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Background: A staggering one million tuberculosis (TB) cases are missing from notification, most of them being diagnosed and treated in the private sector. To curb this issue, the Government of India declared TB as a notifiable disease and NIKSHAY was launched in 2012. However, even after years of implementation, as per the report published by TB India 2020, the proportion of private case notification of total TB cases is very low., Objectives: The objectives of the study were to assess the current practices related to TB Notification being followed by private practitioners of Delhi and to explore the enablers and barriers to TB notification among private-sector treatment providers., Methods: This cross-sectional study was done from January 2019 to January 2020. Six hundred doctors were line listed under the chosen TB unit, 375 gave consent and in depth interview was conducted among them. Data were collected on the reporting status and facilitators and barrier toward NIKSHAY reporting were assessed. For the qualitative component, focused group discussions were done., Results: Out of 375 private practitioners, over two-third (68%) practitioners reported that they were not treating TB patients. Out of 108 doctors treating patients only 50% were reporting the cases. Major reason cited for not reporting was "don't know how to" and major barrier considered was "lack of training.", Conclusion: Strategies such as training and retraining, and one-to-one sensitization of private practitioners to address barriers may enhance TB notification., Competing Interests: None

Background: Despite national implementation of several high impact interventions and innovations to bolster tuberculosis (TB) detection and improve quality of TB services in Zambia, notifications have been declining since 2004. A countrywide data quality assessment (DQA) of Zambia's National TB and Leprosy Programme (NTLP) was undertaken to quantify the degree to which undernotification and underreporting of TB notifications may be occurring., Methods: The NTLP conducted a retrospective DQA of health facilities in high burden districts in all ten Zambian provinces. Multiple routine programmatic data sources were triangulated through a multi-step verification process to enumerate the total number of unique TB patients diagnosed between 1st January and 31st August 2019; both bacteriologically confirmed and clinically diagnosed TB patients were included. Undernotification was defined as the number of TB patients identified through the DQA that were not documented in facility treatment registers, while underreporting was defined as the number of notified TB cases not reported to the NTLP., Results: Overall, 265 health facilities across 55 districts were assessed from which 28,402 TB patients were identified; 94.5% of TB patients were ≥ 15 years old, 65.1% were male, 52.0% were HIV-positive, and 89.6% were a new/relapse case. Among all TB cases, 32.8% (95%CI: 32.2-33.3) were unnotified. Undernotification was associated with age ≥ 15 years old (adjusted prevalence odds ratio [aPOR] = 2.4 [95%CI: 2.0-2.9]), HIV-positive status (aPOR = 1.6 [95%CI: 1.5-1.8]), being a new/relapse TB case (aPOR = 17.5 [95%CI: 13.4-22.8]), being a clinically diagnosed TB case (aPOR = 4.2 [95%CI:3.8-4.6]), and being diagnosed at a hospital (range, aPOR = 1.5 [95%CI: 1.3-1.6] to 2.6 [95%CI: 2.3-2.9]). There was substantial heterogeneity in the proportion of unnotified TB cases by province (range, 18.2% to 43.6%). In a sub-analysis among 22,199 TB patients with further data available, 55.9% (95%CI: 55.2-56.6) were notified and reported to the NTLP, 32.8% (95%CI: 32.2-33.4) were unnotified, and 11.3% (95%CI: 10.9-11.7) went unreported to the NTLP., Conclusions: The findings from Zambia's first countrywide TB programme DQA demonstrate substantial undernotification and underreporting of TB cases across all provinces. This underscores the urgent need to implement a robust and integrated data management system to facilitate timely registration and reporting of all TB patients who are diagnosed and treated., (© 2022. The Author(s).)

Background: The Government of India implemented mandatory TB notification policy since 2012. After that India's TB notifications from the private sector steadily increased; however, less is known about private practitioners' (PP's) experiences with TB notification. The present study aims to fulfil this gap., Methods: We conducted a cross-sectional study during November 2019 to March 2020 in Pimpri-Chinchwad Municipal Corporation (PCMC) area of Maharashtra State. We used a mixed methods approach which involved a survey of 200 PPs and in-depth interviews (IDIs) with 7 PPs and 8 National TB Elimination Program (NTEP) staff. The data were presented in the form of frequencies and percentages and thematic analysis was performed on the qualitative data., Results: The study revealed that most PPs (194 of 200; 97%) were aware of TB notification and 75% reported that they notify TB cases to the NTEP. Of those who notify, majority (129 of 145; 89%) reported that they use paper-based notification being the convenient method due to in-person visit and help by the NTEP staff. Only a third of PPs were aware of electronic notification methods. The main reasons behind low utilization of web based and mobile application were unfamiliarity and technical issues such as poor network connectivity. A third of PPs were aware about monetary incentives for notification and only 17% reported actual receipt of incentive at some point., Conclusions: Our study identifies several areas where the NTEP can undertake interventions to strengthen the implementation of mandatory TB notification policy. Low awareness about electronic notification methods and preference for paper-based notification in this Study area suggest that more efforts are necessary for successful transitioning from paper-based to electronic notification system., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2021 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Setting: Tuberculosis (TB) morbidity in penitentiary sectors is one of the major barriers to ending TB in the World Health Organization (WHO) European Region., Objectives and Design: a comparative analysis of TB notification rates during 2014-2018 and of treatment outcomes in the civilian and penitentiary sectors in the WHO European Region, with an assessment of risks of developing TB among people experience incarceration., Results: in the WHO European Region, incident TB rates in inmates were 4-24 times higher than in the civilian population. In 12 eastern Europe and central Asia (EECA) countries, inmates compared to civilians had higher relative risks of developing TB (RR = 25) than in the rest of the region (RR = 11), with the highest rates reported in inmates in Azerbaijan, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, and Ukraine. The average annual change in TB notification rates between 2014 and 2018 was -7.0% in the civilian sector and -10.9% in the penitentiary sector. A total of 15 countries achieved treatment success rates of over 85% for new penitentiary sector TB patients, the target for the WHO European Region. In 10 countries, there were no significant differences in treatment outcomes between civilian and penitentiary sectors., Conclusion: 42 out of 53 (79%) WHO European Region countries reported TB data for the selected time periods. Most countries in the region achieved a substantial decline in TB burden in prisons, which indicates the effectiveness of recent interventions in correctional institutions. Nevertheless, people who experience incarceration remain an at-risk population for acquiring infection, developing active disease and unfavourable treatment outcomes. Therefore, TB prevention and care practices in inmates need to be improved.

