Public Health Action最新文献

Background: Prior to the COVID-19 pandemic, TB treatment in Peru was delivered almost exclusively through facility-based directly observed therapy (DOT). During the pandemic, selected adolescents were allowed home-based TB treatment under caregiver supervision, along with video-supported treatment (VST) for adolescents with access to a smartphone.

Methods: We conducted 16 focus groups, each with 4-10 participants of adolescents with rifampicin-susceptible TB, their caregivers, and health care workers (HCWs). We used semi-structured guides to gather perspectives on facility-based DOT versus home-based treatment. Two authors applied inductive thematic analysis and identified emerging themes.

Results: HCWs assigned facility-based DOT or home-based treatment based on subjective assessment of the adolescent's level of responsibility and support from caregivers. Almost all adolescents and caregivers preferred home-based treatment because it reduced disruptions to routine activities, TB-related stigma, and costs. A few disagreed, stating that facility-based DOT was better for guaranteeing adherence and support for adverse drug reactions. Most HCWs preferred facility-based DOT because they did not feel confident about adherence without direct visualisation by a provider, even with VST; moreover, they found VST to be time-consuming.

Conclusion: Home-based TB treatment benefits adolescents and caregivers but must be further modified to achieve feasibility and acceptability among HCWs.

Background: In Japan, a low-TB-burden country, approximately 4000 cases of sputum smear-positive TB are reported annually and the patients are typically isolated in a TB ward until they become smear-negative. However, there are some patients who resist or refuse isolation. This study aims to characterize these patients.

Methods: A descriptive study. A self-administered questionnaire was sent to local health offices about patients registered from April 2022 to March 2024 who resisted or refused isolation.

Results: A total of 71 patients (0.99%) who resisted or refused isolation were identified among 7,186 with smear-positive TB in the study period. In 2022, 22 (31.0%) such cases were reported, whereas there were 49 (69.0%) in 2023. Fifty-seven of these patients (80.3%) were male, with age that peaked in their 70s, 61 (85.9%) were born in Japan, and 28 (39.4%) were unemployed. Tokyo, the capital, reported 13 (18.3%) such cases, followed by Osaka (12, 16.9%) and Saitama (8, 11.3%) prefectures, whereas 24 (51.1%) of 47 prefectures reported none.

Conclusion: Although the number of patients with TB who resisted or refused isolation was small, there should be one or two TB facilities with law enforcement officials readily available to enforce isolation.

Recent cuts in international donor funding threaten global progress in TB control, particularly in countries that are heavily reliant on external support. With TB still the deadliest infectious disease, reduced funding could lead to millions of preventable cases and deaths. However, this crisis also presents an opportunity: governments must increase domestic investment, integrate TB care into broader health systems, and build resilient, patient-centered services. Doing so strengthens pandemic preparedness and addresses climate-related health risks. Ultimately, sustained progress against TB requires strong national leadership to move from donor dependency to self-reliant, equitable and sustainable health systems.

Background: Rajasthan in India, is a high TB burden state with a high prevalence to notification ratio. This gap calls for alternative strategies to find the non-notified people with TB. Because cough is the most prominent symptom of TB and cough syrups are one of the highest over the counter drugs in India, its sale might be used as a proxy for missed TB cases.

Methods: This was an ecological study to assess the correlation between cough syrup sales and missed TB notifications in the private sector. We calculated the missed TB notification rate as the difference between the estimated people on TB treatment and TB notification in the private sector from January 2021 to March 2023, across all districts of Rajasthan (n = 33). We analysed district level mean quarterly cough syrup sales and TB notification rates/100,000 population.

Results: We found positive correlation between cough syrup sales and TB notification [overall (r = 0.43), private (r = 0.63) and missed private TB notification (r = 0.39)]. Based on this analysis, missed TB notification rates were 7x more than the reported notifications in the private sector.

Conclusion: We recommend a private sector-based TB surveillance system with TB screening for people who approach pharmacies for cough syrup.

Background: To support BPaL (bedaquiline [Bdq], pretomanid [Pa] and linezolid [Lzd]) rollout, countries require ongoing technical and policy support for standardized drug susceptibility testing (DST).

Methods: The Leveraging Innovation for the Faster Treatment of Tuberculosis (LIFT-TB) operational research project aimed to strengthen laboratory capacity for DST in 7 countries (the Philippines, Myanmar, Indonesia, Vietnam, Uzbekistan, Kyrgyzstan and Ukraine) through needs assessments, reagent and equipment support, quality control and training.

Results: During the project, we trained 157 professionals in phenotypic and molecular DST, enhancing quality assurance and implementation. We found there was variable DST capacity and resistance patterns.

