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Es un estudio explicativo no experimental que identifica probables sintomáticos respiratorios, los factores de riesgo y por ende detección de casos de tuberculosis en los reclusos del pabellón hombres del Centro de Rehabilitación Social Ambato Se identificaron a los sintomáticos respiratorios mediante encuestas, a estas personas identificadas se les realizo baciloscopias de esputo que se ana- lizaron en el laboratorio del Centro de Salud N°2, también se realizo entrevistas al personal de salud encargado del centro de reha- bilitación Ambato y observación de campo para determinar factores de riesgo, Lográndose identificar 11 sintomáticos respiratorios que corresponden al 13% de la población total estudiada lo cual supera el porcentaje de sintomáticos respiratorios que el personal de salud espera detectar, que desde el punto de vista de la programación corresponde al 4% de todas las consultas en mayores de 15 años. Además se pudo detectar que existen falencias en cuanto cumplimiento del programa de control de tuberculosis (PCT) evi- denciado por el porcentaje de reclusos que desconocen acerca de la tuberculosis que corresponden al 89% de la población estudiada. Tomando en cuenta que uno de los objetivos específicos que plantea el PCT es fortalecer el sistema de información , vigilancia y evaluación veraz puntual y de calidad. Palabras clave: (Sintomatico Respiratorio,Tuberculosis,Recluso) ABSTRACT: Is an experimental study for identify likely determine respiratory symptoms, risk factors and therefore case detection of tubercu- losis in men row inmates Social Rehabilitation Center Ambato. We identified patients with respiratory symptoms through surveys identified these people realize they sputum smears that were analyzed in the laboratory of the Health Center No. 2, also conducted interviews with health personnel in charge of the rehabilitation center and observation Ambato field to determine risk factors, achie- ving 11 identify respiratory symptoms that correspond to 13% of the total study population which exceeds the percentage of symp- tomatic respiratory health staff expect to detect that from the point of view of programming corresponds to 4 % of all consultations in over 15 years. Furthermore it was detected that there are shortcomings in compliance with tuberculosis control program (TCP) as evidenced by the percentage of inmates who do not know about TB which correspond to 89% of the study population. Considering that one of the specific objectives posed by the PCT is to strengthen the information system, monitoring and evaluating quality and timely accurate. Keywords: (Symptomatic Respiratory, Tuberculosis,Recluses) &nbsp

Background Against the backdrop of Tuberculosis (TB) elimination strategy within India, all ages have assumed importance including the burden of pediatric TB. The current study was carried out to study the profile of pediatric TB patients and factors associated with treatment outcome of these patients registered in Faridabad district of Haryana, India. Methods This was a descriptive cross-sectional study. Record reviews of 1589 pediatric tuberculosis patients (≤14 years) registered under Revised National Tuberculosis Control Programme of Faridabad district was carried out using TB registers present at tuberculosis units. Socio-demographic data, clinical characteristics, treatment outcome and factors associated with treatment outcome were studied. Results and conclusions Among 1589 pediatric TB patients with records available, 62% were females, majority (68%) belonged to age group 10–14 years, 93% were new cases, and 65% had extra-pulmonary TB. Among 554 pulmonary TB cases, 41% were sputum smear-positive. Majority (97%) patients reported successful treatment outcome (cured or treatment completed). In bivariable analysis, sex, category of TB treatment, sputum result, type of TB and past history of TB treatment were significantly associated with successful treatment outcome. On multivariable analysis, patients who were female, had higher bacillary load and previously treated, had significantly lesser odds for achieving successful treatment outcomes at the end of treatment.

Tuberculosis is an airborne disease caused by the bacterium mycobacterium tuberculosis, transmission occurs when a person inhales droplet nuclei containing mycobacterium tuberculosis, is spread from person to person through the air. The health cadres play an essential role for tuberculosis control and prevention. Therefore tuberculosis knowledge and skills among health cadres needs to be strengthened. Knowledge is a very important factor in shaping a person's actions, behaviors based on knowledge will last longer than those without it. This study aims to analyze and to prove the influence of education with montage learning methods in strengthening the role of health cadre in TB control and prevention. Used an pre experimental design and one group pre test and post test design with sampel of 20 people. Data collected using a questionnaires. Analysis used paired t-test with a significance level of 5% (α = 0,05). The result of the study provides that knowledge and skills of health cadres about TB control and prevention before intervention shows the lowest score of 58,75±14,59 and after intervention of 74,25±10,30. The results of the research used paired t-test showed that the cadres knowledge and skills about TB control and prevention rise after the montage learning methods, while the value of p value was 0,003 < 0,05.

Globally, tuberculosis is still a major health problems including in Indonesia.The program has been implemented however,the tuberculosis cases are still high considering the condition during the COVID-19 pandemic. The purpose of this article is to provide an overview of tuberculosis during the COVID-19 pandemic at the Elopada Health Center through qualitative inquiry by interviewing with one person and three head of the health center in the tuberculosis service department and two village heads. Meanwhile, the triangulation informants consisted of tuberculosis manager in Southwest Sumba Regency and the head of the Controlling Division of infectious diseases. The results showed that the number of tuberculosis cases at the health center had an increase in cases with BTA+. Control measures providing tuberculosis services included active and passive case findings, diagnosis and treatment which were done manually and digitally,based on microscopic laboratory examinations and molecular rapid tests. Treatment and recording and reporting are done manually or digitally. During the pandemic, tuberculosis services were carried out separately from other patient services. The conclusion is that tuberculosis control at the Elopada Community Health Center is still being carried out during the pandemic by paying attention to health protocols and utilizing technology (social media). Key words: control, tuberkulosis, pandemic Covid-19, Elopada health center Abstrak Tuberkulosis masih menjadi perhatian sebagai salah satu masalah kesehatan utama di Indonesia maupun Global. Program sudah dijalankan namun sampai saat ini kasus tuberkulosis masih tinggi. Disamping itu kondisi saat ini menghadapi pandemi covid-19. Puskesmas menjadi ujung tombak dalam memberikan pelayanan kesehatan di masyarakat. Tujuan artikel ini adalah memberikan gambaran pengendalian tuberkulosis pada masa pandemi di Puskesmas Elopada. Jenis penelitian adalah kualitatif observatif yang melakukan wawancara dengan kepala puskesmas dan petugas bagian pelayanan tuberkulosis dan kepala desa. Sedangkan informan triangulasi terdiri dari pengelola tuberkulosis Kabupaten Sumba Barat Daya dan Kepala Bidang Pengendalian Penyakit Menular. Hasil penelitian menunjukkan bahwa jumlah kasus tuberkulosis di puskesmas Elopada terjadi peningkatan pada kasus dengan BTA+. Upaya pengendalian yang dilakukan memberikan pelayanan tuberkulosis meliputi penemuan kasus secara aktif dan pasif yang dilakukan secara manual dan berbasis internet, diagnosis penderita berdasarkan hasil pemeriksaan labotarorium secara mikroskopis dan menggunakan tes cepat molekuler. Pengobatan, pencatatan dan pelaporan dilakukan secara manual maupun digital. Selama masa pandemi pelayanan tuberkulosis dilakukan terpisah dengan pelayanan pasien lainnya. Kesimpulan pengendalian tuberkulosis di Puskesmas Elopada tetap dijalankan di masa pandemi dengan memperhatikan protokol kesehatan dan memanfaatkan teknologi (media sosial). Kata kunci: Pengendalian, tuberkulosis, Pandemi Covid-19, Puskesmas Elopada

