International Union Against Tuberculosis and Lung Disease
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Therapeutic drug monitoring and TB treatment outcomes in patients with diabetes mellitus
Alkabab Y., Warkentin J., Cummins J., Katz B., Denison B.M., Bartok A., Khalil A., Young L.R., Timme E., Peloquin C.A., Ashkin D., Houpt E.R., Heysell S.K.
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International Journal of Tuberculosis and Lung Disease, 2023, цитирований: 5,
open access Open access ,
doi.org, Abstract
BACKGROUND: Diabetes mellitus (DM) increases the risk of TB disease and poor treatment outcomes such as delayed sputum culture conversion due to inadequate drug exposure. Therapeutic drug monitoring (TDM) has improved these outcomes in some settings.METHODS: To compare treatment outcomes in programs with routine TDM vs. programs that did not use TDM, we conducted a retrospective study among people with DM and TB at health departments in four US states.RESULTS: A total of 170 patients were enrolled (73 patients in the non-TDM group and 97 patients in the TDM group). Days to sputum culture conversion and total treatment duration were significantly shorter in the TDM group vs. the non-TDM group. In adjusted analyses, patients who underwent TDM were significantly more likely to achieve sputum culture conversion at 2 months (P = 0.007).CONCLUSION: TDM hastened microbiological cure from TB among people with DM and a high risk for poor treatment outcomes in the programmatic setting.
Outdoor air pollution and respiratory health
Maio S., Sarno G., Tagliaferro S., Pirona F., Stanisci I., Baldacci S., Viegi G.
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International Journal of Tuberculosis and Lung Disease, 2023, цитирований: 12,
open access Open access ,
doi.org, Abstract
The need to address the impact of air pollution on health is reinforced by recent scientific evidence and the 2021 WHO Air Quality Guidelines (AQG). Air pollution is an avoidable risk factor causing a high burden for society with elevated deaths, health disorders, disabilities and huge socio-economic costs, especially in low- and middle-income countries. We have evaluated recent evidence from international reports, systematic reviews and official websites of international agencies. Growing evidence shows a causal relationship between air pollution exposure and acute lower respiratory infections, chronic obstructive pulmonary disease, asthma and lung cancer. Exposure to air pollution in both the short- and long-term has a serious impact on respiratory health. Harmful effects occur even at very low pollutant concentration levels, and there are no detectable thresholds below which exposure may be considered safe. The adverse respiratory health effects of air pollutants, even at low levels, are confirmed by recent epidemiological studies. Scientific respiratory societies and patient associations, along with other stakeholders in the health sector, should increase their engagement and advocacy to raise awareness of clean air policies and the latest WHO AQG.
Concordance of three approaches for operationalizing outcome definitions for multidrug-resistant TB
Zeng C., Mitnick C.D., Hewison C., Bastard M., Khan P., Seung K.J., Rich M.L., Atwood S., Melikyan N., Morchiladze N., Khachatryan N., Khmyz M., Restrepo C.G., Salahuddin N., Kazmi E., et. al.
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International Journal of Tuberculosis and Lung Disease, 2023, цитирований: 6,
open access Open access ,
doi.org, Abstract
BACKGROUND: The WHO provides standardized outcome definitions for rifampicin-resistant (RR) and multidrug-resistant (MDR) TB. However, operationalizing these definitions can be challenging in some clinical settings, and incorrect classification may generate bias in reporting and research. Outcomes calculated by algorithms can increase standardization and be adapted to suit the research question. We evaluated concordance between clinician-assigned treatment outcomes and outcomes calculated based on one of two standardized algorithms, one which identified failure at its earliest possible recurrence (i.e., failure-dominant algorithm), and one which calculated the outcome based on culture results at the end of treatment, regardless of early occurrence of failure (i.e., success-dominant algorithm).METHODS: Among 2,525 patients enrolled in the multi-country endTB observational study, we calculated the frequencies of concordance using cross-tabulations of clinician-assigned and algorithm-assigned outcomes. We summarized the common discrepancies.RESULTS: Treatment success calculated by algorithms had high concordance with treatment success assigned by clinicians (95.8 and 97.7% for failure-dominant and success-dominant algorithms, respectively). The frequency and pattern of the most common discrepancies varied by country.CONCLUSION: High concordance was found between clinician-assigned and algorithm-assigned outcomes. Heterogeneity in discrepancies across settings suggests that using algorithms to calculate outcomes may minimize bias.
