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An estimated one fourth of the world's population is infected with Mycobacterium tuberculosis, and 5–10% of those infected develop tuberculosis in their lifetime. Preventing tuberculosis is one of the most underutilized but essential components of curtailing the tuberculosis epidemic. Moreover, current evidence illustrates that tuberculosis manifestations occur along a dynamic spectrum from infection to disease rather than a binary state as historically conceptualized. Elucidating determinants of transition between these states is crucial to decreasing the tuberculosis burden and reaching the END-TB Strategy goals as defined by the WHO. Vaccination, detection of infection, and provision of preventive treatment are key elements of tuberculosis prevention. This review provides a comprehensive summary of recent evidence and state-of-the-art updates on advancements to prevent tuberculosis in various settings and high-risk populations. We identified relevant studies in the literature and synthesized the findings to provide an overview of the current state of tuberculosis prevention strategies and latest research developments. We present the current knowledge and recommendations regarding tuberculosis prevention, with a focus on M. bovis Bacille-Calmette-Guérin vaccination and novel vaccine candidates, tests for latent infection with M. tuberculosis, regimens available for tuberculosis preventive treatment and recommendations in low- and high-burden settings. Effective tuberculosis prevention worldwide requires a multipronged approach that addresses social determinants, and improves access to tuberculosis detection and to new short tuberculosis preventive treatment regimens. Robust collaboration and innovative research are needed to reduce the global burden of tuberculosis and develop new detection tools, vaccines, and preventive treatments that serve all populations and ages. [Display omitted] [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND: The diagnosis and treatment of latent tuberculosis infection (LTBI) are crucial for tuberculosis (TB) control. Household contacts (HHC) of patients with pulmonary TB are at a high risk of LTBI due to their close proximity to source cases. OBJECTIVE: To describe the diagnosis and treatment of LTBI among HHC. DESIGN AND SETTING: This cross-sectional follow-up study was conducted in the municipality of Paulo Afonso, northeastern Brazil, between 2013 and 2022. METHODS: We retrieved secondary data from the medical records of HHC who were followed up at a specialized referral center for TB. LTBI prevalence estimates were calculated and are presented with 95% confidence intervals (CIs). RESULTS: In total, 622 HHC were screened for LTBI, with 620 evaluated using the tuberculin skin test (TST). Of these, 40 (6.5%) did not return for TST reading. The overall prevalence of LTBI was 53.1% (95% CI: 49–57.1%), with a high prevalence among females and individuals aged 25–34 years. The overall LTBI treatment initiation rate was 26.1% (95%CI: 21.5–31.3%), and 64.2% (95%CI: 53.3–73.8%) of HHC who initiated treatment completed their course. CONCLUSION: This study revealed a high prevalence of LTBI among HHC, particularly among women and individuals aged 25–34 years, underscoring the ongoing TB transmission within the community. Only 26.1% of the diagnosed HHC initiated treatment, with approximately 64% completing their course. This highlights the challenges in managing LTBI and emphasizes the need for targeted screening and interventions for high-risk groups.

Abstract Background Tuberculosis (TB) is a major cause of death worldwide, and Chinese TB burden ranked the second globally. Chinese primary healthcare (PHC) sectors implement the TB Control Program (TCP) to improve active case finding, referral, treatment adherence, and health education. This study aimed to identify barriers and enablers of TCP implementation in high TB burden regions of West China. Methods We conducted a representative study using mixed-methods in 28 counties or districts in Chongqing Municipality and Guizhou Province of West China from October 2021 to May 2022. Questionnaire surveys and semi-structured in-depth interviews were conducted with 2720 TB healthcare workers (HCWs) and 20 interviewees in PHC sectors. Descriptive statistical analysis was used to investigate TB HCWs’ characteristics, and path analysis model was utilized to analyze the impact of associated factors on TCP implementation. Thematic framework analysis was developed with the guide of the adapted Consolidated Framework for Implementation Research (CFIR) on factors of TCP implementation. Results This study found that 84.6% and 94.1% of community and village HCWs had low professional titles. Based on the results of multiple regression analysis and correlation analysis, lower TB core knowledge scores (-0.09) were identified as barriers for TCP implementation in community PHC sectors, and low working satisfaction (-0.17) and low working willingness (-0.10) are barriers for TPC implementation in village PHC sectors. The results of in-depth interviews reported barriers in all domains and enablers in four domains of CFIR. There were identified 19 CFIR constructs associated with TCP implementation, including 22 barriers such as HCWs’ heavy workload, and 12 enablers such as HCWs’ passion towards TCP planning. Conclusions With the guide of the CFIR framework, complex factors (barriers and enablers) of TCP implementation in PHC sectors of West China were explored, which provided important evidences to promote TB program in high TB burden regions. Further implementation studies to translate those factors into implementation strategies are urgent needed. Graphical Abstract

Background: Tuberculosis (TB) is a major cause of death worldwide, and Chinese TB burden ranked the second globally. Chinese primary healthcare (PHC) sectors implement the TB Control Program (TCP) to improve active case finding, referral, treatment adherence, and health education. This study aimed to identify barriers and enablers of TCP implementation in high TB burden regions of West China. Methods: We conducted a representative study using mixed-methods in 28 counties or districts in Chongqing Municipality and Guizhou Province of West China from October 2021 to May 2022. Questionnaire surveys and semi-structured in-depth interviews were conducted with 2720 TB healthcare workers (HCWs) and 20 interviewees in PHC sectors. Descriptive statistical analysis was used to investigate TB HCWs' characteristics, and path analysis model was utilized to analyze the impact of associated factors on TCP implementation. Thematic framework analysis was developed with the guide of the adapted Consolidated Framework for Implementation Research (CFIR) on factors of TCP implementation. Results: This study found that 84.6% and 94.1% of community and village HCWs had low professional titles. Based on the results of multiple regression analysis and correlation analysis, lower TB core knowledge scores (-0.09) were identified as barriers for TCP implementation in community PHC sectors, and low working satisfaction (-0.17) and low working willingness (-0.10) are barriers for TPC implementation in village PHC sectors. The results of in-depth interviews reported barriers in all domains and enablers in four domains of CFIR. There were identified 19 CFIR constructs associated with TCP implementation, including 22 barriers such as HCWs' heavy workload, and 12 enablers such as HCWs' passion towards TCP planning. Conclusions: With the guide of the CFIR framework, complex factors (barriers and enablers) of TCP implementation in PHC sectors of West China were explored, which provided important evidences to promote TB program in high TB burden regions. Further implementation studies to translate those factors into implementation strategies are urgent needed. [ABSTRACT FROM AUTHOR]