Tuberculosis (TB) remains a major public health problem in China and worldwide. In this article, we used a joinpoint regression model to calculate the average annual percent change (AAPC) of TB notification and mortality in China from 2004 to 2019. We also used an age-period-cohort (APC) model based on the intrinsic estimator (IE) method to simultaneously distinguish the age, period and cohort effects on TB notification and mortality in China. A statistically downward trend was observed in TB notification and mortality over the period, with AAPCs of -4.2% * (-4.9%, -3.4%) and -5.8% (-7.5%, -4.0%), respectively. A bimodal pattern of the age effect was observed, peaking in the young adult (aged 15-34) and elderly (aged 50-84) groups. More specifically, the TB notification risk populations were people aged 20-24 years and 70-74 years; the TB mortality risk population was adults over the age of 60. The period effect suggested that TB notification and mortality risks were nearly stable over the past 15 years. The cohort effect on both TB notification and mortality presented a continuously decreasing trend, and it was no longer a risk factor after 1978. All in all, the age effect should be paid more attention.

Background. A significant proportion of tuberculosis (TB) patients globally make their initial visit for medical care to either an informal provider or a private practitioner, and many are not formally notified. Involvement of private practitioners (PPs) in a public-private mix for TB (TB-PPM) provides an opportunity for improving TB control. However, context-specific interventions beyond public-private agreements and mandatory notification are needed. In this study we will evaluate whether a tailored intervention package can increase TB notifications from PPs in Indonesia. Methods. This is a cluster-randomized trial of a multi-component public health intervention. 36 community health centre (CHC) areas will be selected as study locations and randomly allocated to intervention and control arms (1:1). PPs in the intervention areas will be identified using a mapping exercise and recruited into the study if they are eligible and consent. They will receive a tailored intervention package including in-person education about TB management along with bimonthly electronic refreshers, context-specific selection of referral pathways, and access to a TB-reporting app developed in collaboration with the National TB programme. The primary hypothesis is that the intervention package will increase the TB notification rate. The primary outcome will be measured by collecting notification data from the CHCs in intervention and control arms at the end of a 1-year observation period and comparing with the 1-year pre-intervention. The primary analysis will be intention-to-treat at the cluster level, using a generalised mixed model with repeated measures of TB notifications for 1 year pre- and 1 year post-intervention. Discussion. The results from this study will provide evidence on whether a tailored intervention package is effective in increasing the number of TB notifications, and whether the PPs refer presumptive TB cases correctly. The study results will guide policy in the development of TB-PPM in Indonesia and similar settings., Competing Interests: No competing interests were disclosed., (Copyright: © 2022 Hadisoemarto PF et al.)

Background: The greatest risk of infectious disease undernotification occurs in settings with limited capacity to detect it reliably. World Health Organization guidance on the measurement of misreporting is paradoxical, requiring robust, independent systems to assess surveillance rigor. Methods are needed to estimate undernotification in settings with incomplete, flawed, or weak surveillance systems. This study attempted to design a tuberculosis (TB) inventory study that balanced rigor with feasibility for high-need settings., Objective: This study aims to design a hybrid TB inventory study for contexts without World Health Organization preconditions. We estimated the proportion of TB cases that were not reported to the Ministry of Health in 2015. The study sought to describe TB surveillance coverage and quality at different levels of TB care provision. Finally, we aimed to identify structural-, facility-, and provider-level barriers to notification and reasons for underreporting, nonreporting, and overreporting., Methods: Retrospective partial digitalization of paper-based surveillance and facility records preceded deterministic and probabilistic record linkage; a hybrid of health facilities and laboratory census with a stratified sampling of HFs with no capacity to notify leveraged a priori knowledge. Distinct extrapolation methods were applied to the sampled health facilities to estimate bacteriologically confirmed versus clinical TB. In-depth interviews and focus groups were used to identify causal factors responsible for undernotification and test the acceptability of remedies., Results: The hybrid approach proved viable and instructive. High-specificity verification of paper-based records in the field was efficient and had minimal errors. Limiting extrapolation to clinical cases improved precision. Probabilistic record linkage is computationally intensive, and the choice of software influences estimates. Record absence, decay, and overestimation of the private sector TB treatment behavior threaten validity, meriting mitigation. Data management demands were underestimated. Treatment success was modest in all sectors (R=37.9%-72.0%) and did not align with treatment success reported by the state (6665/8770, 75.99%). One-fifth of TB providers (36/178, 20%) were doubtful that the low volume of patients with TB treated in their facility merited mastery of the extensive TB notification forms and procedures., Conclusions: Subnational inventory studies can be rigorous, relevant, and efficient in countries that need them even in the absence of World Health Organization preconditions, if precautions are taken. The use of triangulation techniques, with minimal recourse to sampling and extrapolation, and the privileging of practical information needs of local decision makers yield reasonable misreporting estimates and viable policy recommendations., (©Ellen M H Mitchell, Olusola Adedeji Adejumo, Hussein Abdur-Razzaq, Chidubem Ogbudebe, Nkem Chukwueme, Samson Bamidele Olorunju, Mustapha Gidado. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 15.03.2021.)

Objective: Half of the TB patients in India seek care from private providers resulting in incomplete notification, varied quality of care and out-of-pocket expenditure. The objective of this study was to describe the characteristics of TB patients who remain outside the coverage of treatment in public health services., Methods: Cross-sectional data from National Family Health Survey-4 (2015-16) were analysed using logistic regression analysis. TB treatment was the dependent variable. Sociodemographic factors and place where households generally seek treatment were independent variables., Results: Prevalence of self-reported TB was 308.17/100 000 population (95% CI: 309.44-310.55/100 000 population) and 38.8% (95% CI: 36.5-41.1%) of TB patients were outside care of public health services - 3.3% did not seek treatment and 35.3% accessed treatment from private sector. Factors associated with not seeking treatment were age <10 years [OR = 3.43; 95% CI (1.52-7.77); P = 0.00]; no/preschool education [OR = 1.82; 95% CI (1.10-3.34); P = 0.02]; poorest wealth index [OR = 1.86; 95% CI (1.01-3.34); P = 0.04] and household's general rejection of the public sector when seeking health care [OR = 1.69; 95% CI (1.69-2.26); P = 0.00]. Factors associated with seeking treatment from private providers were female sex [OR = 1.29; 95% CI (1.11-1.50); P = 0.001], younger age of the patient [OR = 2.39; 95% CI (1.62-3.53); P = 0.00], higher education [OR = 1.82; 95% CI (1.11-2.98); P = 0.02] and household's general rejection of the public sector when seeking health care [OR = 4.56; 95% CI (3.95-5.27); P = 0.00]. Patients from households reporting 'poor quality of care' as the reason for not generally preferring public health services were more likely (OR = 1.48, 95% CI = 1.19-1.65; P = 00) to access private treatment., Conclusion: The study provides insights for efforts to involve the private health sector for accurate surveillance and patient groups requiring targeted interventions for linking them to the national programme., (© 2018 John Wiley & Sons Ltd.)

