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McHenry ML, Simmons J, Hong H, Malone LL, Mayanja-Kizza H, Bush WS, Boom WH, Hawn TR, Williams SM, Stein CM. Tuberculosis severity associates with variants and eQTLs related to vascular biology and infection-induced inflammation. PLoS Genet 2023; 19:e1010387. [PMID: 36972313 PMCID: PMC10079228 DOI: 10.1371/journal.pgen.1010387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 04/06/2023] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
Background
Tuberculosis (TB) remains a major public health problem globally, even compared to COVID-19. Genome-wide studies have failed to discover genes that explain a large proportion of genetic risk for adult pulmonary TB, and even fewer have examined genetic factors underlying TB severity, an intermediate trait impacting disease experience, quality of life, and risk of mortality. No prior severity analyses used a genome-wide approach.
Methods and findings
As part of our ongoing household contact study in Kampala, Uganda, we conducted a genome-wide association study (GWAS) of TB severity measured by TBScore, in two independent cohorts of culture-confirmed adult TB cases (n = 149 and n = 179). We identified 3 SNPs (P<1.0 x 10–7) including one on chromosome 5, rs1848553, that was GWAS significant (meta-analysis p = 2.97x10-8). All three SNPs are in introns of RGS7BP and have effect sizes corresponding to clinically meaningful reductions in disease severity. RGS7BP is highly expressed in blood vessels and plays a role in infectious disease pathogenesis. Other genes with suggestive associations defined gene sets involved in platelet homeostasis and transport of organic anions. To explore functional implications of the TB severity-associated variants, we conducted eQTL analyses using expression data from Mtb-stimulated monocyte-derived macrophages. A single variant (rs2976562) associated with monocyte SLA expression (p = 0.03) and subsequent analyses indicated that SLA downregulation following MTB stimulation associated with increased TB severity. Src Like Adaptor (SLAP-1), encoded by SLA, is highly expressed in immune cells and negatively regulates T cell receptor signaling, providing a potential mechanistic link to TB severity.
Conclusions
These analyses reveal new insights into the genetics of TB severity with regulation of platelet homeostasis and vascular biology being central to consequences for active TB patients. This analysis also reveals genes that regulate inflammation can lead to differences in severity. Our findings provide an important step in improving TB patient outcomes.
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Ereso BM, Sagbakken M, Gradmann C, Yimer SA. Total delay and associated factors among tuberculosis patients in Jimma Zone, Southwest Ethiopia. PLoS One 2023; 18:e0281546. [PMID: 36757943 DOI: 10.1371/journal.pone.0281546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Delays in diagnosis and treatment of tuberculosis (TB) increases severity of illness and continued transmission of TB in the community. Understanding the magnitude and factors associated with total delay is imperative to expedite case detection and treatment of TB. The aim of this study was to determine the length and analyze factors associated with total delay. METHODS Analytic cross-sectional study was conducted in Jimma Zone, Southwest Ethiopia. All newly diagnosed TB patients > 15 years of age were included from randomly selected eight districts and one town in the study area. A structured questionnaire was applied to collect socio-demographic and clinical data. The median total delay was used to dichotomize the sample into delayed and non-delayed patient categories. Logistic regression analysis was used to analyse the association between independent and outcome variables. A p-value < 0.05 were considered statistically significant. RESULTS A total of 1,161 patients were included in this study. The median total delay was 35 days. Patients who had swelling or wound in the neck region were more likely to be delayed than their counterpart [adjusted odds ratio (AOR) = 3.02, 95% confidence interval (CI): 1.62, 5.62]. Women were more likely to experience longer total delay (AOR = 1.46, 95% CI:1.00, 2.14) compared to men. Patients who had poor knowledge of TB were more likely to be delayed compared to those who had good knowledge (AOR = 3.92, 95% CI: 2.65, 5.80). CONCLUSION The present study showed long total delay in diagnosis and treatment of TB. Targeted interventions that enhance TB knowledge and practice, expedite early suspect identification, referral and management of all forms of TB is imperative to reduce total delay in diagnosis and treatment of TB.