The National Tuberculosis (TB) Control and Prevention Program in Medina City implements a comprehensive strategy to address TB, aligning with international guidelines set by the American Thoracic Society, the Centers for Disease Control and Prevention (CDC), and the Infectious Diseases Society of America (IDSA), emphasizing evidence-based approaches for TB management and diagnosis. The program differentiates recommendations based on patients' risk levels, employing Interferon-Gamma Release Assays (IGRA) as the preferred diagnostic method over Tuberculin Skin Tests (TST) for certain age groups and BCG-vaccinated individuals. For active TB diagnosis, the program uses Acid-Fast Bacilli (AFB) smear microscopy combined with mycobacterial cultures and Nucleic Acid Amplification Testing (NAAT), allowing rapid identification and assessment of drug-resistant strains. Treatment and prevention measures include Directly Observed Treatment, Short-course (DOTS) to enhance medication adherence, free access to second-line drugs for multidrug-resistant TB, and proactive monitoring of treatment side effects to ensure patient compliance. Preventive strategies, such as the BCG vaccination for infants, stringent infection control in healthcare settings, public awareness initiatives, and regular screenings for high-risk groups, play pivotal roles in reducing TB transmission. The program emphasizes targeted testing and treatment of latent TB infections, leveraging a combination of IGRA and TST methods tailored to each patient's needs. Through extensive surveillance and data collection, Medina's program identifies treatment gaps, tracks drug resistance trends, and informs resource allocation. Moreover, the program collaborates with international organizations, focusing on research, capacity building, and addressing social determinants influencing TB transmission. These efforts illustrate Medina's commitment to TB elimination by integrating diagnostic, preventive, and treatment strategies within a robust public health framework. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is one of the ten leading causes of death globally. The present study aims to examine the treatment outcomes in TB patients and to determine the factors associated with unsuccessful treatment outcomes. Materials and Methods: This study was a retrospective registry-based cohort study conducted in Ordu province of Turkey between 2017-2021. Logistic regression analysis was used to explore the risk factors associated with unsuccessful outcomes. Results: A total of 400 TB patients were included in the analysis. The observed overall treatment success rate (TSR) (cured or treatment completed) was 87.7% (351). 49 patients (12.3%) had unsuccessful treatment results (death, failure or loss to follow-up). Age>65 years (odds ratio [OR] =12.2, 95% confidence intervals [CI] =4.03-36.85), male gender (OR = 2.2, 95% CI = 1.05-4.45) and being foreign-born (OR = 9.2, 95% CI = 1.16-73.72) were identified as risk factors associated with unsuccessful outcomes in patients (p<0.05). Conclusions: Age>65 years, male gender and foreign-born patients tend to have unsuccessful treatment outcomes. Careful monitoring of patients with any of these characteristics and taking special precautions for them may help to decrease unsuccessful treatment outcomes. [ABSTRACT FROM AUTHOR]

Background The persistence of tuberculosis today and its global disparity send a powerful message that effective tuberculosis control must respond to its regional epidemiology. Active case finding through contact investigation is a standard protocol used for tuberculosis control, but its effectiveness has not been established, especially in endemic areas. Methods To quantify the potential effectiveness of contact investigation in Kampala, Uganda, we used a cross-sectional design to evaluate the social networks of 123 tuberculosis index cases and 124 controls without tuberculosis. Results Tuberculous infection was present in 515 of 989 tuberculosis case contacts (52.1%) and 396 of 1026 control contacts (38.6%; adjusted prevalence ratio, 1.4; 95% CI, 1.3–1.6). The proportion of infected participants with known exposure within the social network of the tuberculosis case was 35%. The population-attributable fraction was 11.1% for any known exposure, with 7.3% attributable to household exposure and 3.4% attributable to extrahousehold exposure. Conclusions This low population-attributable fraction indicates that contact tracing in the social networks of index cases will have only a modest effect in reducing tuberculous infection in a community. New approaches to community-level active case finding are needed. [ABSTRACT FROM AUTHOR]

Nigeria is one of the 30 high tuberculosis burden countries globally. Childhood tuberculosis has been identified as a hidden epidemic with a large proportion of the cases remaining undetected. For many years, tuberculosis control programmes have focused on adults, programmes and studies specific to childhood tuberculosis should be prioritized. Healthcare providers are frontline workers fighting against tuberculosis, their knowledge, attitude, and practices are essential to tuberculosis control. This study assessed knowledge, attitude and practice on prevention and control of childhood tuberculosis in selected primary health care (PHC) centres in three Local Government Areas (LGAs) in Ibadan, southwestern Nigeria. A cross-sectional design was employed in the study. A total of 270 participants were selected using multistage sampling technique. A semi-structured questionnaire was used to collect data which were analysed and presented in percentages. Association between variables were tested with chi-square and Fisher's exact test at 0.05 level of significance. Overall, 215 (79.65) of the participants were female, 125 (46.3%) were nurses/midwives, only 27 (10%) ever attended a training on tuberculosis in the preceding 12 months. Sixtynine (25.6%) had good knowledge, 46 (17%) had positive attitude, while 74 (27.4%) had good practice of childhood tuberculosis prevention and control. Good knowledge was found to have significant association with good practice among the participants (P=0.000). The study revealed poor knowledge, attitude and practice towards childhood tuberculosis prevention and control among PHC providers in selected centres in Ibadan, Nigeria. Training and re-training of PHC providers on tuberculosis is recommended at grassroot level. [ABSTRACT FROM AUTHOR]

This study investigated the presence of Mycobacterium bovis (M. bovis) DNA in archived human sputum samples previously collected from residents who reside adjacent to the M. bovis-endemic Hluhluwe-iMfolozi wildlife park, South Africa (SA). Sixty-eight sputum samples were GeneXpert MTB/RIF Ultra-positive for M. tuberculosis complex (MTBC) DNA but culture negative for M. tuberculosis. Amplification and Sanger sequencing of hsp65 and rpoB genes from DNA extracted from stored heat-inactivated sputum samples confirmed the presence of detectable amounts of MTBC from 20 out of the 68 sputum samples. Region of difference PCR, spoligotyping and gyrB long-read amplicon deep sequencing identified M. bovis (n = 10) and M. tuberculosis (n = 7). Notably, M. bovis spoligotypes SB0130 and SB1474 were identified in 4 samples, with SB0130 previously identified in local cattle and wildlife and SB1474 exclusively in African buffaloes in the adjacent park. M. bovis DNA in sputum, from people living near the park, underscores zoonotic transmission potential in SA. Identification of spoligotypes specifically associated with wildlife only and spoligotypes found in livestock as well as wildlife, highlights the complexity of TB epidemiology at wildlife-livestock-human interfaces. These findings support the need for integrated surveillance and control strategies to curb potential spillover and for the consideration of human M. bovis infection in SA patients with positive Ultra results.

