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US-bound immigrants and refugees undergo a mandatory overseas medical examination that includes tuberculosis screening; this exam is not routinely required for temporary visitors applying for non-immigrant visas (NIV) to visit, work, or study in the United States. US health departments and foreign ministries of health report tuberculosis cases in travelers to Centers for Disease Control and Prevention Quarantine Stations. We reviewed cases reported to this passive surveillance system from January 2011 to June 2016. Of 1252 cases of tuberculosis in travelers reported to CDC, 114 occurred in travelers with a long-term NIV. Of these, 83 (73%) were infectious; 18 (16%) with multidrug-resistant tuberculosis (MDR TB) and one with extensively drug-resistant tuberculosis (XDR TB). We found evidence that NIV holders are diagnosed with tuberculosis disease in the United States. Given that long-term NIV holders were over-represented in this data set, despite the small proportion (4%) of overall non-immigrant admissions they represent, expanding the US overseas migration health screening program to this population might be an efficient intervention to further reduce tuberculosis in the United States. [ABSTRACT FROM AUTHOR]

Rationale: Isoniazid-resistant tuberculosis (Hr-TB) is often overlooked in diagnostic algorithms because of reliance on first-line molecular assays testing only for rifampicin resistance. Objectives: To determine the prevalence, outcomes, and molecular mechanisms associated with rifampin-susceptible, isoniazid-resistant TB (Hr-TB) in the Eastern Cape, South Africa. Methods: Between April 2016 and October 2017, sputum samples were collected from patients with rifampin-susceptible TB at baseline and at Weeks 7 and 23 of drug-susceptible TB treatment. We performed isoniazid phenotypic and genotypic drug susceptibility testing, including FluoroTypeMTBDR, Sanger sequencing, targeted next-generation sequencing, and whole-genome sequencing. Results: We analyzed baseline isolates from 766 patients with rifampin-susceptible TB. Of 89 patients (11.7%) who were found to have Hr-TB, 39 (44%) had canonical katG or inhA promoter mutations; 35 (39%) had noncanonical katG mutations (including 5 with underlying large deletions); 4 (5%) had mutations in other candidate genes associated with isoniazid resistance. For 11 (12.4%), no cause of resistance was found. Conclusions: Among patients with rifampin-susceptible TB who were diagnosed using first-line molecular TB assays, there is a high prevalence of Hr-TB. Phenotypic drug susceptibility testing remains the gold standard. To improve the performance of genetic-based phenotyping tests, all isoniazid resistance–associated regions should be included, and such tests should have the ability to identify underlying mutations. [ABSTRACT FROM AUTHOR]

Background Data regarding ocular tuberculosis (OTB) in the United States have not been previously reported. We evaluated trends of OTB compared with other extrapulmonary TB (EPTB). Methods We estimated the proportion of all EPTB cases (with or without concurrent pulmonary involvement) with OTB reported to the National Tuberculosis Surveillance System during 1993–2019. We compared demographics and clinical characteristics of people with OTB and other EPTB during 2010–2019. P values were calculated by chi-square test for categorical variables and Kruskal-Wallis for continuous variables. Results During 1993–2019, 1766 OTB cases were reported, representing 1.6% of 109 834 all EPTB cases: 200 (0.5% of 37 167) during 1993–1999, 395 (1.0% of 41 715) during 2000–2009, and 1171 (3.8% of 30 952) during 2010–2019. In contrast to persons with other EPTB, persons with OTB were older (median, 48 vs 44 years; P <.01), more likely to be US-born (35% vs 28%; P <.01), more likely to have diabetes (17% vs 13%; P <.01), and less likely to have HIV (1% vs 8%; P <.01). OTB was less likely to be laboratory confirmed (5% vs 75%; P <.01), but patients were more likely to be tested by interferon gamma release assay (IGRA; 84% vs 56%; P <.01) and to be IGRA positive (96% vs 80%; P <.01). Conclusions Reported OTB increased during 1993–2019 despite decreasing TB, including EPTB; the largest increase occurred during 2010–2019. OTB was rarely laboratory confirmed and was primarily diagnosed in conjunction with IGRA results. More research is needed to understand the epidemiology of OTB to inform clinical and diagnostic practices. [ABSTRACT FROM AUTHOR]

Treatment of tuberculosis (TB) infection (TBI) to prevent active TB disease is a key component of the National Strategic Plan to end TB in India, without which the strategies to end TB would be futile. There is a need to rapidly scale up access to effective shorter regimens for tuberculosis preventive treatment (TPT) to a wider set of risk groups. This applies for identifying high-risk groups for TPT expansion. Thus, our aim with this review is to determine the TBI prevalence in different risk groups in India. We searched databases like Embase, Medline, Scopus, and CINAHL for studies published between 2012 and 2023 to estimate TBI in different risk groups in India. The PRISMA guidelines were followed when reviewing the publications, and a predetermined search strategy was used to find relevant sources across various databases. Using MetaXL (MS excel) software, we pooled data based on a random-effects model, along with heterogeneity testing using Cochrane's Q and I2 statistic. A total of 68 studies were included from 10,521 records. TBI pooled prevalence was estimated using the IGRA data, while in the absence of IGRA data, TST data were utilized. The key findings revealed a total of 36% pooled TBI prevalence for all risk factors, 59% among smokers, 53% among diabetics and alcoholics, 48% among malnourished, 47% among contacts of TB patients, 44% among HIV, 36% among pregnant women, 35% among COVID-19 patients, 31% among healthcare workers, 18% among sarcoidosis patients, and 15% among rheumatoid arthritis patients in India. Our review depicted a high TBI burden among groups such as diabetes mellitus, smokers, malnourished, and alcoholics. WHO has yet to recommend for systematic screening and treatment for TBI among these groups for want of evidence which this study provides, highlighting the need to reprioritize the risk groups for tailored TPT strategies. [ABSTRACT FROM AUTHOR]

A reflection on public policies to combat Tuberculosis. A global panorama Tuberculosis is an infectious bacterial disease caused by Mycobacterium tuberculosis, mainly affecting the lungs and transmitted from person to person through respiratory droplets. Although the infection does not always cause symptoms in healthy people, when active, it can cause coughing, chest pain, weakness, weight loss and fever. Tuberculosis is currently a global health concern, with millions of deaths and new infections each year, due to factors such as drug resistance, HIV, international travel and homelessness. With a third of the world's population infected, it is essential that healthcare professionals understand the disease and its diagnostic procedures. New research should focus on the social factors that determine TB. In this way, it is believed, Brazil will once again be able to celebrate reaching the WHO targets for the elimination of TB by 2035. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse the spatial patterns and factors associated with the incidence of tuberculosis-diabetes (TB-DM) in Brazil, from 2001 to 2019. Ecological study. Brazilian municipalities were used as the units of analysis. The local empirical Bayesian rate and the spatial autocorrelation test were calculated. Moran and Getis-Ord Gi∗ were used to identify spatial clusters, and spatially weighted regression was conducted. In total, 75,021 new cases of TB associated with DM were reported in Brazil during the study period. Most Brazilian municipalities had an average TB-DM incidence of 1.0–2.0/100,000 inhabitants. The regression showed that the Gini index (β = 0.85) and family health strategy coverage (β = −0.26) were the two indicators that had the most influence on TB-DM incidence in Brazil. This study identified spatial clusters of TB-DM in Brazil. The results also indicated that social inequalities played a key role in the incidence of TB. [ABSTRACT FROM AUTHOR]

