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IntroductionMedicine prescribing practices are integral to quality of care for leading infectious diseases such as tuberculosis (TB). We describe prescribing practices in South Africa’s private health sector, where an estimated third of people with TB symptoms first seek care.MethodsSixteen standardised patients (SPs) presented one of three cases during unannounced visits to private general practitioners (GPs) in Durban and Cape Town: TB symptoms, HIV-positive; TB symptoms, a positive molecular test for TB, HIV-negative; and TB symptoms, history of incomplete TB treatment, HIV-positive. Prescribing practices were recorded in standardised exit interviews and analysed based on their potential to contribute to negative outcomes, including increased healthcare expenditures, antibiotic overuse or misuse, and TB diagnostic delay. Factors associated with antibiotic use were assessed using Poisson regression with a robust variance estimator.ResultsBetween August 2018 and July 2019, 511 SP visits were completed with 212 GPs. In 88.5% (95% CI 85.2% to 91.1%) of visits, at least one medicine (median 3) was dispensed or prescribed and most (93%) were directly dispensed. Antibiotics, which can contribute to TB diagnostic delay, were the most common medicine (76.5%, 95% CI 71.7% to 80.7% of all visits). A majority (86.1%, 95% CI 82.9% to 88.5%) belonged to the WHO Access group; fluoroquinolones made up 8.8% (95% CI 6.3% to 12.3%). Factors associated with antibiotic use included if the SP was asked to follow-up if symptoms persisted (RR 1.14, 95% CI 1.04 to 1.25) and if the SP presented as HIV-positive (RR 1.11, 95% CI 1.01 to 1.23). An injection was offered in 31.9% (95% CI 27.0% to 37.2%) of visits; 92% were unexplained. Most (61.8%, 95% CI 60.2% to 63.3%) medicines were not listed on the South African Primary Healthcare Essential Medicines List.ConclusionPrescribing practices among private GPs for persons presenting with TB-like symptoms in South Africa raise concern about inappropriate antimicrobial use, private healthcare costs and TB diagnostic delay.

Introduction Understanding how influenza vaccine uptake changed during the 2020/2021 influenza season compared to previous pre-pandemic seasons is a key priority, as is identifying the relationship between prior influenza vaccination and COVID-19 vaccine willingness. Methods We analyzed data from a large, nationally representative cohort of Canadian residents aged 50 and older to assess influenza vaccination status three times between 2015 and 2020. We investigated: 1) changes in self-reported influenza vaccine uptake, 2) predictors of influenza vaccine uptake in 2020/2021, and 3) the association between influenza vaccination history and self-reported COVID-19 vaccine willingness using logistic regression models. Results Among 23,385 participants analyzed for aims 1–2, influenza vaccination increased over time: 14,114 (60.4%) in 2015–2018, 15,692 (67.1%) in 2019/2020, and 19,186 (82.0%; combining those already vaccinated and those planning to get a vaccine) in 2020/2021. After controlling for socio-demographics, history of influenza vaccination was most strongly associated with influenza vaccination in 2020/2021 (adjusted odds ratio [aOR] 147.9 [95% CI: 120.9–180.9]); this association remained after accounting for multiple health and pandemic-related factors (aOR 140.3 [95% CI: 114.5–171.8]). To a lesser degree, those more concerned about COVID-19 were also more likely to report influenza vaccination in fall 2020, whereas those reporting a very negative impact of the pandemic were less likely to get vaccinated. Among 23,819 participants with information on COVID-19 vaccine willingness during the last quarter of 2020 (aim 3), prior influenza vaccination was most strongly associated with willingness to get a COVID-19 vaccine (aOR 15.1 [95% CI: 13.5–16.8] for those who had received influenza vaccine at all previous timepoints versus none). Conclusions Our analysis highlights the importance of previous vaccination in driving vaccination uptake and willingness. Efforts to increase vaccination coverage for influenza and COVID-19 should target individuals who do not routinely engage with immunization services regardless of demographic factors.