Abstract Objective This study assesses the diagnostic delay, treatment duration and treatment outcomes of tuberculosis (TB) patients since the implementation of the integrated model of TB control in a county in eastern China. It further identifies factors associated with diagnostic delay and treatment duration in the integrated model. Methods We collected data through the Chinese Tuberculosis Information Management System (TBIMS) for Cangnan County in Zhejiang Province. Chi-square and Mann-Whitney tests were adopted to identify factors associated with duration of treatment and treatment delay for TB patients within the integrated model. Multiple regression analysis was subsequently performed to confirm the identified factors. Results In the integrated model from 2012 to 2018, the median health system delay was maintained at 1 day, and the median patient delay decreased from 14 to 9 days and the median total delay decreased from 15 to 11 days. In addition, the proportion of patients who experienced patient delay > 14 days and total delay > 28 days decreased from 49% to 35% and from 32% to 29% respectively. However, the proportion of patients who had health system delay > 14 days increased from 0.2% to 13% from 2012 to 2018. The median treatment duration increased from 199 to 366 days and the number of TB patients lost to follow-up showed an overall upward trend from 2012 to 2018. The multivariable regression analysis indicated that migrant TB patients and TB patients initially diagnosed in hospitals at the prefectural level and above tended to experience total delay > 28 days (p 60 years tended to have longer treatment duration (p

Summary: Background: Routine whole genome sequencing of Mycobacterium tuberculosis has been implemented with increasing frequency. However, its value for tuberculosis (TB) control programs beyond individual case management and enhanced drug resistance detection has not yet been explored. Methods: We analysed routine sequencing data of culture-confirmed TB cases notified between 1st January 2017 and 31st December 2021 in New South Wales (NSW), Australia. Genomic surveillance included evidence of local TB transmission, defined by single nucleotide polymorphism (SNP) clustering over a variable (0–25) SNP threshold, and drug resistance conferring mutations. Findings: M. tuberculosis sequences from 1831 patients were examined, representing 64.8% of all notified TB cases and 96.2% of culture-confirmed cases. Applying a traditional 5-SNP cluster threshold identified 62 transmission clusters with 183 clustered cases; 101/183 (55.2%) had 0 SNP differences. Cluster assessment over a 5-year period, using a 5-SNP threshold, provided a comprehensive overview of likely recent transmission within NSW, Australia, as an indicator of local TB control. Genotypic drug susceptibility testing (DST) was highly concordant with phenotypic DST and provided a 6.8% increase in antimycobacterial resistance detection. Importantly, it detected mutations missed by routine molecular tests. Lineage 2 strains were more likely to be drug resistant (p

Objective: This study assesses the diagnostic delay, treatment duration and treatment outcomes of tuberculosis (TB) patients since the implementation of the integrated model of TB control in a county in eastern China. It further identifies factors associated with diagnostic delay and treatment duration in the integrated model. Methods: We collected data through the Chinese Tuberculosis Information Management System (TBIMS) for Cangnan County in Zhejiang Province. Chi-square and Mann-Whitney tests were adopted to identify factors associated with duration of treatment and treatment delay for TB patients within the integrated model. Multiple regression analysis was subsequently performed to confirm the identified factors. Results: In the integrated model from 2012 to 2018, the median health system delay was maintained at 1 day, and the median patient delay decreased from 14 to 9 days and the median total delay decreased from 15 to 11 days. In addition, the proportion of patients who experienced patient delay > 14 days and total delay > 28 days decreased from 49% to 35% and from 32% to 29% respectively. However, the proportion of patients who had health system delay > 14 days increased from 0.2% to 13% from 2012 to 2018. The median treatment duration increased from 199 to 366 days and the number of TB patients lost to follow-up showed an overall upward trend from 2012 to 2018. The multivariable regression analysis indicated that migrant TB patients and TB patients initially diagnosed in hospitals at the prefectural level and above tended to experience total delay > 28 days (p < 0.001). Linear regression analysis confirmed that new TB patients>60 years tended to have longer treatment duration (p < 0.05). Conclusions: While our study may suggest the potential of the integrated model in early detection and diagnosis of TB, it also suggests the importance of strengthening supervision and management of designated hospitals to optimize the treatment duration and improve retention of patients in TB care. Enhancing health education for TB patients, especially amongst migrant patients, and training in TB identification and referral for non-TB doctors are also key for early TB detection and diagnosis in the integrated model. [ABSTRACT FROM AUTHOR]

Abstract Background Many infectious diseases, including Tuberculosis (TB), have been put in the background with the COVID-19 pandemic. This study aimed to evaluate the changes in the number of TB patients, the parameters of the TB patients and tuberculosis control programs in the first year of the COVID-19 pandemic in Turkey when compared to the previous year. Methods All TB patients who were recorded in Samsun province between March 1, 2019 and February 28, 2021 were included in this retrospective study. The data were analyzed in 2 groups as the COVID-19 period (March 2020 and February 2021) and the Pre-COVID-19 period (March 2019 and February 2020),the demographic and microbiological characteristics of the tuberculosis patients in both periods were compared according to months and years p

Extrapulmonary tuberculosis (ETB) involving skin with multiple lesions is an uncommon presentation of mycobacterial infection. Cutaneous tuberculosis (TB) having multiple lesions with Poncet’s disease (tuberculous Rheumatism) is rarely reported. We hereby report a multifocal cutaneous tuberculosis with Poncet’s disease in a 19-year-old immunocompetent female.

