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Pre-treatment loss to follow-up in tuberculosis patients in low- and lower-middle-income countries and high-burden countries: a systematic review and meta-analysis/Le manque de suivi avant le traitement chez les patients atteints de tuberculose dans les pays a revenu faible et a revenu moyen inferieur fortement touches par la maladie: meta-analyse et analyse systematique/ Perdida de seguimiento antes del tratamiento de pacientes con tuberculosis en paises de ingresos medios y bajos y en paises con carga alta: una revision sistematica y metanalisis. Objective To assess the magnitude of loss to follow-up in smear- or culture-positive tuberculosis patients before treatment initiation and outcomes among patients who were traced. Methods Ovid Medline and Global Health databases were searched for studies published between 1994 and January 2013 that described pre-treatment loss to follow-up in patients with smear- or culture-positive tuberculosis in routine national tuberculosis programmes (NTPs) in low- and lower-middle-income countries and in countries with a high burden of tuberculosis. Data on the proportion of patients who did not initiate treatment after their tuberculosis diagnosis were extracted from studies meeting inclusion criteria. Where available, data on causes and outcomes, including initiation of tuberculosis treatment at another facility, were investigated. Heterogeneity and publication bias were assessed and random-effects meta-analyses by subgroup (region) were performed. Findings Twenty-three eligible studies were identified, with a total of 34 706 smear- or culture-positive tuberculosis patients from 14 countries (8 in Africa, 5 in Asia and I in the western Pacific). Most studies were retrospective and linked laboratory and treatment registers to identify pre-treatment loss to follow-up. Pre-treatment loss to follow-up varied from 4 to 38% and was common in studies from Africa (random-effects weighted proportion, WP: 18%; 9.5% confidence interval, CI: 13-22) and Asia (WP: 13%; 95% CI: 10-15). Conclusion Pre-treatment loss to follow-up, common in most settings, can hinder tuberculosis control efforts. By not counting individuals who are lost to follow-up before treatment when reporting standard programme indicators, NTPs underestimate case detection rates and mortality and overestimate cure rates. Objectif Evaluer I'ampleur du manque de suivi chez les patients atteints d'une tuberculose a frottis positif ou culture positive avant le debut du traitement, ainsi que les resultats chez les patients qui ont ete suivis. Methodes Des etudes publiees entre 1994 etjanvier 2013, qui decrivaient le manque de suivi des patients atteints de tuberculose a frottis positif ou a culture positive dans des programmes nationaux courants de lutte contre la tuberculose (NTP) dans les pays a revenu faible et a revenu moyen inferieur fortement touches par la tuberculose ont ete recherchees dans les bases de donnees Ovid, Medline et Global Health. Des donnees concernant le taux de patients qui n'ont pas debute le traitement apres leur diagnostic de tuberculose ont ete extraites des etudes satisfaisant les criteres d'inclusion. Le cas echea nt, les donnees portant sur les causes et les resultats, y compris le debut d'un traitement contre la tuberculose dans un autre etablissement, ont ete examinees. L'heterogeneite et le parti pris dans les publications ont ete evalues, et des meta-analyses a effets aleatoires par sous-groupe (region) ont ete realisees. Resultats Vingt-trois etudes eligibles ont ete identifiees pour un total de 34 706 patients atteints de tuberculose a frottis positif ou a culture positive dans 14 pays (8 en Afrique, 5 en Asie et 1 dans le Pacifique occidental). La plupart des etudes etaient retrospectives et associaient des registres de laboratoire et de traitement pour identifier le manque de suivi avant le traitement. Celui-ci variait de 4% a 38% et s'est revele commun dans les etudes provenant d'Afrique (proportion ponderee a effets aleatoires, PP: 18%; intervalle de confiance a 95%, IC: 13-22) et d'Asie (PP: 13%; IC a 95%: 10-15). Conclusion Le manque de suivi avant le traitement, commun dans la plupart des contextes, peut entraver les efforts fournis en matiere de lutte contre la tuberculose. Comme les individus qui ne sont pas suivis avant le traitement ne sont pas pris en compre Iors de I'elaboration des rapports sur les indicateurs de programme standard, les programmes nationaux de lutte contre la tuberculose sous-estiment les taux de depistage des caset la mortalite, mais surestiment les taux de guerison. Objetivo Evaluar la magnitud de la perdida de seguimiento de los pacientes con tuberculosis que dieron positivo en el analisis o el cultivo antes del inicio del tratamiento y los resultados entre los pacientes que se sometieron a un seguimiento. Metodos Se realizo una busqueda en las bases de datos Ovid, Medline y Global Health