The burden of tuberculosis (TB) in migrant children and young people (CYP) is commonly overlooked, despite the increasing incidence of TB in migrant populations in the European region. This study aimed to examine the distribution and disease characteristics of TB among migrant and native-born CYP through analysis of data from the European Centre for Disease Prevention and Control (ECDC) surveillance system (TESSy). Retrospective database analysis. A retrospective database analysis was conducted on all CYP TB cases (0–17 years) reported to TESSy (1995–2017), exploring distribution, site of TB, and presence of MDR-TB using multivariate analysis in R statistical software. Of the 73,176 CYP TB cases reported in the EU/EFTA (1995–2017), 24.4% (n = 17,879) occurred in migrant CYP and 75.6% (n = 55,297) occurred in native-born CYP. Migrant CYP were more likely (P < 0.001) to have pulmonary TB (OR: 1.90; 95% CI: 1.74–2.09) and unsuccessful treatment outcomes (OR: 2.05; 95% CI: 1.74–2.40) compared to native-born CYP. The proportion of extrapulmonary TB, compared to pulmonary TB across total CYP cases was higher than the existing evidence base. Overall, there were significant differences in the site of TB and treatment outcomes between migrant and native-born CYP. To improve outcomes, TB screening and detection practices should focus on facilitating care in migrant CYP. However, to better understand the implications of these findings on broader TB control, TB among CYP should be addressed more frequently in reports and research. [ABSTRACT FROM AUTHOR]

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In the context of the evolving global health landscape shaped by the COVID-19 pandemic, tuberculosis (TB) is gaining renewed attention as a reemerging threat even in low-endemic countries. Immunological tests such as the tuberculin skin test (TST) and interferon-gamma release assay (IGRA) are pivotal in identifying tuberculosis infection (TBI). However, their inability to distinguish between past and ongoing infection poses a diagnostic challenge, possibly leading to the unnecessary treatment of a significant portion of the population with potential side effects. This review delves into the concept of incipient tuberculosis (ITB), a dynamic, presymptomatic stage characterized by heightened Mycobacterium tuberculosis complex (MTC) metabolic activity and replication that result in minimal radiological changes, signifying a transitional state between TBI and TB. Key focus areas include epidemiological factors, underlying pathogenesis, imaging findings, and the ongoing challenges in the identification of individuals with ITB through the development of new biomarkers and the use of whole-genome sequencing-based analyses to implement early treatment strategies. [ABSTRACT FROM AUTHOR]

Purpose: The risk of developing active tuberculosis (TB) is considerably increased in people living with HIV/AIDS (PLWH). However, incidence of HIV/TB coinfection is difficult to assess as surveillance data are lacking in many countries. Here, we aimed to perform a quantitative analysis of HIV/TB coinfections within the Cologne/Bonn HIV cohort and to determine risk factors for active TB. Methods: We systematically evaluated data of patients with HIV/TB coinfection between 2006 and 2017. In this retrospective analysis, we compared HIV/TB-coinfected patients with a cohort of HIV-positive patients. The incidence density rate (IDR) was calculated for active TB cases at different time points. Results: During 2006–2017, 60 out of 4673 PLWH were diagnosed with active TB. Overall IDR was 0.181 cases/100 patient-years and ranged from 0.266 in 2006–2009 to 0.133 in 2014–2017. Patients originating from Sub-Saharan Africa had a significantly (p < 0.001) higher IDR (0.694/100 patient-years of observation, 95% CI [0.435–1.050]) in comparison to patients of German origin (0.053/100 patient-years of observation, 95% CI [0.028–0.091]). In terms of TB-free survival, individuals originating from countries with a TB incidence higher than 10/100,000 exhibited a markedly reduced TB-free survival compared to those originating from regions with lower incidence (p < 0.001). In 22 patients, TB and HIV infection were diagnosed simultaneously. Conclusion: Overall, we observed a decline in the incidence density rate (IDR) of HIV/TB coinfections between 2006 and 2017. Patients originating from regions with high incidence bear a higher risk of falling ill with active TB. For PLWH born in Germany, the observed risk of active TB appears to be lower compared to other groups within the cohort. These findings should be considered when developing TB containment and screening strategies for PLWH in low-incidence countries. [ABSTRACT FROM AUTHOR]

Background Improved epidemiologic and treatment data for active tuberculosis (TB) with chronic hepatitis B virus (cHBV) infection might inform and encourage screening and vaccination programs focused on persons at risk of having both conditions. Methods We matched the California Department of Public Health TB registry during 2016–2020 to the cHBV registry using probabilistic matching algorithms. We used chi-square analysis to compare the characteristics of persons with TB and cHBV with those with TB only. We compared TB treatment outcomes between these groups using modified Poisson regression models. We calculated the time between reporting of TB and cHBV diagnoses for those with both conditions. Results We identified 8435 persons with TB, including 316 (3.7%) with cHBV. Among persons with TB and cHBV, 256 (81.0%) were non–US-born Asian versus 4186 (51.6%) with TB only (P <.0001). End-stage renal disease (26 [8.2%] vs 322 [4.0%]; P <.001) and HIV (21 [6.7%] vs 247 [3.0%]; P =.02) were more frequent among those with TB and cHBV compared with those with TB only. Among those with both conditions, 35 (11.1%) had TB diagnosed >60 days before cHBV (median, 363 days) and 220 (69.6%) had TB diagnosed >60 days after cHBV (median, 3411 days). Conclusions Persons with TB and cHBV were found more frequently in certain groups compared with TB only, and infrequently had their conditions diagnosed together. This highlights an opportunity to improve screening and treatment of TB and cHBV in those at high risk for coinfection. [ABSTRACT FROM AUTHOR]

Background In high-resource settings, the survival of children with immunocompromise (IC) has increased and immunosuppressive therapies are increasingly being used. This study aimed to determine the clinical characteristics, performance of diagnostic tools, and outcome of IC children with tuberculosis (TB) in Europe. Methods Multicenter, matched case-control study within the Pediatric Tuberculosis Network European Trials Group, capturing TB cases <18 years diagnosed 2000–2020. Results A total of 417 TB cases were included, comprising 139 children who are IC (human immunodeficiency virus, inborn errors of immunity, drug-induced immunosuppression, and other immunocompromising conditions) and 278 non-IC children as controls. Nonrespiratory TB was more frequent among cases than controls (32.4% vs 21.2%; P =.013). Patients with IC had an increased likelihood of presenting with severe disease (57.6% vs 38.5%; P <.001; odds ratio [95% confidence interval], 2.073 [1.37–3.13]). Children with IC had higher rates of false-negative tuberculin skin test (31.9% vs 6.0%; P <.001) and QuantiFERON-TB Gold assay (30.0% vs 7.3%; P <.001) results at diagnosis. Overall, the microbiological confirmation rate was similar in IC and non-IC cases (58.3% vs 49.3%; P =.083). Although the mortality in children with IC was <1%, the rate of long-term sequelae was significantly higher than in non-IC cases (14.8% vs 6.1%; P =.004). Conclusions Children with IC and TB in Europe have increased rates of nonrespiratory TB, severe disease, and long-term sequelae. Immune-based TB tests have poor sensitivity in those children. Future research should focus on developing improved immunological TB tests that perform better in patients with IC, and determining the reasons for the increased risk of long-term sequelae, with the aim to design preventive management strategies. [ABSTRACT FROM AUTHOR]