Effect of 6-month vs. 8-month regimen on retreatment success for pulmonary TB
Izudi J., Sheira L.A., Bajunirwe F., McCoy S.I., Cattamanchi A.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 6,
open access Open access ,
doi.org
The Global Asthma Report 2022
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 96,
open access Open access ,
doi.org, Abstract
Published as a Supplement to the IJTLD, the 2022 Global Asthma Report (GAR), highlights the challenges of preventing and managing asthma, and reports on the gaps in asthma care in low- and middle-income countries. Cite as: The Global Asthma Report. Int J Tuberc Lung Dis 2022;26:S1-S102.
Improving access to affordable quality-assured inhaled medicines in low- and middle-income countries
Stolbrink M., Chinouya M.J., Jayasooriya S., Nightingale R., Evans-Hill L., Allan K., Allen H., Balen J., Beacon T., Bissell K., Chakaya J., Chiang C., Cohen M., Devereux G., El Sony A., et. al.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 12,
open access Open access ,
doi.org, Abstract
BACKGROUND: Access to affordable inhaled medicines for chronic respiratory diseases (CRDs) is severely limited in low- and middle-income countries (LMICs), causing avoidable morbidity and mortality. The International Union Against Tuberculosis and Lung Disease convened a stakeholder meeting on this topic in February 2022.METHODS: Focused group discussions were informed by literature and presentations summarising experiences of obtaining inhaled medicines in LMICs. The virtual meeting was moderated using a topic guide around barriers and solutions to improve access. The thematic framework approach was used for analysis.RESULTS: A total of 58 key stakeholders, including patients, healthcare practitioners, members of national and international organisations, industry and WHO representatives attended the meeting. There were 20 pre-meeting material submissions. The main barriers identified were 1) low awareness of CRDs; 2) limited data on CRD burden and treatments in LMICs; 3) ineffective procurement and distribution networks; and 4) poor communication of the needs of people with CRDs. Solutions discussed were 1) generation of data to inform policy and practice; 2) capacity building; 3) improved procurement mechanisms; 4) strengthened advocacy practices; and 5) a World Health Assembly Resolution.CONCLUSION: There are opportunities to achieve improved access to affordable, quality-assured inhaled medicines in LMICs through coordinated, multi-stakeholder, collaborative efforts.
Work-related interstitial lung disease: what is the true burden?
De Matteis S., Murgia N.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 9,
open access Open access ,
doi.org, Abstract
Interstitial lung diseases (ILDs) include a large variety of fibrotic lung conditions caused by genetic and environmental factors. Occupational exposures might also play a significant role, but the real health burden is currently unknown. Here, we aim to evaluate the role of work-related exposures in ILDs, focussing on idiopathic pulmonary fibrosis (IPF) and hypersensitivity pneumonitis (HP). We performed a focused review of the literature on work-related HP and IPF over the past 5 years. Using a meta-analytic approach, we quantified the occupational burden of IPF and HP, and estimated that occupational exposures to metal, silica and environmental tobacco smoke increased IPF risk with a pooled odds ratio of 1.7 (95% CI 1.42–2.03). The proportion of HP cases related to workplace exposure was 17% (95% CI 7–28). Our review supports the hypothesis that occupational exposures are a significant risk factor in the aetiopathogenesis of IPF and HP. We recommend that further research be performed to identify the underlying occupational factors and the maximum permitted exposure to reduce the associated IPF and HP burden.