RESUME CONTEXTE: Le depistage du coronavirus du syndrome respiratoire aigu severe 2 (SRAS-CoV-2) est en grande partie passif, ce qui nuit au controle de l’epidemie. Nous avons elabore des strategies de depistage actif du SRAS-CoV-2 au moyen d’une amplification en chaine par polymerase couplee a une transcription inverse (RT-PCR) chez les groupes courant un risque accru de contracter le virus dans les provinces canadiennes. METHODES: Nous avons identifie 5 groupes qui devraient etre prioritaires pour le depistage actif au moyen d’une RTPCR, soit les gens ayant ete en contact avec une personne infectee par le SRAS-CoV-2 et ceux qui appartiennent a 4 populations a risque : employes d’hopitaux, travailleurs en soins de sante communautaires ainsi qu’employes et residents d’etablissements de soins de longue duree, employes d’entreprises essentielles, et eleves et personnel scolaire. Nous avons estime les couts, les ressources humaines et la capacite de laboratoire necessaires au depistage des membres de ces groupes ou au depistage sur des echantillons aleatoires aux fins de surveillance. RESULTATS: Du 8 au 17 juillet 2020, 41 751 depistages par RT-PCR etaient realises chaque jour en moyenne dans les provinces canadiennes; nous avons estime que ces tests mobilisaient 5122 employes et coutaient 2,4 millions de dollars par jour (67,8 millions de dollars par mois). La recherche et le depistage systematiques des contacts requerraient 1,2 fois plus de personnel et porteraient les couts mensuels a 78,9 millions de dollars. S’il etait realise en 1 mois, le depistage de tous les employes des hopitaux necessiterait 1823 travailleurs supplementaires et couterait 29,0 millions de dollars. Pour la meme periode de temps, le depistage de tous les travailleurs en soins de sante communautaires et de tous les employes et residents des etablissements de soins de longue duree necessiterait 11 074 employes supplementaires et couterait 124,8 millions de dollars, et celui de tous les travailleurs essentiels necessiterait 25 965 employes supplementaires et couterait 321,7 millions de dollars. Enfin, le depistage sur 6 semaines de la population scolaire necessiterait 46 368 employes supplementaires et couterait 816,0 millions de dollars. Les interventions visant a pallier les inefficacites, comme le depistage a partir d’echantillons de salive et le regroupement des echantillons, pourraient reduire les couts de 40 % et les besoins en personnel, de 20 %. Le depistage de surveillance sur des echantillons de la population autre que les contacts couterait 5 % des couts associes a l’adoption d’une approche universelle de depistage aupres des populations a risque. INTERPRETATION: Le depistage actif des groupes courant un risque accru de contracter le SRAS-CoV-2 semble faisable et favoriserait la reouverture sure et a grande echelle de l’economie et des ecoles. Cette strategie semble egalement abordable lorsque comparee aux 169,2 milliards de dollars verses par le gouvernement federal dans la lutte contre la pandemie en date de juin 2020.

IntroductionAlthough universal drug susceptibility testing (DST) is a component of the End-TB Strategy, over 70% of drug-resistant tuberculosis (DR-TB) cases globally remain undetected. This detection gap reflects difficulties in DST scale-up and substantial heterogeneity in policies and implemented practices. We conducted a systematic review and meta-analysis to assess whether implementation of universal DST yields increased DR-TB detection compared with only selectively testing high-risk groups.MethodsPubMed, Embase, Global Health, Cochrane Library and Web of Science Core Collection were searched for publications reporting on the differential yield of universal versus selective DST implementation on the proportion of DR-TB, from January 2007 to June 2019. Random-effects meta-analyses were used to calculate respective pooled proportions of DR-TB cases detected; Higgins test and prediction intervals were used to assess between-study heterogeneity. We adapted an existing risk-of-bias assessment tool for prevalence studies.ResultsOf 18 736 unique citations, 101 studies were included in the qualitative synthesis. All studies used WHO-endorsed DST methods, and most (87.1%) involved both high-risk groups and the general population. We found only cross-sectional, observational, non-randomised studies that compared universal with selective DST strategies. Only four studies directly compared the testing approaches in the same study population, with the proportion of DR-TB cases detected ranging from 2.2% (95% CI: 1.4% to 3.2%) to 12.8% (95% CI: 11.4% to 14.3%) with selective testing, versus 4.4% (95% CI: 3.3% to 5.8%) to 9.8% (95% CI: 8.9% to 10.7%) with universal testing. Broad population studies were very heterogeneous. The vast majority (88/101; 87.1%) reported on the results of universal testing. However, while 37 (36.6%)/101 included all presumptive TB cases, an equal number of studies applied sputum-smear as a preselection criterion. A meaningful meta-analysis was not possible.ConclusionGiven the absence of randomised studies and the paucity of studies comparing strategies head to head, and selection bias in many studies that applied universal testing, our findings have limited generalisability. The lack of evidence reinforces the need for better data to inform policies.