ABSTRACT: Context/Background: The COVID-19 pandemic affected the health care services worldwide, with the target of END TB 2025; it was important to make sure that the TB notification and linkage services were not hampered. The current study aims to document the overall impact of COVID-19 on TB notification and treatment services. Aims/Objectives: To document the impact of COVID-19 on notification and comparison of their outcome between pre-COVID-19 and COVID-19 era. Methodology: Programmatic data of 9893 notified TB cases reported from Surat rural between 2019 and 2021 were collected from Nikshay portal through DTO Surat. Detailed comparison of pre- and COVID-19 era was performed using stratified analysis. Results: There was a significant (P = 0.02) 29% decline in cases reported in 2020 as compared to the cases reported in the previous year. The impact of COVID-19 was also seen on mortality of the reported cases (18% increase). The overall proportion of treatment failure was increased (28%), whereas difference of 20% was seen in cases where treatment regimen was required to be changed. Conclusions: Despite the overall impact of COVID-19 on TB services (2020), the health department has proactively countered and bounce back in 2021 with an overall increase in notification and treatment services. [ABSTRACT FROM AUTHOR]

Context/Background: The COVID-19 pandemic affected the health care services worldwide, with the target of END TB 2025; it was important to make sure that the TB notification and linkage services were not hampered. The current study aims to document the overall impact of COVID-19 on TB notification and treatment services. Aims/Objectives: To document the impact of COVID-19 on notification and comparison of their outcome between pre-COVID-19 and COVID-19 era. Methodology: Programmatic data of 9893 notified TB cases reported from Surat rural between 2019 and 2021 were collected from Nikshay portal through DTO Surat. Detailed comparison of pre- and COVID-19 era was performed using stratified analysis. Results: There was a significant (P = 0.02) 29% decline in cases reported in 2020 as compared to the cases reported in the previous year. The impact of COVID-19 was also seen on mortality of the reported cases (18% increase). The overall proportion of treatment failure was increased (28%), whereas difference of 20% was seen in cases where treatment regimen was required to be changed. Conclusions: Despite the overall impact of COVID-19 on TB services (2020), the health department has proactively countered and bounce back in 2021 with an overall increase in notification and treatment services.

The burden of tuberculosis (TB) in Jordan is largely unknown due to the paucity of high-quality data, under-reporting, and a lack of good quality vital registration system. This study aimed to assess the characteristics of TB patients in Jordan, determine the TB notification rate and assess the trend of TB notification in Jordan between 2016 and 2020. Methods: This study analyzed the TB Surveillance data in Jordan for the period 2016–2020. The obtained data included information on age, gender, nationality, marital status, date of symptoms onset and date of diagnosis, and site of TB. Results: During the period 2016–2020, a total of 1711 patients (989 women and 722 men) were diagnosed with and treated for tuberculosis. The mean (SD) age of patients was 30.1 (17.2) years. Almost half of them (48.4%) were Jordanians. The majority of non-Jordanian patients were from Syria, Philippines, and Bangladesh. Two thirds of patients (66.0%) had pulmonary TB and 34.0% had extra-pulmonary TB. Almost half (50.7%) of the patients were diagnosed within one month of the symptoms’ onset. The average annual TB notification rate during 2016–2020 was 3.32 per 100,000 pop (4.08 per 100,000 women and 2.64 per 100,000 men). The average annual standardized notification rate was 4.13 per 100,000 pop (4.52 per 100,000 women and 3.52 per 100,000 men). The overall age-standardized notification rate increased from 3.88 per 100,000 pop in 2016 to 4.58 per 100,000 pop in 2019 and declined to 2.46 per 100,000 pop in 2020. The trend in TB notification differed significantly according to gender. While the notification increased in the last three years among women, it decreased significantly among men. Conclusions: While TB notification increased in the last three years among women, it decreased significantly among men. There is a need to ensure that the national TB plans set clear targets for reducing the burden of TB.

Evaluating cross-country variability on the impact of the COVID-19 pandemic on tuberculosis (TB) may provide urgent inputs to control programs as countries recover from the pandemic. We compared expected TB notifications, modeled using trends in annual TB notifications from 2013–2019, with observed TB notifications to compute the observed to expected (OE) ratios for 170 countries. We applied the least absolute shrinkage and selection operator (LASSO) method to identify the covariates, out of 27 pandemic- and tuberculosis-relevant variables, that had the strongest explanatory power for log OE ratios. The COVID-19 pandemic was associated with a 1.55 million (95% CI: 1.26–1.85, 21.0% [17.5–24.6%]) decrease in TB diagnoses in 2020 and a 1.28 million (0.90–1.76, 16.6% [12.1–21.2%]) decrease in 2021 at a global level. India, Indonesia, the Philippines, and China contributed the most to the global declines for both years, while sub-Saharan Africa achieved pre-pandemic levels by 2021 (OE ratio = 1.02 [0.99–1.05]). Age-stratified analyses revealed that the ≥ 65-year-old age group experienced greater relative declines in TB diagnoses compared with the under 65-year-old age group in 2020 (RR = 0.88 [0.81–0.96]) and 2021 (RR = 0.88 [0.79–0.98]) globally. Covariates found to be associated with all-age OE ratios in 2020 were age-standardized smoking prevalence in 2019 ( β = 0.973 [0.957–990]), school closures ( β = 0.988 [0.977–0.998]), stay-at-home orders ( β = 0.993 [0.985–1.00]), SARS-CoV-2 infection rate ( β = 0.991 [0.987–0.996]), and proportion of population ≥65 years ( β = 0.971 [0.944–0.999]). Further research is needed to clarify the extent to which the observed declines in TB diagnoses were attributable to disruptions in health services, decreases in TB transmission, and COVID-19 mortality among TB patients. [ABSTRACT FROM AUTHOR]