Cost of TB services: approach and summary findings of a multi-country study (Value TB)
Sweeney S., Laurence Y.V., Cunnama L., Gomez G.B., Garcia-Baena I., Bhide P., Capeding T.J., Chatterjee S., Chikovani I., Eyob H., Kairu A., Terefe M.M., Shengelia N., Toshniwal M., Saadi N., et. al.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 6,
open access Open access ,
doi.org, Abstract
BACKGROUND: There are currently large gaps in unit cost data for TB, and substantial variation in the quality and methods of unit cost estimates. Uncertainties remain about sample size, range and comprehensiveness of cost data collection for different purposes. We present the methods and results of a project implemented in Kenya, Ethiopia, India, The Philippines and Georgia to estimate unit costs of TB services, focusing on findings most relevant to these remaining methodological challenges.METHODS: We estimated financial and economic unit costs, in close collaboration with national TB programmes. Gold standard methods included both top-down and bottom-up approaches to resource use measurement. Costs are presented in 2018 USD and local currency unit.RESULTS: Cost drivers of outputs varied by service and across countries, as did levels of capacity inefficiency. There was substantial variation in unit cost estimates for some interventions and high overhead costs were observed. Estimates were subject to sampling uncertainty, and some data gaps remain.CONCLUSION: This paper describes detailed methods for the largest TB costing effort to date, to inform prioritisation and planning for TB services. This study provides a strong baseline and some cost estimates may be extrapolated from this data; however, regular further studies of similar quality are needed to add estimates for remaining gaps, or to add new or changing services and interventions. Further research is needed on the best approach to extrapolation of cost data. Costing studies are best implemented as partnerships with policy makers to generate a community of mutual learning and capacity development.
Global Asthma Report 2022: a wake-up call to enhance care and treatment for asthma globally
Chakaya J., Aït-Khaled N.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 12,
open access Open access ,
doi.org
User perspectives on the use of X-rays and computer-aided detection for TB
Barrett R., Creswell J., Sahu S., Qin Z.Z.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 3,
open access Open access ,
doi.org
Caregiver willingness to give TPT to children living with drug-resistant TB patients
Rouzier V., Murrill M., Kim S., Naini L., Shenje J., Mitchell E., Raesi M., Lourens M., Mendoza A., Conradie F., Suryavanshi N., Hughes M., Shah S., Churchyard G., Swindells S., et. al.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 2,
open access Open access ,
doi.org, Abstract
BACKGROUND Pediatric household contacts (HHCs) of patients with multidrug-resistant TB (MDR-TB) are at high risk of infection and active disease. Evidence of caregiver willingness to give MDR-TB preventive therapy (TPT) to children is limited.METHODS This was a cross-sectional study of HHCs of patients with MDR-TB to assess caregiver willingness to give TPT to children aged <13 years.RESULTS Of 743 adult and adolescent HHCs, 299 reported caring for children aged <13 years of age. The median caregiver age was 35 years (IQR 27–48); 75% were women. Among caregivers, 89% were willing to give children MDR TPT. In unadjusted analyses, increased willingness was associated with TB-related knowledge (OR 5.1, 95% CI 2.3–11.3), belief that one can die of MDR-TB (OR 5.2, 95% CI 1.2–23.4), concern for MDR-TB transmission to child (OR 4.5, 95% CI 1.6–12.4), confidence in properly taking TPT (OR 4.5, 95% CI 1.6–12.6), comfort telling family about TPT (OR 5.5, 95% CI 2.1–14.3), and willingness to take TPT oneself (OR 35.1, 95% CI 11.0–112.8).CONCLUSIONS A high percentage of caregivers living with MDR- or rifampicin-resistant TB patients were willing to give children a hypothetical MDR TPT. These results provide important evidence for the potential uptake of effective MDR TPT when implemented.
Budget impact of next-generation sequencing for diagnosis of TB drug resistance in Moldova
Cates L., Codreanu A., Ciobanu N., Fosburgh H., Allender C.J., Centner H., Engelthaler D.M., Crudu V., Cohen T., Menzies N.A.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 3,
open access Open access ,
doi.org, Abstract
BACKGROUND Diagnosing drug resistance is critical for choosing effective TB treatment regimens. Next-generation sequencing (NGS) represents an alternative approach to conventional phenotypic drug susceptibility testing (pDST) for diagnosing TB drug resistance.METHODS We undertook a budget impact analysis estimating the costs of introduction and routine use of NGS in the Moldovan National TB Programme. We conducted an empirical costing study and collated price and operating characteristics for NGS platforms. We examined multiple NGS scenarios in comparison to the current approach (pDST) for pre-treatment drug resistance testing over 2021–2025.RESULTS Annual testing volume ranged from 912 to 1,926 patients. For the pDST scenario, we estimated total costs of US$362,000 (2021 USD) over the 5-year study period. Total costs for NGS scenarios ranged from US$475,000 to US$1,486,000. Lowest cost NGS options involved targeted sequencing as a replacement for pDST, and excluded individuals diagnosed as RIF-susceptible on Xpert® MTB/RIF. For all NGS scenarios, the majority (55–80%) of costs were devoted to reagent kits. Start-up costs of NGS were small relative to routine costs borne each year.CONCLUSION NGS adoption will require expanded resources compared to conventional pDST. Further work is required to better understand the feasibility of NGS in settings such as Moldova.
