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Background: Most countries in Subsaharan Africa have well-established National Tuberculosis Control Programs with relatively stable routine performances. However, major epidemiological events may result in significant disruptions. In March 2014, the World Health Organization announced the outbreak of Ebola virus disease in Guinea, a country with a high incidence of TB and HIV. Our study aims to assess the impact of the Ebola virus disease outbreak on TB notification, treatment and surveillance, using main indicators.Methods: This is a retrospective cohort study that compares TB trends using surveillance data from the periods before (2011-2013), during (2014-2016) and after (2017-2018) Ebola virus disease outbreak. A time series analysis is conducted to investigate the linkages between the decline in TB notification and the Ebola virus disease outbreak through cross-correlation. The lag in the cross-correlation test is evaluated using ANCOVA type II delayed variable dependent model. The surveillance system is assessed using TB surveillance standards and benchmarks and vital registration systems recommended by WHO, compared with those of 2015 during the Ebola virus disease.Results: The rate of reporting of TB declined from 120 cases per 100,000 in 2011 to 100 cases per 100,000 in 2014, at the peak of the Ebola virus disease outbreak. The time series cross-correlation test of all notified cases of TB and Ebola shows a significant lag of -0.4 (40%), reflecting a drop in the rate of notification (F-value=5.7 [95% CI: 0.2-21.3]). However, the Ebola virus disease had no negative impact on patient treatment outcomes (F-value=1.3 [95% CI: 0.002-8.8179]). Regarding the surveillance system, five out of 13 WHO standards and benchmarks were met following their evaluation in 2019, after the Ebola virus disease outbreak, compared to three in 2015.Conclusion: Major epidemics such as the Ebola virus disease outbreak may have a significant impact on well-established TB control programs as shown in the example of Guinea. On the other hand, it is noticed that, sudden disruptions of routine performance may lead programs to improve their surveillance system.

Background: Despite the predictor role of the body weight variation on multidrug-resistant tuberculosis (MDR-TB) treatment outcome, little data are available to corroborate this finding. We aimed to study the course of weight in patients with MDR-TB, to identify subgroups of weight evolutions, and to determine factors that influence these evolutions. Methods: Patients treated with a shorter MDR-TB treatment regimen between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centers in Guinea, who had rifampicin resistance, and who were cured or died were analyzed. Patients were seen monthly until the end of treatment. Clinical outcome was the Body Mass Index (BMI). We used a linear mixed model to analyze the course of BMI and a latent class mixed model to identify subgroup of BMI evolutions. Results: Of 232 patients treated for MDR-TB during the study period, 165 were analyzed. These patients had a total of 1387 visits, with a median of 5 visits (interquartile range, 3 – 8 visits). Monthly BMI increase was 0.24 (SE 0.02) per kg/m 2 . Factors that associated with faster BMI progression were cured to MDR-TB treatment (0.24 [SE 0.09] per kg/m 2 ; p = 0.0205), and the absence of lung cavities on X-ray (0.18 [0.06] per kg/m 2 ; p = 0.0068). Two subgroups of BMI evolution were identified: “Rapid BMI (n = 121; 85%) and “Slow BMI evolution (n = 22; 15%). Patients in the slow increasing BMI group were mostly female (68%) without history of TB treatment (41%), with positive HIV infection (59%), with most severe clinical condition at baseline, characterized by a higher frequency of symptoms including depression (18%), dyspnea (68%), poor adherence to MDR-TB treatment (64%), lower platelets count, and higher liver SGOT count. These patients had also a longer time to-initial culture conversion delay (log-rank test: p = 0.0087). Conclusion: The available data provided quantitative information on BMI progression of patients with MDR-TB treated with a shorter regimen, and allowed the identification of the subgroup of patients with different BMI evolutions. Furthermore, they emphasized the usefulness of BMI as biomarker to monitor MDR-TB treatment outcome.

Additional file 1: Appendix: Table 1. Predictors of BMI increase in patients with MDR-TB, univariate linear mixed random-effect regression. Data are given as mean (SE); SE = standard error. Table 2. Summary of the estimated latent class mixed model for the MDR-TB patient data (n = 165). Number of latent classes (G) that correspond to the number of fitted models, log-likelihood (L), number of parameters (P), Bayesian information criterion (BIC), integrated classification likelihood with BIC (ICL-BIC), proportion of patients in each latent class (%). Group membership was explained by treatment outcome and lung cavities on X-ray. The model with the lower ICL-BIC was chosen as the best one, which considers the quality of the classification in addition to the goodness of fit when selecting the optimal number of latent classes. Table 3. Final posterior classification Number (%) of patients in each class, and mean posterior probabilities of the latent class membership according to the final posterior classification. For example, patients in the rapid BMI increase group were assigned to this class with a mean probability of 99.74% vs a probability of 0.26% of belonging to the slow BMI increase group. Conversely, patients classified in the slow BMI increase group were assigned to this class with a mean probability of 81.9% vs. a probability of 18.1% of belonging to the rapid BMI increase group.

Background Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk scoreMethods Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion.Results 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59 – 61) respectively. Lower colony count (< 3 +) of initial culture (aHR = 1.52, 1.09 – 2.14) and previously history of TB treatment (aHR = 2.10, 1.26 – 3.51) were more likely to have culture conversion, while only the higher BMI (aHR = 1.10, 1.03 – 1.18) was associated with rapid smear conversion. The predicted risk score from independent predictors showed good discrimination (0.855 ± 0.023 and 0.883 ± 0.02 respectively for smear and culture conversions). Time-to initial culture conversion provided a better discriminative capacity (AUC) to detect patients with higher chance to being treatment success during the first three months.Conclusion The identified predictors can be considered to improve the management of MDR-TB patients. The optimal time points for culture conversion was three months in shorter regime. Keywords: Conversion, Multidrug-resistant, Tuberculosis, Guinea.