The use of molecular genetic tests as a part of tuberculosis patients examination made it possible to reduce the time for TB diagnosis and determination of drug resistance (DR) of M. tuberculosis (MTB) in Arkhangelsk Region. Early detection of multiple drug resistant tuberculosis (MDR TB) made it possible to prescribe the adequate chemotherapy regimen promptly and thus to improve treatment outcomes.\ud The objective of the study: to evaluate the results of treatment of MDR TB patients in whom MDR TB was diagnosed by molecular genetic tests. It was assumed that the introduction of molecular genetic tests would result in improved treatment outcomes in MDR TB patients [(the research project of the International Union Against Tuberculosis and Lung Diseases and Tuberculosis Control Program of Arkhangelsk Region of the PROVE-IT LPA (Policy Relevant Outcomes from Validating Evidence on Impact of Line Probe Assays)].\ud Subjects: 295 MDR TB patients detected in Arkhangelsk Region were enrolled in the study. MDR TB was detected by molecular genetic tests in the main group (132 patients) and by culture in the control group (163 patients). Patients from both groups received the standard chemotherapy regimen. Chemotherapy outcomes were compared in both groups.\ud Results. Treatment outcomes were better in the group (MGT group) where molecular genetic tests were used for drug susceptibility testing (p = 0.003) versus the comparison group where the culture was used. Effective treatment was documented more frequently (65.2%) in the MGT group versus the comparison group (44.8%). All-cause mortality was lower in the MGT group (7.6%) than in the comparison group (15.9%). There were no statistically significant differences between the groups in the time when sputum conversion (by smear and culture) was achieved.\ud Key words: tuberculosis, multiple drug resistant M. tuberculosis, molecular genetic diagnostic tests

Meeting the 2035 WHO targets of reducing tuberculosis incidence by 90% from 2015 levels requires the implementation of country-specific tuberculosis control strategies. This systematic review aims to identify factors that facilitate or impede the implementation of such strategies in EU and European Economic Area (EEA) settings. Focusing on providers of care, health system constraints, and social and political factors, this Review complements available evidence on the accessibility of tuberculosis services to recipients of care. Databases were searched for EU and EEA articles published between Jan 1, 1997, and Nov 6, 2020, that presented empirical data on tuberculosis policies, strategies, guidelines, or interventions. 2061 articles were screened and 65 were included. The most common barrier to tuberculosis control strategies described the divergence of health-care practices from guidelines, often related to inadequate knowledge or perceived usefulness of the guidelines by clinicians. The most commonly identified enabler to tuberculosis control strategies was the documented positive attitudes of health-care workers towards tuberculosis programmes. Divergence between clinical practice and guidelines was described in most EU and EEA settings, indicating the need for a focused review of guideline adherence. Strengths of this study involve its broad inclusion criteria and wide range of tuberculosis control strategies analysed.

Tuberculosis is an important public health problem in the Eastern Mediterranean Region. It is crucial for each country to develop a national tuberculosis surveillance system. WHO has developed a standardized tuberculosis surveillance system through which two important indicators for tuberculosis control, a cure rate and a case detection rate, can be collected. The number of countries that have adopted the WHO tuberculosis surveillance system has been increasing in the Region. At the moment, 13 countries have reported a cure rate, which is the most important indicator for national tuberculosis control programmes. It is hoped that more countries will adopt this system.

Public-Private Mix (PPM) is a strategy implemented in countries with a high burden of tuberculosis, including Indonesia. This study aims to identify PPM implementation at the Puskesmas and the success of the TB control program at the Puskesmas that have implemented the PPM strategy. The research was conducted in 2019 in Pekanbaru Municipality. It was an observational study that collected quantitative and qualitative data. The implementation of PPM was assessed through guided interviews. The success of the Tuberculosis control program was assessed through the Case Notification Rate and Success Rate using secondary data from 2010 to 2017. The results showed that PPM had been implemented in six health centers in Pekanbaru. However, there were obstacles such as a lack of human resources, NGOs, private clinics, and local governments. The Case Notification Rate and Success Rate showed an increasing trend after the PPM implementation. However, these indicators had not yet reached the national target. It can be concluded that PPM in Pekanbaru had been implemented but needed to be improved at all Puskesmas by involving more partnerships and following up on obstacles encountered. Furthermore, the Tuberculosis Control Indicator had shown an increasing trend, but it needed to reach the national target.

Background Tuberculosis is one of the ten major causes of mortality worldwide. The trend of increasing TB cases and drug resistance in India is very disturbing. The objectives of the study were to study the perspectives and opinions of different stakeholders on the status, challenges and the ways to tackle the issues of TB in India. Methods The online survey was done for the data collection from national and international experts. The data collection took place during October 2017. We received 46 responses. Results The experts had varied answers as to the menace of TB in India, effect of TB on individuals, family and society, failure of government plans in India, TB awareness campaign and ways to create awareness. Everyone believed that urgent action needs to be taken against the disease like improving the healthcare infrastructure of the country (improving the quality and quantity of medical facilities and doctors) and creating awareness about the TB. Conclusion Government of India is making lot of efforts to bring down the problems associated with TB through. In spite of this, there is a long way to go to achieve significant reduction in high incidence and prevalence of TB in India. Factors like lack of awareness and resources, poor infrastructure, increasing drug resistant cases, poor notification and overall negligence are the major challenges. If we eradicate poverty and undernourishment, educate the masses and eliminate the stigma attached with TB, we can hope for a disease free future., Highlights • Tuberculosis is one of the ten major causes of mortality worldwide. • Many government plans have failed in bringing down the high incidence and prevalence of TB in India. • Factors like lack of awareness and resources, poor infrastructure, increasing drug resistant cases, poor notification and overall negligence are the major challenges. • If we eradicate poverty and undernourishment, educate the masses and eliminate the stigma attached with TB, we can hope for a disease free future. • The current Coronavirus pandemic in 2020 has also given us excellent opportunity to create awareness about TB in the community at various levels.

The history of Tuberculosis control in India dates back to 1951 with mass vaccination with BCG and it started as a National Programme in 1962. Radical changes in the form of DOTS were incorporated with the start of Revised National Tuberculosis Control Programme (RNTCP) in 1997. Since then, TB control efforts have witnessed many changes in the form of daily DOTS, Injection free regimen for both drug sensitive & drug resistant TB, moving from fixed Categories of treatment regimen to Individualized treatment regimen based on prior Universal Drug susceptibility testing. Flexibility has been incorporated in the programme to accommodate Private practitioners in the form of various incentives. Introduction of Active case finding strategy has helped in early diagnosis leading to prompt treatments. Engagement of Community and leaders from all sectors and various organizations has helped to reach all communities in this fight against TB. India hopes to End TB by 2025 with rechristening the programme to National TB Elimination Programme (NTEP) and bringing in the much needed changes & flexibilities in the programme.

Background The National Tuberculosis Control Program (NTP) in Pakistan developed, with the Pakistan Paediatric Association, a pediatric scoring chart to aid diagnosis of childhood tuberculosis (TB). Our study compared the diagnostic practice of private healthcare providers in Pakistan with the NTP guidelines. Methods A cross-sectional study comparing diagnosis of TB in children

Background China has successfully reduced tuberculosis (TB) incidence rate over the past three decades, however, challenges remain in improving the quality of TB diagnosis and treatment. In this paper, we assess the effects of the implementation of “China National Health Commission (NHC) and Gates Foundation TB Prevention and Control Project” on the quality of TB care in the three provinces. Methods We conducted the baseline study in 2016 and the final evaluations in 2019 in the 12 selected project counties. We obtained TB patients’ information from the TB Information Management System and reviewed medical records of TB cases in the TB designated hospitals. We compared TB diagnosis and treatment services with the national practice guideline and used Student’s t-test and Pearson χ2 tests or Fisher’s exact tests to compare the difference before and after the project implementation. Results The percentage of sputum smear-negative (SS–) patients taking culture or rapid molecular test (RMT) doubled between 2015 and 2018 (from 35% to 87%), and the percentage of bacteriologically confirmed pulmonary TB cases increased from 36% to 52%. RMT has been widely used and contributed an additional 20% of bacteriologically confirmed TB cases in 2018. The percentage of TB patients taking drug susceptibility tests (DST) also doubled (from 40% in 2015 to 82% in 2018), and the proportion of TB patients receiving adequate diagnosis services increased from 85% to 96%. Among all SS– TB patients, over 86% received the recommended diagnostic services at the end of the study period, an improvement from 75% prior to the project implementation. However, the proportion of TB patients treated irrationally using second-line anti-TB drugs (SLDs) increased from 12.6% in 2015 to 19.9% in 2018. The regional disparities remained within the project provinces, albeit the gaps between them narrowed down for almost all indicators. Conclusions The quality of TB diagnosis services has been improved substantially, which is attributable to the coverage of new diagnosis technology. However, irrational use of SLDs remains a concern after the project implementation. Graphic abstract

