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The coronavirus disease (COVID-19) pandemic has affected clinical management of tuberculosis (TB) and TB-related services (2,2). Reports of the first cohorts of patients with COVID-19 and TB have been recently [...]

Evidence suggests that the COVID-19 pandemic negatively impacts tuberculosis (TB) activities. As TB and COVID-19 have similar symptoms, we assessed the effectiveness of integrated TB/COVID-19 screening in Guinea and Niger. From May to December 2020, TB screening was offered to symptomatic patients after a negative COVID-19 PCR test or after recovery from COVID-19 in Guinea. From December 2020 to March 2021, all presumptive COVID-19 patients with respiratory symptoms were tested simultaneously for COVID-19 and TB in Niger. We assessed the TB detection yield and used micro-costing to estimate the costs associated with both screening algorithms. A total of 863 individuals (758 in Guinea, and 105 in Niger), who were mostly male (60%) and with a median age of 34 (IQR: 26–45), were screened for TB. Reported symptoms were cough ≥2 weeks (49%), fever (45%), and weight loss (30%). Overall, 61 patients (7%) tested positive for COVID-19 (13 in Guinea, 48 in Niger) and 43 (4.9%) were diagnosed with TB disease (35 or 4.6% in Guinea, and 8 or 7.6% in Niger). The cost per person initiating TB treatment was USD $367 in Guinea and $566 in Niger. Overall, the yield of both approaches was high, and the cost was modest. Optimizing integrated COVID-19/TB screening may support maintaining TB detection during the ongoing pandemic.

Background Outcomes of retreatment for rifampicin-resistant tuberculosis (RR-TB) are rarely reported. We report 'definitive outcomes' after a cascade approach to RR-TB treatment. After a bacteriologically adverse outcome for the 9-months fluoroquinolone-based Short Treatment Regimen (STR), patients were retreated with a bedaquiline-based regimen (BDQ-regimen). Methods A Retrospective cohort study of RR-TB patients treated with the STR during 2012–2019 and retreated with a BDQ-regimen in case of failure or relapse was conducted. Definitive relapse-free cure took into account BDQ-regimen outcomes. Results Of 367 patients treated with the STR, 20 (5.4%) experienced failure or relapse. Out of these 20 patients, 14 started a BDQ-regimen, of whom none experienced failure or relapse. Definitive end of treatment outcomes of STR after revising with third-line BDQ-regimen outcomes, 84.7% (311/367) were cured relapse-free, 10.6% (39/367) died during treatment and 3.0% (11/367) were lost to follow-up during treatment with either the STR or BDQ-regimen. Six patients (1.6%; 6/367) with STR failure/relapse died before starting a BDQ-regimen. No patient had definitive treatment failure or relapse and remained without treatment. Conclusions If fluoroquinolone resistance is excluded or rare, it is beneficial to use fluoroquinolone as the core drug for a first RR-TB treatment regimen and to safeguard bedaquiline for those in need of retreatment. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe country-specific lockdown measures and tuberculosis indicators collected during the first year of the COVID-19 pandemic. Data on lockdown/social restrictions (compulsory face masks and hand hygiene; international and local travel restrictions; restrictions to family visits, and school closures) were collected from 24 countries spanning five continents. The majority of the countries implemented multiple lockdowns with partial or full reopening. There was an overall decrease in active tuberculosis, drug-resistant tuberculosis, and latent tuberculosis cases. Although national lockdowns were effective in containing COVID-19 cases, several indicators of tuberculosis were affected during the pandemic.

The short treatment regimen (STR) achieves a >80% cure in rifampicin-resistant tuberculosis (RR-TB) patients. However, ototoxicity induced by the injectable is a concern. This is the first study to evaluate the replacement of injectables by linezolid in patients with audiometry abnormalities at baseline or during the treatment.We conducted a retrospective cohort study of all RR-TB patients started on the STR between 2016 and June, 2019, in Niger. Patients underwent audiometry every 2 months in 2016 and every month since 2017.Of 195 patients, 16.9% (33 out of 195) received linezolid from the start (n=17), or switched from injectables to linezolid during treatment (n=16), based on audiometry abnormalities. In 2016, two patients developed severe ototoxicity despite switching to linezolid. Since 2017, no patient developed severe hearing loss or complete deafness. Severe haematological toxicity was observed in 18.1% (six out of 33) of patients on linezolid, none of which was life threatening. The use of linezolid was associated with severe but manageable adverse events (hazard ratio 8.9, 95% CI 2.5-31.5; p=0.001). A total of 90.9% (30 out of 33) of patients on a linezolid-containing STR were cured, and none experienced treatment failure. Three died, but not due to adverse events.Baseline and monthly audiometry monitoring and using linezolid after detection of hearing abnormalities appears effective to prevent severe ototoxicity, while keeping high treatment success and manageable adverse events., Competing Interests: Conflict of interest: M.B. Souleymane has nothing to disclose. Conflict of interest: A. Piubello has nothing to disclose. Conflict of interest: I.M. Mamane-Lawan has nothing to disclose. Conflict of interest: S. Hassane-Harouna has nothing to disclose. Conflict of interest: M.M. Assao-Neino has nothing to disclose. Conflict of interest: A. Soumana has nothing to disclose. Conflict of interest: Z. Hamidou-Harouna has nothing to disclose. Conflict of interest: A. Gagara-Issoufou has nothing to disclose. Conflict of interest: N. Ortuño-Gutiérez has nothing to disclose. Conflict of interest: A. Roggi has nothing to disclose. Conflict of interest: V. Schwoebel has nothing to disclose. Conflict of interest: S. Mamadou has nothing to disclose. Conflict of interest: L. Lynen has nothing to disclose. Conflict of interest: B. De Jong has nothing to disclose. Conflict of interest: A. Van Deun has nothing to disclose. Conflict of interest: T. Decroo has nothing to disclose., (Copyright ©ERS 2021.)

