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Background: Children aged 0-14 years old make up 4% of the total number of people diagnosed with TB in Bangladesh. Local pediatric treatment outcomes and associated factors are poorly understood; further understanding can inform tailored interventions to close delivery gaps.

Methods: To assess the risk factors for unsuccessful treatment outcomes among children receiving TB treatment in 119 health facilities in Mymensingh Division, we conducted systematic verbal screening from 2018 to 2021. Unsuccessful outcomes, including death, treatment failure, or loss to follow-up (LTFU), were analysed using log-binomial regression to examine the association with demographic and clinical characteristics.

Results: Among 1,967 children with reported outcomes, 99.3% (n = 1,954) were successful. The primary reason for unsuccessful treatment was LTFU (n = 12, 0.6%), followed by treatment failure (n = 1, 0.1%). After controlling for age and sex, children with fever had a reduced risk of unsuccessful outcomes compared to those without fever (RR 0.23, 95% CI 0.06-0.82).

Conclusion: Most children with TB were successfully treated. LTFU was the leading reason for unsuccessful treatment outcomes in this cohort. Children with fever were less likely to have unsuccessful treatment outcomes, possibly because they were more intensely engaged in care than children without fever due to their presentation of symptoms. Continued research on pediatric TB presentation and treatment outcomes is essential for developing targeted strategies for early detection and treatment support.

Setting: To appropriately triage and evaluate people with signs or symptoms of pulmonary TB, clinical, laboratory, and radiological variables, as well as biomarkers, have been prioritised to increase early detection. However, in high TB prevalence areas, few studies used standardised tools to assess both sociodemographic characteristics and accessible biomarkers comprehensively. This study aimed to describe the sociodemographic, radiographic, clinical, and laboratory characteristics associated with pulmonary TB (PTB) in patients with presumed pulmonary TB (pPTB).

Design: A cross-sectional study was conducted at a public health centre in Duque de Caxias, Brazil, involving patients with pPTB from September 2017 to February 2020. Participants were evaluated using standardised tools: Patient Health Questionnaire 9 (PHQ-9) and the Mini International Neuropsychiatric Interview (MINI) Plus for depression, the MINI-Mental State Examination for cognitive functions, and the ASSIST (Alcohol, Smoking, and Substance Involvement Screening Test) questionnaire for substance use. Chest radiographs (CXRs) and blood tests were also performed. Logistic regression was used to identify associations between sociodemographic, radiographic and biological variables with PTB.

Results: Of 315 patients, 149 (47%) were diagnosed with PTB. Factors associated with PTB included the presence of cavitation on CXR (OR 13.7, 95% CI 5.93-34.5; P < 0.001), high alkaline phosphatase levels (OR 3.89; 95% CI 1.68-9.47; P = 0.002), and C-reactive protein above 10 mg/L (OR 5.60, 95% CI 2.23-14.7; P < 0.001). Major depression disorder (OR 0.33, 95% CI 0.11-0.91; P = 0.036) suggested a protective association with PTB.

Conclusion: CXR findings and easy-to-perform blood tests can aid in PTB diagnosis, potentially reducing the time to treatment when microbiological or molecular tests cannot be performed.

Setting: Despite recent progress in TB notification rates, 6.2% of the 3.1 million 'missing' people with TB globally are from Nigeria. Identifying these 'missing' cases will improve TB control efforts in Nigeria.

Objective: This paper aims to describe the outcome of an intensified TB case-finding strategy in northern Nigeria.

Design: An intensified TB case-finding strategy was implemented in four states in northern Nigeria from October 2021 to September 2022. Trained ad-hoc staff screened hospital attendees and linked identified persons with presumptive TB to diagnosis using a hub and spoke approach. People with confirmed TB were linked to treatment. Contributions of the strategy to the national TB notification rates for each state were assessed.