Background In countries with a high tuberculosis incidence such as Gabon, healthcare workers are at enhanced risk to become infected with tuberculosis due to their occupational exposure. In addition, transmission can occur between patients and visitors, if a tuberculosis infection is not suspected in time. Knowledge about tuberculosis and correct infection control measures are therefore highly relevant in healthcare settings. Methods We conducted an interviewer-administered knowledge, attitude and practice survey amongst healthcare workers in 20 healthcare facilities at all levels in the Moyen-Ogooué province, Gabon. Correctly answered knowledge questions were scored and then categorised into four knowledge levels. Additionally, factors associated with high knowledge levels were identified. Fisher’s Exact test was used to identify factors associated with high knowledge levels. Results A total of 103 questionnaires were completed by various healthcare personnel. The most-frequently scored category was ‘intermediate knowledge’, which was scored by 40.8% (42/103), followed by ‘good knowledge’ with 28.2% (29/103) and ‘poor knowledge’ with 21.4% (22/103) of participating healthcare workers, respectively. ‘Excellent knowledge’ was achieved by 9.7% (10/103) of the interviewees. Apart from the profession, education level, type of employing healthcare facility, as well as former training on tuberculosis were significantly associated with high knowledge scores. Attitudes were generally positive towards tuberculosis infection control efforts. Of note, healthcare workers reported that infection control measures were not consistently practiced; 72.8% (75/103) of the participants were scared of becoming infected with tuberculosis, and 98.1% saw a need for improvement of local tuberculosis control. Conclusions The survey results lead to the assumption that healthcare workers in the Moyen-Ogooué province are at high risk to become infected with tuberculosis. There is an urgent need for improvement of tuberculosis infection control training for local healthcare personnel, particularly for less trained staff such as assistant nurses. Furthermore, the lack of adequate infection control measures reported by staff could possibly be correlated with a lack of adequate facility structures and protective equipment and requires further investigation.

Tuberculosis (TB) remains a serious public health problem in Korea. Korea has the highest incidence rate (59 per 100,000 population) and the second-highest TB mortality rate (four per 100,000 population) among Organisation for Economic Cooperation and Development member countries. However, some progress has been made in TB control over the past decade. The notification rate of new TB cases has been gradually decreasing since reaching its highest rate in 2011 (78.9 per 100,000 population). In 2019, the notification rate of new TB cases was 46.4 per 100,000 population, with a reduction of 9.9% from the 2018 rate. Additionally, the number of multidrug-resistant TB cases decreased from 618 in 2018 to 580 in 2019. This progress is thought the result of various TB control programs including a TB public–private mix model, insurance coverage for TB management, and a contact investigation program. Despite the progress made, new challenges have also emerged. The predominant challenges lie in the relatively increasing burden of TB in the vulnerable population (aging, socio-economically vulnerable, and foreign-born population), the implementation of latent TB infection management, and the high rate of multidrug-resistant TB. Since 2019, the Korean government has been implementing the “Midterm strategies to strengthen TB prevention and management” based on the 2nd National Strategic Plan for Tuberculosis Control (2018-2022). This program will be a turning point of TB control in Korea. The results produced in 2023 is expected to be favorable.

Tuberculosis is an infectious disease caused by the Mycobacterium tuberculosis bacterium. Compliance wiyh long-term medication is the key to tuberculosis control. It also has become a complex and dynamic phenomenon with various factors that are impactful on the patients’ behavior of taking drugs. This non experimental observation research aims to measure the patients’ compliance level of using anti-tuberculosis drugs in puskesmas (Community Health Center) Tombulilato. Relying on the cross-sectional design, this study collected the data from qualitative approach and employing the purposive sampling technique in selecting 38 respondents suffering from tuberculosis aged 15-75 years. Further, the collected data were processed using the SPSS program and were analyzed utilizing the univariate analysis. The results reveal that the respondents in the site area are categorized as “being compliant” in using anti-tuberculosis drugs, with the percentage 86,8%.

Evaluate primary health care functions from the perspective of patients with tuberculosis from slums in the city of Buenos Aires, Argentina.Cross-sectional observational study with adult patients with tuberculosis (TB) and without TB (NoTB), living in slums (S) and outside them (NoS). Participants' perceptions were evaluated using the Primary Care Assessment Tool for users (abbreviated version), which measures four main domains (first contact, ongoing care, coordination with specialists, and comprehensiveness) and selected secondary domains. A Likert scale was used, ranging from "No, not at all" (1 point) to "Yes, definitely" (4 points). Scores ≥ 3 were considered to indicate adequate performance of functions. Averages were calculated for each domain, as well as two overall scores: with and without secondary domains.83 participants were included (20 TB-S, 21 TB-NoS, 19 NoTB-S, and 23 NoTB-NoS). The evaluated functions were perceived as inadequate. The TB-S group gave the lowest overall scores, not reaching 3 points in any domain. There were no significant differences in domains or overall scores between groups. Participants with TB gave lower scores in all domains, except in family-centered care, where they gave a significantly higher score than NoTB participants. The overall score without secondary domains was lower for TB participants than for the NoTB groups.According to the perception of participants with TB and without TB, primary health care functions are not satisfactory, either in slums or outside them.Evaluar las funciones de la atención primaria de salud desde la perspectiva de los pacientes con tuberculosis (TB) provenientes de villas de emergencia de la Ciudad Autónoma de Buenos Aires, Argentina.Estudio observacional transversal con pacientes adultos con TB y sin TB (NoTB), residentes en villas de emergencia (V) y fuera de ellas (NoV). La percepción de los participantes se evaluó mediante el cuestionario Primary Care Assessment Tool-usuarios (versión abreviada) que mide cuatro dimensiones principales (primer contacto, longitudinalidad de los cuidados, coordinación entre servicios e integralidad) y algunas secundarias. Se utilizó una escala de Likert, desde “No, en absoluto” (1 punto) hasta “Sí, sin duda” (4 puntos). Puntajes ≥ 3 se consideraron como cumplimiento adecuado de las funciones. Se calcularon promedios para cada dominio y dos puntajes globales: con y sin dominios secundarios.Se incluyeron 83 participantes (20 TB-S, 21 TB-NV, 19 NoTB-S y 23 NoTB-NoS). Las funciones evaluadas se percibieron como no adecuadas. El grupo TB-S tuvo los puntajes globales más bajos y en ningún dominio alcanzó 3 puntos. No hubo diferencias significativas en los dominios ni los puntajes globales entre grupos. Los participantes con TB dieron menores puntajes en todos los dominios, excepto en enfoque familiar que fue significativamente mayor que los de los participantes NoTB; el puntaje global sin dominios secundarios fue menor en los participantes con TB que en los NoTB.Según la percepción de los participantes con TB y sin TB, las funciones de la atención primaria de salud no son satisfactorias, tanto dentro de las villas de emergencia como fuera de ellas.Avaliar as funções da atenção primária à saúde da perspectiva de pacientes com tuberculose (TB) provenientes de comunidades desfavorecidas na cidade de Buenos Aires, Argentina.Estudo observacional transversal com pacientes adultos com ou sem TB (TB, NãoTB), residentes ou não de comunidades desfavorecidas (C, NãoC). Avaliamos as percepções dos participantes utilizando questionário Primary Care Assessment Tool-usuários (versão reduzida), que mede quatro dimensões principais (primeiro contato, longitudinalidade da atenção, coordenação entre serviços e integralidade), bem como algumas dimensões secundárias. Utilizamos uma escala de Likert de 4 pontos, variando de “definitivamente não” (1 ponto) a “definitivamente sim” (4 pontos). Considerou-se que pontuações ≥3 indicavam o cumprimento adequado das funções. Calculamos as médias para cada domínio e duas pontuações globais: com e sem domínios secundários.Ao todo, 83 participantes foram incluídos no estudo (20 TB-C, 21 TB-NãoC, 19 NãoTB-C e 23 NãoTB-NãoC). As funções avaliadas foram percebidas como inadequadas. O grupo TB-C apresentou a pontuação global mais baixa, não alcançando 3 pontos em nenhum domínio. Não houve diferenças significativas entre os grupos nos domínios nem na pontuação global. Os participantes com TB deram pontuações mais baixas em todos os domínios, exceto no enfoque familiar, no qual a pontuação foi significativamente mais alta que a dos participantes sem TB; a pontuação global sem domínios secundários foi mais baixa nos participantes com TB que nos sem TB.De acordo com as percepções dos participantes com e sem TB, as funções da atenção primária à saúde são insatisfatórias, tanto dentro como fora das comunidades desfavorecidas.