We sought to compare the effectiveness of two World Health Organization (WHO)-recommended regimens for the treatment of rifampin- or multidrug-resistant (RR/MDR) tuberculosis (TB): a standardised regimen of 9-12 months (the "shorter regimen") and individualised regimens of ≥20 months ("longer regimens").We collected individual patient data from observational studies identified through systematic reviews and a public call for data. We included patients meeting WHO eligibility criteria for the shorter regimen: not previously treated with second-line drugs, and with fluoroquinolone- and second-line injectable agent-susceptible RR/MDR-TB. We used propensity score matched, mixed effects meta-regression to calculate adjusted odds ratios and adjusted risk differences (aRDs) for failure or relapse, death within 12 months of treatment initiation and loss to follow-up.We included 2625 out of 3378 (77.7%) individuals from nine studies of shorter regimens and 2717 out of 13 104 (20.7%) individuals from 53 studies of longer regimens. Treatment success was higher with the shorter regimen than with longer regimens (pooled proportions 80.0% versus 75.3%), due to less loss to follow-up with the former (aRD -0.15, 95% CI -0.17- -0.12). The risk difference for failure or relapse was slightly higher with the shorter regimen overall (aRD 0.02, 95% CI 0-0.05) and greater in magnitude with baseline resistance to pyrazinamide (aRD 0.12, 95% CI 0.07-0.16), prothionamide/ethionamide (aRD 0.07, 95% CI -0.01-0.16) or ethambutol (aRD 0.09, 95% CI 0.04-0.13).In patients meeting WHO criteria for its use, the standardised shorter regimen was associated with substantially less loss to follow-up during treatment compared with individualised longer regimens and with more failure or relapse in the presence of resistance to component medications. Our findings support the need to improve access to reliable drug susceptibility testing., Competing Interests: Conflict of interest: S. Abidi has nothing to disclose. Conflict of interest: J. Achar has nothing to disclose. Conflict of interest: M.M. Assao Neino has nothing to disclose. Conflict of interest: D. Bang has nothing to disclose. Conflict of interest: A. Benedetti has nothing to disclose. Conflict of interest: S. Brode reports grants from Insmed and the Canadian Institutes for Health Research, personal fees for educational presentations from Boehringer Ingelheim and AstraZeneca, outside the submitted work. Conflict of interest: J.R. Campbell has nothing to disclose. Conflict of interest: E. Casas has nothing to disclose. Conflict of interest: F. Conradie has nothing to disclose. Conflict of interest: G. Dravniece has nothing to disclose. Conflict of interest: P. du Cros reports he was previously a member of the steering committee and protocol writing committee for the PRACTECAL randomised controlled trial of three novel 6-month MDR-TB regimens; and has undertaken a paid consultancy between TB Alliance and Burnet Institute to investigate applicability of the TB-Nix regimen (a novel short MDR-TB regimen) to Papua New Guinea. Conflict of interest: D. Falzon has nothing to disclose. Conflict of interest: E. Jaramillo has nothing to disclose. Conflict of interest: C. Kuaban has nothing to disclose. Conflict of interest: Z. Lan has nothing to disclose. Conflict of interest: C. Lange reports personal fees for lectures from Chiesi, Gilead, Janssen, Lucane, Novartis, Oxoid, Berlin-Chemie and Thermo Fisher, outside the submitted work. Conflict of interest: P.Z. Li has nothing to disclose. Conflict of interest: M. Makhmudova has nothing to disclose. Conflict of interest: A.K.J. Maug has nothing to disclose. Conflict of interest: D. Menzies has nothing to disclose. Conflict of interest: G.B. Migliori has nothing to disclose. Conflict of interest: A. Miller reports that The Eli Lilly Foundation MDR-TB Partnership provided partial salary support in 2015–2016 through a grant to Salmaan Keshavjee, Harvard Medical School, although none of the work in the current paper or analysis was supported through that mechanism; the grant also paid for travel to a meeting in July of 2016. Conflict of interest: B. Myrzaliev has nothing to disclose. Conflict of interest: N. Ndjeka has nothing to disclose. Conflict of interest: J. Noeske has nothing to disclose. Conflict of interest: N. Parpieva has nothing to disclose. Conflict of interest: A. Piubello has nothing to disclose. Conflict of interest: V. Schwoebel has nothing to disclose. Conflict of interest: W. Sikhondze has nothing to disclose. Conflict of interest: R. Singla has nothing to disclose. Conflict of interest: M.B. Souleymane has nothing to disclose. Conflict of interest: A. Trébucq has nothing to disclose. Conflict of interest: A. Van Deun has nothing to disclose. Conflict of interest: K. Viney has nothing to disclose. Conflict of interest: K. Weyer has nothing to disclose. Conflict of interest: B.J. Zhang has nothing to disclose. Conflict of interest: F. Ahmad Khan reports grants from the World Health Organization during the conduct of the study., (The content of this work is copyright of the authors or their employers. Design and branding are copyright ©ERS 2020.)