Abstract Background: Despite the availability of the drug treatment for tuberculosis (TB) more than 75 years, mortality and drug resistance are increasing. Therefore, little data is available in Guinea. We aimed to develop and validate a prognosis nomogram of MDR-TB treatment outcomes. Methods:A retrospective cohort study was conducted among men and women, aged 18 years or older, with MDR-TB, from three major drug-resistance TB centres in Guinea. We used the logistic regression to analyse treatment outcomes. Prognostic factors with a p value less than 0.05 from a multivariate model were used to build nomogram and assessed their performance based on discriminative c-index, and calibration using the Hosmer-Lemeshow (H-L) test. To derive the optimal cut-off point score, the Youden’s index method was used. Results:Among 232 patients with MDR-TBenrolled and followed between June 07, 2016 and June 22, 2018, 218 were analyzed. All patients were resistant to rifampicin, which diagnosed by the Xpert MTB/RIF. The overall rate of success was 73%.Factors associated with successful treatment in drug-resistant TB patients were higher BMI more than 18.5 kg/m2(p = 0.0253; aOR = 2.94), good adherence to treatment (p = < 0.0001; aOR = 33.92), normal platelets count (p = 0.0053; OR = 1.004), and the absence of clinical symptoms such as chest pain (p = 0.0083; aOR = 3.19) and depression (p = 0.0308; aOR = 8.62). The discrimination (c-index= 0.848 [95% bootstrap CI, 0.780 – 0.916] in the derivation sample and 0.803 after correction for optimism) and calibration (H-LX2= 2.91 [p = 0.94]) were good. The optimal absolute risk threshold was 20%, corresponding to a sensibility of 95% and specificity of 58%. Conclusion:Treatment success outcomes was lower than those recommended by the World Health Organization (75%). We recommend to improve the MDR-TB patient monitoring during treatment, nutritional status, and considering the psychological state. Our prognosis nomogram needs to be validated in an external population before it can be used in clinical practice. Keywords:Nomogram, Multidrug-resistant, Tuberculosis, Guinea.

BackgroundThe establishment of research ethics committees (RECs) in charge of reviewing research protocols answers the need to regulate with an ethical framework the development of clinical trials, biomedical research and technologies affecting human health. The first RECs were instituted at the national level in the 60 s, and were gradually put in place in Africa as a result of research projects development in the area of epidemics such as HIV infection, and to meet one of the major requirements of the Helsinki Declaration and the international ethical Guidelines CIOMS: ‘each research protocol involving humans has to be reviewed by an independent ethics committee’. However, RECs in Africa are still facing various challenges in the accomplishment of their missions. Among them, RECs located in the West-African French speaking area are reporting an urgent need for networking and coordinating their effort.Supported by EDCTP, AFREENET (AFRica Ethics Excellence NETwork) is a 3 year collaborative project between three RECs, respectively in Côte d’Ivoire, Guinea and Benin, and coordinated by the Ethics Unit of Institut Pasteur (France), which aims to reinforce RECs capacities.The project will lead to reinforcement of training capacities through a long-term strategy to establish mechanisms to ensure and update members’ training, and to develop a pool of ethics trainers. Based on RECs experiences, network activities will permit to share and identify valuable practices on global ethics oversight, such as monitoring, SOPs, regulatory issues and sensitisation. The preparation of Ethics Committees for the potential occurrence of outbreaks will be specifically addressed through an Outbreak preparation plan built upon lessons learnt from the Ebola crisis.Creating synergies and mutual empowerment between „African RECs will increase their visibility, their capacity for advocacy and their recognition as key actors of a responsible ethics research framework at the national, regional and international level.

La tuberculose est un véritable problème de santé publique. C'est une maladie guérissable et cette guérison passe par une bonne prise en charge thérapeutique. Il arrive parfois on assiste à l’échec thérapeutique, d'où l'intérêt de notre étude portant sur les facteurs prédictifs de ses échecs. Dans l'espace d'une année sur 1300 cas de tuberculose toute forme confondue, 700 cas de tuberculose pulmonaire à microscopie positive ont été répertorié dont 100 cas transférés. La tranche d’âge de 15-25 ans a été la plus touchée avec un sexe-ratio de 2 en faveur des hommes et 41,66% de nos malades ont été les ouvriers suivis de 20,83% des commerçants. La majorité de nos patients provenait de Conakry soit 99, 5%. Sur 600 patients suivis les nouveaux cas représentaient 83,33% et l’échec thérapeutique représentait 12 cas soit 2%. L'interruption du traitement représente le principal facteur de l’échec. Les facteurs qui ont influencé la régularité des malades au traitement ont été multiples. Des facteurs liés à l'organisation du système de santé, la rupture des médicaments antituberculeux, l’éducation sanitaire insuffisante, les contraintes de la supervision du traitement, l'implication insuffisante et la vente des médicaments par le personnel de santé. Des facteurs liés aux patients eux-mêmes, la crainte de perte d'emploi, les contraintes financières. Les renforcements de l'organisation du système sanitaire et l’éducation thérapeutiques pourront réduire le taux d’échec du traitement antituberculeux. L'amélioration de la qualité de la prise en charge des malades en situation d’échec devrait passer par une culture systématique des expectorations avec antibiogramme.