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Lessons for TB from the COVID-19 response: qualitative data from Brazil, India and South Africa 从 COVID-19 应对措施中吸取的结核病教训：来自巴西、印度和南非的定性数据

IF 1.4

Public Health Action

Pub Date : 2023-12-01 DOI: 10.5588/pha.23.0044

H. Myburgh, M. Kaur, P. Kaur, V. Santos, C. Almeida, G. Hoddinott, D. Wademan, P. V. M. Lakshmi, M. Osman, Sue-Ann Meehan, A. Hesseling, A. Purty, U. B. Singh, A. Trajman

BACKGROUND: Brazil, India and South Africa are among the top 30 high TB burden countries globally and experienced high rates of SARS-CoV-2 infection and mortality. The COVID-19 response in each country was unprecedented and complex, informed by distinct political, economic, social and health systems contexts. While COVID-19 responses have set back TB control efforts, they also hold lessons to inform future TB programming and services. METHODS: This was a qualitative exploratory study involving interviews with TB stakeholders (n = 76) in Brazil, India and South Africa 2 years into the COVID-19 pandemic. Interview transcripts were analysed using an inductive coding strategy. RESULTS: Political will – whether national or subnational – enabled implementation of widespread prevention measures during the COVID-19 response in each country and stimulated mobile and telehealth service delivery innovations. Participants in all three countries emphasised the importance of mobilising and engaging communities in public health responses and noted limited health education and information as barriers to implementing TB control efforts at the community level. CONCLUSIONS: Building political will and social mobilisation must become more central to TB programming. COVID-19 has shown this is possible. A similar level of investment and collaborative effort, if not greater, as that seen during the COVID-19 pandemic is needed for TB through multi-sectoral partnerships.

背景:巴西、印度和南非是全球30个结核病高负担国家之一，它们的SARS-CoV-2感染率和死亡率都很高。由于不同的政治、经济、社会和卫生系统背景，每个国家的COVID-19应对工作空前复杂。虽然COVID-19应对措施阻碍了结核病控制工作，但它们也为今后的结核病规划和服务提供了经验教训。方法:这是一项定性探索性研究，涉及对巴西、印度和南非的结核病利益相关者(n = 76)进行访谈。访谈记录分析使用归纳编码策略。结果:无论是国家还是次国家层面的政治意愿，都促使各国在应对COVID-19期间实施了广泛的预防措施，并刺激了移动和远程医疗服务提供创新。所有三个国家的与会者都强调了动员社区参与公共卫生应对的重要性，并指出卫生教育和信息有限是在社区一级实施结核病控制工作的障碍。结论:建立政治意愿和社会动员必须成为结核病规划的核心。COVID-19已经证明这是可能的。在防治结核病方面，需要通过多部门伙伴关系实现与2019冠状病毒病大流行期间类似水平的投资和协作努力，如果不是更大的话。

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引用次数: 0

The importance of public participation in framing air pollution policy: outcome of a judicial review in New Delhi, India 公众参与制定空气污染政策的重要性：印度新德里司法审查的结果

IF 1.4

Public Health Action

Pub Date : 2023-12-01 DOI: 10.5588/pha.23.0047

Raja Singh, Amar Gf, A. Frank

SETTING: Air pollution, including particulate matter, causes health problems for residents of major cities around the world, including New Delhi, India. Public participation is important in framing policies related to such public health issues. OBJECTIVE: To study how the public’s comments on air pollution, which had been collected on the orders of the Indian Supreme Court, influenced air pollution policy in New Delhi. DESIGN: We filed a Right to Information Act, 2005 application with the Commission for Air Quality Management (CAQM) to obtain a copy of the comments. These were compiled and compared with key major areas identified in the policy released by the regulatory authority. RESULTS: There were a wide range of comments from experts, residents and resident associations. In total, 115 comments were compiled and studied, and several recurring themes were found to have been incorporated into the policy. This included the need to switch to green public transport and cycling, the use of alternative fuels and reduced agricultural crop residue burning. CONCLUSION: Our study revealed that the public and experts have indeed influenced the CAQM air pollution policy. This is important, as it highlights a democratic, inclusive and stakeholder-based approach. Nonetheless, a future concern lies in how this policy is translated into actionable regulations with effective implementation in the field.

