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Mansoori N, Pahlavanzadeh B, Atarjalali M. Risk factors associated with multidrug-resistant tuberculosis in areas with a moderate tuberculosis burden. Int Health 2024:ihae039. [PMID: 38873833 DOI: 10.1093/inthealth/ihae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/09/2024] [Accepted: 06/11/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND The emergence of multidrug-resistant tuberculosis (MDR-TB) or rifampicin-resistant (RR) TB poses a significant challenge for TB control initiatives on a global scale. This study's aim was to estimate the incidence of MDR-/RR-TB and identify the risk factors associated with their incidence in four provinces in northern Iran. METHODS Drug susceptibility testing was conducted using the proportion method on Lowenstein-Jensen media. The demographic and clinical data were collected from the Iranian TB registry. RESULTS Among 1083 individuals diagnosed with TB, 27 (2.5%) were identified as having MDR-/RR-TB, while 73 cases (6.7%) were any drug resistant (ADR). The statistical analysis revealed a significant association between marital status and MDR-/RR-TB (p=0.003). In addition, significant associations were observed between ADR-TB and gender (p=0.035) and previous treatment for TB (p=0.02). CONCLUSIONS Our findings provide important information on the drug resistance pattern of Mycobacterium tuberculosis strains, as well as risk factors in northern Iran. Given the identified risk factors, creative approaches to promote treatment adherence in TB patients, particularly divorced/widowed women and individuals with a previous history of TB treatment, are required.
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Affiliation(s)
- Noormohamad Mansoori
- Infectious Diseases Research Centre, Golestan University of Medical Sciences, Gorgan, Iran
| | - Bagher Pahlavanzadeh
- Research Center for Environmental Contaminants, Abadan University of Medical Sciences, Abadan, Iran
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Radfar SR, Nematollahi P, Tayeri K, Dehghan H, Janani M, Higgs P, Mohsenifar S, Noroozi A. Prevalence of latent tuberculosis infection and HIV among people who inject drugs in Iran. Drug Alcohol Rev 2020; 40:572-579. [PMID: 33345378 DOI: 10.1111/dar.13233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 11/05/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Iran has an human immunodeficiency viruses (HIV) epidemic that is concentrated among people who inject drugs (PWID), who have higher risks of progression from latent tuberculosis infection (LTBI) to active disease. The aim of this study is to measure prevalence of LTBI, HIV infection and any risk behaviors among PWID in Iran. METHODS The cross-sectional study was conducted from August to December 2013 in six cities across Iran. A total of 420 PWID were recruited from drop-in centres using convenience sampling. Trained interviewers collected data on socio-demographic characteristics, drug use history and drug-related risk behaviors across the study sites. A tuberculin skin test (TST) was performed, and HIV infection was assessed by a rapid test. Multivariable modified Poisson regression and logistic regression were used for data analysis. RESULTS Prevalence of positive TST and HIV positivity was 35.7% and 8.6%, respectively. The prevalence of LTBI and HIV was significantly different across the cities of this study. Positive TST was independently associated with older age (APR 1.03, 95% CI 1.01, 1.05) and being HIV positive (APR 1.89, 95% CI 1.45, 2.47). HIV infection was associated with lifetime history of sharing syringes (AOR 3.28, 95% CI 1.44, 10.71) and lifetime number of imprisonment (AOR 1.09, 95% CI 1.03-1.14). DISCUSSION AND CONCLUSIONS Prevalence of LTBI infections among PWID is high and independently associated with HIV infection. Given that there are currently no TB services available within drop-in centres, programs which integrate TB case finding, TB preventive therapy, referral and care services for PWID are urgently needed.