The burden of tuberculosis (TB) in Jordan is largely unknown due to the paucity of high-quality data, under-reporting, and a lack of good quality vital registration system. This study aimed to assess the characteristics of TB patients in Jordan, determine the TB notification rate and assess the trend of TB notification in Jordan between 2016 and 2020. Methods: This study analyzed the TB Surveillance data in Jordan for the period 2016–2020. The obtained data included information on age, gender, nationality, marital status, date of symptoms onset and date of diagnosis, and site of TB. Results: During the period 2016–2020, a total of 1711 patients (989 women and 722 men) were diagnosed with and treated for tuberculosis. The mean (SD) age of patients was 30.1 (17.2) years. Almost half of them (48.4%) were Jordanians. The majority of non-Jordanian patients were from Syria, Philippines, and Bangladesh. Two thirds of patients (66.0%) had pulmonary TB and 34.0% had extra-pulmonary TB. Almost half (50.7%) of the patients were diagnosed within one month of the symptoms' onset. The average annual TB notification rate during 2016–2020 was 3.32 per 100,000 pop (4.08 per 100,000 women and 2.64 per 100,000 men). The average annual standardized notification rate was 4.13 per 100,000 pop (4.52 per 100,000 women and 3.52 per 100,000 men). The overall age-standardized notification rate increased from 3.88 per 100,000 pop in 2016 to 4.58 per 100,000 pop in 2019 and declined to 2.46 per 100,000 pop in 2020. The trend in TB notification differed significantly according to gender. While the notification increased in the last three years among women, it decreased significantly among men. Conclusions: While TB notification increased in the last three years among women, it decreased significantly among men. There is a need to ensure that the national TB plans set clear targets for reducing the burden of TB. [ABSTRACT FROM AUTHOR]

Background: A staggering one million tuberculosis (TB) cases are missing from notification, most of them being diagnosed and treated in the private sector. To curb this issue, the Government of India declared TB as a notifiable disease and NIKSHAY was launched in 2012. However, even after years of implementation, as per the report published by TB India 2020, the proportion of private case notification of total TB cases is very low. Objectives: The objectives of the study were to assess the current practices related to TB Notification being followed by private practitioners of Delhi and to explore the enablers and barriers to TB notification among private-sector treatment providers. Methods: This cross-sectional study was done from January 2019 to January 2020. Six hundred doctors were line listed under the chosen TB unit, 375 gave consent and in depth interview was conducted among them. Data were collected on the reporting status and facilitators and barrier toward NIKSHAY reporting were assessed. For the qualitative component, focused group discussions were done. Results: Out of 375 private practitioners, over two-third (68%) practitioners reported that they were not treating TB patients. Out of 108 doctors treating patients only 50% were reporting the cases. Major reason cited for not reporting was “don't know how to” and major barrier considered was “lack of training.” Conclusion: Strategies such as training and retraining, and one-to-one sensitization of private practitioners to address barriers may enhance TB notification.

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Abstract Background Despite national implementation of several high impact interventions and innovations to bolster tuberculosis (TB) detection and improve quality of TB services in Zambia, notifications have been declining since 2004. A countrywide data quality assessment (DQA) of Zambia’s National TB and Leprosy Programme (NTLP) was undertaken to quantify the degree to which undernotification and underreporting of TB notifications may be occurring. Methods The NTLP conducted a retrospective DQA of health facilities in high burden districts in all ten Zambian provinces. Multiple routine programmatic data sources were triangulated through a multi-step verification process to enumerate the total number of unique TB patients diagnosed between 1st January and 31st August 2019; both bacteriologically confirmed and clinically diagnosed TB patients were included. Undernotification was defined as the number of TB patients identified through the DQA that were not documented in facility treatment registers, while underreporting was defined as the number of notified TB cases not reported to the NTLP. Results Overall, 265 health facilities across 55 districts were assessed from which 28,402 TB patients were identified; 94.5% of TB patients were ≥ 15 years old, 65.1% were male, 52.0% were HIV-positive, and 89.6% were a new/relapse case. Among all TB cases, 32.8% (95%CI: 32.2–33.3) were unnotified. Undernotification was associated with age ≥ 15 years old (adjusted prevalence odds ratio [aPOR] = 2.4 [95%CI: 2.0–2.9]), HIV-positive status (aPOR = 1.6 [95%CI: 1.5–1.8]), being a new/relapse TB case (aPOR = 17.5 [95%CI: 13.4–22.8]), being a clinically diagnosed TB case (aPOR = 4.2 [95%CI:3.8–4.6]), and being diagnosed at a hospital (range, aPOR = 1.5 [95%CI: 1.3–1.6] to 2.6 [95%CI: 2.3–2.9]). There was substantial heterogeneity in the proportion of unnotified TB cases by province (range, 18.2% to 43.6%). In a sub-analysis among 22,199 TB patients with further data available, 55.9% (95%CI: 55.2–56.6) were notified and reported to the NTLP, 32.8% (95%CI: 32.2–33.4) were unnotified, and 11.3% (95%CI: 10.9–11.7) went unreported to the NTLP. Conclusions The findings from Zambia’s first countrywide TB programme DQA demonstrate substantial undernotification and underreporting of TB cases across all provinces. This underscores the urgent need to implement a robust and integrated data management system to facilitate timely registration and reporting of all TB patients who are diagnosed and treated.

Background: The "ENDSARS" protest was a 3-week national protest staged by angry Nigerian youths to demand an end to brutality of the Special Anti-robbery Squad (SARS) unit of the Nigeria Police Force in October 2020. It is well reported that crises and armed conflicts have a negative impact on tuberculosis (TB) surveillance and case notifications. We aimed to analyze the impact of the political unrest caused by "ENDSARS" conflict on weekly TB notification and overall TB cascade performance. Methods: A retrospective review of weekly notification data across over 300 health facilities and 103 local government areas participating in active TB case findings in Lagos, Oyo, Ogun, and Osun States, all in Southwest Nigeria. TB cascade data (outpatient department (OPD) attendance, screening, presumptive TB, evaluation, and notification) were aggregated from relevant TB registers, entered into Microsoft Excel, and descriptively analyzed. Percentage increase or decrease in cascade and notification data were compared 3 weeks before and after the onset of the conflict. Results: OPD visits declined from 140,886 to 130,788. TB screening declined from a total of 146,955 to 136,348 while the number of TB diagnostic evaluation declined from 6567 to 5624 from the 3 weeks before to the 3 weeks following the ENDSARS protest. TB notification declined across states (with the exception of Oyo state) and intervention types from 3 weeks before the "ENDSARS" protests to 3 weeks following the onset of the protests. Highest decreases, -27% from 174 to 137, were observed in community interventions, bacteriologically diagnosed declined by -20% from 599 to 481, and in Osun state by -26% from 65 to 48. There was a significant increase in clinical diagnosis, + 58% from 99 in the 3 weeks before to 156 during the 3 weeks of the protest. Conclusion: There is an urgent need for national capacity building on TB program preparedness in crises, with emphasis on how national and sub-national governments, hospitals, and communities could anticipate and respond effectively, thus maintaining the minimum package of TB care in conflict. [ABSTRACT FROM AUTHOR]