Country differences and determinants of yield in programmatic migrant TB screening in four European countries
Menezes D., Zenner D., Aldridge R., Anderson S.R., de Vries G., Erkens C., Marchese V., Matteeli A., Muzyamba M., Nederby-Öhd J., van Rest J., Spruijt I., Were J., Lönnroth K., Abubakar I., et. al.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 6,
open access Open access ,
doi.org, Abstract
INTRODUCTION The WHO End TB Strategy emphasises early diagnosis and screening of TB in high-risk groups, including migrants. We analysed TB yield data from four large migrant TB screening programmes to inform TB policy.METHODS We pooled routinely collected individual TB screening episode data from Italy, the Netherlands, Sweden and the United Kingdom under the European Union Commission E-DETECT.TB grant, described characteristics of the screened population, and analysed TB case yield.RESULTS We collected data on 2,302,260 screening episodes among 2,107,016 migrants, mostly young adults aged 18–44 years (77.8%) from Asia (78%) and Africa (18%). There were 1,658 TB cases detected through screening, with substantial yield variation (per 100,000): 201.1 for Sweden (95% confidence intervals CI 111.4–362.7), 68.9 (95% CI 65.4–72.7) for the United Kingdom, 83.2 (95% CI 73.3–94.4) for the Netherlands and 653.6 (95% CI 445.4–958.2) in Italy. Most TB cases were notified among migrants from Asia (n = 1,206, 75/100,000) or Africa (n = 370, 76.4/100,000), and among asylum seekers (n = 174, 131.5/100,000), migrants to the Netherlands (n = 101, 61.9/100,000) and settlement visa migrants to the United Kingdom (n = 590, 120.3/100,000).CONCLUSIONS We found considerable variations in yield across programmes, types of migrants and country of origin. These variations may be partly explained by differences in migration patterns and programmatic characteristics.
Pediatric delamanid treatment for children with rifampicin-resistant TB
Tyeku N., Apolisi I., Daniels J., Beko B., Memani B., Cengani L., Fatshe S., Gumede N., Joseph K., Mathee S., Furin J., Maugans C., Cox H., Reuter A.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 3,
open access Open access ,
doi.org
Diagnosis of paediatric TB using Xpert® MTB/RIF Ultra on fresh respiratory samples
Sabi I., Olomi W., Nkereuwem E., Togun T., Gomez M.P., Sylla M., Diarra B., Sanogo M., Sichone E., Mahiga H., Njeleka F., Ebonyi A.O., Egere U., Ntinginya N.E., Hoelscher M., et. al.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 5,
open access Open access ,
doi.org, Abstract
OBJECTIVE: To evaluate the diagnostic accuracy of Xpert® MTB/RIF Ultra (Ultra) on fresh respiratory samples for the diagnosis of pulmonary TB (PTB) in children.METHODS: Between July 2017 and December 2019, children with presumed TB were prospectively enrolled at clinical sites in three African countries. Children were assessed using history, physical examination and chest X-ray. Sputum or gastric aspirate samples were analysed using Ultra and culture. The diagnostic accuracy of Ultra was calculated against culture as the reference standard.RESULTS: In total, 547children were included. The median age was 4.7 years, 77 (14.1%) were HIV infected and 77 (14.1%) had bacteriologically confirmed TB. Ultra detected an additional 20 cases in the group of children with negative culture results. The sensitivity of Ultra was 66.3% (95% CI 47–82), and the specificity was 95.4% (95% CI 89–99) when assessed against culture as the reference standard.CONCLUSION: Despite the improved performance of Ultra as compared to Xpert as was previously reported, its sensitivity remains sub-optimal for the detection of TB in children. Ultra detected additional 20 cases which otherwise could not have been detected by culture alone, suggesting that the latter is an imperfect reference standard.
