1
|
Xianyu F, Huang Y, Guo S, Chongsuvivatwong V. Evaluating Treatment Outcomes and Tuberculosis Infection Risks: A Comparative Study of Centralized Hospitalization vs. Home-Based Treatment. Trop Med Infect Dis 2024; 9:119. [PMID: 38787052 PMCID: PMC11125710 DOI: 10.3390/tropicalmed9050119] [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: 03/05/2024] [Revised: 05/04/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Background: Guizhou Province in Southwest China has experimented with a centralized hospitalization (CH) treatment for active and severe cases of pulmonary tuberculosis (PTB). The objective of this study was to compare treatment outcomes of patients with tuberculosis (TB) receiving care in a CH setting with those receiving home-based (HB) care. In addition, this study aimed to assess the probability of their household contacts contracting tuberculosis infection. Method: A retrospective review of medical records was undertaken for patients with TB who completed their treatment in four counties in Guizhou, China, spanning from January 2022 to August 2023. In addition, a cross-sectional survey was conducted on the tuberculin skin test (TST) among household contacts of new patients with TB who had completed their treatment. Results: In the retrospective study, 94.8% had successful CH treatment, and 93.1% had successful HB treatment (p value = 0.70). In the prospective study, 559 and 448 household contacts of patients receiving CH treatment had 16 positive and 89 negative TST results, whereas those with HB treatment showed 26 positive and 74 negative TST results. Regarding a logistic regression analysis, the CH group was nearly two times more likely to test negative on the TST, 1.95 (95% CI: 0.98, 3.92). After adjusting for confounding variables, the odds ratio increased significantly to 4.42 (95% CI: 1.22, 16.04). Conclusions: CH for treatment of TB did not show superior success rates, but it may reduce the risk of transmitting tuberculosis infection to household contacts compared to home treatment.
Collapse
Affiliation(s)
- Fangming Xianyu
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Yuemei Huang
- Guizhou Medical University, Guiyang 550031, China
| | - Shengqiong Guo
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China
| | | |
Collapse
|
2
|
Zhang M, Tseng AS, Anguzu G, Barnabas RV, Davis JL, Mujugira A, Flaxman AD, Ross JM. Modeled estimates of HIV-serodifferent couples in tuberculosis-affected households in four sub-Saharan African countries. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002609. [PMID: 38696500 PMCID: PMC11065259 DOI: 10.1371/journal.pgph.0002609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/20/2024] [Indexed: 05/04/2024]
Abstract
Household-based tuberculosis (TB) contact evaluation may be an efficient strategy to reach people who could benefit from oral pre-exposure prophylaxis (PrEP) because of the epidemiological links between HIV and TB. This study estimated the number of HIV serodifferent couples in TB-affected households and potential HIV acquisitions averted through their PrEP use in 4 TB-HIV high-burden countries. We conducted a model-based analysis set in Ethiopia, Kenya, South Africa, and Uganda using parameters from population-based household surveys, systematic literature review and meta-analyses, and estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We parameterized the nonlinear relationship between the proportion of serodifferent couples among people living with HIV and population-level HIV prevalence using Markov chain Monte Carlo methods. We integrated all parameters in a mathematical model and propagated uncertainty using a Monte Carlo approach. We estimated the HIV prevalence among adults aged 15-49 living in TB-affected households to be higher than in the general population in all 4 countries. The proportion of serodifferent couples among all couples in TB-affected households was also higher than in the general population (South Africa: 20.7% vs. 15.7%, Kenya: 15.7% vs. 5.7%, Uganda: 14.5% vs. 6.0%, Ethiopia: 4.1% vs. 0.8%). We estimated that up to 1,799 (95% UI: 1,256-2,341) HIV acquisitions in South Africa could be prevented annually by PrEP use in serodifferent couples in TB-affected households, 918 (95% UI: 409-1,450) in Kenya, 686 (95% UI: 505-871) in Uganda, and 408 (95% UI: 298-522) in Ethiopia. As couples in TB-affected households are more likely to be serodifferent than couples in the general population, offering PrEP during household TB contact evaluation may prevent a substantial number of HIV acquisitions.
