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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Infectious Disease Epidemiology".

Deadline for manuscript submissions: closed (28 February 2022) | Viewed by 33918

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Dr. Ibou Thior

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PATH, Washington, DC 20001, USA
Interests: HIV; AIDS; infectious disease epidemiology

Special Issue Information

Dear Colleagues,

A Special Issue entitled “Addressing gaps in tuberculosis program implementation" in the International Journal of Environmental Research and Public Health is being planned. For detailed information on the journal, please use the following link https://0-www-mdpi-com.brum.beds.ac.uk/journal/ijerph.

According to the World Health Organization, prior to the COVID-19 pandemic, many countries were experiencing a reduction in tuberculosis incidence and mortality. However, the latest global tuberculosis report shows that there was still a large gap in TB notifications, bacteriologically confirmed cases, detection and treatment of MDR/RR-TB. A substantial scale-up of TB preventive services is needed to reduce the risk of TB infection progressing to active disease. Although funding has doubled since 2006, it has fallen far short of what is needed.

Program managers, public health specialists and researchers in the tuberculosis field have been looking at innovative tools or interventions to address the different programmatic gaps and to mitigate the negative impact of COVID-19.

The keywords listed below provide an outline of some of the possible areas of interest.

Dr. Ibou Thior
Guest Editor

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Keywords

case finding
pediatric TB
diagnostic test
latent TB infection
laboratory monitoring
MDR-TB
treatment
program implementation
program management
COVID-19
cost effectiveness
financing
treatment adherence
gaps
capacity building
public private partnership
monitoring and evaluation
operational research

Published Papers (11 papers)

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Research

15 pages, 347 KiB

Open AccessArticle

Tuberculosis Co-Infection Is Common in Patients Requiring Hospitalization for COVID-19 in Belarus: Mixed-Methods Study

by Yuliia Sereda, Oleksandr Korotych, Dzmitry Klimuk, Dzmitry Zhurkin, Varvara Solodovnikova, Malgorzata Grzemska, Viatcheslav Grankov, Hennadz Hurevich, Askar Yedilbayev and Alena Skrahina

Int. J. Environ. Res. Public Health 2022, 19(7), 4370; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19074370 - 05 Apr 2022

Cited by 8 | Viewed by 1957

Abstract

A significant drop in tuberculosis (TB) case-finding has been widely reported during the period of the COVID-19 pandemic. To address a decrease in TB notification, Belarus introduced laboratory TB testing in patients with the laboratory-confirmed coronavirus disease 2019 (COVID-19). We conducted a secondary analysis of health records among 844 patients with laboratory-confirmed COVID-19 diagnosis who were admitted to repurposed departments at TB hospitals and who were tested by Xpert MTB/RIF (Cepheid Inc., Sunnyvale, CA, USA) in five Belarus regions between April and October 2021. Quantitative analysis followed by 13 individual interviews with health managers, physicians, and nurses participating in the intervention. Most patients were male (64%) and mean age was 43.5 ± 16 years. One in twenty (n = 47, 5.6%) patients were co-infected with active pulmonary TB, and over one-third of them (n = 18) had rifampicin resistance. In-hospital mortality was comparable in patients with and without TB co-infection (2.1% and 2.3% respectively, p > 0.99). Laboratory TB testing among patients with COVID-19 at repurposed departments of TB hospitals is feasible in Belarus and may improve TB case-finding. Full article

(This article belongs to the Special Issue Tuberculosis Program Implementation)

11 pages, 577 KiB

Open AccessArticle

Losses in the Sputum Specimen Referral Cascade in Mpulungu District, Zambia: A Cross-Sectional Study

by Ruth Goma, Josphat Bwembya, Brian Mwansa, Phillimon Ndubani, Francis Kasongo, William Siame, Lutinala Mulenga, Ramya Kumar, Seraphine Kaminsa, Vimbai Makwambeni, Victoria Musonda, Ibou Thior and Alwyn Mwinga

Int. J. Environ. Res. Public Health 2022, 19(3), 1621; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031621 - 31 Jan 2022

