London, UK, Department of Paediatrics, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
| | - M A Tovar
- Socios En Salud Sucursal Perú, Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - B Tsogt
- Research and Innovation, Mongolian Anti-TB Coalition, Ulaanbaatar, Mongolia
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H Welch
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, Department of Paediatrics, The University of Papua New Guinea School of Medicine and Health Sciences, Port Moresby, Papua New Guinea
| | - G B Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italy
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9
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Nguyen PT, Nguyen TT, Huynh LT, Graham SM, Marais BJ. Clinical algorithm reduces antibiotic use among children presenting with respiratory symptoms to hospital in central Vietnam. Pneumonia (Nathan) 2023; 15:11. [PMID: 37488633 PMCID: PMC10367404 DOI: 10.1186/s41479-023-00113-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 06/29/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE To assess the safety and utility of a pragmatic clinical algorithm to guide rational antibiotic use in children presenting with respiratory infection. METHODS The effect of an algorithm to guide the management of young (< 5 years) children presenting with respiratory symptoms to the Da Nang Hospital for Women and Children, Vietnam, was evaluated in a before-after intervention analysis. The main outcome was reduction in antibiotic use, with monitoring of potential harm resulting from reduced antibiotic use. The intervention comprised a single training session of physicians in the use of an algorithm informed by local evidence; developed during a previous prospective observational study. The evaluation was performed one month after the training. RESULTS Of the 1290 children evaluated before the intervention, 102 (7.9%) were admitted to hospital and 556/1188 (46.8%) were sent home with antibiotics. Due to COVID-19, only 166 children were evaluated after the intervention of whom 14 (8.4%) were admitted to hospital and 54/152 (35.5%) were sent home with antibiotics. Antibiotic use was reduced (from 46.8% to 35.5%; p = 0.009) after clinician training, but adequate comparison was compromised. The reduction was most pronounced in children with wheeze or runny nose and no fever, or a normal chest radiograph, where antibiotic use declined from 46.7% to 28.8% (p < 0.0001). The frequency of repeat presentation to hospital was similar between the two study periods (141/1188; 11.9% before and 10/152; 6.6% after; p = 0.10). No child represented with serious disease after being sent home without antibiotics. CONCLUSIONS We observed a reduction in antibiotic use in young children with a respiratory infection after physician training in the use of a simple evidence-based management algorithm. However, the study was severely impacted by COVID-19 restrictions, requiring further evaluation to confirm the observed effect.
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Affiliation(s)
- Phuong Tk Nguyen
- Respiratory Department, Da Nang Hospital for Women and Children, Da Nang, Vietnam.
- Sydney Vietnam Initiative, The University of Sydney, Sydney, Australia.
| | - Tam Tm Nguyen
- Respiratory Department, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Lan Tb Huynh
- Respiratory Department, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Stephen M Graham
- Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Ben J Marais
- Discipline of Paediatrics and Adolescent Medicine, The Children's Hospital at Westmead, Westmead, Australia
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, Australia
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10
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Olbrich L, Nliwasa M, Sabi I, Ntinginya NE, Khosa C, Banze D, Corbett EL, Semphere R, Verghese VP, Michael JS, Graham SM, Egere U, Schaaf HS, Morrison J, McHugh TD, Song R, Nabeta P, Trollip A, Geldmacher C, Hoelscher M, Zar HJ, Heinrich N. Rapid and Accurate Diagnosis of Pediatric Tuberculosis Disease: A Diagnostic Accuracy Study for Pediatric Tuberculosis. Pediatr Infect Dis J 2023; 42:353-360. [PMID: 36854097 PMCID: PMC10097493 DOI: 10.1097/inf.0000000000003853] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION An estimated 1.2 million children develop tuberculosis (TB) every year with 240,000 dying because of missed diagnosis. Existing tools suffer from lack of accuracy and are often unavailable. Here, we describe the scientific and clinical methodology applied in RaPaed-TB, a diagnostic accuracy study. METHODS This prospective diagnostic accuracy study evaluating several candidate tests for TB was set out to recruit 1000 children <15 years with presumptive TB in 5 countries (Malawi, Mozambique, South Africa, Tanzania, India). Assessments at baseline included documentation of TB signs and symptoms, TB history, radiography, tuberculin skin test, HIV testing and spirometry. Respiratory samples for reference standard testing (culture, Xpert Ultra) included sputum (induced/spontaneous) or gastric aspirate, and nasopharyngeal aspirate (if <5 years). For novel tests, blood, urine and stool were collected. All participants were followed up at months 1 and 3, and month 6 if on TB treatment or unwell. The primary endpoint followed NIH-consensus statements on categorization of TB disease status for each participant. The study was approved by the sponsor's and all relevant local ethics committees. DISCUSSION As a diagnostic accuracy study for a disease with an imperfect reference standard, Rapid and Accurate Diagnosis of Pediatric Tuberculosis Disease (RaPaed-TB) was designed following a rigorous and complex methodology. This allows for the determination of diagnostic accuracy of novel assays and combination of testing strategies for optimal care for children, including high-risk groups (ie, very young, malnourished, children living with HIV). Being one of the largest of its kind, RaPaed-TB will inform the development of improved diagnostic approaches to increase case detection in pediatric TB.
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Affiliation(s)
- Laura Olbrich
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Oxford Vaccine Group, Department of Paediatrics, and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Marriott Nliwasa
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- Helse Nord Tuberculosis Initiative, Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Issa Sabi
- National Institute for Medical Research – Mbeya Medical Research Centre, Mbeya, Tanzania
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Nyanda E. Ntinginya
- National Institute for Medical Research – Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Celso Khosa
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - Denise Banze
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - Elizabeth L. Corbett
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robina Semphere
- Helse Nord Tuberculosis Initiative, Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Valsan P. Verghese
- Pediatric Infectious Diseases, Department of Pediatrics, Christian Medical College (CMC), Vellore, India
| | - Joy Sarojini Michael
- Department of Clinical Microbiology, Christian Medical College (CMC), Vellore, India
| | - Stephen M. Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics, Royal Children’s Hospital, Melbourne, Australia
| | - Uzochukwu Egere
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
| | - H. Simon Schaaf
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Julie Morrison
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Timothy D. McHugh
- Centre for Clinical Microbiology, Division of Infection & Immunity, University College, London, London, United Kingdom
| | - Rinn Song
- Oxford Vaccine Group, Department of Paediatrics, and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Pamela Nabeta
- FIND (Foundation for Innovative New Diagnostics), Geneva, Switzerland
| | - Andre Trollip
- FIND (Foundation for Innovative New Diagnostics), Geneva, Switzerland
| | - Christof Geldmacher
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Michael Hoelscher
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Heather J. Zar
- Department of Paediatrics & Child Health, SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Norbert Heinrich
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
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11
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Gunasekera KS, Marcy O, Muñoz J, Lopez-Varela E, Sekadde MP, Franke MF, Bonnet M, Ahmed S, Amanullah F, Anwar A, Augusto O, Aurilio RB, Banu S, Batool I, Brands A, Cain KP, Carratalá-Castro L, Caws M, Click ES, Cranmer LM, García-Basteiro AL, Hesseling AC, Huynh J, Kabir S, Lecca L, Mandalakas A, Mavhunga F, Myint AA, Myo K, Nampijja D, Nicol MP, Orikiriza P, Palmer M, Sant'Anna CC, Siddiqui SA, Smith JP, Song R, Thuong Thuong NT, Ung V, van der Zalm MM, Verkuijl S, Viney K, Walters EG, Warren JL, Zar HJ, Marais BJ, Graham SM, Debray TPA, Cohen T, Seddon JA. Development of treatment-decision algorithms for children evaluated for pulmonary tuberculosis: an individual participant data meta-analysis. Lancet Child Adolesc Health 2023; 7:336-346. [PMID: 36924781 PMCID: PMC10127218 DOI: 10.1016/s2352-4642(23)00004-4] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Many children with pulmonary tuberculosis remain undiagnosed and untreated with related high morbidity and mortality. Recent advances in childhood tuberculosis algorithm development have incorporated prediction modelling, but studies so far have been small and localised, with limited generalisability. We aimed to evaluate the performance of currently used diagnostic algorithms and to use prediction modelling to develop evidence-based algorithms to assist in tuberculosis treatment decision making for children presenting to primary health-care centres. METHODS For this meta-analysis, we identified individual participant data from a WHO public call for data on the management of tuberculosis in children and adolescents and referral from childhood tuberculosis experts. We included studies that prospectively recruited consecutive participants younger than 10 years attending health-care centres in countries with a high tuberculosis incidence for clinical evaluation of pulmonary tuberculosis. We collated individual participant data including clinical, bacteriological, and radiological information and a standardised reference classification of pulmonary tuberculosis. Using this dataset, we first retrospectively evaluated the performance of several existing treatment-decision algorithms. We then used the data to develop two multivariable prediction models that included features used in clinical evaluation of pulmonary tuberculosis-one with chest x-ray features and one without-and we investigated each model's generalisability using internal-external cross-validation. The parameter coefficient estimates of the two models were scaled into two scoring systems to classify tuberculosis with a prespecified sensitivity target. The two scoring systems were used to develop two pragmatic, treatment-decision algorithms for use in primary health-care settings. FINDINGS Of 4718 children from 13 studies from 12 countries, 1811 (38·4%) were classified as having pulmonary tuberculosis: 541 (29·9%) bacteriologically confirmed and 1270 (70·1%) unconfirmed. Existing treatment-decision algorithms had highly variable diagnostic performance. The scoring system derived from the prediction model that included clinical features and features from chest x-ray had a combined sensitivity of 0·86 [95% CI 0·68-0·94] and specificity of 0·37 [0·15-0·66] against a composite reference standard. The scoring system derived from the model that included only clinical features had a combined sensitivity of 0·84 [95% CI 0·66-0·93] and specificity of 0·30 [0·13-0·56] against a composite reference standard. The scoring system from each model was placed after triage steps, including assessment of illness acuity and risk of poor tuberculosis-related outcomes, to develop treatment-decision algorithms. INTERPRETATION We adopted an evidence-based approach to develop pragmatic algorithms to guide tuberculosis treatment decisions in children, irrespective of the resources locally available. This approach will empower health workers in primary health-care settings with high tuberculosis incidence and limited resources to initiate tuberculosis treatment in children to improve access to care and reduce tuberculosis-related mortality. These algorithms have been included in the operational handbook accompanying the latest WHO guidelines on the management of tuberculosis in children and adolescents. Future prospective evaluation of algorithms, including those developed in this work, is necessary to investigate clinical performance. FUNDING WHO, US National Institutes of Health.
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Affiliation(s)
- Kenneth S Gunasekera
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
| | - Olivier Marcy
- Inserm UMR1219, Institut de Recherche pour le Développement EMR 271, GHiGS, University of Bordeaux, Bordeaux, France
| | - Johanna Muñoz
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Elisa Lopez-Varela
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Maryline Bonnet
- University of Montpellier, TransVIHMI, Institut de Recherche pour le Développement, Inserm, Montpellier, France; Epicentre, Mbarara, Uganda
| | - Shakil Ahmed
- Department of Paediatrics, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Farhana Amanullah
- Indus Hospital & Health Network, Karachi, Pakistan; The Aga Khan University Hospital, Karachi, Pakistan
| | - Aliya Anwar
- Indus Hospital & Health Network, Karachi, Pakistan
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Rafaela Baroni Aurilio
- Instituto de Puericultura e Pediatria Martagao Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sayera Banu
- Programme on Emerging Infections, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Iraj Batool
- Indus Hospital & Health Network, Karachi, Pakistan
| | | | - Kevin P Cain
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lucía Carratalá-Castro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Maxine Caws
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Birat Nepal Medical Trust, Lazmipat, Kathmandu, Nepal
| | - Eleanor S Click
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa M Cranmer
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA, USA; Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Alberto L García-Basteiro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Julie Huynh
- Oxford University Clinical Research Unit, Centre for Tropical Diseases, Ho Chi Minh City, Viet Nam; Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Senjuti Kabir
- Programme on Emerging Infections, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Leonid Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Socios En Salud Surcursal Perú, Lima, Perú
| | - Anna Mandalakas
- Global TB Program, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; Clinical Infectious Disease Group, German Center for Infectious Research, Clinical TB Unit, Research Center Borstel, Borstel, Germany
| | | | - Aye Aye Myint
- Department of Paediatrics, University of Medicine, Mandalay, Myanmar
| | - Kyaw Myo
- Department of Paediatrics, University of Medicine, Magway, Myanmar
| | - Dorah Nampijja
- Department of Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark P Nicol
- Division of Infection and Immunity, Department of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Patrick Orikiriza
- Epicentre, Mbarara, Uganda; Department of Microbiology, Division of Basic Medical Sciences, School of Medicine, University of Global Health Equity, Kigali, Rwanda
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - Sara Ahmed Siddiqui
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Indus Hospital & Health Network, Karachi, Pakistan
| | - Jonathan P Smith
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA; US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rinn Song
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Nguyen Thuy Thuong Thuong
- Oxford University Clinical Research Unit, Centre for Tropical Diseases, Ho Chi Minh City, Viet Nam; Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Vibol Ung
- University of Health Sciences, Phnom Penh, Cambodia; National Pediatric Hospital, Phnom Penh, Cambodia
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - Kerri Viney
- Global Tuberculosis Programme, WHO, Geneva, Switzerland; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Elisabetta G Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Directorate of Integrated Laboratory Medicine, Institute of Human Genetics, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Ben J Marais
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stephen M Graham
- Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, VIC, Australia; Burnet Institute, Melbourne, VIC, Australia
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Department of Infectious Diseases, Imperial College London, London, UK
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Marcy O, Wobudeya E, Font H, Vessière A, Chabala C, Khosa C, Taguebue JV, Moh R, Mwanga-Amumpaire J, Lounnas M, Mulenga V, Mavale S, Chilundo J, Rego D, Nduna B, Shankalala P, Chirwa U, De Lauzanne A, Dim B, Tiogouo Ngouana E, Folquet Amorrissani M, Cisse L, Amon Tanoh Dick F, Komena EA, Kwedi Nolna S, Businge G, Natukunda N, Cumbe S, Mbekeka P, Kim A, Kheang C, Pol S, Maleche-Obimbo E, Seddon JA, Mao TE, Graham SM, Delacourt C, Borand L, Bonnet M. Effect of systematic tuberculosis detection on mortality in young children with severe pneumonia in countries with high incidence of tuberculosis: a stepped-wedge cluster-randomised trial. Lancet Infect Dis 2023; 23:341-351. [PMID: 36395782 DOI: 10.1016/s1473-3099(22)00668-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/09/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tuberculosis diagnosis might be delayed or missed in children with severe pneumonia because this diagnosis is usually only considered in cases of prolonged symptoms or antibiotic failure. Systematic tuberculosis detection at hospital admission could increase case detection and reduce mortality. METHODS We did a stepped-wedge cluster-randomised trial in 16 hospitals from six countries (Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Uganda, and Zambia) with high incidence of tuberculosis. Children younger than 5 years with WHO-defined severe pneumonia received either the standard of care (control group) or standard of care plus Xpert MTB/RIF Ultra (Xpert Ultra; Cepheid, Sunnyvale, CA, USA) on nasopharyngeal aspirate and stool samples (intervention group). Clusters (hospitals) were progressively switched from control to intervention at 5-week intervals, using a computer-generated random sequence, stratified on incidence rate of tuberculosis at country level, and masked to teams until 5 weeks before switch. We assessed the effect of the intervention on primary (12-week all-cause mortality) and secondary (including tuberculosis diagnosis) outcomes, using generalised linear mixed models. The primary analysis was by intention to treat. We described outcomes in children with severe acute malnutrition in a post hoc analysis. This study is registered with ClinicalTrials.gov (NCT03831906) and the Pan African Clinical Trial Registry (PACTR202101615120643). FINDINGS From March 21, 2019, to March 30, 2021, we enrolled 1401 children in the control group and 1169 children in the intervention group. In the intervention group, 1140 (97·5%) children had nasopharyngeal aspirates and 942 (80·6%) had their stool collected; 24 (2·1%) had positive Xpert Ultra. At 12 weeks, 110 (7·9%) children in the control group and 91 (7·8%) children in the intervention group had died (adjusted odds ratio [OR] 0·986, 95% CI 0·597-1·630, p=0·957), and 74 (5·3%) children in the control group and 88 (7·5%) children in the intervention group had tuberculosis diagnosed (adjusted OR 1·238, 95% CI 0·696-2·202, p=0·467). In children with severe acute malnutrition, 57 (23·8%) of 240 children in the control group and 53 (17·8%) of 297 children in the intervention group died, and 36 (15·0%) of 240 children in the control group and 56 (18·9%) of 297 children in the intervention group were diagnosed with tuberculosis. The main adverse events associated with nasopharyngeal aspirates were samples with blood in 312 (27·3%) of 1147 children with nasopharyngeal aspirates attempted, dyspnoea or SpO2 less than 95% in 134 (11·4%) of children, and transient respiratory distress or SpO2 less than 90% in 59 (5·2%) children. There was no serious adverse event related to nasopharyngeal aspirates reported during the trial. INTERPRETATION Systematic molecular tuberculosis detection at hospital admission did not reduce mortality in children with severe pneumonia. High treatment and microbiological confirmation rates support more systematic use of Xpert Ultra in this group, notably in children with severe acute malnutrition. FUNDING Unitaid and L'Initiative. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Olivier Marcy
- Inserm UMR 1219, IRD EMR 271, University of Bordeaux, Bordeaux, France.