周边环境:包括颗粒物在内的空气污染给包括印度新德里在内的世界主要城市的居民带来了健康问题。公众参与在制定与此类公共卫生问题有关的政策方面非常重要。目的:研究根据印度最高法院的命令收集的公众对空气污染的评论如何影响新德里的空气污染政策。设计:我们向空气质量管理委员会(CAQM)提交了一份2005年《信息权利法》申请，以获得一份评论的副本。将这些数据与监管机构发布的政策中确定的关键主要领域进行了汇总和比较。结果:来自专家、居民和居民协会的意见广泛。总共汇编和研究了115项评论，发现若干反复出现的主题已纳入政策。这包括需要转向绿色公共交通和骑自行车，使用替代燃料和减少农作物秸秆燃烧。结论:我们的研究表明，公众和专家确实影响了CAQM空气污染政策。这一点很重要，因为它突出了一种民主、包容和基于利益攸关方的方法。尽管如此，今后的一个问题是如何将这项政策转化为可操作的规章，并在实地得到有效执行。

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引用次数: 0

Health-seeking pathway of drug-resistant TB patients in Vadodara, India 印度瓦多达拉耐药结核病患者的就医途径

IF 1.4

Public Health Action

Pub Date : 2023-12-01 DOI: 10.5588/pha.23.0019

Margi B. Sheth, Raj Appartment, Choksipark, K. Shringarpure, B. Modi, R. Damor, L. Manikam

BACKGROUND: Health-seeking behaviour refers to patients’ choices regarding their preferred healthcare destination and the timing of seeking assistance for treatment. Patients with TB usually first approach the private sector and/or lose several months’ time in inappropriate diagnosis and treatment due to lack of awareness regarding the availability of standard treatment protocols. This can lead to poor outcomes such as drug-resistant TB (DR-TB) and/or death. METHODOLOGY: A cross-sectional study was conducted to examine the health-seeking pathway and delays in diagnosis and initiation of DR-TB treatment among patients registered with the DR-TB centre in Vadodara District (India). RESULTS: A total of 93 patients were enrolled in the study; the median age was 35 years (IQR 24–45). For the first visit, 59 (63%) patients chose a public healthcare facility, mainly because the facility was near their residence (n = 20, 21.5%). The median delay in reaching the first healthcare facility was 12 days (IQR 7.5–30). Delay in reaching second- and third-level care was respectively 25 days (IQR 9–68) and 16 days (IQR 4–67). CONCLUSION: Two-thirds of patients required visits to a second healthcare centre for diagnosis, while one third needed a third visit. The overall median delay for reaching the DR-TB centre was 60 days (IQR 26–122). The median duration from symptom onset to the first healthcare contact fell within the timeframe for screening symptoms in standard diagnosis.

背景:求医行为是指患者对其首选医疗目的地和寻求治疗援助的时机的选择。结核病患者通常首先求助于私营部门，并且(或)由于缺乏对标准治疗方案可得性的认识，在不适当的诊断和治疗中浪费了几个月的时间。这可能导致诸如耐药结核病和/或死亡等不良结果。方法:进行了一项横断面研究，以检查在Vadodara区(印度)耐药结核病中心登记的患者的求医途径以及诊断和开始耐药结核病治疗的延误。结果:共有93例患者入组;中位年龄为35岁(IQR 24-45岁)。第一次就诊时，59名(63%)患者选择了公共医疗机构，主要是因为该机构离他们的住所很近(n = 20, 21.5%)。到达第一家医疗机构的中位延迟为12天(IQR为7.5-30)。到达二级和三级护理的延迟分别为25天(IQR 9-68)和16天(IQR 4-67)。结论:三分之二的患者需要前往第二家医疗保健中心进行诊断，而三分之一的患者需要第三次就诊。到达耐药结核病中心的总体中位延迟为60天(IQR 26-122)。从症状出现到首次医疗接触的中位持续时间在标准诊断中筛查症状的时间范围内。

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引用次数: 0

Addressing the needs of people with extensively drug-resistant TB through pre-approval access to drugs and research 通过批准前获得药物和研究，满足广泛耐药结核病患者的需求

IF 1.4

Public Health Action

Pub Date : 2023-12-01 DOI: 10.5588/pha.23.0033

J. Stillo, M. Frick, J. Galarza, S. Kondratyuk, A. Makone, L. McKenna, W. Vandevelde, P. Winarni, P. Agbassi

Multiple therapeutic options exist for people with drug-resistant TB (DR-TB), but there is an urgent need to improve access to novel compounds and regimens for people with difficult to treat forms of TB. In additional to formal research studies and clinical trials, other mechanisms of accessing promising new TB compounds need to be introduced as soon as these drugs have shown efficacy and safety in phase II trials. Pre-approval access programs for newer TB drugs such as bedaquiline, delamanid, and pretomanid all suffered from shortcomings. These can be addressed for the next generation of new TB drugs through a series of concerted actions by stakeholders at multiple levels. In this viewpoint, we advocate for transparent, accessible pre-approval access as a core element of person-centered care for DR-TB.