Background: Prevention of diabetes in the general population can help reduce the incidence of tuberculosis. Hence it is necessary to document that diabetes is strongly associated with tuberculosis as a risk factor. Objective: To study if diabetes is associated with tuberculosis compared to controls. Materials and Methods: A community based case-control study was carried out. 215 newly diagnosed cases of tuberculosis on treatment for not more than three months were selected randomly from the randomly selected tuberculosis unit. 215 neighbourhood controls were selected. They were matched for the age group of ± 10 years and sex. Fasting blood sugar (FBS) was estimated using a glucometer. Results: Tobacco chewing, residence and family history of TB were significantly more in cases (P < 0.05). Mean BMI was significantly lower in cases compared to controls. The proportion of TB cases among the known cases of diabetes was 67% compared to 33% in controls, which was statistically significant. Mean FBS was significantly higher in cases compared to controls (P < 0.05). The odds of cases being diabetic was 2.456 times more than those of controls. On binary logistic regression, diabetes was an independent risk factor for tuberculosis. Other independent risk factors were tobacco chewing, and family history of TB. Conclusion: Family history of tuberculosis, and tobacco chewing were positively associated with tuberculosis whereas body mass index was negatively associated with tuberculosis. Diabetes was significantly associated with tuberculosis. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is still a health problem in Indonesia because its prevalence ranks second in the world after India in 2023. Regional factors, inadequate health facilities, and limited resources (financial, human, and infrastructure) are challenges requiring innovation to help the government control TB. TB eradication efforts need to be made with a comprehensive and effective approach. One method used is to look at the vast territory of Indonesia; therefore, mapping the vulnerability of TB is highly recommended. Using a Geographic Information System is expected to help map the TB vulnerability areas in Indonesia. Given several epidemiological, socio-geographic, and environmental factors influencing TB, the question arises of how to map TB vulnerability areas in Indonesia. This study used a cross-sectional design, secondary data was collected from several sources, and a vulnerability analysis was performed by considering several socio-environmental epidemiological variables. Furthermore, after the analysis, the TB area vulnerability category would be obtained along with a map of TB vulnerability areas in Indonesia according to regional and district analysis units. This study produces a TB susceptibility index and map for Sumatra, Java-Bali, and other regions in Indonesia. [ABSTRACT FROM AUTHOR]

Prevention and treatment of diabetes will have a positive influence on tuberculosis (TB) since people may get TB because they have diabetes mellitus (DM). Recording and reporting through the TB Information System are not run optimally because of many factors. The information system must be strengthened to be used by private health facilities. This study used secondary data from the 2013 and 2018 Indonesian Basic Health Research (IBHR). The data was analyzed univariately and analyzed further using Orange Data Mining Tools to test the screening tool model used to predict TB in diabetic individuals. The total sample in this study from each data was 38,136 people. The 2013 IBHR stated that 749 people (2%) were diagnosed with pulmonary TB, while the 2018 IBHR stated that 97 people (0.3%) were diagnosed in the previous six months. The results of the Orange analysis showed that precision and recall calculations in this study were quite good, at 0.9. Therefore, the model would likely predict the occurrence of TB in diabetic individuals. According to Orange, the TB-DM electronic screening tool model tends to estimate the incidence of TB in diabetic individuals. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is one of the top ten causes of death worldwide, with approximately 10 million cases annually. Focus has been on pulmonary TB, while extrapulmonary TB (EPTB) has received little attention. Diagnosis of EPTB remains challenging due to the invasive procedures required for sample collection. Spinal TB (STB) accounts for 10% of EPTB and often leads to lifelong debilitating disease due to devastating spinal deformation and compression of neural structures. Little is known about the extent of disease, although both isolated STB and a disseminated form of STB have been described. In our Spinal TB X cohort study, we aim to describe the clinical phenotype of STB using whole-body 18FDG-PET/CT, identify a specific gene expression profile for different stages of dissemination and compare findings to previously described gene expression signatures for latent and active pulmonary TB. Methods: A single-centre, prospective cohort study will be established to describe the distributional pattern of STB detected by whole-body 18FDG-PET/CT and gene expression profile of patients with suspected STB on magnetic resonance imaging (MRI) at point of diagnosis, six months, and 12 months. Blood biobanking will be performed at these time points. Specimens for microbiology will be obtained from sputum/urine, from easily accessible sites of disease (e.g., lymph nodes, abscess) identified in the first 18FDG-PET/CT, from CT-guided biopsy and/or surgery. Clinical parameters and functional scores will be collected at every physical visit. Data will be entered into RedCap® database; data cleaning, validation and analysis will be performed by the study team. The University of Cape Town Ethics Committee approved the protocol (243/2022). Discussion: The Spinal TB X cohort study is the first prospective cohort study using whole-body 18FDG-PET/CT scans in patients with microbiologically confirmed spinal tuberculosis. Dual imaging techniques of the spine using 18FDG-PET/CT and magnetic resonance imaging as well as tissue diagnosis (microbiology and histopathology) will allow us to develop a virtual biopsy model. If successful, a distinct gene-expression profile will aid in blood-based diagnosis (point of care testing) as well as treatment monitoring and would lead to earlier diagnosis of this devastating disease. Trial registration: The study has been registered on ClinicalTrials.gov (NCT05610098). [ABSTRACT FROM AUTHOR]

Background: Tuberculosis preventive therapy is vital in caring for HIV-positive individuals, as it prevents the progression from latent tuberculosis infection to tuberculosis disease. The aim of the study is to assess the completion of tuberculosis preventive therapy and associated factors among clients receiving antiretroviral therapy in Debre Berhan town, Ethiopia, in 2022. Method: Institutional based cross sectional study was conducted. Random sampling methods were used to select both study participants and health facilities. Both bivariate and multivariate logistic regression analyses were performed. P-values less than 0.05 were statistically significant. Result: The study found that, 83% of participants were completed tuberculosis preventive therapy. Completed tuberculosis preventive therapy was associated with no adverse drug events, taking first-line ART, and good ART adherence. Conclusion: According to the Ethiopian ART guidelines, the study found a low completion rate of tuberculosis preventive therapy among HIV-positive clients on antiretroviral therapy. Factors like no adverse drug events, first-line antiretroviral regimen, and good adherence were significantly associated with completing tuberculosis preventive therapy. [ABSTRACT FROM AUTHOR]