Mycobacterium tuberculosis (Mtb), the causative agent of Tuberculosis (TB), remains a pathogen of great interest on a global scale. This airborne pathogen affects the lungs, where it interacts with macrophages. Acidic pH, oxidative and nitrosative stressors, and food restrictions make the macrophage's internal milieu unfriendly to foreign bodies. Mtb subverts the host immune system and causes infection due to its genetic arsenal and secreted effector proteins. In vivo and in vitro research have examined Mtb-host macrophage interaction. This interaction is a crucial stage in Mtb infection because lung macrophages are the first immune cells Mtb encounters in the host. This review summarizes Mtb effectors that interact with macrophages. It also examines how macrophages control and eliminate Mtb and how Mtb manipulates macrophage defense mechanisms for its own survival. Understanding these mechanisms is crucial for TB prevention, diagnosis, and treatment. [ABSTRACT FROM AUTHOR]

Background: Many infectious diseases, including Tuberculosis (TB), have been put in the background with the COVID-19 pandemic. This study aimed to evaluate the changes in the number of TB patients, the parameters of the TB patients and tuberculosis control programs in the first year of the COVID-19 pandemic in Turkey when compared to the previous year. Methods: All TB patients who were recorded in Samsun province between March 1, 2019 and February 28, 2021 were included in this retrospective study. The data were analyzed in 2 groups as the COVID-19 period (March 2020 and February 2021) and the Pre-COVID-19 period (March 2019 and February 2020),the demographic and microbiological characteristics of the tuberculosis patients in both periods were compared according to months and years p < 0.05 was considered statistically significant. Results: The total number of TB patients was 320, although it was 172 in the Pre-COVID-19 period, it was 148 in the COVID-19 pandemic period. It was found that the TB incidence rate (IR) was 15.32%, the total number of examinations performed in TB dispensary decreased 33.54%, and the total number of contact examinations decreased by 53.54% during the pandemic period. The mean age of the patients decreased significantly during the COVID-19 period (p = 0.047), and it was found that culture positivity rates and smear positivity rates increased compared to the previous year (7.97%, p = 0.166, 1.86%; p = 0.507, respectively). SARS-CoV-2 PCR test result was found to be (−) in 46 (82.1%) of the 56 TB patients who were examined. Conclusions: In the present study, it was found that the incidence of TB, the number of examinations, and the number of contact examinations decreased at significant levels. The decrease in TB patients was mostly in the first 3 months when COVID-19 precautions and restrictions were intense. As a conclusion, it was observed that the application of TB patients to the healthcare institution and TB control were affected negatively by the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Abstract Tuberculosis (TB) is a deadly infectious disease that kills approximately 1.5 million people per year and is among the most frequent respiratory infections in developing countries. Morocco has made significant progress in the control and management of TB during the past 30 years thanks to its National Plan for Tuberculosis and the continuous support of national and international partners. While tremendous efforts were undertaken to tilt the balance against the COVID-19 pandemic, new challenges resurfaced with regard to long-standing health problems amongst which is TB. The spill-over effect of the COVID-19 pandemic disrupted health service delivery globally, threatening to reverse years of progress made on the TB control front. In Morocco, this crisis highlighted deep shortcomings within the national health system and in the adopted approach to TB control. This article discusses national efforts to get back on track with regard to TB management, the multitude of challenges that co-emerged with the onset of COVID-19 and lays down key recommendations to implement in order to build back a TB control plan that is resilient in the face of health hazards.

Abstract Background A major constraint to tuberculosis control is low case finding with under-reporting to national authorities. Evidence shows that Patent Medicine Dealers are first port of call for most people with symptoms of tuberculosis, yet there is poor referral of such clients to tuberculosis treatment facilities for further evaluation. This study investigated constraints to involvement of Patent Medicine Dealers in tuberculosis control. Methods This was a cross-sectional qualitative study among Patent Medicine Dealers and Tuberculosis Control Programme Managers in Ebonyi State Nigeria. Sixty-four Patent Medicine Dealers and five Tuberculosis Control Programme Managers were interviewed using Focus Group Discussion and In-Depth Interview respectively. Data was collected with electronic audio-recording device and analyzed using thematic approach. Results There are some knowledge gaps about tuberculosis signs, symptoms, free-treatment policy and mode of operation of care service among Patent Medicine Dealers. Patent Medicine Dealers and Tuberculosis Control Programme Managers are willing to collaborate in tuberculosis control effort but constant demand for incentives by Patent Medicine Dealers and inability of National Tuberculosis Control Programme to keep up with such demands are obvious constraints. Conclusions Knowledge gaps in tuberculosis, its control, constant demand for incentives by Patent Medicine Dealers and inability of National Tuberculosis Control Programme to satisfy such demands are constraints to involvement of Patent Medicine Dealers in tuberculosis control. More robust engagement of Patent Medicine Dealers in tuberculosis control with clear job description through tuberculosis education and provision of incentives to support them are recommended policy approaches to improve linkage of clients to tuberculosis treatment facilities.

Abstract Background Early diagnosis and treatment of pulmonary tuberculosis (PTB) is essential for an effective control of the tuberculosis (TB) epidemic. Delayed diagnosis and treatment of TB increases the chance of complications and mortality for the patients, and enhances TB transmission in the population. Therefore, the aim of this study was to characterize patient, healthcare and total delay in diagnosing PTB and assess the effect of clinical and sociodemographic factors on the time until first contact with healthcare or reaching a PTB diagnosis. Methods Retrospective cohort study that included active PTB patients notified in the National Tuberculosis Surveillance System (SVIG-TB), between 2008 and 2017. Descriptive statistics, Kaplan-Meier estimates, logrank test and Cox proportional hazards model were used to characterize patient, healthcare and total delay and estimate the effect of clinical and sociodemographic variables on these delays. Significance level was set at 0.05. Results Median patient, healthcare and total delays was 37 days (Interquartile range (IQR): 19–71), 8 days (IQR: 1–32) and 62 days (IQR: 38–102), respectively. The median patient delay showed a constant increase, from 33 days in 2008 to 44 days in 2017. The median total delay presented a similar trend, increasing from 59 days in 2008 to 70 days in 2017. Healthcare delay remained constant during the study period. More than half of the PTB cases (82.9%) had a delay > 1 month between symptom onset and diagnosis. In the final Cox model, alcohol abuse, unemployment and being from a high TB incidence country were factors significantly associated with longer patient delay, while being female, having more than 45 years, oncologic and respiratory diseases were associated with longer healthcare delay. Being female, having more than 45 years and being from a high TB incidence country were associated with longer total delay. Conclusions Patient delay and total delay have increased in recent years. Older patients, patients with alcohol problems, other comorbidities, unemployed or from countries with high TB incidence would benefit from the development of specific public health strategies that could help reduce the delay in TB diagnosis observed in our study. This study emphasizes the need to promote awareness of TB in the general population and among the healthcare community, especially at ambulatory care level, in order to reduce the gap between beginning of symptoms and TB diagnosis.

