scholarly journals Source Case Investigation for Children with TB Disease in Pune, India

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Debalina De ◽  
Aarti Kinikar ◽  
P. S. Adhav ◽  
Sunanda Kamble ◽  
Prasanna Sahoo ◽  
...  
Keyword(s):  
Preventive Therapy ◽  
Contact Tracing ◽  
Cross Sectional ◽  
Missed Opportunities ◽  
Tb Treatment ◽  
Resource Limited ◽  
Source Case ◽  
Pediatric Tb ◽  
Index Cases ◽  
Special Risk

Setting.Contact tracing is broadly encouraged for tuberculosis (TB) control. In many high-burden countries, however, little effort is made to identify contacts of newly diagnosed TB patients. This failure puts children, many of whom live in poor crowded communities, at special risk.Objectives.To perform source-case investigations for 50 pediatric TB cases in Pune, India.Design.A descriptive cross-sectional observational study of pediatric TB cases < 5 years of age. Information was collected about the index case and household contacts.Results.In 15 (30%) of the 50 pediatric index cases, the household contained known TB contacts, 14 (86%) of whom were adults. Prior to their own diagnosis of TB, only one of the 15 pediatric index cases who met criteria for isoniazid preventive therapy received it. The index cases with known household TB contacts had a longer delay in initiating TB treatment than those without TB contacts (17.5 versus 2 days;P=0.03). Use of contact tracing identified 14 additional household TB suspects, 8 (57%) of whom were children.Conclusions.This study identified missed opportunities for TB prevention, as contact tracing is poorly implemented in resource-limited countries, like India. Further strategies to improve the implementation of TB prevention, especially in young children, are urgently needed.

scholarly journals Isoniazid Preventative Therapy uptake for child household contacts of tuberculosis index cases, Kisumu County, Kenya, 2014-2015

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Barbara Burmen ◽  
Kennedy Mutai ◽  
Timothy Malika
Keyword(s):  
Cross Sectional Study ◽  
Diagnostic Tools ◽  
Case Detection ◽  
Preventative Therapy ◽  
Cross Sectional ◽  
Worker Training ◽  
Household Contacts ◽  
Isoniazid Preventative Therapy ◽  
Pediatric Tb ◽  
Index Cases

Isoniazid Preventative Therapy (IPT) is recommended for children aged less than 5 years that have been in contact with an open case of TB, and screen negative for TB, to prevent the risk of TB progression. We examined IPT uptake among child household contacts of TB index cases, within a TB case detection study, in a high TB burden region. A cross-sectional study involving all IPT-eligible children drawn from a TB case detection study was done in Kisumu County, Kenya between 2014 and 2015. By linking a subset of the study database to the TB program IPT register, we described Child contacts as initiated on IPT and TB index cases as having child contacts initiated on IPT based on whether their names or their child contacts names respectively, were found in the IPT register. Logistic regression analysis was used to describe index and contact characteristics associated with IPT initiation. Of 555 TB index cases recruited into the study, 243 (44%) had a total of 337 IPT-eligible child contacts. Forty-seven (19%) index cases that had child contacts initiated on IPT; they were more likely to have been diagnosed with smear positive TB compared to those who were diagnosed with smear negative TB (OR 5.1, 95% CI 1.1-23.2; P=0.03) and to reside in rural Kisumu compared to those in urban Kisumu (OR 3.3, 95% CI 1.6-6.8; P<0.01). The 51 (15%) child contacts that were initiated on IPT were more likely to be were first degree relatives of the index case compared to those who were not (OR 2.6, 95% CI 1.2-5.5; P=0.02) and to reside in rural Kisumu compared to those in urban Kisumu (OR 2.6, 95% CI 1.2-5.1; P<0.01). IPT initiation, which is influenced by index and contact characteristics, is suboptimal. The TB program should provide health worker training, avail appropriate pediatric TB diagnostic tools, job aids and monitoring tools, and ensure continuous supply of medication, and to facilitate IPT implementation. Additionally, targeted health education interventions should be formulated to reach those who are unlikely to accept IPT.

scholarly journals Missed opportunities for tuberculosis investigation in a municipal hospital in Ghana: evidence from patient exit interviews

2020 ◽  
Author(s):  
Joyce B Der ◽  
Daniel J Grint ◽  
Clement T Narh ◽  
Frank Bonsu ◽  
Alison D Grant
Keyword(s):  
Multivariable Analysis ◽  
Cross Sectional Study ◽  
Hiv Positive ◽  
Symptom Duration ◽  
Hiv Status ◽  
Cross Sectional ◽  
Missed Opportunities ◽  
Tb Treatment ◽  
Symptom Screening ◽  
Night Sweats