Summary: Background: The COVID-19 pandemic has had adverse effects on tuberculosis (TB) management in high-burden countries. We conducted a qualitative study to assess the impact of COVID-19 on Uttarakhand's TB elimination program. Methods: A mixed-methods study was conducted to assess the impact of COVID-19 on the National Tuberculosis Elimination Program (NTEP) in Uttarakhand, India. We collected secondary data through the NIKSHAY portal from April 1, 2019, to March 31, 2021, interviewed program managers for the qualitative part of the study, and documented changes in some of the program core indicators during the study period. Results: The study showed a decrease in TB case notification, an increase in the proportion of missing cases, and a fall in the treatment success rate of new cases during the ongoing COVID-19 pandemic by 17%, 54%, and 45%, respectively. Content analysis of in-depth interviews showed disruption in TB-care services because of COVID-19. Conclusion: TB care services in Uttarakhand have been impacted by measures taken to curb the spread of COVID-19. Both the quantitative and qualitative aspects of the study showed a serious impact on notification rates, diagnostic services, and treatment outcomes for TB patients. In addition, some negative changes have been observed when documenting program indicators (annual case notifications, success rate, treatment success rate) of the National Tuberculosis Elimination Program (NTEP). It is thus predicted that COVID-19 will undermine the Government of India's goal to eradicate TB by 2025 and will negatively affect the TB Program.

Evaluating cross-country variability on the impact of the COVID-19 pandemic on tuberculosis (TB) may provide urgent inputs to control programs as countries recover from the pandemic. We compared expected TB notifications, modeled using trends in annual TB notifications from 2013–2019, with observed TB notifications to compute the observed to expected (OE) ratios for 170 countries. We applied the least absolute shrinkage and selection operator (LASSO) method to identify the covariates, out of 27 pandemic- and tuberculosis-relevant variables, that had the strongest explanatory power for log OE ratios. The COVID-19 pandemic was associated with a 1.55 million (95% CI: 1.26–1.85, 21.0% [17.5–24.6%]) decrease in TB diagnoses in 2020 and a 1.28 million (0.90–1.76, 16.6% [12.1–21.2%]) decrease in 2021 at a global level. India, Indonesia, the Philippines, and China contributed the most to the global declines for both years, while sub-Saharan Africa achieved pre-pandemic levels by 2021 (OE ratio = 1.02 [0.99–1.05]). Age-stratified analyses revealed that the ≥ 65-year-old age group experienced greater relative declines in TB diagnoses compared with the under 65-year-old age group in 2020 (RR = 0.88 [0.81–0.96]) and 2021 (RR = 0.88 [0.79–0.98]) globally. Covariates found to be associated with all-age OE ratios in 2020 were age-standardized smoking prevalence in 2019 (β = 0.973 [0.957–990]), school closures (β = 0.988 [0.977–0.998]), stay-at-home orders (β = 0.993 [0.985–1.00]), SARS-CoV-2 infection rate (β = 0.991 [0.987–0.996]), and proportion of population ≥65 years (β = 0.971 [0.944–0.999]). Further research is needed to clarify the extent to which the observed declines in TB diagnoses were attributable to disruptions in health services, decreases in TB transmission, and COVID-19 mortality among TB patients.

In many high TB burden countries with enormous private-sector presence, up to 60–80% of the initial health-seeking behavior occurs in the private sector when people fall sick. Private-sector providers are also perceived to offer poorer-quality health service, and contribute to TB notification gaps and the spread of multidrug-resistant tuberculosis (MDR-TB). Recent efforts have focused on the expansion of TB services among private providers through public–private mix (PPM) initiatives. However, whether such efforts have matched the contribution of the private sector in TB notification, considering its enormous health-seeking volume, is debatable. Here, we argue that evaluating PPM program performance on the basis of the proportion of private-sector health seeking and level of undernotification is an imperfect approach due to differentials in tuberculosis risk profiles and access among patient populations seeking private care when compared with the public sector. We suggest a uniform definition of what constitutes PPM, and the standardization of PPM reporting tools across countries, including the ability to track patients who might initially seek care in the private sector but are ultimately publicly notified. PPM programs continue to gain prominence with rapid urbanization in major global cities. A universal health coverage framework as part of the PPM expansion mandate would go a long way to reduce the catastrophic cost of seeking TB care. [ABSTRACT FROM AUTHOR]

Context: The framework for tuberculosis (TB) notification is one of the components of the World Health Organization's End TB strategy. Notification is essential for estimating the true burden of TB and its control in community which is currently lacking in the private health sector. Aims: The objectives are to identify awareness, willingness, barriers, and preferred methods of TB notification among private practitioners (PPs) in Trichy, South India. Methods: A descriptive cross-sectional study was conducted among 152 doctors working in the private sector and having at least 1 year of clinical experience using nonprobability sampling. A semi-structured, pretested questionnaire was used to obtain details about the general profile, awareness, and willingness regarding TB notification, as well as factors that facilitate and hinder it. Results: Among PPs, 90.7% referred TB cases/suspects to other health facilities and 71.7% were aware that TB notification is mandatory. Only 52.6% and 38.2% were ready to provide the patients' Aadhaar number and bank account details respectively during notification. The most common barriers for notification were: not being aware about the notification procedure (50.7%), lack of time (32.2%), process being tedious (29.6%) and difficulties in getting information from patients (25.7%). Mobile SMS/App/call (74.3%) were preferred by PPs over notification through online (32.2%) and government health staff (26.3%). Conclusions: Although three-fourth of the practitioners were aware and willing to notify TB, more than half of them were not aware about the notification procedure. Improving the awareness on the techniques for notification could motivate PPs to notify TB.

Background. A significant proportion of tuberculosis (TB) patients globally make their initial visit for medical care to either an informal provider or a private practitioner, and many are not formally notified. Involvement of private practitioners (PPs) in a public–private mix for TB (TB-PPM) provides an opportunity for improving TB control. However, context-specific interventions beyond public–private agreements and mandatory notification are needed. In this study we will evaluate whether a tailored intervention package can increase TB notifications from PPs in Indonesia. Methods. This is a cluster-randomized trial of a multi-component public health intervention. 36 community health centre (CHC) areas will be selected as study locations and randomly allocated to intervention and control arms (1:1). PPs in the intervention areas will be identified using a mapping exercise and recruited into the study if they are eligible and consent. They will receive a tailored intervention package including in-person education about TB management along with bimonthly electronic refreshers, context-specific selection of referral pathways, and access to a TB-reporting app developed in collaboration with the National TB programme. The primary hypothesis is that the intervention package will increase the TB notification rate. The primary outcome will be measured by collecting notification data from the CHCs in intervention and control arms at the end of a 1-year observation period and comparing with the 1-year pre-intervention. The primary analysis will be intention-to-treat at the cluster level, using a generalised mixed model with repeated measures of TB notifications for 1 year pre- and 1 year post-intervention. Discussion. The results from this study will provide evidence on whether a tailored intervention package is effective in increasing the number of TB notifications, and whether the PPs refer presumptive TB cases correctly. The study results will guide policy in the development of TB-PPM in Indonesia and similar settings.