Background: The global vision is a world free of tuberculosis (TB). Even in resource-rich TB low-incidence settings, we need more focus on the role of social risk factors to end the TB epidemic.Methods: Nationwide, retrospective register-based, case-control study from 1990 to 2018, including all TB patients in Denmark ≥18 years old (n = 9581) matched 1:3 on sex and age with population controls. TB risk factors were assessed in logistic regression models and estimated by odds ratio (OR).Results: All TB patients had considerably lower socio-economic status compared with controls (P < 0.0001). Among ethnic Danes, TB was mostly found among males, persons between 35 and 65 years, those living alone, those with low educational level, persons on social welfare benefits and those with low income. Conversely, for migrants, being younger, sex and living alone were less important, whereas having children was protective. In an adjusted multivariable regression model among Danes, key risk factors for TB were being on disability pension (OR = 2.7) and cash benefits (OR = 4.7). For migrants, fewer social risk factors increased TB risk, although low income and cash benefits did (OR = 3.1).Conclusion: Even today in a resourceful setting, socio-economic status drives disparities in health. In our study, multifactorial social deprivation was highly associated with TB. Especially household structure, education, employment and income were important risk factors that should be addressed in the future to accelerate TB control and end the TB epidemic. [ABSTRACT FROM AUTHOR]

Abstract 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.

Abstract Background Tuberculosis is a communicable disease that is one of the leading cause of death from a single infectious agent (ranking above human immunodeficiency virus/acquired immunodeficiency syndrome). The aim of this work was to study the trend of applying the tuberculosis control program at the ministry of health and population chest hospitals, Sharkia, Egypt. Results This retrospective cross-sectional study was carried out using medical records from the tuberculosis registry at Ministry of Health and Population chest hospitals, Sharkia Governorate. The investigated variables included demographic characteristics, type of tuberculosis infection, and affected organs. All data were coded and statistically analyzed. A total 1404 cases of tuberculosis were notified between 2016 and 2019 with male predominance, where 67.1% were males and 32.9% were females. The highest number of tuberculosis patients was from the reproductive age groups. During the 4-year study period, the highest percentage of cases was new cases and the highest frequency of cases was during 2017 and the lowest frequency was during 2016. There was a decline in the total number of cases in 2018 and 2019 after sharp increase of total cases in 2017: pulmonary tuberculosis cases showed a sharp decline in 2017; however, there was an increase in extrapulmonary tuberculosis cases during 2017 then a slight decrease in 2018 and 2019. Of the pulmonary tuberculosis cases, 83.8% were smear-positive tuberculosis. Conclusions Pulmonary smear-positive and new cases were the most common among the recorded cases of tuberculosis. Productive age groups represented large percentage of the studied cases of tuberculosis. Lymph node and bones were the most common sites of extrapulmonary tuberculosis among reported cases in this study.

Tuberculosis (TB) remains one of the top ten leading causes of death worldwide despite effective therapy. The present study aims to examine the characteristics of TB-related deaths in Samsun Province and to determine the risk factors. In this retrospective registry-based cohort study, the medical records of patients registered with Samsun Tuberculosis Control Dispensary between 1 January 2018 and 31 December 2019 were retrospectively reviewed. The Cox proportional-hazards model was used to determine the factors associated with the risk of death in patients with TB. The treatment outcomes of a total of 382 patients were reviewed. It was found that the treatment was successful in 346 patients (90.6%), and 31 patients (8.1%) died before or during TB therapy. The median survival time of patients who died during the therapy was 1.86 months (95% CI = 0.07–5.17 months), and more than 50% (13/25) of the deaths occurred in the first two months of the treatment. Age above 70 years (HR 15.06 (3.33–67.95)), male gender (HR 2.74 (1.02–7.33)), pulmonary TB (HR 2.92 (1.002–8.52)), multidrug-resistant (MDR) tuberculosis (HR 1.69 (1.22–12.75)), and a delay in the treatment of more than ten days (HR 2.71 (1.22–6.04)) were identified as risk factors associated with mortality in TB patients (p < 0.05). The majority of deaths in our cohort occurred within the first two months after starting the treatment. Advanced age, male sex, a new diagnosis of TB, pulmonary TB, MDR-TB, and a treatment delay of more than ten days after diagnosis increased the risk for mortality during antituberculosis treatment. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a deadly infectious disease that kills approximately 1.5 million people per year and is among the most frequent respiratory infections in developing countries. Morocco has made significant progress in the control and management of TB during the past 30 years thanks to its National Plan for Tuberculosis and the continuous support of national and international partners. While tremendous efforts were undertaken to tilt the balance against the COVID-19 pandemic, new challenges resurfaced with regard to long-standing health problems amongst which is TB. The spill-over effect of the COVID-19 pandemic disrupted health service delivery globally, threatening to reverse years of progress made on the TB control front. In Morocco, this crisis highlighted deep shortcomings within the national health system and in the adopted approach to TB control. This article discusses national efforts to get back on track with regard to TB management, the multitude of challenges that co-emerged with the onset of COVID-19 and lays down key recommendations to implement in order to build back a TB control plan that is resilient in the face of health hazards. [ABSTRACT FROM AUTHOR]