Background The widespread use of antibiotics plays a major role in the development and spread of antimicrobial resistance. However, important knowledge gaps still exist regarding the extent of their use in low- and middle-income countries (LMICs), particularly at the primary care level. We performed a systematic review and meta-analysis of studies conducted in primary care in LMICs to estimate the prevalence of antibiotic prescriptions as well as the proportion of such prescriptions that are inappropriate. Methods and findings We searched PubMed, Embase, Global Health, and CENTRAL for articles published between 1 January 2010 and 4 April 2019 without language restrictions. We subsequently updated our search on PubMed only to capture publications up to 11 March 2020. Studies conducted in LMICs (defined as per the World Bank criteria) reporting data on medicine use in primary care were included. Three reviewers independently screened citations by title and abstract, whereas the full-text evaluation of all selected records was performed by 2 reviewers, who also conducted data extraction and quality assessment. A modified version of a tool developed by Hoy and colleagues was utilized to evaluate the risk of bias of each included study. Meta-analyses using random-effects models were performed to identify the proportion of patients receiving antibiotics. The WHO Access, Watch, and Reserve (AWaRe) framework was used to classify prescribed antibiotics. We identified 48 studies from 27 LMICs, mostly conducted in the public sector and in urban areas, and predominantly based on medical records abstraction and/or drug prescription audits. The pooled prevalence proportion of antibiotic prescribing was 52% (95% CI: 51%–53%), with a prediction interval of 44%–60%. Individual studies’ estimates were consistent across settings. Only 9 studies assessed rationality, and the proportion of inappropriate prescription among patients with various conditions ranged from 8% to 100%. Among 16 studies in 15 countries that reported details on prescribed antibiotics, Access-group antibiotics accounted for more than 60% of the total in 12 countries. The interpretation of pooled estimates is limited by the considerable between-study heterogeneity. Also, most of the available studies suffer from methodological issues and report insufficient details to assess appropriateness of prescription. Conclusions Antibiotics are highly prescribed in primary care across LMICs. Although a subset of studies reported a high proportion of inappropriate use, the true extent could not be assessed due to methodological limitations. Yet, our findings highlight the need for urgent action to improve prescription practices, starting from the integration of WHO treatment recommendations and the AWaRe classification into national guidelines. Trial registration PROSPERO registration number: CRD42019123269., Giorgia Sulis and colleagues report the prevalence of antibiotic prescriptions in primary care in low-middle income countries in a systematic review and meta-analysis., Author summary Why was this study done? Inappropriate use of antibiotics, both in terms of incorrect regimens and prescription without clinical indication, is a major driver of antibiotic resistance. Global drug sales data indicate a substantial increase in antibiotic use in low- and middle-income countries (LMICs) over the past 2 decades. An accurate quantification of antibiotic prescribing in primary care across LMICs is not available. What did the researchers do and find? We conducted a systematic review and meta-analysis to estimate the proportion of antibiotic prescribing across primary care settings in LMICs. Our study showed that, on average, approximately half of patients attending primary care facilities in LMICs received at least 1 antibiotic. Very few included studies made an attempt to assess the extent of inappropriate prescriptions and indicate potential misuse. Among studies that provided information on the types of antibiotics used, we found that, in 12/16 studies, 60% of prescriptions were for antibiotics with low potential for resistance selection as defined by the World Health Organization (WHO). What do these findings mean? Our study highlights that antibiotics are highly prescribed in outpatient primary care settings. Better quality data are necessary to dig deeper into the patterns of inappropriate use according to local epidemiologic scenarios. Adapting WHO treatment recommendations and incorporating the WHO Access, Watch, and Reserve (AWaRe) classification of antibiotics into national guidelines will be a first key step to improve prescription practices.