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Yaqoob A, Alvi MR, Fatima R, Najmi H, Samad Z, Nisar N, Haq AU, Javed B, Khan AW, Hinderaker SG. Geographic accessibility to childhood tuberculosis care in Pakistan. Glob Health Action 2022; 15:2095782. [PMID: 35848796 PMCID: PMC9297715 DOI: 10.1080/16549716.2022.2095782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) in children is difficult to detect and often needs specialists to diagnose; the health system is supposed to refer to higher level of health care when diagnosis is not settled in a sick child. In Pakistan, the primary health care level can usually not diagnose childhood TB and will refer to a paediatricians working at a secondary or tertiary care hospital. We aimed to determine the health services access to child TB services in Pakistan. Objective We aimed to determine the geographical access to child TB services in Pakistan. Method We used geospatial analysis to calculate the distance from the nearest public health facility to settlements, using qGIS, as well as population living within the World Health Organization’s (WHO) recommended 5-km distance. Result At primary health care level, 14.1% of facilities report child TB cases to national tuberculosis program and 74% of the population had geographical access to general primary health care within 5-km radius. To secondary- and tertiary-level health care, 33.5% of the population had geographical access within 5-km radius. The average distance from a facility for diagnosis of childhood TB was 26.3 km from all settlement to the nearest child TB sites. The population of one province (Balochistan) had longer distances to health care services. Conclusion With fairly good coverage of primary health care but lower coverage of specialist care for childhood TB, the health system depends heavily on a good referral system from the communities.
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Affiliation(s)
- Aashifa Yaqoob
- Research Unit, Common Management Unit [TB, HIV/AIDS & Malaria], Islamabad, Pakistan.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Muhammad Rizwan Alvi
- Digital Security & Intelligence, Inbox Business Technologies, Islamabad, Pakistan
| | - Razia Fatima
- Research Unit, Common Management Unit [TB, HIV/AIDS & Malaria], Islamabad, Pakistan
| | - Hina Najmi
- Maternal Newborn and child Health, Health Services Academy, Islamabad, Pakistan
| | - Zia Samad
- M & E and Surveillance, Common Management Unit (TB, HIV/AIDS & Malaria), Islamabad, Pakistan
| | - Nadia Nisar
- International Health Regulations Strengthening project, Public Health England, Islamabad, Pakistan
| | - Anwar Ul Haq
- Directorate of Central Health, Ministry of National Health Services Regulation & Coordination, Government of Pakistan, Islamabad, Pakistan
| | - Basharat Javed
- M & E and Surveillance, Common Management Unit (TB, HIV/AIDS & Malaria), Islamabad, Pakistan
| | - Abdul Wali Khan
- National TB Control Program, Common Management Unit (TB, HIV/AIDS & Malaria), Islamabad, Pakistan
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Almeida PFD, Santos AMD, Silva Cabral LMD, Anjos EFD, Fausto MCR, Bousquat A. Water, land, and air: how do residents of Brazilian remote rural territories travel to access health services? Arch Public Health 2022; 80:241. [PMID: 36419173 PMCID: PMC9682791 DOI: 10.1186/s13690-022-00995-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 10/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ensuring adequate and safe means of travel is essential for maintaining and improving the health and well-being of residents of rural communities worldwide. This article maps costs, distances, travel times, and means of elective and urgent/emergency health transport in Brazilian remote rural municipalities. METHODS Multiple case studies were conducted in 27 remote rural municipalities using a qualitative method. A total of 178 key informants (managers, doctors, and nurses) were interviewed. Secondary data from national information systems were analyzed for the socioeconomic characterization, to identify the costs, distances, and travel times. Through the thematic content analysis of the interviews, the means of transport, and strategies developed by managers, professionals and users for their provision were identified. RESULTS The costs of traveling between remote rural municipalities and locations where most of specialized and hospital services are centered can compromise a significant part of the families' income. The insufficiency, restriction of days, times, and routes of health transport affects the selection of beneficiaries based on socioeconomic criteria in places of high vulnerability and less investment in road infrastructure. In remote rural municipalities, travelling to seek health care involves inter-municipal and intra-municipal flows, as their territories have dispersed populations. Several means of transport were identified - air, river, and land - which are often used in a complementary way in the same route. Some patients travel for more than 1000 km, with travel times exceeding 20 h, especially in the Amazon region. While the demands for urgent and emergency transport are partially met by national public policy, the same is not true for the elective transport of patients. The impossibility of providing health transport under the exclusive responsibility of the municipalities is identified. CONCLUSIONS For the remote rural municipalities populations, the absence of national public policies for sufficient, continuous, and timely provision of transport for health services worsens the cycle of inequities and compromises the assumption of the universal right to health care.