Collapse
Affiliation(s)
- Meixin Zhang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Ashley S. Tseng
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Godwin Anguzu
- PART Fellowship, Makerere University, Kampala, Uganda
- Department of Social Science Research Institute, Duke University, Durham, North Carolina, United States of America
| | - Ruanne V. Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - J. Lucian Davis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, United States of America
- Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Andrew Mujugira
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Abraham D. Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, United States of America
| | - Jennifer M. Ross
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
3
|
Razbek J, Daken M, Chen Y, Ma L, Zhang Y, Xu W, Wen B, Wang J, Wang X, Cao M. Association Studies of Serum Levels of TNF- α, IL-10, IFN-γ and CXCL 5 with Latent Tuberculosis Infection in Close Contacts. Infect Drug Resist 2024; 17:899-910. [PMID: 38468847 PMCID: PMC10926862 DOI: 10.2147/idr.s442682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/22/2024] [Indexed: 03/13/2024] Open
Abstract
Purpose Early recognition and treatment of latent tuberculosis infection(LTBI) is key to tuberculosis(TB) prevention. However, the emergence of LTBI is influenced by a combination of factors, of which the role of individual immune cytokines remains controversial. The aim of this study is to explore the influencing factors of LTBI and their effects with cytokines on LTBI. Patients and Methods Close contacts of tuberculosis in Urumqi City from 2021 to 2022 were selected for the study to conduct a field survey. It used logistic regression model to analyse the influencing factors of LTBI, principal component analysis to extract a composite indicators of cytokines, and structural equation modelling to explore the direct and indirect effects of cytokines and influencing factors on LTBI. Results LTBI infection rate of 33.3% among 288 TB close contacts. A multifactorial Logistic model showed that factors influencing LTBI included education, daily contact hours, eating animal liver, and drinking coffee (P<0.05); After controlling for confounding factors and extracting composite indicators of cytokines using principal component analysis, CXCL5 and IFN-γ is a protective factor for LTBI(OR=0.572, P=0.047), IL-10 and TNF-α is a risk factor for LTBI(OR=2.119, P=0.010); Structural equation modelling shows drinking coffee, eating animal liver, daily contact hours, and IL-10 and TNF-α had direct effects on LTBI and educations had indirect effects on LTBI(P<0.05). Conclusion IL-10 and TNF-α are involved in the immune response and are directly related to LTBI. By monitoring the cytokine levels of TB close contacts and paying attention to their dietary habits and exposure, we can detect and intervene in LTBI at an early stage and control their progression to TB.
Collapse
Affiliation(s)
- Jaina Razbek
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, 830011, People’s Republic of China
| | - Mayisha Daken
- Department of Epidemic Prevention, Karamay Centre for Disease Control and Prevention, Karamay, 834000, People’s Republic of China
| | - Yanggui Chen
- Department of Prevention and Control of Tuberculosis, Urumqi Centre for Disease Control and Prevention, Urumqi, 830011, People’s Republic of China
| | - Li Ma
- Department of Prevention and Control of Tuberculosis, Urumqi Centre for Disease Control and Prevention, Urumqi, 830011, People’s Republic of China
| | - Yan Zhang
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, 830011, People’s Republic of China
| | - Wanting Xu
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, 830011, People’s Republic of China
| | - Baofeng Wen
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, 830011, People’s Republic of China
| | - Junan Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, 830011, People’s Republic of China
| | - Xiaomin Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, 830011, People’s Republic of China
| | - Mingqin Cao
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, 830011, People’s Republic of China
| |
Collapse
|
4
|
