Public Health Action最新文献

Background: The global TB burden shows significant gender disparity with men and women facing distinct challenges in accessing comprehensive care for TB. A full understanding of the gender dimensions of the TB epidemic is crucial for appropriate policy interventions and we therefore explored gender differences in the TB service cascade in Nigeria.

Methods: A retrospective gender-based analysis of the TB care cascade was conducted covering the four-year period between 2018-2021. We obtained sex-disaggregated service utilisation data for adults (aged ≥15 years) in 14 states through the monitoring and evaluation systems of the TB control programme. Using a care cascade framework, we present numbers accessing care at each step and gaps for men and women including TB/HIV collaborative services.

Results: Overall, amongst men, 12.3 million visited health facilities, 6 million were screened for TB and 833,483 were identified as presumptive cases, of which 79% were tested for TB. For women, 12.3 million visited facilities, 6.9 million screened and 664,130 identified as presumptive cases, of which 76% were tested. Men exhibited a higher screening gap, whereas women had a higher testing gap, with variations in treatment outcomes across both genders.

Conclusion: The TB surveillance system screened more women and diagnosed more men with the disease, with significant missed opportunities and gaps along the continuum of care for both men and women. Targeted policy interventions are required to strengthen surveillance, data systems and to reduce gender inequity across the TB care cascade in Nigeria.

Background: To inform future decision-making on pandemic preparedness for COVID-19, we evaluated the acceptability and perceived feasibility of implementation strategies for COVID-19 self-testing among decision-makers in Mozambique. National and provincial directors, heads of programs and division chiefs were selected as decision-makers.

Methods: We conducted semi-structured interviews with decision-makers involved in COVID-19 diagnosis, management, and policy development. Topics included knowledge and perceptions of COVID-19, testing policies, implementation considerations, and linkage to care. Using a thematic approach, we analysed the interviews.

Results: Seventeen decision-makers were interviewed - most perceived self-testing as an acceptable strategy for early COVID-19 detection. The benefits were improved access to testing, decongesting health facilities, minimising infection risk and decreasing healthcare workers' workload. Concerns included low testing interest in the post-pandemic period, literacy barriers, affordability and equity issues, mistrust that patients might not take the test due to fear of positive results, and the healthcare system's capacity to follow up positive cases.

Conclusion: COVID-19 self-testing is feasible and acceptable to decision-makers; however, the changing epidemiology has shifted perspectives. This study highlights self-testing's value in emergencies and pandemic preparedness, enabling rapid detection and isolation of cases, thus minimising the spread of infectious diseases in vulnerable populations in Mozambique and similar contexts.

As part of the LIFT-TB project, we investigated the efficacy and safety of the BPaL regimen, while enhancing laboratory diagnostic capacity for drug-resistant-TB. Challenges include sample contamination, excessive workload, test kit shortages, unreliable results and systemic issues such as infrastructure, delayed procurement, workforce constraints and reliance on paper-based data reporting. Our study highlights the need for a system-level approach backed by strong national leadership to strengthen TB diagnostic capacity. Although countries must take ownership of laboratory system improvements, a harmonized and coordinated approach among international stakeholders is essential in specialized areas, such as external quality assurance, capacity building, and introducing innovative diagnostic technologies.

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.