| | - Eric Wobudeya
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Hélène Font
- Inserm UMR 1219, IRD EMR 271, University of Bordeaux, Bordeaux, France
| | - Aurélia Vessière
- Inserm UMR 1219, IRD EMR 271, University of Bordeaux, Bordeaux, France
| | - Chishala Chabala
- University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Celso Khosa
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | - Raoul Moh
- Teaching Unit of Dermatology and Infectiology, UFR of Medical Sciences, Felix-Houphouet Boigny University, Abidjan, Côte d'Ivoire; Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire
| | | | - Manon Lounnas
- MIVEGEC, University of Montpellier, CNRS, IRD, Montpellier, France
| | - Veronica Mulenga
- University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Sandra Mavale
- Paediatrics Department, Maputo Central Hospital, Maputo, Mozambique
| | - Josina Chilundo
- Paediatrics Department, Maputo Central Hospital, Maputo, Mozambique
| | - Dalila Rego
- Paediatrics Department, José Macamo General Hospital, Maputo, Mozambique
| | | | - Perfect Shankalala
- University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Uzima Chirwa
- Children's Hospital, University Teaching Hospital, Lusaka, Zambia
| | - Agathe De Lauzanne
- Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Bunnet Dim
- Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | | | - Lassina Cisse
- Paediatrics Department, Treichville University Teaching Hospital, Abidjan, Côte d'Ivoire
| | | | - Eric A Komena
- Teaching Unit of Dermatology and Infectiology, UFR of Medical Sciences, Felix-Houphouet Boigny University, Abidjan, Côte d'Ivoire; Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Sylvie Kwedi Nolna
- IRD UMI233, Inserm U1175, University of Montpellier, Montpellier, France
| | - Gerald Businge
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | | | | | - Ang Kim
- Pulmonology Department, National Pediatric Hospital, Phnom Penh, Cambodia
| | - Chanrithea Kheang
- Paediatrics Department, Kompong Cham Provincial Hospital, Kompong Cham, Cambodia
| | - Sokha Pol
- Paediatrics Department, Takeo Provincial Hospital, Takeo, Cambodia
| | | | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa; Department of Infectious Disease, Imperial College London, London, UK
| | - Tan Eang Mao
- National Center for Tuberculosis and Leprosy, Ministry of Health, Phnom Penh, Cambodia
| | - Stephen M Graham
- University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia; International Union Against Tuberculosis and Lung Disease, Paris, France; Burnet Institute, Melbourne, VIC, Australia
| | - Christophe Delacourt
- Department of Paediatric Pulmonology, Necker University Teaching Hospital, Paris, France
| | - Laurence Borand
- Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Maryline Bonnet
- IRD UMI233, Inserm U1175, University of Montpellier, Montpellier, France
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13
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Yuen CM, Sekadde MP, Kaiser B, Waning B, Graham SM. Towards Shorter, Child-Friendly Regimens for Treatment of Tuberculosis Disease and Infection in Children. Pediatr Infect Dis J 2023; 42:e77-e79. [PMID: 36201662 DOI: 10.1097/inf.0000000000003729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Courtney M Yuen
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | | | - Brian Kaiser
- University of Melbourne Department of Paediatrics, Royal Children's Hospital, Melbourne, Australia
| | - Brenda Waning
- University of Melbourne Department of Paediatrics, Royal Children's Hospital, Melbourne, Australia
| | - Stephen M Graham
- Global Drug Facility, Stop TB Partnership, Geneva, Switzerland
- National Tuberculosis and Leprosy Programme, Kampala, Uganda
- Harvard Medical School, Boston, USA
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14
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Gafar F, Wasmann RE, McIlleron HM, Aarnoutse RE, Schaaf HS, Marais BJ, Agarwal D, Antwi S, Bang ND, Bekker A, Bell DJ, Chabala C, Choo L, Davies GR, Day JN, Dayal R, Denti P, Donald PR, Engidawork E, Garcia-Prats AJ, Gibb D, Graham SM, Hesseling AC, Heysell SK, Idris MI, Kabra SK, Kinikar A, Kumar AKH, Kwara A, Lodha R, Magis-Escurra C, Martinez N, Mathew BS, Mave V, Mduma E, Mlotha-Mitole R, Mpagama SG, Mukherjee A, Nataprawira HM, Peloquin CA, Pouplin T, Ramachandran G, Ranjalkar J, Roy V, Ruslami R, Shah I, Singh Y, Sturkenboom MGG, Svensson EM, Swaminathan S, Thatte U, Thee S, Thomas TA, Tikiso T, Touw DJ, Turkova A, Velpandian T, Verhagen LM, Winckler JL, Yang H, Yunivita V, Taxis K, Stevens J, Alffenaar JWC. Global estimates and determinants of antituberculosis drug pharmacokinetics in children and adolescents: a systematic review and individual patient data meta-analysis. Eur Respir J 2023; 61:2201596. [PMID: 36328357 PMCID: PMC9996834 DOI: 10.1183/13993003.01596-2022] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Suboptimal exposure to antituberculosis (anti-TB) drugs has been associated with unfavourable treatment outcomes. We aimed to investigate estimates and determinants of first-line anti-TB drug pharmacokinetics in children and adolescents at a global level. METHODS We systematically searched MEDLINE, Embase and Web of Science (1990-2021) for pharmacokinetic studies of first-line anti-TB drugs in children and adolescents. Individual patient data were obtained from authors of eligible studies. Summary estimates of total/extrapolated area under the plasma concentration-time curve from 0 to 24 h post-dose (AUC0-24) and peak plasma concentration (C max) were assessed with random-effects models, normalised with current World Health Organization-recommended paediatric doses. Determinants of AUC0-24 and C max were assessed with linear mixed-effects models. RESULTS Of 55 eligible studies, individual patient data were available for 39 (71%), including 1628 participants from 12 countries. Geometric means of steady-state AUC0-24 were summarised for isoniazid (18.7 (95% CI 15.5-22.6) h·mg·L-1), rifampicin (34.4 (95% CI 29.4-40.3) h·mg·L-1), pyrazinamide (375.0 (95% CI 339.9-413.7) h·mg·L-1) and ethambutol (8.0 (95% CI 6.4-10.0) h·mg·L-1). Our multivariate models indicated that younger age (especially <2 years) and HIV-positive status were associated with lower AUC0-24 for all first-line anti-TB drugs, while severe malnutrition was associated with lower AUC0-24 for isoniazid and pyrazinamide. N-acetyltransferase 2 rapid acetylators had lower isoniazid AUC0-24 and slow acetylators had higher isoniazid AUC0-24 than intermediate acetylators. Determinants of C max were generally similar to those for AUC0-24. CONCLUSIONS This study provides the most comprehensive estimates of plasma exposures to first-line anti-TB drugs in children and adolescents. Key determinants of drug exposures were identified. These may be relevant for population-specific dose adjustment or individualised therapeutic drug monitoring.
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Affiliation(s)
- Fajri Gafar
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen, The Netherlands
| | - Roeland E Wasmann
- University of Cape Town, Department of Medicine, Division of Clinical Pharmacology, Cape Town, South Africa
| | - Helen M McIlleron
- University of Cape Town, Department of Medicine, Division of Clinical Pharmacology, Cape Town, South Africa
- University of Cape Town, Institute of Infectious Disease and Molecular Medicine, Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Cape Town, South Africa
| | - Rob E Aarnoutse
- Radboud University Medical Center, Radboud Institute of Health Sciences, Department of Pharmacy, Nijmegen, The Netherlands
| | - H Simon Schaaf
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu Tuberculosis Centre, Tygerberg, South Africa
| | - Ben J Marais
- The Children's Hospital at Westmead, Sydney, Australia
- The University of Sydney, Sydney Institute for Infectious Diseases, Sydney, Australia
| | - Dipti Agarwal
- Ram Manohar Lohia Institute of Medical Sciences, Department of Paediatrics, Lucknow, India
| | - Sampson Antwi
- Komfo Anokye Teaching Hospital, Department of Child Health, Kumasi, Ghana
- Kwame Nkrumah University of Science and Technology, School of Medical Sciences, Department of Child Health, Kumasi, Ghana
| | | | - Adrie Bekker
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu Tuberculosis Centre, Tygerberg, South Africa
| | - David J Bell
- NHS Greater Glasgow and Clyde, Infectious Diseases Unit, Glasgow, UK
| | - Chishala Chabala
- University of Cape Town, Department of Medicine, Division of Clinical Pharmacology, Cape Town, South Africa
- University of Zambia, School of Medicine, Department of Paediatrics, Lusaka, Zambia
- University Teaching Hospitals - Children's Hospital, Lusaka, Zambia
| | - Louise Choo
- University College London, Medical Research Council Clinical Trials Unit, London, UK
| | - Geraint R Davies
- Malawi Liverpool Wellcome Clinical Research Programme, Clinical Department, Blantyre, Malawi
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
| | - Jeremy N Day
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- University of Oxford, Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford, UK
| | - Rajeshwar Dayal
- Sarojini Naidu Medical College, Department of Pediatrics, Agra, India
| | - Paolo Denti
- University of Cape Town, Department of Medicine, Division of Clinical Pharmacology, Cape Town, South Africa
| | - Peter R Donald
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu Tuberculosis Centre, Tygerberg, South Africa
| | - Ephrem Engidawork
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Addis Ababa, Ethiopia
| | - Anthony J Garcia-Prats
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu Tuberculosis Centre, Tygerberg, South Africa
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, USA
| | - Diana Gibb
- University College London, Medical Research Council Clinical Trials Unit, London, UK
| | - Stephen M Graham
- University of Melbourne, Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Anneke C Hesseling
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu Tuberculosis Centre, Tygerberg, South Africa
| | - Scott K Heysell
- University of Virginia, Division of Infectious Diseases and International Health, Charlottesville, VA, USA
| | - Misgana I Idris
- University of Alabama at Birmingham, Department of Biology, Birmingham, AL, USA
| | - Sushil K Kabra
- All India Institute of Medical Sciences, Departments of Pediatrics, New Delhi, India
| | - Aarti Kinikar
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
| | - Agibothu K Hemanth Kumar
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Awewura Kwara
- University of Florida, Emerging Pathogens Institute, College of Medicine, Gainesville, FL, USA
| | - Rakesh Lodha
- All India Institute of Medical Sciences, Departments of Pediatrics, New Delhi, India
| | | | - Nilza Martinez
- Instituto Nacional de Enfermedades Respiratorias y Del Ambiente, Asunción, Paraguay
| | - Binu S Mathew
- Christian Medical College and Hospital, Department of Pharmacology and Clinical Pharmacology, Vellore, India
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University, Department of Medicine and Infectious Diseases, Baltimore, MD, USA
| | - Estomih Mduma
- Haydom Lutheran Hospital, Center for Global Health Research, Haydom, Tanzania
| | | | | | - Aparna Mukherjee
- All India Institute of Medical Sciences, Departments of Pediatrics, New Delhi, India
| | - Heda M Nataprawira
- Universitas Padjadjaran, Hasan Sadikin Hospital, Faculty of Medicine, Department of Child Health, Division of Paediatric Respirology, Bandung, Indonesia
| | | | - Thomas Pouplin
- Mahidol University, Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Geetha Ramachandran
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Jaya Ranjalkar
- Christian Medical College and Hospital, Department of Pharmacology and Clinical Pharmacology, Vellore, India
| | - Vandana Roy
- Maulana Azad Medical College, Department of Pharmacology, New Delhi, India
| | - Rovina Ruslami
- Universitas Padjadjaran, Faculty of Medicine, Department of Biomedical Sciences, Division of Pharmacology and Therapy, Bandung, Indonesia
| | - Ira Shah
- Bai Jerbai Wadia Hospital for Children, Department of Pediatric Infectious Diseases, Pediatric TB Clinic, Mumbai, India
| | - Yatish Singh
- Sarojini Naidu Medical College, Department of Pediatrics, Agra, India
| | - Marieke G G Sturkenboom
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Elin M Svensson
- Radboud University Medical Center, Radboud Institute of Health Sciences, Department of Pharmacy, Nijmegen, The Netherlands
- Uppsala University, Department of Pharmacy, Uppsala, Sweden
| | - Soumya Swaminathan
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
- World Health Organization, Public Health Division, Geneva, Switzerland
| | - Urmila Thatte
- Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Department of Clinical Pharmacology, Mumbai, India
| | - Stephanie Thee
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin, Germany
| | - Tania A Thomas
- University of Virginia, Division of Infectious Diseases and International Health, Charlottesville, VA, USA
| | - Tjokosela Tikiso
- University of Cape Town, Department of Medicine, Division of Clinical Pharmacology, Cape Town, South Africa
| | - Daan J Touw
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Anna Turkova
- University College London, Medical Research Council Clinical Trials Unit, London, UK
| | - Thirumurthy Velpandian
- All India Institute of Medical Sciences, Ocular Pharmacology and Pharmacy Division, Dr R.P. Centre, New Delhi, India
| | - Lilly M Verhagen
- Radboud University Medical Center, Radboud Center for Infectious Diseases, Laboratory of Medical Immunology, Section of Pediatric Infectious Diseases, Nijmegen, The Netherlands
- Radboud University Medical Center, Amalia Children's Hospital, Department of Paediatric Infectious Diseases and Immunology, Nijmegen, The Netherlands
- Stellenbosch University, Family Centre for Research with UBUNTU, Department of Paediatrics and Child Health, Cape Town, South Africa
| | - Jana L Winckler
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu Tuberculosis Centre, Tygerberg, South Africa
| | - Hongmei Yang
- University of Rochester, School of Medicine and Dentistry, Department of Biostatistics and Computational Biology, Rochester, NY, USA
| | - Vycke Yunivita
- Universitas Padjadjaran, Faculty of Medicine, Department of Biomedical Sciences, Division of Pharmacology and Therapy, Bandung, Indonesia
| | - Katja Taxis
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen, The Netherlands
| | - Jasper Stevens
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
- Both authors contributed equally and shared senior authorship
| | - Jan-Willem C Alffenaar
- The University of Sydney, Sydney Institute for Infectious Diseases, Sydney, Australia
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, Australia
- Westmead Hospital, Sydney, Australia
- Both authors contributed equally and shared senior authorship
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15
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Liu J, Maleche-Obimbo E, Shanthikumar S, Graham SM. A scoping review of lung function in children and adolescents living with HIV in the era of antiretroviral treatment. Pediatr Pulmonol 2023; 58:1344-1354. [PMID: 36811157 DOI: 10.1002/ppul.26365] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/01/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) in children and adolescents remains an important health challenge in many countries and is commonly associated with lung disease. The introduction of antiretroviral therapy (ART) has greatly improved survival but chronic lung disease is a common ongoing challenge. We conducted a scoping review of studies that have reported lung function in school-aged children and adolescents living with HIV. METHODS A systematic literature search was performed by searching Medline, Embase, and PubMed databases, limited to articles published between 2011 and 2021 in English language. Inclusion criteria were studies involving participants living with HIV aged 5-18 years and having spirometry data. The primary outcome was lung function as measured by spirometry. RESULTS Twenty-one studies were included in the review. Most study participants were living in the sub-Saharan African region. The prevalence of reduced forced expiratory volume in 1 s (FEV1 ) ranged from 25.3% to 73% across studies, reduced forced vital capacity (FVC) ranged from 10% to 42% and reduced FEV1 /FVC ranged from 3% to 26%. The mean z-score of FEV1 ranged from -2.19 to -0.73, mean zFEV1 /FVC ranged from -0.74 to 0.2, and mean FVC ranged from -1.86 to -0.63. CONCLUSION There is a high prevalence of lung function impairment in children and adolescents living with HIV, which persists in the ART era. Further studies are needed of interventions that might improve lung function in these vulnerable populations.