Abstract Background We assessed coverage of symptom screening and sputum testing for tuberculosis (TB) in hospital outpatient clinics in Ghana. Methods In a cross-sectional study, we enrolled adults (≥18 years) exiting the clinics reporting ≥1 TB symptom (cough, fever, night sweats or weight loss). Participants reporting a cough ≥2 weeks or a cough of any duration plus ≥2 other TB symptoms (per national criteria) and those self-reporting HIV-positive status were asked to give sputum for testing with Xpert MTB/RIF. Results We enrolled 581 participants (median age 33 years [IQR: 24–48], 510/581 [87.8%] female). The most common symptoms were fever (348, 59.9%), chest pain (282, 48.5%) and cough (270, 46.5%). 386/581 participants (66.4%) reported symptoms to a healthcare worker, of which 157/386 (40.7%) were eligible for a sputum test per national criteria. Only 31/157 (19.7%) had a sputum test requested. Thirty-two additional participants gave sputum among 41 eligible based on positive HIV status. In multivariable analysis, symptom duration ≥2 weeks (adjusted odds ratio [aOR] 6.99, 95% confidence interval [CI] 2.08–23.51) and previous TB treatment (aOR: 6.25, 95% CI: 2.24–17.48) were the strongest predictors of having a sputum test requested. 6/189 (3.2%) sputum samples had a positive Xpert MTB/RIF result. Conclusion Opportunities for early identification of people with TB are being missed in health facilities in Ghana.

scholarly journals Yield of Systematic Longitudinal Screening of Household Contacts of Pre-Extensively Drug Resistant (PreXDR) and Extensively Drug Resistant (XDR) Tuberculosis Patients in Mumbai, India

2020 ◽  
Vol 5 (2) ◽  
pp. 83
Author(s):  
Roma Haresh Paryani ◽  
Vivek Gupta ◽  
Pramila Singh ◽  
Madhur Verma ◽  
Sabira Sheikh ◽  
...  
Keyword(s):  
Contact Tracing ◽  
Drug Resistant ◽  
Household Contacts ◽  
Tb Treatment ◽  
Extensively Drug Resistant ◽  
High Incidence ◽  
Resistance Patterns ◽  
One Year ◽  
Index Cases

While risk of tuberculosis (TB) is high among household contacts (HHCs) of pre-extensively drug resistant (pre-XDR) TB and XDR-TB, data on yield of systematic longitudinal screening are lacking. We aim to describe the yield of systematic longitudinal TB contact tracing among HHCs of patients with pre-XDR-TB and XDR-TB. At the Médecins Sans Frontières (MSF) clinic, Mumbai, India a cohort comprising 518 HHCs of 109 pre-XDR and XDR index cases was enrolled between January 2016 and June 2018. Regular HHC follow-ups were done till one year post treatment of index cases. Of 518 HHCs, 23 had TB (21 on TB treatment and two newly diagnosed) at the time of first visit. Of the rest, 19% HHCs had no follow-ups. Fourteen (3.5%) TB cases were identified among 400 HHCs; incidence rate: 2072/100,000 person-years (95% CI: 1227–3499). The overall yield of household contact tracing was 3% (16/518). Of 14 who were diagnosed with TB during follow-up, six had drug susceptible TB (DSTB); six had pre-XDR-TB and one had XDR-TB. Five of fourteen cases had resistance patterns concordant with their index case. In view of the high incidence of TB among HHCs of pre-XDR and XDR-TB cases, follow-up of HHCs for at least the duration of index cases’ treatment should be considered.

scholarly journals Isoniazid preventative therapy uptake for child household contacts of TB index cases, Kisumu County, Kenya, 2014-2015

2018 ◽  
Vol 9 (1) ◽  
Author(s):  
Barbara Burmen ◽  
Kennedy Mutai ◽  
Timothy Malika
Keyword(s):  
Cross Sectional Study ◽  
Diagnostic Tools ◽  
Case Detection ◽  
Preventative Therapy ◽  
Cross Sectional ◽  
Worker Training ◽  
Household Contacts ◽  
Isoniazid Preventative Therapy ◽  
Pediatric Tb ◽  
Index Cases