Tuberculosis (TB) is a major public health problem in Bangladesh. Although the National TB control program of Bangladesh is implementing a comprehensive expansion of TB control strategies, logistical challenges exist, and there is significant uncertainty concerning the disease burden. Mathematical modelling of TB is considered one of the most effective ways to understand the dynamics of infection transmission and allows quantification of parameters in different settings, including Bangladesh. In this study, we present a two-strain mathematical modelling framework to explore the dynamics of drug-susceptible (DS) and multidrug-resistant (MDR) TB in Bangladesh. We calibrated the model using DS and MDR-TB annual incidence data from Bangladesh from years 2001 to 2015. Further, we performed a sensitivity analysis of the model parameters and found that the contact rate of both strains had the largest influence on the basic reproduction numbers $${\text{R}}_{{0{\text{s}}}}$$ R 0 s and $${\text{R}}_{{0{\text{m}}}}$$ R 0 m of DS and MDR-TB, respectively. Increasingly powerful intervention strategies were developed, with realistic impact and coverage determined with the help of local staff. We simulated for the period from 2020 to 2035. Here, we projected the DS and MDR-TB burden (as measured by the number of incident cases and mortality) under a range of intervention scenarios to determine which of these scenario is the most effective at reducing burden. Of the single-intervention strategies, enhanced case detection is the most effective and prompt in reducing DS and MDR-TB incidence and mortality in Bangladesh and that with GeneXpert testing was also highly effective in decreasing the burden of MDR-TB. Our findings also suggest combining additional interventions simultaneously leads to greater effectiveness, particularly for MDR-TB, which we estimate requires a modest investment to substantially reduce, whereas DS-TB requires a strong sustained investment.

Background China has made progress in tuberculosis control, but this disease remains a burden in many regions of China. We performed time-series analysis to examine changes in the rates of newly notified and newly smear-positive cases of tuberculosis in different regions of China from 1997 to 2018 and assessed the effect of the current control program. Methods National and provincial notification data on tuberculosis from 1997 to 2018, which covers 31 provinces in the mainland of China, were extracted from the Chinese public health science data center. The annual percentage changes in newly notified and smear-positive cases were analyzed using a joinpoint regression method. Results There were 18 646 672 newly notified tuberculosis cases from 1997 to 2018, with the greatest number in 2005. A total of 6 605 414 of these cases (35.42%) were smear-positive cases. The number of newly notified cases in China overall decreased (96.88–59.27 cases per 100 000) significantly during the most recent years. The decline during this period ranged from −3.9% (95% CI −5.7 to −2.9) in the western region to −4.3% (95% CI −4.8 to −3.7) in the eastern region. Most provinces had significant declines in newly notified and smear-positive cases, whereas the decline of newly smear-positive cases in Xinjiang was about half of that observed during the same period in China overall (−4.1% vs −9.9%). In addition to disparities in annual percentage changes, the rate of newly notified cases was higher in the western region than in the eastern and central regions. Conclusions The burden of tuberculosis has been on declining throughout China during recent years, but tuberculosis in western China continues to be a public health emergency that needs to be urgently addressed. Effective prevention and control strategies are needed for regions with high disease burdens and those with increasing or unchanging numbers of newly notified and smear-positive cases of tuberculosis.

BACKGROUND Tuberculosis (TB) is a curable and preventable disease. Emergence of multi drug resistance TB (MDR TB) threatens to undo the progress made towards control of TB. While treatment is available for MDR TB, it is of a long duration and is also more expensive and toxic. Understanding the various factors that are associated with MDR TB may help to formulate and implement effective preventive practices for control of MDR TB. We wanted to assess the various epidemiological factors among MDR TB cases registered under Revised National Tuberculosis Control Programme (RNTCP) in East Sikkim and study the current & past TB treatment including adverse drug reactions. METHODS A community-based case control study was conducted over 4 months in the eastern district of Sikkim. MDR TB cases registered under Revised National Tuberculosis Control Programme (RNTCP) in the first two quarters of 2019 were compared with matched healthy controls. Data was collected by a door to door survey using a pre-designed and pre-tested questionnaire and analysed on Statistical Package for the Social Sciences (SPSS) 20. RESULTS A total of 62 cases (14 non-respondents) of MDR TB were identified and were matched with 63 controls. 30.5 % cases were young adults in the age group 15 to 25 years, 66 % of the cases reported being currently unemployed, 16 % were homemakers, 11 % of cases fell below poverty line. A higher proportion of cases as compared to controls reported a habit of skipping a meal, poor housing conditions and comorbidities than controls. A known history of contact with a case of tuberculosis was given by 11.3 % cases; 18 % cases gave a previous history of TB; about 51 % cases reported a delay in diagnosis which delayed treatment initiation. CONCLUSIONS Previous history of TB with history of relapse / failure, contact of MDR TB emerged as the most significant risk factors and presence of comorbid conditions like diabetes & hypertension can be used to indicate higher risks of drug resistance. KEYWORDS Multi Drug Resistant Tuberculosis, MDR TB, Case control, Revised National Tuberculosis Control Programme, Sikkim

Context: Silicosis is a progressive, irreversible and incurable respiratory morbidity and often becomes a cause for pre-mature mortality among occupationally silica dust-exposed workers in India and similar countries. It has a dual problem of associated silico-tuberculosis as a co-morbidity. The present study was done to assess the respiratory morbidity caused by silicosis in sandstone mine of Rajasthan, India. Methods: The chest X-rays of 529 subjects having history of employment in stone mines with respiratory morbidity were subjected for this study and evaluated in accordance with ILO Classification 2000. The X-rays were classified into various categories of silicosis and progressive massive fibrosis (PMF) in relation to years of work in stone mines. Results: Out of 529 chest radiographs evaluated, 275 (52%) showed radiological evidence of silicosis. Of them, 40 (7.5%) subjects showed large opacities suggestive of progressive massive fibrosis. Both silicosis and progressive massive fibrosis were associated with increasing duration of work in stone mines. Sixty-one (12.4%) subjects with silicosis also had associated pulmonary tuberculosis, termed as silico-tuberculosis. Conclusion: The present study showed a high prevalence of silicosis, progressive massive fibrosis and silico-tuberculosis among stone mine workers. It appears that that unless silicosis is controlled, elimination of tuberculosis is far from reality in the country. Hence, states and central authorities must work together towards control of both silicosis as well as silico-tuberculosis. Similarly, there is an urgent need of initiation of national silicosis control programme, similar to existing national tuberculosis control programme, considering the huge burden of silicosis in India

