Ending Tuberculosis Epidemic: Current Status and Future Prospects

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: closed (20 January 2023) | Viewed by 28770

Special Issue Editor

Department of Biological Sciences, University of Texas at El Paso, El Paso, TX 79968, USA
Interests: tuberculosis vaccines; tuberculosis chemotherapy and drug development; mycobacterium tuberculosis pathogenesis; host directed therapies; BCG induced trained immunity
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Mycobacterium tuberculosis, a causative agent of tuberculosis (TB), causes millions of deaths around the world. In 2020, ~1.5 million people died due to drug-susceptible and ~0.5 million people died due to multidrug-resistant (MDR) TB. Tuberculosis (TB) short chemotherapy for drug-sensitive strains requires treatment with multiple drugs for 6 months, 1–2 years or longer for drug-resistant TB. Long duration of treatments and associated adverse side effects lead to patient incompliance, causing treatment failure and recurrence of infection after the end of the treatment. These factors contribute to the emergence of multidrug-resistant TB (MDR-TB), as well as totally drug-resistant TB, which is a major challenge to global public health, as only 55% of cases of drug-resistant TB and 30% in XDR-TB are successfully cured after treatment. Bacille Calmette–Guérin (BCG), an attenuated strain of Mycobacterium bovis, is currently the only approved vaccine for TB prevention, and has been since 1921. BCG confers protection to neonates against childhood TB as well as disseminated TB but does not protect against adult pulmonary TB.

As we move forward, there is an acute need for the development of preventative or therapeutic vaccine strategies, adjunctive host-directed therapeutic (HDT) approaches and chemotherapeutics for TB treatment in order to end the global TB epidemic by 2035, to achieve the goals of the WHO End TB strategy. This Special Issue, on "Ending TB Epidemic: Current Status and Future Prospects", invites submissions on TB-preventive vaccines, therapeutic vaccines and strategies, adjunctive host-directed therapies to control TB, chemotherapeutics to sterilize TB, Mtb virulence and pathogenesis, epidemiology, reported cases, clinical trials and policy research, as well as other relevant approaches. 

Dr. Sangeeta Tiwari
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Tropical Medicine and Infectious Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • tuberculosis vaccines
  • tuberculosis diagnostics
  • tuberculosis chemotherapy and drug development
  • mycobacterium tuberculosis pathogenesis
  • host-directed therapies and clinical trials

Published Papers (14 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review, Other