Background: Early diagnosis and treatment of pulmonary tuberculosis (PTB) is essential for an effective control of the tuberculosis (TB) epidemic. Delayed diagnosis and treatment of TB increases the chance of complications and mortality for the patients, and enhances TB transmission in the population. Therefore, the aim of this study was to characterize patient, healthcare and total delay in diagnosing PTB and assess the effect of clinical and sociodemographic factors on the time until first contact with healthcare or reaching a PTB diagnosis.Methods: Retrospective cohort study that included active PTB patients notified in the National Tuberculosis Surveillance System (SVIG-TB), between 2008 and 2017. Descriptive statistics, Kaplan-Meier estimates, logrank test and Cox proportional hazards model were used to characterize patient, healthcare and total delay and estimate the effect of clinical and sociodemographic variables on these delays. Significance level was set at 0.05.Results: Median patient, healthcare and total delays was 37 days (Interquartile range (IQR): 19-71), 8 days (IQR: 1-32) and 62 days (IQR: 38-102), respectively. The median patient delay showed a constant increase, from 33 days in 2008 to 44 days in 2017. The median total delay presented a similar trend, increasing from 59 days in 2008 to 70 days in 2017. Healthcare delay remained constant during the study period. More than half of the PTB cases (82.9%) had a delay > 1 month between symptom onset and diagnosis. In the final Cox model, alcohol abuse, unemployment and being from a high TB incidence country were factors significantly associated with longer patient delay, while being female, having more than 45 years, oncologic and respiratory diseases were associated with longer healthcare delay. Being female, having more than 45 years and being from a high TB incidence country were associated with longer total delay.Conclusions: Patient delay and total delay have increased in recent years. Older patients, patients with alcohol problems, other comorbidities, unemployed or from countries with high TB incidence would benefit from the development of specific public health strategies that could help reduce the delay in TB diagnosis observed in our study. This study emphasizes the need to promote awareness of TB in the general population and among the healthcare community, especially at ambulatory care level, in order to reduce the gap between beginning of symptoms and TB diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Prisons are high-risk settings for drug-resistant tuberculosis because the prevalence of the tuberculosis (TB) is much higher than in the general population. This study to investigated the factors associated with drug-resistant tuberculosis in prisons in the state of São Paulo, Brazil. Methodology: Retrospective cohort of drug-resistant TB cases for incarcerated people in São Paulo state, reported in the Tuberculosis Patient Control System between 2006 and 2016. To analyze the factors associated with drug-resistant TB, the backward method (likelihood ratio) was used, determining the adjusted odds ratio and respective 95%CI coefficients. Multiple models were proposed to adjust for potential confusion and interaction. The best fit model was selected based on the lowest Akaike information criterion coefficient. Results: In total, 473 drug-resistant tuberculosis cases were reported in the prison population of Sāo Paulo state, the majority were male. The cases that presented negative results for sputum smear and sputum culture had, respectively, an aOR=0.6 and aOR=0.16 for drug-resistant tuberculosis in relation to the cases with positive results. The cases where the patient had AIDS and reported alcoholism, respectively, an aOR=1.47 and aOR=1.60 for drug-resistant TB. Individuals with a background treatment history for TB presented a stronger association with drug-resistant tuberculosis, aOR=35.08. Conclusions: Sputum spear, sputum culture, chest X-ray, AIDS, alcoholism and background treatment history for TB were factors associated with resistance to antituberculosis drugs among prisoners. This is useful for the implementation of disease control measures related to the detection and monitoring of cases in the prison system. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Contact investigation is recommended for close contacts of TB patients to identify undiagnosed cases of active and latent TB to initiate them on curative and preventive therapy respectively. Because contact invitation is conducted in Kenya, the value of TB contact investigation in childhood TB control is unknown. To compare the yield of contact investigation (intervention arm) to contact invitation (control arm) in contributing to childhood TB control, a cluster randomized trial was conducted in Kisumu County between 2014 and 2015 a period prior to the implementation of standardized contact investigation. This was done to compare TB cases diagnosed and children receiving IPT in the pre- intervention (2012-2013) and intervention (2014-2015) years, and in the intervention years using a minimum sample size of 15 per arm. Of 77 facilities identified for the study, 65 facilities were randomized to a contact screening strategy; a TB contact investigation strategy in isolation (n=4), in combination with health facility screening (n=19), or in combination with both enhanced facility screening and mobile units (n=31) with the remainder, (n=11) randomized to the standard approach i.e. TB contact invitation. Facilities distribution did not differ by category of services or patient type. In the pre-intervention and post-intervention years, TB number of TB cases diagnosed in children increased by 20 (75% from intervention arm). During the intervention years TB cases decreased by 17 (29% from intervention arm); the intervention arm contributed to 100% and 75% of the children put on IPT whose implementation had just begun. Contact investigation enhanced childhood TB control in comparison to routine approaches. Critical support ought to be availed to the TB screening cascade to facilitate contact investigation and IPT implementation as well as ingrain contact investigation within existing community health systems.

Tuberculosis (TB), an airborne infectious disease caused by Mycobacterium tuberculosis complex (MTBC), remains a global health problem. West Africa has a unique epidemiology of TB that is characterized by medium- to high-prevalence. Moreover, the geographical restriction of M. africanum to the sub-region makes West Africa have an extra burden to deal with a two-in-one pathogen. The region is also burdened with low case detection, late reporting, poor treatment adherence leading to development of drug resistance and relapse. Sporadic studies conducted within the subregion report higher burden of drug resistant TB (DRTB) than previously thought. The need for more sensitive and robust tools for routine surveillance as well as to understand the mechanisms of DRTB and transmission dynamics for the design of effective control tools, cannot be overemphasized. The advancement in molecular biology tools including traditional fingerprinting and next generation sequencing (NGS) technologies offer reliable tools for genomic epidemiology. Genomic epidemiology provides in-depth insight of the nature of pathogens, circulating strains and their spread as well as prompt detection of the emergence of new strains. It also offers the opportunity to monitor treatment and evaluate interventions. Furthermore, genomic epidemiology can be used to understand potential emergence and spread of drug resistant strains and resistance mechanisms allowing the design of simple but rapid tools. In this review, we will describe the local epidemiology of MTBC, highlight past and current investigations toward understanding their biology and spread as well as discuss the relevance of genomic epidemiology studies to TB control in West Africa.

Empowering marginalised urban islanders with limited heatlh accessibility for controlling pulmonary tuberculosis (PTB) requires a specific training module. Developing a training module for knowledge transfer to empower these marginalised islanders in high PTB occurrence region can be adapted based on IMCI framework. Structuring knowledge and skills for PTB control is based on the National Strategic Plan for Tuberculosis Control 2016-2020 and the Integrated Management of Childhood Illness (IMCI) framework is adapted for developing the training module. A total of five knowledge and skills were structured: 1) PTB disease and diagnosis, 2) PTB treatment, 3) preventive PTB measures, 4) prevention of malnutrion, and 5) psychosocial discrimination. The IMCI framework was adapted in 3 ways: 1) identifying signs and symptoms of PTB, 2) emphasising 5 steps: assess, diagnose, treat, counsel and detect, as the integrated management, and 3) counseling on BCG immunisation, malnutrition, environmental modifications and stigma on PTB.

