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Rationale South African adolescents carry a high tuberculosis disease burden. It is not known if schools are high-risk settings for Mycobacterium tuberculosis (MTB) transmission. Objectives To detect airborne MTB genomic DNA in classrooms. Methods We studied 72 classrooms occupied by 1,836 students in two South African schools. High-volume air filtration was performed for median 40 minutes (interquartile range 35-54) and assayed by droplet digital PCR (ddPCR) targeting MTB Region of Difference 9 (RD9), with concurrent CO2 concentration measurement. Classroom data were benchmarked against public health clinics. Students who consented to individual TB screening completed a questionnaire and sputum collection (Xpert MTB/RIF Ultra) if symptom-positive. Poisson statistics were used for MTB RD9 copy quantification. Measurements and Main Results ddPCR assays were positive in 13/72 (18.1%) classroom and 4/39 (10.3%) clinic measurements (p=0.276). Median ambient CO2 concentration was 886 ppm (IQR 747-1223) in classrooms vs. 490 ppm (IQR 405-587) in clinics (p

Background: The World Health Organization is considering substituting Xpert MTB/RIF (Xpert) with Xpert MTB/RIF Ultra (Ultra) for tuberculosis (TB) diagnosis, but supportive evidence is scarce, particularly among people more likely (presumptive) to have paucibacillary pulmonary TB (PTB). Methods: During January-July 2018, presumptive PTB patients visiting TB Screening and Treatment Centres of Dhaka for routine chest X-ray (CXR) and conventional Xpert were enrolled. Sputum specimens were additionally tested with microscopy, culture, and Ultra. Specimens with “Trace call” by Ultra (Ultra-trace) were retested. Yield and diagnostic accuracy using various approaches to Ultra-trace and concordance of Ultra with bacteriological-positive PTB were assessed. Results: Altogether, 1,083 participants (104 ‘Xpert-positive’; 979 ‘Xpert-negative and CXR-suggestive’) were enrolled. All Xpert-positives and 900 (92%) Xpert-negatives were concordant with Ultra, however, seventy-nine (8.1%) Xpert-negative specimens tested positive with Ultra; 37 (46.8%) were categorically positives, and 42 (53.2%) were Ultra-trace. Sixteen of the 42 were retested, of whom eight (50.1%) Ultra-trace turned categorically positive, leading to 45 (4.6%) additionally detected by Ultra. Ultra sensitivity and specificity were 93.9% and 94.6%, and it additionally detected 5.4% more TB patients with a concordance of 94.6% (kappa, □=0.78) compared to any bacteriologically positive specimen (microscopy, culture, or Xpert). Conclusion: Ultra exhibited improved detection and accuracy among Xpert-negatives in a cohort with a high likelihood of PTB.

BACKGROUND: Preventing tuberculosis (TB) in children needs the family to be engaged; however, limited studies about how the family engages in TB prevention. AIM: This aimed of study was to develop the process of family engagement in TB prevention for children with household contact of TB patient. METHODS: Guided by Straussian grounded theory, we developed a substantive theory from 14 primary caregivers in West Java-Indonesia as the key participants of families whose child ≤5 years old received TB screening and preventive therapy, and have had an adult in the household with active TB diagnosis. Data were collected by in-depth interviews and analyzed by coding procedures. RESULTS: Sustaining togetherness aimed to maintain the children’s health, which underpinned three main stages that consisted of “moving from fear to realization,” “making the family’s collective decision,” and “holding on together.” CONCLUSION: Implications for nursing practice in providing optimum care of preventing TB among children through engagement of family.

SETTING: Migrants to Europe face a disproportionate burden of infections, including TB, yet little is known about the approach taken by primary and secondary care providers to screening and treatment. We therefore explored policy and practice relating to screening of active TB and latent TB infection (LTBI) in France.METHODS: We conducted an online national survey of French primary and secondary care physicians regarding their practices in relation to TB/LTBI screening among migrants.RESULTS: 367 physicians responded to the questionnaire among which 195 (53.1%) were primary care physicians, 126 (34.3%) were TB specialists in secondary care, and 46 (12.5%) other physicians; 303 (85.5%) were involved daily in the care of migrants. Most respondents recommended systematic TB screening with chest X-ray for migrants from medium and high-incidence countries (71.9%). Primary care physicians were less likely to offer screening than physicians in other settings (aOR 0.21, 95% CI 0.09–0.48). 220 (61.8%) offered LTBI screening for children (CONCLUSION: Improving awareness on TB screening is a critical next step to improve health outcomes in migrant groups and meet regional targets for tackling TB.

Background: TB screening in children having close contact with smear-positive TB patients is urgent to conduct to improve the case detection rate and to achieve the “End TB” target. In fact, the implementation of screening in Indonesia is still inadequate.Objective: To analyze the factors associated with the non-adherence of TB screening in children aged

Introduction: Systematic screening for TB among patients presenting to care and among high risk populations is recom- mended to improve TB case finding. We aimed to describe the comparative yield of three TB screening approaches imple- mented by a large urban TB project in central Uganda. Methods: We abstracted data on the screening cascade from 65 health facilities and their surrounding communities (num- bers screened, with presumptive TB, receiving a diagnostic test and diagnosed with TB) from the different clinic and com- munity TB registers. Results: From January 2018 to December 2019, 93,378 (24%) of all patients screened at health facilities had presumptive TB; 77,381 (82.9%) received a diagnostic test and 14,305 (18.5%) were diagnosed with TB. The screening yield (the number of patients diagnosed with TB out of all patients screened) was 0.3% and was three times higher among men than women (0.6% vs 0.2% p

Background: The School of Pharmacy of the University of the Western Cape implemented a service learning programme where second year students participated in tuberculosis (TB) screening. Objectives: To determine the views of students and nurses about student-led TB screening at primary healthcare (PHC) facilities. Methods: The study was descriptive and quantitative. The target populations were pharmacy students and nurses, who completed self-administered semi-structured questionnaires. Results: Study participants included 99 students from 19 facilities and 38 nurses who represented 15 facilities. Students had screened 1323 patients and referred 210 for further testing. Students and nurses felt students were adequately trained to conduct TB screening and seemed to screen patients with ease. Students and nurses believed that students gained more TB knowledge and clinical experience. Students also believed the TB screenings were beneficial to the patients and nurses. Conclusion: Students and nurses perceived the outcomes of student-led TB screening to be mostly positive.

Background Active tuberculosis (TB) during pregnancy has an adverse effect on maternal and neonatal outcomes. This study analysed the results of a pilot project integrating TB screening into antenatal care (ANC) visits in a high-TB-burden, low-resource setting. Methods Data were extracted from the TB screening pilot in obstetrician-gynaecologist clinics of six tertiary care facilities in Karachi, Pakistan from April to December 2017. Data from the verbal symptom screening conducted at each ANC visit for all women and the Xpert MTB/RIF testing for all symptomatic women to investigate TB yield were analysed by assessing the numbers screened, presumptive patients and active TB diagnoses among pregnant women and neonates. Results Symptom screening was performed on 113,078 pregnant women, 2,965 (2.6%) of whom reported at least one TB symptom. Sputum samples were collected from 2,896 (97.7%) symptomatic women. Of the 27 (0.9%) newly diagnosed bacteriologically positive TB patients, 25 (93%) initiated TB treatment. No case of vertical TB transmission was reported among 26 live births. Discussion TB screening is feasible and should be implemented during routine ANC visits in high-TB-burden settings. There is a need to explore a multi-faceted approach with inclusion of clinical examination and chest X-rays to diagnose TB in pregnant women.

