New Tools and Approaches to End TB

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: closed (30 December 2021) | Viewed by 28256

Special Issue Editors

KIT Royal Tropical Institute, Global Health, 95001 Amsterdam, The Netherlands
Interests: Tuberculosis; NTDs; active case finding; geospatial analysis; monitoring and evaluation; data for decision making
Stop TB Partnership, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
Interests: tuberculosis; infectious disease epidemiology; artificial intelligence; case detection; diagnostics; monitoring and evaluation
New Dimension Consulting (T) Ltd, tSunny Polyclinic House, P O Box 6489 Dar es Salaam, Tanzania
Interests: tuberculosis; case detection; TB/HIV; monitoring and evaluation; surveillance; operational research
KIT Royal Tropical Institute, Global Health, 95001 Amsterdam, The Netherlands
Interests: tuberculosis; monitoring and evaluation; global health epidemiology; digital tools in health; quality assurance
Friends for International TB Relief, Hanoi, Vietnam
Interests: case detection; private sector engagement; social protection; analytics; community health

Special Issue Information

Dear Colleagues,

Advances in healthcare are growing exponentially, with new diagnostics, treatments, and technology, supporting patients, health care providers, and policy makers across a wide range of health topics/diseases. Tuberculosis has plagued humanity for millennia, but research into this disease has often lagged behind other disease areas. Many people with TB are still diagnosed with tools that were developed in the 1800s, most of the drugs widely used were developed decades ago, and TB programs generally use antiquated paper-based systems to track the disease and report outcomes. For too long, a one-size-fits-all approach has been promoted for TB, yet recently, this has begun to change.

When new tools are developed, they often struggle to find uptake due to difficult processes for their evaluation and recommendation by health agencies, regulations that limit innovation, and unambitious national responses, and they do not always fit the context. However, there are various promising new tools that are being piloted by innovative partners in the TB response, while innovation can also come via changing processes and new approaches of delivering care.

In this Special Issue, we are calling for papers that document the testing, evaluation, implementation, or scaling up of new tools and approaches that will help to accelerate the global response to end TB. Submissions based on work that originates in high-burden TB countries are especially encouraged. We are looking for original research and perspectives on a wide range of new tools and approaches across the TB care cascade, such as digital tools, artificial intelligence, connectivity solutions, and mHealth applications, and real-time data for planning and surveillance, to push the TB response into modern times.

Dr. Mirjam I. Bakker
Dr. Jacob Creswell
Dr. Sode Matiku
Dr. Masja Straetemans
Mr. Luan Vo
Guest Editors

Manuscript Submission Information

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Keywords

  • Tuberculosis
  • New tools
  • Process innovation
  • Digital tools
  • mHealth
  • Connectivity

Published Papers (8 papers)