Background Human immunodeficiency virus (HIV) treatment reduces tuberculosis (TB) disease and mortality; however, the population-level impact of universal HIV-test-and-treat interventions on TB infection and transmission remain unclear. Methods In a sub-study nested in the SEARCH trial, a community cluster-randomized trial (NCT01864603), we assessed whether a universal HIV-test-and-treat intervention reduced population-level incident TB infection in rural Uganda. Intervention communities received annual, population-level HIV testing and patient-centered linkage. Control communities received population-level HIV testing at baseline and endline. We compared estimated incident TB infection by arms, defined by tuberculin skin test conversion in a cohort of persons aged 5 and older, adjusting for participation and predictors of infection, and accounting for clustering. Results Of the 32 trial communities, 9 were included, comprising 90 801 participants (43 127 intervention and 47 674 control). One-year cumulative incidence of TB infection was 16% in the intervention and 22% in the control; SEARCH reduced the population-level risk of incident TB infection by 27% (adjusted risk ratio = 0.73; 95% confidence interval [CI]:.57–.92, P =.005). In pre-specified analyses, the effect was largest among children aged 5–11 years and males. Conclusions A universal HIV-test-and-treat intervention reduced incident TB infection, a marker of population-level TB transmission. Investments in community-level HIV interventions have broader population-level benefits, including TB reductions. [ABSTRACT FROM AUTHOR]

Background An active search for tuberculosis cases through mass screening is widely described as a tool to improve case detection in hyperendemic settings. However, its effectiveness in high-risk populations, such as incarcerated people, is debated. Methods Between 2017 and 2021, 3 rounds of mass screening were carried out in 3 Brazilian prisons. Social and health questionnaires, chest X-rays, and Xpert MTB/RIF were performed. Results More than 80% of the prison population was screened. Overall, 684 cases of pulmonary tuberculosis were diagnosed. Prevalence across screening rounds was not statistically different. Among incarcerated persons with symptoms, the overall prevalence of tuberculosis per 100 000 persons was 8497 (95% confidence interval [CI], 7346–9811), 11 115 (95% CI, 9471–13 082), and 7957 (95% CI, 6380–9882) in screening rounds 1, 2, and 3, respectively. Similar to our overall results, there were no statistical differences between screening rounds and within individual prisons. We found no statistical differences in Computer-Aided Detection for TB version 5 scores across screening rounds among people with tuberculosis—the median scores in rounds 1, 2, and 3 were 82 (interquartile range [IQR], 63–97), 77 (IQR, 60–94), and 81 (IQR, 67–92), respectively. Conclusions In this environment with hyperendemic rates of tuberculosis, 3 rounds of mass screening did not reduce the overall tuberculosis burden. In prisons, where a substantial number of tuberculosis cases is undiagnosed annually, a range of complementary interventions and more frequent tuberculosis cases screening may be required. [ABSTRACT FROM AUTHOR]

This article aims to analyse the evolution of 40 Sustainable Development Goals' (SDGs) health-related indicators in Brazil and Ecuador from 1990 to 2019. Epidemiological study of long-term trends in 40 SDGs' health-related indicators for Brazil and Ecuador from 1990 to 2019, using estimates from the Global Burden of Disease Study. Forty SDGs' health-related indicators and an index from 1990 to 2017 for Brazil and Ecuador, and their projections up to 2030 were extracted from the Institute for Health Metrics and Evaluation's Global Burden of Disease website and analysed. The percent annual change (PC) between 1990 and 2019 was calculated for both countries. Both countries have made progress on child stunting (Brazil: PC = −38%; Ecuador: PC = −43%) and child wasting prevalences (Brazil: PC = −42%; Ecuador: PC = −41%), percent of vaccine coverage (Brazil: PC = +215%; Ecuador: PC = +175%), under-5 (Brazil: PC = −75%; Ecuador: PC = −60%) and neonatal mortality rates (Brazil: PC = −69%; Ecuador: PC = −51%), health worker density per 1000 population (Brazil: PC = +153%; Ecuador: PC = +175%), reduction of neglected diseases prevalences (Brazil: PC = −40%; Ecuador: PC = −58%), tuberculosis (Brazil: PC = −27%; Ecuador: PC = −55%) and malaria incidences (Brazil: PC = −97%; Ecuador: PC = −100%), water, sanitation and hygiene mortality rates (Brazil and Ecuador: PC = −89%). However, both countries did not show sufficient improvement in maternal mortality ratio to meet SDGs targets (Brazil: PC = −37%; Ecuador: PC = −40%). Worsening of indicators were found for violence, such as non-intimate partner violence for both countries (Brazil: PC = +26%; Ecuador: PC = +18%) and suicide mortality rate for Ecuador (PC = +66%), child overweight indicator for Brazil (PC = −67%), disaster mortality rates (Brazil: PC = +100%; Ecuador: PC = +325%) and alcohol consumption (Brazil: PC = +46%; Ecuador: PC = +35%). Significant improvements are necessary in both countries requiring the strengthening of health and other policies, particularly concerning the prevention and management of violence and alcohol consumption, and preparedness for dealing with environmental disasters. [ABSTRACT FROM AUTHOR]

Background The duration of the protective effect of tuberculosis preventive therapy (TPT) is controversial. Some studies have found that the protective effect of TPT is lost after cessation of therapy among people with human immunodeficiency virus (HIV) in settings with very high tuberculosis incidence, but others have found long-term protection in low-incidence settings. Methods We estimated the incidence rate (IR) of new tuberculosis disease for up to 12 years after randomization to 4 months of rifampin or 9 months of isoniazid, among 991 Brazilian participants in a TPT trial in the state of Rio de Janeiro, with an incidence of 68.6/100 000 population in 2022. The adjusted hazard ratios (aHRs) of independent variables for incident tuberculosis were calculated. Results The overall tuberculosis IR was 1.7 (95% confidence interval [CI], 1.01– 2.7) per 1000 person-years (PY). The tuberculosis IR was higher among those who did not complete TPT than in those who did (2.9 [95% CI, 1.3–5.6] vs 1.1 [.4–2.3] per 1000 PY; IR ratio, 2.7 [1.0–7.2]). The tuberculosis IR was higher within 28 months after randomization (IR, 3.5 [95% CI, 1.6–6.6] vs 1.1 [.5–2.1] per 1000 PY between 28 and 143 months; IR ratio, 3.1 [1.2–8.2]). Treatment noncompletion was the only variable associated with incident tuberculosis (aHR, 3.2 [95% CI, 1.1–9.7]). Conclusions In a mostly HIV-noninfected population, a complete course of TPT conferred long-term protection against tuberculosis. [ABSTRACT FROM AUTHOR]

The article offers information on the concerning pattern of increasing Mycobacterium tuberculosis (M. Tuberculosis) incidence case counts in the United States (US) after a decline in 2020 due to the COVID-19 pandemic. Topics include the increase in TB case counts each year since 2020, particularly among foreign-born persons, and the importance of public health programs in TB prevention, control, and elimination.