Impact of COVID-19 on diagnosis and testing for TB in a high-resource, low-burden setting
Jones A.J., Jones-López E.C., Butler-Wu S.M., Wilson M.L., Rodman J., Flors L., Voyageur C., Jones B.E.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 4,
open access Open access ,
doi.org
Evidence and ethical considerations for the treatment of contacts exposed to drug-resistant TB
Khan U., Guglielmetti L.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 1,
open access Open access ,
doi.org
TB in the elderly: clinical features and outcomes
Tabernero E., Rodrigo T., Garros J., Altube L., Garay E., Medina J., Rodríguez J., Ortiz N., Gullón J., García-García; J.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 4,
open access Open access ,
doi.org, Abstract
BACKGROUND: TB in low-incidence countries is characterised by changes in age distribution towards larger numbers of cases among the elderly.OBJECTIVES: To investigate clinical features and outcomes of TB treatment in older patients and identify predictors of poor outcome.METHODS: Multicentre retrospective study of new TB cases from 53 hospitals included in the registry of the Integrated Tuberculosis Research Programme of the Spanish Society of Pulmonology and Thoracic Surgery (Sociedad Española de Neumología y Cirugía Torácica) between 2006 and 2020.RESULTS: We identified 731 patients aged ≥75 years from a cohort of 7,505 patients with TB. In the elderly, weight loss, disseminated disease and normal X-rays or infiltrates without cavitation were more common. All-cause mortality was 16% (5% of deaths due to TB). The elderly had higher rates of toxicity (6.7%) and hospital admissions (36%). In the multivariate analysis of predictors of TB mortality in ≥75-year-olds, only weight, age and treatment with non-standard regimens remained significant.CONCLUSIONS: TB in older patients needs more attention and remains a challenge because of a lack of specific clinical and radiological features. Standard treatment is effective, although mortality is higher than in young patients. Low weight, non-standard regimens and age are significant predictors of TB mortality
Responding to the post-pandemic crisis: post-exposure prophylaxis for TB
Heffernan C., Savić R.M., Long R.G., Raviglione M.C., Ferrara G.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 1,
open access Open access ,
doi.org
Uptake of the lateral flow urine LAM test in Europe and Central Asia
Kraef C., Yedilbayev A., Seguy N., Bentzon A., Podlekareva D., Cirillo D.M., van der Werf M.J., Kirk O.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 6,
open access Open access ,
doi.org, Abstract
INTRODUCTION: Since 2015 (updated in 2019), the WHO has recommended to include the commercial lateral flow urine lipoarabinomannan TB test (LF-LAM), AlereLAM, in the diagnostic toolkit for severely ill people living with HIV.METHODS: To assess the current use and barriers to the implementation of the test, we conducted an electronic survey among national focal points and managers of TB and HIV programmes in the 53 Member States of the WHO European Region and a European network of clinicians working in TB and HIV medicine.RESULTS: In all, 45 individual responses (37 countries) were received from programme managers and focal points and 17 responses (14 countries) from clinicians. Only eight countries reported adopting LF-LAM policies, with only four currently using the AlereLAM (Armenia, Belarus, Ukraine and Uzbekistan). The most commonly reported barriers to implementing the test were the small number of eligible patients (with HIV-TB co-infections), the test not being included in the TB or HIV programme´s mandate and lack of budget allocation.CONCLUSION: Consistent with findings from high TB burden countries in Africa and Asia, the survey demonstrated that uptake of AlereLAM is almost non-existent. Addressing the identified barriers and the intrinsic limitations of the test could help to increase the use of the test.
The COVID-19 and TB syndemic: the way forward
Trajman A., Felker I., Alves L.C., Coutinho I., Osman M., Meehan S., Singh U.B., Schwartz Y.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 37,
open access Open access ,
Обзор, doi.org, Abstract
Together, SARS-CoV-2 and M. tuberculosis have killed approximately 5.7 million people worldwide over the past 2 years. The COVID-19 pandemic, and the non-pharmaceutical interventions to mitigate COVID-19 transmission (including social distancing regulations, partial lockdowns and quarantines), have disrupted healthcare services and led to a reallocation of resources to COVID-19 care. There has also been a tragic loss of healthcare workers who succumbed to the disease. This has had consequences for TB services, and the fear of contracting COVID-19 may also have contributed to reduced access to TB services. Altogether, this is projected to have resulted in a 5-year setback in terms of mortality from TB and a 9-year setback in terms of TB detection. In addition, past and present TB disease has been reported to increase both COVID-19 fatality and incidence. Similarly, COVID-19 may adversely affect TB outcomes. From a more positive perspective, the pandemic has also created opportunities to improve TB care. In this review, we highlight similarities and differences between these two infectious diseases, describe gaps in our knowledge and discuss solutions and priorities for future research.