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Affiliation(s)
- Patty Fidelis de Almeida
- grid.411173.10000 0001 2184 6919Collective Health Institute, Federal Fluminense University - Niterói, Rio de Janeiro, Brazil
| | - Adriano Maia dos Santos
- grid.8399.b0000 0004 0372 8259Multidisciplinary Health Institute, Federal University of Bahia - Vitória da Conquista, Bahia, Brazil
| | - Lucas Manoel da Silva Cabral
- grid.412211.50000 0004 4687 5267Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduarda Ferreira dos Anjos
- grid.8399.b0000 0004 0372 8259Multidisciplinary Health Institute, Federal University of Bahia - Vitória da Conquista, Bahia, Brazil
| | | | - Aylene Bousquat
- grid.11899.380000 0004 1937 0722Public Health Faculty, University of São Paulo, São Paulo, Brazil
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Beyer K, Kasasa S, Anguzu R, Lukande R, Nambooze S, Amulen PM, Zhou Y, Nansereko B, Jankowski C, Oyana T, Savino D, Feustel K, Wabinga H. High-resolution disease maps for cancer control in low-resource settings: A spatial analysis of cervical cancer incidence in Kampala, Uganda. J Glob Health 2022; 12:04032. [PMID: 35493778 PMCID: PMC9022722 DOI: 10.7189/jogh.12.04032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The global burden of cervical cancer is concentrated in low-and middle-income countries (LMICs), with the greatest burden in Africa. Targeting limited resources to populations with the greatest need to maximize impact is essential. The objectives of this study were to geocode cervical cancer data from a population-based cancer registry in Kampala, Uganda, to create high-resolution disease maps for cervical cancer prevention and control planning, and to share lessons learned to optimize efforts in other low-resource settings. Methods Kampala Cancer Registry records for cervical cancer diagnoses between 2008 and 2015 were updated to include geographies of residence at diagnosis. Population data by age and sex for 2014 was obtained from the Uganda Bureau of Statistics. Indirectly age-standardized incidence ratios were calculated for sub-counties and estimated continuously across the study area using parish level data. Results Overall, among 1873 records, 89.6% included a valid sub-county and 89.2% included a valid parish name. Maps revealed specific areas of high cervical cancer incidence in the region, with significant variation within sub-counties, highlighting the importance of high-resolution spatial detail. Conclusions Population-based cancer registry data and geospatial mapping can be used in low-resource settings to support cancer prevention and control efforts, and to create the potential for research examining geographic factors that influence cancer outcomes. It is essential to support LMIC cancer registries to maximize the benefits from the use of limited cancer control resources.
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Affiliation(s)
- Kirsten Beyer
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Ronald Anguzu
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Robert Lukande
- Makerere University, Kampala, Uganda
- Kampala Cancer Registry, Kampala, Uganda
| | - Sarah Nambooze
- Makerere University, Kampala, Uganda
- Kampala Cancer Registry, Kampala, Uganda
| | - Phoebe M Amulen
- Makerere University, Kampala, Uganda
- Kampala Cancer Registry, Kampala, Uganda
| | - Yuhong Zhou
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | | | | | | | - Henry Wabinga
- Makerere University, Kampala, Uganda
- Kampala Cancer Registry, Kampala, Uganda
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Sultana S, Salwa M, Towhid MII, Islam SS, Haque MA. Challenges for tuberculosis control at selected primary healthcare centers in Bangladesh: A mixed-method study. Indian J Tuberc 2022; 69:134-140. [PMID: 35379392 DOI: 10.1016/j.ijtb.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/06/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The national tuberculosis control program in Bangladesh is progressing to end tuberculosis (TB) epidemic by 2035. Despite improved diagnostic and treatment facilities, the disease burden remains high. This mixed-method study aimed to identify existing challenges for successfully implementing the tuberculosis control program in primary healthcare centers (PHCs) of Bangladesh. METHODS Qualitative data were collected by observing six PHCs and interviewing TB patients (n = 12) and healthcare providers (n = 12). Quantitative data were collected by interviewing 94 TB patients. Data were integrated through a narrative approach. RESULTS Mean patient and health system delay were 99.0 (SD = 98.7) and 42.9 (SD = 79.9) days respectively. Patient delay was related to poor care-seeking behavior, unfamiliarity with tuberculosis symptoms, and unavailability of healthcare facilities. About 74 percent of patients sought initial treatment from village doctors or drug vendors. Health system delay was related to inadequate manpower, unskilled staff, and limited diagnostic facilities. Every second patient reported non-adherence to the directly observed treatment short-course (DOTS) guideline. DOTS provider's inaccessibility, inadequate incentive, and unreasonable patient demand lead to non-adherence. Insufficient administrative and structural facilities for infection control were observed at the selected facilities. CONCLUSIONS This study provides an insight into the recent challenges in TB control at PHCs in Bangladesh.