10 pages, 221 KiB  
Article
The Challenges of Tuberculosis Management beyond Professional Competence: Insights from Tuberculosis Outbreaks among Ethiopian Immigrants in Israel
by Hashem Bishara, Daniel Weiler-Ravell, Amer Saffouri and Manfred Green
Trop. Med. Infect. Dis. 2024, 9(2), 29; https://doi.org/10.3390/tropicalmed9020029 - 24 Jan 2024
Viewed by 1070
Abstract
Controlling tuberculosis (TB) among immigrants from high-incidence countries presents a public health concern as well as a medical challenge. In this article, we investigate a TB outbreak in a community of people of Jewish descent who emigrated from Ethiopia to Israel (Israeli Ethiopians) [...] Read more.
Controlling tuberculosis (TB) among immigrants from high-incidence countries presents a public health concern as well as a medical challenge. In this article, we investigate a TB outbreak in a community of people of Jewish descent who emigrated from Ethiopia to Israel (Israeli Ethiopians) that started in June 2022. The index case was a 20-year-old female who had recently immigrated to Israel with her family. Her pre-immigration tuberculin skin test was positive. After excluding active TB, treatment with daily isoniazid for latent TB (LTB) was started shortly after her arrival. A year later, she was diagnosed with smear-positive, culture-positive, pulmonary TB. Investigation of 83 contacts revealed five additional patients with active TB, and three of whom were members were of her household. In this article, we report the current TB outbreak, review previously published TB outbreaks involving Israeli Ethiopians, analyze the factors that triggered each of these outbreaks, and discuss the challenges that face the Israeli TB control program in an era of declining TB incidence and diminishing resources available for TB control. Full article
(This article belongs to the Special Issue Ending Tuberculosis Epidemic: Current Status and Future Prospects)
12 pages, 976 KiB  
Article
Computer-Aided Detection for Chest Radiography to Improve the Quality of Tuberculosis Diagnosis in Vietnam’s District Health Facilities: An Implementation Study
by Anh L. Innes, Andres Martinez, Xiaoming Gao, Nhi Dinh, Gia Linh Hoang, Thi Bich Phuong Nguyen, Viet Hien Vu, Tuan Ho Thanh Luu, Thi Thu Trang Le, Victoria Lebrun, Van Chinh Trieu, Nghi Do Bao Tran, Zhi Zhen Qin, Huy Minh Pham, Van Luong Dinh, Binh Hoa Nguyen, Thi Thanh Huyen Truong, Van Cu Nguyen, Viet Nhung Nguyen and Thu Hien Mai
Trop. Med. Infect. Dis. 2023, 8(11), 488; https://doi.org/10.3390/tropicalmed8110488 - 29 Oct 2023
Cited by 1 | Viewed by 2327
Abstract
In Vietnam, chest radiography (CXR) is used to refer people for GeneXpert (Xpert) testing to diagnose tuberculosis (TB), demonstrating high yield for TB but a wide range of CXR abnormality rates. In a multi-center implementation study, computer-aided detection (CAD) was integrated into facility-based [...] Read more.
In Vietnam, chest radiography (CXR) is used to refer people for GeneXpert (Xpert) testing to diagnose tuberculosis (TB), demonstrating high yield for TB but a wide range of CXR abnormality rates. In a multi-center implementation study, computer-aided detection (CAD) was integrated into facility-based TB case finding to standardize CXR interpretation. CAD integration was guided by a programmatic framework developed for routine implementation. From April through December 2022, 24,945 CXRs from TB-vulnerable populations presenting to district health facilities were evaluated. Physicians interpreted all CXRs in parallel with CAD (qXR 3.0) software, for which the selected TB threshold score was ≥0.60. At three months, there was 47.3% concordance between physician and CAD TB-presumptive CXR results, 7.8% of individuals who received CXRs were referred for Xpert testing, and 858 people diagnosed with Xpert-confirmed TB per 100,000 CXRs. This increased at nine months to 76.1% concordant physician and CAD TB-presumptive CXRs, 9.6% referred for Xpert testing, and 2112 people with Xpert-confirmed TB per 100,000 CXRs. Our programmatic CAD-CXR framework effectively supported physicians in district facilities to improve the quality of referral for diagnostic testing and increase TB detection yield. Concordance between physician and CAD CXR results improved with training and was important to optimize Xpert testing. Full article
(This article belongs to the Special Issue Ending Tuberculosis Epidemic: Current Status and Future Prospects)
Show Figures