deestudios publicados entre 1994y enerode 2013 que describian perdidas de seguimiento antes del tratamiento en pacientes que dieron positivo en el analisis o el cultivo de tuberculosis en los programas nacionales contra la tuberculosis (PNT) ordinarios en paises de ingresos medios y baios y en paises con carga alta de tuberculosis. Se extrajeron datos sobre la proporcion de pacientes que no inicio un tratamiento despues del diagnostico de la tuberculosis de estudios que cumplian los criterios de inclusion. Siempre que fue posible, se investigaron los datos sobre las causas y resultados, incluida la iniciadon del tratamiento de la tuberculosis en otro centro. Se evaluo el sesgo de las publicaciones y la heterogeneidad, y se realizaron metanalisis de erectos aleatorios por subgrupos (region). Resultados Se identificaron veintitres estudios que cumplian los criterios, con un total de 34 706 pacientes que dieron positivo enel analisis o cultivo de tuberculosis de 14 paises (8 de Africa, 5 de Asia y 1 del Pacifico occidental). La mayoria de los estudios eran retrospectivos y relacionaban los registros de laboratorio con los registros de tratamiento para identificar la perdida de seguimiento antes del tratamiento, que oscilo entre el 4 y 38% y fue frecuente en los estudios de Africa (proporcion ponderada de erectos aleatorios, WP: 18%; intervalo de confianza del 95%, IC: 13-22) y Asia (WP: 13%; IC del 95%: 10-15). Conclusion La perdida de seguimiento antes del tratamiento, comun en la mayoria de los entornos, puede obstaculizar los esfuerzos de control de la tuberculosis. Sin contar los pacientes cuyo seguimiento se pierde antes del tratamiento, los programas nacionales contra la tuberculosis subestiman la mortalidad y las tasas de deteccion de casos, a la vez que sobrestiman las rasas de curacion ai informar sobre los indicadores del programa estandar., Introduction Since tuberculosis was declared a global emergency in 1993 by the World Health Organization (WHO), new cases of tuberculosis and deaths from the disease have dropped dramatically in several [...]

In Ho Chi Minh City, Vietnam, reporting rates for tuberculosis (TB) are rising in an emerging HIV epidemic. To describe the HIV epidemic among TB patients and quantify its impact [...]

Background Tuberculosis (TB) case notification rates are usually higher in men than in women, but notification data are insufficient to measure sex differences in disease burden. This review set out to systematically investigate whether sex ratios in case notifications reflect differences in disease prevalence and to identify gaps in access to and/or utilisation of diagnostic services. Methods and Findings In accordance with the published protocol (CRD42015022163), TB prevalence surveys in nationally representative and sub-national adult populations (age [greater than or equal to] 15 y) in low- and middle-income countries published between 1 January 1993 and 15 March 2016 were identified through searches of PubMed, Embase, Global Health, and the Cochrane Database of Systematic Reviews; review of abstracts; and correspondence with the World Health Organization. Random-effects meta-analyses examined male-to-female (M:F) ratios in TB prevalence and prevalence-to-notification (P:N) ratios for smear-positive TB. Meta-regression was done to identify factors associated with higher M:F ratios in prevalence and higher P:N ratios. Eighty-three publications describing 88 surveys with over 3.1 million participants in 28 countries were identified (36 surveys in Africa, three in the Americas, four in the Eastern Mediterranean, 28 in South-East Asia and 17 in the Western Pacific). Fifty-six surveys reported in 53 publications were included in quantitative analyses. Overall random-effects weighted M:F prevalence ratios were 2.21 (95% CI 1.92-2.54; 56 surveys) for bacteriologically positive TB and 2.51 (95% CI 2.07-3.04; 40 surveys) for smear-positive TB. M:F prevalence ratios were highest in South-East Asia and in surveys that did not require self-report of signs/symptoms in initial screening procedures. The summary random-effects weighted M:F ratio for P:N ratios was 1.55 (95% CI 1.25-1.91; 34 surveys). We intended to stratify the analyses by age, HIV status, and rural or urban setting; however, few studies reported such data. Conclusions TB prevalence is significantly higher among men than women in low- and middle-income countries, with strong evidence that men are disadvantaged in seeking and/or accessing TB care in many settings. Global strategies and national TB programmes should recognise men as an underserved high-risk group and improve men's access to diagnostic and screening services to reduce the overall burden of TB more effectively and ensure gender equity in TB care., Author(s): Katherine C. Horton 1,2,*, Peter MacPherson 3,4, Rein M. G. J. Houben 2,5, Richard G. White 2,5, Elizabeth L. Corbett 1,6 Introduction Over the past twenty years, tuberculosis (TB) [...]