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Affiliation(s)
- Sarmin Sultana
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh.
| | - Marium Salwa
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Muhammad Ibrahim Ibne Towhid
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Syed Shariful Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - M Atiqul Haque
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
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Khundi M, Macpherson P, Feasey HRA, Nzawa Soko R, Nliwasa M, Corbett EL, Carpenter JR. Clinical, health systems and neighbourhood determinants of tuberculosis case fatality in urban Blantyre, Malawi: a multilevel epidemiological analysis of enhanced surveillance data. Epidemiol Infect 2021; 149:e198. [DOI: 10.1017/s0950268821001862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We investigated whether household to clinic distance was a risk factor for death on tuberculosis (TB) treatment in Malawi. Using enhanced TB surveillance data, we recorded all TB treatment initiations and outcomes between 2015 and 2018. Household locations were geolocated, and distances were measured by a straight line or shortest road network. We constructed Bayesian multi-level logistic regression models to investigate associations between distance and case fatality. A total of 479/4397 (10.9%) TB patients died. Greater distance was associated with higher (odds ratio (OR) 1.07 per kilometre (km) increase, 95% credible interval (CI) 0.99–1.16) odds of death in TB patients registered at the referral hospital, but not among TB patients registered at primary clinics (OR 0.98 per km increase, 95% CI 0.92–1.03). Age (OR 1.02 per year increase, 95% CI 1.01–1.02) and HIV-positive status (OR 2.21, 95% CI 1.73–2.85) were also associated with higher odds of death. Model estimates were similar for both distance measures. Distance was a risk factor for death among patients at the main referral hospital, likely due to delayed diagnosis and suboptimal healthcare access. To reduce mortality, targeted community TB screening interventions for TB disease and HIV, and expansion of novel sensitive diagnostic tests are required.
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Alene M, Assemie MA, Yismaw L, Gedif G, Ketema DB, Gietaneh W, Chekol TD. Patient delay in the diagnosis of tuberculosis in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2020; 20:797. [PMID: 33109110 PMCID: PMC7590610 DOI: 10.1186/s12879-020-05524-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022] Open
Abstract
Background Delay in the diagnosis of Tuberculosis (TB) remains a major challenge against achieving effective TB prevention and control. Though a number of studies with inconsistent findings were conducted in Ethiopia; unavailability of a nationwide study determining the median time of patient delays to TB diagnosis is an important research gap. Therefore, this study aimed to determine the pooled median time of the patient delay to TB diagnosis and its determinants in Ethiopia. Methods We followed PRISMA checklist to present this study. We searched from Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library databases for studies. The comprehensive search for relevant studies was done by two of the authors (MA and LY) up to the 10th of October 2019. Risk of bias was assessed using the Newcastle-Ottawa scale adapted for observational studies. Data were pooled and a random effect meta-analysis model was fitted to provide the overall median time of patient delay and its determinants in Ethiopia. Furthermore, subgroup analyses were conducted to investigate how the median time of patient delay varies across different groups of studies. Results Twenty-four studies that satisfied the eligibility criteria were included. Our meta-analysis showed that the median time of the patient delay was 24.6 (95%CI: 20.8–28.4) days. Living in rural area (OR: 2.19, 95%CI: 1.51–3.18), and poor knowledge about TB (OR: 2.85, 95%CI: 1.49–5.47) were more likely to lead to prolonged delay. Patients who consult non-formal health providers (OR: 5.08, 95%CI: 1.56–16.59) had a prolonged delay in the diagnosis of TB. Moreover, the narrative review of this study showed that age, educational level, financial burden and distance travel to reach the nearest health facility were significantly associated with a patient delay in the diagnosis of TB. Conclusions In conclusion, patients are delayed more-than three weeks in the diagnosis of TB. Lack of awareness about TB, consulting non-formal health provider, and being in the rural area had increased patient delay to TB diagnosis. Increasing public awareness about TB, particularly in rural and disadvantaged areas could help to early diagnosis of TB. Supplementary information Supplementary information accompanies this paper at 10.1186/s12879-020-05524-3.