Cited by 1 | Viewed by 2835

Abstract

Sputum specimen referral cascades in resource-limited settings are characterized by losses of specimens, resulting in delays in tuberculosis (TB) diagnosis. Mpulungu District Health Office in Zambia conducted a quantitative based cross-sectional study using both primary and secondary data to identify points at which loss of specimens occurred in the sputum referral cascade. Primary data were collected through observations and interviews with 22 TB service providers. Secondary data were collected through examination of patient files and presumptive TB and laboratory registers to retrospectively track sputum specimens referred by ten health centers from April to September 2018. Proportions of specimens/laboratory results at every stage of the referral cascade were calculated using Epi Info v7. Only 49 (23%) out of 209 sputum specimens completed the referral cascade. The remaining 160 (76%) were lost at various stages of the referral cascade. The largest loss (51%) occurred between the release of laboratory results by the diagnostic facility and their receipt at referring facilities. Barriers included an inadequate number of staff oriented in sputum specimen referral, negative staff attitudes, and lack of specimen packaging material and specimen transportation. The district health office should strengthen the sputum specimen referral system by providing transport and specimen packaging material and by training staff in sputum collection transportation and tracking. Full article

(This article belongs to the Special Issue Tuberculosis Program Implementation)

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13 pages, 666 KiB

Open AccessArticle

Assessment of Factors Associated with Unfavorable Outcomes among Drug-Resistant TB Patients: A 6-Year Retrospective Study from Pakistan

by Farman Ullah Khan, Asim ur Rehman, Faiz Ullah Khan, Khezar Hayat, Amjad Khan, Nafees Ahmad, Jie Chang, Usman Rashid Malik and Yu Fang

Int. J. Environ. Res. Public Health 2022, 19(3), 1574; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031574 - 29 Jan 2022

Cited by 7 | Viewed by 3638

Abstract

The spread of drug-resistant tuberculosis (DR TB) poses significant challenges to the control and successful eradication of TB globally. The current retrospective study was designed to evaluate the treatment outcomes and identify the risk factors associated with unsuccessful outcomes among DR TB patients. A total of 277/308 eligible DR TB patients were enrolled for treatment at the programmatic management unit of DR TB at the Pakistan Institute of Medical Sciences, Islamabad between January 2014 and July 2019. Treatment outcomes were defined according to the WHO recommendations. Death, treatment failure, and lost to follow-up (LTFU) were collectively grouped as unsuccessful treatment outcomes, whereas cured and treatment completed were summed up together as successful treatment outcomes. Out of the total 277 patients, 265 (95.67%) were multidrug/rifampicin-resistant TB (MDR/RR-TB) cases, 8 (2.89%) were isoniazid resistant cases, and 4 (1.44%) were extensively drug-resistant ones. In the current cohort, a total of 177 (63.9%) achieved successful treatment outcomes. Among them, 153 (55.2%) were declared cured and 24 (8.7%) completed their treatment. Of the remaining 100 (36.1%) patients with unsuccessful outcomes, 60 (21.7%) died, 32 (11.5%) were LTFU, and 8 (2.9%) had failed treatment. The proportion of male patients was relatively higher (55.2%), within the age group of 21–40 years (47.3%) and lived in rural areas (66.8%). The multivariate analysis revealed that unsuccessful outcomes had a statistically significant association with being male (adjusted odds ratio, AOR: 1.92, 95% confidence interval (CI): 1.10–3.36), being in an age group above 60 years (AOR: 3.34, 95% CI: 1.09–10.1), suffering from any comorbidity (AOR: 2.69, 95% CI: 1.35–5.38), and the history of use of second-line drugs (AOR; 3.51, 95% CI 1.35–9.12). In conclusion, treatment outcomes among DR TB patients at the study site were poor and did not achieve the treatment success target (≥75%) set by the World Health Organization. Full article

(This article belongs to the Special Issue Tuberculosis Program Implementation)

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16 pages, 1599 KiB

Open AccessArticle

Economic Evaluation of Community Tuberculosis Active Case-Finding Approaches in Cambodia: A Quasi-Experimental Study

by Alvin Kuo Jing Teo, Kiesha Prem, Yi Wang, Tripti Pande, Marina Smelyanskaya, Lisanne Gerstel, Monyrath Chry, Sovannary Tuot and Siyan Yi

Int. J. Environ. Res. Public Health 2021, 18(23), 12690; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182312690 - 02 Dec 2021

Cited by 1 | Viewed by 2224

Abstract

This study aimed to estimate the costs and incremental cost-effectiveness of two community-based tuberculosis (TB) active case-finding (ACF) strategies in Cambodia. We also assessed the number needed to screen and test to find one TB case. Program and national TB notification data from a quasi-experimental study of a cohort of people with TB in 12 intervention operational districts (ODs) and 12 control ODs between November 2018 and December 2019 were analyzed. Two ACF interventions (ACF seed-and-recruit (ACF SAR) model and one-off roving (one-off) ACF) were implemented concurrently. The matched control sites included PCF only. We estimated costs using the program and published data in Cambodia. The primary outcome was disability-adjusted life years (DALY) averted over 14 months. We considered the gross domestic product per capita of Cambodia in 2018 as the cost-effectiveness threshold. ACF SAR needed to test 7.7 people with presumptive TB to identify one all-forms TB, while one-off ACF needed to test 22.4. The costs to diagnose one all-forms TB were USD 458 (ACF SAR) and USD 191 (one-off ACF). The incremental cost per DALY averted was USD 257 for ACF SAR and USD 204 for one-off ACF. Community-based ACF interventions that targeted key populations for TB in Cambodia were highly cost-effective. Full article