Conclusion: Our study highlights the need for continued investment in training and infrastructure to integrate DST into routine diagnostics and to support scale-up of BPaL regimens in high TB-burden settings.

The Sub-Saharan Africa Regional Child and Adolescent TB Centre of Excellence (COE) was established in 2019 to address gaps in child and adolescent TB care in the region. The COE promotes the south-to-south exchange of best practices and innovation through virtual and in-person engagements, including webinars, workshops, and annual meetings. The COE's training efforts, including an interactive curriculum, have strengthened capacity that has increased TB detection and enhanced knowledge among health professionals.

Setting: Five districts with large coalmining workforces in Pakistan.

Objective: To assess the burden of TB among returnee coalminers (RCMs) and associated community members (ACMs) in their home districts through active case finding (ACF).

Design: This cross-sectional study (October 2020-September 2021) used portable chest X-ray (CXR) with artificial intelligence (AI) in camps and verbal screening in camps and communities. Individuals screening positive were tested with GeneXpert, and those diagnosed were initiated on TB treatment.

Results: A total of 150,242 individuals were screened, including 44% RCMs. Of these, 8.3% underwent CXR, 10% verbal screening in camps, and 81% verbal screening in communities. Symptoms were reported by 45% of RCMs and 15% of ACMs, while CXR abnormalities were comparable. TB was diagnosed in 226 RCMs and 204 ACMs, with overall prevalence per 100,000 of 341 (95% confidence interval [CI]: 296-385) and 243 (95% CI: 209-276), respectively. TB prevalence varied by screening strategy and was significantly higher among those screened with CXR: 1,156 in RCMs and 497 in ACMs.

Conclusion: AI-assisted CXR was substantially more effective than verbal screening, detecting significantly higher numbers of TB cases among RCMs and ACMs, supporting its use for targeted ACF in high-risk populations.

Objective: To retrospectively review TB surveillance data to detect whether there was a possible outbreak in the area and verify it in the city of Sapporo, a megalopolis with a low burden of TB.

Design: A cohort study in which TB notification rates of wards each year were compared with those for the rest of the city. If the rate was significantly higher, the notification rates by sex and age groups were further compared with those of the rest of the city.

Results: Six possible TB outbreaks were found in six wards: Chuo in 2007, Atsubetsu in 2010, Higashi in 2014, Shiroishi in 2015, Nishi in 2017, and Minami in 2018. Further analysis found that the notification rates were significantly higher in specific sex and age groups than those of the rest of the city. The city's outbreak records showed three actual outbreaks (one in Atsubetsu ward in 2010 and two in Higashi in 2014) corresponding to two events found in our analysis.

Conclusion: Our study shows that retrospectively reviewing TB surveillance data could detect possible outbreaks. Local health offices and prefectures of Japan should monitor their TB surveillance data at least monthly to detect possible outbreaks and take appropriate actions if needed.

The Structured Operational Research and Training Initiative (SORT IT), implemented through the Collaborative Medical Oncology Group in India, strengthened oncology research capacity by training clinicians, expanding research into underserved regions, and fostering a sustainable mentorship culture. Using a descriptive evaluation (2014-2025), the programme documented growth in research outputs, mentoring, and dissemination through a Real-World Evidence Conference and Stats Decoded pre-conference workshop. Context-specific innovations - hybrid learning, mobile data capture, and faculty development - enhanced scalability. Case examples demonstrated translation of research into improved cancer screening and diagnostics. SORT IT contributed to evidence-informed cancer care and provides a replicable framework for other medical disciplines.

Background: Mesothelioma is causally established to be primarily related to asbestos exposure as a risk factor. Before considering other possible causative factors for mesothelioma, a detailed exposure history is warranted, which looks at possible prior exposures to asbestos. Some exposures may be unknown to patients, may be forgotten or may not be readily available as a comprehensive tool for the clinicians dealing with mesothelioma patients.

Methods: We used the Delphi anonymous consensus technique to develop and validate a detailed, seven-sectioned, and comprehensive questionnaire that can be readily used by clinicians and researchers. Over two rounds, the experts followed a thorough and rigorous process to validate the questionnaire, including medical history along with occupational, non-occupational as well as para-occupational exposure to asbestos, and many other parameters that can be both rule in and rule out the possibility of mesothelioma. Questions have also been included to factor in other types of dust exposure for an informed differential diagnosis.

Results: We have created a readily available history-taking questionnaire validated by experts, which can be replicated for other conditions and become an essential tool for diagnosis.

Conclusion: Apart from accurate and informed diagnosis, this documentation can be valuable for epidemiological, research, policy-informing, legal and compensation related issues.