Background: In high TB/HIV settings, the increased risk for TB amongst children exposed to HIV has been established through biomedical tests. Screening HIV exposed children for TB can improve early childhood TB detection and treatment. Objective: This study assessed the utility of a modified World Health Organization (WHO) tool by including HIV variables, to determine TB exposure amongst HIV exposed children presenting to a “Well Child” Clinic (CWC). Methods: Clinical data were obtained from medical records and/or from the caregivers of children presenting to CWC. Data was analyzed to explore factors associated with positive screening for TB, including being exposed to HIV and current HIV status. Results: Five percent (55/1100) screened reported a close TB contact and 21% (n=231) had positive TB symptom screen. History of close TB contact was a risk factor for positive screening for TB symptoms (OR 1.89 CI 1.05-3.4) while being HIV negative was protective (OR 0.3, Cl 0.19-0.62). HIV exposure was associated with increased risk of TB exposure (OR 2.9 CI 1.61-5.19). Conclusion: Integrating HIV variables in the existing WHO screening tool for childhood TB can be useful in early detec- tion and treatment of TB in HIV exposed children in resource limited settings. Keywords: Childhood TB screening; HIV Exposure screening; TB/HIV integration.

Tuberculosis (TB) is a dangerous bacterial infection. The illness is extremely infectious and is normally spread from person to person by inhaling bacteria-carrying air droplets. TB is a disease that mostly affects the lungs, although it may also affect other organs. It has culminated in a progressive rise in the number of orphans owing to parental deaths, and is projected to be 10 million, with maternal mortality accounting for 6%-15% of the total, or 15%-34% if only indirect factors are included. TB screening is performed using a clinical procedure that looks for current cough, sputum intake, temperature, weight loss, and night sweats. The pursuit of fresh, urgently required anti-TB drugs from natural sources necessitates a multidisciplinary approach. The usage of allopathic medications in such a complicated disease leads to more serious complications such as cross-resistance, whereas natural drugs have been seen to be more effective in this situation. The key criterion is the exploration of new remedies for the effective weakening of the unstable disease associated with TB.

Background Pediatric tuberculosis (TB), human immunodeficiency virus (HIV), and TB-HIV co-infection are health problems with evidence-based diagnostic and treatment algorithms that can reduce morbidity and mortality. Implementation and operational barriers affect adherence to guidelines in many resource-constrained settings, negatively affecting patient outcomes. This study aimed to assess performance in the pediatric HIV and TB care cascades in Mozambique. Methods A retrospective analysis of routine PEPFAR site-level HIV and TB data from 2012 to 2016 was performed. Patients 0–14 years of age were included. Descriptive statistics were used to report trends in TB and HIV indicators. Linear regression was done to assess associations of site-level variables with performance in the pediatric TB and HIV care cascades using 2016 data. Results Routine HIV testing and cotrimoxazole initiation for co-infected children in the TB program were nearly optimal at 99% and 96% in 2016, respectively. Antiretroviral therapy (ART) initiation was lower at 87%, but steadily improved from 2012 to 2016. From the HIV program, TB screening at the last consultation rose steadily over the study period, reaching 82% in 2016. The percentage of newly enrolled children who received either TB treatment or isoniazid preventive treatment (IPT) also steadily improved in all provinces, but in 2016 was only at 42% nationally. Larger volume sites were significantly more likely to complete the pediatric HIV and TB care cascades in 2016 (p value range 0.05 to Conclusions Mozambique has made significant strides in improving the pediatric care cascades for children with TB and HIV, but there were missed opportunities for TB diagnosis and prevention, with IPT utilization being particularly problematic. Strengthened TB/HIV programming that continues to focus on pediatric ART scale-up while improving delivery of TB preventive therapy, either with IPT or newer rifapentine-based regimens for age-eligible children, is needed.

Background Substantial numbers of patients are now receiving either immunosuppressive therapies or chemotherapy. There are significant risks in such patients of developing opportunistic infections or re-activation of latent infections, with higher associated morbidity and mortality. The aim of this quality improvement project was to determine how effective 5 different specialties were in assessing and mitigating risks of developing opportunistic infections or re-activation of latent infections in patients undergoing immunosuppressive therapies. Methods This was a single centre audit where records of patients attending clinics providing immunosuppressive therapies were reviewed for the following: evidence of screening for blood-borne virus [BBV] infections, varicella and measles immunity, latent/active TB or hypogammaglobulinaemia, and whether appropriate vaccines had been advised or various infection risks discussed. These assessments were audited against both national and international guidelines, or a cross-specialty consensus guideline where specific recommendations were lacking. Two sub-populations were also analysed separately: patients receiving more potent immunosuppression and black and minority ethnic [BME] patients,. Results For the 204 patients fulfilling the inclusion criteria, BBV, varicella/measles and latent TB screening was inconsistent, as was advice for vaccinations, with few areas complying with specialty or consensus guidelines. Less than 10% of patients in one specialty were tested for HIV. In BME patients screening for HIV [60%], measles [0%] and varicella [40%] immunity and latent [30%] or active [20%] TB was low. Only 38% of patients receiving potent immunosuppression received Pneumocystis prophylaxis, with 3 of 4 specialties providing less than 15% of patients in this category with prophylaxis. Conclusions Compliance with guidelines to mitigate risks of infection from immunosuppressive therapies was either inconsistent or poor for most specialties. New approaches to highlight such risks and assist appropriate pre-immunosuppression screening are needed.

BACKGROUND: Correctional inmates are at a high risk of tuberculosis (TB). The optimal approach to screening this population is unclear.METHODS: We retrospectively reviewed records from TB screening in 64 correctional facilities in South Africa between January 2015 and July 2016. Inmates received symptom screening (any of cough, fever, weight loss, or night sweats) combined with digital chest X-ray (CXR), when available. CXRs were assessed as ‘abnormal' or with no abnormalities. Inmates with either a symptom or an ‘abnormal' CXR were asked to provide a single spot sputum for Xpert® MTB/RIF testing. We estimated the incremental cost-effectiveness ratio (ICER) per additional TB case detected using CXR screening among asymptomatic inmates.RESULTS: Of 61 580 inmates, CXR screening was available for 41 852. Of these, 19 711 (47.1%) had TB symptoms. Among 22 141 inmates without symptoms, 1939/19 783 (9.8%) had an abnormal CXR, and 8 (1.2%) were Xpert-positive among those with Xpert tests done. Of 14 942 who received symptom screening only and had symptoms, 84% (12 616) had an Xpert result, and 105 (0.8%) were positive. The ICER for CXR screening was US$22 278.CONCLUSION: Having CXR in addition to symptom screening increased yield but added considerable cost. A major limitation of screening was the low specificity of the symptom screen.

BackgroundCommunity-based screening for tuberculosis (TB) could improve detection but is resource intensive. We set out to evaluate the accuracy of computer-aided TB screening using digital chest X-ray (CXR) to determine if this approach met target product profiles (TPP) for community-based screening.MethodsCXR images from participants in the 2016 Kenya National TB Prevalence Survey were evaluated using CAD4TBv6 (Delft Imaging), giving a probabilistic score for pulmonary TB ranging from 0 (low probability) to 99 (high probability). We constructed a Bayesian latent class model to estimate the accuracy of CAD4TBv6 screening compared to bacteriologically-confirmed TB across CAD4TBv6 threshold cut-offs, incorporating data on Clinical Officer CXR interpretation, participant demographics (age, sex, TB symptoms, previous TB history), and sputum results. We compared model-estimated sensitivity and specificity of CAD4TBv6 to optimum and minimum TPPs.ResultsOf 63,050 prevalence survey participants, 61,848 (98%) had analysable CXR images, and 8,966 (14.5%) underwent sputum bacteriological testing; 298 had bacteriologically-confirmed pulmonary TB. Median CAD4TBv6 scores for participants with bacteriologically-confirmed TB were significantly higher (72, IQR: 58-82.75) compared to participants with bacteriologically-negative sputum results (49, IQR: 44-57, pConclusionsCAD4TBv6 met the optimal TPP for TB community screening. To optimise screening accuracy and efficiency of confirmatory sputum testing, we recommend that an adaptive approach to threshold setting is adopted based on participant characteristics.Take home messageCAD4TBv6 met the optimal WHO target product profile for a community TB screening tool. Specificity was lower in adults with previous TB and those aged 41 years or older; an adaptive approach to setting CAD thresholds will likely be required to optimize use.