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Affiliation(s)
- Jingbo Liu
- Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
| | | | | | - Stephen M Graham
- Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
- International Union Against Tuberculosis and Lung Disease, Paris, France
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16
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Jops P, Cowan J, Kupul M, Trumb RN, Graham SM, Bauri M, Nindil H, Bell S, Keam T, Majumdar S, Pomat W, Marais B, Marks GB, Kaldor J, Vallely A, Kelly-Hanku A. Beyond patient delay, navigating structural health system barriers to timely care and treatment in a high burden TB setting in Papua New Guinea. Glob Public Health 2023; 18:2184482. [PMID: 36883701 DOI: 10.1080/17441692.2023.2184482] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Tuberculosis (TB) is a major public health issue in Papua New Guinea, with incidence rates particularly high in the South Fly District of Western Province. We present three case studies, along with additional vignettes, that were derived from interviews and focus groups carried out between July 2019 and July 2020 of people living in rural areas of the remote South Fly District depicting their challenges accessing timely TB diagnosis and care; most services within the district are only offered offshore on Daru Island. The findings detail that rather than 'patient delay' attributed to poor health seeking behaviours and inadequate knowledge of TB symptoms, many people were actively trying to navigate structural barriers hindering access to and utilisation of limited local TB services. The findings highlight a fragile and fragmented health system, a lack of attention given to primary health services, and undue financial burdens placed on people living in rural and remote areas associated with costly transportation to access functioning health services. We conclude that a person-centred and effective decentralised model of TB care as outlined in health policies is imperative for equitable access to essential health care services in Papua New Guinea.
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Affiliation(s)
- Paula Jops
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - John Cowan
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Martha Kupul
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Richard Nake Trumb
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Stephen M Graham
- Burnet Institute, Melbourne, Australia.,Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | - Mathias Bauri
- Western Provincial Health Authority, Daru, Papua New Guinea
| | - Herolyn Nindil
- National TB Program, National Department of Health, Port Moresby, Papua New Guinea
| | - Stephen Bell
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia
| | - Tess Keam
- Burnet Institute, Melbourne, Australia
| | - Suman Majumdar
- Burnet Institute, Melbourne, Australia.,Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | - William Pomat
- Kirby Institute, UNSW Sydney, Sydney, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ben Marais
- Sydney Institute for Infectious Diseases (Sydney ID), University of Sydney, Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Sydney, Australia.,Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - John Kaldor
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Andrew Vallely
- Kirby Institute, UNSW Sydney, Sydney, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Angela Kelly-Hanku
- Kirby Institute, UNSW Sydney, Sydney, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
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17
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Kazi S, Hernstadt H, Abo YN, Graham H, Palmer M, Graham SM. The utility of chest x-ray and lung ultrasound in the management of infants and children presenting with severe pneumonia in low-and middle-income countries: A pragmatic scoping review. J Glob Health 2022; 12:10013. [PMID: 36560909 PMCID: PMC9789364 DOI: 10.7189/jogh.12.10013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Chest x-ray (CXR) is commonly used (when available) to support clinical management decisions for child pneumonia and provide a reference standard for diagnosis in research studies. However, its diagnostic and technical limitations for both purposes are well recognised. Recent evidence suggests that lung ultrasound (LUS) may have diagnostic utility in pneumonia. This systematic scoping review of research on the utility of CXR and LUS in the management of severe childhood pneumonia aims to inform pragmatic guidelines for low- and middle-income countries (LMICs) and identify gaps in knowledge. Methods We included peer-reviewed studies published between 2000 and 2020 in infants and children aged from one month to nine years, presenting with severe pneumonia. CXR studies were limited to those from LMICs, while LUS studies included any geographic region. LUS and CXR articles were mapped into the following themes: indications, role in diagnosis, role in management, impact on outcomes, and practical considerations for LMIC settings. Results 85 articles met all eligibility criteria, including 27 CXR studies and 58 LUS studies. CXR studies were primarily observational and examined associations between radiographic abnormalities and pneumonia aetiology or outcomes. The most consistent finding was an association between CXR consolidation and risk of mortality. Difficulty obtaining quality CXR images and inter-reader variability in interpretation were commonly reported challenges. Research evaluating indications for CXR, role in management, and impact on patient outcomes was very limited. LUS studies primarily focused on diagnostic accuracy. LUS had higher sensitivity for identification of consolidation than CXR. There are gaps in knowledge regarding diagnostic criteria, as well as the practical utility of LUS in the diagnosis and management of pneumonia. Most LUS studies were conducted in HIC settings with experienced operators; however, small feasibility studies indicate that good inter-operator reliability may be achieved by training of novice clinicians in LMIC settings. Conclusions The available evidence does not support the routine use of CXR or LUS as essential tools in the diagnosis and initial management of severe pneumonia. Further evaluation is required to determine the clinical utility and feasibility of both imaging modalities in low-resource settings.
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Affiliation(s)
- Saniya Kazi
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,Monash Health, Melbourne, Victoria, Australia
| | | | - Yara-Natalie Abo
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
| | - Hamish Graham
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
| | - Megan Palmer
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephen M Graham
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,Monash Health, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
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18
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Maleche-Obimbo E, Odhiambo MA, Njeri L, Mburu M, Jaoko W, Were F, Graham SM. Magnitude and factors associated with post-tuberculosis lung disease in low- and middle-income countries: A systematic review and meta-analysis. PLOS Glob Public Health 2022; 2:e0000805. [PMID: 36962784 PMCID: PMC10021795 DOI: 10.1371/journal.pgph.0000805] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/03/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Emerging evidence suggests that after completion of treatment for tuberculosis (TB) a significant proportion of patients experience sequelae. However, there is limited synthesized evidence on this from low-income countries, from Sub-Saharan Africa, and in HIV infected individuals. We seek to provide an updated comprehensive systematic review and meta-analysis on the magnitude and factors associated with post-TB lung disease (PTLD) in low- and middle-income countries (LMICs). METHODS We searched PubMed, Embase and CINAHL for studies from LMICs with data on post-TB lung health in patients who had previously completed treatment for pulmonary TB. Data on study characteristics, prevalence of PTLD-specifically abnormal lung function (spirometry), persisting respiratory symptoms and radiologic abnormalities were abstracted. Statistical analysis was performed using Microsoft Excel and R version 4.1 software, and random effects meta-analysis conducted to compute pooled prevalence of PTLD, evaluate heterogeneity, and assess factors associated with PTLD. RESULTS We identified 32 eligible studies with 6225 participants. Twenty-one studies were from Africa, 16 included HIV infected participants, spirometry was conducted in 20 studies, symptom assessment in 16 and chest imaging in eight. Pooled prevalence of abnormal lung function was 46.7%, persistent respiratory symptoms 41.0%, and radiologic abnormalities 64.6%. Magnitude of any type of PTLD varied by HIV status (HIV- 66.9%, HIV+ 32.8%, p = 0.0013), across geographic setting (SE Asia 57.5%, Southern America 50.8%, and Africa 38.2%, p = 0.0118), and across urban-rural settings (symptom prevalence: rural 68.8%, urban 39.1%, mixed settings 27.9%, p = 0.0035), but not by income settings, sex or age-group. CONCLUSIONS There is high burden of post-TB persistent respiratory symptoms, functional lung impairment and radiologic structural abnormalities in individuals living in LMICs. Burden varies across settings and by HIV status. This evidence may be valuable to advocate for and inform implementation of structured health care specific to the needs of this vulnerable population of individuals.
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Affiliation(s)
| | | | - Lynette Njeri
- School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Moses Mburu
- Clinical Trials Facility, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Walter Jaoko
- Department of Medical Microbiology & Immunology, University of Nairobi, Nairobi, Kenya
| | - Fredrick Were
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | - Stephen M. Graham
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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19
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Tchakounte Youngui B, Tchounga BK, Graham SM, Bonnet M. Tuberculosis Infection in Children and Adolescents. Pathogens 2022; 11:pathogens11121512. [PMID: 36558846 PMCID: PMC9784659 DOI: 10.3390/pathogens11121512] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
The burden of tuberculosis (TB) in children and adolescents remains very significant. Several million children and adolescents are infected with TB each year worldwide following exposure to an infectious TB case and the risk of progression from TB infection to tuberculosis disease is higher in this group compared to adults. This review describes the risk factors for TB infection in children and adolescents. Following TB exposure, the risk of TB infection is determined by a combination of index case characteristics, contact features, and environmental determinants. We also present the recently recommended approaches to diagnose and treat TB infection as well as novel tests for infection. The tests for TB infection have limitations and diagnosis still relies on an indirect immunological assessment of cellular immune response to Mycobacterium tuberculosis antigens using immunodiagnostic testing. It is recommended that TB exposed children and adolescents and those living with HIV receive TB preventive treatment (TPT) to reduce the risk of progression to TB disease. Several TPT regimens of similar effectiveness and safety are now available and recommended by the World Health Organisation.
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Affiliation(s)
- Boris Tchakounte Youngui
- TransVIHMI, Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche Médicale (INSERM), University of Montpellier, 34090 Montpellier, France
- Department of Public Health Evaluation and Research, Elizabeth Glaser Paediatric AIDS Foundation, Yaoundé 99322, Cameroon
- Correspondence:
| | - Boris Kevin Tchounga
- Department of Public Health Evaluation and Research, Elizabeth Glaser Paediatric AIDS Foundation, Yaoundé 99322, Cameroon
| | - Stephen M. Graham
- Department of Paediatrics and Murdoch Children’s Research Institute, Royal Children’s Hospital, University of Melbourne, Melbourne 3052, Australia
| | - Maryline Bonnet
- TransVIHMI, Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche Médicale (INSERM), University of Montpellier, 34090 Montpellier, France
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20
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Quach A, Spence H, Nguyen C, Graham SM, von Mollendorf C, Mulholland K, Russell FM. Slow progress towards pneumonia control for children in low-and-middle income countries as measured by pneumonia indicators: A systematic review of the literature. J Glob Health 2022; 12:10006. [PMID: 36282893 PMCID: PMC9595578 DOI: 10.7189/jogh.12.10006] [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: 11/16/2022] Open
Abstract
Background The integrated Global Action Plan for Prevention and Control of Pneumonia and Diarrhoea (GAPPD) has the goal of ending preventable childhood deaths from pneumonia and diarrhoea by 2025 with targets and indicators to monitor progress. The aim of this systematic review is to summarise how low-and-middle income countries (LMICs) reported pneumonia-specific GAPPD indicators at national and subnational levels and whether GAPPD targets have been achieved. Methods We searched MEDLINE, Embase, PubMed and Global Health Databases, and the World Health Organization (WHO) website. Publications/reports between 2015 and 2020 reporting on two or more GAPPD-pneumonia indicators from LMICs were included. Data prior to 2015 were included if available in the same report series. Quality of publications was assessed with the Quality Assessment Tool for Quantitative Studies. A narrative synthesis of the literature was performed to describe which countries and WHO regions were reporting on GAPPD indicators and progress in GAPPD coverage targets. Results Our search identified 17 publications/reports meeting inclusion criteria, with six from peer-reviewed publications. Data were available from 139 LMICs between 2010 and 2020, predominantly from Africa. Immunisation coverage rates were the indicators most commonly reported, followed by exclusive breastfeeding rates and pneumonia case management. Most GAPPD indicators were reported at the national level with minimal reporting at the subnational level. Immunisation coverage (Haemophilus influenzae, measles, diphtheria-tetanus-pertussis vaccines) in the WHO Europe, Americas and South-East Asia regions were meeting 90% coverage targets, while pneumococcal conjugate vaccine coverage lagged globally. The remaining GAPPD indicators (breastfeeding, pneumonia case management, antiretroviral prophylaxis, household air pollution) were not meeting GAPPD targets in LMICs. There was a strong negative correlation between pneumonia specific GAPPD coverage rates and under-five mortality (Pearson correlation coefficient range = -0.74, -0.79). Conclusion There is still substantial progress to be made in LMICs to achieve the 2025 GAPPD targets. Current GAPPD indicators along with country reporting mechanisms should be reviewed with consideration of adding undernutrition and access to oxygen therapy as important indicators which impact pneumonia outcomes. Further research on GAPPD indicators over longer time periods and at subnational levels can help identify high-risk populations for targeted pneumonia interventions.