Figure 1

10 pages, 272 KiB  
Article
Is the Pharmacokinetics of First-Line Anti-TB Drugs a Cause of High Mortality Rates in TB Patients Admitted to the ICU? A Non-Compartmental Pharmacokinetic Analysis
by Francisco Beraldi-Magalhaes, Suzanne L. Parker, Cristina Sanches, Leandro Sousa Garcia, Brenda Karoline Souza Carvalho, Amanda Araujo Costa, Mariana Millan Fachi, Marcus Vinicius de Liz, Alexandra Brito de Souza, Izabella Picinin Safe, Roberto Pontarolo, Steven Wallis, Jeffrey Lipman, Jason A. Roberts and Marcelo Cordeiro-Santos
Trop. Med. Infect. Dis. 2023, 8(6), 312; https://doi.org/10.3390/tropicalmed8060312 - 08 Jun 2023
Viewed by 1382
Abstract
Background: Patients with tuberculosis (TB) may develop multi-organ failure and require admission to intensive care. In these cases, the mortality rates are as high as 78% and may be caused by suboptimal serum concentrations of first-line TB drugs. This study aims to compare [...] Read more.
Background: Patients with tuberculosis (TB) may develop multi-organ failure and require admission to intensive care. In these cases, the mortality rates are as high as 78% and may be caused by suboptimal serum concentrations of first-line TB drugs. This study aims to compare the pharmacokinetics of oral rifampin, isoniazid, pyrazinamide and ethambutol patients in intensive care units (ICU) to outpatients and to evaluate drug serum concentrations as a potential cause of mortality. Methods: A prospective pharmacokinetic (PK) study was performed in Amazonas State, Brazil. The primary PK parameters of outpatients who achieved clinical and microbiological cure were used as a comparative target in a non-compartmental analysis. Results: Thirteen ICU and twenty outpatients were recruited. The clearance and volume of distribution were lower for rifampin, isoniazid, pyrazinamide and ethambutol. ICU thirty-day mortality was 77% versus a cure rate of 89% in outpatients. Conclusions: ICU patients had a lower clearance and volume of distribution for rifampin, isoniazid, pyrazinamide and ethambutol compared to the outpatient group. These may reflect changes to organ function, impeded absorption and distribution to the site of infection in ICU patients and have the potential to impact clinical outcomes. Full article
(This article belongs to the Special Issue Ending Tuberculosis Epidemic: Current Status and Future Prospects)
13 pages, 277 KiB  
Article
Scaling Up TB Screening and TB Preventive Treatment Globally: Key Actions and Healthcare Service Costs
by Srinath Satyanarayana, Carel Pretorius, Avinash Kanchar, Ines Garcia Baena, Saskia Den Boon, Cecily Miller, Matteo Zignol, Tereza Kasaeva and Dennis Falzon
Trop. Med. Infect. Dis. 2023, 8(4), 214; https://doi.org/10.3390/tropicalmed8040214 - 01 Apr 2023
Viewed by 2110
Abstract
The 2018 United Nations High-Level Meeting on Tuberculosis (UNHLM) set targets for case detection and TB preventive treatment (TPT) by 2022. However, by the start of 2022, about 13.7 million TB patients still needed to be detected and treated, and 21.8 million household [...] Read more.
The 2018 United Nations High-Level Meeting on Tuberculosis (UNHLM) set targets for case detection and TB preventive treatment (TPT) by 2022. However, by the start of 2022, about 13.7 million TB patients still needed to be detected and treated, and 21.8 million household contacts needed to be given TPT globally. To inform future target setting, we examined how the 2018 UNHLM targets could have been achieved using WHO-recommended interventions for TB detection and TPT in 33 high-TB burden countries in the final year of the period covered by the UNHLM targets. We used OneHealth-TIME model outputs combined with the unit cost of interventions to derive the total costs of health services. Our model estimated that, in order to achieve UNHLM targets, >45 million people attending health facilities with symptoms would have needed to be evaluated for TB. An additional 23.1 million people with HIV, 19.4 million household TB contacts, and 303 million individuals from high-risk groups would have required systematic screening for TB. The estimated total costs amounted to ~USD 6.7 billion, of which ~15% was required for passive case finding, ~10% for screening people with HIV, ~4% for screening household contacts, ~65% for screening other risk groups, and ~6% for providing TPT to household contacts. Significant mobilization of additional domestic and international investments in TB healthcare services will be needed to reach such targets in the future. Full article
(This article belongs to the Special Issue Ending Tuberculosis Epidemic: Current Status and Future Prospects)
10 pages, 1695 KiB  
Article
Systemic Levels of Pro-Inflammatory Cytokines and Post-Treatment Modulation in Tuberculous Lymphadenitis
by Gokul Raj Kathamuthu, Kadar Moideen, Rathinam Sridhar, Dhanaraj Baskaran and Subash Babu
Trop. Med. Infect. Dis. 2023, 8(3), 150; https://doi.org/10.3390/tropicalmed8030150 - 27 Feb 2023
Viewed by 1246
Abstract
Pro-inflammatory cytokines are potent stimulators of inflammation and immunity and markers of infection severity and bacteriological burden in pulmonary tuberculosis (PTB). Interferons could have both host-protective and detrimental effects on tuberculosis disease. However, their role has not been studied in tuberculous lymphadenitis (TBL). [...] Read more.
Pro-inflammatory cytokines are potent stimulators of inflammation and immunity and markers of infection severity and bacteriological burden in pulmonary tuberculosis (PTB). Interferons could have both host-protective and detrimental effects on tuberculosis disease. However, their role has not been studied in tuberculous lymphadenitis (TBL). Thus, we evaluated the systemic pro-inflammatory (interleukin (IL)-12, IL-23, interferon (IFN)α, and IFNβ) cytokine levels in TBL, latent tuberculosis (LTBI), and healthy control (HC) individuals. In addition, we also measured the baseline (BL) and post-treatment (PT) systemic levels in TBL individuals. We demonstrate that TBL individuals are characterized by increased pro-inflammatory (IL-12, IL-23, IFNα, IFNβ) cytokines when compared to LTBI and HC individuals. We also show that after anti-tuberculosis treatment (ATT) completion, the systemic levels of pro-inflammatory cytokines were significantly modulated in TBL individuals. A receiver operating characteristic (ROC) analysis revealed IL-23, IFNα, and IFNβ significantly discriminated TBL disease from LTBI and/or HC individuals. Hence, our study demonstrates the altered systemic levels of pro-inflammatory cytokines and their reversal after ATT, suggesting that they are markers of disease pathogenesis/severity and altered immune regulation in TBL disease. Full article
(This article belongs to the Special Issue Ending Tuberculosis Epidemic: Current Status and Future Prospects)
Show Figures