Background Tuberculosis screening of people living with HIV (PLHIV) – an intervention to reduce the burden of TB among PLHIV – is being implemented at HIV clinics in Ghana since 2007, but TB screening coverage remains low. Facility adherence to intervention guidelines may be a factor but is missing in implementation science literature. This study assesses the level of HIV clinic adherence to the guidelines and related facility characteristics in selected district hospitals in Ghana. Methods This cross-sectional study was conducted in all 27 district hospitals with HIV clinics, X-ray and geneXpert machines in Ghana. These hospitals are in 27 districts representing about 27% of the 100 district hospitals with HIV clinics in Ghana. A data collection tool with 18-items (maximum score of 29) was developed from the TB/HIV collaborative guidelines to assess facility adherence to four interrelated components of the TB screening programme as stated in the guidelines: intensive TB case-finding among PLHIV (ITCF), Isoniazid preventive therapy initiation (IPT), TB infection control (TIC), and programme review meetings (PRM). Data were collected through record review and interviews with 27 key informants from each hospital. Adherence scores per component were summed to determine an overall adherence score per facility and summarized using medians and converted to proportions. Facility characteristics were assessed and compared across facilities with high (above median) versus low (below median) overall adherence scores, using nonparametric test statistics. Results From the 27 key interviews and facility records reviewed, the median adherence scores for ITCF, IPT, TIC, and PRM components were 85.7% (IQR: 85.5–100.0), 0% (IQR: 0–66.7), 33.3% (IQR: 33.3–50.0), and 90.0% (IQR: 70.0–90.0), respectively. The overall median adherence score was 62.1% (IQR: 58.6–65.1), and 17 clinics (63%) with overall adherence score above the median were categorized as high adherence. Compared to low adherence facilities, high adherence facilities had statistically significant lower PLHIV clinic attendees per month (256 (IQR: 60–904) vs. 900 (IQR: 609–2622); p = 0.042), and lower HIV provider workloads (28.6 (IQR: 8.6–113) vs. 90 (IQR: 66.7–263.5); p = 0.046), and most had screening guidelines (76%, p p Conclusion PRM had highest score while the IPT component had the lowest score. Almost a third of the facilities implemented the TB screening programme activities with a high level of adherence to the guidelines. We suggest to ensure adherence to all four components, reducing staff workloads and making TB screening questionnaires and guidelines available on-site would increase facility adherence to the intervention and ultimately achieve intervention targets.

European countries are increasingly targeting migrant populations in latent TB programmes. Dr Zenner will describe recent initiatives to deliver these often complex screening programmes through primary care services, exploring lessons learned and best practice approaches.

Tuberculosis is an infectious bacterial disease that mainly impacts the lungs. But these bacteria could attack any part of the body such as the kidney, brain, and spine. Therefore, if tuberculosis is not detected early, it could damage the body parts may also lead to death. In contrast to other infectious diseases, the diagnosis of tuberculosis is highly doughty. Numerous checks are usually needed where chest X-rays are mostly used for TB screening. This paper proposes a deep learning-based method to detect tuberculosis from a chest X-ray. For this, we have proposed a VGG16-based model for tuberculosis detection. For training, the model used two publically available datasets Shenzhen and Montgomery datasets [7]. We have achieved 91% and 89% accuracy, respectively, on the Shenzhen and Montgomery datasets. The results we have obtained show promising results in tuberculosis detection.

IntroductionFactors associated with losses in the latent tuberculosis infection (LTBI) cascade of care in contacts of patients with tuberculosis (TB) were investigated in a multicentre prospective cohort from highly endemic regions in Brazil.MethodsClose contacts of 1187 patients with culture-confirmed pulmonary TB were prospectively studied between 2015 and 2019, with follow-up of 6–24 months. Data on TB screening by clinical investigation, radiographic examination and interferon-gamma release assay (IGRA) were collected. Multivariable regressions were used to identify determinants of losses in the LTBI cascade.ResultsAmong 4145 TB contacts initially identified, 1901 were examined (54% loss). Among those examined, 933 were people living with HIV, ≤5 years old and/or had positive IGRA results, and therefore had a recommendation to start TB preventive treatment (TPT). Of those, 454 (23%) initiated treatment, and 247 (54% of those initiating; 26% of those in whom treatment was recommended) completed TPT. Multivariable regression analysis revealed that living with HIV, illiteracy and black/pardo (brown) race were independently associated with losses in the cascade.ConclusionThere were losses at all LTBI cascade stages, but particularly at the initial screening and examination steps. Close contacts of low socioeconomic status and living with HIV were at heightened risk of not completing the LTBI cascade of care in Brazil.

A qualitative research aimed to describe life experiences of pulmonary tuberculosis (TB) patients affected by delays in treatment among 25 pulmonary TB patients in Nakhon Ratchasima, Thailand from October to December 2018. The data were collected by in-depth interviews, analyzed by the content analysis, and managed with the NVivo version 12. The findings found there were two major consequences: patient-related and community-related consequences. For the patient-related consequences, patients claimed that they had more severe symptoms before getting treatment. It affected their daily-life including work that led them to stop working or leave their job. The result of having a longer duration of delays in treatment increased the severity of the disease which may result in death. For the community-related consequences, patients had opinions that they could spread TB to other people. However, some patients felt that they could not spread TB germs because the TB screening test results were not found in the infection. These findings can be used for improving the TB controlling strategies by exchanging knowledge and experience of these TB patients which may help to reduce the severity of the disease, mortality rate, and transmission rate in the community.

The results of a tuberculosis (TB) active case finding (ACF) program, implemented by International Care Ministries (ICM) in the Philippines, were examined to understand how the presence of physical symptoms might influence ACF outcomes among extreme low-income Filipinos. ICM health staff implemented symptom screening in villages and suspected cases were referred to the closest rural health unit (RHU) for TB testing. ACF was carried out in Mindanao and the Visayas, across 16 different provinces. All participants were interviewed pre/postprogram, and screening outcomes were collected. A multilevel regression model was constructed to explore the effect of factors on the likelihood of getting tested. A total of 4635 individuals were screened; 1290 (27.8%) were symptom positive and referred. From those referred, 336 (7.2%) were tested for TB and 53 (1.1%) were TB positive. “Cough for more than two weeks” was associated with a 1.09 (95% CI 1.01, 1.15) times increase in likelihood of getting tested. The finding that the presence of cough is associated with higher rate of testing suggests that individuals in these settings might not know or believe that the lack of cough does not equate to lack of TB infection. While technologies and screening algorithms give us the ability to refine the ‘supply’ side of the TB screening, addressing the knowledge gap should improve ‘demand’.

Purpose The study aimed to assess the magnitude of depression and associated factors among patients with tuberculosis (TB) visiting outpatient clinics in Ethiopia. Patients and methods A cross-sectional study was conducted among 415 TB patients. Study participants were selected through a systematic random sampling technique. Patient Health Questionnaire-9 (PHQ-9) was used to assess depression using face-to-face interviews. Data were analyzed using SPSS version 20. Bivariate and multivariate binary logistic analyses were done to identify associated factors with depression. P-values less than 0.05 were considered statistically significant, and the strength of the association was presented by adjusted OR (AOR) with 95% CI. Results The magnitude of depression was found to be 31.1% with 95% CI (26.5-35.7). Extrapulmonary TB [AOR =1.8, 95% CI (1.02, 3.24)], poor social support [AOR =3.3, 95% CI (1.8, 6.03)] and perceived TB stigma [AOR =2.0, 95% CI (1.28, 3.18)] were variables found to be statistically significantly connected with depression. Conclusion The magnitude of depression was high compared to the general population and some other studies. Therefore, the current study area and other settings which provide TB screening and treatment need to assess patients for depression and provide intervention, giving more emphasis to patients with risk factors.

