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BackgroundThe WHO-recommended tuberculosis screening and diagnostic algorithm in ambulatory people living with HIV is a four-symptom screen (known as the WHO-recommended four symptom screen [W4SS]) followed by a WHO-recommended molecular rapid diagnostic test (eg Xpert MTB/RIF [hereafter referred to as Xpert]) if W4SS is positive. To inform updated WHO guidelines, we aimed to assess the diagnostic accuracy of alternative screening tests and strategies for tuberculosis in this population.MethodsIn this systematic review and individual participant data meta-analysis, we updated a search of PubMed (MEDLINE), Embase, the Cochrane Library, and conference abstracts for publications from Jan 1, 2011, to March 12, 2018, done in a previous systematic review to include the period up to Aug 2, 2019. We screened the reference lists of identified pieces and contacted experts in the field. We included prospective cross-sectional, observational studies and randomised trials among adult and adolescent (age ≥10 years) ambulatory people living with HIV, irrespective of signs and symptoms of tuberculosis. We extracted study-level data using a standardised data extraction form, and we requested individual participant data from study authors. We aimed to compare the W4SS with alternative screening tests and strategies and the WHO-recommended algorithm (ie, W4SS followed by Xpert) with Xpert for all in terms of diagnostic accuracy (sensitivity and specificity), overall and in key subgroups (eg, by antiretroviral therapy [ART] status). The reference standard was culture. This study is registered with PROSPERO, CRD42020155895.FindingsWe identified 25 studies, and obtained data from 22 studies (including 15 666 participants; 4347 [27·7%] of 15 663 participants with data were on ART). W4SS sensitivity was 82% (95% CI 72-89) and specificity was 42% (29-57). C-reactive protein (≥10 mg/L) had similar sensitivity to (77% [61-88]), but higher specificity (74% [61-83]; n=3571) than, W4SS. Cough (lasting ≥2 weeks), haemoglobin (

Data on the prevalence of sleep-disordered breathing (SDB) in the African general population are scarce, and a better understanding is urgently needed. Our study aimed to objectively determine the prevalence of, and factors associated with, SDB in a large sample in Benin, west Africa. In the Benin Society and Sleep (BeSAS) cross-sectional study, participants aged 25 years and older were recruited from both urban and rural areas. Rural participants were recruited from Tanve, a village located 200 km north of Cotonou, and urban participants were recruited from Cotonou. The participants underwent respiratory polygraphy at home using a type-3 device that measures airflow through a nasal pressure sensor, respiratory effort (thoracic movement), and pulse oximetry. Clinical and morphometric data were also collected. SDB severity categories were defined according to the apnoea–hypopnoea index (AHI), with mild-to-severe SDB (AHI ≥5/h), moderate-to-severe SDB (AHI ≥15/h), and severe SDB (AHI ≥30/h). The study was completed from April 4, 2018 to Jan 15, 2021. Of 2909 participants recruited in the BeSAS study, 2168 (74·5%) underwent respiratory polygraphy. For the 1810 participants with complete polygraphic data (mean age 46 years, SD 15; 1163 [64·2%] women), the prevalence of mild-to-severe SDB (AHI ≥5/h) was 43·2% (95% CI 40·9–45·5), of moderate-to-severe SDB (AHI ≥15/h) was 11·6% (10·2–13·1), and of severe SDB (AHI ≥30/h) was 2·7% (2·0–3·5). Factors independently associated with SDB were advanced age, male sex, large neck circumference, abdominal obesity, overweight or obesity, and snoring. After multivariable adjustment, severe SDB was independently associated with hypertension in women (odds ratio 3·99, 95% CI 1·04–15·33; p trend =0·044), but not in men (odds ratio 0·67, 0·22–2·05; P trend =0·63). The BeSAS study provides the first large-scale objective evaluation of SDB prevalence and associated factors in Africa. The high prevalence of SDB identified should stimulate the development of public health policies to prevent and treat this condition in African countries. Ligue Pulmonaire Vaudoise, Switzerland. [ABSTRACT FROM AUTHOR]

