Public Health Action最新文献

Setting: Linezolid (LZD) has emerged as a critical agent and core component of regimens to treat drug-resistant TB (DR-TB); however, there are ongoing uncertainties regarding its safety and the optimal dosing approach. Since 2016, linezolid has been used in the treatment of patients diagnosed with DR-TB at Daru Provincial Hospital, PNG.

Objective: To describe the patient characteristics, treatment outcomes, and tolerability of linezolid-containing regimens used to treat DR-TB in Daru, Western Province.

Design: This was a retrospective analysis of programmatic data.

Results: A total of 632 eligible patients were diagnosed with DR-TB during the study period. Of these, 580 (91.8%) were commenced on a LZD-containing regimen. Among patients with baseline haemoglobin results available (380/632, 60.1%), the median value was 10.1 g/dL, with a mean corpuscular volume of 70.7 fL, 78.1% of those with haemoglobin results were anaemic at baseline. Despite this, 242/580 (41.7%) patients were able to complete the full LZD course of treatment (typically 18 months) without dose reduction or interruption. Treatment success was observed in 87.9% of the cohort. Neurotoxicity was not commonly reported, but adverse events were likely under-reported.

Conclusion: In this cohort, with high rates of baseline anaemia, prolonged therapy with LZD was relatively well tolerated.

Setting: In sub-Saharan Africa, the syndemic of HIV and non-communicable diseases (NCDs) poses a significant challenge. To address this, leading global think tanks like the WHO advocate for integrated HIV/NCD care at primary healthcare levels. However, comparative empirical data on the costs of integrated care are limited. South Africa, with the largest HIV programme globally, was purposively selected for our comparative case study.

Objective: To determine the cost of integrated HIV/NCD care from the providers' perspective at two 'ideal status' public healthcare facilities in South Africa as case studies.

Design: A multi-pronged methodology was used to collect provider cost data via retrospective documentary sources or records and a question-and-answer session with facility managers who provided key information on cost-related data. Data analysis utilised an activity-based costing (ABC) method.

Results: Despite the difference in the size of the clinics, the cost per patient in terms of ABC is similar between the two primary healthcare facilities, USD261.60 and USD226.30, respectively.

Conclusion: The ABC method can be utilised to cost integrated care, foster health economic data availability for future research, and inform health policymakers.

Setting: Papua New Guinea (PNG) is a high-burden country for multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB). There are limited data on MDR/RR-TB notifications and treatment from the most populous province.

Objective: Describe MDR/RR-TB detection and treatment outcomes in Morobe Province, the impact of the COVID-19 pandemic and factors associated with unfavourable treatment outcomes.

Design: Retrospective cohort study of MDR/RR-TB notifications between 2012 and 2021 using routine programme registration data. Favourable outcomes were compared to unfavourable outcomes using multivariable regression.

Results: Between 2012 and 2021, 160 cases of MDR/RR-TB were bacteriologically confirmed. Few diagnoses were made among children (2.5%), extrapulmonary cases (0.6%) or rural residents (38%). Case notifications rose sharply from 2016 after the introduction of GeneXpert to 5.6 cases per 100,000 population in 2020 before a reduction in 2021 coinciding with COVID-19 disruptions. Loss to follow-up (27.5%) and death (8.1%) were common. Unfavourable treatment outcomes were more common among male participants (aOR 3.00, 95% CI 1.38-6.45) and those treated with longer injectable-containing regimens (aOR 3.39, 95% CI 1.30-8.80).

Conclusion: MDR/RR-TB detection has increased overall, but enhanced and decentralised diagnostic capacity is needed, including in important sub-populations. Persisting low treatment success rates must be urgently addressed to minimise the further emergence of drug-resistant TB in Morobe Province.

Setting: Papua New Guinea is a high-burden multidrug-resistant TB (MDR/RR-TB) country that reports low rates of bacteriological confirmation. Sputum drug susceptibility testing for second-line drugs is important. Access to culture is limited.

Objective: To evaluate the prevalence of mycobacterial sputum sample culture contamination and determine factors associated with contamination.

Design: A retrospective analysis of data from a TB diagnostic accuracy study that used culture as the diagnostic reference standard. Data included characteristics of people with presumptive pulmonary TB who provided sputum, sputum quality and culture results.

Results: Sputum (1-3 samples) was collected from 174 adults. The median age was 33 years (IQR 24-47). Of 337 samples sent for culture, 28% were contaminated. Contamination was strongly associated with samples self-collected by participants outside clinic hours (aOR 5.69; 95% CI 2.62-12.38). Contamination risk increased with delays in shipping to the reference laboratory (aOR 1.19 per day, 95% CI 1.10-1.29) beyond the minimum 3 days. Contamination was less frequent among people aged 35-44 years compared to 18-24 years (aOR 0.27, 95% CI 0.10-0.73). Sputum quality was not associated with culture contamination.

Conclusion: Culture contamination could be reduced using spot sputum collection, expedited submission to laboratories and faster shipping when required.

Objective: We adapted a mobile TB screening unit to create an integrated screening program for noncommunicable diseases and TB, using community health worker (CHW) navigators to support linkage to care. We piloted the model in underserved communities of Lima, Peru, evaluating its feasibility, acceptability, and ability to continue supporting TB case detection.