(This article belongs to the Special Issue Tuberculosis Program Implementation)

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14 pages, 488 KiB

Open AccessArticle

Impact of Protracted Displacement on Delay in the Diagnosis Associated with Treatment Outcomes: A Cross-Sectional Study in Internally Displaced Tuberculosis Patients of Pakistan

by Farman Ullah Khan, Faiz Ullah Khan, Khezar Hayat, Jie Chang, Muhammad Kamran, Asad Khan, Usman Rashid Malik, Asif Khan and Yu Fang

Int. J. Environ. Res. Public Health 2021, 18(22), 11984; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182211984 - 15 Nov 2021

Cited by 3 | Viewed by 1958

Abstract

Human displacement is on the rise globally, and the increase in the burden of tuberculosis (TB) is also attributed to migrations worldwide. A significant number of such displacements occur in regions with considerably higher areas of TB burden. Displacements may delay TB diagnosis and treatment, which will possibly lead to TB transmission among healthy individuals. In this study, we assessed the association of existing determinants after a protracted internal displacement of people with delay in TB diagnosis and treatment outcomes. A cross-sectional study was conducted on internally displaced TB patients (IDPs), registered at selected health facilities in three urban districts of Pakistan from March 2019 to February 2020. The univariate and multivariate logistic regression model was used to assess the delay in diagnosis and treatment outcomes. IDPs with delay in initiation of treatment beyond 30 days were at high possibility of unsuccessful TB treatment outcomes (adjusted odds ratio AOR, 2.60; 95% CI 1.06–6.40). Furthermore, the multivariate regression analysis showed a statistically significant association (p > 0.05) between TB patients who were aged 55 to 65 years (AOR, 2.66; 95% CI 1.00–7.07), female patients (AOR, 2.42; 95% CI 1.21–4.81), visited non-formal health provider (AOR, 8.81; 95% CI 3.99–19.46), self-medication (AOR, 2.72; 95 % CI 1.37–5.37), poor knowledge of TB (AOR, 11.39; 95% CI 3.31–39.1), and perceived stigma (AOR, 8.81; 95% CI 3.99–19.4). Prolonged delay in treatment was associated with unfavorable treatment outcomes among IDPs. Migrants and IDPs are more likely to experience an interruption in care due to overall exclusion from social and health care services. Therefore, it is imperative to understand the barriers to providing public health care services, particularly in preventing and treating TB. Full article

(This article belongs to the Special Issue Tuberculosis Program Implementation)

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8 pages, 3590 KiB

Open AccessArticle

Engaging Private Health Care Providers to Identify Individuals with TB in Nepal

by Rajesh Sah, Upendra Kumar Singh, Ranju Mainali, Ataulhaq Sanaie, Tripti Pande, Nathaly Aguilera Vasquez and Amera Khan

Int. J. Environ. Res. Public Health 2021, 18(22), 11762; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182211762 - 09 Nov 2021

Cited by 1 | Viewed by 1844

Abstract

In Nepal, 47% of individuals who fell ill with TB were not reported to the National TB Program in 2018. Approximately 60% of persons with TB initially seek care in the private sector. From November 2018 to January 2020, we implemented an active case finding intervention in the Parsa and Dhanusha districts targeting private provider facilities. To evaluate the impact of the intervention, we reported on crude intervention results. We further compared case notification during the implementation to baseline and control population (Bara and Siraha) notifications. We screened 203,332 individuals; 11,266 (5.5%) were identified as presumptive for TB and 8077 (71.7%) were tested for TB. Approximately 8% had a TB diagnosis, of whom 383 (56.2%) were bacteriologically confirmed (Bac+). In total, 653 (95.7%) individuals were initiated on treatment at DOTS facilities. For the intervention districts, there was a 17%increase for bacteriologically positive TB and 10% for all forms TB compared to baseline. In comparison, the change in notifications in the control population were 4% for bacteriologically positive, and −2% all forms. Through engagement of private sector facilities, our intervention was able to increase the number of individuals identified with TB by over 10% in the Parsa and Dhanusha districts. Full article