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Affiliation(s)
- Seyed Ramin Radfar
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,UCLA Integrated Substance Abuse Programs, Los Angeles, USA
| | - Pardis Nematollahi
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Katayoun Tayeri
- Iranian Research Center of HIV and AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Dehghan
- Consultation Center for Secondary Researches, Data Mining, and Knowledge Transfer in Health and Medical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Majid Janani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia.,Burnet Institute, Behaviours and Health Risks, Melbourne, Australia
| | | | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.,Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Farhoudian A, Baldacchino A, Clark N, Gerra G, Ekhtiari H, Dom G, Mokri A, Sadeghi M, Nematollahi P, Demasi M, Schütz CG, Hash-emian SM, Tabarsi P, Galea-Singer S, Carrà G, Clausen T, Kouimtsidis C, Tolomeo S, Radfar SR, Razaghi EM. COVID-19 and Substance Use Disorders: Recommendations to a Comprehensive Healthcare Response. An International Society of Addiction Medicine Practice and Policy Interest Group Position Paper. Basic Clin Neurosci 2020; 11:133-150. [PMID: 32855772 PMCID: PMC7368103 DOI: 10.32598/bcn.11.covid19.1] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/19/2022] Open
Abstract
Coronavirus Disease 2019 (COVID-19) is escalating all over the world and has higher morbidities and mortalities in certain vulnerable populations. People Who Use Drugs (PWUD) are a marginalized and stigmatized group with weaker immunity responses, vulnerability to stress, poor health conditions, high-risk behaviors, and lower access to health care services. These conditions put them at a higher risk of COVID-19 infection and its complications. In this paper, an international group of experts on addiction medicine, infectious diseases, and disaster psychiatry explore the possible raised concerns in this issue and provide recommendations to manage the comorbidity of COVID-19 and Substance Use Disorder (SUD).
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Affiliation(s)
- Ali Farhoudian
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Alexander Baldacchino
- Division of Population and Behavioral Sciences, St Andrews University Medical School, University of St Andrews, UK
| | - Nicolas Clark
- North Richmond Community Health, Victoria, Melbourne, Australia
- Royal Melbourne Hospital, Victoria, Melbourne, Australia
| | - Gilberto Gerra
- Drug Prevention and Health Branch, Division for Operations, United Nations Office on Drugs and Crime, Vienna, Austria
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
| | - Azarakhsh Mokri
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mandana Sadeghi
- Aftab Mehrvarzi Substance Abuse Treatment Center, Tehran, Iran
| | - Pardis Nematollahi
- Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryanne Demasi
- North Richmond Community Health, Victoria, Melbourne, Australia
| | - Christian G. Schütz
- Department of Psychiatry, University of British Columbia, Vancouver BC, Canada
| | - Seyed Mohammadreza Hash-emian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute for Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Susanna Galea-Singer
- Institute for Innovation and Improvement, IWaitematâ DHB, Centre for Addictions Research, University of Auckland, Auckland, New Zealand
| | - Giuseppe Carrà
- Department of Medicine and Surgery, Section of Psychiatry, University of Milan Bicocca, Milan, Italy
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF); University of Oslo, Oslo, Norway
| | | | - Serenella Tolomeo
- Department of Psychology, National University of Singapore (NUS), Singapore
| | - Seyed Ramin Radfar
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Integrated Substance Abuse Programs, University of California, Los Angeles, California, USA
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Importance of Detection of Isoniazid and Rifampicin Mono Drug Resistance and Determining Rate of MDR-TB in Smear Positive Sputum Samples from a Tertiary Care Hospital of West U.P. India. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2019. [DOI: 10.22207/jpam.13.2.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Li Y, Lin G, Chen B, Zhang J, Wang L, Li Z, Cao Y, Wen C, Yang X, Cao G, Wang X, Cao G. Effect of alprazolam on rat serum metabolic profiles. Biomed Chromatogr 2017; 31. [PMID: 28187228 DOI: 10.1002/bmc.3956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/30/2017] [Accepted: 02/07/2017] [Indexed: 01/30/2023]
Abstract
We developed a serum metabolomic method by gas chromatography-mass spectrometry (GC-MS) to evaluate the effect of alprazolam in rats. The GC-MS with HP-5MS (0.25 μm × 30 m × 0.25 mm) mass was conducted in electron impact ionization (EI) mode with electron energy of 70 eV, and full-scan mode with m/z 50-550. The rats were randomly divided to four groups, three alprazolam-treated groups and a control group. The alprazolam-treated rats were given 5, 10 or 20 mg/kg (low, medium, high) of alprazolam by intragastric administration each day for 14 days. The serum samples were corrected on the seventh and fourteenth days for metabolomic study. The blood was collected for biochemical tests. Then liver and brain were rapidly isolated and immersed for pathological study. Compared with the control group, on the seventh and fourteen days, the levels of d-glucose, 9,12-octadecadienoic acid, butanoic acid, l-proline, d-mannose and malic acid had changed, indicating that alprazolam induced energy metabolism, fatty acid metabolism and amino acid metabolism perturbations in rats. There was no significant difference for alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, urea and uric acid between controls and alprazolam groups. According to the pathological results, alprazolam is not hepatotoxic. Metabolomics could distinguish different alprazolam doses in rats.
