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Coleman M, Hill J, Timeon E, Tonganibeia A, Eromanga B, Islam T, Trauer JM, Chambers ST, Christensen A, Fox GJ, Marks GB, Britton WJ, Marais BJ. Population-wide active case finding and prevention for tuberculosis and leprosy elimination in Kiribati: the PEARL study protocol. BMJ Open 2022; 12:e055295. [PMID: 35414551 PMCID: PMC9006843 DOI: 10.1136/bmjopen-2021-055295] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Population-wide interventions offer a pathway to tuberculosis (TB) and leprosy elimination, but 'real-world' implementation in a high-burden setting using a combined approach has not been demonstrated. This implementation study aims to demonstrate the feasibility and evaluate the effect of population-wide screening, treatment and prevention on TB and leprosy incidence rates, as well as TB transmission. METHODS AND ANALYSIS A non-randomised 'screen-and-treat' intervention conducted in the Pacific atoll of South Tarawa, Kiribati. Households are enumerated and all residents ≥3 years, as well as children <3 years with recent household exposure to TB or leprosy, invited for screening. Participants are screened using tuberculin skin testing, signs and symptoms of TB or leprosy, digital chest X-ray with computer-aided detection and sputum testing (Xpert MTB/RIF Ultra). Those diagnosed with disease are referred to the National TB and Leprosy Programme for management. Participants with TB infection are offered TB preventive treatment and those without TB disease or infection, or leprosy, are offered leprosy prophylaxis. The primary study outcome is the difference in the annual TB case notification rate before and after the intervention; a similar outcome is included for leprosy. The effect on TB transmission will be measured by comparing the estimated annual risk of TB infection in primary school children before and after the intervention, as a co-primary outcome used for power calculations. Comparison of TB and leprosy case notification rates in South Tarawa (the intervention group) and the rest of Kiribati (the control group) before, during and after the intervention is a secondary outcome. ETHICS AND DISSEMINATION Approval was obtained from the University of Sydney Human Research Ethics Committee (project no. 2021/127) and the Kiribati Ministry of Health and Medical Services (MHMS). Findings will be shared with the MHMS and local communities, published in peer-reviewed journals and presented at international conferences.
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Affiliation(s)
- Mikaela Coleman
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Tuberculosis Research Program, Centenary Institute Medical Research Foundation, Newtown, New South Wales, Australia
| | - Jeremy Hill
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Tuberculosis Research Program, Centenary Institute Medical Research Foundation, Newtown, New South Wales, Australia
| | - Eretii Timeon
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Alfred Tonganibeia
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Baraniko Eromanga
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Tauhid Islam
- Division of Programmes for Disease Control, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - James M Trauer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephen T Chambers
- The Pacific Leprosy Foundation, Christchurch, New Zealand
- Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Greg J Fox
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Warwick J Britton
- Department of Clinical Immunology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- The Centenary Institute at the University of Sydney, Camperdown, New South Wales, Australia
| | - Ben J Marais
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
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Roland HB, Curtis KJ. The Differential Influence of Geographic Isolation on Environmental Migration: A Study of Internal Migration Amidst Degrading Conditions in the Central Pacific. Popul Environ 2020; 42:161-182. [PMID: 34732946 PMCID: PMC8562694 DOI: 10.1007/s11111-020-00357-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study investigates how geographic isolation interacts with declining environmental and economic conditions in Kiribati, an island nation wherein which limited access to financial resources amidst degrading environmental conditions potentially constrain capital-intensive, long distance migration. We examine whether geographic isolation modifies the tenets of two dominant environmental migration theses. The environmental scarcity thesis suggests that environmental degradation prompts migration by urging households to reallocate labor to new environments. In contrast, the environmental capital thesis asserts that declining natural resource availability restricts capital necessary for migration. Results show that the commonly applied environmental scarcity thesis is less valid and the environmental capital thesis is more relevant in geographically isolated places. Findings indicate that geographic isolation is an important dimension along which migration differences emerge. As overall environmental and economic conditions worsen, likelihoods of out-migration from less remote islands increase whereas likelihoods of out-migration from more isolated islands decrease.