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Research

14 pages, 2404 KiB  
Article
Factors Affecting the Transition from Paper to Digital Data Collection for Mobile Tuberculosis Active Case Finding in Low Internet Access Settings in Pakistan
by Christina Mergenthaler, Jake D. Mathewson, Abdullah Latif, Hasan Tahir, Vincent Meurrens, Andreas van Werle, Aamna Rashid, Muhammad Tariq, Tanveer Ahmed, Farah Naureen and Ente Rood
Trop. Med. Infect. Dis. 2022, 7(8), 201; https://0-doi-org.brum.beds.ac.uk/10.3390/tropicalmed7080201 - 22 Aug 2022
Viewed by 1704
Abstract
Between September 2020 and March 2021, Mercy Corps piloted hybrid digital (CAPI) and paper-based (PAPI) data collection as part of its tuberculosis (TB) active case finding strategy. Data were collected using CAPI and PAPI at 140 TB chest camps in low Internet access [...] Read more.
Between September 2020 and March 2021, Mercy Corps piloted hybrid digital (CAPI) and paper-based (PAPI) data collection as part of its tuberculosis (TB) active case finding strategy. Data were collected using CAPI and PAPI at 140 TB chest camps in low Internet access areas of Punjab and Khyber Pakhtunkhwa provinces in Pakistan. PAPI data collection was performed primarily during the camp and entered using a tailor-performed CAPI tool after camps. To assess the feasibility of this hybrid approach, quality of digital records were measured against the paper “gold standard”, and user acceptance was evaluated through focus group discussions. Completeness of digital data varied by indicator, van screening team, and month of implementation: chest camp attendees and pulmonary TB cases showed the highest CAPI/PAPI completeness ratios (1.01 and 0.96 respectively), and among them, all forms of TB diagnosis and treatment initiation were lowest (0.63 and 0.64 respectively). Vans entering CAPI data with high levels of completeness generally did so for all indicators, and significant differences in mean indicator completeness rates between PAPI and CAPI were observed between vans. User feedback suggested that although the CAPI tool required practice to gain proficiency, the technology was appreciated and will be better perceived once double entry in CAPI and PAPI can transition to CAPI only. CAPI data collection enables data to be entered in a more timely fashion in low-Internet-access settings, which will enable more rapid, evidence-based program steering. The current system in which double data entry is conducted to ensure data quality is an added burden for staff with many activities. Transitioning to a fully digital data collection system for TB case finding in low-Internet-access settings requires substantial investments in M&E support, shifts in data reporting accountability, and technology to link records of patients who pass through separate data collection stages during chest camp events. Full article
(This article belongs to the Special Issue New Tools and Approaches to End TB)
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17 pages, 828 KiB  
Article
Time Trend Analysis of Tuberculosis Treatment While Using Digital Adherence Technologies—An Individual Patient Data Meta-Analysis of Eleven Projects across Ten High Tuberculosis-Burden Countries
by Liza M. de Groot, Masja Straetemans, Noriah Maraba, Lauren Jennings, Maria Tarcela Gler, Danaida Marcelo, Mirchaye Mekoro, Pieter Steenkamp, Riccardo Gavioli, Anne Spaulding, Edwin Prophete, Margarette Bury, Sayera Banu, Sonia Sultana, Baraka Onjare, Egwuma Efo, Jason Alacapa, Jens Levy, Mona Lisa L. Morales, Achilles Katamba, Aleksey Bogdanov, Kateryna Gamazina, Dzhumagulova Kumarkul, Orechova-Li Ekaterina, Adithya Cattamanchi, Amera Khan and Mirjam I. Bakkeradd Show full author list remove Hide full author list
Trop. Med. Infect. Dis. 2022, 7(5), 65; https://0-doi-org.brum.beds.ac.uk/10.3390/tropicalmed7050065 - 22 Apr 2022
Cited by 3 | Viewed by 3412
Abstract
Worldwide, non-adherence to tuberculosis (TB) treatment is problematic. Digital adherence technologies (DATs) offer a person-centered approach to support and monitor treatment. We explored adherence over time while using DATs. We conducted a meta-analysis on anonymized longitudinal adherence data for drug-susceptible (DS) TB ( [...] Read more.
Worldwide, non-adherence to tuberculosis (TB) treatment is problematic. Digital adherence technologies (DATs) offer a person-centered approach to support and monitor treatment. We explored adherence over time while using DATs. We conducted a meta-analysis on anonymized longitudinal adherence data for drug-susceptible (DS) TB (n = 4515) and drug-resistant (DR) TB (n = 473) populations from 11 DAT projects. Using Tobit regression, we assessed adherence for six months of treatment across sex, age, project enrolment phase, DAT-type, health care facility (HCF), and project. We found that DATs recorded high levels of adherence throughout treatment: 80% to 71% of DS-TB patients had ≥90% adherence in month 1 and 6, respectively, and 73% to 75% for DR-TB patients. Adherence increased between month 1 and 2 (DS-TB and DR-TB populations), then decreased (DS-TB). Males displayed lower adherence and steeper decreases than females (DS-TB). DS-TB patients aged 15–34 years compared to those >50 years displayed steeper decreases. Adherence was correlated within HCFs and differed between projects. TB treatment adherence decreased over time and differed between subgroups, suggesting that over time, some patients are at risk for non-adherence. The real-time monitoring of medication adherence using DATs provides opportunities for health care workers to identify patients who need greater levels of adherence support. Full article