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Affiliation(s)
- Alicia Quach
- Asia-Pacific Health Group, Murdoch Children's Research Institute, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Victoria, Australia
| | - Hollie Spence
- Murdoch Children's Research Institute, Victoria, Australia.,The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Cattram Nguyen
- Asia-Pacific Health Group, Murdoch Children's Research Institute, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Victoria, Australia
| | - Stephen M Graham
- Department of Paediatrics, The University of Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Victoria, Australia.,The Royal Children's Hospital, Parkville, Victoria, Australia.,Burnet Institute, Melbourne, Victoria, Australia
| | - Claire von Mollendorf
- Asia-Pacific Health Group, Murdoch Children's Research Institute, Victoria, Australia
| | - Kim Mulholland
- Department of Paediatrics, The University of Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Victoria, Australia.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fiona M Russell
- Asia-Pacific Health Group, Murdoch Children's Research Institute, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Victoria, Australia
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21
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Marais BJ, Graham SM. The Value of Chest Radiography in Tuberculosis Preventive Treatment Screening in Children and Adolescents. Am J Respir Crit Care Med 2022; 206:814-816. [PMID: 35653694 PMCID: PMC9799261 DOI: 10.1164/rccm.202205-1023ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Ben J. Marais
- Sydney Institute for Infectious Diseases and the Children’s Hospital WestmeadThe University of SydneySydney, Australia,National Health and Medical Research Council (NHMRC),Centre for Research Excellence in TuberculosisCamperdown, New South Wales, Australia
| | - Stephen M. Graham
- National Health and Medical Research Council (NHMRC),Centre for Research Excellence in TuberculosisCamperdown, New South Wales, Australia,Department of Paediatrics and Murdoch Children’s Research Institute,University of MelbourneMelbourne, Australia,Burnet InstituteMelbourne, Australia
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22
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Laemmle-Ruff I, Graham SM, Williams B, Horyniak D, Majumdar SS, Paxton GA, Soares Caplice LV, Hellard ME, Trauer JM. Detecting Mycobacterium tuberculosis Infection in Children Migrating to Australia. Emerg Infect Dis 2022; 28:1833-1841. [PMID: 35997353 PMCID: PMC9423895 DOI: 10.3201/eid2809.212426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
In 2015, Australia updated premigration screening for tuberculosis (TB) disease in children 2-10 years of age to include testing for infection with Mycobacterium tuberculosis and enable detection of latent TB infection (LTBI). We analyzed TB screening results in children <15 years of age during November 2015-June 2017. We found 45,060 child applicants were tested with interferon-gamma release assay (IGRA) (57.7% of tests) or tuberculin skin test (TST) (42.3% of tests). A total of 21 cases of TB were diagnosed: 4 without IGRA or TST, 10 with positive IGRA or TST, and 7 with negative results. LTBI was detected in 3.3% (1,473/44,709) of children, for 30 applicants screened per LTBI case detected. LTBI-associated factors included increasing age, TB contact, origin from a higher TB prevalence region, and testing by TST. Detection of TB and LTBI benefit children, but the updated screening program's effect on TB in Australia is likely to be limited.
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23
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Martinez L, Cords O, Liu Q, Acuna-Villaorduna C, Bonnet M, Fox GJ, Carvalho ACC, Chan PC, Croda J, Hill PC, Lopez-Varela E, Donkor S, Fielding K, Graham SM, Espinal MA, Kampmann B, Reingold A, Huerga H, Villalba JA, Grandjean L, Sotgiu G, Egere U, Singh S, Zhu L, Lienhardt C, Denholm JT, Seddon JA, Whalen CC, García-Basteiro AL, Triasih R, Chen C, Singh J, Huang LM, Sharma S, Hannoun D, Del Corral H, Mandalakas AM, Malone LL, Ling DL, Kritski A, Stein CM, Vashishtha R, Boulahbal F, Fang CT, Boom WH, Netto EM, Lemos AC, Hesseling AC, Kay A, Jones-López EC, Horsburgh CR, Lange C, Andrews JR. Infant BCG vaccination and risk of pulmonary and extrapulmonary tuberculosis throughout the life course: a systematic review and individual participant data meta-analysis. Lancet Glob Health 2022; 10:e1307-e1316. [PMID: 35961354 PMCID: PMC10406427 DOI: 10.1016/s2214-109x(22)00283-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [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: 04/04/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND BCG vaccines are given to more than 100 million children every year, but there is considerable debate regarding the effectiveness of BCG vaccination in preventing tuberculosis and death, particularly among older children and adults. We therefore aimed to investigate the age-specific impact of infant BCG vaccination on tuberculosis (pulmonary and extrapulmonary) development and mortality. METHODS In this systematic review and individual participant data meta-analysis, we searched MEDLINE, Web of Science, BIOSIS, and Embase without language restrictions for case-contact cohort studies of tuberculosis contacts published between Jan 1, 1998, and April 7, 2018. Search terms included "mycobacterium tuberculosis", "TB", "tuberculosis", and "contact". We excluded cohort studies that did not provide information on BCG vaccination or were done in countries that did not recommend BCG vaccination at birth. Individual-level participant data for a prespecified list of variables, including the characteristics of the exposed participant (contact), the index case, and the environment, were requested from authors of all eligible studies. Our primary outcome was a composite of prevalent (diagnosed at or within 90 days of baseline) and incident (diagnosed more than 90 days after baseline) tuberculosis in contacts exposed to tuberculosis. Secondary outcomes were pulmonary tuberculosis, extrapulmonary tuberculosis, and mortality. We derived adjusted odds ratios (aORs) using mixed-effects, binary, multivariable logistic regression analyses with study-level random effects, adjusting for the variable of interest, baseline age, sex, previous tuberculosis, and whether data were collected prospectively or retrospectively. We stratified our results by contact age and Mycobacterium tuberculosis infection status. This study is registered with PROSPERO, CRD42020180512. FINDINGS We identified 14 927 original records from our database searches. We included participant-level data from 26 cohort studies done in 17 countries in our meta-analysis. Among 68 552 participants, 1782 (2·6%) developed tuberculosis (1309 [2·6%] of 49 686 BCG-vaccinated participants vs 473 [2·5%] of 18 866 unvaccinated participants). The overall effectiveness of BCG vaccination against all tuberculosis was 18% (aOR 0·82, 95% CI 0·74-0·91). When stratified by age, BCG vaccination only significantly protected against all tuberculosis in children younger than 5 years (aOR 0·63, 95% CI 0·49-0·81). Among contacts with a positive tuberculin skin test or IFNγ release assay, BCG vaccination significantly protected against tuberculosis among all participants (aOR 0·81, 95% CI 0·69-0·96), participants younger than 5 years (0·68, 0·47-0·97), and participants aged 5-9 years (0·62, 0·38-0·99). There was no protective effect among those with negative tests, unless they were younger than 5 years (0·54, 0·32-0·90). 14 cohorts reported on whether tuberculosis was pulmonary or extrapulmonary (n=57 421). BCG vaccination significantly protected against pulmonary tuberculosis among all participants (916 [2·2%] in 41 119 vaccinated participants vs 334 [2·1%] in 16 161 unvaccinated participants; aOR 0·81, 0·70-0·94) but not against extrapulmonary tuberculosis (106 [0·3%] in 40 318 vaccinated participants vs 38 [0·2%] in 15 865 unvaccinated participants; 0·96, 0·65-1·41). In the four studies with mortality data, BCG vaccination was significantly protective against death (0·25, 0·13-0·49). INTERPRETATION Our results suggest that BCG vaccination at birth is effective at preventing tuberculosis in young children but is ineffective in adolescents and adults. Immunoprotection therefore needs to be boosted in older populations. FUNDING National Institutes of Health.
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Affiliation(s)
- Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA.
| | - Olivia Cords
- Center for Animal Disease Modeling and Surveillance, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Carlos Acuna-Villaorduna
- Section of Infectious Diseases, Department of Medicine, Boston University Medical Center, Boston, MA, USA
| | - Maryline Bonnet
- Université de Montpellier, IRD, INSERM, TransVIHMI, Montpellier, France
| | - Greg J Fox
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - Anna Cristina C Carvalho
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Pei-Chun Chan
- Division of Chronic Infectious Disease, Taiwan Centers for Disease Control, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Julio Croda
- Oswaldo Cruz Foundation Mato Grosso do Sul, Campo Grande, Brazil; Federal University of Mato Grosso do Sul, Campo Grande, Brazil; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Philip C Hill
- Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Elisa Lopez-Varela
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Simon Donkor
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen M Graham
- Centre for International Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Marcos A Espinal
- Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, DC, USA
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Arthur Reingold
- Division of Epidemiology, University of California, Berkeley, Berkeley, CA, USA
| | | | - Julian A Villalba
- Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Louis Grandjean
- Department of Infection, Inflammation and Immunity, Institute of Child Health, University College London, London, UK
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Uzochukwu Egere
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sarman Singh
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India; Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India; Medical Science and Engineering Research Centre, Indian Institute of Science Education and Research, Bhopal, India
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Christian Lienhardt
- Université de Montpellier, IRD, INSERM, TransVIHMI, Montpellier, France; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Justin T Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Australia; Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, VIC, Australia
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa; Department of Infectious Disease, Imperial College London, London, UK
| | - Christopher C Whalen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA; Global Health Institute, University of Georgia, Athens, GA, USA
| | - Alberto L García-Basteiro
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain
| | - Rina Triasih
- Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada and Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Cheng Chen
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Jitendra Singh
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India; Translational Medicine Centre, All India Institute of Medical Sciences, Bhopal, India; Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Surendra Sharma
- Department of Molecular Medicine, Jamia Hamdard Institute of Molecular Medicine, New Delhi, India; Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India; Department of Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Djohar Hannoun
- Department of Information, National Institute of Public Health, Algiers, Algeria
| | - Helena Del Corral
- Grupo de Inmunología Celulare Inmunogenética, Facultad de Medicina, Sede de Investigación Universitaria, Universidad de Antioquia, Medellin, Colombia; Grupo de Epidemiologıa, Universidad de Antioquia, Medellin, Colombia
| | - Anna M Mandalakas
- The Global TB Program, Texas Children's Hospital, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Division of Clinical Infectious Diseases, Medical Clinic, Research Center Borstel, Borstel, Germany; Tuberculosis Unit, German Center for Infection Research, Borstel, Germany
| | - LaShaunda L Malone
- Uganda-CWRU Research Collaboration, Kampala, Uganda; Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Du-Lin Ling
- Taichung Regional Center, Taiwan Centers for Disease Control, Taipei, Taiwan
| | - Afrânio Kritski
- Tuberculosis Academic Program, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Catherine M Stein
- Uganda-CWRU Research Collaboration, Kampala, Uganda; Tuberculosis Research Unit, Case Western Reserve University, Cleveland, OH, USA; Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Richa Vashishtha
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Fadila Boulahbal
- Groupe de recherche sur la tuberculose latente, Laboratoire National de Référence pour la Tuberculose, Institut Pasteur d'Algérie, Algiers, Algeria
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - W Henry Boom
- Uganda-CWRU Research Collaboration, Kampala, Uganda; Tuberculosis Research Unit, Case Western Reserve University, Cleveland, OH, USA; Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Eduardo Martins Netto
- Medicine Department, University Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Antonio Carlos Lemos
- Medicine Department, University Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Alexander Kay
- The Global TB Program, Texas Children's Hospital, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Edward C Jones-López
- Division of Infectious Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - C Robert Horsburgh
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Christoph Lange
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Division of Clinical Infectious Diseases, Medical Clinic, Research Center Borstel, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany; Tuberculosis Unit, German Center for Infection Research, Borstel, Germany
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Kazi S, Corcoran H, Abo YN, Graham H, Oliwa J, Graham SM. A systematic review of clinical, epidemiological and demographic predictors of tuberculosis in children with pneumonia. J Glob Health 2022; 12:10010. [PMID: 35939347 PMCID: PMC9527007 DOI: 10.7189/jogh.12.10010] [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: 11/25/2022] Open
Abstract
Background Tuberculosis (TB) can present as acute, severe pneumonia in children, but features which distinguish TB from other causes of pneumonia are not well understood. We conducted a systematic review to determine the prevalence and to explore clinical and demographic predictors of TB in children presenting with pneumonia over three decades. Methods We searched for peer-reviewed, English language studies published between 1990 and 2020 that included children aged between 1 month and 17 years with pneumonia and prospectively evaluated for TB. There were 895 abstracts and titles screened, and 72 full text articles assessed for eligibility. Results Thirteen clinical studies, two autopsy studies and one systematic review were included in analyses. Majority of studies were from Africa (12/15) and included children less than five years age. Prevalence of bacteriologically confirmed TB in children with pneumonia ranged from 0.2% to 14.8% (median = 3.7%, interquartile range (IQR) = 5.95) and remained stable over the three decades. TB may be more likely in children with pneumonia if they have a history of close TB contact, HIV infection, malnutrition, age less than one year or failure to respond to empirical antibiotics. However, these features have limited discriminatory value as TB commonly presents as acute severe pneumonia – with a short duration of cough, and clinical and radiographic features indistinguishable from other causes of pneumonia. Approximately half of patients with TB respond to initial empirical antibiotics, presumably due to bacterial co-infection, and follow-up may be critical to detect and treat TB. Conclusion TB should be considered as a potential cause or comorbidity in all children presenting with pneumonia in high burden settings. Clinicians should be alert to the presence of known risk factors for TB and bacteriological confirmation sought whenever possible. Quality data regarding clinical predictors of TB in childhood pneumonia are lacking. Further, prospective research is needed to better understand predictors and prevalence of TB in childhood pneumonia, particularly in TB endemic settings outside of Africa and in older children. Children of all ages with pneumonia should be included in research on improved, point-of-care TB diagnostics to support early case detection and treatment.
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Affiliation(s)
- Saniya Kazi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia
| | - Hannah Corcoran
- Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Yara-Natalie Abo
- Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Hamish Graham
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
| | - Jacquie Oliwa
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,University of Nairobi, Nairobi, Kenya
| | - Stephen M Graham
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia.,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
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25
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Click ES, Song R, Smith JP, Mchembere W, Fajans M, Hariri P, Okeyo E, McCarthy KD, Gethi D, Odeny L, Musau S, Okumu A, Orwa J, Perez-Velez CM, Wright CA, Andres M, Marais BJ, Schaaf HS, Graham SM, Cruz AT, Cain KP. Performance of Xpert MTB/RIF and Mycobacterial Culture on Multiple Specimen Types for Diagnosis of Tuberculosis Disease in Young Children and Clinical Characterization According to Standardized Research Case Definitions. Pediatr Infect Dis J 2022; 41:671-677. [PMID: 35703284 PMCID: PMC9288526 DOI: 10.1097/inf.0000000000003582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tuberculosis (TB) is a leading cause of illness and death in children globally. Improved bacteriologic and clinical diagnostic approaches in children are urgently needed. METHODS In a prospective cohort study, a consecutive series of young (<5 years) children presenting with symptoms suggestive of TB and parenchymal abnormality on chest radiograph in inpatient and outpatient settings in Kisumu County, Kenya from October 2013 to August 2015 were evaluated at baseline and over 6 months. Up to 14 specimens per child were tested for the Mycobacterium tuberculosis complex by fluorescence microscopy, Xpert MTB/RIF and mycobacterial culture. Using detailed clinical characterization, cases were retrospectively classified according to standardized research case definitions and the sensitivity and specificity of microbiological tests on different specimen types were determined. RESULTS Among 300 young children enrolled, 266 had sufficient information to be classified according to the research clinical case definition. Of these, 36% (96/266) had TB disease; 32% (31/96) with bacteriologically confirmed intrathoracic TB. Compared to culture, the sensitivity of a single Xpert test ranged from 60 to 67% and specificity from 97.5 to 100% for different specimen types. CONCLUSIONS Despite extensive specimen collection and laboratory testing, TB could not be bacteriologically confirmed in almost two-thirds of children with intrathoracic TB classified by research clinical case definitions. Improved diagnostic tests are needed to identify children with TB and to exclude other potential causes of illness.