BackgroundThis study aimed to assess the pharmacokinetic profile of 150 mg rifabutin (RBT) taken every other day (every 48 h) versus 300 mg RBT taken every other day (E.O.D), both in combination with lopinavir/ritonavir (LPV/r), in adult patients with human immunodeficiency virus (HIV) and tuberculosis (TB) co-infection.MethodsThis is a two-arm, open-label, pharmacokinetic, randomised study conducted in Burkina Faso between May 2013 and December 2015. Enrolled patients were randomised to receive either 150 mg RBT EOD (arm A, 9 subjects) or 300 mg RBT EOD (arm B, 7 subjects), both associated with LPV/r taken twice daily. RBT plasma concentrations were evaluated after 2 weeks of combined HIV and TB treatment. Samples were collected just before drug ingestion and at 1, 2, 3, 4, 6, 8, and 12 h after drug ingestion to measure plasma drug concentration using an HPLC-MS/MS assay.ResultsThe Cmax and AUC0–12hmedians in arm A (Cmax = 296 ng/mL, IQR: 205–45; AUC0–12h = 2528 ng.h/mL, IQR: 1684–2735) were lower than those in arm B (Cmax = 600 ng/mL, IQR: 403–717; AUC0–12h = 4042.5 ng.h/mL, IQR: 3469–5761), with a statistically significant difference in AUC0–12h(p = 0.044) but not in Cmax (p = 0.313). No significant differences were observed in Tmax (3 h versus 4 h). Five patients had a Cmax below the plasma therapeutic limit ( 64 ng/mL) in the 300 mg RBT arm, while 4/9 patients had such values in the 150 mg RBT arm.ConclusionThis study confirmed that the 150 mg dose of rifabutin ingested EOD in combination with LPV/r is inadequate and could lead to selection of rifamycin-resistant mycobacteria.Trial registrationPACTR201310000629390, 28th October 2013.

No large study to date has ever evaluated the effectiveness, safety and tolerability of imipenem/clavulanateversusmeropenem/clavulanate to treat multidrug- and extensively drug-resistant tuberculosis (MDR- and XDR-TB). The aim of this observational study was to compare the therapeutic contribution of imipenem/clavulanateversusmeropenem/clavulanate added to background regimens to treat MDR- and XDR-TB cases.84 patients treated with imipenem/clavulanate-containing regimens showed a similar median number of antibiotic resistances (8versus8) but more fluoroquinolone resistance (79.0%versus48.9%, pversus49.0%, p=0.01) in comparison with 96 patients exposed to meropenem/clavulanate-containing regimens. Patients were treated with imipenem/clavulanate- and meropenem/clavulanate-containing regimens for a median (interquartile range) of 187 (60–428)versus85 (49–156) days, respectively.Statistically significant differences were observed on sputum smear and culture conversion rates (79.7%versus94.8%, p=0.02 and 71.9%versus94.8%, pversus77.5%, p=0.03). Adverse events to imipenem/clavulanate and meropenem/clavulanate were reported in 5.4% and 6.5% of cases only.Our study suggests that meropenem/clavulanate is more effective than imipenem/clavulanate in treating MDR/XDR-TB patients.

Background We carried out a study to evaluate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae genital infections in school-based adolescents in Northern Italy. Methods Systematic screening for C. trachomatis and N. gonorrhoeae genital infection was performed in 13th grade students in the province of Brescia, an industrialized area in Northern Italy. Student filled in a questionnaire on sexual behaviour and provided a urine sample for microbiological testing. Results A total of 2,718 students (mean age: 18.4 years; 59.1 % females) provided complete data (62.2 % of those eligible). Overall 2,059 students (75.8 %) were sexually active (i.e. had had at least one partner), and the mean age at sexual debut was 16.1 years (SD: 1.4). Only 27.5 % of the sexually active students reported regular condom use during the previous 6 months, with higher frequency in males than in females (33.8 % vs 24.2 %). No case of N. gonorrhoeae infection was detected, while C. trachomatis was found in 36 adolescents, with a prevalence of 1.7 % (95 % CI: 1.2–2.4) among sexually active students, and no statistical difference between females and males (1.9 and 1.4 %, respectively). Inconsistent condom use (odds ratio, OR = 5.5) and having had more than one sexual partner during the previous 6 months (OR = 6.8) were associated with an increased risk of Chlamydia infection at multivariate analysis. Conclusion The prevalence of C. trachomatis infection among sexually active adolescents in Northern Italy was low, despite a high proportion of students who engage in risky sexual behaviour. No cases of N. gonorrhoeae infection were identified. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2839-x) contains supplementary material, which is available to authorized users.