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Affiliation(s)
- Muluneh Alene
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia.
| | | | - Leltework Yismaw
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | - Getnet Gedif
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | | | - Wodaje Gietaneh
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
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Robsky KO, Hughes S, Kityamuwesi A, Kendall EA, Kitonsa PJ, Dowdy DW, Katamba A. Is distance associated with tuberculosis treatment outcomes? A retrospective cohort study in Kampala, Uganda. BMC Infect Dis 2020; 20:406. [PMID: 32527306 PMCID: PMC7291553 DOI: 10.1186/s12879-020-05099-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 05/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background Challenges accessing nearby health facilities may be a barrier to initiating and completing tuberculosis (TB) treatment. We aimed to evaluate whether distance from residence to health facility chosen for treatment is associated with TB treatment outcomes. Methods We conducted a retrospective cohort study of all patients initiating TB treatment at six health facilities in Kampala from 2014 to 2016. We investigated associations between distance to treating facility and unfavorable TB treatment outcomes (death, loss to follow up, or treatment failure) using multivariable Poisson regression. Results Unfavorable treatment outcomes occurred in 20% (339/1691) of TB patients. The adjusted relative risk (aRR) for unfavorable treatment outcomes (compared to treatment success) was 0.87 (95% confidence interval [CI] 0.70, 1.07) for patients living ≥2 km from the facility compared to those living closer. When we separately compared each type of unfavorable treatment outcome to favorable outcomes, those living ≥2 km from the facility had increased risk of death (aRR 1.42 [95%CI 0.99, 2.03]) but decreased risk for loss to follow-up (aRR 0.57 [95%CI 0.41, 0.78]) than those living within 2 km. Conclusions Distance from home residence to TB treatment facility is associated with increased risk of death but decreased risk of loss to follow up. Those who seek care further from home may have advanced disease, but once enrolled may be more likely to remain in treatment.
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Affiliation(s)
- Katherine O Robsky
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. .,Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda.
| | | | - Alex Kityamuwesi
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Emily A Kendall
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | | | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda.,Johns Hopkins School of Medicine, Baltimore, USA
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda.,Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
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McHenry ML, Bartlett J, Igo RP, Wampande EM, Benchek P, Mayanja-Kizza H, Fluegge K, Hall NB, Gagneux S, Tishkoff SA, Wejse C, Sirugo G, Boom WH, Joloba M, Williams SM, Stein CM. Interaction between host genes and Mycobacterium tuberculosis lineage can affect tuberculosis severity: Evidence for coevolution? PLoS Genet 2020; 16:e1008728. [PMID: 32352966 PMCID: PMC7217476 DOI: 10.1371/journal.pgen.1008728] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 05/12/2020] [Accepted: 03/20/2020] [Indexed: 12/16/2022] Open
Abstract
Genetic studies of both the human host and Mycobacterium tuberculosis (MTB) demonstrate independent association with tuberculosis (TB) risk. However, neither explains a large portion of disease risk or severity. Based on studies in other infectious diseases and animal models of TB, we hypothesized that the genomes of the two interact to modulate risk of developing active TB or increasing the severity of disease, when present. We examined this hypothesis in our TB household contact study in Kampala, Uganda, in which there were 3 MTB lineages of which L4-Ugandan (L4.6) is the most recent. TB severity, measured using the Bandim TBscore, was modeled as a function of host SNP genotype, MTB lineage, and their interaction, within two independent cohorts of TB cases, N = 113 and 121. No association was found between lineage and severity, but association between multiple polymorphisms in IL12B and TBscore was replicated in two independent cohorts (most significant rs3212227, combined p = 0.0006), supporting previous associations of IL12B with TB susceptibility. We also observed significant interaction between a single nucleotide polymorphism (SNP) in SLC11A1 and the L4-Ugandan lineage in both cohorts (rs17235409, meta p = 0.0002). Interestingly, the presence of the L4-Uganda lineage in the presence of the ancestral human allele associated with more severe disease. These findings demonstrate that IL12B is associated with severity of TB in addition to susceptibility, and that the association between TB severity and human genetics can be due to an interaction between genes in the two species, consistent with host-pathogen coevolution in TB.