Line Probe Assay (LPA) is a rapid molecular technique used for the diagnosis of Mycobacterium Tuberculosis (MTB) presence and resistance to first-line drugs such as Rifampicin and Isoniazid. The study presented here is part of an initiative of the Brazilian Tuberculosis Network (REDE-TB) researchers, together with the National Brazilian Tuberculosis Control Program from Health Ministry for the development of mechanisms that improve the clinical and epidemiological impact of LPA use in reference centers in Brazil. Here we use the operational model concept to see sharply the whole flow of processes in order to evaluate diagnostics cascades. Based on that, first, we developed a design of tuberculosis system operations in discrete-time based model, then we made a description of an agent-based transmission model developed to be incorporated to the operational design. After the implementation of the design, we can make a prediction that directly influences the choice of the most appropriate intervention and consequently the result of the cost-effectiveness analysis, translated by the feasibility of the chosen test to future works.

Teniendo en cuenta que la tuberculosis es una meta del tercer Objetivo de Desarrollo Sostenible, se propuso a través de un estudio transversal descriptivo, evaluar el estado del indicador de captación del programa de control de tuberculosis del departamento de Bolívar, se revisaron 334 fichas de notificación de 2016 a 2018, el porcentaje de captación fue menor al 80%, y solo se cumplió la meta de concentración de BK en el año 2017 con un promedio de 2,5%. Se concluye que no existe cumplimiento de la búsqueda de sintomáticos respiratorios, sin embargo, la concentración de baciloscopias reportó en el programa un mantenimiento adecuado.

Background: Tuberculosis is a global problem. However, the impact on the countries of Africa and Asia is really devastating. The countries like India which comes under high burden countries with TB, the prevalence of TB in the nation’s capital and at a large district in the west Delhi has not been reported so far in the medical literature. The present study is a retrospective study and data will serve as a tool to formulate new or modify already existing guidelines and devise methods to control and eradicate TB from the urban population. Materials and Methods: We conducted a retrospective descriptive study at the Chest Clinic Moti Nagar from 2010 to 2015. The data were obtained from the quarterly reports freely available on the internet. Results: There has been a steady rise in the diagnosis of various types of TB cases falling under DOTS and DOTS-Plus strategies of the Revised National Tuberculosis Control Programme. Conclusions: The RNTCP is the best solution to the problem of TB. The role of well trained and dedicated staff inclined to solve the various problems associated with the TB patients is very important. Keywords: Aerosol; Mycobacterium tuberculosis; TB; WHO.

Rationale: Most U.S. residents who develop tuberculosis (TB) were born abroad, and U.S. TB incidence is increasingly driven by infection risks in other countries. Objectives: To estimate the potential impact of effective global TB control on health and economic outcomes in the United States. Methods: We estimated outcomes using linked mathematical models of TB epidemiology in the United States and migrants’ birth countries. A base-case scenario extrapolated country-specific TB incidence trends. We compared this with scenarios in which countries achieve 90% TB incidence reductions between 2015 and 2035, as targeted by the World Health Organization’s End TB Strategy (“effective global TB control”). We also considered pessimistic scenarios of flat TB incidence trends in individual countries. Measurements and Main Results: We estimated TB cases, deaths, and costs and the total economic burden of TB in the United States. Compared with the base-case scenario, effective global TB control would avert 40,000 (95% uncertainty interval, 29,000–55,000) TB cases in the United States in 2020–2035. TB incidence rates in 2035 would be 43% (95% uncertainty interval, 34–54%) lower than in the base-case scenario, and 49% (95% uncertainty interval, 44–55%) lower than in 2020. Summed over 2020–2035, this represents 0.8 billion dollars (95% uncertainty interval, 0.6–1.0 billion dollars) in averted healthcare costs and $2.5 billion dollars (95% uncertainty interval, 1.7–3.6 billion dollars) in productivity gains. The total U.S. economic burden of TB (including the value of averted TB deaths) would be 21% (95% uncertainty interval, 16–28%) lower (18 billion dollars [95% uncertainty level, 8–32 billion dollars]). Conclusions: In addition to producing major health benefits for high-burden countries, strengthened efforts to achieve effective global TB control could produce substantial health and economic benefits for the United States.

OBJECTIVES: In Japan, the first case of coronavirus disease 2019 (COVID-19) was diagnosed on January 15, 2020 and subsequent infections rapidly increased. The Bacillus Calmette-Guerin (BCG) vaccination program is the principal element of tuberculosis control in Japan. We investigated the impact of routine infant BCG vaccination on prevention of local COVID-19 spread. METHODS: Data on the prevalence of SARS-CoV-2 infection, annual routine infant BCG vaccine coverage (represented by the number of BCG vaccinations per live births), and other candidate factors in each prefecture were obtained from the official notifications database in Japan. We analysed the association of vaccine coverage with the prevalence of SARS-CoV-2 infection. RESULTS: The BCG vaccine coverage in 1999-2002, 2004, and 2012 in five prefectures with no COVID-19 infections was significantly higher than that in five prefectures with a high prevalence of infections (Mann-Whitney U test, p

Background: In India, the active case-finding (ACF) strategy began in 2017 under the Revised National Tuberculosis Control Programme to find its missing tuberculosis (TB) cases. Few studies have been conducted in India to assess the treatment outcome of TB patients detected by ACF. Aim: The aim of this study was to assess the treatment outcomes of patients detected through ACF campaigns during the year 2018 in Haridwar district, Uttarakhand. Study Design: This was a cross-sectional study which used the existing data and records. Materials and Methods: The ACF campaign records of 2018 were extracted from six TB units of Haridwar district. Details of sociodemographic, clinical profile, and treatment outcome of 100 diagnosed patients were obtained and analyzed. Results: Out of the total 100 TB patients detected, the site of disease was pulmonary in 98% of patients. Almost all (92%) the patients were diagnosed microbiologically and treatment was initiated by 78% of the patients. The proportion of successful treatment outcome was found in 64% of the patients. The median time interval from diagnosis to treatment was found to be 2 days. Conclusion: In spite of these efforts of ACF, a high proportion of initial loss to follow-up (22%) and unsuccessful treatment outcome (18%) among ACF patients is a major concern. Findings of ACF campaign pose a concern for active follow-up after diagnosis and close monitoring during treatment.

The effectiveness of tuberculosis control is associated with efficacy of treatment of TB patients and above all patients with multiple and extensive drug resistance (MDR/XDR MTB). Patients with TB/HIV co-infection providethe significant impact on the situation.The objective of the studyis to assess outcomes of chemotherapy regimens containing bedaquiline in patients with MDR/XDR TB including those with concurrent HIV infection.Subjects and methods. The efficacy and safety of the regimes containing bedaquiline were assessed in the intensive phase of chemotherapy in 80 patients with MDR/XDR TB: Group1 consisted of 46 patients with negative HIV status (ICD10 code A15-A19); Group 2 – 34 HIV positive patients at the advanced stage with manifestations of a mycobacterial infection (ICD10 code B20.0).Results. Treatment outcomes in the groups were as follows: the effective treatment was statistically significantly more frequent in Group 1 versus Group 2 (80.4 and 52.9%, respectively, p = 0.0088). Treatment failure was registered in 3 patients from each group; treatment defaults were statistically significantly more frequent in Group 2 compared to Group 1: in 8/34 versus 2/46 (p = 0.011). 3 patients were transferred out in both Group 1 and Group 2 (3/46 and 3/34, p = 0.69). During treatment, only 1 patient from Group 2 developed an adverse event, most likely associated with the in-take of bedaquiline, a heart rhythm disorder (ventricular arrhythmia) and prolongation of QTcF > 450 ms.