耐药结核病患者有多种治疗选择，但迫切需要改善难以治疗的结核病患者获得新化合物和方案的途径。除了正式的研究和临床试验之外，一旦这些药物在II期试验中显示出疗效和安全性，就需要引入其他获得有希望的结核病新化合物的机制。贝达喹啉、delamanid和pretomanid等较新的结核病药物的预先批准可及性项目都存在缺陷。这些问题可以通过利益攸关方在多个层面采取一系列协调一致的行动，为下一代新的结核病药物解决。在这一观点中，我们主张将透明、可及的批准前获取作为耐药结核病以人为本护理的核心要素。

引用次数: 0

Socio-economic burden of TB and its impact on child contacts in The Gambia 冈比亚结核病的社会经济负担及其对儿童接触者的影响

IF 1.4

Public Health Action

Pub Date : 2023-12-01 DOI: 10.5588/pha.23.0025

Denise Evans, Medical Abdou K Sillah, I. Devoid, J. J. Ndenkeh, G. Moonga, I. Loum, A. Touray, O. Owolabi, J. Sutherland, A. Rachow, O. Ivanova, B. Kampmann

OBJECTIVE: To determine the social impact of adult TB on child household contacts living in the Greater Banjul Area, The Gambia. METHODS: This was a prospective observational cohort study among adults (≥18 years) starting treatment for drug-susceptible pulmonary TB between June 2019 and July 2021 who reported having at least one child household contact. We collected data from 51 adults and 180 child contacts at the start of TB treatment (baseline) and again at 6 months of treatment. Participants were asked about expenses for school fees, healthcare, festivities and food security of child contacts. RESULTS: While school attendance of the child contacts remained largely unaffected, there was a significant drop in school performance at 6 months (P < 0.001). Furthermore, child contacts faced significant food insecurity in terms of food quantity and variety available, with up to a four-fold increase in some instances at 6 months compared to baseline (P < 0.001) CONCLUSION: Child contacts face a potential decline in school performance and risk of food insecurity. While a plethora of work is being undertaken to alleviate costs of care for TB patients, further emphasis is needed to ensure educational and social prosperity for child contacts, as adults with TB have socio-economic implications for the wider household.

目的:了解冈比亚大班珠尔地区成人结核病对儿童家庭接触者的社会影响。方法:这是一项前瞻性观察队列研究，研究对象为2019年6月至2021年7月期间开始治疗药物敏感肺结核的成人(≥18岁)，报告至少有一名儿童家庭接触者。我们在结核病治疗开始时(基线)和治疗6个月时再次收集了51名成人和180名儿童接触者的数据。参与者被问及孩子的学费、医疗保健、庆祝活动和食品安全方面的开支。结果:虽然儿童接触者的上学出勤率基本未受影响，但在6个月时学校表现显著下降(P < 0.001)。此外，儿童接触者在可获得的食物数量和种类方面面临着严重的粮食不安全，在某些情况下，6个月时与基线相比增加了4倍(P < 0.001)。结论:儿童接触者面临着学校成绩下降和粮食不安全风险的潜在风险。虽然正在开展大量工作以减轻结核病患者的护理费用，但需要进一步强调确保儿童接触者的教育和社会繁荣，因为患有结核病的成年人对更广泛的家庭具有社会经济影响。

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引用次数: 0

Feasibility and acceptability of COVID-19 self-testing in the Philippines 菲律宾 COVID-19 自我检测的可行性和可接受性

IF 1.4

Public Health Action

Pub Date : 2023-12-01 DOI: 10.5588/pha.23.0045

Sara Keller, E. U. Mallari, J. F. Febre, J. Timbol, R. Powers, R. R. Peregrino, A. Slyzkii, C. Mulder, M. V. Magno, I. Spruijt

Self-testing for COVID-19 using antigen-detecting rapid diagnostic tests (Ag-RDTs) shows high promise in the Philippines. Self-testing has the potential to provide broader access to testing, empowering individuals by bringing healthcare services closer to them. We conducted 15 semi-structured interviews with health officers and decision-makers in the Philippines. These interviews explored the experiences and perspectives on the acceptability and feasibility of self-test use and implementation. We found that self-testing is easy-to-use, provides rapid results and can facilitate early detection. However, regulatory policies, linkages to care and effective health education plans must be in place for successful implementation.