Background The neutrophil to lymphocyte ratio (NL ratio) has been reported to be a predictive biomarker of tuberculosis (TB). We assessed the association between the NL ratio and the incidence of active TB cases within 1 year after TB screening among HIV-infected individuals in Thailand. Methods A day care center that supports HIV-infected individuals in northernmost Thailand performed TB screening and follow-up visits. We compared the baseline characteristics between the TB screening positive group and the TB screening negative group. The threshold value of NL ratio was determined by cubic-spline curves and NL ratios were categorized as high or low NL ratio. We assessed the association between NL ratio and progression to active TB within 1-year using the Cox-proportional hazard model. Results Of the 1064 HIV-infected individuals who screened negative for TB at baseline, 5.6% (N = 60) eventually developed TB and 26 died after TB diagnosis. A high NL ratio was associated with a higher risk of TB (adjusted hazard ratio (aHR) 2.19, 95% CI: 1.23–3.90), after adjusting for age, sex, ethnicity, CD4 counts, and other risk factors. A high NL ratio in HIV-infected individuals with normal chest X-ray predicted TB development risk. In particular, a high NL ratio with TB symptoms could predict the highest risk of TB development (aHR 2.58, 95%CI: 1.07–6.23). Conclusions Our results showed that high NL ratio increased the risk of TB. NL ratio combined with TB symptoms could increase the accuracy of TB screening among HIV-infected individuals. Electronic supplementary material The online version of this article (10.1186/s12879-019-4292-9) contains supplementary material, which is available to authorized users.

Kejadian Tuberculosis sangat tinggi di Indonesia. Penemuan suspek TB sebanyak-banyaknya akan membantu dalam penegakan awal diagnosa penyakit TB dan segera mungkin mendapatkan pengobatan. Tujuan penelitian ini adalah untuk menggambarkan angka penjaringan suspek TB dengan menggunakan metode Pengelola Kasus TB (PEKA TB). Penelitian ini menggunakan desain deskriptif dengan 116 sampel yang digunakan. Hasilnya adalah penemuan suspek TB dengan menggunakan peran kader menunjukkan angka penemuan sebanyak 58 suspek TB pada bulan April s.d Juni. Sedangkan penggunaan metode PEKA TB untuk menemukan suspek TB sebanyak 67 Suspek. Sehingga total penemuan suspek selama 3 bulan meningkat dari total 70 suspek menjadi 125 suspek TB. Kesimpulan dari penelitian ini adalah penggunaan metode PEKA TB dapat menjadi sebuah pilihan untuk menemukan kasus-kasus baru pasien Tuberculosis.

Background: Paediatric central nervous system (CNS) tuberculosis (TB) imposes a high risk of death and neurologic sequelae, particularly if the diagnosis is delayed. Children from non-TB endemic countries are particularly at risk of delayed or missed diagnosis. We aimed to investigate CNS TB in Denmark, a TB low-endemic country and where Bacillus Calmette–Guerin (BCG) vaccination is not a part of the vaccination schedule. Methods: A nationwide retrospective case survey of all children with CNS TB in 2000–2015 identified through the National Danish TB Notification Register. We assessed epidemiology, clinical and paraclinical features, diagnostic criteria, treatment and outcome. Results: Nine ethnic Danes and 12 children from TB-endemic countries with CNS TB were identified. Clinical features, C-reactive protein, chest X-ray and indirect TB screening assays all had low sensitivity (19–75%). All (18/18) patients had elevated cerebrospinal fluid (CSF) white blood cells and 15 of 17 (88%) had a combination of at least two characteristic CSF findings (lymphocyte predominance, elevated protein and/or hypoglycorrhachia). Cerebral computed tomography and magnetic resonance imaging were abnormal in 10 of 16 (63%) and 12 of 14 (86%), respectively. Treatment was initiated after a median of 3 days in children from TB-endemic countries, and after 10 days in ethnic Danish children. One patient died (5%): A native Danish girl who died before the diagnosis was established. Conclusions: Children from non-TB endemic countries may be at risk of delayed diagnosis and poorer prognosis compared to high-risk children. Cerebral magnetic resonance imaging and characteristic CSF findings had high diagnostic sensitivity.

The tuberculin skin test (TST) is a long-established screening method for tuberculosis. However, the Mantoux technique is often difficult to reliably perform, which affects testing results and safety, which causes local skin pain and pruritus. In this study, dissolving microneedle-array patches (MNP) were used to deliver purified protein derivative (PPD) tuberculin into the skin. The skin reaction was compared between MNP delivery and conventional injection. The MNP penetrated the skin easily with a thumb press, and the microneedle dissolved into the skin completely after 1 h. The storage life of MNP loaded with PPD (MNP-PPD) was 7 weeks at atmospheric pressure and room temperature. Only 1/50 dosage of PPD (approximately 0.04 IU) was needed in MNP compared with conventional injection (2 IU) in terms of skin reactivity to TST. When TST was tested in volunteers, the redness and induration of the skin were 19.7 ± 5.6 mm in TB patients, 12.6 ± 4.4 mm in LTBI (latent TB infection) patients, and 5.8 ± 2.7 mm in BCG vaccination healthy volunteers and lasted approximately 26 ± 5.4 days. When applied with MNP-PPD, the redness and induration on the skin decreased significantly to 3.1 ± 0.7 mm in TB patients and 2.0 ± 0.5 mm in LTBI, and the duration time was only 8.5 ± 1.5 days. Moreover, despite the relatively mild skin reactivity in BCG vaccination healthy volunteers with conventional injection, there was no skin reactivity in BCG vaccination healthy volunteers with MNP-PPD. In addition to being minimally invasive, needle-free, and painless, no adverse effects were attributed to the new diagnostic method, which may be of value for the safe and effective clinical administration of TB screening. When applied with MNP-PPD, an area of redness and induration greater than 2.5 mm can identify a TB-positive patient.

Background Every year around 4 million people with tuberculosis (TB) are not detected. Thus may not get the medical care that they need and deserve from their respective health systems. Ethiopia is included in the 12 countries who contribute 75% of the globally estimated “missed” cases. This study assessed if there are missed Pulmonary TB (PTB) cases among inpatients of a large referral hospital in Ethiopia. Method A cross sectional survey was conducted in the general medical wards of the large referral hospital from June to August 2015. Inpatients not diagnosed with TB were screened for TB symptoms and requested to submit a morning sputum sample for smear microscopy and molecular testing by GeneXpert MTB/RIF assay. The results of the symptom screening, smear and GeneXpert testing were analyzed as the main outcome characteristics for “missed” PTB cases. Result Over the 3-month period, 300 inpatients were evaluated for TB. The patients median age was 38 years (IQR 26–51.5), 41% were female, median reported duration of sickness before admission was 30 days (IQR 14–240), and median body mass index (BMI) was 21.5 (IQR 20–22.67). HIV status was documented for 198/300 (66%) of patients, 37 (18.7%) were found to be HIV positive, with a median CD4 count of 176 (IQR 52–400). All 300 inpatients submitted a sputum sample and 10 (3.3%) were found to be GeneXpert MTB positive, with 4/10 also being smear positive. All GeneXpert positive inpatients reported having a cough of > 2 weeks duration. Eight had at least 3 common symptoms of TB (i.e. cough, fever, weight loss or night sweat). Co-morbidity with Diabetes Mellitus (DM) and HIV was found in 1/10 and 4/10 cases respectively. Conclusion Bacteriological confirmed TB cases were found to have been “missed” amongst the general medical ward inpatients in the hospital. The identified TB cases all reported typical signs and symptoms of TB. Basic clinical practices were not being followed (i.e. history taking/documentation and requesting of appropriate laboratory tests) by the attending health care workers (HCWs) in the hospital. The index of suspicion for TB disease needs to improve and the use of more sensitive technologies, such as GeneXpert could assist the diagnosis of TB. However, the findings of the study need to be investigated in other hospital settings in Ethiopia.