Carter N, Webb EL, Lebina L, Motsomi K, Bosch Z, Martinson NA, MacPherson P. Prevalence of subclinical pulmonary tuberculosis and its association with HIV in household contacts of index tuberculosis patients in two South African provinces: a secondary, cross-sectional analysis of a cluster-randomised trial. BMC GLOBAL AND PUBLIC HEALTH 2023; 1:21. [PMID: 38798821 PMCID: PMC11116238 DOI: 10.1186/s44263-023-00022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/19/2023] [Indexed: 05/29/2024]
Abstract
Background People with subclinical tuberculosis (TB) have microbiological evidence of disease caused by Mycobacterium tuberculosis, but either do not have or do not report TB symptoms. The relationship between human immunodeficiency virus (HIV) and subclinical TB is not yet well understood. We estimated the prevalence of subclinical pulmonary TB in household contacts of index TB patients in two South African provinces, and how this differed by HIV status. Methods This was a cross-sectional, secondary analysis of baseline data from the intervention arm of a household cluster randomised trial. Prevalence of subclinical TB was measured as the number of household contacts aged ≥ 5 years who had positive sputum TB microscopy, culture or nucleic acid amplification test (Xpert MTB/Rif or Xpert Ultra) results on a single sputum specimen and who did not report current cough, fever, weight loss or night sweats on direct questioning. Regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the association between HIV status and subclinical TB; adjusting for province, sex and age in household contacts; and HIV status in index patients. Results Amongst household contacts, microbiologically confirmed prevalent subclinical TB was over twice as common as symptomatic TB disease (48/2077, 2.3%, 95% CI 1.7-3.1% compared to 20/2077, 1.0%, 95% CI 0.6-1.5%). Subclinical TB prevalence was higher in people living with HIV (15/377, 4.0%, 95% CI 2.2-6.5%) compared to those who were HIV-negative (33/1696, 1.9%, 95% CI 1.3-2.7%; p = 0.018). In regression analysis, living with HIV (377/2077, 18.2%) was associated with a two-fold increase in prevalent subclinical TB with 95% confidence intervals consistent with no association through to a four-fold increase (adjusted OR 2.00, 95% CI 0.99-4.01, p = 0.052). Living with HIV was associated with a five-fold increase in prevalent symptomatic TB (adjusted OR 5.05, 95% CI 2.22-11.59, p < 0.001). Conclusions Most (70.6%) pulmonary TB diagnosed in household contacts in this setting was subclinical. Living with HIV was likely associated with prevalent subclinical TB and was associated with prevalent symptomatic TB. Universal sputum testing with sensitive assays improves early TB diagnosis in subclinical household contacts. Supplementary Information The online version contains supplementary material available at 10.1186/s44263-023-00022-5.
Collapse
Affiliation(s)
- Naomi Carter
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Emily L. Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Limakatso Lebina
- Clinical Trials Unit, Africa Health Research Institute, Johannesburg, South Africa
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Kegaugetswe Motsomi
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Zama Bosch
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Neil A. Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
- Johns Hopkins University Center for TB Research, Baltimore, MD USA
| | - Peter MacPherson
- Liverpool School of Tropical Medicine, Liverpool, UK
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
5
|
Martinson NA, Nonyane BAS, Genade LP, Berhanu RH, Naidoo P, Brey Z, Kinghorn A, Nyathi S, Young K, Hausler H, Connell L, Lutchminarain K, Swe Swe-Han K, Vreede H, Said M, von Knorring N, Moulton LH, Lebina L. Evaluating systematic targeted universal testing for tuberculosis in primary care clinics of South Africa: A cluster-randomized trial (The TUTT Trial). PLoS Med 2023; 20:e1004237. [PMID: 37216385 DOI: 10.1371/journal.pmed.1004237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends systematic symptom screening for tuberculosis (TB). However, TB prevalence surveys suggest that this strategy does not identify millions of TB patients, globally. Undiagnosed or delayed diagnosis of TB contribute to TB transmission and exacerbate morbidity and mortality. We conducted a cluster-randomized trial of large urban and rural primary healthcare clinics in 3 provinces of South Africa to evaluate whether a novel intervention of targeted universal testing for TB (TUTT) in high-risk groups diagnosed more patients with TB per month compared to current standard of care (SoC) symptom-directed TB testing. METHODS