Background Isoniazid Preventative Therapy (IPT) is recommended for children aged less than 5 years that have been in contact with an open case of TB and screen negative for TB to prevent the risk of TB progression. We examined IPT uptake among child household contacts of TB index cases within a TB case detection study in a high TB burden region. Methods A cross-sectional study involving all IPT eligible children drawn from a TB case detection study was done in Kisumu County, Kenya between 2014 and 2015. By linking a subset study database to the TB program IPT register, we described Child contacts as ‘initiated on IPT’ and TB index cases as ‘having child contacts initiated on IPT’ based on whether their names or their child contacts names respectively, were found in the IPT register. Logistic regression analysis was used to describe index and contact characteristics associated with IPT initiation Results Of 555 TB index cases into the study, 243 (44%) had a total of 337 IPT-eligible child household contacts. Forty-seven (19%) index cases that had child contacts initiated on IPT; they were more likely to have been diagnosed with smear positive TB compared to those who were diagnosed with smear negative TB (OR 5.1, 95% CI 1.1-23.2; p=0.03) and to reside in rural Kisumu compared to those in urban Kisumu (OR 3.3, 05% CI 1.6-6.8; p<0.01). The 51 (15%) child contacts that were initiated on IPT were more likely to be were first degree relatives of the index case compared to those who were not (OR 2.6, 95% CI 1.2-5.5; p=0.02) and to reside in rural Kisumu compared to those in urban Kisumu (OR 2.6, 95% CI 1.2-5.1; p<0.01). Conclusion IPT initiation, which is influenced by index and contact characteristics, is suboptimal. The TB program should provide health worker training, avail appropriate pediatric TB diagnostic tools and continuous supply of medication, and job aids and monitoring tools to facilitate IPT implementation. Additionally, targeted health education interventions should be formulated to reach those who are unlikely to accept IPT.

scholarly journals Assessment of the Isoniazid Preventive Therapy Uptake and Associated Characteristics: A Cross-Sectional Study

2018 ◽  
Vol 2018 ◽  
pp. 1-9
Author(s):  
Francine Mwayuma Birungi ◽  
Stephen Graham ◽  
Jeannine Uwimana ◽  
Brian van Wyk
Keyword(s):  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
Sputum Smear ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Health Centres ◽  
Index Cases

Objective. To assess the uptake of isoniazid preventive therapy (IPT) by eligible children in Kigali, Rwanda, and associated individual, households, and healthcare systems characteristics. Methods. A cross-sectional study was conducted among child contacts of index cases having sputum smear-positive pulmonary tuberculosis. Data were collected from 13 selected primary health centres. Descriptive statistics were used to generate frequency tables and figures. Logistic regression models were performed to determine characteristics associated with IPT uptake. Results. Of 270 children (under 15 years), who were household contacts of 136 index cases, 94 (35%) children were less than 5 years old and eligible for IPT; and 84 (89%, 95% CI 81–94) were initiated on IPT. The reasons for not initiating IPT in the remaining 10 children were parents/caregivers’ lack of information on the need for IPT, refusal to give IPT to their children, and poor quality services offered at health centres. Factors associated with no uptake of IPT included children older than 3 years, unfriendly healthcare providers, HIV infected index cases, and the index case not being the child’s parent. Conclusion. The National Tuberculosis Program’s policy on IPT delivery was effectively implemented. Future interventions should find strategies to manage factors associated with IPT uptake.

scholarly journals Willingness to Take Multidrug-resistant Tuberculosis (MDR-TB) Preventive Therapy Among Adult and Adolescent Household Contacts of MDR-TB Index Cases: An International Multisite Cross-sectional Study

2019 ◽  
Vol 70 (3) ◽  
pp. 436-445
Author(s):  
Nishi Suryavanshi ◽  
Matthew Murrill ◽  
Amita Gupta ◽  
Michael Hughes ◽  
Anneke Hesseling ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Preventive Therapy ◽  
Sectional Study ◽  
Cross Sectional ◽  
Household Contacts ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Index Cases

Abstract Background Household contacts (HHCs) of individuals with multidrug-resistant tuberculosis (MDR-TB) are at high risk of infection and subsequent disease. There is limited evidence on the willingness of MDR-TB HHCs to take MDR-TB preventive therapy (MDR TPT) to decrease their risk of TB disease. Methods In this cross-sectional study of HHCs of MDR-TB and rifampicin-resistant tuberculosis (RR-TB) index cases from 16 clinical research sites in 8 countries, enrollees were interviewed to assess willingness to take a hypothetical, newly developed MDR TPT if offered. To identify factors associated with willingness to take MDR TPT, a marginal logistic model was fitted using generalized estimating equations to account for household-level clustering. Results From 278 MDR-TB/RR-TB index case households, 743 HHCs were enrolled; the median age of HHCs was 33 (interquartile range, 22–49) years, and 62% were women. HHC willingness to take hypothetical MDR TPT was high (79%) and remained high even with the potential for mild side effects (70%). Increased willingness was significantly associated with current employment or schooling (adjusted odds ratio [aOR], 1.83 [95% confidence interval {CI}, 1.07–3.13]), appropriate TB-related knowledge (aOR, 2.22 [95% CI, 1.23–3.99]), confidence in taking MDR TPT (aOR, 7.16 [95% CI, 3.33–15.42]), and being comfortable telling others about taking MDR TPT (aOR, 2.29 [95% CI, 1.29–4.06]). Conclusions The high percentage of HHCs of MDR-TB/RR-TB index cases willing to take hypothetical MDR TPT provides important evidence for the potential uptake of effective MDR TPT when implemented. Identified HHC-level variables associated with willingness may inform education and counseling efforts to increase HHC confidence in and uptake of MDR TPT.