Objectives: To examine the prevalence and characteristics of HIV-tuberculosis (TB) co-infected patients in Singapore, an intermediate TB-burden country. Methods: Retrospective data across 11 years was obtained from the National University Hospital (NUH), a quaternary hospital and the National Centre for Infectious Diseases (NCID), the national HIV center. Results: From December 2005 to December 2016, 4015 HIV-infected patients were managed at NUH and NCID, of whom, respectively, 48 and 272 were diagnosed with active TB disease. Only 2 patients (0.6%) were screened for latent TB infection on HIV diagnosis. Mean CD4 count at TB diagnosis was 125.0 +/- 153.9 cells/mm(3). More patients with HIV diagnosed >= 6 weeks before TB (41%) were associated with CD4 counts > 200 cells/mm(3) than patients with TB diagnosed > 6 weeks before HIV (2%). Of 124 (38.6%) HIV-TB patients with CD4 count

BACKGROUND: Early recognition of TB symptoms in children is critical in order to link children to appropriate testing and treatment. Healthcare workers (HCWs) in high TB burden countries are often overburdened with competing clinical priorities, leading to incomplete presumptive TB screening. We assessed if implementing a community health volunteer (CHV) led presumptive pediatric TB mobile android application (PPTBMAPP) in pediatric outpatient, primary care clinics in western Kenya would be feasible, appropriate, and effective.METHODS: We used a mixed-methods participatory, iterative approach to design and implement the PPTBMAPP during a 6-month period. We compared the proportion of children identified in presumptive TB and active TB disease registers out of all patients before and after the implementation of the intervention.RESULTS: Of the 1787 children aged ≤15 years screened using the PPTBMAPP, 376 (21%) met the criteria for presumptive TB. There was a statistically significant increase in the proportion of children to all patients in the presumptive TB registers (97/908, 10.7% vs. 160/989, 16.2%; P = 0.0005), and a trend towards an increase in the proportion of children to all patients in the TB case register (17/117, 14.5% vs. 15/83, 18.1%; P = 0.5). HCWs interviewed commented that the application sped up the presumptive TB screening process.CONCLUSION: Our CHV-led mobile screening intervention significantly increased presumptive TB notification. HCWs reported that the mobile screening intervention was feasible, appropriate, and effective.

Screening of high-risk groups for Tuberculosis (TB) is considered as the cornerstone for TB elimination but the measure of cost-effectiveness is also crucial in deciding the strategy for TB screening. This study aims to measure the cost-effectiveness of TB screening between the various high-risk groups in Malaysia. A decision tree model was developed to assess the cost-effectiveness of TB screening among the high-risk groups from a provider perspective using secondary data from the year 2016 to 2018. The results are presented in terms of an Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per TB case detected. Deterministic and Probabilistic Sensitivity Analysis was also performed to measure the robustness of the model. TB screening among Person Living with Human Immunodeficiency Virus (PL HIV) was the most cost-effective strategy, with MYR 2,597.00 per TB case detected. This was followed by elderly, prisoners and smokers with MYR 2,868.62, MYR 3,065.24, and MYR 4,327.76 per one TB case detected, respectively. There was an incremental cost of MYR 2.49 per screening, and 3.4 TB case detection per 1,000 screening for TB screening among PL HIV in relation to TB screening among prisoners. The probability of symptomatic cases diagnosed as TB was the key driver for increasing cost-effectiveness efficacy among PL HIV. Results of the study suggest prioritization of high-risk group TB screening program by focusing on the most cost-effective strategy such as screening among PL HIV, prisoners and elderly, which has a lower cost per TB case detected.

BackgroundFactors associated with losses in the latent tuberculosis infection (LTBI) cascade of care in contacts of tuberculosis (TB) patients were investigated in a multicenter prospective cohort from highly endemic regions in Brazil.MethodsClose contacts of 1,187 culture-confirmed pulmonary TB patients were prospectively studied between 2015 and 2019, with follow-up between 6 and 24 months. Data on TB screening by clinical investigation, radiographic examination and interferon-gamma release assay (IGRA) were collected. Stepwise multivariable models were used to identify determinants of losses in the LTBI cascade.ResultsAmong 4,145 TB contacts initially identified, 1,901 were examined (54% loss). Within those individuals, 933 were people living with HIV, ≤5 years-old and/or had positive IGRA results, therefore having recommendation to start TB preventive treatment (TPT). Of those, 454 (23%) initiated treatment, and 247 (6% of all TB contacts) completed TPT. Multivariable regression analysis revealed that living with HIV, illiteracy, and black/pardo (brown) race were independently associated with losses in cascade.ConclusionThere were losses at all LTBI cascade stages, but particularly at the initial screening and examination steps. Close contacts who are socially vulnerable and living with HIV were at heightened risk of not completing the LTBI cascade of care in Brazil.40-word summary of the article’s main pointWe investigated factors associated with losses in the latent tuberculosis infection cascade of care in a large cohort of contacts in Brazil. Social vulnerability and HIV infection were the most relevant determinants of losses in the LTBI cascade of care.

Background. In the EU, tuberculosis (TB) mainly affects vulnerable people, including migrants. From 2014 to 2017, we have estimated the frequency of both tuberculosis and latent tuberculosis infection (LTBI) among the migrant population hosted in 41 reception centers in western Sicily (ITaCA network). Materials and Methods. All migrants were consecutively recruited for the screening of TB infection with physical examination and TST in 1,020 migrants and with IGRA in the others 2,690. The screening was carried out 4–8 weeks after landing in Sicily. For all migrants with a positive screening test, chest X-ray and smear examination were performed. LTBI was defined by positivity of TST or IGRA with negative X-ray chest, clinical, and smear examination. Active TB was defined by radiological and/or clinical and/or sputum positivity in a patient with a TST or IGRA positivity. Results. We evaluated a total of 3,710 migrants, of which 89% came from Sub-Saharan countries; 2,811 were males, 899 were females, with a median age of 22 years (IQR: 18–25). TB infection was diagnosed in 501 persons (13.5%) of which 440 (11.8%) had LTBI and 61 had active TB (1.6%): 1 had lymph node TB, 1 had intestinal TB, and 59 had pulmonary TB (38 sputum smear positive TB; no drug-resistant TB were observed). Conclusions. TB screening is critical to early diagnosis and treatment.

ObjectivesTuberculosis (TB) is a common infection in HIV patients. Our study aims to determine the prevalence and characteristics of HIV-TB co-infected patients in Singapore, a high-income, intermediate TB-burden country.MethodsRetrospective data of 11-years was obtained from the National University Hospital (NUH), a quaternary care hospital and the National Centre for Infectious Diseases, the national HIV centre.ResultsFrom December 2005 to December 2016, 48 out of 819 HIV patients and 272 out of 3,196 HIV patients who were managed in NUH and TTSH respectively, were diagnosed with TB. 89.1% (n=285) were males and 2 (0.6%) were screened for latent TB on HIV diagnosis. The median age at TB diagnosis was 47.3 years old (Interquartile range, IQR 41-57). Mean CD4 count at TB diagnosis was 125.0 ± 153.9 cells/mm3. 124 (38.6%) patients had CD4 < 50 cells/mm3. 41.3% (n=132) of patients had HIV diagnosed at least 6 weeks before TB diagnosis, indicating an opportunity to initiate latent TB preventive therapy. 55.0% (n=176) had HIV and TB concomitantly diagnosed within 6 weeks whilst 2.25% (n=7) had TB diagnosed before HIV. Of those HIV-TB co-infected patients with CD4 ≤ 50 cells/mm3, 18 (14.2%) had anti-retroviral therapy (ART) started ConclusionThere is a lack of latent TB screening in HIV patients and a delay in initiation of ART in HIV-TB patients with low CD4 counts in our study. Clinical practices can be further improved for the benefit of outcomes in HIV-TB patients.