AND FINDINGS Sixty-two clinics were randomized; with initiation of the intervention clinics over 6 months from March 2019. The study was prematurely stopped in March 2020 due to clinics restricting access to patients, and then a week later due to the Coronavirus Disease 2019 (COVID-19) national lockdown; by then, we had accrued a similar number of TB diagnoses to that of the power estimates and permanently stopped the trial. In intervention clinics, attendees living with HIV, those self-reporting a recent close contact with TB, or a prior episode of TB were all offered a sputum test for TB, irrespective of whether they reported symptoms of TB. We analyzed data abstracted from the national public sector laboratory database using Poisson regression models and compared the mean number of TB patients diagnosed per clinic per month between the study arms. Intervention clinics diagnosed 6,777 patients with TB, 20.7 patients with TB per clinic month (95% CI 16.7, 24.8) versus 6,750, 18.8 patients with TB per clinic month (95% CI 15.3, 22.2) in control clinics during study months. A direct comparison, adjusting for province and clinic TB case volume strata, did not show a significant difference in the number of TB cases between the 2 arms, incidence rate ratio (IRR) 1.14 (95% CI 0.94, 1.38, p = 0.46). However, prespecified difference-in-differences analyses showed that while the rate of TB diagnoses in control clinics decreased over time, intervention clinics had a 17% relative increase in TB patients diagnosed per month compared to the prior year, interaction IRR 1.17 (95% CI 1.14, 1.19, p < 0.001). Trial limitations were the premature stop due to COVID-19 lockdowns and the absence of between-arm comparisons of initiation and outcomes of TB treatment in those diagnosed with TB. CONCLUSIONS Our trial suggests that the implementation of TUTT in these 3 groups at extreme risk of TB identified more TB patients than SoC and could assist in reducing undiagnosed TB patients in settings of high TB prevalence. TRIAL REGISTRATION South African National Clinical Trials Registry DOH-27-092021-4901.
Collapse
Affiliation(s)
- Neil A Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
- Johns Hopkins University Center for TB Research, Baltimore, Maryland, United States of America
| | - Bareng A S Nonyane
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, United States of America
| | - Leisha P Genade
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Rebecca H Berhanu
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Pren Naidoo
- Public Health Management Consultant, South Africa, Johannesburg, South Africa
| | - Zameer Brey
- Bill and Melinda Gates Foundation, South Africa, Johannesburg, South Africa
| | - Anthony Kinghorn
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | - Keeren Lutchminarain
- National Health Laboratory Service Department of Microbiology, Inkosi Albert Luthuli Central Hospital, eThekwini, South Africa
- University of Kwa Zulu Natal, Durban, South Africa
| | - Khine Swe Swe-Han
- National Health Laboratory Service Department of Microbiology, Inkosi Albert Luthuli Central Hospital, eThekwini, South Africa
- University of Kwa Zulu Natal, Durban, South Africa
| | - Helena Vreede
- National Health Laboratory Service, Chemical Pathology, Groote Schuur Hospital, Cape Town, South Africa
| | - Mohamed Said
- National Health Laboratory Service, Microbiology and Academic Division, Tshwane, South Africa
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Nina von Knorring
- National Health Laboratory Service, Clinical Microbiology, Johannesburg, South Africa
- Division of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence H Moulton
- Johns Hopkins University Center for TB Research, Baltimore, Maryland, United States of America
| | - Limakatso Lebina
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
- Africa Health Research Institute, KwaZulu Natal, South Africa
| |
Collapse
|
6
|