scholarly journals A mortality review of tuberculosis and HIV co-infected patients in Mahalapye, Botswana: Does cotrimoxazole preventive therapy and/or antiretroviral therapy protect against death?

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Stephane Tshitenge ◽  
Gboyega A. Ogunbanjo ◽  
Andre Citeya
Keyword(s):  
Antiretroviral Therapy ◽  
Mortality Rate ◽  
Health Management ◽  
Cross Sectional Study ◽  
Preventive Therapy ◽  
World Health ◽  
District Health ◽  
Cross Sectional ◽  
Tb Treatment ◽  
Health Organization

Background: The World Health Organization aims to reduce tuberculosis (TB) mortality rate from 15% in 2015 to 6.5% by 2025.Aim: This study determined the profile of TB and human immunodeficiency virus (HIV) co-infected patients who died in Mahalapye District, Botswana, while on anti-TB medication and the factors that contributed to such outcome.Setting: The study was conducted in the Mahalapye Health District in Botswana.Methods: This was a cross-sectional study that reviewed patient records from the Mahalapye District Health Management Team Electronic Tuberculosis Register from January 2013 to December 2015.Results: The majority of the TB and HIV co-infected patients were on antiretroviral therapy (ART) (486 [81.63%]) or were initiated cotrimoxazole preventive therapy (CPT) (518 [87.2%]) while taking anti-TB treatment. Seventy-three (13.6%) TB and HIV co-infected patients died before completing anti-TB treatment. Three-quarters (54 [74.4%]) of patients who died before completing anti-TB treatment were on ART, among them two patients who were on ART at least 3 months prior to commencing anti-TB. Also, the majority (64 [87.7%]) of TB and HIV co-infected patients were commenced on CPT prior to death. There was a bimodal density curve of death occurrence in those who did not commence ART and in those who did not commence CPT.Conclusion: This study established that TB and HIV co-infected patients had a TB mortality of 13.6%. A high mortality rate was observed during the first 3 months in those who did not take ART and during the second and the fifth month in those who did not commence CPT. Further study is needed to clarify this matter.

scholarly journals New approach for tuberculosis contact tracing implemented in the two regions of Kyrgyz Republic during 2017-2018

2020 ◽  
Vol 14 (11.1) ◽  
pp. 109S-115S
Author(s):  
Bakyt Dzhangaziev ◽  
Aizat Kulzhabaeva ◽  
Nune Truzyan ◽  
Abdykadyr Zhoroev ◽  
Dinagul Otorbaeva ◽  
...  
Keyword(s):  
Contact Tracing ◽  
Kyrgyz Republic ◽  
National Guidelines ◽  
Cross Sectional ◽  
New Approach ◽  
Tb Control ◽  
Contact Investigation ◽  
The Mean ◽  
Index Cases ◽  
Close Contacts

Introduction: Tuberculosis (TB) contact investigation as a proved approach for finding new TB cases, is not fully performed in Kyrgyzstan. In 2018, the country started aligning the National Guidelines for tracking contacts with the WHO recommendations by expanding the definition for TB index cases to all close contacts, regardless of their TB risk status. Methodology: This cross-sectional census aimed to determine the active case detection changes among TB contacts after implementation of a new TB tracing strategy using the National Surveillance data. We compared populations in Chui and Issyk-Kul regions of Kyrgyzstan who had contacts with TB index cases before (2017) and after (2018) strategic changes for the rates of indexes, contacts, screened contacts, and detected TB among screened contacts. Results: New TB tracing strategy resulted in increased numbers of indexes (21%) and contacts (36%). Though the smaller number of contacts (1730 vs. 1590) have been screened in 2018, the proportion of TB diagnosed was substantially higher (95% CI: 0.024-0.005; p = 0.002) in 2018 vs. 2017. The mean numbers of TB contacts per-one-index-case also has increased dramatically by 117% (1.8 vs. 3.9) in Chui and by 43% (3.0 vs. 4.3) in Issyk-Kul regions (95% CI: 3.20-3.37; p < 0.001 and 95% CI: 2.97-3.09; p < 0.001, respectively) between 2018 and 2017. Conclusion: Extending new tracing approach to other regions of Kyrgyzstan will increase the number of identified contacts, leading to better TB control in the country and prevention of more severe TB development among the unidentified contacts.