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Affiliation(s)
- Yan Li
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Gaotong Lin
- The Department of Pharmacy, Taizhou Cancer Hospital, Wenling, China
| | - Bingbao Chen
- Analytical and Testing Center, Wenzhou Medical University, Wenzhou, China
| | - Jing Zhang
- Analytical and Testing Center, Wenzhou Medical University, Wenzhou, China
| | - Lingtian Wang
- School of Medicine, Shandong University, Jinan, China
| | - Zixia Li
- Analytical and Testing Center, Wenzhou Medical University, Wenzhou, China
| | - Yungang Cao
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Congcong Wen
- Analytical and Testing Center, Wenzhou Medical University, Wenzhou, China
| | - Xuezhi Yang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Gaozhong Cao
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xianqin Wang
- Analytical and Testing Center, Wenzhou Medical University, Wenzhou, China
| | - Guoquan Cao
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Hermosilla S, El-Bassel N, Aifah A, Terlikbayeva A, Zhumadilov Z, Berikkhanova K, Darisheva M, Gilbert L, Schluger N, Galea S. Tuberculosis report among injection drug users and their partners in Kazakhstan. Public Health 2015; 129:569-75. [PMID: 25795015 DOI: 10.1016/j.puhe.2015.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 01/05/2015] [Accepted: 01/21/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Tuberculosis (TB) is a major threat to global public health. Kazakhstan has the second highest percentage of multidrug-resistant tuberculosis (MDR-TB) cases among incident tuberculosis cases in the world (WHO 2013). A high burden of MDR-TB suggests TB prevention, control, and treatment programs are failing. This study provides an epidemiologic profile of TB among injection drug users (IDUs), a high-risk and chronically underserved population, in Kazakhstan. STUDY DESIGN Cross-sectional study. METHODS The authors studied the characteristics and risk environment of IDUs with self-reported previous active TB and their primary sexual partners in Almaty, Kazakhstan. 728 individuals (364 couples) participated in a couple-based study in 2009. RESULTS 16.75% of participants reported at least one positive TB test (x-ray) in their lifetime. In a multivariable logistic regression adjusting for couple-based sampling, persons with positive TB test were significantly more likely to be older (odds ratio (OR) 7.26, 95% confidence interval (CI): 1.73, 30.43), male (OR 5.53, 95% CI: 2.74, 11.16), have a shorter duration of injection drug use (OR 0.17, 95% CI: 0.04, 0.65), have received high social support from their significant other (OR 2.13, 95% CI: 1.03, 4.40) and more likely (non-significantly) to have been incarcerated (OR 7.03, 95% CI: 0.64, 77.30). CONCLUSIONS Older men with a history of incarceration and recent injection drug use were more likely to have positive TB test in Kazakhstan. Social network support, while potentially positive for many aspects of population health, may increase risk of TB among IDUs in this context. Public health policies that target high-risk populations and their at-risk networks may be necessary to stem the rise of MDR-TB in Central Asia.
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Affiliation(s)
| | - N El-Bassel
- Columbia University School of Social Work, USA
| | - A Aifah
- Columbia University School of Social Work, USA
| | | | | | | | - M Darisheva
- Global Health Research Center of Central Asia, USA
| | - L Gilbert
- Columbia University School of Social Work, USA
| | | | - S Galea
- Columbia University Medical Center, USA
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7
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Mumtaz GR, Weiss HA, Thomas SL, Riome S, Setayesh H, Riedner G, Semini I, Tawil O, Akala FA, Wilson D, Abu-Raddad LJ. HIV among people who inject drugs in the Middle East and North Africa: systematic review and data synthesis. PLoS Med 2014; 11:e1001663. [PMID: 24937136 PMCID: PMC4061009 DOI: 10.1371/journal.pmed.1001663] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 05/08/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It is perceived that little is known about the epidemiology of HIV infection among people who inject drugs (PWID) in the Middle East and North Africa (MENA). The primary objective of this study was to assess the status of the HIV epidemic among PWID in MENA by describing HIV prevalence and incidence. Secondary objectives were to describe the risk behavior environment and the HIV epidemic potential among PWID, and to estimate the prevalence of injecting drug use in MENA. METHODS AND FINDINGS This was a systematic review following the PRISMA guidelines and covering 23 MENA countries. PubMed, Embase, regional and international databases, as well as country-level reports were searched up to December 16, 2013. Primary studies reporting (1) the prevalence/incidence of HIV, other sexually transmitted infections, or hepatitis C virus (HCV) among PWIDs; or (2) the prevalence of injecting or sexual risk behaviors, or HIV knowledge among PWID; or (3) the number/proportion of PWID in MENA countries, were eligible for inclusion. The quality, quantity, and geographic coverage of the data were assessed at country level. Risk of bias in predefined quality domains was described to assess the quality of available HIV prevalence measures. After multiple level