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Affiliation(s)
- Hugh B Roland
- Nelson Institute for Environmental Studies, University of Wisconsin-Madison, 122 Science Hall 550 North Park Street, Madison, WI 53706
| | - Katherine J Curtis
- Community and Environmental Sociology, University of Wisconsin-Madison, 316B Agricultural Hall 1450 Linden Drive, Madison, WI 53706
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Mollel EW, Maokola W, Todd J, Msuya SE, Mahande MJ. Incidence Rates for Tuberculosis Among HIV Infected Patients in Northern Tanzania. Front Public Health 2019; 7:306. [PMID: 31709218 PMCID: PMC6821649 DOI: 10.3389/fpubh.2019.00306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Received: 07/19/2019] [Accepted: 10/07/2019] [Indexed: 12/21/2022] Open
Abstract
Background: HIV and tuberculosis (TB) are leading infectious diseases, with a high risk of co-infection. The risk of TB in people living with HIV (PLHIV) is high soon after sero-conversion and increases as the CD4 counts are depleted. Methodology: We used routinely collected data from Care and Treatment Clinics (CTCs) in three regions in northern Tanzania. All PLHIV attending CTCs between January 2012 to December 2017 were included in the analysis. TB incidence was defined as cases started on anti-TB medications divided by the person-years of follow-up. Poisson regression with frailty models were used to determine incidence rate ratios (IRR) and 95% confidence intervals (95% CI) for predictors of TB incidences among HIV positive patients. Results: Among 78,748 PLHIV, 405 patients developed TB over 195,296 person-years of follow-up, giving an overall TB incidence rate of 2.08 per 1,000 person-years. There was an increased risk of TB incidence, 3.35 per 1,000 person-years, in hospitals compared to lower level health facilities. Compared to CD4 counts of <350 cells/μl, a high CD4 count was associated with lower TB incidence, 81% lower for a CD4 count of 350–500 cells/μl (IRR 0.19, 95% CI 0.04–0.08) and 85% lower for those with a CD4 count above 500 cells/μl (IRR 0.15, 95% CI 0.04–0.64). Independently, those taking ART had 66% lower TB incidences (IRR 0.34, 95% CI 0.15–0.79) compared to those not taking ART. Poor nutritional status and CTC enrollment between 2008 and 2012 were associated with higher TB incidences IRR 9.27 (95% CI 2.15–39.95) and IRR 2.97 (95% CI 1.05–8.43), respectively. Discussion: There has been a decline in TB incidence since 2012, with exception of the year 2017 whereby there was higher TB incidence probably due to better diagnosis of TB following a national initiative. Among HIV positive patients attending CTCs, poor nutritional status, low CD4 counts and not taking ART treatment were associated with higher TB incidence, highlighting the need to get PLHIV on treatment early, and the need for close monitoring of CD4 counts. Data from routinely collected and available health services can be used to provide evidence of the epidemiological risk of TB.
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Affiliation(s)
- Edson W Mollel
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Northern Zone Blood Transfusion Center, Moshi, Tanzania
| | - Werner Maokola
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,National AIDS Control Program, Dar es Salaam, Tanzania
| | - Jim Todd
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sia E Msuya
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Community Medicine, KCMC Hospital, Moshi, Tanzania
| | - Michael J Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Lin C, Russell C, Soll B, Chow D, Bamrah S, Brostrom R, Kim W, Scott J, Bankowski MJ. Increasing Prevalence of Nontuberculous Mycobacteria in Respiratory Specimens from US-Affiliated Pacific Island Jurisdictions 1. Emerg Infect Dis 2019; 24:485-491. [PMID: 29460734 PMCID: PMC5823340 DOI: 10.3201/eid2403.171301] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nontuberculous mycobacteria (NTM) respiratory infections represent a growing public health problem in many countries. However, there are limited published epidemiologic studies for the Western Pacific region. We reviewed respiratory specimens submitted to Diagnostic Laboratory Services in Hawaii, USA, for culture of Mycobacterium tuberculosis during August 2007–December 2011 to determine the NTM isolation rate. We observed a statistically significant increase in the rate of specimens with NTM isolated in respiratory culture (adjusted rate ratio per year 1.65, 95% CI 1.54–1.77; p<0.01). In contrast, the number of patients with respiratory cultures positive for M. tuberculosis showed no increase (adjusted rate ratio per year 0.98, 95% CI 0.94–1.01; p = 0.19). A 6-month subset of NTM isolates was identified by using a nucleic acid probe or 16S rRNA sequencing. M. avium complex and M. fortuitum were the most common NTM identified.
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