Figure 1

16 pages, 496 KiB  
Article
A Qualitative Study on the Implementation of the Workplace TB Program in the Philippines: Challenges and Way Forward
by Evalyn A. Roxas, Vivien Fe F. Fadrilan-Camacho, Maria Margarita M. Lota, Paul Michael R. Hernandez, Adrian Paul M. Agravante, Loisse Mikaela M. Loterio, Micaela J. Arevalo, Richelle Liza F. Maglalang, Carlo R. Lumangaya and Vicente Y. Belizario, Jr.
Trop. Med. Infect. Dis. 2023, 8(2), 93; https://doi.org/10.3390/tropicalmed8020093 - 30 Jan 2023
Cited by 1 | Viewed by 2883
Abstract
Tuberculosis (TB) is a chronic infectious disease that remains to be a primary health concern globally. The Philippines is among the top TB-burdened countries. Workplace TB prevention and control programs are essential to ensure the health and safety of workers and economic security. [...] Read more.
Tuberculosis (TB) is a chronic infectious disease that remains to be a primary health concern globally. The Philippines is among the top TB-burdened countries. Workplace TB prevention and control programs are essential to ensure the health and safety of workers and economic security. There remains a knowledge gap regarding the Philippine workplace TB prevention and control program implementation. This qualitative study involving key informant interviews reviewed the implementation of the workplace TB program in selected companies in a high TB burden region in Eastern Philippines. Results were presented under four themes in accordance with the components of the workplace TB policy: preventive strategies, medical management, data recording and reporting, and social policy. Various good practices, opportunities, and challenges in the implementation of the workplace TB program were identified. There is a need to strengthen the enforcement of policy across different components. Compliance with guidelines on preventive strategies and recording and reporting schemes needs to be intensified. Coordination across different levels and agencies may also be enhanced to allow more efficient implementation. Increased awareness of corporate decision-makers may improve company ownership of the program leading to improved implementation while increased awareness of employees on their rights and entitlements may likewise enhance compliance. Full article
(This article belongs to the Special Issue Ending Tuberculosis Epidemic: Current Status and Future Prospects)
Show Figures

Figure 1

12 pages, 599 KiB  
Article
Missing Cases of Bacteriologically Confirmed TB/DR-TB from the National Treatment Registers in West and North Sumatra Provinces, Indonesia
by Ratno Widoyo, Defriman Djafri, Ade Suzana Eka Putri, Finny Fitry Yani, R Lia Kusumawati, Thakerng Wongsirichot and Virasakdi Chongsuvivatwong
Trop. Med. Infect. Dis. 2023, 8(1), 31; https://doi.org/10.3390/tropicalmed8010031 - 02 Jan 2023
Viewed by 2611
Abstract
This study aimed to assess the percentage of confirmed drug-sensitive (DS) TB and drug-resistant (DR) TB patients who were missing in the national treatment registration in North Sumatra and West Sumatra, where treatment services for DR-TB in North Sumatra are relatively well established [...] Read more.
This study aimed to assess the percentage of confirmed drug-sensitive (DS) TB and drug-resistant (DR) TB patients who were missing in the national treatment registration in North Sumatra and West Sumatra, where treatment services for DR-TB in North Sumatra are relatively well established compared with West Sumatra, where the system recently started. Confirmed DS/DR-TB records in the laboratory register at 40 government health facilities in 2017 and 2018 were traced to determine whether they were in the treatment register databases. A Jaro–Winkler soundexed string distance analysis enhanced by socio-demographic information matching had sensitivity and specificity over 98% in identifying the same person in the same or different databases. The laboratory data contained 5885 newly diagnosed records of bacteriologically confirmed TB cases. Of the 5885 cases, 1424 of 5353 (26.6%) DS-TB cases and 133 of 532 (25.0%) DR-TB cases were missing in the treatment notification database. The odds of missing treatment for DS-TB was similar for both provinces (AOR = 1.0 (0.9, 1.2), but for DR-TB, North Sumatra had a significantly lower missing odds ratio (AOR = 0.4 (0.2, 0.7). The system must be improved to reduce this missing rate, especially for DR-TB in West Sumatra. Full article
(This article belongs to the Special Issue Ending Tuberculosis Epidemic: Current Status and Future Prospects)
Show Figures