Mayito J, Martineau AR, Tiwari D, Nakiyingi L, Kateete DP, Reece ST, Biraro IA. Determinants of QuantiFERON Plus-diagnosed tuberculosis infection in adult Ugandan TB contacts: A cross-sectional study. PLoS One 2023; 18:e0281559. [PMID: 36972254 PMCID: PMC10042355 DOI: 10.1371/journal.pone.0281559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/26/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The tuberculin skin test is commonly used to diagnose latent tuberculosis infection (LTBI) in resource-limited settings, but its specificity is limited by factors including cross-reactivity with BCG vaccine and environmental mycobacteria. Interferon-gamma release assays (IGRA) overcome this problem by detecting M. tuberculosis complex-specific responses, but studies to determine risk factors for IGRA-positivity in high TB burden settings are lacking. METHODS We conducted a cross-sectional study to determine factors associated with a positive IGRA by employing the QuantiFERON-TB® Gold-plus (QFT Plus) assay in a cohort of asymptomatic adult TB contacts in Kampala, Uganda. Multivariate logistic regression analysis with forward stepwise logit function was employed to identify independent correlates of QFT Plus-positivity. RESULTS Of the 202 participants enrolled, 129/202 (64%) were female, 173/202 (86%) had a BCG scar, and 67/202 (33%) were HIV-infected. Overall, 105/192 (54%, 95% CI 0.48-0.62) participants had a positive QFT Plus result. Increased risk of QFT-Plus positivity was independently associated with casual employment/unemployment vs. non-casual employment (adjusted odds ratio (aOR) 2.18, 95% CI 1.01-4.72), a family vs. non-family relation to the index patient (aOR 2.87, 95% CI 1.33-6.18), living in the same vs. a different house as the index (aOR 3.05, 95% CI 1.28-7.29), a higher body mass index (BMI) (aOR per additional kg/m2 1.09, 95% CI 1.00-1.18) and tobacco smoking vs. not (aOR 2.94, 95% CI 1.00-8.60). HIV infection was not associated with QFT-Plus positivity (aOR 0.91, 95% CI 0.42-1.96). CONCLUSION Interferon Gamma Release Assay positivity in this study population was lower than previously estimated. Tobacco smoking and BMI were determinants of IGRA positivity that were previously unappreciated.
Collapse
Affiliation(s)
- Jonathan Mayito
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Adrian R Martineau
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Divya Tiwari
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Lydia Nakiyingi
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David P Kateete
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stephen T Reece
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Irene Andia Biraro
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| |
Collapse
|
7
|
Sagili KD, Muniyandi M, Shringarpure K, Singh K, Kirubakaran R, Rao R, Tonsing J, Sachdeva KS, Tharyan P. Strategies to detect and manage latent tuberculosis infection among household contacts of pulmonary TB patients in high TB burden countries - a systematic review and meta-analysis. Trop Med Int Health 2022; 27:842-863. [PMID: 35927930 PMCID: PMC9825928 DOI: 10.1111/tmi.13808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To summarise latent tuberculosis infection (LTBI) management strategies among household contacts of bacteriologically confirmed pulmonary tuberculosis (TB) patients in high-TB burden countries. METHODS PubMed/MEDLINE (NCBI) and Scopus were searched (January 2006 to December 2021) for studies reporting primary data on LTBI management. Study selection, data management and data synthesis were protocol-driven (PROSPERO-CRD42021208715). Primary outcomes were the proportions of LTBI, initiating and completing tuberculosis preventive treatment (TPT). Reported factors influencing the LTBI care cascade were qualitatively synthesised. RESULTS From 3694 unique records retrieved, 58 studies from 23 countries were included. Most identified contacts were screened (median 99%, interquartile range [IQR] 82%-100%; 46 studies). Random-effects meta-analysis yielded pooled proportions for: LTBI 41% (95% confidence interval [CI] 33%-49%; 21,566 tested contacts); TPT initiation 91% (95% CI 79%-97%; 129,573 eligible contacts, 34 studies); TPT completion 65% (95% CI 54%-74%; 108,679 TPT-initiated contacts, 28 studies). Heterogeneity was significant (I2 ≥ 95%-100%) and could not be explained in subgroup analyses. Median proportions (IQR) were: LTBI 44% (28%-59%); TPT initiation 86% (60%-100%); TPT completion 68% (44%-82%). Nine broad themes related to diagnostic testing, health system structure and functions, risk perception, documentation and adherence were considered likely to influence the LTBI care cascade. CONCLUSION The proportions of household contacts screened, detected with LTBI and initiated on TPT, though variable was high, but the proportions completing TPT were lower indicating current strategies used for LTBI management in high TB burden countries are not sufficient.