(This article belongs to the Special Issue Tuberculosis Program Implementation)

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12 pages, 611 KiB

Open AccessArticle

Barriers to Access of Healthcare Services for Rural Women—Applying Gender Lens on TB in a Rural District of Sindh, Pakistan

by Shifa Salman Habib, Wafa Zehra Jamal, Syed Mohammad Asad Zaidi, Junaid-Ur-Rehman Siddiqui, Hira Mustafa Khan, Jacob Creswell, Srichand Batra and Anna Versfeld

Int. J. Environ. Res. Public Health 2021, 18(19), 10102; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph181910102 - 26 Sep 2021

Cited by 14 | Viewed by 5011

Abstract

Background: Women in the rural districts of Pakistan face numerous barriers to healthcare, rendering gender-responsive health programming important, including for the disease of tuberculosis (TB). This study was conducted to assess the general understanding of TB and for women’s access to healthcare, as a first step towards implementation of a gender responsive TB program in Tando Allahyar, a rural district of Pakistan. Methods: A total of 36 participants were interviewed for the study. The focus group discussion guide comprised of questions on: (1) family/household dynamics, (2) community norms, (3) healthcare systems, (4) women’s access to healthcare, (5) TB Awareness, and (6) women’s access to TB Care. Results: Limited autonomy in household financial decision-making, disapproval of unassisted travel, long travel time, lack of prioritization of spending on women’s health and inadequate presence of female health providers, were identified as barriers to access healthcare for women, which is even higher in younger women. Facilitators to access of TB care included a reported lack of TB-related stigma, moderate knowledge about TB disease, and broad understanding of tuberculosis as a curable disease. Other suggested facilitators include health facilities closer to the villages and the availability of higher quality services. Conclusion: Significant barriers are faced by women in accessing TB care in rural districts of Pakistan. Program implementers in high burden countries should shift towards improved gender-responsive TB programming. Full article

(This article belongs to the Special Issue Tuberculosis Program Implementation)

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12 pages, 1692 KiB

Open AccessArticle

Improving Treatment Adherence with Integrated Patient Management for TB Patients in Morocco

by Seup Park, Narae Moon, Byungkwon Oh, Miyeon Park, Kilho Kang, Ilham Sentissi and Sung-Heui Bae

Int. J. Environ. Res. Public Health 2021, 18(19), 9991; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18199991 - 23 Sep 2021

Cited by 3 | Viewed by 3159

Abstract

In Morocco, there are challenges in the management of high-risk tuberculosis (TB) patients, including paper-based management and a shortage of healthcare workers related to TB. Additionally, TB management has not been accounted for in various patient types, which affects treatment adherence. This study aims to examine the delivery model of TB management and the outcomes of an integrated patient management system that uses a patient-centered and community-based approach, along with mobile health technology. A total of 3605 TB patients were enrolled in this program in Morocco’s five prefectures (Rabat, Salé, Kénitra, Khemisset, Skhirat–Témara) from January 2018 to December 2019. Patients were managed based on demographic characteristics, socioeconomic status, areas (rural or urban), health literacy levels, and distance to primary health centers. Our mobile health intervention “smart pillbox” was interposed with high-risk TB patients, along with patient education. The rate of successful treatment was 92.2%, which was higher than the national rate (88%). The “lost to follow-up” rate was 4.1%, which was significantly lower than the existing non-adherence rate of 7.9%. Therefore, integrated patient management for TB patients in Morocco is more effective than the existing conventional programs. This comprehensive approach provides an alternative method for countries with limited resources. Full article

(This article belongs to the Special Issue Tuberculosis Program Implementation)

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13 pages, 1034 KiB

Open AccessArticle

Tuberculosis Death Epidemiology and Its Associated Risk Factors in Sabah, Malaysia

by Richard Avoi and Yau Chun Liaw

Int. J. Environ. Res. Public Health 2021, 18(18), 9740; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18189740 - 16 Sep 2021