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Affiliation(s)
| | - Rinn Song
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Jonathan P. Smith
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT USA
| | - Walter Mchembere
- Kenya Medical Research Institute – Center for Global Health Research, Kisumu, Kenya
| | - Mark Fajans
- US Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Parisa Hariri
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Elisha Okeyo
- Kenya Medical Research Institute – Center for Global Health Research, Kisumu, Kenya
| | | | - Dickson Gethi
- Kenya Medical Research Institute – Center for Global Health Research, Kisumu, Kenya
| | - Lazarus Odeny
- Kenya Medical Research Institute – Center for Global Health Research, Kisumu, Kenya
| | - Susan Musau
- Kenya Medical Research Institute – Center for Global Health Research, Kisumu, Kenya
| | - Albert Okumu
- Kenya Medical Research Institute – Center for Global Health Research, Kisumu, Kenya
| | - James Orwa
- Kenya Medical Research Institute – Center for Global Health Research, Kisumu, Kenya
| | - Carlos M. Perez-Velez
- Pima County Health Department, Tucson, AZ USA
- University of Arizona College of Medicine, Tucson, AZ USA
| | - Colleen A. Wright
- Division of Anatomical Pathology, Stellenbosch University, Cape Town, South Africa
| | - Mariaem Andres
- Institute of Radiology, St. Luke’s Medical Center, St. Luke’s Medical Center, Global City, Philippines
| | - Ben J. Marais
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - H. Simon Schaaf
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Stephen M. Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | | | - Kevin P. Cain
- Centers for Disease Control and Prevention, Kisumu, Kenya
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26
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von Mollendorf C, Berger D, Gwee A, Duke T, Graham SM, Russell FM, Mulholland EK. Aetiology of childhood pneumonia in low- and middle-income countries in the era of vaccination: a systematic review. J Glob Health 2022; 12:10009. [PMID: 35866332 PMCID: PMC9305023 DOI: 10.7189/jogh.12.10009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 01/11/2023] Open
Abstract
Background This systematic review aimed to describe common aetiologies of severe and non-severe community acquired pneumonia among children aged 1 month to 9 years in low- and middle-income countries. Methods We searched the MEDLINE, EMBASE, and PubMed online databases for studies published from January 2010 to August 30, 2020. We included studies on acute community-acquired pneumonia or acute lower respiratory tract infection with ≥1 year of continuous data collection; clear consistent case definition for pneumonia; >1 specimen type (except empyema studies where only pleural fluid was required); testing for >1 pathogen including both viruses and bacteria. Two researchers reviewed the studies independently. Results were presented as a narrative summary. Quality of evidence was assessed with the Quality Assessment Tool for Quantitative Studies. The study was registered on PROSPERO [CRD42020206830]. Results We screened 5184 records; 1305 duplicates were removed. The remaining 3879 titles and abstracts were screened. Of these, 557 articles were identified for full-text review, and 55 met the inclusion criteria - 10 case-control studies, three post-mortem studies, 11 surveillance studies, eight cohort studies, five cross-sectional studies, 12 studies with another design and six studies that included patients with pleural effusions or empyema. Studies which described disease by severity showed higher bacterial detection (Streptococcus pneumoniae, Staphylococcus aureus) in severe vs non-severe cases. The most common virus causing severe disease was respiratory syncytial virus (RSV). Pathogens varied by age, with RSV and adenovirus more common in younger children. Influenza and atypical bacteria were more common in children 5-14 years than younger children. Malnourished and HIV-infected children had higher rates of pneumonia due to bacteria or tuberculosis. Conclusions Several viral and bacterial pathogens were identified as important targets for prevention and treatment. Bacterial pathogens remain an important cause of moderate to severe disease, particularly in children with comorbidities despite widespread PCV and Hib vaccination.
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Affiliation(s)
- Claire von Mollendorf
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Daria Berger
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Amanda Gwee
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia
| | - Trevor Duke
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stephen M Graham
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia
| | - Fiona M Russell
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - E Kim Mulholland
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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27
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Bainomugisa A, Lavu E, Pandey S, Majumdar S, Banamu J, Coulter C, Marais B, Coin L, Graham SM, du Cros P. Evolution and spread of a highly drug resistant strain of Mycobacterium tuberculosis in Papua New Guinea. BMC Infect Dis 2022; 22:437. [PMID: 35524232 PMCID: PMC9077924 DOI: 10.1186/s12879-022-07414-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Molecular mechanisms determining the transmission and prevalence of drug resistant tuberculosis (DR-TB) in Papua New Guinea (PNG) are poorly understood. We used genomic and drug susceptibility data to explore the evolutionary history, temporal acquisition of resistance and transmission dynamics of DR-TB across PNG. METHODS We performed whole genome sequencing on isolates from Central Public Health Laboratory, PNG, collected 2017-2019. Data analysis was done on a composite dataset that also included 100 genomes previously sequenced from Daru, PNG (2012-2015). RESULTS Sampled isolates represented 14 of the 22 PNG provinces, the majority (66/94; 70%) came from the National Capital District (NCD). In the composite dataset, 91% of strains were Beijing 2.2.1.1, identified in 13 provinces. Phylogenetic tree of Beijing strains revealed two clades, Daru dominant clade (A) and NCD dominant clade (B). Multi-drug resistance (MDR) was repeatedly and independently acquired, with the first MDR cases in both clades noted to have emerged in the early 1990s, while fluoroquinolone resistance emerged in 2009 (95% highest posterior density 2000-2016). We identified the presence of a frameshift mutation within Rv0678 (p.Asp47fs) which has been suggested to confer resistance to bedaquiline, despite no known exposure to the drug. Overall genomic clustering was significantly associated with rpoC compensatory and inhA promoter mutations (p < 0.001), with high percentage of most genomic clusters (12/14) identified in NCD, reflecting its role as a potential national amplifier. CONCLUSIONS The acquisition and evolution of drug resistance among the major clades of Beijing strain threaten the success of DR-TB treatment in PNG. With continued transmission of this strain in PNG, genotypic drug resistance surveillance using whole genome sequencing is essential for improved public health response to outbreaks. With occurrence of resistance to newer drugs such as bedaquiline, knowledge of full drug resistance profiles will be important for optimal treatment selection.
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Affiliation(s)
| | - Evelyn Lavu
- University of Papua New Guinea, Port Moresby, Papua New Guinea.,Central Public Health Laboratory, Port Moresby, Papua New Guinea
| | - Sushil Pandey
- Queensland Mycobacteria Reference Laboratory, Brisbane, QLD, Australia
| | - Suman Majumdar
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Jennifer Banamu
- Central Public Health Laboratory, Port Moresby, Papua New Guinea
| | - Chris Coulter
- Queensland Mycobacteria Reference Laboratory, Brisbane, QLD, Australia
| | - Ben Marais
- University of Sydney, Sydney, NSW, Australia
| | - Lachlan Coin
- Peter Doherty Institute, Melbourne, VIC, Australia
| | - Stephen M Graham
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Philipp du Cros
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
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28
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Quach A, Tosif S, Graham SM, von Mollendorf C, Mulholland K, Graham H, Duke T, Russell FM. Quality of care for children with acute respiratory infections in health facilities: a comparative analysis of assessment tools. J Glob Health 2022; 12:10003. [PMID: 35356657 PMCID: PMC8942384 DOI: 10.7189/jogh.12.10003] [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: 11/26/2022] Open
Abstract
Background Severe childhood pneumonia requires treatment in hospital by trained health care workers. It is therefore important to determine if health facilities provide quality health services for children with acute respiratory infections (ARI), including pneumonia. Using established indicators from WHO to measure quality of care (QoC) as a reference standard, this review aims to evaluate how well existing tools assess QoC for children presenting to health facilities with ARI. Methods Existing assessment tools identified from a published systematic literature review that evaluated QoC assessment tools for children (<15 years) in health facilities for all health conditions were included in this ARI-specific review. 27 ARI-specific indicators or “quality measures” from the WHO “Standards for improving quality of care for children and young adolescents in health facilities” were selected for use as a reference standard to assess QoC for children presenting to health facilities with ARI symptoms. Each included assessment tool was evaluated independently by two paediatricians to determine how many of the WHO ARI quality measures were assessable by the tool. The assessment tools were then ranked in order of percentage of ARI quality measures assessable. Results Nine assessment tools that assessed QoC for children attending health facilities were included. Two hospital care tools developed by WHO had the most consistency with ARI-specific indicators, assessing 22/27 (81.5%) and 20/27 (74.1%) of the quality measures. The remaining tools were less consistent with the ARI-specific indicators, including between zero to 16 of the 27 quality measures. The most common indicators absent from the tools were assessment of appropriate use of pulse oximetry and administration of oxygen, how often oxygen supply was unavailable, and mortality rates. Conclusions The existing WHO hospital-based QoC assessment tools are comprehensive but could be enhanced by improved data quality around oxygen availability and appropriate use of pulse oximetry and oxygen administration. Any tools, however, should be considered within broader assessments of QoC, rather than utilised in isolation. Further adaptation to local settings will improve feasibility and facilitate progress in the delivery of quality health care for children with ARI. Registration The protocol of the original systematic review was registered in PROSPERO ID: CRD42020175652.
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Affiliation(s)
- Alicia Quach
- Asia-Pacific Health Group, Murdoch Children’s Research Institute, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Victoria, Australia
| | - Shidan Tosif
- Department of Paediatrics, The University of Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Victoria, Australia
- The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Stephen M Graham
- Department of Paediatrics, The University of Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Victoria, Australia
- The Royal Children’s Hospital, Parkville, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Claire von Mollendorf
- Asia-Pacific Health Group, Murdoch Children’s Research Institute, Victoria, Australia
| | - Kim Mulholland
- Department of Paediatrics, The University of Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Victoria, Australia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Hamish Graham
- Department of Paediatrics, The University of Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Victoria, Australia
- The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Trevor Duke
- Department of Paediatrics, The University of Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Victoria, Australia
- The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Fiona M Russell
- Asia-Pacific Health Group, Murdoch Children’s Research Institute, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Victoria, Australia
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29
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Graham SM, Marais BJ, Amanullah F. Tuberculosis in Children and Adolescents: Progress and Perseverance. Pathogens 2022; 11:pathogens11040392. [PMID: 35456067 PMCID: PMC9029126 DOI: 10.3390/pathogens11040392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- Stephen M. Graham
- Department of Paediatrics and Murdoch Children’s Research Institute, University of Melbourne, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
- The Burnet Institute, Melbourne, VIC 3004, Australia
- Correspondence: ; Tel.: +61-405782505
| | - Ben J. Marais
- Department of Paediatrics and Child Health, The Children’s Hospital at Westmead, The University of Sydney, Westmead, NSW 2145, Australia;
| | - Farhana Amanullah
- Department of Paediatrics, The Indus Hospital and Health Network, The Aga Khan University Hospital, Karachi 75500, Pakistan;
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30
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Gunasekera KS, Vonasek B, Oliwa J, Triasih R, Lancioni C, Graham SM, Seddon JA, Marais BJ. Diagnostic Challenges in Childhood Pulmonary Tuberculosis-Optimizing the Clinical Approach. Pathogens 2022; 11:pathogens11040382. [PMID: 35456057 PMCID: PMC9032883 DOI: 10.3390/pathogens11040382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/08/2022] [Accepted: 03/14/2022] [Indexed: 12/25/2022] Open
Abstract
The management of childhood tuberculosis (TB) is hampered by the low sensitivity and limited accessibility of microbiological testing. Optimizing clinical approaches is therefore critical to close the persistent gaps in TB case detection and prevention necessary to realize the child mortality targets of the End TB Strategy. In this review, we provide practical guidance summarizing the evidence and guidelines describing the use of symptoms and signs in decision making for children being evaluated for either TB preventive treatment (TPT) or TB disease treatment in high-TB incidence settings. Among at-risk children being evaluated for TPT, a symptom screen may be used to differentiate children who require further investigation for TB disease before receiving TPT. For symptomatic children being investigated for TB disease, an algorithmic approach can inform which children should receive TB treatment, even in the absence of imaging or microbiological confirmation. Though clinical approaches have limitations in accuracy, they are readily available and can provide valuable guidance for decision making in resource-limited settings to increase treatment access. We discuss the trade-offs in using them to make TB treatment decisions.
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Affiliation(s)
- Kenneth S. Gunasekera
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
- Correspondence:
| | - Bryan Vonasek
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA;
| | - Jacquie Oliwa
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi P.O. Box 43640-00100, Kenya;
- Department of Paediatrics and Child Health, School of Medicine, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya
| | - Rina Triasih
- Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55284, Indonesia;
| | - Christina Lancioni
- Department of Pediatrics, School of Medicine, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Stephen M. Graham
- Centre for International Child Health, University of Melbourne and Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC 3052, Australia;
- Burnet Institute, Melbourne, VIC 3004, Australia
| | - James A. Seddon
- Department of Infectious Diseases, Imperial College London, London W2 1PG, UK;
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa
| | - Ben J. Marais
- University of Sydney and The Children’s Hospital at Westmead, Sydney, NSW 2145, Australia;
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31
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Turkova A, Wills GH, Wobudeya E, Chabala C, Palmer M, Kinikar A, Hissar S, Choo L, Musoke P, Mulenga V, Mave V, Joseph B, LeBeau K, Thomason MJ, Mboizi RB, Kapasa M, van der Zalm MM, Raichur P, Bhavani PK, McIlleron H, Demers AM, Aarnoutse R, Love-Koh J, Seddon JA, Welch SB, Graham SM, Hesseling AC, Gibb DM, Crook AM. Shorter Treatment for Nonsevere Tuberculosis in African and Indian Children. N Engl J Med 2022; 386:911-922. [PMID: 35263517 PMCID: PMC7612496 DOI: 10.1056/nejmoa2104535] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Two thirds of children with tuberculosis have nonsevere disease, which may be treatable with a shorter regimen than the current 6-month regimen. METHODS We conducted an open-label, treatment-shortening, noninferiority trial involving children with nonsevere, symptomatic, presumably drug-susceptible, smear-negative tuberculosis in Uganda, Zambia, South Africa, and India. Children younger than 16 years of age were randomly assigned to 4 months (16 weeks) or 6 months (24 weeks) of standard first-line antituberculosis treatment with pediatric fixed-dose combinations as recommended by the World Health Organization. The primary efficacy outcome was unfavorable status (composite of treatment failure [extension, change, or restart of treatment or tuberculosis recurrence], loss to follow-up during treatment, or death) by 72 weeks, with the exclusion of participants who did not complete 4 months of treatment (modified intention-to-treat population). A noninferiority margin of 6 percentage points was used. The primary safety outcome was an adverse event of grade 3 or higher during treatment and up to 30 days after treatment. RESULTS From July 2016 through July 2018, a total of 1204 children underwent randomization (602 in each group). The median age of the participants was 3.5 years (range, 2 months to 15 years), 52% were male, 11% had human immunodeficiency virus infection, and 14% had bacteriologically confirmed tuberculosis. Retention by 72 weeks was 95%, and adherence to the assigned treatment was 94%. A total of 16 participants (3%) in the 4-month group had a primary-outcome event, as compared with 18 (3%) in the 6-month group (adjusted difference, -0.4 percentage points; 95% confidence interval, -2.2 to 1.5). The noninferiority of 4 months of treatment was consistent across the intention-to-treat, per-protocol, and key secondary analyses, including when the analysis was restricted to the 958 participants (80%) independently adjudicated to have tuberculosis at baseline. A total of 95 participants (8%) had an adverse event of grade 3 or higher, including 15 adverse drug reactions (11 hepatic events, all but 2 of which occurred within the first 8 weeks, when the treatments were the same in the two groups). CONCLUSIONS Four months of antituberculosis treatment was noninferior to 6 months of treatment in children with drug-susceptible, nonsevere, smear-negative tuberculosis. (Funded by the U.K. Medical Research Council and others; SHINE ISRCTN number, ISRCTN63579542.).