Background: Tuberculosis (TB) remains a major health problem worldwide, including in Nepal where around 33,000 new cases of TB were diagnosed in 2018 and 5400 patients died. There are challenges in the diagnostic process, treatment, and follow-up. Deaths, increased transmission and development of multi- drug resistant TB could be the consequences. Young doctors play an important role in this struggle, and therefore, their knowledge of and attitudes towards TB are crucial. Objective: We surveyed medical interns in Nepal regarding their knowledge, attitude and practices on TB and their adherence to the National Tuberculosis Programmes’ guidelines. The objective was to determine the associations between TB knowledge, and attitude and the factors that influence them. Methods: A WHO cross-sectional questionnaire template was modified and piloted. It was distributed anonymously among medical interns at three private medical colleges. Statistical analyses were performed to establish possible associations between TB knowledge and attitude, and the investigated variables, and to investigate differences between the medical colleges. Results: Of 270 interns, 185 (69%) interns were included. The mean knowledge score was 13,3 (SD: 2,12) of a maximum of 19. The possible attitude scores ranged from zero to 14 points, whereas the mean attitudes score was 9,4 (SD: 1,89). Some unacceptable attitudes and knowledge gaps were identified, including disease detection and management. There was an association between the knowledge score and attitude score and between the number of TB patients seen and knowledge/attitude. Conclusion: The surveyed interns had an adequate level of TB related knowledge, and acceptable attitudes. However, some unacceptable knowledge gaps and attitudes were detected. This survey underlines the considerable need of closing these knowledge gaps, and improving the attitudes, for which it is important for medical students to practice at a TB clinic and see a certain number of TB patients.

Abstract Objectives Israel has absorbed > 60,000 migrant from the horn of Africa (MHOA) since 2006. No cross-transmission of Mycobacterium tuberculosis from MOHA to Israeli citizens has yet been reported. This study describes the results of contact investigation and laboratory work-out of a unique mixed cluster which included both MOHA and Israeli citizens. Methods Description of the results of epidemiological investigation including laboratory confirmation. Results This unique Mycobacterium tuberculosis strain included 29 patients: 26 were MOHA and three citizens who immigrated to Israel from the former Soviet Union. This is the first mixed cluster described in Israel, which has not been represented in the SITVIT international database of genotyping markers. The transmission from non-citizens to citizens occurred in a nursing institution, when MOHA infected three other contacts- two of whom were retarded residents, one of them died. The index case was screened before employment, and was permitted to return to wok although his chest X-ray demonstrated radiological findings compatible with tuberculosis. Epidemiological links were found in other 12 MOHA members of the cluster. Conclusion This report describes cross-transmission of Mycobacterium tuberculosis from non-citizens MOHA to Israeli citizens who were residents of a nursing home, which may be the first sign for an epidemiological shift. Although cross-ethnical transmission is still rare in Israel, medical settings should employ efficient infection control measures to protect both patients and staff from Mycobacterium tuberculosis.

Empowering marginalised urban islanders with limited health accessibility through knowledge transfer program for controlling pulmonary tuberculosis (PTB) requires a specific training module. The study was aimed to develop this training module by adapting and modifying the IMCI (Integrated Management of Childhood Illness) framework. Structuring the content for the knowledge and skills for PTB control in the module was based on the National Strategic Plan for Tuberculosis Control 2016-2020. A total of five knowledge and skills were structured: i) PTB disease and diagnosis, ii) PTB treatment, iii) preventive PTB measures, iv) prevention of malnutrition, and v) psychosocial discrimination. The IMCI framework was modified through 3 ways: i) identifying signs and symptoms of PTB, ii) emphasising the IMCI's 5 steps of integrated management: assess, diagnose, treat, counsel and detect, and iii) counseling on BCG immunisation, malnutrition, environmental modifications and stigma on PTB. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

India is grappling with the problem of controlling tuberculosis nearly for the past 50 years. The problem of nonadherence to treatment regimen has also worsened the situation of multidrug resistant tuberculosis (MDR-TB) in India. This article explores the factors behind nonadherence among erstwhile TB defaulters in a rural district in India. In-depth interviews with seven chronic defaulters and with healthcare professionals were conducted at a government-run Chest Clinic. In addition to in-depth interviews with defaulters and healthcare professionals, medical records and government orders related to TB control were examined extensively. Participants were also observed to understand their interaction with healthcare professionals and fellow patients, especially during drug delivery time. Qualitative content analysis is the most appropriate method to analyze the transcribed text and archival records. Qualitative content analysis brought out five major themes responsible for their past nonadherence behavior, namely, (a) Awareness about tuberculosis and treatment, (b) Symptom recognition and self-medication, (c) Family support, (d) Accessibility, and (e) Stigma. Findings are documented according to the major themes and documenting direct quotes from participants and with healthcare professionals wherever appropriate. This case study also provided context-specific recommendations to the healthcare professionals as regards the nonadherence behavior among TB patients. It is hoped these focused recommendations, albeit known to the healthcare professionals, would be extremely useful in making modifications to the existing program to tackle the nonadherence behavior. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) incidence is projected to decline at too slow a rate to meet the targets set at the UN high level meeting on ending TB, convened in New York in 2018. To understand the causes of the slow progress in TB control, the Bill and Melinda Gates Foundation supported a patient-pathway analysis that identified significant gaps with patients being "lost" at all points along the care cascade. Although each country differed in the reasons for failure, some commonalities were identified. Most striking was the failure to diagnose and report TB patients to a national registry making finding the missing patients a priority for TB control globally. The analysis also found that optimal use of existing tools will not accelerate the rate of decline in TB incidence sufficiently, necessitating the development of new and improved tools for TB control. Finally, it was recognized that gaps in our understanding of TB pathogenesis and protective immunity as well as limited knowledge about the host pathogen interactions in granulomas of infected tissues, hinder the progress needed to develop the new tools for improved TB control. A commitment of all governments to support research, develop new tools such as new diagnostics, better drug regimens and efficacious vaccines, and improving service delivery by TB control programs will be needed to accelerate the reduction in incidence and reduce disease burden globally. [ABSTRACT FROM AUTHOR]

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Many adolescents who are prescribed therapy for tuberculosis (TB) infection fail to complete it. This article presents the results of a demographic and epidemiological assessment of TB treatment completion in adolescent populations using (a) surveillance data from the Los Angeles Health County Department and (b) a prospective/retrospective medical chart review from targeted clinics. Patients who did not complete the 6-month recommended medical treatment for latent tuberculosis therapy (LTBI) averaged 13 weeks in care. Younger age (OR = 1.15; 95% CI 1.03-1.29), birth in the United States (OR = 1.92; 95% CI 1.14-3.22, compared to Mexico), and Asian ethnicity were associated with completion of care. In multiple logistic regression analysis, age (OR = .88; 95% CI .78-.98) and Latino ethnicity (OR = .53; 95% CI .29-.95) remained significant predictors of completion of treatment. These findings indicate the need for age-specific educational reinforcement and cultural differentials in completing care for LTBI.