BACKGROUND Although the management of latent tuberculous infection (LTBI) is a core component of the End TB Strategy, there is limited information about the status of implementation of such interventions in most African countries. METHODS A web-based survey involving the 47 countries of the African Region was conducted between November 2016 and April 2017. RESULTS The questionnaire was completed by 32/47 (68.1%) National TB Programme managers or their delegates. LTBI guidelines were available in four countries (12.5%), while 13 (40.6%) had an LTBI section in their national TB guidelines; there was no significant association with socio-economic conditions and funding allocation. LTBI diagnosis was mostly based on clinical evaluation to rule out active disease, rather than on systematic use of the tuberculin skin test. Respectively 23 (71.8%) and 17 countries (53.1%) reported providing treatment to child contacts aged

To develop and test a simple system for recording and reporting the diagnosis and treatment of latent tuberculosis infection and to compare the effects of passive and active tracing of child contacts on indicators of such infection.We revised Burkina Faso's latent tuberculosis infection register and quarterly tuberculosis reporting form. Subsequently, coverage of the routine screening of contacts, who were younger than five years, for active tuberculosis and the corresponding percentages of such contacts who, if eligible, initiated preventive therapy were measured, nationwide, between 1 April 2016 and 31 March 2017. In 2016, we evaluated indicators of latent tuberculosis infection in the Hauts-Bassins region before and after community health workers had begun the active tracing of contacts who were younger than five years.In Burkina Faso, during our study period, 3717 cases of pulmonary tuberculosis and 1166 corresponding contacts who were younger than five years were reported as the result of routine screening and passive contact tracing. The overall contact:index ratio was 0.31 and corresponding screening coverage was 82.0% (956/1166) and proportion of children starting on preventive treatment was 90.5% (852/941). Active tracing in Hauts-Bassins led to a substantially higher contact/index ratio (1.83) and screening coverage (99.3%; 145/146).The newly established recording and reporting system proved feasible and user-friendly and allowed measurement of global indicators of latent tuberculosis infection. Compared with active tracing, passive tracing led to much lower estimates of the numbers of child contacts.Élaborer et tester un système simple pour enregistrer et déclarer le diagnostic et le traitement des cas d'infection tuberculeuse latente et comparer les effets de la recherche passive et active des contacts enfants sur les indicateurs de cette infection.Nous avons passé en revue le registre des infections tuberculeuses latentes et le formulaire de rapport trimestriel des cas de tuberculose du Burkina Faso. Ensuite, nous avons mesuré, dans tout le pays, entre le 1Au Burkina Faso, au cours de la période étudiée, 3717 cas de tuberculose pulmonaire et 1166 contacts correspondants âgés de moins de cinq ans ont été déclarés dans le cadre du dépistage systématique et de la recherche passive des contacts. Le ratio total contacts/cas index était de 0,31 et le taux de couverture du dépistage correspondant s'élevait à 82,0% (956/1166), tandis que la proportion d'enfants ayant commencé un traitement préventif était de 90,5% (852/941). La recherche active dans les Hauts-Bassins a entraîné une hausse sensible du ratio total contacts/cas index (1,83) et du taux de couverture du dépistage (99,3%; 145/146).Le nouveau système d'enregistrement et de déclaration s'est avéré utilisable et convivial et a permis de mesurer les indicateurs globaux de l'infection tuberculeuse latente. En comparaison avec la recherche active, la recherche passive a généré des estimations beaucoup plus faibles du nombre de contacts enfants.Desarrollar y probar un sistema simple de registro y presentación de informes sobre el diagnóstico y el tratamiento de la infección tuberculosa latente y comparar los efectos del seguimiento pasivo y activo de los contactos infantiles con indicadores de dicha infección.Se revisó el registro de infección tuberculosa latente de Burkina Faso y el formulario trimestral de información sobre la tuberculosis. Posteriormente, se midió la cobertura de los exámenes de detección rutinarios a los contactos, menores de cinco años, para la tuberculosis activa y los porcentajes correspondientes de contactos que, de ser aptos, iniciaron la terapia preventiva a nivel nacional, entre el 1 de abril de 2016 y el 31 de marzo de 2017. En 2016, se evaluaron los indicadores de infección tuberculosa latente en la región de Hauts-Bassins antes y después de que los trabajadores comunitarios de la salud empezaran el seguimiento activo de los contactos menores de cinco años.En Burkina Faso, en nuestro periodo de estudio, se registraron 3717 casos de tuberculosis pulmonar y 1166 contactos correspondientes