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Affiliation(s)
- Anna Turkova
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Genevieve H Wills
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Eric Wobudeya
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Chishala Chabala
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Megan Palmer
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Aarti Kinikar
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Syed Hissar
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Louise Choo
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Philippa Musoke
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Veronica Mulenga
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Vidya Mave
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Bency Joseph
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Kristen LeBeau
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Margaret J Thomason
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Robert B Mboizi
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Monica Kapasa
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Marieke M van der Zalm
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Priyanka Raichur
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Perumal K Bhavani
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Helen McIlleron
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Anne-Marie Demers
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Rob Aarnoutse
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - James Love-Koh
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - James A Seddon
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Steven B Welch
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Stephen M Graham
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Anneke C Hesseling
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Diana M Gibb
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
| | - Angela M Crook
- From the Medical Research Council Clinical Trials Unit, University College London (A.T., G.H.W., L.C., K.L., M.J.T., D.M.G., A.M.C.), and the Department of Infectious Diseases, Imperial College London (J.A.S.), London, the Centre for Health Economics, University of York, York (J.L.-K.), and the Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham (S.B.W.) - all in the United Kingdom; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (E.W., P.M., R.B.M.); University Teaching Hospital, Lusaka, Zambia (C.C., V. Mulenga, M.K.); Desmond Tutu TB Centre, the Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (M.P., M.M.Z., A.-M.D., J.A.S., A.C.H.), and the Division of Clinical Pharmacology, University of Cape Town, Cape Town (H.M.) - both in South Africa; B.J. Medical College, Pune (A.K., V. Mave, P.R.), and the National Institute for Research in Tuberculosis, Chennai (S.H., B.J., P.K.B.) - both in India; Radboud University Medical Center, Nijmegen, the Netherlands (R.A.); the Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Royal Children's Hospital - both in Melbourne, VIC, Australia (S.M.G.); and the International Union against Tuberculosis and Lung Disease, Paris (S.M.G.)
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Affiliation(s)
- S M Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics, Royal Children´s Hospital, Melbourne, VIC, Australia, The Burnet Institute, Melbourne, VIC, Australia
| | - F Amanullah
- The Indus Hospital and Health Network, Karachi, Pakistan
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du Preez K, Jenkins HE, Donald PR, Solomons RS, Graham SM, Schaaf HS, Starke JR, Hesseling AC, Seddon JA. Tuberculous Meningitis in Children: A Forgotten Public Health Emergency. Front Neurol 2022; 13:751133. [PMID: 35370901 PMCID: PMC8970690 DOI: 10.3389/fneur.2022.751133] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Tuberculous meningitis (TBM) remains a major cause of morbidity and mortality in children with tuberculosis (TB), yet there are currently no estimates of the global burden of pediatric TBM. Due to frequent non-specific clinical presentation and limited and inadequate diagnostic tests, children with TBM are often diagnosed late or die undiagnosed. Even when diagnosed and treated, 20% of children with TBM die. Of survivors, the majority have substantial neurological disability with significant negative impact on children and their families. Surveillance data on this devastating form of TB can help to quantify the contribution of TBM to the overall burden, morbidity and mortality of TB in children and the epidemiology of TB more broadly. Pediatric TBM usually occurs shortly after primary infection with Mycobacterium tuberculosis and reflects ongoing TB transmission to children. In this article we explain the public health importance of pediatric TBM, discuss the epidemiology within the context of overall TB control and health system functioning and the limitations of current surveillance strategies. We provide a clear rationale for the benefit of improved surveillance of pediatric TBM using a TB care cascade framework to support monitoring and evaluation of pediatric TB, and TB control more broadly. Considering the public health implications of a diagnosis of TBM in children, we provide recommendations to strengthen pediatric TBM surveillance and outline how improved surveillance can help us identify opportunities for prevention, earlier diagnosis and improved care to minimize the impact of TBM on children globally.
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Affiliation(s)
- Karen du Preez
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- *Correspondence: Karen du Preez
| | - Helen E. Jenkins
- 2Department of Biostatistics, School of Public Health, Boston University, Boston, MA, United States
| | - Peter R. Donald
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Regan S. Solomons
- 3Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephen M. Graham
- 4Department of Paediatrics and Murdoch Children's Research Institute, Centre for International Child Health, University of Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
- 5International Union Against Tuberculosis and Lung Disease, Paris, France
| | - H. Simon Schaaf
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- 3Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jeffrey R. Starke
- 6Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Anneke C. Hesseling
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James A. Seddon
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- 7Department of Infectious Diseases, Imperial College London, London, United Kingdom
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Lestari T, Kamaludin, Lowbridge C, Kenangalem E, Poespoprodjo JR, Graham SM, Ralph AP. Impacts of tuberculosis services strengthening and the COVID-19 pandemic on case detection and treatment outcomes in Mimika District, Papua, Indonesia: 2014-2021. PLOS Glob Public Health 2022; 2:e0001114. [PMID: 36962674 PMCID: PMC10021881 DOI: 10.1371/journal.pgph.0001114] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022]
Abstract
Indonesia is a high-burden tuberculosis (TB) country with a wide case detection gap, exacerbated by the COVID-19 pandemic. We aimed to review the epidemiology of TB in a high-endemic setting of Indonesia before and during the implementation of health system strengthening activities for TB, including during the first two years of the COVID-19 pandemic. We analysed TB program data from Mimika District, Papua, Indonesia from 2014 to 2021. Health system strengthening activities to improve the programmatic management of TB were implemented from 2017 onwards. Activities included decentralization of TB services, training and mentoring of healthcare workers, improved screening for co-morbidities, and introduction and optimisation of Xpert testing in 2018. A total of 11,803 TB cases were notified to the Mimika District Health Office over eight years (2014-21). Between 2015 and 2019, there was a 67% increase in annual case notifications, an 89% increase in bacteriologically confirmed cases and the proportion of TB cases detected in primary care increased from 26% to 46%. In 2020, coinciding with the COVID-19 pandemic, investigation of people with presumptive TB fell by 38%, but the proportion of those tested with Xpert increased. TB case notifications decreased by 19% from 1,796 in 2019 to 1,461 in 2020, but then increased by 17% to 1,716 in 2021. Routine screening for co-morbidities (HIV, diabetes) among TB patients improved over time and was not affected by the pandemic. Treatment success overall was 71% and remained relatively unchanged. Loss to follow-up and death were 18% and 3.7% respectively. Improvements in TB case finding were observed over a period in which a range of health system strengthening activities were implemented. While COVID-19 had a negative impact on the TB program in Mimika District, there are encouraging signs of recovery. Further work is needed to improve TB treatment outcomes.
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Affiliation(s)
- Trisasi Lestari
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Timika Research Facility, Papuan Health and Community Development Foundation, Timika, Indonesia
| | - Kamaludin
- Mimika District Health Office, Timika, Indonesia
| | - Christopher Lowbridge
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Enny Kenangalem
- Timika Research Facility, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika District Hospital, Timika, Indonesia
| | - Jeanne Rini Poespoprodjo
- Timika Research Facility, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika District Hospital, Timika, Indonesia
| | - Stephen M Graham
- University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- The Burnet Institute, Melbourne, Australia
| | - Anna P Ralph
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Quach A, Tosif S, Nababan H, Duke T, Graham SM, Were WM, Muzigaba M, Russell FM. Assessing the quality of care for children attending health facilities: a systematic review of assessment tools. BMJ Glob Health 2021; 6:bmjgh-2021-006804. [PMID: 34607894 PMCID: PMC8491295 DOI: 10.1136/bmjgh-2021-006804] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/09/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Assessing quality of healthcare is integral in determining progress towards equitable health outcomes worldwide. Using the WHO 'Standards for improving quality of care for children and young adolescents in health facilities' as a reference standard, we aimed to evaluate existing tools that assess quality of care for children. METHODS We undertook a systematic literature review of publications/reports between 2008 and 2020 that reported use of quality of care assessment tools for children (<15 years) in health facilities. Identified tools were reviewed against the 40 quality statements and 510 quality measures from the WHO Standards to determine the extent each tool was consistent with the WHO Standards. The protocol was registered in PROSPERO ID: CRD42020175652. RESULTS Nine assessment tools met inclusion criteria. Two hospital care tools developed by WHO-Europe and WHO-South-East Asia Offices had the most consistency with the WHO Standards, assessing 291 (57·1%) and 208 (40·8%) of the 510 quality measures, respectively. Remaining tools included between 33 (6·5%) and 206 (40·4%) of the 510 quality measures. The WHO-Europe tool was the only tool to assess all 40 quality statements. The most common quality measures absent were related to experience of care, particularly provision of educational, emotional and psychosocial support to children and families, and fulfilment of children's rights during care. CONCLUSION Quality of care assessment tools for children in health facilities are missing some key elements highlighted by the WHO Standards. The WHO Standards are, however, extensive and applying all the quality measures in every setting may not be feasible. A consensus of key indicators to monitor the WHO Standards is required. Existing tools could be modified to include priority indicators to strengthen progress reporting towards delivering quality health services for children. In doing so, a balance between comprehensiveness and practical utility is needed. PROSPERO REGISTRATION NUMBER CRD42020175652.
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Affiliation(s)
- Alicia Quach
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia .,Asia Pacific Health Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Shidan Tosif
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.,The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Herfina Nababan
- Health System Strengthening Unit, World Health Organisation Country Office for Indonesia, Jakarta, Indonesia
| | - Trevor Duke
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.,The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Stephen M Graham
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.,International Child Health Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Wilson M Were
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Moise Muzigaba
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Fiona M Russell
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.,Asia Pacific Health Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
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Nguyen TKP, Bui BBS, Ngo QC, Fitzgerald DA, Graham SM, Marais BJ. Applying lessons learnt from research of child pneumonia management in Vietnam. Paediatr Respir Rev 2021; 39:65-70. [PMID: 33158773 DOI: 10.1016/j.prrv.2020.09.005] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
Pneumonia is the leading cause of paediatric hospitalisation in Vietnam, placing a huge burden on the health care system. Pneumonia is also the main reason for antibiotic use in children. Unfortunately many hospital admissions for child pneumonia in Vietnam are unnecessary and inappropriate use of antibiotics is common, as in the rest of Asia, with little awareness of its adverse effects. We explored the value of an alternative approach that, instead of focusing on the identification of children with severe bacterial pneumonia, focuses on the identification of children with 'unlikely bacterial pneumonia' to improve patient care and rational antibiotic use. Implementing improved models of care require pragmatic management algorithms that are well validated, but it is ultimately dependent on financial structures, management support and evidence-based training of healthcare providers at all relevant levels. Apart from better case management, sustained reductions in the pneumonia disease burden also require increased emphasis on primary prevention.
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Affiliation(s)
- T K P Nguyen
- Respiratory Department, Da Nang Hospital for Women and Children, Viet Nam.
| | - B B S Bui
- Discipline of Paediatrics, Hue University of Medicine and Pharmacy, Viet Nam
| | - Q C Ngo
- Vietnam Respiratory Society, Ha Noi, Viet Nam
| | - D A Fitzgerald
- Respiratory Medicine, The Children's Hospital at Westmead, The University of Sydney, Australia
| | - S M Graham
- Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - B J Marais
- Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, The University of Sydney, Australia
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Dongo JP, Graham SM, Nsonga J, Wabwire-Mangen F, Maleche-Obimbo E, Mupere E, Nyinoburyo R, Nakawesi J, Sentongo G, Amuge P, Detjen A, Mugabe F, Turyahabwe S, Sekadde MP, Zawedde-Muyanja S. Implementation of an Effective Decentralised Programme for Detection, Treatment and Prevention of Tuberculosis in Children. Trop Med Infect Dis 2021; 6:tropicalmed6030131. [PMID: 34287383 PMCID: PMC8293469 DOI: 10.3390/tropicalmed6030131] [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: 05/19/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
Childhood tuberculosis (TB) is consistently under-detected in most high-burden countries, including Uganda, especially in young children at high risk for severe disease and mortality. TB preventive treatment (TPT) for high-risk child contacts is also poorly implemented. The centralised concentration of services for child TB at the referral level is a major challenge in the prevention, detection and treatment of TB in children. In 2015, the DETECT Child TB Project was implemented in two districts of Uganda and involved decentralisation of healthcare services for child TB from tertiary to primary healthcare facilities, along with establishing linkages to support community-based household contact screening and management. The intervention resulted in improved case finding of child and adult TB cases, improved treatment outcomes for child TB and high uptake and completion of TPT for eligible child contacts. A detailed description of the development and implementation of this project is provided, along with findings from an external evaluation. The ongoing mentorship and practical support for health workers to deliver optimal services in this context were critical to complement the use of training and training tools. A summary of the project’s outcomes is provided along with the key challenges identified and the lessons learnt.
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Affiliation(s)
- John Paul Dongo
- International Union against Tuberculosis and Lung Disease, Kampala P.O. Box 16094, Uganda; (J.P.D.); (J.N.)
| | - Stephen M. Graham
- International Union against Tuberculosis and Lung Disease, Kampala P.O. Box 16094, Uganda; (J.P.D.); (J.N.)
- Centre for International Child Health, Department of Paediatrics and Murdoch Children’s Research Institute, University of Melbourne, Royal Children’s Hospital, Melbourne 3052, Australia
- Correspondence: ; Tel.: +61-(0)405-782-505
| | - Joseph Nsonga
- International Union against Tuberculosis and Lung Disease, Kampala P.O. Box 16094, Uganda; (J.P.D.); (J.N.)
| | - Fred Wabwire-Mangen
- School of Public Health, Makerere University College of Health Sciences, Kampala P.O. Box 16094, Uganda;
| | - Elizabeth Maleche-Obimbo
- Department of Paediatrics and Child Health, School of Medicine, University of Nairobi, Nirobi P.O. Box 30197-00100, Kenya;
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda;
| | | | - Jane Nakawesi
- Mildmay Uganda, Kampala P.O. Box 24985, Uganda; (R.N.); (J.N.)
| | - Gerald Sentongo
- Baylor College of Medicine Children’s Foundation-Uganda, Kampala P.O. Box 72052, Uganda; (G.S.); (P.A.)
| | - Pauline Amuge
- Baylor College of Medicine Children’s Foundation-Uganda, Kampala P.O. Box 72052, Uganda; (G.S.); (P.A.)
| | | | - Frank Mugabe
- National Tuberculosis and Leprosy Program, Kampala P.O. Box 16069, Uganda; (F.M.); (S.T.); (M.P.S.)
| | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Program, Kampala P.O. Box 16069, Uganda; (F.M.); (S.T.); (M.P.S.)
| | - Moorine P. Sekadde
- National Tuberculosis and Leprosy Program, Kampala P.O. Box 16069, Uganda; (F.M.); (S.T.); (M.P.S.)
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda;
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Oktaria V, Triasih R, Graham SM, Bines JE, Soenarto Y, Clarke MW, Lauda M, Danchin M. Vitamin D deficiency and severity of pneumonia in Indonesian children. PLoS One 2021; 16:e0254488. [PMID: 34242372 PMCID: PMC8270442 DOI: 10.1371/journal.pone.0254488] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To determine the prevalence of vitamin D deficiency in Indonesian children hospitalized with pneumonia and evaluate the association between vitamin D status and severity of pneumonia. Methods A hospital-based cross-sectional study was conducted from February 2016 to July 2017 in two district hospitals in Yogyakarta province, Indonesia. Infants and young children aged 2–59 months hospitalized with pneumonia were recruited. Serum blood samples were collected on admission and analyzed for total serum 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 concentrations using liquid chromatography-tandem mass spectrometry. Vitamin D deficiency was defined as a level of serum vitamin D <50 nmol/L. The association between vitamin D deficiency and severity of hospitalized pneumonia according to WHO criteria, including the presence of danger signs, hypoxemia (SpO2 in air below 90%), duration of hospitalization, and admission to Intensive Care Unit (ICU), was analyzed using logistic regression. Results 133 children with WHO-defined pneumonia were enrolled in the study and 127 (96%) had their vitamin D status determined. The mean vitamin D concentration was 67 (± 24 SD) nmol/L and 19% of participants were vitamin D deficient. Age younger than 6 months was associated with prolonged hospitalization (> 5 days) and low birth weight and poor nutritional status on admission were risk factors for hypoxemia. However, vitamin D status was not associated with the presence of danger signs, duration of hospitalization, or hypoxemia. Conclusions One in every five children hospitalized with pneumonia was vitamin D deficient. Vitamin D status was not associated with the severity of pneumonia.