Collapse
Affiliation(s)
- Karuna Devi Sagili
- International Union Against Tuberculosis and Lung DiseaseSouth East Asia OfficeNew DelhiIndia
| | - Malaisamy Muniyandi
- Indian Council of Medical Research (ICMR)National Institution for Research in TuberculosisChennaiIndia
| | | | - Kavita Singh
- International Union Against Tuberculosis and Lung DiseaseSouth East Asia OfficeNew DelhiIndia
| | | | - Raghuram Rao
- National TB Elimination Program, Central TB DivisionMinistry of HealthNew DelhiIndia
| | - Jamhoih Tonsing
- Technical Advice and Partnerships DepartmentThe Global FundGenevaSwitzerland
| | - Kuldeep Singh Sachdeva
- International Union Against Tuberculosis and Lung DiseaseSouth East Asia OfficeNew DelhiIndia
| | - Prathap Tharyan
- Clinical Epidemiology UnitChristian Medical CentreVelloreIndia
| |
Collapse
|
8
|
Djibougou DA, Mensah GI, Sagna T, Sawadogo LT, Ouedraogo AK, Kabore A, Hien H, Meda CZ, Combary A, Belem AMG, Addo KK, Dabiré RK, Perreau M, Zinsstag J, Diagbouga SP. Magnitude and associated factors of latent tuberculosis infection due to Mycobacterium tuberculosis complex among high-risk groups in urban Bobo-Dioulasso, Burkina Faso. IJID REGIONS 2022; 4:1-9. [PMID: 36093366 PMCID: PMC9453046 DOI: 10.1016/j.ijregi.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 11/02/2022]
Abstract
The overall prevalence of latent tuberculosis infection (LTBI) in this study was 63.36%. The positivity rate for the tuberculin skin test was higher compared with the QuantiFERON-TB Gold Plus test. The prevalence of LTBI was high among slaughterhouse workers (100%). Protozoal infection was found to be significantly associated with LTBI.
Objectives Methods Results Conclusion
Collapse
|
9
|
Singh R, Shaheer M, Sobhia ME. Molecular dynamic assisted investigation on impact of mutations in deazaflavin dependent nitroreductase against pretomanid: a computational study. J Biomol Struct Dyn 2022:1-23. [PMID: 35574601 DOI: 10.1080/07391102.2022.2069156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In the past decade, TB drugs belonging to the nitroimidazole class, pretomanid and delamanid, have been authorised to treat MDR-TB and XDR-TB. With a novel inhibition mechanism and a reduction in the span of treatment, it is now being administered in various combinations. This approach is not the ultimate remedy since the target protein Deazaflavin dependent nitroreductase (Ddn) has a high mutation frequency, and already pretomanid resistant clinical isolates are reported in various studies. Ddn is essential for M.tuberculosis to emerge from hypoxia, and point mutations in critical residues confer resistance to Nitro-imidazoles. Among the pool of available mutants, we have selected seven mutants viz DdnL49P, DdnY65S, DdnS78Y, DdnK79Q, DdnW88R, DdnY133C, and DdnY136S, all of which exhibited resistance to pretomanid. To address this issue, through computational study primarily by MD simulation, we attempted to elucidate these point mutations' impact and investigate the resistance mechanism. Hence, the DdnWT and mutant (MT) complexes were subjected to all-atom molecular dynamics (MD) simulations for 100 ns. Interestingly, we observed the escalation of the distance between cofactor and ligand in some mutants, along with a significant change in ligand conformation relative to the DdnWT. Moreover, we confirmed that mutations rendered ligand instability and were ejected from the binding pocket as a result. In conclusion, the results obtained provide a new structural insight and vital clues for designing novel inhibitors to combat nitroimidazole resistanceCommunicated by Ramaswamy H. Sarma.