使用抗原检测快速诊断检测(Ag-RDTs)对COVID-19进行自我检测在菲律宾显示出很大的希望。自我检测有可能提供更广泛的检测途径，通过拉近医疗保健服务的距离来增强个人的能力。我们对菲律宾的卫生官员和决策者进行了15次半结构化访谈。这些访谈探讨了关于自测使用和实现的可接受性和可行性的经验和观点。我们发现自检易于使用，提供快速的结果，可以促进早期发现。然而，要成功实施，必须制定监管政策、与护理的联系以及有效的卫生教育计划。

引用次数: 0

Participation of private providers in the National TB Programme in South India 私营医疗机构参与印度南部的国家结核病防治计划

IF 1.4

Public Health Action

Pub Date : 2023-12-01 DOI: 10.5588/pha.23.0032

Anand D Meundi, J. Richardus

SETTING: India has the highest number of new TB cases worldwide. The participation of private providers (PPs) in the National TB Elimination Programme (NTEP) has remained suboptimal. OBJECTIVE: To explore the experiences, barriers and facilitators about their participation in the NTEP as perceived by PPs working in varied settings. DESIGN: Focus group discussions and in-depth interviews were used to engage PPs to obtain their views on participation in the NTEP. Framework and thematic content analysis was used to analyse qualitative data. RESULTS: Non-availability of a comprehensive range of diagnostics and lack of flexibility in the NTEP were barriers to participation in NTEP. PPs were predisposed to think that NTEP was for those who could not afford to purchase medications. Attitudes and previous experiences with NTEP made them sceptical about the NTEP regimen. Although more frequent interactions were sought with NTEP, some bitterness about previous interactions was perceived. CONCLUSION: Challenges identified by PPs for the NTEP include improvement of the quality of TB care, especially at the lower levels of care, availability of a comprehensive range of diagnostics, being friendly to PPs and patients, more frequent interactions with PPs, and more caring conversations with patients at NTEP centres.

背景:印度是全球新发结核病病例最多的国家。私营医疗机构参与国家消除结核病规划的情况仍不理想。目的:探讨在不同环境中工作的PPs参与NTEP的经验、障碍和促进因素。设计:采用焦点小组讨论和深度访谈的方式与PPs进行接触，以获取他们对参与NTEP的看法。采用框架分析和专题内容分析对定性数据进行分析。结果:缺乏全面的诊断范围和缺乏灵活性的NTEP是障碍参加NTEP。PPs倾向于认为NTEP是为那些买不起药物的人准备的。对NTEP的态度和以前的经验使他们对NTEP疗法持怀疑态度。虽然寻求与NTEP更频繁的互动，但对以前的互动感到一些痛苦。结论:门诊医生确定的NTEP面临的挑战包括提高结核病治疗的质量，特别是在较低水平的治疗中，提供全面的诊断，对门诊医生和患者友好，与门诊医生更频繁的互动，以及在NTEP中心与患者进行更多的关怀对话。

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引用次数: 0

A unique and colossal development in global health 全球卫生领域独一无二的巨大发展

IF 1.4

Public Health Action

Pub Date : 2023-12-01 DOI: 10.5588/pha.23.0049

G. N. Kazi

引用次数: 0

A single synthetic lipid antigen for improved serological diagnosis of Buruli ulcer 改进布路里溃疡血清学诊断的单一合成脂质抗原

IF 1.4

Public Health Action

Pub Date : 2023-12-01 DOI: 10.5588/pha.23.0038

J. Hacking, V. V. Gwenin, R. J. Dacombe, M. S. Baird, M. Frimpong, R. O. Phillips, C. D. Gwenin

SETTING: The diagnosis of Buruli ulcer (BU) is frequently made by experienced health workers in rural regions. This leads to long turnaround times to confirm the diagnosis as it requires specialised laboratory infrastructure to perform confirmatory testing. BACKGROUND: Given the lack of success with protein antigens to detect BU in human sera, the aim of this study was to evaluate a range of single synthetic lipid antigens using an enzyme-linked immunosorbent assay (ELISA). The ELISA system used was initially developed to detect TB using single synthetic lipid antigens. METHODS: Thirty polymerase chain reaction (PCR) positive BU samples and 30 PCR-negative healthy contact samples collected from Asante Akim North and Ahafo Ano North Districts, Ghana, that are endemic for BU between 2013 and 2016 were used to evaluate the synthetic lipid antigen ELISA. A Quantikine ELISA was also conducted on a randomly blinded sub-set of 30 samples. RESULTS: The synthetic lipid ELISA evaluated here outperforms all other ELISA tests using protein antigens to detect BU to date and has shown potential as a fast (2 h) test for BU which may be adapted for use at the point of care. A sensitivity of 63% and specificity of 80% was observed for 30 BU-positive and 30 BU-negative samples, with significantly reduced interleukin-8 (IL-8) levels in a subset of patients with BU. CONCLUSION: A single lipid was shown for the first time to have the ability to distinguish between PCR-positive BU and negative sera using ELISA. The low lipid antibody load detected may be a result of immune suppression caused by the presence of mycolactone in patients with BU, given that levels of IL-8 were significantly reduced in patients with BU compared to the control serum samples.