Results: A total of 1.17 million individuals were screened for TB across the four project States. 64,079 people with presumptive TB were identified, of which 10.1% were diagnosed with TB and 97% of those diagnosed were placed on treatment. Averagely, 33.3% of the TB cases notified from each state were contributions from the hospital-based Intensified TB case-finding intervention.

Conclusion: Facility-based intensified TB case-finding results in significant improvement in TB notification rates and a good strategy to improve the identification of missing TB cases in Nigeria.

Background: TB poses a significant global health challenge due to a substantial case-detection gap. Traditional contact tracing primarily targets contacts of bacteriologically confirmed pulmonary TB index patients, often excluding pediatric, clinically diagnosed, and extrapulmonary cases. This review assessed the potential of expanding contact tracing to these frequently overlooked subgroups.

Methods: We conducted a focused, targeted literature review by searching PubMed, Web of Science, Google Scholar and Lens.org using identified keywords. A title and abstract review was conducted using predefined inclusion/exclusion criteria.

Results: We identified 13 relevant studies reporting contact tracing yields from these index patient groups. Contact tracing of pediatric, clinically diagnosed, and extrapulmonary TB index patients yielded up to 8.1%, 3.0%, and 2.1% for active disease and up to 17.9%, 12.6%, and 11.1% for TB infection, respectively.

Conclusion: Findings suggest that expanding contact tracing for these typically excluded index patients can improve case detection. By refining contact tracing protocols and adopting more inclusive strategies, TB programs can enhance case detection rates and improve overall disease control efforts, aligning with global goals for TB elimination.

Background: Limited data exist on TB treatment outcomes among pregnant women with TB. Physiological and immunological adaptations during pregnancy may affect the efficacy of TB treatment. We aimed to evaluate factors associated with unsuccessful TB treatment outcomes among pregnant women living with HIV (PWLHIV) and diagnosed with TB in the Tshepiso study.

Methods: In this secondary analysis, we used multivariable logistic regression to evaluate factors associated with unsuccessful TB treatment outcomes among PWLHIV with drug-sensitive TB disease enrolled in the Tshepiso study in Soweto, South Africa, from 2011-2014.

Results: This analysis includes 79 PWLHIV diagnosed with drug-sensitive TB during pregnancy; 18 (23%) had an unsuccessful treatment outcome. Factors associated with unsuccessful TB treatment include detectable HIV RNA viral load at enrollment to the study (aOR 5.1, 95% CI 1.1-25.3), presence of extrapulmonary TB (aOR 2.2, 95% CI 0.4-11.7), bacteriological (positive smear and/or culture) confirmation of TB (aOR 2.1, 95% CI 0.7-6.7), and anemia (Hb ≤ 10.5 g/dL) (aOR 1.0, 95% CI 0.3-3.1). The only factor with statistical significance was a detectable HIV RNA viral load.

Conclusion: Detectable HIV viral load emerges as a critical factor associated with an unsuccessful TB treatment outcome in pregnant women living with HIV and diagnosed with TB.

Setting: TB screening cascade and performance of active case-finding strategies across six states of Nigeria.

Objective: To analyse the impact of portable digital X-ray (PDX) on TB screening in hard-to-reach areas in Nigeria.

Design: A cross-sectional study involving enrollees with a CAD4TB score of ≥50 had Xpert (sputum) and/or radiographic assessment for TB diagnosis. A TB screening algorithm guided the step-by-step process of identifying a presumptive TB client up to diagnosis and linkage for appropriate treatment. Data were collected, collated, and reported using the national TB tools.

Results: Seven PDX with CAD4TB used as TB screening and diagnostic tools across six states screened 85,910 persons and identified 8,416 presumptive TB cases. From this study, PDX had the lowest number needed to screen (NNS) of 45 and the number needed to test (NNT) of 4. Similarly, PDX, with a presumptive TB yield of 10%, had the highest TB yield of 23%.

Conclusion: Using PDX with CAD contributed to the highest TB yield during Active TB case finding in hard-to-communities of Nigeria. With a very low NNS and NNT, its national scale-up and use across remote locations will significantly improve TB case-finding.