Figure 1

10 pages, 439 KiB  
Article
Impact of Coronavirus Pandemic on Tuberculosis and Other Imported Diseases Screening among Migrant Minors in Spain
by Isabel Mellado-Sola, Paula Rodríguez-Molino, Elisa-Andrea Armas, Javier Nogueira López, Iker Falces-Romero, Cristina Calvo Rey, Carlos Grasa Lozano, María José Mellado, Milagros García López-Hortelano and Talía Sainz
Trop. Med. Infect. Dis. 2023, 8(1), 28; https://doi.org/10.3390/tropicalmed8010028 - 29 Dec 2022
Cited by 1 | Viewed by 2922
Abstract
Background: In recent decades, the increase in population movements has turned the focus to imported diseases. The COVID-19 pandemic has negatively impacted the access to health care systems, especially in highly vulnerable populations. We address the effects of the pandemic on the health [...] Read more.
Background: In recent decades, the increase in population movements has turned the focus to imported diseases. The COVID-19 pandemic has negatively impacted the access to health care systems, especially in highly vulnerable populations. We address the effects of the pandemic on the health screening of migrant unaccompanied minors (UM) in Spain. Method: Retrospective cross-sectional study including UM screened for imported diseases with a unified protocol at a pediatric reference unit for tropical and infectious diseases in Madrid, Spain. We compared the pre-pandemic (2018–2019) and post-pandemic periods (2020–2021). Results: A total of 192 minors were screened during the study period, with a drop in UM’s referral to our center in the post-pandemic years (140 in 2018–2019 vs. 52 in 2020–2021). Out of 192, 161 (83.9%) were diagnosed with at least one medical condition. The mean age was 16.8 years (SD 0.8) and 96.9% were males. Most cases were referred for a health exam; only 38% of children were symptomatic. Eosinophilia was present in 20.8%. The most common diagnosis were latent tuberculosis infection (LTBI) (72.9%), schistosomiasis (15.1%), toxocariasis (4.9%) and strongyloidiasis (4.9%). The prevalence of LTBI did not vary significantly (69.3% vs. 82.7%, p = 0.087). A total of 38% of the patients diagnosed with LTBI never started treatment or were lost to follow-up, as were two out of three patients with active pulmonary tuberculosis. Conclusions: In this series, the number of UM referred for health screening has dropped dramatically after the COVID pandemic, and two years after the beginning of the pandemic, access to care is still limited. Lost to follow-up rates are extremely high despite institutionalization. Specific resources, including multidisciplinary teams and accessible units are needed to improve diagnoses and linkage to care in this vulnerable population. Full article
(This article belongs to the Special Issue Ending Tuberculosis Epidemic: Current Status and Future Prospects)
Show Figures