Résumé Objectif de l’étude Apprécier les résultats de traitement des patients souffrant d’une forme sévère d’asthme parmi ceux traités dans deux centres de pneumophtisiologie impliqués dans un projet de prise en charge des asthmatiques au Bénin. Patients et méthode Étude de cohorte rétrospective ayant inclus tous les patients enrôlés de 01/2013 à 11/2015. Les caractéristiques du patient, la sévérité de l’asthme, le respect des contrôles planifiés, les résultats de l’évaluation annuelle étaient colligés, enregistrées puis analysées dans EpiData et SPSS 21. Résultats Sur 491 asthmatiques ayant au moins une crise hebdomadaire, 194 (40 %) avaient une forme sévère, sex-ratio = 0,81, âge médian = 47 ans (écart interquartile = 32–60 ans). Parmi eux, la proportion venue aux contrôles avait progressivement diminué : 98 % (15 e jour), 74 % (1 mois), 63 % (3 mois), 54 % (6 mois), 51 % (9 mois) et 41 % (1 an). À l’évaluation annuelle, 115 (59 %) étaient absents. L’état était stationnaire chez 52 (27 %) vus. Seul un âge supérieur à 41 ans (risque relatif = 2,14 ; IC 95 % = 1,11–4,13 ; p = 0,02) était associé à une absence d’amélioration de l’état. Conclusion Les formes d’asthme diagnostiquées sévères dans le projet sont nombreuses. Ces patients honorent de moins en moins leur rendez-vous de contrôle et sont peu améliorés à l’évaluation annuelle. L’application des recommandations de GINA et le subventionnement d’autres molécules devraient aider à améliorer leur état. Objective To assess treatment outcomes of patients with severe diagnosed asthma among those treated in the two major pulmonology-tuberculosis centers involved in an asthma management programme in Benin. Patients and methods This was retrospective cohort study that included all patients enrolled between January 2013 and November 2015. Data on patient's characteristics, asthma severity, compliance with planned control visits, and annual evaluation results were collected, entered and analyzed using the EpiData and SPSS 21 software packages. Results Of the 491 asthmatic patients presenting at least one weekly attack, 194 (40%) had a severe form, with a male-female ratio of 0.81 and a median age of 47 years (interquartile range = 32–60 years). The proportion of those adhering to control visits gradually fell: 98% (2 weeks), 74% (1 month), 63% (3 months), 54% (6 months), 51% (9 months) and 41% (1 year). The annual assessment of 52 (27%) patients showed no improvement. In addition, of the 115 (59%) not attending this appointment, 82 (42%) did not improve, based on their last assessment in the programme. The only factor associated with lack of improvement was being aged over 41 years (adjusted relative risk = 2.14; 95% CI = 1.11–4.13; P = 0.02). Conclusion Many patients in the project were diagnosed with severe asthma. Their attendance of follow-up gradually decreased during and their condition showed little improvement at their annual evaluation visits. Application of the GINA recommendations and subsidizing other drugs would doubtless help to improve their condition. [ABSTRACT FROM AUTHOR]

Objectives: Owing to its ease-of-use and excellent diagnostic performance for the assessment of respiratory symptoms, point-of-care lung ultrasound (POC-LUS) has emerged as an attractive skill in resource-low settings, where limited access to specialist care and inconsistent radiology services erode health equity.To narrow down the research to practice gap, this study aims to gain in-depth insights in the perceptions on POC-LUS and computer-assisted POC-LUS for the diagnosis of lower respiratory tract infections (LRTIs) in a low-income and middle-income country (LMIC) of sub-Saharan Africa., Design and Setting: Qualitative study using face-to-face semi-structured interviews with three pneumologists and five general physicians in a tertiary centre for pneumology and tuberculosis in Benin, West Africa. The center hosts a prospective cohort study on the diagnostic performance of POC-LUS for LRTI. In this context, all participants started a POC-LUS training programme 6 months before the current study. Transcripts were coded by the interviewer, checked for intercoder reliability by an independent psychologist, compared and thematically summarised according to grounded theory methods., Results: Various barriers- and facilitators+ to POC-LUS implementation were identified related to four principal categories: (1) hospital setting (eg, lack of resources for device renewal or maintenance-, need for POC tests+), (2) physician's perceptions (eg, lack of opportunity to practice-, willingness to appropriate the technique+), (3) tool characteristics (eg, unclear lifespan-, expedited diagnosis+) and (4) patient's experience (no analogous image to keep-, reduction in costs+). Furthermore, all interviewees had positive attitudes towards computer-assisted POC-LUS., Conclusions: There is a clear need for POC affordable lung imaging techniques in LMIC and physicians are willing to implement POC-LUS to optimise the diagnostic approach of LRTI with an affordable tool. Successful integration of POC-LUS into clinical routine will require adequate responses to local challenges related to the lack of available maintenance resources and limited opportunity to supervised practice for physicians., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: We sought to evaluate the yield, cost, feasibility, and acceptability of routine tuberculosis (TB) screening of pregnant women in Cotonou, Benin., Design: Mixed-methods, cross-sectional study with a cost assessment., Setting: Eight participating health facilities in Cotonou, Benin., Participants: Consecutive pregnant women presenting for antenatal care at any participating site who were not in labor or currently being treated for TB from April 2017 to April 2018., Interventions: Screening for the presence of TB symptoms by midwives and Xpert MTB/RIF for those with cough for at least two weeks. Semi-structured interviews with 14 midwives and 16 pregnant women about experiences with TB screening., Primary and Secondary Outcome Measures: Proportion of pregnant women with cough of at least two weeks and/or microbiologically confirmed TB. The cost per pregnant woman screened and per TB case diagnosed in 2019 USD from the health system perspective., Results: Out of 4,070 pregnant women enrolled in the study, 94 (2.3%) had a cough for at least two weeks at the time of screening. The average (standard deviation) age of symptomatic women was 26 ± 5 years and 5 (5.3%) had HIV. Among the 94 symptomatic women, 2 (2.3%) had microbiologically confirmed TB for a TB prevalence of 49 per 100,000 (95% CI: 6 to 177 per 100,000) among pregnant women enrolled in the study. The average cost to screen one pregnant woman for TB was $1.12 USD and the cost per TB case diagnosed was $2271 USD. Thematic analysis suggested knowledge of TB complications in pregnancy was low, but that routine TB screening was acceptable to both midwives and pregnant women., Conclusion: Enhanced screening for TB among pregnant women is feasible, acceptable, and inexpensive per woman screened, however in this setting has suboptimal yield even if it can contribute to enhance TB case finding., Competing Interests: CSM is currently a staff member of the World Health Organization; the author alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the WHO.