O farmacêutico deve atuar de forma estratégica no controle da tuberculose, por meio do acompanhamento de pacientes durante todo o tratamento. Para isso, deve possuir um nível de conhecimento adequado para as suas atividades. O objetivo com o presente estudo é avaliar o conhecimento sobre tuberculose pelos farmacêuticos que atuavam na Atenção Primária à Saúde em Belo Horizonte, Minas Gerais. Trata-se de um estudo transversal, mediante a aplicação de questionário semiestruturado e autoaplicável. O instrumento de pesquisa apresentava itens de avaliação de conhecimento nos seguintes domínios: tuberculose, Tratamento Diretamente Observado (TDO), diagnóstico e tratamento. Observou-se que 53 (94,6%) farmacêuticos participaram da pesquisa. A proporção de acertos nas questões relativas ao conhecimento de aspectos da tuberculose variou de 61,8% a 97,1%, com média de 79,6%. A proporção média de acertos foi de 88,0%, 89,9%, 64,6% e 77,7% nos domínios tuberculose, TDO, diagnóstico e tratamento, respectivamente. Os farmacêuticos apresentaram proporção média de acertos acima de 70% nos domínios de conhecimento tuberculose, tratamento e TDO. No entanto, observaram-se lacunas de conhecimento no diagnóstico e esquemas terapêuticos para grupos especiais.

Background: The Revised National Tuberculosis Control Programme (RNTCP) in Andhra Pradesh, India, introduced TrueNat™ MTB/Rif, a rapid molecular test for detecting Mycobacterium tuberculosis (MTB) and rifampicin (RIF) resistance at 193 TB units (TUs) in October 2018. We evaluated its impact on TB diagnosis and assessed the operational feasibility of its deployment at point-of-care (POC) settings.Methods: We compared the number of presumptive TB cases tested and the number (proportion) of microbiologically positive before (January–August 2018) and after (January–August 2019) the deployment of TrueNat. We interviewed laboratory technicians and Senior TB Laboratory Supervisor from 25 randomly selected TUs to assess operational feasibility.Results: In 2018, 10.5% (range 8.9–13.1) of 245,989 presumptive cases tested were positive. In 2019, of the 185,435 presumptive cases tested, 13.7% (range 9.6–18.9) were positive. The proportion of presumptive TB cases in whom MTB was detected using TrueNat was 14.4% (range 10.0–21.2). TrueNat significantly increased case detection (incidence rate ratio [IRR] 1.30; 95%CI 1.15–1.46), yielding an additional 18 TB cases per 100 000 population. Laboratory technicians became comfortable in performing TrueNat after a median of 10 tests (interquartile range 5–17.5). Invalid reports declined from 6.8% to 3.6%.Conclusion: The deployment of TrueNat as POC diagnostic test improved case detection and was operationally feasible under RNTCP.

Since World War II, a tradition of fighting infectious diseases had proven its worth in stopping chains of contamination and controlling diseases. Contradicting this tradition, the choices made in France regarding the COVID-19 pandemic failed to prevent deaths and protect the most exposed populations. Workers, in particular, are the victims of this failure. Based on the experience of tuberculosis control, this article shows that another strategy is not only possible, but crucial to overcome such epidemic.

Relapses in tuberculosis occur due to endogenous reactivations or exogenous reinfections and represent up to 27% of tuberculosis cases. Its importance lies in the risk of the appearance of multidrug-resistant Mycobacterium tuberculosis strains. According to the reports published in 2011 by the Colombian Instituto Nacional de Salud, there were 572 relapse cases reported in the country, i.e., a rate of 4.9%. Data of the tuberculosis control program from the Secretaría de Salud Municipal in Cali reported a relapse rate of 6%, higher than the national one, during 2013 and 2014.To determine the risk factors associated with relapse in patients with pulmonary tuberculosis in Cali.We conducted an observational, analytical, and case-control study (1:1), which comprised 81 cases of pulmonary tuberculosis relapses detected in 2013 and 2014. Additionally, we collected data on socio-demographic and clinical variables, as well as lifestyle and health services, to identify the potential risk factors associated with tuberculosis relapses. We used logistic regression to identify the risk factors.After adjustments for some variables, our multivariate logistic regression analysis showed that the body mass index (BMI) (OR=0.90, 95%CI: 0.81-0.99) and population density (OR=0.99, 95%CI: 0.98-1.00) were inversely associated with tuberculosis relapses. Alcohol consumption increased the likelihood of tuberculosis relapse (OR=5.56, 95%CI: 1.18-26.26).Body mass index and population density were inversely associated with pulmonary tuberculosis relapses in Cali. On the contrary, alcohol consumption increased the likelihood of tuberculosis relapses.Introducción. Las recaídas en la tuberculosis se deben a reactivaciones endógenas o reinfecciones exógenas y alcanzan hasta el 27 % de los casos. Su importancia radica en el riesgo de aparición de cepas de Mycobacterium tuberculosis resistentes a múltiples fármacos. Según informes del Instituto Nacional de Salud de Colombia, en el 2011 se reportaron 572 recaídas, lo que representa un porcentaje del 4,9 %. Datos del programa de tuberculosis de la Secretaría de Salud Municipal de Cali registraron una tasa de recaídas del 6 % durante el 2013 y el 2014, lo que supera la tasa nacional. Objetivo. Determinar los factores asociados con la recaída en pacientes con tuberculosis pulmonar. Materiales y métodos. Se hizo un estudio observacional, analítico y de casos y controles en pacientes diagnosticados con tuberculosis pulmonar detectados entre el 2013 y el 2014. Se estudiaron las variables sociodemográficas, clínicas, de estilo de vida y las relacionadas con el programa y los factores de riesgo; se determinaron utilizando regresión logística. Resultados. Después de ajustar por otras variables, la regresión logística evidenció dos factores inversamente asociados con las recaídas: el índice de masa corporal (OR=0,90; IC95%: 0,81–0,99) y la densidad poblacional en las comunas (OR=0,99; IC95%:0,99–1,00. El consumo de alcohol aumentó la probabilidad de recaída (OR=5,56; IC95%: 1,18 – 26,26). Conclusiones. El índice de masa corporal y la densidad poblacional se asociaron inversamente con las recaídas por tuberculosis pulmonar en Cali. El consumo de alcohol estuvo directamente relacionado.

Background: Tuberculosis (TB) is a significant health and economic burden in our environment and consistently ranks amongst the most common disease that affects individuals whose immunity has been compromised. It is also one of the major infectious diseases that affect those living with HIV and AIDS. Patent Medicine Vendors (PMVs) are ubiquitous in our Communities and are highly patronized by the populace. This is because they are at close proximity, affordable and accessible to many underprivileged and underserved people in Low and middle income countries. Inadequate knowledge and practice among PMVs will increase morbidity, mortality and promote spread of TB and emergence of Multi-drug resistant strains of TB. The study therefore aimed to understand the knowledge and practices of PMVs towards TB control to enable appropriate intervention. Method: The study was of a descriptive cross-sectional design. Semi-structured self-administered questionnaires in English were administered to forty ‘in-charge’ Patent medicine vendors to obtain quantitative data on their socio-demographics, their knowledge and their practices towards clients who present with chronic cough or tuberculosis. Results: From our study, more than half (65.0%) of the respondents identified prolonged cough -lasting more than 2 weeks and bloody cough (75.0%) as symptoms of TB. Only 27.5% of the PMVs have heard of DOTS (Directly Observed Treatment Short-course). Only 20.0% of the PMVs were aware that TB treatment required a minimum of 4 different drugs while 60.0% of them knew that drug treatment of TB should last for a minimum of 6 months. The majority (80.0%) of the PMVs correctly answered that TB drugs in government hospitals are free. When asked the most important tests to request for a client with chronic cough, all (100%) the PMVs mentioned sputum test and X-ray. The result shows that most of the respondents had good practice on the management of tuberculosis because they tended to refer clients with chronic cough or confirmed cases of TB to the government hospital. In our study, level of education of the PMVs was significantly associated with good practice of TB management, p=0.005. Conclusion: From our study, we understood that the level of knowledge and practices of TB management among PMVs in Alakahia Community is fairly adequate as we assessed them based on knowledge appropriate for them. A lot more still need to be done in area of training and retraining of PMVs on knowledge and practices, as well as educating the public on proper health-seeking behavior.