The introduction of bedaquiline (BDQ) has reduced the reliance on ototoxic drugs (e.g., aminoglycosides) for drug-resistant TB (DR-TB). This has significantly reduced ototoxic symptoms, such as tinnitus and dizziness, which often precede irreversible hearing loss. However, aminoglycosides remain essential for some extensively drug-resistant individuals with TB (XDR-TB) who are resistant to BDQ. In South Africa, there is a lack of adequate awareness of the potential ototoxic effects of aminoglycosides. The increasing prevalence of XDR-TB has, therefore, intensified the need for comprehensive information counselling. We call for a proactive role for audiologists in providing early, structured information counselling for these individuals.

Introduction: Despite the effectiveness of TB preventive treatment (TPT) in reducing TB incidence and mortality among people living with HIV (PLHIV), uptake has been low. We conducted a cluster randomised trial to evaluate a choice architecture-based intervention for prescribing TPT (the 'CAT' study) to PLHIV in Mozambique, nested within the short-course 3HP regimen roll-out, and qualitatively assessed intervention acceptability and feasibility with healthcare workers (HCWs).

Methods: The CAT intervention comprised training on default TPT prescribing and prescribing stickers integrated into antiretroviral therapy (ART) stationery. We assessed intervention acceptability and feasibility to increase TPT prescribing through 25 in-depth interviews (IDIs) with HCWs from participating clinics between August and September 2022. Thematic analysis of the IDIs identified key themes.

Results: Participants reported a positive impact of the intervention on patient care, though workload opinions varied. Participants reported that CAT did not significantly alter routine TPT prescribing processes but highlighted the need for reminders and decision-support tools. CAT was viewed to streamline patient management, particularly identifying eligible TPT patients and simplifying documentation.

Conclusion: The CAT strategy could enhance TPT delivery to PLHIV and integrate it into preventive care for other diseases.

An electronic dashboard for oxygen monitoring and stockout prevention was implemented during the COVID-19 pandemic in 2022 by Jhpiego through the United States Agency for International Development Reaching Impact, Saturation, and Epidemic Control program and Government of Lesotho across 12 hospitals in Lesotho. Nurses documented patient blood oxygen levels, oxygen usage, and facility-level stocks on a daily checklist, which populated a dashboard that estimated oxygen demand usage and visualized facility-level oxygen stocks and impending stockouts. During 359 facility days evaluated, dashboard data reported 82/1,796 patients (4.6%) as hypoxemic, 186,802 L/day average oxygen usage, and successful prevention of all 14 potential stockouts.

Setting: An established response to an outbreak of drug-resistant TB (DR-TB) on Daru Island, South Fly District (SFD), Western Province, Papua New Guinea (PNG).

Objective: To describe and evaluate the trends in TB case notification disaggregated by demographic and clinical characteristics, programmatic interventions for TB and COVID-19 and treatment outcomes in 2017-2022.

Design: A cohort study of routinely collected programmatic data of all patients registered for TB treatment in SFD comparing pre-COVID (2017-2019) to COVID (2020-2022) periods.

Results: Of the 3,751 TB cases registered, 19.6% had DR-TB, and the case notification rate was 1,792/100,000 for Daru and 623/100,000 for SFD. There was a 29.2% reduction in case notifications from 2019 to 2021, with recovery in 2022. During COVID, the healthcare workforce was adversely impacted, and active TB case-finding was stopped. During COVID, compared to pre-COVID, bacteriological confirmation increased (62.3% to 71.9%), whereas rates of child TB notifications (11.6% to 9.1%), pulmonary TB (60.8% to 57.4%) and DR-TB (20.7% to 18.6%) decreased. High rates of treatment success were maintained for both drug-susceptible (86.5%) and DR-TB (83.6%).

Conclusion: Health systems strengthening and community engagement before COVID likely contributed to resilience and mitigated potential impacts on TB in this remote and resource-limited setting. Case notifications remain very high, and additional interventions are needed to interrupt transmission.