Figure 1

9 pages, 570 KiB  
Article
The Role of Post-Bronchoscopy Sputum Examination in Screening for Active Tuberculosis
by Gawahir A. Ali, Wael Goravey, Faraj S. Howady, Maisa Ali, Awni Alshurafa, Ahmed M. Abdalhadi, Muhammed Hajmusa, Joanne Daghfal, Abdullatif Al Khal, Muna Al Maslamani, Hussam Al Soub and Ali S. Omrani
Trop. Med. Infect. Dis. 2023, 8(1), 13; https://doi.org/10.3390/tropicalmed8010013 - 26 Dec 2022
Cited by 3 | Viewed by 2458
Abstract
Early diagnosis is a fundamental component of global tuberculosis control. The objective of this study was to evaluate the diagnostic yield of post-bronchoscopy sputum (PBS) testing as part of a tuberculosis diagnostic work-up. All new residents in the State of Qatar undergo a [...] Read more.
Early diagnosis is a fundamental component of global tuberculosis control. The objective of this study was to evaluate the diagnostic yield of post-bronchoscopy sputum (PBS) testing as part of a tuberculosis diagnostic work-up. All new residents in the State of Qatar undergo a tuberculosis (TB) screening program. Those with abnormal chest radiology, negative sputum acid-fast bacilli (AFB) smears, and nucleic acid amplification testing (NAAT) for M. tuberculosis, undergo an additional bronchoscopic evaluation for TB. We prospectively enrolled individuals who were going to undergo bronchoscopy to provide two PBS samples for AFB smears and mycobacterial cultures between 18 September 2018 and 12 March 2021. A total of 495 individuals, with a median age of 31 years, were included. The majority of the patients were males (329, 66.5%). The most frequent country of origin was India (131, 26.5%) followed by the Philippines (123, 24.8%). The addition of PBS to bronchoalveolar lavage (BAL) testing allowed microbiological confirmation of tuberculosis in an additional 13 patients (3.9%), resulting in improved sensitivity (from 77.9% to 81.9%), negative predictive value (from 69.2% to 73.2%), and negative likelihood ratio (from 0.22 to 0.18). Where resources are available, the incorporation of routine PBS examination as part of tuberculosis diagnostic work-up can enhance the diagnostic yield. Full article
(This article belongs to the Special Issue Ending Tuberculosis Epidemic: Current Status and Future Prospects)
Show Figures

Figure 1

8 pages, 1723 KiB  
Article
Individuals’ Vulnerability Based Active Surveillance for TB: Experiences from India
by Shibu K. Balakrishnan, Rakesh P. Suseela, Sunilkumar Mrithyunjayan, Manu E. Mathew, Suresh Varghese, Shubin Chenayil, Suja Aloysius, Twinkle Prabhakaran and Sreenivas A. Nair
Trop. Med. Infect. Dis. 2022, 7(12), 441; https://doi.org/10.3390/tropicalmed7120441 - 15 Dec 2022
Cited by 1 | Viewed by 2734
Abstract
Community-based active TB case finding (ACF) has become an essential part of TB elimination efforts in high-burden settings. In settings such as the state of Kerala in India, which has reported an annual decline of 7.5% in the estimated TB incidence since 2015, [...] Read more.
Community-based active TB case finding (ACF) has become an essential part of TB elimination efforts in high-burden settings. In settings such as the state of Kerala in India, which has reported an annual decline of 7.5% in the estimated TB incidence since 2015, if ACF is not well targeted, it may end up with a less-than-desired yield, the wastage of scarce resources, and the burdening of health systems. Program managers have recognized the need to optimize resources and workloads, while maximizing the yield, when implementing ACF. We developed and implemented the concept of ‘individuals’-vulnerability-based active surveillance’ as a substitute for the blanket approach for population/geography-based ACF for TB. Weighted scores, based on an estimate of relative risk, were assigned to reflect the TB vulnerabilities of individuals. Vulnerability data for 22,042,168 individuals were available to the primary healthcare team. Individuals with higher cumulative vulnerability scores were targeted for serial ACF from 2019 onwards. In 2018, when a population-based ACF was conducted, the number needed to screen to diagnose one microbiologically confirmed pulmonary TB case was 3772 and the number needed to test to obtain one microbiologically confirmed pulmonary TB case was 112. The corresponding figures in 2019 for individuals’-vulnerability-based ACF were 881 and 39, respectively. Individuals’-vulnerability-based active surveillance is proposed here as a practical solution to improve health system efficiency in settings where the population is relatively stationary, the TB disease burden is low, and the health system is strong. Full article
(This article belongs to the Special Issue Ending Tuberculosis Epidemic: Current Status and Future Prospects)
Show Figures