Cited by 17 | Viewed by 3835

Abstract

Tuberculosis (TB) is a leading killer from a single infectious agent globally. In 2019, Malaysia’s TB incidence rate was 92 per 100,000 population, and the TB mortality rate was estimated at 4 cases per 100,000 population per year. However, the state of Sabah had a higher burden of TB with a notification rate of 128 per 100,000 population and a TB case fatality rate of 8% compared to the national figure. This study aims to provide a comprehensive report on TB deaths epidemiology and its associated factors at a sub-national level. This nested case-control study used Sabah State Health Department TB surveillance data from the Malaysia national case-based TB registry (MyTB) between 2014 and 2018. Cases were defined as all-cause TB deaths that occurred before anti-TB treatment completion from the time of TB diagnosis. Controls were randomly selected from TB patients who completed anti-TB treatment. The TB mortality rate had increased significantly from 9.0/100,000 population in 2014 to 11.4/100,000 population in 2018. The majority of TB deaths occurred in the first two months of treatment. TB-related deaths were primarily due to advanced disease or disseminated TB, whereas non-TB-related deaths were primarily due to existing comorbidities. Many important independent risk factors for TB deaths were identified which are useful to address the increasing TB mortality rate. Full article

(This article belongs to the Special Issue Tuberculosis Program Implementation)

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14 pages, 870 KiB

Open AccessArticle

Factors Affecting Motivation among Key Populations to Engage with Tuberculosis Screening and Testing Services in Northwest Tanzania: A Mixed-Methods Analysis

by Rabia Abeid Khaji, Venance Muzuka Kabwebwe, Annasia Goodluck Mringo, Thomas Faustine Nkwabi, Jacob Bigio, Christina Mergenthaler, Nathaly Aguilera Vasquez, Tripti Pande, Md Toufiq Rahman and Fredrick Haraka

Int. J. Environ. Res. Public Health 2021, 18(18), 9654; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18189654 - 14 Sep 2021

Cited by 3 | Viewed by 3064

Abstract

In northwest Tanzania, many artisanal small-scale miners (ASMs) and female sex workers (FSWs) live in informal communities surrounding mines where tuberculosis (TB) is highly prevalent. An active case finding (ACF) intervention to increase TB case notification was undertaken in two districts. Alongside this, a study was implemented to understand engagement with the intervention through: (1) quantitative questionnaires to 128 ASMs and FSWs, who either engaged or did not engage in the ACF intervention, to assess their views on TB; (2) qualitative interviews with 41 ASMs and FSWs, 36 community health workers (CHWs) and 30 community stakeholders. The mean perceived severity of TB score was higher in the engaged than in the non-engaged group (p = 0.01). Thematic analysis showed that health-seeking behaviour was similar across both groups but that individuals in the non-engaged group were more reluctant to give sputum samples, often because they did not understand the purpose. CHWs feared contracting TB on the job, and many noted that mining areas were difficult to access without transportation. Community stakeholders provided various recommendations to increase engagement. This study highlights reasons for engagement with a large-scale ACF intervention targeting key populations and presents insights from implementers and stakeholders on the implementation of the intervention. Full article

(This article belongs to the Special Issue Tuberculosis Program Implementation)

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11 pages, 1013 KiB

Open AccessArticle

A Multi-Faceted Approach to Tuberculosis Active Case Finding among Remote Riverine Communities in Southern Nigeria

by Andy Samuel Eyo, Valerie Okon Obot, Okezie Onyedinachi, Nathaly Aguilera Vasquez, Jacob Bigio, Ataulhaq Sanaie, Favour Beulah, Uduak Ette, Dennis Uju and Md. Toufiq Rahman

Int. J. Environ. Res. Public Health 2021, 18(18), 9424; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18189424 - 07 Sep 2021

Cited by 4 | Viewed by 2774

Abstract

Nigeria accounts for 11% of the worldwide gap between estimated and reported individuals with tuberculosis (TB). Hard-to-reach communities on the Southern Nigeria coast experience many difficulties accessing TB services. We implemented an active case finding (ACF) intervention in Akwa Ibom and Cross River states utilizing three approaches: house-to-house/tent-to-tent screening, community outreach and contact investigation. To evaluate the impact, we compared TB notifications in intervention areas to baseline and control population notifications, as well as to expected notifications based on historical trends. We also gathered field notes from discussions with community volunteers who provided insights on their perspectives of the intervention. A total of 509,768 individuals were screened of which 12,247 (2.4%) had TB symptoms and 11,824 (96.5%) were tested. In total, 1015 (8.6%) of those identified as presumptive had confirmed TB—98.2% initiated treatment. Following implementation, TB notifications in intervention areas increased by 112.9% compared to baseline and increased by 138.3% when compared to expected notifications based on historical trends. In contrast, control population notifications increased by 101% and 49.1%, respectively. Community volunteers indicated a preference for community outreach activities. Multi-faceted, community-based interventions in Nigeria’s coastal areas successfully increase TB detection for communities with poor access to health services. Full article

(This article belongs to the Special Issue Tuberculosis Program Implementation)

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