screening, 192 eligible reports were included in the review. There were 197 HIV prevalence measures on a total of 58,241 PWID extracted from reports, and an additional 226 HIV prevalence measures extracted from the databases. We estimated that there are 626,000 PWID in MENA (range: 335,000-1,635,000, prevalence of 0.24 per 100 adults). We found evidence of HIV epidemics among PWID in at least one-third of MENA countries, most of which are emerging concentrated epidemics and with HIV prevalence overall in the range of 10%-15%. Some of the epidemics have however already reached considerable levels including some of the highest HIV prevalence among PWID globally (87.1% in Tripoli, Libya). The relatively high prevalence of sharing needles/syringes (18%-28% in the last injection), the low levels of condom use (20%-54% ever condom use), the high levels of having sex with sex workers and of men having sex with men (15%-30% and 2%-10% in the last year, respectively), and of selling sex (5%-29% in the last year), indicate a high injecting and sexual risk environment. The prevalence of HCV (31%-64%) and of sexually transmitted infections suggest high levels of risk behavior indicative of the potential for more and larger HIV epidemics. CONCLUSIONS Our study identified a large volume of HIV-related biological and behavioral data among PWID in the MENA region. The coverage and quality of the data varied between countries. There is robust evidence for HIV epidemics among PWID in multiple countries, most of which have emerged within the last decade and continue to grow. The lack of sufficient evidence in some MENA countries does not preclude the possibility of hidden epidemics among PWID in these settings. With the HIV epidemic among PWID in overall a relatively early phase, there is a window of opportunity for prevention that should not be missed through the provision of comprehensive programs, including scale-up of harm reduction services and expansion of surveillance systems.
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Affiliation(s)
- Ghina R. Mumtaz
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen A. Weiss
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sara L. Thomas
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Suzanne Riome
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Hamidreza Setayesh
- Joint United Nations Programme on HIV/AIDS Regional Support Team, Middle East and North Africa, Cairo, Egypt
| | - Gabriele Riedner
- Regional Office of the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Iris Semini
- Joint United Nations Programme on HIV/AIDS Regional Support Team, Middle East and North Africa, Cairo, Egypt
| | - Oussama Tawil
- Joint United Nations Programme on HIV/AIDS Regional Support Team, Middle East and North Africa, Cairo, Egypt
| | - Francisca Ayodeji Akala
- Human Development Sector, Middle East and North Africa Region, World Bank, Washington (D.C.), United States of America
| | - David Wilson
- Global HIV/AIDS Program, World Bank, Washington (D.C.), United States of America
| | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
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Delayed diagnosis and associated factors among new pulmonary tuberculosis patients diagnosed at the emergency department of a tertiary care hospital in Porto Alegre, South Brazil: a prospective patient recruitment study. BMC Infect Dis 2013; 13:538. [PMID: 24219185 PMCID: PMC3840591 DOI: 10.1186/1471-2334-13-538] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 11/05/2013] [Indexed: 11/23/2022] Open
Abstract
Background Control of tuberculosis (TB) depends on early diagnosis and treatment at the primary health care level. However, many patients are still diagnosed late with TB at hospitals. The present study aimed to investigate the delay in diagnosis of TB patients at the emergency department. Methods This was a prospective study in a general, tertiary care, university-affiliated hospital of a city with a high prevalence of TB in Brazil. New TB patients ≥ 14 years diagnosed with pulmonary TB at the emergency department of Hospital de Clínicas de Porto Alegre were prospectively recruited between February 2010 and January 2012. The consenting patients meeting our inclusion criteria were interviewed using a pre-tested questionnaire. We evaluated the delay in time until diagnosis and identified factors associated with delayed diagnosis (patient and health care system delays). Results We included 153 patients. The median total time of delay, patient delay, and health care system delay were 60 (interquartile range [IQR]: 30–90.5 days), 30 (lQR: 7–60 days), and 18 (IQR: 9–39.5 days) days, respectively. The factors that were independently associated with patient delay (time ≥ 30 days) were crack (odds ratio [OR] = 4.88, p = 0.043) and cocaine (OR = 6.68, p = 0.011) use. The factors that were independently associated with health care system delay (time ≥ 18 days) were weight loss (OR = 2.76, p = 0.025), miliary pattern (OR = 5.33, p = 0.032), and fibrotic changes (OR = 0.12, p = 0.013) on chest X-ray. Conclusions Patient delay appears to be the main problem in this city with a high prevalence of TB in Brazil. The main factor associated with patient delay is drug abuse (crack and cocaine). Our study shows substance abuse programs need to be aware of control of TB, with health interventions focusing on TB education programs.