In South Korea where the tuberculosis (TB) burden is intermediate, the risk of in-hospital transmission of TB remains high. We conducted a retrospective cohort study of 244 inpatients diagnosed with pulmonary TB (2015–2018) to evaluate the impact of the Xpert MTB/RIF assay (Xpert) screening on timely isolation. TB screening was performed with smear microscopy and a polymerase chain reaction test, and the Xpert was additionally used from November 2016. Among all patients with pulmonary TB, the median time-to-isolation was significantly reduced (22.6 vs. 69.7 h; p p = 0.096). Among 213 patients who were timely screened (≤ 72 h after admission), time-to-isolation decreased significantly (− 38.2 h; 95% CI − 70.6, − 5.8; p = 0.021) with the introduction of the Xpert, and its decreasing trend continued. The Xpert provided a shorter turnaround time (4.8 vs. 49.1 h; p p

Objectives: Tuberculosis symptoms are very common among people living with HIV (PLHIV) initiating antiretroviral therapy (ART), are not specific for tuberculosis disease and may result in delayed ART start. The risks and benefits of same‐day ART initiation in PLHIV with tuberculosis symptoms are unknown. Methods: We systematically reviewed nine databases on 12 March 2020 to identify studies that investigated same‐day ART initiation among PLHIV with tuberculosis symptoms and reported both their approach to TB screening and clinical outcomes. We extracted and summarized data about TB screening, numbers of people starting same‐day ART and outcomes. Results: We included four studies. Two studies deferred ART for everyone with any tuberculosis symptoms (one or more of cough, fever, night sweats or weight loss) and substantial numbers of people had deferred ART start (28% and 39% did not start same‐day ART). Two studies permitted some people with tuberculosis symptoms to start same‐day ART, and fewer people deferred ART (2% and 16% did not start same‐day). Two of the four studies were conducted sequentially; proven viral load suppression at 8 months was 31% when everyone with tuberculosis symptoms had ART deferred, and 44% when the algorithm was changed so that some people with tuberculosis symptoms could start same‐day ART. Conclusions: Although tuberculosis symptoms are very common in people starting ART, there is insufficient evidence about whether presence of tuberculosis symptoms should lead to ART start being deferred or not. Research to inform clear guidelines would help to maximise the benefits of same‐day ART.

We describe gender-based differences in a community-wide TB screening programme in Karachi, Pakistan, in which 311 732 individuals were screened in mobile camps using symptom questionnaires and van-mounted digital chest X-ray, between 1 January 2018 and 31 December 2019. Only 22.4% (69 869) of camp attendees were women. Female attendees were less likely to have sputum collected and tested (31.5% (95% CI 30.4% to 32.7%) vs 38.5% (95% CI 37.6% to 39.1%)) or to initiate TB treatment (75.9% (95% CI 68.1% to 82.6%) vs 82.8% (95% CI 78.9% to 86.2%)), when indicated. Among the participants, the age-standardised prevalence of active TB was higher among women (prevalence ratio 1.4, 95% CI 1.1 to 1.7). These findings underscore the importance of integrating gender into the design and monitoring of TB screening programmes to ensure that women and men benefit equally from this important intervention.

Tuberculosis (TB) is a contagious bacterial airborne disease, and is one of the top 10 causes of death worldwide. According to the World Health Organization (WHO), around 1.8 billion people are infected with TB and 1.6 million deaths were reported in 2018. More importantly,95% of cases and deaths were from developing countries. Yet, TB is a completely curable disease through early diagnosis. To achieve this goal one of the key requirements is efficient utilization of existing diagnostic technologies, among which chest X-ray is the first line of diagnostic tool used for screening for active TB. The presented deep learning pipeline consists of three different state of the art deep learning architectures, to generate, segment and classify lung X-rays. Apart from this image preprocessing, image augmentation, genetic algorithm based hyper parameter tuning and model ensembling were used to to improve the diagnostic process. We were able to achieve classification accuracy of 97.1% (Youden's index-0.941,sensitivity of 97.9% and specificity of 96.2%) which is a considerable improvement compared to the existing work in the literature. In our work, we present an highly accurate, automated TB screening system using chest X-rays, which would be helpful especially for low income countries with low access to qualified medical professionals., Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization (2020)

Background There are no guidelines to screen haemato-oncologic children when a tuberculosis (TB) outbreak is suspected. Methods After exposition to an adult with active TB, children exposed from a haemato-oncology unit were screened according to immunosuppression status and time of exposure. Until an evaluation after 8–12 weeks from last exposure, isoniazid was indicated to those with negative initial work-up. Results After 210 interventions, we detected a case of pulmonary TB, and another with latent TB infection. Pulmonary findings and treatment approach were challenging in some patients. Conclusions The TB screening of oncologic children required a multidisciplinary approach, and clinicians managed challenging situations.

Background The securitisation of borders against the threat of invading microbes, carried by immigrant bodies, is not a new phenomenon. Tuberculosis (TB), transmitted through coughing, has been a core member of the infectious diseases deemed important to control for more than a century. Following evidence suggesting airport screening for TB using chest x-rays was ad hoc, ineffective and costly, the UK - following in the footsteps of other high-income, low TB-burden countries - moved to pre-entry screening of migrants for TB. Thus the 'biosecuritisation' of immigrant bodies was shifted off-shore. Since 2014, pre-entry screening for TB has been a mandatory part of the visa application system for those moving to the UK for a period of 6 months or longer from high-incidence countries. This ethnographic study explores how pre-entry screening is experienced by migrants. Methods Data was drawn from a project exploring migrants' experiences of accessing healthcare. This involved a focused ethnography, comprising 180 hours of field work over four weeks including interviews with clients and staff, in a pre-entry TB screening centre in India in 2017. During this time over 1000 individuals were screened for active pulmonary TB as part of their visa application. In addition, 14 in-depth interviews were conducted with migrants diagnosed with TB in the UK. Foucault's concept 'governmentality' and sociological theories of bordering were used alongside thematic analysis to analyse the data. Results This study reveals the previously undocumented harms experienced by individuals who are required to undergo pre-entry screening for TB. Through the 'biosecuritisation' of some, but not all, off-shore bodies; some, but not all, off-shore TB; some, but not all, infectious diseases; pre-entry screening becomes a border force, reinforcing global inequities and racialised hierarchies. In this context, I argue pre-entry screening makes UK citizens live while letting 'others' die. Key messages Pre-entry screening marks migrants as ‘other’ in a global, racialised, hierarchy of TB risk that ignores intra-country heterogeneity, obfuscating solutions that might reduce inter-country inequities. The global health security agenda must consider the experiences of those caught up in its policies and practices in order to ensure disease control does not do more harm than good.