World Health Organization (WHO) control policy for tuberculosis (TB) includes Bacillus Calmette-Guérin (BCG) vaccine at birth, case detection, and treatment of cases with directly observed therapy short-course (DOTS). This policy has been applied through the Ministry of Health and Population in Egypt for more than 30 years. The controversies about the efficacy of the BCG vaccination against TB in adults initiate some suggestions for its discontinuation from compulsory vaccinations in countries with low incidence of TB. The present work aimed to study the trend of applying the WHO control policy for TB in Egypt among the Egyptian population throughout the last 20 years (1992–2011). The documented database of the country, bibliographic review on MEDLINE, published studies and reports, WHO and EMRO databases that covered the period from 1992 to 2011 were used in this study. The incidence rate of all forms of TB (pulmonary and extrapulmonary) dropped by 50% from 34 cases to 17 cases per 100,000 population, as well as the prevalence rate declined by 60.6% from 71 cases per 100,000 population throughout the last 20 years. Case detection and treatment success rates have increased throughout the studied period while it flat-lined over the past 6 years which may need attention. The results of this study introduce an evidence-based recommendation for continuation of the WHO TB control policy in Egypt towards elimination of the disease.

This study investigated the presence of Mycobacterium bovis ( M. bovis ) DNA in archived human sputum samples previously collected from residents who reside adjacent to the M. bovis -endemic Hluhluwe-iMfolozi wildlife park, South Africa (SA). Sixty-eight sputum samples were GeneXpert MTB/RIF Ultra-positive for M. tuberculosis complex (MTBC) DNA but culture negative for M. tuberculosis . Amplification and Sanger sequencing of hsp65 and rpoB genes from DNA extracted from stored heat-inactivated sputum samples confirmed the presence of detectable amounts of MTBC from 20 out of the 68 sputum samples. Region of difference PCR, spoligotyping and gyrB long-read amplicon deep sequencing identified M. bovis ( n  = 10) and M. tuberculosis ( n  = 7). Notably, M. bovis spoligotypes SB0130 and SB1474 were identified in 4 samples, with SB0130 previously identified in local cattle and wildlife and SB1474 exclusively in African buffaloes in the adjacent park. M. bovis DNA in sputum, from people living near the park, underscores zoonotic transmission potential in SA. Identification of spoligotypes specifically associated with wildlife only and spoligotypes found in livestock as well as wildlife, highlights the complexity of TB epidemiology at wildlife-livestock-human interfaces. These findings support the need for integrated surveillance and control strategies to curb potential spillover and for the consideration of human M. bovis infection in SA patients with positive Ultra results., Competing Interests: All authors declare no competing financial and/or non-financial interests in relation to the work described., (© 2024 The Authors.)

Tuberculosis and smoking are responsible for significant mortality worldwide. Smoking is spreading in emerging countries, and its prevalence is high in developed countries among socially disadvantaged populations; it could be the source of a resurgence of tuberculosis in future years. The aim of this review is to clarify the consequences of the association between smoking and tuberculosis, and the benefits of smoking cessation for smokers with tuberculosis., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Tuberculosis (TB) burden in Nigeria is a reflection of the challenges of TB control strategy in the country. This study explored the challenges encountered by the health workers in public and private TB treatment centers in Lagos, Nigeria. Methods: In-depth interviews were held with 34 health workers providing TB services in private and public health facilities and the Lagos state Program Officer between October 1, 2016 and January 31, 2017. The transcripts were read severally and coded for qualitative data analysis. Themes were developed from coding. Results: Insufficient or lack of funds to track patients lost to follow-up, conduct home visits, collect drugs from the central stores, and shortage of laboratory reagents were some of the logistical challenges encountered by the health workers. There was shortage of health workers and some were yet to be trained resulting in work overload. This was situation aggravated by the frequent redeployment and health worker attrition in the public and private sector respectively. Conclusion: The government need be proactive and show leadership by finding lasting solutions to the logistical and human resource challenges facing the LAgos State TB and Leprosy Program. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a global infectious disease and one of the ten leading causes of death worldwide. As TB incidence is seasonal, a reliable forecasting model that incorporates both seasonal and trend effects would be useful to improve the prevention and control of TB. In this study, the X12 autoregressive integrated moving average (X12-ARIMA) model was constructed by dividing the sequence into season term and trend term to forecast the two terms, respectively. Data regarding the TB report rate from January 2004 to December 2015 were included in the model, and the TB report data from January 2016 to December 2016 were used to validate the results. The X12-ARIMA model was compared with the seasonal autoregressive integrated moving average (SARIMA) model. A total of 383,797 cases were reported from January 2004 to December 2016 in Chongqing, China. The report rate of TB was highest in 2005 (151.06 per 100,000 population) and lowest in 2016 (72.58 per 100,000 population). The final X12-ARIMA model included the ARIMA (3,1,3) model for the trend term and the ARIMA (2,1,3) model for the season term. The SARIMA (1,0,2) * (1,1,1)12 model was selected for the SARIMA model. The mean absolute error (MAE) and mean absolute percentage error (MAPE) of fitting and predicting performance based on the X12-ARIMA model were less than the SARIMA model. In conclusion, the occurrence of TB in Chongqing is controlled, which may be attributed to socioeconomic developments and improved TB prevention and control services. Applying the X12-ARIMA model is an effective method to forecast and analyze the trend and seasonality of TB. [ABSTRACT FROM AUTHOR]