Design: The program provided screening for TB, hypertension, diabetes, and depression and was rebranded to avoid TB-associated stigma. CHW navigators were trained to link people to care for all four conditions. Implementation barriers and facilitators were identified from the implementation team's meeting minutes.

Results: During August-December 2023, we screened 1,000 adults, of whom 254 (25%) were referred for evaluation and paired with CHW navigators. Of these, 197 (78%) underwent evaluation at a health center, and 151 (59%) initiated some form of treatment, including 4 for TB. Completion of the linkage cascade was 93% for TB, 81% for hypertension, 71% for diabetes and 69% for depression. Limitations in equipment and staff were implementation barriers, while multiple flexibility-related facilitators were identified.

Conclusion: The integrated screening program was acceptable and feasible and still identified people with TB. CHW navigators were effective in supporting linkage to primary care services.

Setting: Three health facilities: Chongwe Health Centre (CHC), Chongwe District Hospital (CDH), and Ngwerere Health Centre (NHC) in Chongwe District, Lusaka Province, Zambia.

Objective: To describe the epidemiological trend of TB in 2015-2018, with the 2014 data as baseline.

Design: This was an observational study.

Results: At CHC, CDH, and NHC, 457, 851 and 85 cases, respectively, of all types of TB were registered in 2014-2018. The numbers of patients with presumptive TB at CHC and CDH increased from 606 and 406, respectively, in 2014 to 1068 and 1848, respectively, in 2018. The proportion of patients with bacteriologically positive TB among patients with presumptive TB decreased at CHC and CDH from over 10% in 2014 to less than 5% in late 2018. The treatment success rates decreased at CHC and CDH in 2017 from respectively 93.7% and 93.0% in 2014 to 69.1% and 73.0% in 2017. GeneXpert equipment was installed at CHC in 2016 and CDH in 2017.

Conclusion: After introducing GeneXpert equipment at CHC and CDH, the proportion of bacteriologically-positive TB among presumptive TB significantly decreased because of the high number of patients with presumptive TB screened; however, it may have also caused treatment success rates to have stumbled.

Four clinics implemented an intervention to increase TB household contact identification and evaluation in rural Eastern Cape, South Africa. We applied a care cascade framework to assess gaps in evaluation and treatment initiation from April 2021 to June 2023. We identified 1,698 contacts of 287 individuals with TB. The majority of contacts (71%) were screened; 9% of those with symptoms were fully evaluated, and of these, 14% were diagnosed with active TB. This intervention substantially increased TB contact identification and evaluation compared to prior efforts in the same area; however, additional barriers limited the ability to identify and treat secondary cases.

Setting: This study is a retrospective review of a large-scale systematic TB screening project conducted in six states of Nigeria.

Objective: To determine the magnitude and characteristics of subclinical TB and the relative contributions of bacteriological versus clinical diagnosis in its identification in Nigeria.

Design: Data were retrospectively analysed from six states of Nigeria, where parallel screening with any TB symptoms and chest X-ray (CXR) with artificial intelligence (AI) was used for active case finding. Diagnosis of TB among presumptive was confirmed using either bacteriological tests or clinical review of CXR.

Results: Out of 8,516 presumptive identified during the project, 172 (2.0%) had no TB symptoms (males: 73.8%, females: 26.2%). The overall prevalence of TB among all presumptive was 21.9% (n = 1,867), including 62 (3.3%) subclinical TB and 1,805 (97.3%) active TB cases. The proportion of clinical diagnosis using CXR was significantly higher in the subclinical TB group than in the active TB group (79.0% vs. 63.5%; P = 0.012, OR = 2.2, 95% CI 1.17-4.03).

Conclusion: Subclinical TB contributed 3.3% of the large TB burden in this study (22 per 100 presumptive). These cases would have been missed if only symptom-based TB screening had been employed.

Objective: To evaluate the impact of Truenat assays on the diagnosis of TB at peripheral facilities in Nigeria.

Methods: This was a retrospective cross-sectional study across 34 out of 38 Truenat-implementing facilities in Nigeria. These facilities offer DOTS services. Information on turnaround time (TAT) for TB diagnosis and time to commencement of treatment was obtained. Also, trends in TB case notifications at the facilities 9 months prior to and 9 months during Truenat implementation were compared.

Results: Of 2,335 entries, 70.1% (1,636) were used to determine TAT, while 45.8% (n = 1,070) were used for time to treatment initiation. The median time to diagnosis was <24 hours (IQR 0-1 days). The majority (57.9%) were diagnosed in <24 hours. The median time to treatment initiation was 1.5 days (IQR 0-3). In 9 months before the introduction of Truenat, 8% of 20,424 presumptives evaluated were positive for TB, while during the implementation, 9% of 37,087 presumptives were positive for TB.

Conclusion: Truenat deployment led to an increase in TB and DR-TB case detection in peripheral facilities in Nigeria. It also decreased TAT and time to TB treatment initiation. These have positive implications in the fight against TB, and Truenat is relevant in finding missing TB cases in Nigeria.