de menos de cinco años como resultado de un examen rutinario y un seguimiento del contacto pasivo. La tasa global de índice de contacto fue del 0,31 y la cobertura de detección correspondiente fue del 82,0% (956/1166), además, la proporción de niños que iniciaron el tratamiento preventivo fue del 90,5% (852/941). El seguimiento activo en Hauts-Bassins dio lugar a una relación de contacto/índice (1,83) y una cobertura de detección (99,3%; 145/146) sustancialmente más altas.El recién establecido sistema simple de registro y presentación de informes resultó factible y fácil de usar y permitió la medición de indicadores globales de la infección tuberculosa latente. En comparación con el seguimiento activo, el seguimiento pasivo dio lugar a estimaciones mucho más bajas de la cantidad de contactos secundarios.وضع واختبار نظام بسيط للتسجيل والإبلاغ عن حالات تشخيص وعلاج العدوى الكامنة بداء السل، ومقارنة آثار التتبع السلبي والنشط لحالات تعرض الأطفال إلى المرض بمؤشرات تلك العدوى.لقد راجعنا سجل الإصابة بداء السل الكامن في بوركينا فاصو، ونموذج البلاغات ربع السنوية للإصابة بداء السل. وبعد ذلك، تم قياس حجم تغطية الفحص الدوري لحالات الاتصال بالمرض بين الأطفال دون سن خمس سنوات للكشف عن حالات الإصابة النشطة بداء السل وما يقابلها من نسب الاتصال بالمرض بين الأطفال الذين شرعوا في تعاطي العلاج الوقائي إذا كانوا مؤهلين له، وذلك على مستوى البلاد في الفترة ما بين 1 أبريل/نيسان 2016 و31 مارس/آذار 2017. وفي عام 2016، قمنا بتقييم مؤشرات الإصابة بداء السل الكامن في منطقة أوت باسان قبل وبعد قيام الأخصائيين الصحيين المجتمعيين بالبدء في عمليات التتبع النشط لحالات الاتصال بالمرض بين الأطفال الذين تقل أعمارهم عن خمس سنوات.في بوركينا فاصو، تم الإبلاغ عن 3717 حالة للإصابة بداء السل الرئوي و1166 حالة مقابلة من الاتصال بالمرض بين الأطفال الأقل من خمس سنوات – كنتيجة للفحص الدوري وعمليات التتبع السلبي – وذلك خلال فترة الدراسة. وبلغت النسبة الإجمالية لحالات التعرض للمرض إلى مؤشر الإصابة 0.31، أما النسبة المقابلة لشمول خدمات الفحص فبلغت نسبتها 82.0‏% (بواقع ‏956/1166)، وبلغت نسبة الأطفال الذين بدأوا العلاج الوقائي 90.5‏% (852/941). وقادت عمليات التتبع النشط في منطقة أوت باسان إلى ارتفاع ملحوظ في نسبة حالات التعرض للمرض إلى مؤشر الإصابة (1.83)، أما نسبة شمول خدمات الفحص فبلغت (99.3‏%؛ 145/146).أثبت النظام الذي تم تأسيسه مؤخرًا لتسجيل حالات الإصابة وتقديم البلاغات عنها جدواه وسهولة استخدامه، وسمح بقياس المؤشرات العالمية لحالات العدوى الكامنة بداء السل. وبالمقارنة مع عمليات التتبع النشط، فقد قاد التتبع السلبي إلى تقديرات أقل كثيرًا لأعداد الأطفال الذين تعرضوا إلى الاتصال بالمرض.研发并测试一个简易系统，用于记录和报告潜在结核病感染的诊断与治疗，并对此类感染指标下针对儿童接触者分别进行被动追踪和主动追踪的效果进行比较。.我们修订了布基纳法索潜在结核病感染登记和季度结核病申报表。随后，在 2016 年 4 月 1 日至 2017 年 3 月 31 日之间，针对年龄不足 5 岁的活动性结核病患者进行常规性筛查并对此类符合条件的接触者开始实施预防性治疗，分别测量其在全国范围内的覆盖率和相应的百分比。2016 年，我们先评估了上盆地大区潜在结核病感染指标，之后，社区健康工作者开始积极追踪年龄不足 5 岁的儿童接触者。.在我们研究期间，经过常规性筛查和被动接触追踪，据报告称，布基纳法索有 3717 例结核病案例和 1166 位年龄不足 5 岁的相应接触者。总体接触指数比为 0.31，相应的筛查覆盖率为 82.0%（956/1166)，开始预防性治疗的儿童比例为 90.5%（852/941)。对上盆地大区的结核病积极追踪导致更高的接触指数比 （1.83） 和筛查覆盖率 （99.3%，145/146）。.新建立的记录报告系统被证明行之有效且用户友好，其可以评估潜伏结核病感染的全球指标。与积极追踪相比，消极追踪会造成对儿童接触者数量的低估。.Разработать и протестировать простую систему регистрации и отчетности для диагностики и лечения латентной туберкулезной инфекции и сравнить влияние пассивного и активного отслеживания детей, находившихся в контакте с инфицированным человеком, на показатели такой инфекции.Авторы изучили реестр лиц, больных латентным туберкулезом, в Буркина-Фасо и ежеквартальную форму отчетности о количестве больных туберкулезом. После этого по всей стране в период с 1 апреля 2016 года по 31 марта 2017 года была проведена оценка охвата регулярным скрининговым обследованием детей младше пяти лет, находившихся в контакте с инфицированным человеком, на предмет выявления активного туберкулеза и соответствующей доли таких детей, для которых при необходимости была назначена профилактическая терапия. В 2016 году мы оценили показатели латентной туберкулезной инфекции в области Верхних Бассейнов до и после того, как работники здравоохранения начали активное отслеживание детей младше пяти лет, находившихся в контакте с инфицированным человеком.В Буркина-Фасо в течение периода исследования авторов в результате регулярного скрининга и пассивного отслеживания контактов было зарегистрировано 3717 случаев туберкулеза легких и 1166 соответствующих детей младше пяти лет, находившихся в контакте с инфицированным человеком. Общее соотношение «контакт/показатель» составило 0,31, соответствующий охват скрининговым обследованием — 82,0% (956/1166), а доля детей, для которых было назначено профилактическое лечение, — 90,5% (852/941). Активное отслеживание в области Верхних Бассейнов привело к значительно более высокому соотношению «контакт/показатель» (1,83) и охвату скрининговым обследованием (99,3%, 145/146).Недавно созданная система регистрации и отчетности оказалась выполнимой и удобной для пользователей и позволила измерить глобальные показатели латентной туберкулезной инфекции. При сравнении с активным отслеживанием пассивное отслеживание привело к значительно более низким показателям количества детей, находившихся в контакте с инфицированным человеком.