Figure 1

12 pages, 887 KiB  
Article
Clinical-Epidemiological Characteristics and Outcomes of Latent Tuberculosis Treatment at a Tertiary Center in Central-West Brazil from 2017 to 2019
by Moara Alves Santa Bárbara Borges, Iago Dib Cunha, Luís Henrique Candini, Vitor Alves de Souza and Paulo Sérgio Sucasas da Costa
Trop. Med. Infect. Dis. 2022, 7(12), 432; https://doi.org/10.3390/tropicalmed7120432 - 12 Dec 2022
Viewed by 1208
Abstract
Detailed information concerning latent tuberculosis infection (LTBI) and treatment outcomes is scarce in Brazil. This retrospective cross-sectional study aimed to describe LTB treatment (LTBT) at a tertiary center in Central-West Brazil from 2017 to 2019. We recommended the use of LTBTs before the [...] Read more.
Detailed information concerning latent tuberculosis infection (LTBI) and treatment outcomes is scarce in Brazil. This retrospective cross-sectional study aimed to describe LTB treatment (LTBT) at a tertiary center in Central-West Brazil from 2017 to 2019. We recommended the use of LTBTs before the implementation of a rifapentine-isoniazid (3HP) regimen in Brazil. We conducted a descriptive analysis using chi-square or t-tests to assess differences in the proportions and means. Of 79 notified adult patients (males, 68%; median age, 40 (interquartile range, 30–51) years), most people were living with human immunodeficiency virus (PLHIV) (82%) or receiving immunosuppressant medication (15%), and 92% were receiving their first treatment. Isoniazid (INH) for 6–9 months had previously been proposed for 95% of the patients, with only 35% completeness. Four patients treated with rifampicin (4RMP) completed the regimen (p = 0.009). Adverse events occurred in 19% of the patients. In this Brazilian tertiary center, the target population for LTBT were young PLHIV patients under immunosuppression with low education levels. However, the INH monotherapy dropout rate was 65%. Therefore, shorter courses, such as 3HP and 4RMP, are promising alternatives. Behavioral aspects, education level, and regimen length can influence the course completion, and further studies are required to evaluate the 3HP regime in Brazil. Full article
(This article belongs to the Special Issue Ending Tuberculosis Epidemic: Current Status and Future Prospects)
Show Figures

Figure 1

Review

Jump to: Research, Other

11 pages, 364 KiB  
Review
Engaging the Private Health Service Delivery Sector for TB Care in India—Miles to Go!
by Rakesh P. Suseela and Mohd Shannawaz
Trop. Med. Infect. Dis. 2023, 8(5), 265; https://doi.org/10.3390/tropicalmed8050265 - 04 May 2023
Cited by 2 | Viewed by 1710
Abstract
More than half of the people with TB in India seek care from the private sector, where suboptimal quality of care is a concern. Significant progress has been made over the last five years to expand the coverage and to involve more private [...] Read more.
More than half of the people with TB in India seek care from the private sector, where suboptimal quality of care is a concern. Significant progress has been made over the last five years to expand the coverage and to involve more private sector providers in TB care under the National TB Elimination Program (NTEP) in India. The objective of this review is to describe the major efforts and the progress made with regard to the engagement of the ‘for-profit’ private health service delivery sector for TB care in India, to critically discuss this, and to suggest the way forward. We described the recent efforts by the NTEP for private sector engagement based on the literature, including strategy documents, guidelines, annual reports, evaluation studies, and critically looked at the strategies against the vision of partnership. The NTEP has taken a variety of approaches, including education, regulation, provision of cost-free TB services, incentives, and partnership schemes to engage the private sector. As a result of all these interventions, private sector contribution has increased substantially, including TB notification, follow-up, and treatment success. However, these still fall short of achieving the set targets. Strategies were focused more towards the purchase of services rather than creating sustainable partnerships. There are no major strategies to engage the diverse set of providers, including informal health care providers and chemists, who are the first point of contact for a significant number of people with TB. India needs an integrated private sector engagement policy focusing on ensuring standards of TB care for every citizen. The NTEP should adopt an approach specifically tailored to the various categories of providers. For meaningful inclusion of the private sector, it is also essential to build understanding and generate data intelligence for better decision making, strengthen the platforms for engagement, and expand the social insurance coverage. Full article
(This article belongs to the Special Issue Ending Tuberculosis Epidemic: Current Status and Future Prospects)
Show Figures