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Grenfell P, Baptista Leite R, Garfein R, de Lussigny S, Platt L, Rhodes T. Tuberculosis, injecting drug use and integrated HIV-TB care: a review of the literature. Drug Alcohol Depend 2013; 129:180-209. [PMID: 23306095 DOI: 10.1016/j.drugalcdep.2012.11.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 11/13/2012] [Accepted: 11/17/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are at increased risk of tuberculosis (TB) and reduced retention in treatment. There is a need to document strategies for integrated delivery of HIV, TB and drug dependency care. METHODS This article reviews the literature on rates of TB mono- and co-infection, and published and grey literature descriptions of TB and HIV-TB care, among PWID. RESULTS Latent TB infection prevalence was high and active disease more common among HIV-positive PWID. Data on multidrug-resistant TB and co-infections among PWID were scarce. Models of TB care fell into six categories: screening and prevention within HIV-risk studies; prevention at TB clinics; screening and prevention within needle-and-syringe-exchange (NSP) and drug treatment programmes; pharmacy-based TB treatment; TB service-led care with harm reduction/drug treatment programmes; and TB treatment within drug treatment programmes. Co-location with NSP and opioid substitution therapy (OST), combined with incentives, consistently improved screening and prevention uptake. Small-scale combined TB treatment and OST achieved good adherence in diverse settings. Successful interventions involved collaboration across services; a client-centred approach; and provision of social care. No peer-reviewed studies described models of integrated HIV-TB care for PWID but grey literature highlighted key components: co-located services, provision of drug treatment, multidisciplinary staff training; and remaining barriers: staffing inefficiencies, inadequate funding, police interference, and limited OST availability. CONCLUSIONS Integration with drug treatment improves PWID engagement in TB services but there is a need to document approaches to HIV-TB care, improve surveillance of TB and co-infections among PWID, and advocate for improved OST availability.
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Affiliation(s)
- Pippa Grenfell
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene & Tropical Medicine, London, UK.
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Malekmohammad M, Marjani M, Tabarsi P, Baghaei P, Sadr Z, Naghan PA, Mansouri D, Masjedi MR, Velayati AA. Diagnostic yield of post-bronchoscopy sputum smear in pulmonary tuberculosis. ACTA ACUST UNITED AC 2012; 44:369-73. [PMID: 22497518 DOI: 10.3109/00365548.2011.643820] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The early definitive diagnosis of pulmonary tuberculosis (TB) is important for control of the disease in the community. We performed this study to evaluate the additional gain of post-bronchoscopy sputum in the diagnosis of pulmonary TB. METHODS Bronchoscopy and bronchoalveolar lavage were performed for 126 patients suspected of pulmonary TB who either had 3 negative sputum smears for acid-fast bacilli or could not expectorate. After bronchoscopy the patients were asked to give sputum samples for 3 consecutive days. All of the obtained specimens were investigated for Mycobacterium tuberculosis by smear and culture. RESULTS Pulmonary TB was confirmed in 56 patients. Among all confirmed cases, the sensitivity of bronchoalveolar lavage smear was 57.1% (32 of 56), sensitivity of post-bronchoscopy smear was 76.7% (43 of 56), and the yield of a combination of the 2 methods was 83.9% (47 of 56). Results of post-bronchoscopy sputum smears were not significantly related to sex, age, human immunodeficiency virus (HIV) infection, presence of cavitary lesions on chest X-ray, or the ability to expectorate before bronchoscopy (p > 0.05). CONCLUSION Evaluation of post-bronchoscopy sputum smears is helpful for earlier diagnosis of pulmonary TB and is an inexpensive and accessible assay.
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Affiliation(s)
- Majid Malekmohammad
- Clinical Tuberculosis and Epidemiology Research Centre, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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