Background: In the "Centre National Hospitalier de Pneumo-Phtisiologie" of Cotonou, Benin, little is known about the characteristics of patients who have not attended their scheduled appointment, the results of tracing and the possible benefits on improving treatment outcomes. This study aimed to determine the contribution of tracing activities for those who missed scheduled appointments towards a successful treatment outcome., Methods: A retrospective cohort study was carried out among all smear-positive pulmonary tuberculosis patients treated between January and September 2013. Data on demographic and diagnostic characteristics and treatment outcomes were accessed from tuberculosis registers and treatment cards. Information on those who missed their scheduled appointments was collected from the tracing tuberculosis register. A univariate analysis was performed to explore factors associated with missing a scheduled appointment., Results: Of 457 patients (410 new smear-positive and 47 retreatment tuberculosis), 37 (8%) missed one or more of their appointments with a total of 44 episodes of missed appointments. The 3.5th (32%) and 5th (43%) month appointments were the ones most likely to be missed. Being male was associated with a higher risk of missing appointments (RR = 4.2; 95% CI = 1.5-11.8, p = 0.004) while having HIV infection was associated with a lower risk (RR = 0.3, 95% CI = 0.1-0.9, p = 0.03). Principal reasons for missed appointments were travelling outside Cotonou (34%) and feeling better (21%). In 24 (55%) of these 44 episodes of missed appointments, contact was made with the patient who returned to the programme. These follow-up activities increased the treatment success by 4%., Conclusion: In Cotonou, Benin, less than 10% of tuberculosis patients miss at least one of their scheduled appointments. Tracing activities increase the treatment success rate by 4% and current on-going practices in the Programme need to be endorsed and encouraged.

Objective. To determine among retreatment tuberculosis patients in Benin baseline characteristics, culture, and drug sensitivity testing (DST) results and treatment outcomes. Materials and Methods. A retrospective national cohort study of all retreatment tuberculosis patients in Benin in 2013 using registers and treatment cards. Results. Of 3957 patients with tuberculosis, 241 (6%) were retreatment cases. Compared to new pulmonary bacteriologically confirmed tuberculosis (NPBCT) patients, there were significantly higher numbers of males (P = 0.04), patients from "Atlantique-Littoral" (P = 0.006), patients aged 45-64 years (P = 0.007), and HIV-positive patients (P = 0.04) among those retreated. Overall, 171 (71%) patients submitted sputum for DST, of whom (163) 95% were positive for Mycobacterium tuberculosis on Xpert MTB/RIF and/or culture and 17 (10%) were rifampicin resistant (9 with MDR-TB and 8 monoresistant to rifampicin). For those without MDR-TB (n = 224), treatment success was 93%. Worse outcomes occurred in those with unknown HIV status (RR: 0.27; 0.05-1.45; P < 0.01) while better outcomes occurred in those who relapsed (RR: 1.06, 95 CI: 1.02-1.10, P = 0.04). Conclusion. In 2013, a high proportion of retreatment patients received DST. Treatment success was good although more needs to be done to systematically increase the final follow-up smear examination. Reasons of high losses to follow-up from "Oueme-Plateau" should be investigated.

Setting: The main tuberculosis (TB) centre in Benin, West Africa, where only 2% of adult pulmonary TB cases are sputum smear-negative, all other pulmonary cases being smear-positive., Objectives: To assess the burden of smear-negative, culture-positive pulmonary TB among TB suspects in Cotonou, and to estimate the total number of non-smear-positive TB cases at country level., Design: For 1 year, one morning sputum culture was performed for every TB suspect (cough lasting >3 weeks, as defined in Benin's national guidelines) with three negative sputum smears (fluorescence technique)., Results: Of 214 TB suspects for whom culture was performed, only 22 smear-negative, culture-positive cases were identified. During the same period, 831 sputum smear-positive cases were diagnosed. Culture therefore contributed only 2.6% of the total number of bacteriologically proven cases., Conclusion: These results show the relatively low input of culture in TB diagnosis among chronic coughers in Cotonou, Benin, and demonstrates that the expected number of non-smear-positive TB cases in Benin is probably much lower than the World Health Organization's current annual estimates.