Figure 1

Other

Jump to: Research, Review

8 pages, 232 KiB  
Brief Report
Latent Tuberculosis Treatment among Hard-to-Reach Ethiopian Immigrants: Nurse-Managed Directly Observed versus Self-Administered Isoniazid Therapy
by Hashem Bishara, Manfred Green, Amer Saffouri and Daniel Weiler-Ravell
Trop. Med. Infect. Dis. 2023, 8(2), 123; https://doi.org/10.3390/tropicalmed8020123 - 16 Feb 2023
Cited by 1 | Viewed by 1209
Abstract
Background: The treatment of latent tuberculosis infection (LTBI) among high-risk populations is an essential component of Tuberculosis (TB) elimination. However, non-compliance with LTBI treatment remains a major obstacle hindering TB elimination efforts. We have previously reported high treatment compliance with nurse-managed, twice-weekly, directly [...] Read more.
Background: The treatment of latent tuberculosis infection (LTBI) among high-risk populations is an essential component of Tuberculosis (TB) elimination. However, non-compliance with LTBI treatment remains a major obstacle hindering TB elimination efforts. We have previously reported high treatment compliance with nurse-managed, twice-weekly, directly observed Isoniazid treatment (DOT) for LTBI among hard-to-reach Ethiopian immigrants (EI’s). Objectives: to compare rate of completion of treatment, cost, and major adverse drug events with daily self-administered Isoniazid treatment (SAT) to nurse-managed Isoniazid DOT among hard-to-reach EIs. Materials and Methods: We conducted a retrospective study and compared self-administered LTBI treatment outcomes among EIs housed in reception centers during 2008–2012 to EIs treated with DOT. Results: Overall, 455 EIs were included (231 DOT, 224 SAT) in the study. We found no significant difference in treatment completion rates between the two groups (93.0% DOT vs. 87.9% SAT, p = 0.08). However, cases of grade III, drug-induced hepatitis were significantly fewer and treatment costs were significantly lower with the nurse–managed DOT compared with SAT (0% vs. 2.2%, p = 0.028, 363 vs. 521 United States Dollars, p < 0.001, respectively). Conclusions: Nurse-managed, twice-weekly DOT among hard-to-reach EIs housed in reception centers had less severe drug-related adverse events and reduced treatment cost compared with daily isoniazid SAT, yet we found no significant difference in treatment completion between the two strategies in this population. Full article
(This article belongs to the Special Issue Ending Tuberculosis Epidemic: Current Status and Future Prospects)
14 pages, 5659 KiB  
Systematic Review
Effect of Oral Antidiabetic Drugs on Tuberculosis Risk and Treatment Outcomes: Systematic Review and Meta-Analysis
by Edinson Dante Meregildo-Rodriguez, Martha Genara Asmat-Rubio, Petterson Zavaleta-Alaya and Gustavo Adolfo Vásquez-Tirado
Trop. Med. Infect. Dis. 2022, 7(11), 343; https://doi.org/10.3390/tropicalmed7110343 - 31 Oct 2022
Cited by 2 | Viewed by 1933
Abstract
Tuberculosis and diabetes mellitus are two global pandemics and rising public health problems. Recent studies suggest that oral antidiabetic drugs (OADs) could reduce the risk of tuberculosis and improve clinical outcomes. However, the evidence is controversial. Therefore, we aimed to assess the effect [...] Read more.
Tuberculosis and diabetes mellitus are two global pandemics and rising public health problems. Recent studies suggest that oral antidiabetic drugs (OADs) could reduce the risk of tuberculosis and improve clinical outcomes. However, the evidence is controversial. Therefore, we aimed to assess the effect of OADs on the risk of tuberculosis and treatment outcomes. We systematically searched for six databases from inception to 31 August 2022. We followed a predefined PICO/PECO strategy and included two randomized controlled trials and sixteen observational studies. This study collects 1,109,660 participants, 908,211 diabetic patients, and at least 13,841 tuberculosis cases. Our results show that metformin decreases the risk of active tuberculosis by 40% (RR 0.60; 95% CI 0.47–0.77) in diabetic patients. In addition, metformin exhibits a dose-response gradient (medium doses reduce the risk of active tuberculosis by 45%, while high doses reduce this risk by 52%). On the other hand, DPP IV inhibitors increase the risk of active tuberculosis by 43% (RR 1.43; 95% CI 1.02–2.02). Subgroup analysis showed that study design and metformin dose accounted for the heterogeneity. We conclude that metformin significantly protects against active tuberculosis among diabetic patients. On the contrary, DPP IV inhibitors could increase the risk of developing active tuberculosis. Full article
(This article belongs to the Special Issue Ending Tuberculosis Epidemic: Current Status and Future Prospects)
Show Figures

Figure 1

Back to TopTop