Purpose: This study aimed to assess the extent of patient, health system and total delays in diagnosis and treatment of pulmonary tuberculosis (TB) in Somali pastoralist setting, Ethiopia. Patients and Methods: A cross-sectional study among 444 confirmed new pulmonary TB patients aged ≥15 years in 5 TB care units was conducted between December 2017 and October 2018. Data were collected using a structured questionnaire and record review. We measured delays from symptom onset to provider visit, provider visit to diagnosis and diagnosis to treatment initiation. Delays were summarized using median days. Mann- Whitney and Kruskal-Wallis tests were used to compare delays between categories of explanatory variables. The Log-binomial regression model was used to reveal factors associated with health system delay ≥15 days, presented in adjusted prevalence ratio (APR) with 95% confidence interval (CI). Results: The median age of patients was 30 years, ranged from 15 to 82. The majority (62.4%) were male, and nearly half (46.4%) were pastoralists. The median patient, health system and total delays were 30 (19-48.5), 14 (4.5-29.5) and 50 (35-73.5) days, respec-tively. The median patient delay (35.5 days) and total delay (58.5 days) among pastoralists were substantially higher than the equivalent delays among non-pastoralists [p

To synthesise the evidence for estimating the direct and indirect patient costs of drug-sensitive and drug-resistant tuberculosis care in India.PubMed, Embase, Web of Science, IndMED and Google Scholar were searched for studies conducted in India between 2000 and 2018 and published in English. The search terms were "tuberculosis" AND "costs" (cost Analysis, economics, cost of illness, health care costs, health expenditures, direct service costs, catastrophic cost) AND "India". The cost of TB care was from the patient's perspective. Data regarding costs were extracted, indexed to the year 2018 using cumulative inflation rate and converted to US dollars at the exchange rate of 2018.Thirteen studies were included in this review. The mean (unweighted) total cost incurred by patients being treated for drug-sensitive TB in a public health facility was $ 235.00 (SD- 222.10), and the median of means was $ 170.60 (range - 43.70-718.40). The mean direct cost was 45.5% of the total cost. Only one study, which was conducted in a private facility, reported the mean total cost for drug-resistant TB as $ 7778.04. Catastrophic cost (total cost ≥ 20% of the total annual household income) was experienced by 7% to 32.4% of drug-sensitive TB patients and by 68% of drug-resistant TB patients.Despite free diagnostic and treatment services provided under the Revised National Tuberculosis Control Programme, the patient cost of tuberculosis care is high. Relevant studies vary widely in methodology and cost reporting.Synthétiser les données probantes permettant d'estimer les coûts directs et indirects des soins anti-TB pour les patients avec une TB sensible ou résistante aux médicaments en Inde. MÉTHODE: PubMed, Embase, Web of Science, IndMED et Google Scholar ont été recherchés pour des études menées en Inde entre 2000 et 2018 et publiées en anglais. Les termes de recherche étaient ‘tuberculose’ ET ‘coûts’ (analyse des coûts, économie, coût de la maladie, coûts des soins de santé, dépenses de santé, coûts directs des services, coût catastrophique) ET ‘Inde’. Le coût des soins anti-TB était du point de vue du patient. Les données concernant les coûts ont été extraites, indexées pour l'année 2018 en utilisant le taux d'inflation cumulé et converties en dollars US au taux de change de 2018. RÉSULTATS: Treize études ont été incluses dans cette revue. Le coût total moyen (non pondéré) encouru par les patients traités pour une TB sensible aux médicaments dans un établissement de santé public était de 235,00 USD (SD-222,10), et la médiane des moyennes était de 170,60 USD (intervalle - 43,70 - 718,40). Le coût direct moyen était de 45,5% du coût total. Une seule étude, qui a été menée dans un établissement privé, a rapporté le coût moyen total pour la TB résistante aux médicaments équivalent à 7.778,04 USD. Des coûts catastrophiques (coût total ≥ 20% du revenu annuel total du ménage ) ont été subis par 7% à 32,4% des patients avec une TB sensible aux médicaments et par 68% des patients avec une TB résistante aux médicaments.Malgré les services gratuits de diagnostic et de traitement fournis dans le cadre du Programme National Révisé de Lutte contre la TB, le coût des soins anti-TB pour les patients est élevé. Les études pertinentes varient considérablement dans la méthodologie et la communication des coûts.

Background/aim This study aimed to analyze delays in diagnosis and treatment by defining the related demographic and clinical factors, to reveal obstacles, and to develop essential attempts to help reduce treatment delays. Materials and methods We created a questionnaire on the subject of delays in diagnosis and treatment in tuberculosis (TB) control to be administered to the patients. The forms were distributed to dispensaries across the country by the General Directorate of Public Health via an official letter. Results The study included 853 new patients with smear-positive pulmonary TB. The mean patient delay was 18.06 ± 22.27 days, the mean diagnosis delay was 35.63 ± 34.86 days, and the mean treatment delay was 0.90 ± 2.39 days. We found no association between sex, age, literacy, residential location, the presence of chronic respiratory diseases, and patient delay. It was determined that patient delay was shorter for patients with hemoptysis, fever, dyspnoea, and chest pain. In women, the diagnosis delay was longer than in men. Conclusion In the diagnosis process of patients with tuberculosis, it was determined that there was an improvement in the patient delay; however, the improvement in the diagnosis delay was still not acceptable as an ideal duration.

Objectives The American state of Hawaii presents a tuberculosis (TB) burden more consistent with that of the Philippines and the Pacific Islands than that with the United States (US) or Europe. This study seeks to determine if the genetic families of Mycobacterium tuberculosis (Mtb) that are prevalent in Hawaii display differences in host demographics that may be of use for TB control in Hawaii and the Pacific. Study design This retrospective study was conducted by analyzing data from the Hawaii State Department of Health to investigate the demographics associated with the Beijing (global lineage 2) and Manila (lineage 1) families of Mtb in Hawaii. Methods Deidentified records of all culture-positive TB cases reported by the Hawaii State Department of Health Tuberculosis Control Program from 2004 to 2016 were analyzed to identify lineage-specific demographic differences and trends. Patients' countries of origin, age, sex, and time in the US before TB diagnosis were included in this analysis. Results Manila family isolates were found to predominantly enter Hawaii through Filipino immigrants, whereas Beijing family isolates originated from a diverse set of countries. Both families exhibited significant differences in age and sex demographics. In addition, Manila family cases presented from patients with significantly longer average time of residence in the US than non-Manila cases, whereas Beijing family cases presented from patients with significantly shorter time of residence in the US than non-Beijing cases. Conclusions Both the Beijing and Manila families of Mtb demonstrated demographic differences in Hawaii that may prove important for improving TB control and surveillance policy in Hawaii and throughout the Pacific. Areas with heavy Filipino immigration may benefit from directing more resources toward screening and education efforts for middle-aged men and those who have resided in the country longer, whereas other areas of the Pacific should consider a younger and more sex-balanced allocation. Specific to the US and Hawaii, effective screening of youths emigrating from the Compact of Free Association states remains vital.