People undergoing chronic dialysis are at an increased risk of active tuberculosis (TB). In 2012, the Canadian province of British Columbia began systematically screening people initiating dialysis for latent TB using interferon-gamma release assay (IGRA), and treating when appropriate.The objective of this study was to compare active TB rate in people who initiated dialysis and were screened using an IGRA compared with those not screened during the same period.Retrospective cohort study.British Columbia (BC), a Canadian province of 5.0 million people with an active TB incidence of 5.1 per 100 000 population.All people in BC who initiated at least 90 days of dialysis between January 2012 and May 2017 were included in the study. People were excluded if they were18 years of age or had a prior history of active TB diagnosis or treatment for latent TB.A retrospective cohort was created of British Columbians who initiated dialysis between 2012 and 2017. Individuals were stratified into a screened and nonscreened group. Multivariable Cox regression was used to determine the association between latent TB screening and the development of active TB. The primary outcome was incident active TB, either microbiologically confirmed or clinically diagnosed.Of the 3190 people included in the study, 1790 (56.1%) were screened, of which 152 (8.5%) initiated latent TB treatment postscreening. During follow-up, incident active TB was diagnosed in 6 (0.3%) of the 1790 people screened, compared with 11 (0.8%) of the 1400 people who received no screening. In multivariable analysis, latent TB screening and treatment was associated with a significant reduction in the rate of active TB (adjusted hazard ratio = 0.3, 95% confidence interval = 0.1-0.8;This was an observational retrospective study and the potential for unmeasured confounding should be carefully assessed.These findings suggest that systematically screening and treating people initiating dialysis can significantly decrease the rate of active TB in this high-risk population. Given the importance of screening high-risk groups, the results from this analysis could inform scale-up of TB screening in dialysis programs in other low incidence regions. Trial registration is not applicable as this was a retrospective cohort analysis and not a randomized trial.Les patients sous dialyse chronique sont plus susceptibles de développer une tuberculose (TB) active. En 2012, la Colombie-Britannique (province canadienne) a entrepris de dépister systématiquement la TB latente chez les patients qui amorcent un traitement de dialyse. Le dépistage s’effectue à l’aide du test sanguin de libération d’interféron gamma (test IGRA—L’objectif de l’étude était de comparer le taux de TB active chez les patients dépistés par le test IGRA à celui des individus non testés au cours de la même période.Étude de cohorte rétrospective.L’étude s’est tenue en Colombie-Britannique, une province canadienne de cinq millions d’habitants dont l’incidence de TB active est de 5,1 cas pour 100 000 habitants.Ont été inclus tous les Britanno-Colombiens ayant amorcé une dialyse de plus de 90 jours entre janvier 2012 et mai 2017. Les mineurs et les individus avec des antécédents de TB active ou ayant déjà été traités pour une TB latente ont été exclus.Une étude de cohorte rétrospective a été menée auprès des Britanno-Colombiens ayant amorcé une dialyse entre 2012 et 2017. Les individus ont été divisés en deux groupes: un groupe dépisté et un groupe non dépisté. Une régression de Cox à variables multiples a servi à établir l’association entre une TB latente et le développement d’une TB active. Le principal résultat d’intérêt était une TB active confirmée par analyse microbiologique ou diagnostiquée cliniquement.Des 3 190 individus retenus pour l’étude, 1 790 (56,1 %) ont été testés et de ceux-ci, 152 (8,5 %) ont été traités pour une TB latente après l’examen. Pendant le suivi, parmi les 1 790 individus dépistés, 6 patients (0,3 %) ont reçu un diagnostic de TB active comparativement à onze (0,8 %) parmi les 1400 qui n’avaient pas été examinés. Dans l’analyse multivariée, le traitement et le dépistage de la TB latente ont été associés à une réduction significative du taux de TB active (aHR 0,3; IC 95%: 0,1 à 0,8;Il s’agit d’une étude observationnelle rétrospective et le risque de confusion devrait être rigoureusement évalué.Ces résultats suggèrent que le taux de TB active chez les patients dialysés pourrait être réduit significativement par le dépistage et le traitement systématique des individus qui entreprennent un traitement de dialyse. Vu l’importance du dépistage des populations à haut risque, les résultats de cette étude sont susceptibles d’éclairer l’augmentation du dépistage de la TB au sein des programmes de dialyse dans d’autres régions de faible incidence.

In Myanmar from July 2018, as a pilot project in 32 townships, all tuberculosis (TB) patients aged &ge, 40 years were eligible for diabetes mellitus (DM) screening by random blood sugar (RBS) and all DM patients attending hospitals were eligible for TB screening. We assessed the bidirectional screening coverage of target groups through a cross sectional study involving secondary analysis of routine program data. From January to March 2019, of the 5202 TB patients enrolled, 48% were aged &ge, 40 years. Of those aged &ge, 40 years, 159 (6%) were known to have DM, and the remaining 2343 with unknown DM status were eligible for DM screening. Of these, 1280 (55%) were screened and 139 (11%) had high RBS values (&ge, 200 mg/dL, as defined by the national program). There was no information on whether patients with high RBS values were linked to DM care. Of the total 8198 DM patients attending hospitals, 302 (3.7%) patients were tested for sputum smear and 147 (1.7%) were diagnosed with TB. In conclusion, only half of the eligible TB patients were screened for DM and the yield of TB cases among screened DM patients was high. There is an urgent need for improving and scaling up bidirectional screening in the country.

Purpose of Review: Tuberculosis (TB) is a global health concern, and Mozambique is one of the few high burden tuberculosis countries where the estimated TB incidence has not improved in recent years. The objective of this review is to provide a snapshot of the current situation of the TB epidemic in Mozambique, highlighting the main epidemiological features and particularities of TB care and control in the country. Recent Findings: Despite several efforts aimed at improving diagnosis and treatment success, the overall burden of TB, HIV-TB, and multidrug-resistant (MDR)-TB is enormous, with high TB-associated mortality. Improving surveillance is a key step for understanding the TB epidemic in the country, and the first TB prevalence survey is underway. Overall, drug-sensitive and MDR-TB notifications have increased markedly over the last 5 years, likely due in part to a more active case finding approaches, but the diagnosis gap is still substantial. The roll-out of Xpert technology to decentralized settings is improving TB diagnosis in the country, particularly for MDR-TB. Summary: Although some progress has been made in TB control in Mozambique, the challenges for TB control and elimination are enormous. More actively finding cases at health facilities and in communities via contact tracing, improving national surveillance/monitoring and evaluation systems, expanding TB molecular diagnosis, implementing shorter MDR-TB treatments, and improving HIV-TB case management (including rigorous TB screening and higher coverage of preventive therapies in people living with HIV) are considered key priorities for the National TB Control Program.

Setting In 2007, the US Centers for Disease Control and Prevention (CDC) revised its tuberculosis (TB) technical instructions for panel physicians who administer mandatory medical examinations among US-bound immigrants. Many US-bound immigrants come from the Philippines, a high TB prevalence country. Objective To quantify economic and health impacts of smear- vs. culture-based TB screening. Design Decision tree modeling was used to compare three Filipino screening programs: 1) no screening, 2) smear-based screening, and 3) culture-based screening. The model incorporated pre-departure TB screening results from Filipino panel physicians and CDC databases with post-arrival follow-up outcomes. Costs (2013 $US) were examined from societal, immigrant, US Public Health Department and hospitalization perspectives. Results With no screening, an annual cohort of 35 722 Filipino immigrants would include an estimated 450 TB patients with 264 hospitalizations, at a societal cost of US$9.90 million. Culture-based vs. smear-based screening would result in fewer imported cases (80.9 vs. 310.5), hospitalizations (19.7 vs. 68.1), and treatment costs (US$1.57 million vs. US$4.28 million). Societal screening costs, including US follow-up, were greater for culture-based screening (US$5.98 million) than for smear-based screening (US$3.38 million). Culture-based screening requirements increased immigrant costs by 61% (US$1.7 million), but reduced costs for the US Public Health Department (22%, US$750 000) and of hospitalization (70%, US$1 020 000). Conclusion Culture-based screening reduced imported TB and US costs among Filipino immigrants.

Background INFEII registry (ClinicalTrials.gov: NCT02904590) is a prospective study promoted by GETECCU to determine the incidence and risk factors of infection in an inception cohort of IBD patients. Despite preventive measures and recommendations of scientific societies, TB remains a problem in patients with IBD treated with immunosuppressants (IMM) and biologics. AIMS To asses: (1) the screening of TB performed at the time of inclusion of a patient in the INFEII registry, (2) the incidence of latent TB; and (3) compliance with national and European recommendations. Methods A longitudinal prospective study of incident cases with IBD, initiated in October 2016 and with a planned follow-up of 5 years. In September 2019, INFEII registry had 1241 patients from 28 centres throughout Spain. The study protocol determines the mandatory fulfilment of TB screening in every patient, leaving to the centre the freedom of decision on what procedures to perform. Guidelines recommend a mandatory study before starting immunosuppression, especially with biological treatment, using the combination of tuberculin skin test (TST) and interferon-gamma release assay (IGRA) or at least one TST with a booster test1,2. Results Of the 1241 patients 233 (19%) had no screening, 494 (40%) had one [TST 158, IGRA 299, thorax-X-ray 37], 288 (23%) two [TST + IGRA 87, IGRA + thorax-X-ray 130, TST + thorax-X-ray 30, TST + booster 41], 128 (10%) three [TST + IGRA + thorax-X-ray 65, TST + booster + IGRA 23, TST + booster + thorax-X-ray 40] and 98 (7.9%) the four tests [TST + booster + IGRA + thorax-X-ray]. 486 patients (48%) receive pharmacological immunosuppression (172 IMMS, 195 biologics, 119 COMBO) and from them 198 (41%) followed the guidelines recommendation (131 TST and IGRA and 118 TST-booster), 245 (50%) had some method for TB screening [TST 43, IGRA 112, thorax-X-ray 15, IGRA + thorax-X-ray 57, TST + thorax-X-ray 18] and 43 patients (8.8%) had no screening. With the baseline screening, latent TB was detected in 134 patients (13%), 63 (47%) receiving anti-TB chemotherapy. In patients initiating immunosuppression, latent TB was detected in 35 cases [of which 28 received prophylaxis but 7 under IMM did not]. Active TB was detected in 4 cases: 2 during baseline screening, one without screening and one with negative screening (negative TST and IGRA, without booster receiving biological treatment). Conclusion Despite TB in IBD is a relevant problem, there is ample room for improvement for the implementation of mandatory minimum screening recommendations, even in prospective protocolised projects. References