Objective: Tuberculosis (TB) is a major health threat in adolescents and young adults. However, its burden in this population remains unclear. This study aimed to assess TB burden and changing trends in individuals aged 10 to 24 years from 1990 to 2019. Methods: All data were obtained from the Global Burden of Disease Study 2019. We calculated the percentage of relative changes in incident cases, deaths, and disability-adjusted life years (DALYs). The temporal trends of the incidence, mortality, and DALYs were assessed using estimated annual percentage changes (EAPCs). Results: At global level, TB incidence (per 100 000 population) decreased from 144.12 in 1990 to 97.56 in 2019, with average 1.28% (95% confidence interval [CI]: 1.36%-1.19%) of decline per year. Similar decreasing trends occurred across sex, age, sociodemographic index regions, and in most Global Burden of Disease study regions and countries. TB incidence in female adolescents decreased faster than that in male. However, there was an increasing trend in the incidence of extensively drug-resistant TB (EAPC = 11.23, 95% CI: 8.22-14.33) and multidrug-resistant TB without extensive drug resistance (EAPC = 3.28, 95% CI: 1.73-4.86). South Africa had the highest increase in TB incidence (EAPC = 3.51, 95% CI: 3.11-3.92). Conclusions: Global TB incidence, mortality, and DALYs in adolescents and young adults decreased from 1990 to 2019. However, the incidence of drug-resistant TB increased. TB remains a threat in adolescents and young adults worldwide, especially in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Tuberculosis is caused by Mycobacterium tuberculosis. If the treatment is inadequate or if host defenses are impaired, the apical lesion in primary tuberculosis expands into adjacent lung tissues and may spread via airways, lymphatic channels, or the vascular system. It may also circulate back to the lung and cause miliary pulmonary disease. Systemic miliary tuberculosis occurs when bacteria disseminate through the systemic arterial system to involve any organ. In the present study, we discuss five such cases of systemic miliary tuberculosis wherein the deceased succumbed to the illness. [ABSTRACT FROM AUTHOR]

Purpose: This study investigates the potential of inflammatory parameters (IP), symptoms, and patient-related outcome measurements as biomarkers of severity and their ability to predict tuberculosis (TB) evolution. Methods: People with TB were included prospectively in the Stage-TB study conducted at five clinical sites in Barcelona (Spain) between April 2018 and December 2021. Data on demographics, epidemiology, clinical features, microbiology, and Sanit George Respiratory Questionnaire (SGRQ) and Kessler-10 as Health-Related Quality of Life (HRQoL) were collected at three time points during treatment. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil/lymphocyte, and monocyte/lymphocyte ratios (NLR and MLR), complement factors C3, C4, and cH50, clinical and microbiological data, and HRQoL questionnaires were assessed at baseline, 2 months, and 6 months. Their ability to predict sputum culture conversion (SCC) and symptom presence after 2 months of treatment was also analysed. Results: The study included 81 adults and 13 children with TB. The CRP, ESR, NLR, and MLR values, as well as the presence of symptoms, decreased significantly over time in both groups. Higher IP levels at baseline were associated with greater bacillary load and persistent symptoms. Clinical severity at baseline predicted a delayed SCC. Kessler-10 improved during follow-up, but self-reported lung impairment (SGRQ) persisted in all individuals after 6 months. Conclusions: IP levels may indicate disease severity, and sustained high levels are linked to lower treatment efficacy. Baseline clinical severity is the best predictor of SCC. Implementing health strategies to evaluate lung function and mental health throughout the disease process may be crucial for individuals with TB. [ABSTRACT FROM AUTHOR]

We conducted secondary data analysis using a biobehavioral survey dataset of 1538 MSM from Zimbabwe. Survey participants were screened for the four symptoms suggestive of tuberculosis infection using the WHO TB screening algorithm. Results: All participants experienced at least one symptom suggestive of tuberculosis. 40% of HIV-positive MSM reported having had a cough in the last month and 13% of them experienced unexpected weight loss. The prevalence of experiencing any of the four TB symptoms amongst HIV-positive MSM was 23%. Contribution There is an urgent need for active TB case finding and treatment amongst HIV-positive MSM in Zimbabwe. Clinicians will need to ensure that MSM who need TB testing receive it timeously. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) incidence rates among migrants are higher than those in low-incidence countries. We evaluated smear-positive, pulmonary TB notifications of foreign-born individuals, comparing time since arrival and time since last return travel to the country of origin. TB incidence suggests a time course consistent with recent infection during travel. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The total annual count of reported tuberculosis (TB) cases continues to decline throughout Turkey. Recognizing the regions with high and low burdens and revealing the factors affecting TB notification rates may play a role in guiding national control programs. This study aimed to analyze the spatial distribution of TB notification rates from 2005 to 2018 and evaluate the factors contributing to TB rates. MATERIAL AND METHODS: In this ecological study, we used freely available open data from the Internet. We employed global and local spatial autocorrelation analysis to identify the spatial distribution and the clusters with low and high burdens. We conducted an ordinary least square regression model, spatial lag model, and spatial error model. The best-fitting model was selected via model parameters. RESULTS: Throughout the study period, the provinces in West Marmara Region (Edirne, Kırklareli, Tekirdağ, Çanakkale) were consistently in a high-burden cluster. In univariate ordinary least square regression, population density, the proportion of contacts screened for TB, the proportion of TB contacts who received prophylaxis, TB dispensary count, mean particulate matter 10 levels, and gross domestic product were found to be positively associated with TB notification rate. The best-fitting multivariate spatial lag model revealed that the proportion of contacts screened for TB (ß, z-value: 0.89, 2.21) positively affected TB notification rate. CONCLUSION: The high TB burden in West Marmara Region should warn policymakers to maintain a focused approach to controlling TB in this area. This study showed the importance of contact tracing efforts to prevent the underdetection of TB cases. [ABSTRACT FROM AUTHOR]

As a tropical country, Indonesia continues to grapple with the prevalence of tuberculosis. This study conducted by the Department of Public Health and Preventive Medicine at Universitas Airlangga, Surabaya, Indonesia, presented a novel approach to prevent tuberculosis through measures tailored to the socio-cultural context of the population. Specifically, this study assessed how effective the use of tuberculosis comics is as an educational tool to inform junior high school students about tuberculosis. This research was quasi-experimental, with a one-group pre-test-post-test design. Seventy junior high school students in Dukun District, Gresik, Indonesia participated in this study. Each participant received a questionnaire consisting of ten questions about tuberculosis. Afterward, tuberculosis education was shared through comics. The post-test was carried out using the same questions as the pre-test. The data were analyzed using the R Program for Windows, version 4.1.3 (Auckland University, New Zealand). The analysis revealed a significant difference between the pre-test and post-test results (p < 0.0001). As indicated by the data, comics proved to be an effective method of educating people about infectious diseases, specifically tuberculosis. Here, we introduce an educational tool designed to revitalize the educational method for disseminating knowledge about infectious diseases. Ultimately, comics can increase students' interest in learning about tuberculosis, including its etiology, prevention, and treatment strategies. [ABSTRACT FROM AUTHOR]

Background Tuberculosis (TB) is an infectious disease that is still a common threat worldwide, especially in pediatric populations. TB transmission occurs particularly when the transmitter has no obvious manifestation of the disease. There is a higher incidence of TB infection in children than in the general population, especially in high risk populations such as children in orphanages. However, the incidence of TB infection in orphaned children in Indonesia, including Bali, is unknown. Objective To describe the incidence and risk factors for TB infection in children in orphanages in Bali. Methods This case-control study was conducted in 12 orphanages in Bali. Subjects were divided into a case group comprised of children with TB infection, and a control group comprised of those without TB infection. TB infection was diagnosed by positive tuberculin test without clinically confirmed TB. Results A total of 175 children were recruited as subjects. There were 49 (28.0%) children with TB infection. Bivariate analysis revealed significant associations between density, humidity, ventilation/room area ratio, and area of origin with TB infection. Multivariate analysis showed that ventilation/room area ratio and room humidity of =73% were independently positive correlated with TB infection. Natural lighting and BCG scar were not significantly different between groups. Conclusion The occurence of TB infection in children residing in orphanages in Bali is high (28%). The risk factors identified independently are lower ventilation and higher room humidity. [ABSTRACT FROM AUTHOR]