Collapse
Affiliation(s)
- Ravi Singh
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research (NIPER), Punjab, India
| | - Muhammed Shaheer
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research (NIPER), Punjab, India
| | - M Elizabeth Sobhia
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research (NIPER), Punjab, India
| |
Collapse
|
10
|
Martinson NA, Lebina L, Webb EL, Ratsela A, Varavia E, Kinghorn A, Lala SG, Golub JE, Bosch Z, Motsomi KP, MacPherson P. Household contact tracing with intensified tuberculosis and HIV screening in South Africa: a cluster randomised trial. Clin Infect Dis 2021; 75:849-856. [PMID: 34950944 PMCID: PMC9477445 DOI: 10.1093/cid/ciab1047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background Household contact tracing for tuberculosis (TB) may facilitate diagnosis and access to TB preventive treatment (TPT). We investigated whether household contact tracing and intensive TB/human immunodeficiency virus (HIV) screening would improve TB-free survival. Methods Household contacts of index TB patients in 2 South African provinces were randomized to home tracing and intensive HIV/TB screening or standard of care (SOC; clinic referral letters). The primary outcome was incident TB or death at 15 months. Secondary outcomes included tuberculin skin test (TST) positivity in children ≤14 years and undiagnosed HIV. Results From December 2016 through March 2019, 1032 index patients (4459 contacts) and 1030 (4129 contacts) were randomized to the intervention and SOC arms. Of intervention arm contacts, 3.2% (69 of 2166) had prevalent microbiologically confirmed TB. At 15 months, the cumulative incidence of TB or death did not differ between the intensive screening (93 of 3230, 2.9%) and SOC (80 of 2600, 3.1%) arms (hazard ratio, 0.90; 95% confidence interval [CI], .66–1.24). TST positivity was higher in the intensive screening arm (38 of 845, 4.5%) compared with the SOC arm (15 of 800, 1.9%; odds ratio, 2.25; 95% CI, 1.07–4.72). Undiagnosed HIV was similar between arms (41 of 3185, 1.3% vs 32 of 2543, 1.3%; odds ratio, 1.02; 95% CI, .64–1.64). Conclusions Household contact tracing with intensive screening and referral did not reduce incident TB or death. Providing referral letters to household contacts of index patients is an alternative strategy to home visits. Clinical Trials Registration ISRCTN16006202.
Collapse
Affiliation(s)
- Neil A Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa.,Johns Hopkins University Center for TB Research, Baltimore, MD
| | - Limakatso Lebina
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Emily L Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, UK
| | - Andrew Ratsela
- Department of Internal Medicine, University of Limpopo, Polokwane, South Africa
| | - Ebrahim Varavia
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine. Klerksdorp Tshepong Hospital Complex, North West Provincial Department of Health, and University of the Witwatersrand, South Africa
| | - Anthony Kinghorn
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, University of the Witwatersrand, South Africa
| | | | - Zama Bosch
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Kegaugetswe P Motsomi
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Peter MacPherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, UK.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Malawi.,Clinical Research Department, London School of Hygiene and Tropical Medicine
| |
Collapse
|
11
|
Krishnamoorthy Y, Ezhumalai K, Murali S, Rajaa S, Jose M, Sathishkumar A, Soundappan G, Horsburgh C, Hochberg N, Johnson WE, Knudsen S, Salgame P, Ellner J, Prakash Babu S, Sarkar S. Prevalence and risk factors associated with latent tuberculosis infection among household contacts of smear positive pulmonary tuberculosis patients in South India. Trop Med Int Health 2021; 26:1645-1651. [PMID: 34654061 DOI: 10.1111/tmi.13693] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to determine the prevalence and find the risk factors associated with latent tuberculosis infection (LTBI) among the household contacts (HHC) of pulmonary TB patients. METHODS This cohort study was conducted from 2014 to 2019. Pretested standardised questionnaires and tools were used for data collection. The prevalence of LTBI among HHCs of TB patients was summarised as proportion with 95% confidence interval (CI). Mixed-effects generalised linear modelling function (meglm) in STATA with family Poisson and log link was performed to find the factors associated with LTBI. RESULTS In total, 1523 HHC of pulmonary TB patients were included in the study. Almost all HHC shared their residence with the index case (IC) for more than a year; 25% shared the same bed with the IC. The prevalence of LTBI among the HHC of TB patients was 52.6% (95% CI: 50.1-55.1%). In an adjusted model, we found that among HHC belonging to the age group of 19-64 years (aIRR = 1.2; 95% CI: 1.1-1.3; p-value: 0.02), to the age group >65 years (aIRR = 1.4, 95% CI: 1.1-1.9, p-value: 0.02) and sharing the same bed with the IC (aIRR = 1.2, 95% CI: 1.1-1.3, p value: 0.04) were independent determinants of LTBI among the HHC. CONCLUSION One in two household contacts of TB patients have latent tuberculosis infection. This underscores the need of targeted contact screening strategies, effective contact tracing and testing using standardised methods in high TB burden settings.