Background: Until 2016, microscopy was the main tool for the early detection of pulmonary tuberculosis in Cameroon, especially in remote settings. Due to the poor sensitivity of microscopy, there was a need to implement a molecular assay in order to improve tuberculosis case detection. Intervention: In 2017, tuberculosis loop-mediated isothermal amplification (TB-LAMP), a molecular rapid diagnostic test recommended by the World Health Organization, was implemented in Cameroon as a replacement test of microscopy for initial diagnosis of pulmonary tuberculosis and also as a follow-on test to microscopy for smear-negative sputum specimens. A roll out plan for TB-LAMP implementation in Cameroon had been developed from January 2017 to April 2017, followed by initial implementation at four sites in May 2017. Additional sites were added progressively. Lessons learnt: The use of TB-LAMP as a follow-on test to microscopy for smear-negative sputum specimens helped in the detection of tuberculosis in 14.77% of those who were sputum-smear negative in 2019. Tuberculosis-loop-mediated isothermal amplification usage as an initial test, followed by testing with Xpert MTB/RIF for rapid tuberculosis and rifampicin resistance detection during tuberculosis mass screening campaigns, reduced the turn-around time by 73.23% as compared to when the Gene Xpert instrument was used alone. Recommendations: The implementation and scaling up of TB-LAMP in Cameroon contributed to increase access to tuberculosis molecular diagnosis in remote settings and as such improved tuberculosis case notification. However, to better enhance this notification and optimise the use of a TB-LAMP instrument, a suitable sample transport system is recommended. [ABSTRACT FROM AUTHOR]

Background: The Revised National TB Control Programme developed a case based web-based online reporting mechanism called NIKSHAY. A community-based survey conducted in 2011 reported that 46% of the tuberculosis (TB) patients in India were treated outside the public health system (private sector) and hence they are not the part of the national TB notification system. Methodology: The objective of the study was to assess the profile of the TB individuals in the Chittoor district in Andhra Pradesh, south India. A secondary data were retrieved from the district TB center NIKSHAY web-based online portal in Chittoor and analyzed using SPSS 21.0 version. Data were taken from the last 1 year (April 2017 to March 2018). Results: A total of 3952 individuals were registered in the web based online NIKSHAY portal during the study. Among them in 2918 (73.7%) were males and 1033 (26.2%) were females with the mean age of the patients was 44.6 years with a standard deviation of ± 16.3 ranges. The clinically confirmed cases were 587 patients and microbiologically positive were 2495 (79.8%) and negative were 633 (20.2%). Majority 3263 (82.5%) were had pulmonary and 452 (11.4%) had extra-pulmonary TB. Depending on the HIV-positive cases were 274 (6.9%) and 3560 (90.2%) were negative and the remaining 118 (2.9%) do not know the status of the HIV/AIDS. The CBNAAT results were 411 (10.5%) of the patients had rifampicin sensitivity and 26 (0.6%) of them were resistant. Conclusion: India had taken the nice initiative for the web-based online portal for the notification of the TB patients. Several ongoing efforts have been implemented to improve the quality of surveillance reporting. A series of trainings on quality assurance of TB data should be taken to all the field staff.

Background. A significant proportion of tuberculosis (TB) patients globally make their initial visit for medical care to either an informal provider or a private practitioner, and many are not formally notified. Involvement of private practitioners (PPs) in a public–private mix for TB (TB-PPM) provides an opportunity for improving TB control. However, context-specific interventions beyond public–private agreements and mandatory notification are needed. In this study we will evaluate whether a tailored intervention package can increase TB notifications from PPs in Indonesia. Methods. This is a cluster-randomized trial of a multi-component public health intervention. 36 community health centre (CHC) areas will be selected as study locations and randomly allocated to intervention and control arms (1:1). PPs in the intervention areas will be identified using a mapping exercise and recruited into the study if they are eligible and consent. They will receive a tailored intervention package including in-person education about TB management along with bimonthly electronic refreshers, context-specific selection of referral pathways, and access to a TB-reporting app developed in collaboration with the National TB programme. The primary hypothesis is that the intervention package will increase the TB notification rate. The primary outcome will be measured by collecting notification data from the CHCs in intervention and control arms at the end of a 1-year observation period and comparing with the 1-year pre-intervention. The primary analysis will be intention-to-treat at the cluster level, using a generalised mixed model with repeated measures of TB notifications for 1 year pre- and 1 year post-intervention. Discussion. The results from this study will provide evidence on whether a tailored intervention package is effective in increasing the number of TB notifications, and whether the PPs refer presumptive TB cases correctly. The study results will guide policy in the development of TB-PPM in Indonesia and similar settings.

Background. A significant proportion of tuberculosis (TB) patients globally make their initial visit for medical care to either an informal provider or a private practitioner, and many are not formally notified. Involvement of private practitioners (PPs) in a public–private mix for TB (TB-PPM) provides an opportunity for improving TB control. However, context-specific interventions beyond public–private agreements and mandatory notification are needed. In this study we will evaluate whether a tailored intervention package can increase TB notifications from PPs in Indonesia. Methods. This is a cluster-randomized trial of a multi-component public health intervention. 36 community health centre (CHC) areas will be selected as study locations and randomly allocated to intervention and control arms (1:1). PPs in the intervention areas will be identified using a mapping exercise and recruited into the study if they are eligible and consent. They will receive a tailored intervention package including in-person education about TB management along with bimonthly electronic refreshers, context-specific selection of referral pathways, and access to a TB-reporting app developed in collaboration with the National TB programme. The primary hypothesis is that the intervention package will increase the TB notification rate. The primary outcome will be measured by collecting notification data from the CHCs in intervention and control arms at the end of a 1-year observation period and comparing with the 1-year pre-intervention. The primary analysis will be intention-to-treat at the cluster level, using a generalised mixed model with repeated measures of TB notifications for 1 year pre- and 1 year post-intervention. Discussion. The results from this study will provide evidence on whether a tailored intervention package is effective in increasing the number of TB notifications, and whether the PPs refer presumptive TB cases correctly. The study results will guide policy in the development of TB-PPM in Indonesia and similar settings.