Background: The war in Ukraine has led to significant migration to neighboring countries, raising public health concerns. Notable tuberculosis (TB) incidence rates in Ukraine emphasize the immediate requirement to prioritize approaches that interrupt the spread and prevent new infections. Methods: We conducted a prospective genomic surveillance study to assess migration's impact on TB epidemiology in the Czech Republic and Slovakia. Mycobacterium tuberculosis isolates from Ukrainian war refugees and migrants, collected from September 2021 to December 2022 were analyzed alongside 1574 isolates obtained from Ukraine, the Czech Republic, and Slovakia. Results: Our study revealed alarming results, with historically the highest number of Ukrainian tuberculosis patients detected in the host countries. The increasing number of cases of multidrug-resistant TB, significantly linked with Beijing lineage 2.2.1 (p < 0.0001), also presents substantial obstacles to control endeavors. The genomic analysis identified the three highly related genomic clusters, indicating the recent TB transmission among migrant populations. The largest clusters comprised war refugees diagnosed in the Czech Republic, TB patients from various regions of Ukraine, and incarcerated individuals diagnosed with pulmonary TB specialized facility in the Kharkiv region, Ukraine, pointing to a national transmission sequence that has persisted for over 14 years. Conclusions: The data showed that most infections were likely the result of reactivation of latent disease or exposure to TB before migration rather than recent transmission occurring within the host country. However, close monitoring, appropriate treatment, careful surveillance, and social support are crucial in mitigating future risks, though there is currently no evidence of local transmission in EU countries. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to compare the prevalence of latent tuberculosis infection and tuberculosis (TB) in the prepandemic period (2017-2019) with the pandemic period (2020-2022), in a group of healthcare workers (HCWs). Methods: This is a retrospective study. Data on TB diagnosis was retrieved from the hospital information system database. All HCWs who underwent tuberculin skin test (TST) from January 2017 to December 2022 were included in the study. Results: In the prepandemic period (2017-2019), 163 HCWs out of 710 were TST positive (22.9%), and in the pandemic period (2020-2022), 85 HCWs out of 449 were TST positive (18.9%) (P = 0.11). There were 10 HCWs diagnosed with TB in the prepandemic period (incidence: 41.7/100,000) and 2 in the pandemic period (incidence: 8.3/100,000) (P < 0.0001). Conclusions: This study showed that TB incidence was reduced during the pandemic period in HCWs. TST positivity was also reduced, though not statistically significant. [ABSTRACT FROM AUTHOR]

Active case finding leveraging new molecular diagnostics and chest X-rays with automated interpretation algorithms is increasingly being developed for high-risk populations to drive down tuberculosis incidence. We consider why such an approach did not deliver a decline in tuberculosis prevalence in Brazilian prison populations and what to consider next. [ABSTRACT FROM AUTHOR]

Abstract Background The war in Ukraine has led to significant migration to neighboring countries, raising public health concerns. Notable tuberculosis (TB) incidence rates in Ukraine emphasize the immediate requirement to prioritize approaches that interrupt the spread and prevent new infections. Methods We conducted a prospective genomic surveillance study to assess migration's impact on TB epidemiology in the Czech Republic and Slovakia. Mycobacterium tuberculosis isolates from Ukrainian war refugees and migrants, collected from September 2021 to December 2022 were analyzed alongside 1574 isolates obtained from Ukraine, the Czech Republic, and Slovakia. Results Our study revealed alarming results, with historically the highest number of Ukrainian tuberculosis patients detected in the host countries. The increasing number of cases of multidrug-resistant TB, significantly linked with Beijing lineage 2.2.1 (p

Abstract Background Despite global tuberculosis (TB) interventions, the disease remains one of the major public health concerns. Kenya is ranked 15th among 22 high burden TB countries globally. Methods A cross-sectional study was conducted in Western Kenya, which comprises 10 counties. A multistage sampling method was used where a single sub-county was randomly selected followed by sampling two high volume health facility from each sub-county. Identification of spoligotype profiles and their family distribution and lineage level were achieved by comparison with SITVIT database. Results Lineage distribution pattern revealed that the most predominant lineage was CAS 220 (39.8%) followed by Beijing 128 (23.1%). The other lineages identified were T, LAM, H, X, S and MANU which were quantified as 87 (15.7%), 67 (12.1%), 16 (2.8%), 10 (1.8%), 8 (1.4%) and 5 (0.9%) respectively. CAS and Beijing strains were the most predominant lineage in both HIV negative and positive TB patients. The Beijing lineage was also the most predominant in resistant M. tuberculosis strains as compared to wild type. A total of 12 (2.0%) were orphaned M. tuberculosis strains which were spread across all the 10 counties of the study site. In multivariate logistic regression adjusting for potential cofounders three potential risk factors were significant. HIV status (OR = 1.52, CI = 0.29–3.68 and P value of 0.001), Alcohol use (OR = 0.59, CI = 0.43–3.12 and P-value =0.001) and cross border travel (OR = 0.61, CI = 0.49–3.87 and P value = 0.026). Most M. tuberculosis clinical isolates showed genetic clustering with multivariate logistic regression indicating three potential risk factors to clustering. HIV status (OR = 1.52, CI = 0.29–3.68 and P value of 0.001), Alcohol use (OR = 0.59, CI = 0.43–3.12 and P-value =0.001) and cross border travel (OR = 0.61, CI = 0.49–3.87 and P value = 0.026). Conclusion There exist diverse strains of M. tuberculosis across the 10 counties of Western Kenya. Predominant distribution of clustered genotype points to the fact that most TB cases in this region are as a result of resent transmission other than activation of latent TB.