To solve the problems of tuberculosis (TB) in penitentiary institutions, it is advisable to conduct a retrospective analysis, to find the most successful ways to prevent the spread of the infection in this system. Objective: to study the historical aspects of tuberculosis control in the penitentiary system of the Russian Federation. Methods. Information analysis methods were used. Data from 61 sources were studied. Results. The most significant attention was given to tuberculosis control in the penitentiary units at the beginning of the XXI century, which resulted in the significant improvement of the situation. In recent years, less attention has been paid to this problem, which is capable of stagnating positive changes. It is proposed, along with the continued implementation of proven measures, to intensify research activities, the interaction between civil and penitentiary health care and social communication.

Management of latent tuberculosis infection (LTBI) is a critical element in the elimination of tuberculosis (TB). However, the low positive predictive value of the current diagnostic tests and the low acceptance and completion rate of the isoniazid- based regimen are major barriers to the implementation and scale-up of programmatic management of LTBI. In the past decade, there has been some progress in the conception, diagnosis, and treatment of LTBI. LTBI is now understood as a dynamic spectrum rather than the traditional binary distinction between active and latent TB. New insight into LTBI has led to a renewed interest in incipient TB, which would be a potential target for developing new diagnostics and therapeutics of LTBI. Recent studies showed that host transcriptomic signatures could be a potential biomarker for incipient TB. The new shorter rifamycin-based regimens have shown comparable efficacy, but better completion rate and safety compared to the isoniazid-based regimen. In South Korea, LTBI management has been expanded and integrated into key elements of the National Tuberculosis Control Program. For the programmatic approach to LTBI management, the following challenges need to be addressed; target group selection, treatment-related interventions, monitoring and surveillance system, and extending the plan for vulnerable groups.

Tuberculosis disease burden remains a fundamental global public health concern for decades. The disease may not uniformly distributed with certain geographical areas recording higher notification rate than others. However, the Ethiopian national TB control program does not provide services based on those areas with the greatest notifications but rather on a uniform strategy. Therefore, this study aimed to assess the spatial distribution and presence of the spatio-temporal clustering of the disease in different geographic settings over 8 years in the East Hararge Zone. A retrospective space-time and spatial analysis were carried out at districts of East Hararghe zone based on a total of 34,564 notified TB cases during the study period. The study identified different case notification rate over districts and clustering effects for the purely spatial and spatiotemporal with different estimated relative risks. The study recommends national tuberculosis control program to give attention to highly observed case notification rates specially Babile, Haramaya and Jarso districs of East Hararge Zone to have effective TB intervention in the study area.

The objective: to study the perception of the problem of tuberculosis in physicians working in primary medical care and enhance motivation to implement tuberculosis control activities.Subjects and methods. A questionnaire survey was conducted in 114 physicians from primary medical care before and after the lecture on phthisiology. A subjective assessment of the knowledge on tuberculosis (self-assessment) and results of an objective assessment were studied and compared.Results. 30% of physicians had the fear of getting infected and developing tuberculosis. The level of theoretical phthisiologic knowledge among physicians from primary medical care is insufficient; the self-assessment of this knowledge is overstated in 58.8%.

Background: Indonesia suffers from a high burden of tuberculosis (TB) and diabetes (DM). The government initiated national TB-DM co-management activities under the National TB Control Program in 2017. This study investigates the detection and treatment outcomes of TB-DM in Jakarta after implementing these activities, and identifies the main factors associated with these outcomes. Methods: A retrospective cohort study was conducted using TB registry data in two districts of Jakarta, East Jakarta (low-income) and South Jakarta (high-income). A 5-step cascade analysis was used: diagnosed TB patients; TB patients tested for DM; diagnosed TB-DM patients; and patients received and completed TB treatment/cured. We conducted descriptive analyses to understand the characteristics of TB and TB-DM patients, and used a two-level mixed-effect logistic regression to explore factors associated with having a DM test and completing TB treatment/being cured. Results: Over the study period (2017-2019) 50.8% of the new pulmonary TB patients aged over 15 were tested for DM. The percentage increased from 41.7% in 2017-2018 to 60.1% in 2019. Of the TB patients tested for DM, 20.8% were diagnosed with DM. Over 90% of the detected TB-DM patients received standard TB treatment, 86.3% of whom completed treatment/were cured. Patients in East Jakarta were more likely to be tested for DM and to complete standard TB treatment/be cured than patients in South Jakarta (PConclusions: TB-DM case detection significantly improved in 2019 after introducing TB-DM co-management activities in Jakarta, while gaps in TB-DM co-management existed between bacteriologically positive and clinically diagnosed TB patients, and across different types of health facilities. Collaboration between TB and DM departments should be strengthened, and more resources need to be mobilized to further improve the co-management of TB-DM in Indonesia.

Background Systematic screening for active tuberculosis (TB) is a strategy which requires the health system to seek out individuals, rather than waiting for individuals to self-present with symptoms (i.e., passive case finding). Our review aimed to summarize the current economic evidence and understand the costs and cost-effectiveness of systematic screening approaches among high-risk groups and settings. Methods We conducted a systematic review on economic evaluations of screening for TB disease targeting persons with clinical and/or structural risk factors, such as persons living with HIV (PLHIV) or persons experiencing homelessness. We searched three databases for studies published between January 1, 2010 and February 1, 2020. Studies were included if they reported cost and a key outcome measure. Owing to considerable heterogeneity in settings and type of screening strategy, we synthesized data descriptively. Results A total of 27 articles were included in our review; 19/27 (70%) took place in high TB burden countries. Seventeen studies took place among persons with clinical risk factors, including 14 among PLHIV, while 13 studies were among persons with structural risk factors. Nine studies reported incremental cost-effectiveness ratios (ICERs) ranging from US$51 to $1980 per disability-adjusted life year (DALY) averted. Screening was most cost-effective among PLHIV. Among persons with clinical and structural risk factors there was limited evidence, but screening was generally not shown to be cost-effective. Conclusions Studies showed that screening is most likely to be cost-effective in a high TB prevalence population. Our review highlights that to reach the “missing millions” TB programmes should focus on simple, cheaper initial screening tools (i.e., symptom screen and CXR) followed by molecular diagnostic tools (i.e., Xpert®) among the highest risk groups in the local setting (i.e., PLHIV, urban slums). Programmatic costs greatly impact cost-effectiveness thus future research should provide both fixed and variable costs of screening interventions to improve comparability.

In developing countries, Ziehl-Neelsen (Z-N) sputum smear microscopy is widely used.The present prospective study was under taken to see the efficacy of Ziehl-Neelson method versus Gabbett and Fluorescent staining in the detection of mycobacteria in sputum sample. 80 sputum samples were collected from suspected tuberculosis patients attending RNTCP OPD at, Nerul, Navi Mumbai. Triplicate smears were prepared from all these samples and stained by the Z-N, Gabbet’s, and Fluorescent stain. Number of smears positive for Acid Fast Bacilli by, Z-N method 13(16%), Gabbett’s method 7(9%), Fluorescent method 26(33%). Combination of two staining methods yielded following results: Z- N + Fluorescent26 (33%) and Z- N + Gabbett 13(16%). The conclusion from this study is that when smear examination by Z-N is done, there are possibilities of false negative results which can be reduced by using Fluorescent staining. The rate of positivity can be improved by combination of Z-N + Fluorescent staining. So, it may be concluded that combination of ZN and Fluorescent Microscopy may be considered for diagnosis of pulmonary tuberculosis in any diagnostic set up along with culture which is the gold standard. Keywords: Fluorescent, Gabbett’s, Mycobacterium tuberculosis, Revised National Tuberculosis Control Programme (RNTCP), Zehil-Neelson (Z-N).