scholarly journals Evaluation of directly observed treatment for tuberculosis in the Bojanala health district, North West Province of South Africa

2011 ◽  
Vol 3 (1) ◽  
Author(s):  
John M. Tumbo ◽  
Gboyega A. Ogunbanjo
Keyword(s):  
South Africa ◽  
Control Strategies ◽  
Health District ◽  
World Health ◽  
Contact Tracing ◽  
Cross Sectional ◽  
North West ◽  
Tb Treatment ◽  
North West Province ◽  
Directly Observed Treatment

Background: Tuberculosis (TB) remains one of the top public health problems in South Africa. Approximately 150 000 new cases and 10 000 TB-related deaths are reported in South Africa annually. In declaring TB a global emergency in 1993, the World Health Organization developed control strategies that include active case finding, laboratory support, directly observed treatment (DOT), contact tracing, and prevention of multidrug– and extreme drugresistant tuberculosis (MDR-TB and XDR-TB). High DOT rates reported in some countries have been discordant with ‘low cure’ and ‘high MDR’ rates.Objectives: The aim of the study was to evaluate the use of DOT for TB in the Bojanala health district, North West Province, South Africa, by estimating the proportion of DOT use (1) amongst all TB patients and (2) in the initial TB treatment regimen compared to retreatment regimens.Method: A cross-sectional, descriptive study was conducted in 2008. Data regarding implementation of DOT were collected from eight purposefully selected primary health care clinics and one prison clinic in the health district. Upon receiving their informed consent, a questionnaire was administered to patients receiving TB treatment at the selected facilities.Results: A total of 88 (of 90 selected) patients participated in the study, of whom 50(56.8%) were on DOT and had DOT supporters. However, 35 (40%) had never heard of DOT. DOT was used mainly for patients on the retreatment regimen (87.5%), rather than for those on first-line treatment (48.6%).Conclusion: In this South African rural health district, the DOT utilisation rate for TB was 56.8%, mainly for patients on the TB retreatment regimen. Strict implementation of DOT in all patients undergoing TB treatment is a known strategy for improving TB cure rate and preventing recurrence and drug resistance.

scholarly journals Should NICE reconsider the 2016 UK guidelines on TB contact tracing? A cost-effectiveness analysis of contact investigations in London

Thorax ◽  
2018 ◽  
Vol 74 (2) ◽  
pp. 185-193 ◽  
Author(s):  
Sean M Cavany ◽  
Emilia Vynnycky ◽  
Charlotte S Anderson ◽  
Helen Maguire ◽  
Frank Sandmann ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Contact Tracing ◽  
National Guidelines ◽  
Cross Sectional ◽  
Life Years ◽  
The Uk ◽  
The Cost ◽  
Sectional Analysis ◽  
Index Cases

BackgroundIn January 2016, clinical TB guidance in the UK changed to no longer recommend screening contacts of non-pulmonary, non-laryngeal (ETB) index cases. However, no new evidence was cited for this change, and there is evidence that screening these contacts may be worthwhile. The objective of this study was to estimate the cost-effectiveness of screening contacts of adult ETB cases and adult pulmonary or laryngeal TB (PTB) cases in London, UK.MethodsWe carried out a cross-sectional analysis of data collected on TB index cases and contacts in the London TB register and an economic evaluation using a static model describing contact tracing outcomes. Incremental cost-effectiveness ratios (ICERs) were calculated using no screening as the baseline comparator. All adult TB cases (≥15 years old) in London from 2012 to 2015, and their contacts, were eligible (2465/5084 PTB and 2559/6090 ETB index cases were included).ResultsAssuming each contact with PTB infects one person/month, the ICER of screening contacts of ETB cases was £78 000/quality-adjusted life-years (QALY) (95% CI 39 000 to 140 000), and screening contacts of PTB cases was £30 000/QALY (95% CI 18 000 to 50 000). The ICER of screening contacts of ETB cases was £30 000/QALY if each contact with PTB infects 3.4 people/month. Limitations of this study include the use of self-reported symptomatic periods and lack of knowledge about onward transmission from PTB contacts.ConclusionsScreening contacts of ETB cases in London was almost certainly not cost-effective at any conventional willingness-to-pay threshold in England, supporting recent changes to National Institute for Health and Care Excellence national guidelines.

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