Collapse
Affiliation(s)
| | - Komala Ezhumalai
- Department of Preventive & Social Medicine, JIPMER, Puducherry, India
| | - Sharan Murali
- Department of Preventive & Social Medicine, JIPMER, Puducherry, India
| | - Sathish Rajaa
- Department of Preventive & Social Medicine, JIPMER, Puducherry, India
| | - Maria Jose
- Department of Preventive & Social Medicine, JIPMER, Puducherry, India
| | | | | | - Charles Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Natasha Hochberg
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts, USA
| | - William Evan Johnson
- Department of Medicine and Biostatistics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Selby Knudsen
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Padmini Salgame
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jerrold Ellner
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | - Sonali Sarkar
- Department of Preventive & Social Medicine, JIPMER, Puducherry, India
| |
Collapse
|
12
|
Alemu A, Wubie Aycheh M, Dilnessa T. Tuberculosis and Human Immunodeficiency Virus Co-Infection and Associated Factors at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia: A Four-Year Retrospective Study. HIV AIDS (Auckl) 2021; 13:293-299. [PMID: 33758551 PMCID: PMC7979325 DOI: 10.2147/hiv.s284034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/03/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) and tuberculosis (TB) are the principal global causes of death among patients with communicable diseases. Because of shared immune defense mechanisms, they are the primary cause of morbidity worldwide. However, little information was found regarding the magnitude of TB/HIV co-infection in the study area, in Northwest Ethiopia. OBJECTIVE The main aim of this study was to assess the prevalence of TB and HIV co-infection and associated factors among TB patients. METHODS All TB patients at Debre Markos Comprehensive Specialized Hospital were included from September 11, 2012 to September 10, 2016. Data were analyzed using SPSS version 22. Logistic regression was used to determine the associations between independent and outcome variables. RESULTS A total of 180 TB patients were enrolled. Pulmonary tuberculosis (PTB) accounted for 97/180 (53.9%), followed by extrapulmonary tuberculosis (EPTB) in 83/180 (46.1%). There were 164/180 (91.1%) new TB cases and 16/180 (8.9%) treatment failures, but no relapsing or defaulting cases were observed. Forty percent (72/180) of patients were co-infected with TB and HIV. The likelihoods of having TB/HIV co-infection were 3.2 and 2.1 times higher in PTB smear-positive and PTB smear-negative patients (AOR=3.2, 95% CI 1.4-8.1, p=0.006; and AOR=2.1, 95% CI 1.0-4.3, respectively, p=0.05), in comparison to EPTB. The rate of TB/HIV co-infection was 28/66 (42.4%) in 2013, 18/38 (47.4%) in 2014, 13/32 (40.6%) in 2015, and 13/44 (29.5%) in 2016. CONCLUSION TB/HIV co-infection showed a decreasing trend in the past 2 years in the study area. TB/HIV co-infection is one of the most serious community health concerns in the study area. Therefore, TB/HIV collaborative activities should be implemented to reduce co-infection and its impact on the community.
Collapse
Affiliation(s)
- Adugnaw Alemu
- School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Moges Wubie Aycheh
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tebelay Dilnessa
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| |
Collapse
|