Infant mortality is a crucial indicator of socio-economic development, reflecting the conditions in which children are born and raised. Despite notable reductions in Latin America, infant mortality rates remain relatively high compared to other regions worldwide. By understanding the socio-economic factors that influence infant mortality, we not only uncover immediate causes of infant deaths but also shed light on broader socio-economic and healthcare disparities contributing to the burden of disease. This study analyzes the impact of socio-economic factors on infant mortality rates in Latin America from 2000 to 2019, estimating the speed and magnitude of the response of infant mortality rates to changes in specific socio-economic factors. Longitudinal panel study. Panel data regression models were used to examine the influence of specific socio-economic factors on infant mortality rates in Latin America. Additionally, impulse response functions estimated by local projections were used to estimate the speed and magnitude of the impact of socio-economic factors on infant mortality rates. The results highlight the importance of factors such as healthcare expenditure, female literacy, public expenditures on education, maternal mortality, physician density, total fertility rate, and tuberculosis incidence as significant determinants of infant mortality rates in the region. This study adds to the existing literature by offering empirical evidence on the association between these socio-economic factors and infant mortality in Latin America. It also provides a foundation for future research that investigates specific cases within Latin America and examines the variations of these socio-economic factors within those countries. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the incidence of tuberculosis (TB) and find the risk factors of TB patients with a high burden of TB in socioeconomic level, the high level of TB incidence and the great changes of economic and social factors, explore the possible factors, construct scientific and robust prediction model, and analyse whether the task of stopping TB can be accomplished by the expected global deadline. This was an ecological study. Descriptive analysis, spatial and space-time scan, correlation analysis, and regression analysis were carried out, based on cases of TB in Sichuan Province and ecological data from 2006 to 2017, to explore the characters of TB and ecological factors, using the transfer function–noise model to forecast the trend of TB until 2035. Factors affecting the incidence of TB, increasing per capita green area, reporting status of TB among Tibetans and Yi minorities, comprehensive treatment management, total cost of TB per capita for urban residents, proportion of males with high school education, 20 to 20 h of 24-h accumulated precipitation, reducing HIV at the same time as AIDS deaths, the increase in the proportion of males in junior high school education, and the increase in the number of registered TB cases can reduce the incidence of TB. There was concentration mainly on enhanced control of the environment and society measures, helpful in guiding government planning to control TB. Reinforcement is required to reduce the TB of population aged 15–24 and aged 25–64 in socioeconomic level by 2035. [ABSTRACT FROM AUTHOR]

Objectives. To examine impacts of racial and ethnic disaggregation on the characterization of tuberculosis (TB) epidemiology among American Indian and Alaska Native (AI/AN) persons in the United States. Methods. Using data reported to the National Tuberculosis Surveillance System during 2001 to 2020, we compared annual age-adjusted TB incidence and the frequency of TB risk factors among 3 AI/AN analytic groups: non-Hispanic AI/AN alone persons, multiracial/Hispanic AI/AN persons, and all AI/AN persons (aggregate of the first 2 groups). Results. During 2009 to 2020, annual TB incidence (cases per 100 000 persons) among non-Hispanic AI/AN alone persons (range = 3.87–8.56) was on average 1.9 times higher than among all AI/AN persons (range = 1.89–4.70). Compared with non-Hispanic AI/AN alone patients with TB, multiracial/Hispanic AI/AN patients were significantly more likely to be HIV positive (prevalence ratio [PR] = 2.05) and to have been diagnosed while a resident of a correctional facility (PR = 1.71), and significantly less likely to have experienced homelessness (PR = 0.53) or died during TB treatment (PR = 0.47). Conclusions. Racial and ethnic disaggregation revealed significant differences in TB epidemiology among AI/AN analytic groups. Exclusion of multiracial/Hispanic AI/AN persons from AI/AN analytic groups can substantively affect estimates of racial and ethnic health disparities. (Am J Public Health. 2024;114(2):226–236. https://doi.org/10.2105/AJPH.2023.307498) [ABSTRACT FROM AUTHOR]

Introduction In high-burden settings, low-complexity screening tests for tuberculosis (TB) could expand the reach of community-based case-finding efforts. The potential costs and cost-effectiveness of approaches incorporating these tests are poorly understood. Methods We developed a microsimulation model assessing 3 approaches to community-based case-finding in hypothetical populations (India-, South Africa-, The Philippines-, Uganda-, and Vietnam-like settings) with TB prevalence 4 times that of national estimates: (1) screening with a point-of-care C-reactive protein (CRP) test, (2) screening with a more sensitive "Hypothetical Screening test" (95% sensitive for Xpert Ultra-positive TB, 70% specificity; equipment/labor costs similar to Xpert Ultra, but using a $2 cartridge) followed by sputum Xpert Ultra if positive, or (3) testing all individuals with sputum Xpert Ultra. Costs are expressed in 2023 US dollars and include treatment costs. Results Universal Xpert Ultra was estimated to cost a mean $4.0 million (95% uncertainty range: $3.5 to $4.6 million) and avert 3200 (2600 to 3900) TB-related disability-adjusted life years (DALYs) per 100 000 people screened ($670 [The Philippines] to $2000 [Vietnam] per DALY averted). CRP was projected to cost $550 (The Philippines) to $1500 (Vietnam) per DALY averted but with 44% fewer DALYs averted. The Hypothetical Screening test showed minimal benefit compared to universal Xpert Ultra, but if specificity were improved to 95% and per-test cost to $4.5 (all-inclusive), this strategy could cost $390 (The Philippines) to $940 (Vietnam) per DALY averted. Conclusions Screening tests can meaningfully improve the cost-effectiveness of community-based case-finding for TB but only if they are sensitive, specific, and inexpensive. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a major global public health concern. Although the incidence of TB in China is declining, the country continues to face many challenges regarding TB control. This study aimed to develop an active case finding (ACF) strategy for high-risk populations in areas with high TB burden and evaluate the effectiveness of the ACF strategy for early TB detection in patients to reduce TB transmission. This was a descriptive study. From May to October 2019, active TB screening was conducted in Zhejiang Province, China. Overall, 24 high-burden townships were chosen as study sites. Residents aged ≥65 years, suffering from diabetes, diagnosed with HIV/AIDS, or with a history of TB were mobilized for screening. Chest radiography was performed for all participants in the community. Sputum specimens were collected for sputum smear tests and cultures at county-level TB-designed hospitals. A professional medical team performed the final diagnoses. Overall, 130,643 residents were included, accounting for 8.85% of the total population in the selected areas. After screening, 89 confirmed cases and 419 suspected cases were identified. The detection rates for suspected and confirmed cases were 320.72/100,000 and 68.12/100,000, respectively. Individuals with a history of TB accounted for a large proportion of detected cases, and the detection rate was higher among males than in females. This study identified 10.5% of reported cases in the selected areas in 2019. In Zhejiang province, compared with the previous year, the rates of TB notification in 2019 and 2020 declined by 7.0% and 7.4%, respectively, compared with the previous year. However, the TB notification rate in 2019 was almost the same as that in 2018 (a decline of 2.5%) but sharply declined in 2020 (14.4%) in the screened areas. Our findings suggest that the ACF strategy may have helped to maintain the downward trends in TB notification rates by detecting patients with TB and suspected cases in the short term. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis is a major cause of mortality worldwide. Prisoners in Guiana have multiple risk factors. The primary objective of this study was to describe tuberculosis occurring in prison and after release in French Guiana between 2008 and 2020. Secondary objectives were to identify tuberculosis risk factors and determine annual incidences. Methods: A retrospective cohort study of tuberculosis cases was carried out at the Guiana prison between 2008 and 2020. Data were collected from prison registers and cross-referenced with the list of tuberculosis notifications in French Guiana. Results: A total of 36 cases of tuberculosis were studied. Incidence was high, at 263/100,000 per year, higher than elsewhere in France and comparable to that in Brazil. Despite visibly effective screening on entry, with little evidence of intra-prison circulation of tuberculosis, 39% of patients were diagnosed within two years of leaving prison (76% were symptomatic). This could be explained by the high prevalence of latent forms (LTI). Discussion: Continued screening on entry, in combination with annual radiological and clinical screening, and reinforced follow-up on release seem indicated to improve patient management and the search for possible LTI. [ABSTRACT FROM AUTHOR]