BACKGROUND Tuberculosis (TB) is the major cause of mortality in HIV-infected children globally. Current guidelines about the management of antiretroviral therapy in children with TB are based on a limited number of nonrandomized studies involving small numbers of participants. The aim of the study was to systematically retrieve and critically appraise available evidence on the efficacy and safety of different antiretroviral regimens in children with HIV infection who are receiving treatment for active TB. METHODS We conducted a systematic review of the literature according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Records were retrieved through March 2016 from Medline, Embase and manual screening of key conference proceedings. Four specific research questions assessing available treatment options were defined. RESULTS Although 4 independent searches were conducted (1 for each Population, Intervention, Comparator, Outcomes question), results were elaborated and interpreted together because of significant overlap among the retrieved records. Six observational studies were selected for qualitative synthesis while meta-analysis could not be performed. CONCLUSION Evidence for optimal treatment options for HIV/TB coinfected children is limited. As the global community strives to reach the fast-track HIV treatment targets and eliminate childhood TB deaths, it must ensure that coinfected children are included in key treatment studies and expand this neglected but crucial area of research.

Tuberculosis (TB) is a major public health issue worldwide, with ~9.6 million new incident cases and 1.5 million deaths in 2014. The End-TB Strategy launched by the World Health Organization in the context of the post-2015 agenda aims to markedly abate the scourge of TB towards global elimination, by improving current diagnostic and therapeutic practices, promoting preventative interventions, stimulating government commitment and increased financing, and intensifying research and innovation. The emergence and spread of multidrug-resistant strains is currently among the greatest concerns, which may hinder the achievement of future goals. It is crucial that primary healthcare providers are sufficiently familiar with the basic principles of TB diagnosis and care, to ensure early case detection and prompt referral to specialised centres for treatment initiation and follow-up. Given their special relationship with patients, they are in the best position to promote educational interventions and identify at-risk individuals as well as to improve adherence to treatment.