Introduction: The Collaborative TB Strategy recommends latent TB (LTBI) screening in New Entrants who have entered the UK in the previous 5 years, are aged 16–35 and from countries with a TB incidence of ≥150 cases/100,000 population.1 This screening programme was started in Bolton in 2017 and in discussion with Local Commissioning Group all screening activity was carried out via secondary care. Aims and Objectives: We aimed to look at the effectiveness of our new entrant TB screening program. Methods: We collected data from consecutive new entrants referred for TB screening between April 2018 and December 2018. The data included the source of referral (asylum centres and primary care registration [Flag 4]), country of origin, and diagnosis of LTBI by interferon gamma release assay (IGRA) results. Patients from the asylum team are pre-screened using Mantoux test and are only referred if positive (>5mm). Results: 279 new entrants were referred to our service. 118 were from Africa, many of whom were referred by the asylum centre, 88 (74%) of those referred attended the TB clinic, and 34 (38%) were diagnosed with LTBI. 161 patients referred were from Asia (mostly GP registration data), 98 (60%) of those attended clinic and only 16 (16%) were diagnosed with LTBI. Conclusions: The majority of new entrants invited to our clinic attended (66%). A significant number (26%) of these patients are diagnosed with LTBI. The incidence of LBTI is greater in the patients referred by asylum team, noting that they were pre-screened with the Mantoux test. We aim to continue to monitor our new entrant screening service and clinic outcomes, and to compare with services in neighbouring regions. Reference: 1. Collaborative TB Strategy for England 2015–2020: PHE2015, January

Of the estimated 1.2 million tuberculosis (TB) cases among people living with HIV (PLHIV), less than half are diagnosed and reported to health authorities. This is a key reason why TB remains the leading cause of death among PLHIV. Systematic screening approaches coupled with improved diagnostics are critical to reducing the gap and have begun to emerge over recent years. This chapter reviews current approaches to screening for and diagnosing HIV-associated TB, including drug-resistant TB, in adults. The chapter is organized into three parts: Part I provides an overview of World Health Organization (WHO)-recommended tools to facilitate TB screening and diagnosis among PLHIV, Part II provides a selective overview of tools and tests currently in the later stages of the TB diagnostic pipeline and Part III provides a clinically-oriented, step-wise approach for diagnosing TB in PLHIV in resource-limited settings.

The early detection of Tuberculosis (TB) among TB contacts is a strategy to find TB cases in earlier stage and to stop the transmission. This study aimed to assess the implementation of early detection in TB contact investigation to improve TB case finding. This was an operational research study conducted in Badung District, Bali, Indonesia. The samples were TB contacts, identified in the period July through September (third quarter) 2017. Contacts were household members who were living and sharing a room at least for 3 months with infectious TB patients and were not previously diagnosed with TB. Data were collected through face-to-face interview using structured questionnaires and registration reviews using a checklist. We visited 124 TB patients and successfully identified 498 contacts, thus the ratio of contacts to cases is 4:1. All TB contacts were invited to participate in TB screening and evaluation program. A total of 100 (20.1%) contacts have attended at least one examination session and 41 contacts have completed all sessions. Ten TB cases were found among the contacts, of which four of them were adults (three bacteriologically confirmed and one clinically confirmed) and six were children (aged under 15 years). The positivity rate among children was higher (46.2%) compared with adults (14.3%). The positivity rate of confirmed TB among contacts with any TB symptoms was 43.8% and that without symptoms was 12.0%. The contribution of early detection in TB contact investigation to improve TB case finding was 8.1% through all TB patients. The early detection in TB contact investigation yielded additional notified cases, especially among children. A comprehensive education, covering cognitive and psychological aspect, is needed to encourage TB contacts to completely participate in early detection program until their diagnosis is confirmed.

In Africa, TB-HIV co-infection rates are estimated to be 72%. Within sub-Saharan Africa, 34 countries recently reported patients with newly diagnosed MDR-TB, representing 14% of all emerging multi-drug resistant reports worldwide. In addition, eight African countries reported patients harboring extensively drug-resistant TB. More importantly, sub-Saharan Africa bears unacceptably high TB incidence rates coupled with the highest HIV prevalence rates globally. Occurrence of TB related death and new TB infections persist, with men disproportionately affected. A gradual reduction in TB incidence rates from 1.4% per annum between 2000 to 2017 to 1.9% per annum between 2015 and 2016 has been observed. Of note, eight out of the sixteen high burden African countries showed a sharp decline in TB incidence rates, surpassing the “End TB Strategy” goal of a 4% per annum decline. Additionally, substantial decreases in TB mortality in HIV infected patients in nine of sixteen high TB burden African countries were also observed. Programmatic uptake and scale up of TB screening, introduction of new TB diagnostic tests, TB preventive therapy and ART have collectively contributed to this success. Regardless of these improvements, TB remains Africa’s foremost cause of ill-health and death, with greater efforts required in curbing drug resistant TB incidence, poor drug resistant TB treatment outcomes, and in finding and treating missing TB patients.

Background Data on active TB case finding activities among artisanal gold mining communities (AMC) is limited. The study assessed the yield of TB cases from the TB screening activities among AMC in Ghana, the factors associated with TB in these communities and the correlation between the screening methods and a diagnosis of TB. Methods We conducted secondary data analyses of NTP program data collected from TB case finding activities using symptom screening and mobile X-ray implemented in hard to reach AMC. Yield of TB cases, number needed to screen (NNS) and the number needed to test (NNT) to detect a TB case were assessed and logistic regression were conducted to assess factors associated with TB. The performance of screening methods chest X-ray and symptoms in the detection of TB cases was also evaluated. Results In total 10,441 people from 78 communities in 24 districts were screened, 55% were female and 60% (6,296) were in the aged 25 to 54 years. Ninety-five TB cases were identified, 910 TB cases per 100,000 population screened; 5.6% of the TB cases were rifampicin resistant. Being male (aOR 5.96, 95% CI 3.25–10.92, P < 0.001), a miner (aOR 2.70, 95% CI 1.47–4.96, P = 0.001) and age group 35 to 54 years (aOR 2.27, 95% CI 1.35–3.84, P = 0.002) were risk factors for TB. NNS and NNT were 110 and 24 respectively.; Cough of any duration had the strongest association with X-ray suggestive of TB with a correlation coefficient of 0.48. Cough was most sensitive for a diagnosis of TB; sensitivity of 86.3% (95% CI 79.4–93.2) followed by X-ray, sensitivity 81.1% (95% CI 71.7–88.4). The specificities of the symptoms and X-rays ranged from 80.2% (cough) to 97.3% (sputum). Conclusion The high risk of TB in the artisanal mining communities and in miners in this study reinforces the need to target these populations with outreach programs particularly in hard to reach areas. The diagnostic value of cough highlights the usefulness of symptom screening in this population that may be harnessed even in the absence of X-ray to identify those suspected to have TB for further evaluation.