Tuberculosis is a global health concern n impacting communities, health systems, and economies This study assessed the TB treatment outcomes among individuals aged 15+ at Chawama first level hospital in Lusaka, Zambia, using a retrospective design focussing on individuals notified in 2020. The sample was described using descriptive statistics. The Pearson Chi-square test and logistics regression were used to analyse the characteristics of the patients influencing the treatment outcomes at 5% significant level. Out of 404 participants, 83.4% of them had successful treatment outcomes. Varied outcomes were noted in sex, patient type, TB type, HIV status, and DOT plan, but lacked significance. Odds of success were lower by 72.4% for those aged 65+ compared to those aged 15–24 years (OR (95% CI): 0.276 (0.086–0.881), p = .030). Similarly, after adjusting for other variables, the odds of success were lower by 72.9% (AOR (95% CI): 0.271 (0.083–0.882), p = .030). This study yielded an encouraging 83.4% TB success rate highlighting the potential for improvement to meet WHO targets. Notably, individuals aged 65+ showed a distinct pattern with lower treatment success odds, suggesting a need for focussed interventions. Special attention to elderly patients and targeted TB program interventions are recommended. [ABSTRACT FROM AUTHOR]

Purpose: To explore the type of language used on tuberculosis treatment adherence in an informal settlement in Nairobi County, Kenya. Methodology: This was by a descriptive qualitative research design. The sample size was 67 and comprised 10 healthcare workers and 57 TB patients. Purposive sampling technique was used to sample the participants. The study conducted 37 unstructured in-depth interviews and 3 focus group discussions. Data analysis was conducted by first translating the data, then transcribing the verbatim of the in-depth unstructured interviews and focus group discussions. The transcribed data was later analyzed using thematic analysis. Data was presented using tables, bar charts and pie charts. Findings: The findings of the study indicated that majority of the tuberculosis patients found that the type of language used by the healthcare workers when communicating with them determined whether they would adhere to treatment or not. If the language used was not well understood by the patient or if the healthcare worker used complex language, then the patient was not likely to adhere to treatment. The findings further indicated that more than half of the patients were fluent in Swahili language while the remaining patients only had basic knowledge of the language. Sixty percent that is 34 of the participants were fluent in Swahili language whereas thirty-eight percent that is 22 patients had basic knowledge of the language, and one did not understand the language and opted to communicate with the help of an interpreter. Seventy percent that is 40 of the patients indicated that when the healthcare workers communicated with them in simple language they were more likely to adhere to TB treatment. Findings from the healthcare workers indicated that Swahili was the preferred language used by both the healthcare workers and the tuberculosis patients. If a patient did not understand Swahili language, the healthcare workers would look for an interpreter who would then translate to the patient the required information. The use of complex medical language was only used when the healthcare workers were communicating amongst themselves. Unique Contribution to Theory and Practice and Policy: The constructs of the theories informed the study in terms of treatment adherence by emphasizing the benefits of seeking healthcare early. On practice, healthcare workers needed to be aware of type of language used when interacting with their patients as they are likely to affect their patients' adherence to treatment. Based on these findings, policymakers should ensure that all healthcare workers should use simple language that is, the use of plain common words to make it easier for the patients to understand. In addition, any health messages, appointment cards or any other TB information whether spoken or written meant for the patients, should be designed in a language that is simple for the patient to comprehend. [ABSTRACT FROM AUTHOR]

Background: Despite global tuberculosis (TB) interventions, the disease remains one of the major public health concerns. Kenya is ranked 15th among 22 high burden TB countries globally. Methods: A cross-sectional study was conducted in Western Kenya, which comprises 10 counties. A multistage sampling method was used where a single sub-county was randomly selected followed by sampling two high volume health facility from each sub-county. Identification of spoligotype profiles and their family distribution and lineage level were achieved by comparison with SITVIT database. Results: Lineage distribution pattern revealed that the most predominant lineage was CAS 220 (39.8%) followed by Beijing 128 (23.1%). The other lineages identified were T, LAM, H, X, S and MANU which were quantified as 87 (15.7%), 67 (12.1%), 16 (2.8%), 10 (1.8%), 8 (1.4%) and 5 (0.9%) respectively. CAS and Beijing strains were the most predominant lineage in both HIV negative and positive TB patients. The Beijing lineage was also the most predominant in resistant M. tuberculosis strains as compared to wild type. A total of 12 (2.0%) were orphaned M. tuberculosis strains which were spread across all the 10 counties of the study site. In multivariate logistic regression adjusting for potential cofounders three potential risk factors were significant. HIV status (OR = 1.52, CI = 0.29–3.68 and P value of 0.001), Alcohol use (OR = 0.59, CI = 0.43–3.12 and P-value =0.001) and cross border travel (OR = 0.61, CI = 0.49–3.87 and P value = 0.026). Most M. tuberculosis clinical isolates showed genetic clustering with multivariate logistic regression indicating three potential risk factors to clustering. HIV status (OR = 1.52, CI = 0.29–3.68 and P value of 0.001), Alcohol use (OR = 0.59, CI = 0.43–3.12 and P-value =0.001) and cross border travel (OR = 0.61, CI = 0.49–3.87 and P value = 0.026). Conclusion: There exist diverse strains of M. tuberculosis across the 10 counties of Western Kenya. Predominant distribution of clustered genotype points to the fact that most TB cases in this region are as a result of resent transmission other than activation of latent TB. [ABSTRACT FROM AUTHOR]

A key metric in tuberculosis epidemiology is the annual risk of infection (ARI), which is usually derived from tuberculin skin test (TST) and interferon-γ release assay (IGRA) prevalence surveys carried out in children. Derivation of the ARI assumes that immunoreactivity is persistent over time; however, reversion of immunoreactivity has long been documented. We used a deterministic, compartmental model of Mycobacterium tuberculosis (Mtb) infection to explore the impact of reversion on ARI estimation using age-specific reversion probabilities for the TST and IGRA. Using empirical data on TST reversion (22.2%/year for persons aged ≤19 years), the true ARI was 2–5 times higher than that estimated from immunoreactivity studies in children aged 8–12 years. Applying empirical reversion probabilities for the IGRA (9.9%/year for youths aged 12–18 years) showed a 1.5- to 2-fold underestimation. ARIs are increasingly underestimated in older populations, due to the cumulative impact of reversion on population reactivity over time. Declines in annual risk did not largely affect the results. Ignoring reversion leads to a stark underestimation of the true ARI in populations and our interpretation of Mtb transmission intensity. In future surveys, researchers should adjust for the reversion probability and its cumulative effect with increasing age to obtain a more accurate reflection of the burden and dynamics of Mtb infection. [ABSTRACT FROM AUTHOR]

Pandemic-related disruptions led to lower Bacille Calmette-Guérin (BCG) vaccine coverage in Brazil. This study highlights a link between reduced vaccinations and increased tuberculosis pulmonary and extrapulmonary cases in infants. Addressing vaccine hesitancy and ensuring healthcare stability is vital for mitigating impacts. [ABSTRACT FROM AUTHOR]