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Giriş: Tüberküloz (TB), dünyada yaklaşık her yıl 10 milyon kişide görülmektedir ve enfeksiyondan kaynaklanan ölümlerin başında yer almaktadır. Dünya genelinde 2017 yılı için, tahmin edilen vaka sayısı ile resmi rakamları oluşturan raporlanmış vakalar arasındaki 3,6 milyon hasta farkının yetersiz tanı ve eksik bildirimlerden kaynaklandığı düşünülmektedir. Türkiye’de ulusal TB programının temelini, hastaların erken bulunması ve etkili olarak tedavilerinin sağlanması oluşturmaktadır. Ülkemizde yasal olarak bildirimi zorunlu bir hastalık olan TB hastalığı bildirimleri halen yeterli düzeyde olmamaktadır. Özellikle akciğer dışı TB vakalarının bildirimi bazen ihmal edilmektedir. Materyal ve Metot: Ankara ilinde İl TB Kurulu kararıyla 2003 yılında TB hasta bildirimlerinde aktif sürveyans çalışması başlatılmıştır. Bu kapsamda her birimin görev tanımları yapılarak hastanelerde aktif sürveyans sorumlu ve görevlileri belirlenmiş olup ayrıca çalışmaları yerinde incelemek için VSD hekim ve hemşirelerinden oluşan ekipler görevlendirilmiştir. Bulgular: Hastanelerin poliklinik, klinik, eczane, laboratuar, bilgi-işlem gibi birimleri, aktif sürveyans görevlileri tarafından ziyaret edilerek TB tanısı veya tedavisiyle ilgili kaydı bulunan hastalar bulunmakta ve bildirimi yapılmaktadır. Ankara’daki bütün yataklı tedavi kurumlarını kapsayan bu uygulamanın başlamasıyla ilk yıl bildirimlerde %100’den fazla artış sağlanmış ve bu sayı yıllar boyunca devam etmiştir. En fazla bildirim göğüs hastalıkları hastanesi tarafından yapılmakta, ardından tıp fakülteleri ve kamu hastaneleri gelmektedir. Özel hastanelerde TB ile ilgili tanı ve tedavi işlemlerinin oldukça düşük sayıda olduğu görülmüştür. Sonuç: Ankara’daki TB bildirimlerinde aktif sürveyans uygulaması diğer illere de örnek olmuş ve Sağlık Bakanlığı tarafından 2014 yılında yayınlanan bir genelgeyle tüm ülkede aktif sürveyans uygulamasına geçilmiştir. Bu sayede hastanelerde tanısı konan ve tedavisi başlanan TB hastalarının tedavilerine devam ederek tamamlamaları, temaslılarının muayene edilebilmeleri ve ülkemizde kayıt dışı hastanın mümkün olabildiği kadar azaltılarak gerçeğe en yakın şekilde raporlanabilmesi mümkün olacaktır.

Background: Ecological factors are important indicators for tuberculosis (TB) notification. However, consolidation of evidence on the effect of altitude and temperature on TB notification rate has not yet been done. The aim of this review is to illustrate the effect of altitude and temperature on TB notification rate. Methods: Electronic searches were undertaken from PubMed, EMBASE, and Scopus databases. Hand searches of bibliographies of retrieved papers provided additional references. A review was performed using the Meta-analysis Of Observational Studies in Epidemiology guideline. Results: Nine articles from various geographic regions were included in the study. Five out of nine studies showed the effect of altitude and four articles identified temperature effects. Results showed that TB notification rates were lower at higher altitude and higher at a higher temperature. Conclusion: This review provides qualitative evidence that TB notification rates increase with temperature and decrease with altitude. The findings of this review will encourage policymakers and program managers to consider seasonality and altitude differences in the design and implementation of TB prevention and control strategies.

Background: The Revised National TB Control Programme developed a case based web-based online reporting mechanism called NIKSHAY. A community-based survey conducted in 2011 reported that 46% of the tuberculosis (TB) patients in India were treated outside the public health system (private sector) and hence they are not the part of the national TB notification system. Methodology: The objective of the study was to assess the profile of the TB individuals in the Chittoor district in Andhra Pradesh, south India. A secondary data were retrieved from the district TB center NIKSHAY web-based online portal in Chittoor and analyzed using SPSS 21.0 version. Data were taken from the last 1 year (April 2017 to March 2018). Results: A total of 3952 individuals were registered in the web based online NIKSHAY portal during the study. Among them in 2918 (73.7%) were males and 1033 (26.2%) were females with the mean age of the patients was 44.6 years with a standard deviation of ± 16.3 ranges. The clinically confirmed cases were 587 patients and microbiologically positive were 2495 (79.8%) and negative were 633 (20.2%). Majority 3263 (82.5%) were had pulmonary and 452 (11.4%) had extra-pulmonary TB. Depending on the HIV-positive cases were 274 (6.9%) and 3560 (90.2%) were negative and the remaining 118 (2.9%) do not know the status of the HIV/AIDS. The CBNAAT results were 411 (10.5%) of the patients had rifampicin sensitivity and 26 (0.6%) of them were resistant. Conclusion: India had taken the nice initiative for the web-based online portal for the notification of the TB patients. Several ongoing efforts have been implemented to improve the quality of surveillance reporting. A series of trainings on quality assurance of TB data should be taken to all the field staff. [ABSTRACT FROM AUTHOR]

Introduction: Though two-third of rural healthcare is served by URPs, most of them lack in proper training on treatment of Tuberculosis. Objective: To evaluate effect of educational intervention on perception of Tuberculosis management among URPs. Methodology: Knowledge and Attitude of participants were assessed using a predesigned questionnaire before and after an educational intervention. Results: Pre-intervention assessment revealed that majority (92.9%) had heard about PTB. Only 39.3% knew at-least 3 sites of EPTB. Nearly one-third knew about daily regime but 10.7% could name all five first-line ATDs. Few responded that Levofloxacin (25%), Moxifloxacin (10.7%), Amikacin (7.1%) should be avoided in chest symptomatics. Knowledge of punishment for intentional nonnotification (10.7%) was poor. Only 42.9% opined for ATD use in pregnant and children. After intervention, knowledge had improved significantly (P<0.001). Attitude improved with no statistical significance. Conclusion: Educational intervention can improve knowledge of Tuberculosis among URPs and regular reinforcement is recommended for such programs. [ABSTRACT FROM AUTHOR]