背景:布鲁里溃疡(BU)的诊断通常由农村地区经验丰富的卫生工作者做出。这导致确认诊断的周转时间较长，因为它需要专门的实验室基础设施来进行确认测试。背景:鉴于缺乏成功的蛋白质抗原检测人血清中的布鲁里溃疡，本研究的目的是利用酶联免疫吸附试验(ELISA)评估一系列单一合成脂质抗原。ELISA系统最初用于使用单一合成脂质抗原检测结核病。方法:采用2013 - 2016年在加纳Asante Akim North和Ahafo Ano North地区采集的30例布鲁里溃疡聚合酶链反应(PCR)阳性样本和30例PCR阴性健康接触者样本，对合成脂质抗原ELISA进行评价。对随机盲法的30个样本进行定量酶联免疫吸附试验。结果:本文评估的合成脂质酶联免疫吸附试验优于迄今为止使用蛋白质抗原检测布鲁里溃疡的所有其他酶联免疫吸附试验，并显示出作为布鲁里溃疡快速(2小时)检测的潜力，可能适用于护理点。在30例BU阳性和30例BU阴性样本中，观察到敏感性为63%，特异性为80%，在一部分BU患者中，白细胞介素-8 (IL-8)水平显著降低。结论:首次发现一种脂质具有区分pcr阳性和阴性血清的能力。考虑到与对照血清样本相比，布鲁里溃疡患者的IL-8水平显著降低，检测到的低脂抗体负荷可能是由于布鲁里溃疡患者中霉菌内酯的存在引起的免疫抑制。

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引用次数: 0

IF 1.4

Public Health Action

Pub Date : 2023-09-21 DOI: 10.5588/pha.23.0021

E C Mendoza-Hisey, A Dier, N V Marquez, L V Bumanglag, S B A Cadiao, S F Guirgis

Setting: The Philippines is one of the countries with the highest TB burdens. While TB affects men and women differently, studies also show that gender affects people's experience of and access to healthcare. Men and women have usually assigned roles and responsibilities that affect their decisions and health-seeking behaviour.

Objective: The gender analysis aimed to examine the relationship between gender and access to TB services and treatment outcomes according to five domains: cultural norms and beliefs; patterns of power and decision-making; gender roles and responsibilities; access to resources; laws and policies.

Design: The team conducted 19 in-depth interviews and five focus group discussions with project staff, TB coordinators from healthcare facilities, representatives from the private and informal business sector and representatives from the Philippine Department of Health from August to November 2019.

Results: Study findings indicated that men faced greater limitations than women in terms of accessing TB resources and services, which highlight the differences between genders in relation to health-seeking behaviours and ability to access healthcare.

Conclusion: This demonstrates the importance of integrating a gender lens into the service provision set up, from screening to treating and monitoring, to ensure equitable health benefits for men, women, transgender and gender-diverse persons.

背景：菲律宾是结核病负担最高的国家之一。虽然结核病对男性和女性的影响不同，但研究也表明，性别会影响人们的医疗体验和获得医疗保健的机会。男性和女性通常被赋予影响其决策和寻求健康行为的角色和责任。目的：性别分析旨在根据五个领域审查性别与获得结核病服务和治疗结果之间的关系：文化规范和信仰；权力和决策模式；性别角色和责任；获得资源；法律和政策。设计：该团队与项目工作人员、医疗机构的结核病协调员、，2019年8月至11月，来自私营和非正规商业部门的代表以及菲律宾卫生部的代表。结果：研究结果表明，在获得结核病资源和服务方面，男性比女性面临更大的限制，这突出了性别在寻求健康行为和获得医疗保健能力方面的差异。结论：这表明了将性别视角纳入服务提供的重要性，从筛查到治疗和监测，以确保为男性、女性、跨性别者和性别多样化者提供公平的健康福利。

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