No large study has ever evaluated the efficacy, safety and tolerability of meropenem/clavulanate to treat multidrug- and extensively drug-resistant tuberculosis (MDR- and XDR-TB). The aim of this observational study was to evaluate the therapeutic contribution, effectiveness, safety and tolerability profile of meropenem/clavulanate added to a background regimen when treating MDR- and XDR-TB cases.Patients treated with a meropenem/clavulanate-containing regimen (n=96) showed a greater drug resistance profile than those exposed to a meropenem/clavulanate-sparing regimen (n=168): in the former group XDR-TB was more frequent (49% versus 6.0%, pversus 5 (4–6)). Patients were treated with a meropenem/clavulanate-containing regimen for a median (IQR) of 85 (49–156) days.No statistically significant differences were observed in the overall MDR-TB cohort and in the subgroups with and without the XDR-TB patients; in particular, sputum smear and culture conversion rates were similar in XDR-TB patients exposed to meropenem/clavulanate-containing regimens (88.0% versus 100.0%, p=1.00 and 88.0% versus 100.0%, p=1.00, respectively). Only six cases reported adverse events attributable to meropenem/clavulanate (four of them then restarting treatment).The nondifferent outcomes and bacteriological conversion rate observed in cases who were more severe than controls might imply that meropenem/clavulanate could be active in treating MDR- and XDR-TB cases.

Simon Tiberi, Giovanni Sotgiu, Lia D’Ambrosio, Rosella Centis, Marcos Abdo Arbex, Edith Alarcon Arrascue, Jan Willem Alffenaar, Jose A. Caminero, Mina Gaga, Gina Gualano, Alena Skrahina, Ivan Solovic, Giorgia Sulis, Marina Tadolini, Valentina Alarcon Guizado, Saverio De Lorenzo, Aurora Jazmin Roby Arias, Anna Scardigli, Onno W. Akkerman, Alena Aleksa, Janina Artsukevich, Vera Avchinko, Eduardo Henrique Bonini, Felix Antonio Chong Marin, Lorena Collahuazo Lopez, Gerard de Vries, Simone Dore, Heinke Kunst, Alberto Matteelli, Charalampos Moschos, Fabrizio Palmieri, Apostolos Papavasileiou, Marie-Christine Payen, Andrea Piana, Antonio Spanevello, Dante Vargas Vasquez, Pietro Viggiani, Veronica White, Alimuddin Zumla and Giovanni Battista Migliori

Evaluation of drug resistances is needed to identify candidates for the shorter regimen in MDR-TB hot spots http://ow.ly/wZV33022VXt

Tuberculosis (TB) is a major public health concern worldwide: despite a regular, although slow, decline in incidence over the last decade, as many as 8.6 million new cases and 1.3 million deaths were estimated to have occurred in 2012. TB is by all means a poverty-related disease, mainly affecting the most vulnerable populations in the poorest countries. The presence of multidrug-resistant strains of M. tuberculosis in most countries, with some where prevalence is high, is among the major challenges for TB control, which may hinder recent achievements especially in some settings. Early TB case detection especially in resource-constrained settings and in marginalized groups remains a challenge, and about 3 million people are estimated to remain undiagnosed or not notified and untreated. The World Health Organization (WHO) has recently launched the new global TB strategy for the “post-2015 era” aimed at “ending the global TB epidemic” by 2035, based on the three pillars that emphasize patient-centred TB care and prevention, bold policies and supportive systems, and intensified research and innovation.This paper aims to provide an overview of the global TB epidemiology as well as of the main challenges that must be faced to eliminate the disease as a public health problem everywhere.

Background Aim of our study is to investigate the clinical and immunological outcomes according to first-line HAART adherence in a large cohort of HIV-infected patients in Burkina Faso. Methods A retrospective study was conducted between 2001 and 2009 among patients from two urban medical centers [St. Camille Medical Center (CMSC) and “Pietro Annigoni” Biomolecular Research Center (CERBA)] and 1 in the rural District of Nanoro (St. Camille District Hospital). Socio-demographical and clinical data were analyzed. Adherence was evaluated through a questionnaire investigating 5 key points related to drugs, consultations and blood exams, by assigning 0 to 2 points each up to 10 points overall. Data were collected at baseline and regularly thereafter. Adherence score was considered as a continuous variable and classified in optimal (8–10 points) and sub-optimal (0–7 points). Immunological outcome was evaluated as modification in CD4+ T-cell count over time, while predictors of death were explored by a univariate and multivariate Cox model considering adherence score as a time-varying covariate. Results A total of 625 patients were included: 455 (72.8%) were females, the median age was 33.3 (IQR 10.2) years, 204 (32.6.%) were illiterates, the median CD4+ T-cell count was 149 (IQR 114) cells/μl at baseline. At the end of the observation period we recorded 60/625 deaths and 40 lost to follow-up. The analysis of immunological outcomes showed a significant variation in CD4+ T-cell count between M12 and M24 only for patients with optimal adherence (Δ=78.2, p