Objective: Tuberculosis (TB) is still a major public health problem worldwide. In Turkey, TB cases have to be reported to the Ministry of Health via the National Tuberculosis Surveillance System which has been active since 2005. In this study, our aim is to investigate how effectively the system is working at a tertiary center. Material and Methods: TB cases aged 0 to 18 years who admitted to Hacettepe University Pediatric Pulmonology for diagnosis or treatment between January 2005 and December 2015 were detected. These cases were later screened from the records of the National Tuberculosis Surveillance System by the help of the managers from Tuberculosis Department of the Ministry of Health. Unreported cases and delays in reporting were evaluated. Results: From January 2005 to December 2015 there were 93 pediatric TB patients. In the preliminary evaluation, 92 of the 93 patients were properly reported via the National Tuberculosis Surveillance System. The single unreported patient had been hospitalized in the intensive care unit with a diagnosis of severe TB meningitis and transferred to another center upon the family request. It was learned that she died during her hospitalization. Conclusion: Reporting of tuberculosis cases and national registration systems are very important for public health. Thanks to the direct supervision treatment policy implemented in our country since 2005, almost all TB cases are recorded. Considering our patient who was not notified from our center, it has seen that it is very important to report patients with a poor condition as soon as they are diagnosed. Early notifications allow earlier evaluation of contacts, especially children, in terms of the need for tuberculosis prevention or tuberculosis treatment. [ABSTRACT FROM AUTHOR]

Background: Ecological factors are important indicators for tuberculosis (TB) notification. However, consolidation of evidence on the effect of altitude and temperature on TB notification rate has not yet been done. The aim of this review is to illustrate the effect of altitude and temperature on TB notification rate. Methods: Electronic searches were undertaken from PubMed, EMBASE, and Scopus databases. Hand searches of bibliographies of retrieved papers provided additional references. A review was performed using the Meta-analysis Of Observational Studies in Epidemiology guideline. Results: Nine articles from various geographic regions were included in the study. Five out of nine studies showed the effect of altitude and four articles identified temperature effects. Results showed that TB notification rates were lower at higher altitude and higher at a higher temperature. Conclusion: This review provides qualitative evidence that TB notification rates increase with temperature and decrease with altitude. The findings of this review will encourage policymakers and program managers to consider seasonality and altitude differences in the design and implementation of TB prevention and control strategies. [ABSTRACT FROM AUTHOR]

Objectives: Tuberculosis (TB) is seen in 10 million people every year in the world and is one of the leading deaths caused by infection. In the year 2017, there are 3.6 million patients difference between the reported cases, and estimated cases. It's thought that, the main reasons are inadequate diagnosis and incomplete reporting. Early diagnosis and effective treatment of tuberculosis patients are constitute the basis of the national TB program in Turkey. TB, which is a legally required notification in our country, is unfortunately not properly reported. In particular, the notification of cases of extrapulmonary TB is sometimes neglected. Materials and Methods: In 2003, the active surveillance study was initiated in TB patient notifications by the Provincial TB Board decision in Ankara. For this purpose, the duty definitions of each unit were made and the active surveillance officer / responsible was determined in the hospitals and the teams consisting of VSD physicians and nurses were assigned to on‐site inspection. Results: The patients who are registered in the polyclinic, clinic, pharmacy, laboratory, information Objectives: Tuberculosis (TB) is seen in 10 million people every year in the world and is one of the leading deaths caused by infection. In the year 2017, there are 3.6 million patients difference between the reported cases, and estimated cases. It's thought that, the main reasons are inadequate diagnosis and incomplete reporting. Early diagnosis and effective treatment of tuberculosis patients are constitute the basis of the national TB program in Turkey. TB, which is a legally required notification in our country, is unfortunately not properly reported. In particular, the notification of cases of extrapulmonary TB is sometimes neglected. Materials and Methods: In 2003, the active surveillance study was initiated in TB patient notifications by the Provincial TB Board decision in Ankara. For this purpose, the duty definitions of each unit were made and the active surveillance officer / responsible was determined in the hospitals and the teams consisting of VSD physicians and nurses were assigned to on‐site inspection. Results: The patients who are registered in the polyclinic, clinic, pharmacy, laboratory, information processing department for diagnosis or treatment of TB are visited and reported by the officers. With the start of this process, which covers all inpatient treatment institutions in Ankara, more than 100% increase has been achieved in the notifications and this number has continued for years. The highest number of reports is done by the chest diseases hospital, followed by medical schools and public hospitals. It has been observed that the number of diagnosis and treatment procedures for TB in private hospitals is quite low. Conclusion: Active surveillance study for tuberculosis notifications in Ankara, became an example for other provinces and was put into practice in 2014 with a circular published by the Ministry of Health. In this way, it will be possible for TB patients diagnosed in hospitals continued to be treated, their contacts can be examined and the number of unregistered patient in our country is reduced as much as possible and can be reported closest to reality. [ABSTRACT FROM AUTHOR]

Under-detection and -reporting in the private sector constitute a major barrier in Viet Nam’s fight to end tuberculosis (TB). Effective private-sector engagement requires innovative approaches. We established an intermediary agency that incentivized private providers in two districts of Ho Chi Minh City to refer persons with presumptive TB and share data of unreported TB treatment from July 2017 to March 2019. We subsidized chest x-ray screening and Xpert MTB/RIF testing, and supported test logistics, recording, and reporting. Among 393 participating private providers, 32.1% (126/393) referred at least one symptomatic person, and 3.6% (14/393) reported TB patients treated in their practice. In total, the study identified 1203 people with TB through private provider engagement. Of these, 7.6% (91/1203) were referred for treatment in government facilities. The referrals led to a post-intervention increase of +8.5% in All Forms TB notifications in the intervention districts. The remaining 92.4% (1112/1203) of identified people with TB elected private-sector treatment and were not notified to the NTP. Had this private TB treatment been included in official notifications, the increase in All Forms TB notifications would have been +68.3%. Our evaluation showed that an intermediary agency model can potentially engage private providers in Viet Nam to notify many people with TB who are not being captured by the current system. This could have a substantial impact on transparency into disease burden and contribute significantly to the progress towards ending TB.

Tuberculosis (TB) is a major public health problem. An emerging menace in India is drug resistant forms of TB. In order to ensure proper TB diagnosis and case management, reduce TB transmission and address the problems of emergence of spread of Drug Resistant-TB, it is essential to have complete information of all TB cases. Therefore, Govt. of India declared Tuberculosis a notifiable disease on 7th May 2012. This paper highlights the fact that notification of TB in the absence of regulation of diagnostic practices, rational use of anti-TB medicines and availability of diagnostic and treatment facilities for drug-resistant TB will pose more problems rather than provide solutions to this problem.