Altered drug exposures of first-line TB drugs in a moxifloxacin-containing treatment regimen
Perumal R., Arodola-Oladoyinbo O., Naidoo A., Kawuma A.N., Naidoo K., Gengiah T.N., Chirehwa M., Padayatchi N., Denti P.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 3,
open access Open access ,
doi.org, Abstract
BACKGROUND: Pharmacokinetic variability arising from drug-drug interactions and pharmacogenetics may influence the effectiveness of treatment regimens for TB. The Improving Treatment Success Trial compared the WHO-recommended standard treatment in TB patients with an experimental regimen substituting ethambutol with moxifloxacin (MFX) in Durban, South Africa.METHODS: Non-linear mixed-effects modelling was used to investigate the population pharmacokinetics of rifampicin (RIF), isoniazid (INH) and pyrazinamide (PZA). A total of 25 single-nucleotide polymorphisms, including pregnane-X-receptor, were selected for analysis.RESULTS: TB drug concentrations were available in a subset of 101 patients: 58 in the MFX arm and 43 in the control arm. Baseline characteristics were well-balanced between study arms: median age and weight were respectively 36 years and 57.7 kg; 75.2% of the patients were living with HIV. Although weight-based drug dosing was the same in the two arms, we found that RIF exposure was increased by 19.3%, INH decreased by 19% and PZA decreased by 19.2% when administered as part of the MFX-containing regimen. Genetic variation in pregnane-X-receptor (rs2472677) was associated with a 25.3% reduction in RIF exposure.CONCLUSION: Optimised weight-based TB treatment dosing is essential when RIF, INH and PZA are co-administered with fluoroquinolones. The reduction in RIF exposure associated with pharmacogenetic variation is worrying.
Bridging the gap: key evidence needed to strengthen global policies to end TB
Gebreselassie N., Falzon D., Zignol M., Viney K., Ismail N., Mirzayev F., Mavhunga F., Kasaeva T.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 1,
open access Open access ,
doi.org
Implementing 3HP vs. IPT as TB preventive treatment in Pakistan
Jaswal M., Farooq S., Madhani F., Noorani S., Salahuddin N., Amanullah F., Khowaja S., Safdar N., Khan A., Yuen C., Keshavjee S., Becerra M., Hussain H., Malik A.A.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 10,
open access Open access ,
doi.org, Abstract
BACKGROUND: We assessed treatment uptake and completion for 6 months of isoniazid (6H) and 3 months of isoniazid plus rifapentine weekly (3HP) in a programmatic setting in Pakistan.METHODS: All household contacts were clinically evaluated to rule out TB disease. 6H was used for TB preventive treatment (TPT) from October 2016 to April 2017; from May to September 2017, 3HP was used for contacts aged ≥2 years. We compared clinical evaluation, TPT uptake and completion rates between contacts aged ≥2 years in the 6H period and in the 3HP period.RESULTS: We identified 3,442 contacts for the 6H regimen. After clinical evaluation, 744/1,036 (72%) started treatment, while 46% completed treatment. In contrast, 3,722 contacts were identified for 3HP. After clinical evaluation, 990/1,366 (72%) started treatment, while 67% completed treatment. Uptake of TPT did not differ significantly between the 6H and 3HP groups (OR 1.03, 95%CI 0.86–1.24). However, people who initiated 3HP had 2.3 times greater odds (95% CI 1.9–2.8) of completing treatment than those who initiated 6H after adjusting for age and sex.CONCLUSION: In programmatic settings in a high-burden country, household contacts of all ages were more likely to complete TPT with shorter weekly regimens, although treatment uptake rate for the two regimens was similar.
Travel reimbursements, distance to health facility and preventive treatment cascade for drug-resistant TB
Malik A.A., Siddique M., Chandir S., Jaswal M., Siddiqui S., Fuad J., Khan A.J., Amanullah F., Hussain H.
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International Journal of Tuberculosis and Lung Disease, 2022, цитирований: 1,
open access Open access ,
doi.org
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