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Affiliation(s)
- Vicka Oktaria
- Faculty Medicine, Department of Paediatrics, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia
- Faculty of Medicine, Department of Biostatistics, Epidemiology and Population Health, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Center for Child Health–Pediatric Research Office (CCH_PRO), Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- * E-mail:
| | - Rina Triasih
- Faculty of Medicine, Center for Child Health–Pediatric Research Office (CCH_PRO), Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Child Health Department, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Stephen M. Graham
- Faculty Medicine, Department of Paediatrics, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia
| | - Julie E. Bines
- Faculty Medicine, Department of Paediatrics, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia
| | - Yati Soenarto
- Faculty of Medicine, Center for Child Health–Pediatric Research Office (CCH_PRO), Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Child Health Department, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Michael W. Clarke
- Faculty of Health, and Medical Sciences, Metabolomics Australia, Centre for Microscopy, Characterisation, and Analysis, and School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Mike Lauda
- Faculty of Medicine, Child Health Department, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Margaret Danchin
- Faculty Medicine, Department of Paediatrics, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia
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Chan G, Triasih R, Nababan B, du Cros P, Wilks N, Main S, Huang GKL, Lin D, Graham SM, Majumdar SS, Bakker M, Khan A, Khan FA, Dwihardiani B. Adapting active case-finding for TB during the COVID-19 pandemic in Yogyakarta, Indonesia. Public Health Action 2021; 11:41-49. [PMID: 34159059 PMCID: PMC8202624 DOI: 10.5588/pha.20.0071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/16/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
The COVID-19 pandemic and response measures, including lockdowns and the reorientation of health services, have disrupted essential health services for other diseases, including TB, HIV and malaria. For TB, reductions in case detection due to the COVID-19 pandemic are projected to result in increased TB transmission, morbidity and mortality. Active case-finding (ACF) for TB using community-based approaches is a potential strategy to offset reductions in TB detection by obviating the need for patients to seek care at a health facility. A number of approaches can be used to conduct TB ACF safely and screen designated target populations while managing the risks of SARS-CoV-2 transmission for staff, individuals and the community. We present a framework of options for and experience of adapting TB ACF services in response to the challenges of COVID-19 in our programme in Yogyakarta, Indonesia. Key changes have included revised prioritisation of target populations focusing on household contacts, reducing case-finding throughput, implementation of additional infection control measures and precautions, and integration of COVID-19 screening among those being screened for TB. Our approach could inform other programmes seeking to adapt TB ACF services to mitigate the negative impact of COVID-19 on TB case detection.
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Affiliation(s)
- G Chan
- Burnet Institute, Melbourne, VIC, Australia
| | - R Triasih
- Department of Paediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - B Nababan
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - P du Cros
- Burnet Institute, Melbourne, VIC, Australia
| | - N Wilks
- Burnet Institute, Melbourne, VIC, Australia
| | - S Main
- Burnet Institute, Melbourne, VIC, Australia
| | | | - D Lin
- Burnet Institute, Melbourne, VIC, Australia
| | - S M Graham
- Burnet Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Melbourne, VIC, Australia
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - S S Majumdar
- Burnet Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - M Bakker
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - A Khan
- STOP TB Partnership, Geneva, Switzerland
| | - F A Khan
- STOP TB Partnership, Geneva, Switzerland
| | - B Dwihardiani
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Moyo N, Tay EL, Nolan A, Graham HR, Graham SM, Denholm JT. TB contact tracing for young children: an Australian cascade of care review. Public Health Action 2021; 11:91-96. [PMID: 34159069 DOI: 10.5588/pha.20.0086] [Citation(s) in RCA: 4] [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: 12/20/2020] [Accepted: 04/01/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To evaluate care cascades for programmatic active case finding and latent TB infection (LTBI) management in young child TB contacts (aged <5 years) in Victoria, Australia. DESIGN This was a retrospective review of public health surveillance data to identify contacts of all pulmonary TB cases notified from 2016 to 2019. RESULTS Contact tracing identified 574 young child contacts of 251 pulmonary TB cases. Active TB was found in 28 (4.9%) contacts, none of whom had previously received bacille Calmette-Guérin vaccination, and 529 were tested for TB infection using the tuberculin skin test (TST). The overall TST positivity was 15.3% (95% CI 0.1-0.2). Among the 574 children, 150 (26.1%) were close contacts of sputum smear-positive cases and 25 (16.7%) of these were not referred to TB clinics. Of the 125 referred, 81 were considered to have LTBI, 79 agreed to commence TB preventive treatment (TPT) and 71 (89.9%) completed TPT. Following completion of TPT, no child was subsequently diagnosed with active TB. CONCLUSION There was a high yield from active case finding and uptake of TPT. Notable losses in the cascade of care occurred around referral to tertiary clinics, but high treatment completion rates and good outcomes were found in those prescribed treatment.
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Affiliation(s)
- N Moyo
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Australia.,School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
| | - E L Tay
- Health Protection Branch, Department of Health and Human Services, Melbourne, VIC, Australia
| | - A Nolan
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Australia
| | - H R Graham
- Department of General Medicine, Royal Children's Hospital, Parkville, VIC, Australia.,Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - S M Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Respiratory Medicine, Royal Children's Hospital, Parkville, VIC, Australia
| | - J T Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Australia.,Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, VIC, Australia
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Schwoebel V, Koura KG, Adjobimey M, Gnanou S, Wandji AG, Gody JC, Delacourt C, Detjen A, Graham SM, Masserey E, Mselatti P, Roggi A, Trébucq A. Tuberculosis contact investigation and short-course preventive therapy among young children in Africa. Int J Tuberc Lung Dis 2021; 24:452-460. [PMID: 32317071 DOI: 10.5588/ijtld.19.0712] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: The largest cities in Benin, Burkina Faso, Cameroon and Central African Republic.OBJECTIVE: To demonstrate the feasibility and document the effectiveness of household contact investigation and preventive therapy in resource-limited settings.DESIGN: Children under 5 years living at home with adults with bacteriologically confirmed pulmonary tuberculosis (TB) were screened using questionnaire, clinical examination, tuberculin skin test and chest X-ray. Children free of active TB were offered preventive treatment with a 3-month rifampicin-isoniazid (3RH) or 6-month isoniazid (6H) regimen in Benin. Children were followed-up monthly during treatment, then quarterly over 1 year. Costs of transportation, phone contacts and chest X-rays were covered.RESULTS: A total of 1965 children were enrolled, of whom 56 (2.8%) had prevalent TB at inclusion. Among the 1909 children free of TB, 1745 (91%) started preventive therapy, 1642 (94%) of whom completed treatment. Mild adverse reactions, mostly gastrointestinal, were reported in 2% of children. One case of incident TB, possibly due to a late TB infection, was reported after completing the 3RH regimen.CONCLUSION: Contact investigation and preventive therapy were successfully implemented in these resource-limited urban settings in programmatic conditions with few additional resources. The 3RH regimen is a valuable alternative to 6H for preventing TB.
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Affiliation(s)
- V Schwoebel
- International Union Against Tuberculosis and Lung Disease, Paris
| | - K G Koura
- International Union Against Tuberculosis and Lung Disease, Paris, école Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Epidémiologique, Université de Parakou, Parakou
| | - M Adjobimey
- National Tuberculosis Program, Cotonou, Benin
| | - S Gnanou
- National Tuberculosis Program, Ouagadougou, Burkina Faso
| | - A G Wandji
- National Tuberculosis Program, Yaoundé, Cameroon
| | - J-C Gody
- Complexe pédiatrique, Bangui, Central African Republic
| | - C Delacourt
- Centre Hospitalier Universitaire Necker-Enfants Malades, Paris, France
| | - A Detjen
- United Nations Childrens' Fund, New York, NY, USA
| | - S M Graham
- International Union Against Tuberculosis and Lung Disease, Paris, University of Melbourne and Burnet Institute, Melbourne, Australia
| | - E Masserey
- Département de Santé publique, Canton de Vaud, Lausanne, Switzerland
| | - P Mselatti
- UMI TransVIHMI, Institut de Recherche pour le Développement, Montpellier, France
| | - A Roggi
- International Union Against Tuberculosis and Lung Disease, Paris
| | - A Trébucq
- International Union Against Tuberculosis and Lung Disease, Paris
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Oktaria V, Danchin M, Triasih R, Soenarto Y, Bines JE, Ponsonby AL, Clarke MW, Graham SM. The incidence of acute respiratory infection in Indonesian infants and association with vitamin D deficiency. PLoS One 2021; 16:e0248722. [PMID: 33755666 PMCID: PMC7987198 DOI: 10.1371/journal.pone.0248722] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/26/2020] [Accepted: 03/03/2021] [Indexed: 02/02/2023] Open
Abstract
Background Vitamin D deficiency has been associated with acute respiratory infection (ARI) in early life, but this has not been evaluated in Indonesia. We aimed to determine the incidence of ARI in Indonesian infants, and to evaluate the association with vitamin D deficiency. Methods From 23 December 2015 to 31 December 2017, we conducted a community-based prospective cohort study in Yogyakarta province. We enrolled 422 pregnant women and followed their infants from birth until 12 months of age for ARI episodes. Vitamin D status was measured at birth and at age six months. We performed Cox proportional hazard regression analysis to evaluate the association between vitamin D deficiency and pneumonia incidence. Results At study completion, 95% (400/422) of infants retained with a total of 412 child years of observation (CYO). The incidence of all ARI and of WHO-defined pneumonia was 3.89 (95% CI 3.70–4.08) and 0.25 (95% CI 0.21–0.30) episodes per CYO respectively. Vitamin D deficiency at birth was common (90%, 308/344) and associated with more frequent episodes of ARI non-pneumonia (adjusted odds ratio 4.48, 95% CI:1.04–19.34). Vitamin D status at birth or six months was not associated with subsequent pneumonia incidence, but greater maternal sun exposure during pregnancy was associated with a trend to less frequent ARI and pneumonia in infants. Conclusion ARI, pneumonia, and vitamin D deficiency at birth were common in Indonesian infants. Minimising vitamin D deficiency at birth such as by supplementation of mothers or safe sun exposure during pregnancy has the potential to reduce ARI incidence in infants in this setting.
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Affiliation(s)
- Vicka Oktaria
- Department of Paediatrics, Murdoch Children’s Research Institute, Royal Children’s Hospital, University of Melbourne, Melbourne, Australia
- Child Health Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- * E-mail:
| | - Margaret Danchin
- Department of Paediatrics, Murdoch Children’s Research Institute, Royal Children’s Hospital, University of Melbourne, Melbourne, Australia
| | - Rina Triasih
- Child Health Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yati Soenarto
- Child Health Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Julie E. Bines
- Department of Paediatrics, Murdoch Children’s Research Institute, Royal Children’s Hospital, University of Melbourne, Melbourne, Australia
| | - Anne-Louise Ponsonby
- Department of Paediatrics, Murdoch Children’s Research Institute, Royal Children’s Hospital, University of Melbourne, Melbourne, Australia
| | - Michael W. Clarke
- Metabolomics Australia, Centre for Microscopy, Characterisation, and Analysis, and School of Biomedical Sciences, Faculty of Health, and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Stephen M. Graham
- Department of Paediatrics, Murdoch Children’s Research Institute, Royal Children’s Hospital, University of Melbourne, Melbourne, Australia
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Marais BJ, Verkuijl S, Casenghi M, Triasih R, Hesseling AC, Mandalakas AM, Marcy O, Seddon JA, Graham SM, Amanullah F. Paediatric tuberculosis - new advances to close persistent gaps. Int J Infect Dis 2021; 113 Suppl 1:S63-S67. [PMID: 33716193 DOI: 10.1016/j.ijid.2021.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/24/2021] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
Young children are most vulnerable to develop severe forms of tuberculosis (TB) and are over-represented among TB deaths. Almost all children estimated to have died from TB were never diagnosed or offered TB treatment. Improved access to TB preventive treatment (TPT) requires major upscaling of household contact investigation with allocation of adequate resources. Symptom-based screening is often discouraged in adults for fear of generating drug resistance, if TB cases are missed. However, the situation in vulnerable young children is different, as they present minimal risk of drug resistance generation. Further, the perceived need for additional diagnostic evaluation presents a major barrier to TPT access and underlies general reluctance to consider pragmatic decentralised models of care. Widespread roll-out of Xpert MTB/RIF Ultra® represents an opportunity for improved case detection in young children, but attaining full impact will require the use of non-sputum specimens. The new Fujifilm SILVAMP TB LAM® urine assay demonstrated good diagnostic accuracy in HIV-positive and malnourished children, but further validation is required. Given the limited accuracy of all available tests and the excellent tolerance of TB drugs in children, the global community may have to accept some over-treatment if we want to close the persistent case detection gap in young children.
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Affiliation(s)
- Ben J Marais
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.
| | - Sabine Verkuijl
- Global TB Programme, World Health Organisation (WHO), Geneva, Switzerland
| | | | - Rina Triasih
- Department of Paediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada and Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, South Africa
| | - Anna M Mandalakas
- Global Tuberculosis Program, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, United States
| | - Olivier Marcy
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development, UMR 1219, Bordeaux, France
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, South Africa; Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Stephen M Graham
- Centre for International Child Health, University of Melbourne, Melbourne, Australia; International Union against Tuberculosis and Lung Disease, Paris, France
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Vasiliu A, Eymard-Duvernay S, Tchounga B, Atwine D, de Carvalho E, Ouedraogo S, Kakinda M, Tchendjou P, Turyahabwe S, Kuate AK, Tiendrebeogo G, Dodd PJ, Graham SM, Cohn J, Casenghi M, Bonnet M. Community intervention for child tuberculosis active contact investigation and management: study protocol for a parallel cluster randomized controlled trial. Trials 2021; 22:180. [PMID: 33653385 PMCID: PMC7927252 DOI: 10.1186/s13063-021-05124-9] [Citation(s) in RCA: 3] [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: 08/14/2020] [Accepted: 02/11/2021] [Indexed: 01/22/2023] Open
Abstract
Background There are major gaps in the management of pediatric tuberculosis (TB) contact investigation for rapid identification of active tuberculosis and initiation of preventive therapy. This study aims to evaluate the impact of a community-based intervention as compared to facility-based model for the management of children in contact with bacteriologically confirmed pulmonary TB adults in low-resource high-burden settings. Methods/design This multicenter parallel open-label cluster randomized controlled trial is composed of three phases: I, baseline phase in which retrospective data are collected, quality of data recording in facility registers is checked, and expected acceptability and feasibility of the intervention is assessed; II, intervention phase with enrolment of index cases and contact cases in either facility- or community-based models; and III, explanatory phase including endpoint data analysis, cost-effectiveness analysis, and post-intervention acceptability assessment by healthcare providers and beneficiaries. The study uses both quantitative and qualitative analysis methods. The community-based intervention includes identification and screening of all household contacts, referral of contacts with TB-suggestive symptoms to the facility for investigation, and household initiation of preventive therapy with follow-up of eligible child contacts by community healthcare workers, i.e., all young (< 5 years) child contacts or older (5–14 years) child contacts living with HIV, and with no evidence of TB disease. Twenty clusters representing TB diagnostic and treatment facilities with their catchment areas are randomized in a 1:1 ratio to either the community-based intervention arm or the facility-based standard of care arm in Cameroon and Uganda. Randomization was stratified by country and constrained on the number of index cases per cluster. The primary endpoint is the proportion of eligible child contacts who initiate and complete the preventive therapy. The sample size is of 1500 child contacts to identify a 10% difference between the arms with the assumption that 60% of children will complete the preventive therapy in the standard of care arm. Discussion This study will provide evidence of the impact of a community-based intervention on household child contact screening and management of TB preventive therapy in order to improve care and prevention of childhood TB in low-resource high-burden settings. Trial registration ClinicalTrials.gov NCT03832023. Registered on 6 February 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05124-9.