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Affiliation(s)
- Michael L. McHenry
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Jacquelaine Bartlett
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Robert P. Igo
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Eddie M. Wampande
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Penelope Benchek
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Harriet Mayanja-Kizza
- Department of Medicine and Mulago Hospital, School of Medicine, Makerere University, Kampala, Uganda
| | - Kyle Fluegge
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Noemi B. Hall
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sarah A. Tishkoff
- Departments of Genetics and Biology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Christian Wejse
- Department of Infectious Diseases and Center for Global Health, Aarhus University, Aarhus, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea Bissau
| | - Giorgio Sirugo
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, Unites States of America
| | - W. Henry Boom
- Tuberculosis Research Unit, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Moses Joloba
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Scott M. Williams
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- * E-mail: (SMW); (CMS)
| | - Catherine M. Stein
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Tuberculosis Research Unit, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- * E-mail: (SMW); (CMS)
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11
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Ereso BM, Yimer SA, Gradmann C, Sagbakken M. Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study. PLoS One 2020; 15:e0226307. [PMID: 31895932 PMCID: PMC6939902 DOI: 10.1371/journal.pone.0226307] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/22/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ethiopia is one of the countries with a high burden of tuberculosis (TB). Jimma Zone has the lowest TB case notification rate compared to the national and World Health Organization's (WHO) targets. The aim of the present study was to identify barriers, and explore the origin of these barriers in relation to TB case finding. METHODS A qualitative study was conducted by using different data collection methods and sources. Sixty in-depth interviews with TB treatment providers, program managers and TB patients were included. In addition, 42 governmental health facilities were observed for availability of resources. Data obtained from the in-depth interviews were transcribed, coded, categorized and thematized. Atlas.ti version 7.1 software was used for the data coding and categorizing. RESULTS Inadequate resources for TB case finding, such as a shortage of health-care providers, inadequate basic infrastructure, and inadequate diagnostic equipment and supplies, as well as limited access to TB diagnostic services such as an absence of nearby health facilities providing TB diagnostic services and health system delays in the diagnostic process, were identified as barriers for TB case finding. We identified the absence of trained laboratory professionals in 11, the absence of clean water supply in 13 and the electricity in seven health facilities. Furthermore, we found that difficult topography, the absence of proper roads, an inadequate collaboration with other sectors (such as education), a turnover of laboratory professionals, and a low community mobilization, as the origin of some of these barriers. CONCLUSION Inadequate resources for TB case finding, and a limited access to diagnostic services, were major challenges affecting TB case finding. The optimal application of the directly observed treatment short course (Stop TB) strategy is crucial to increase the current low TB case notification rate. Practical strategies need to be designed to attract and retain health professionals in the health system.
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Affiliation(s)
- Berhane Megerssa Ereso
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Solomon Abebe Yimer
- Department of Microbiology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
| | - Christoph Gradmann
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Mette Sagbakken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Jiang J, Lucas H, Long Q, Xin Y, Xiang L, Tang S. The Effect of an Innovative Financing and Payment Model for Tuberculosis Patients on Health Service Utilization in China: Evidence from Hubei Province of China. Int J Environ Res Public Health 2019; 16:ijerph16142494. [PMID: 31336947 PMCID: PMC6678436 DOI: 10.3390/ijerph16142494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/01/2019] [Accepted: 07/10/2019] [Indexed: 11/16/2022]
Abstract
Background: Tuberculosis (TB) remains a major social and public health problem in China. The "China-Gates TB Project" started in 2012, and one of its objectives was to reduce the financial burden on TB patients and to improve access to quality TB care. The aims of this study were to determine if the project had positive impacts on improving health service utilization. Methods: The 'China-Gates TB Project' was launched in Yichang City (YC), Hubei Province in April 2014 and ended in March 2015, lasting for one year. A series of questionnaire surveys of 540 patients were conducted in three counties of YC at baseline and final evaluations. Inpatient and outpatient service utilization were assessed before and after the program, with descriptive statistics. Propensity score matching was used to evaluate the impact of the China-Gates TB Project on health service utilization by minimizing the differences in the other characteristics of baseline and final stage groups. Focus group discussions (FGDs) were held to further enrich the results. Results: A total of 530 patients were included in this study. Inpatient rates significantly increased from 33.5% to 75.9% overall (p < 0.001), with the largest increase occurring for low income patients. Outpatient visits increased from 4.6 to 5.6 (p < 0.001), and this increase was also greatest for the poorest patients. Compared with those who lived in developed counties, the overall increase in outpatient visits for illness in the remote Wufeng county was higher. Conclusions: The China-Gates TB Project has effectively improved health service utilization in YC, and poor patients benefited more from it. TB patients in remote underdeveloped counties are more likely to increase the use of outpatient services rather than inpatient services. There is a need to tilt policy towards the poor, and various measures need to be in place in order to ensure health services utilization in undeveloped areas.
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Affiliation(s)
- Junnan Jiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Henry Lucas
- Institute of Development Studies, University of Sussex, Brighton BN1 9RE, UK
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan 215316, China
| | - Yanjiao Xin
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Li Xiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA
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