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Affiliation(s)
- Anca Vasiliu
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | - Sabrina Eymard-Duvernay
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | - Boris Tchounga
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | | | - Elisabete de Carvalho
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | - Sayouba Ouedraogo
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | | | | | | | | | - Georges Tiendrebeogo
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | - Peter J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen M Graham
- Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.,International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Jennifer Cohn
- Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland
| | | | - Maryline Bonnet
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France.
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Nguyen PTK, Tran HT, Tran TS, Fitzgerald DA, Graham SM, Marais BJ. Predictors of Unlikely Bacterial Pneumonia and Adverse Pneumonia Outcome in Children Admitted to a Hospital in Central Vietnam. Clin Infect Dis 2021; 70:1733-1741. [PMID: 31132089 DOI: 10.1093/cid/ciz445] [Citation(s) in RCA: 4] [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: 04/12/2019] [Accepted: 05/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pneumonia is the leading cause of antibiotic use and hospitalization in Vietnam. There is a need for better prediction of unlikely bacterial pneumonia and adverse pneumonia outcome in order to guide hospital admission and improve rational antibiotic use. METHODS All children under 5 admitted with pneumonia (per clinician assessment) to the Da Nang Hospital for Women and Children were prospectively enrolled. Children were classified as having likely or unlikely bacterial pneumonia and followed for outcome assessment. A Bayesian model averaging approach was used to identify predictors of unlikely bacterial pneumonia and adverse pneumonia outcome, which guided the development of a pragmatic management algorithm. RESULTS Of 3817 patients assessed, 2199 (57.6%) met World Health Organization (WHO) pneumonia criteria. In total, 1594 (41.7%) children were classified as having unlikely and 129 (3.4%) as having likely bacterial pneumonia. The remainder (2399; 62.9%) were considered to have disease of uncertain etiology. Factors predictive of unlikely bacterial pneumonia were no fever, no consolidation on chest radiograph, and absolute neutrophil count <5 × 109/L at presentation, which had a negative predictive value (NPV) for likely bacterial pneumonia of 99.0%. Among those who met WHO pneumonia criteria, 8.6% (189/2199) experienced an adverse outcome. Not having any WHO danger sign or consolidation on chest radiograph had an NPV of 96.8% for adverse pneumonia outcome. CONCLUSIONS An algorithm that screens for predictors of likely bacterial pneumonia and adverse pneumonia outcome could reduce unnecessary antibiotic use and hospital admission, but its clinical utility requires validation in a prospective study.
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Affiliation(s)
- Phuong T K Nguyen
- Discipline of Child and Adolescent Health, Sydney Medical School, the Children's Hospital at Westmead, University of Sydney, Australia.,Da Nang Hospital for Women and Children, Vietnam
| | - Hoang T Tran
- Da Nang Hospital for Women and Children, Vietnam
| | - Thach S Tran
- Clinical Studies and Epidemiology, Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst
| | - Dominic A Fitzgerald
- Discipline of Child and Adolescent Health, Sydney Medical School, the Children's Hospital at Westmead, University of Sydney, Australia.,Respiratory Medicine, the Children's Hospital at Westmead, University of Sydney
| | - Stephen M Graham
- Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Australia
| | - Ben J Marais
- Discipline of Child and Adolescent Health, Sydney Medical School, the Children's Hospital at Westmead, University of Sydney, Australia
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Oktaria V, Graham SM, Triasih R, Soenarto Y, Bines JE, Ponsonby AL, Clarke MW, Dinari R, Nirwati H, Danchin M. The prevalence and determinants of vitamin D deficiency in Indonesian infants at birth and six months of age. PLoS One 2020; 15:e0239603. [PMID: 33017838 PMCID: PMC7535980 DOI: 10.1371/journal.pone.0239603] [Citation(s) in RCA: 13] [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: 05/18/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Vitamin D deficiency in infants has been associated with an increased risk of a number of diseases but there are limited data on the prevalence and determinants of vitamin D deficiency from tropical settings with high infant morbidity and mortality. Objective To determine the prevalence and determinants of vitamin D deficiency in infants at birth and at six months of age in Yogyakarta province, Indonesia. Design Serum vitamin D of eligible infants was measured in cord blood at birth and at six months of age. Factors associated with vitamin D deficiency (serum 25-hydroxyvitamin D <50 nmol/L) were collected prospectively monthly from birth and concentrations measured by liquid chromatography-tandem mass spectrometry. Independent risk factors were identified by multiple logistic regression. Results Between December 2015 to December 2017, 350 maternal-newborn participants were recruited and followed up. Vitamin D deficiency was detected in 90% (308/344) of cord blood samples and 13% (33/255) of venous blood samples at six months. Longer time outdoors (≥2 hours per day) and maternal multivitamin intake containing vitamin D during pregnancy were protective against vitamin D deficiency at birth (AOR: 0.10, 95% CI: 0.01–0.90 and AOR: 0.21, 95% CI: 0.06–0.68, respectively). Risk factors for vitamin D deficiency at six months included lower cumulative skin-sun exposure score (AOR: 1.12, 95% CI: 1.04–1.20), severe vitamin D deficiency at birth (AOR: 7.73, 95% CI: 1.20–49.60) and exclusive breastfeeding (AOR: 2.64, 95% CI: 1.07–6.49) until six months. Among exclusively breast fed (EBF) infants, a higher skin-sun exposure score was associated with reduced vitamin D deficiency risk. Conclusion In equatorial regions, the role of ‘safe’ morning sun exposure in infants and mothers in populations with medium to dark brown skin pigmentation and effective interventions to prevent vitamin D deficiency in newborns and EBF infants, need further consideration and evaluation.
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Affiliation(s)
- Vicka Oktaria
- Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Child Health Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Paediatrics Research Office, Child Health Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- * E-mail:
| | - Stephen M. Graham
- Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Rina Triasih
- Child Health Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Paediatrics Research Office, Child Health Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yati Soenarto
- Child Health Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Paediatrics Research Office, Child Health Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Julie E. Bines
- Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Anne-Louise Ponsonby
- Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael W. Clarke
- Metabolomics Australia, Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Perth, Western Australia, Australia
- School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Rizka Dinari
- Paediatrics Research Office, Child Health Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Hera Nirwati
- Paediatrics Research Office, Child Health Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Microbiology Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Margaret Danchin
- Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Majumdar SS, Triasih R, Graham SM. Scaling up tuberculosis preventive therapy for contacts in high transmission settings. Lancet Glob Health 2020; 8:e617-e618. [PMID: 32353300 PMCID: PMC7185935 DOI: 10.1016/s2214-109x(20)30133-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Suman S Majumdar
- Burnet Institute, Melbourne, VIC 3004, Australia; Centre for International Child Health, Department of Paediatrics University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.
| | - Rina Triasih
- Department of Paediatrics, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Stephen M Graham
- Burnet Institute, Melbourne, VIC 3004, Australia; Centre for International Child Health, Department of Paediatrics University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
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Harries AD, Schwoebel V, Monedero-Recuero I, Aung TK, Chadha S, Chiang CY, Conradie F, Dongo JP, Heldal E, Jensen P, Nyengele JPK, Koura KG, Kumar AMV, Lin Y, Mlilo N, Nakanwagi-Mukwaya A, Ncube RT, Nyinoburyo R, Oo NL, Patel LN, Piubello A, Rusen ID, Sanda T, Satyanarayana S, Syed I, Thu AS, Tonsing J, Trébucq A, Zamora V, Zishiri C, Hinderaker SG, Aït-Khaled N, Roggi A, Caminero Luna J, Graham SM, Dlodlo RA, Fujiwara PI. Challenges and opportunities to prevent tuberculosis in people living with HIV in low-income countries. Int J Tuberc Lung Dis 2020; 23:241-251. [PMID: 30808459 DOI: 10.5588/ijtld.18.0207] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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
People living with the human immunodeficiency virus (HIV) (PLHIV) are at high risk for tuberculosis (TB), and TB is a major cause of death in PLHIV. Preventing TB in PLHIV is therefore a key priority. Early initiation of antiretroviral therapy (ART) in asymptomatic PLHIV has a potent TB preventive effect, with even more benefits in those with advanced immunodeficiency. Applying the most recent World Health Organization recommendations that all PLHIV initiate ART regardless of clinical stage or CD4 cell count could provide a considerable TB preventive benefit at the population level in high HIV prevalence settings. Preventive therapy can treat tuberculous infection and prevent new infections during the course of treatment. It is now established that isoniazid preventive therapy (IPT) combined with ART among PLHIV significantly reduces the risk of TB and mortality compared with ART alone, and therefore has huge potential benefits for millions of sufferers. However, despite the evidence, this intervention is not implemented in most low-income countries with high burdens of HIV-associated TB. HIV and TB programme commitment, integration of services, appropriate screening procedures for excluding active TB, reliable drug supplies, patient-centred support to ensure adherence and well-organised follow-up and monitoring that includes drug safety are needed for successful implementation of IPT, and these features would also be needed for future shorter preventive regimens. A holistic approach to TB prevention in PLHIV should also include other important preventive measures, such as the detection and treatment of active TB, particularly among contacts of PLHIV, and control measures for tuberculous infection in health facilities, the homes of index patients and congregate settings.
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Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, London School of Hygiene & Tropical Medicine, London, UK
| | - V Schwoebel
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - I Monedero-Recuero
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - T K Aung
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Myanmar Office, Mandalay, Myanmar
| | - S Chadha
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi, India
| | - C-Y Chiang
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - F Conradie
- Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa, Vital Strategies, New York, New York, USA
| | - J-P Dongo
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Uganda Office, Kampala, Uganda
| | - E Heldal
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - P Jensen
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - J P K Nyengele
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, DRC Office, Kinshasa, Democratic Republic of Congo
| | - K G Koura
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Mère et enfant face aux infections tropicales Institut de recherche pour le développement, Université Paris 5, Sorbonne Paris Cité, Paris, France
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi, India
| | - Y Lin
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, China Office, Beijing, China
| | - N Mlilo
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Zimbabwe Office, Harare, Zimbabwe
| | - A Nakanwagi-Mukwaya
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Uganda Office, Kampala, Uganda
| | - R T Ncube
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Zimbabwe Office, Harare, Zimbabwe
| | - R Nyinoburyo
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Uganda Office, Kampala, Uganda
| | - N L Oo
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Myanmar Office, Mandalay, Myanmar
| | - L N Patel
- Vital Strategies, New York, New York, USA
| | - A Piubello
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Damien Foundation, Brussels, Belgium
| | - I D Rusen
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Vital Strategies, New York, New York, USA
| | - T Sanda
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, DRC Office, Kinshasa, Democratic Republic of Congo
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi, India
| | - I Syed
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - A S Thu
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Myanmar Office, Mandalay, Myanmar
| | - J Tonsing
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi, India
| | - A Trébucq
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - V Zamora
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Peru Office, Lima, Peru
| | - C Zishiri
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Zimbabwe Office, Harare, Zimbabwe
| | - S G Hinderaker
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, University of Bergen, Bergen, Norway
| | - N Aït-Khaled
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - A Roggi
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - J Caminero Luna
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Pneumology Department, Dr Negrin General Hospital of Gran Canaria, Las Palmas, Spain
| | - S M Graham
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Zimbabwe Office, Harare, Zimbabwe
| | - P I Fujiwara
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
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Gröschel MI, Seddon JA, Prabowo SA, Migliori GB, Graham SM, van den Boom M, Dara M. European guidance on drug-resistant tuberculosis in children and adolescents. Lancet Child Adolesc Health 2020; 4:9-11. [PMID: 31676193 DOI: 10.1016/s2352-4642(19)30332-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Matthias I Gröschel
- Joint TB, HIV and Viral Hepatitis Programme, Division of Health Emergencies and Communicable Diseases, WHO Regional Office for Europe, UN City, 2100 Copenhagen Ø, Denmark; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - James A Seddon
- Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London, London, UK; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Satria A Prabowo
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Giovanni B Migliori
- Istituti Clinici Scientifici Maugeri Istituto di Recovero e Cura a Carattere Scientifico, Tradate, Italy
| | - Stephen M Graham
- Centre for International Child Health, Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Martin van den Boom
- Joint TB, HIV and Viral Hepatitis Programme, Division of Health Emergencies and Communicable Diseases, WHO Regional Office for Europe, UN City, 2100 Copenhagen Ø, Denmark
| | - Masoud Dara
- Joint TB, HIV and Viral Hepatitis Programme, Division of Health Emergencies and Communicable Diseases, WHO Regional Office for Europe, UN City, 2100 Copenhagen Ø, Denmark.
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Lavu EK, Johnson K, Banamu J, Pandey S, Carter R, Coulter C, Aia P, Majumdar SS, Marais BJ, Graham SM, Vince J. Drug-resistant tuberculosis diagnosis since Xpert ® MTB/RIF introduction in Papua New Guinea, 2012-2017. Public Health Action 2019; 9:S12-S18. [PMID: 31579644 PMCID: PMC6735453 DOI: 10.5588/pha.19.0005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/02/2019] [Accepted: 04/01/2019] [Indexed: 11/10/2022] Open
Abstract
SETTING Xpert® MTB/RIF was introduced in Papua New Guinea in 2012 for the diagnosis of tuberculosis (TB) and of rifampicin-resistant TB (RR-TB), a marker of multi-drug-resistant TB (MDR-TB). OBJECTIVE To assess the concordance of Xpert with phenotypic drug susceptibility testing (DST) performed at the supranational reference laboratory and to describe the patterns of drug-resistant TB observed. DESIGN This was a retrospective descriptive study of laboratory data collected from April 2012 to December 2017. RESULTS In 69 months, 1408 specimens with Xpert results were sent for mycobacterial culture and DST; Mycobacterium tuberculosis was cultured from 63% (884/1408) and DST was completed in 99.4%. The concordance between Xpert and culture for M. tuberculosis detection was 98.6%. Of 760 RR-TB cases, 98.7% were detected using Xpert; 98.5% of 620 MDR-TB cases were identified using phenotypic DST. Phenotypic resistance to second-line drugs was detected in 59.4% (522/879) of specimens tested, including 29 with fluoroquinolone resistance; the majority were from the National Capital District and Daru Island. CONCLUSION The high concordance between phenotypic DST and Xpert in identifying RR-TB cases supports the scale-up of initial Xpert testing in settings with high rates of drug resistance. However, rapid DST in addition to the detection of RR-TB is required.
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Affiliation(s)
- E K Lavu
- Central Public Health Laboratory, Port Moresby, Papua New Guinea (PNG)
| | - K Johnson
- Central Public Health Laboratory, Port Moresby, Papua New Guinea (PNG)
- Health and HIV Implementation Services Provider, Port Moresby, PNG
| | - J Banamu
- Central Public Health Laboratory, Port Moresby, Papua New Guinea (PNG)
| | - S Pandey
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland Central Laboratory at Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - R Carter
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland Central Laboratory at Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - C Coulter
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland Central Laboratory at Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - P Aia
- Papua New Guinea National TB Programme, Port Moresby, PNG
| | - S S Majumdar
- Burnet Institute, Melbourne, Victoria, Australia
| | - B J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
| | - S M Graham
- Burnet Institute, Melbourne, Victoria, Australia
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - J Vince
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, PNG
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