(This article belongs to the Special Issue New Tools and Approaches to End TB)
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9 pages, 911 KiB  
Article
Data Mining for ICD-10 Admission Diagnoses Preceding Tuberculosis within 1 Year among Non-HIV and Non-Diabetes Patients
by Ponlagrit Kumwichar and Virasakdi Chongsuvivatwong
Trop. Med. Infect. Dis. 2022, 7(4), 61; https://0-doi-org.brum.beds.ac.uk/10.3390/tropicalmed7040061 - 14 Apr 2022
Cited by 1 | Viewed by 2758
Abstract
Delayed diagnosis of tuberculosis (TB) increases mortality and extends the duration of disease transmission. This study aimed to identify significant ICD-10 admission diagnoses preceding TB. All hospital electronic medical records from fiscal year 2015 to 2020 in the Songkhla Province, Thailand were retrieved. [...] Read more.
Delayed diagnosis of tuberculosis (TB) increases mortality and extends the duration of disease transmission. This study aimed to identify significant ICD-10 admission diagnoses preceding TB. All hospital electronic medical records from fiscal year 2015 to 2020 in the Songkhla Province, Thailand were retrieved. After excluding diabetes and HIV patients, a case-control analysis was performed. Exposures of interest were ICD-10 diagnoses on admissions 1–12 months prior to the visit during which TB was detected. Incident cases of respiratory tuberculosis (A15.0–A16.9) that had been admitted with at least one such exposure were chosen. For every case, controls were retrieved from weekly concurrent OPD patients who had the same 10-year interval of age, sex, and preceding admission and discharge week as the case. The 10 most common comorbidities during hospitalization preceding TB with their relative odds ratios (RORs) and 95% confidence intervals were identified. These included five significant exposures related to lower respiratory infection without adequate TB investigation. Significant RORs ranged from 3.10 (unspecified pneumonia) to 34.69 (hemoptysis). Full TB investigation was not performed due to problems with health insurance. In conclusion, the physicians should be informed about this pitfall, and the insurance system should be revised accordingly. Full article
(This article belongs to the Special Issue New Tools and Approaches to End TB)
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14 pages, 236 KiB  
Article
Digital Storytelling and Community Engagement to Find Missing TB Cases in Rural Nuh, India
by Subhi Quraishi, Hilmi Quraishi, Hemlata Yadav, Ayushi Singh, Ilmana Fasih, Nathaly Aguilera Vasquez, Lavanya Huria, Tripti Pande, Olive Mumba, Vishnu Vardhan Kamineni and Amera Khan
Trop. Med. Infect. Dis. 2022, 7(3), 49; https://0-doi-org.brum.beds.ac.uk/10.3390/tropicalmed7030049 - 11 Mar 2022
Cited by 2 | Viewed by 2777
Abstract
Nuh, Haryana, is one of India’s least developed districts. To improve TB case notifications, ZMQ carried out an active case-finding (ACF) intervention conducted by community health workers (MIRAs) using a digital TB storytelling platform to create TB awareness in the community. The combined [...] Read more.
Nuh, Haryana, is one of India’s least developed districts. To improve TB case notifications, ZMQ carried out an active case-finding (ACF) intervention conducted by community health workers (MIRAs) using a digital TB storytelling platform to create TB awareness in the community. The combined storytelling and ACF intervention were conducted house-to-house or in community group settings. Steps included (A) the development of digital TB awareness-raising stories using a participatory approach called Story Labs; (B) the implementation of the intervention; and (C) process, outcome, and impact evaluation of these activities. Six digital stories were created and used during ACF in which 19,345 people were screened and 255 people were diagnosed with TB. Of 731 participants surveyed, the stories were well received and resulted in an increase in TB knowledge. ACF activities resulted in a 56% increase in bacteriologically confirmed TB and an 8% decrease in all forms of TB compared to baseline. All form notifications may have been impacted by COVID-19 lockdowns. Digital TB storytelling can improve TB awareness and knowledge, particularly for low-literacy populations. The use of these tools may benefit ACF campaigns and improve TB case finding. Full article
(This article belongs to the Special Issue New Tools and Approaches to End TB)
14 pages, 1659 KiB  
Article
TB Hackathon: Development and Comparison of Five Models to Predict Subnational Tuberculosis Prevalence in Pakistan
by Sandra Alba, Ente Rood, Fulvia Mecatti, Jennifer M. Ross, Peter J. Dodd, Stewart Chang, Matthys Potgieter, Gaia Bertarelli, Nathaniel J. Henry, Kate E. LeGrand, William Trouleau, Debebe Shaweno, Peter MacPherson, Zhi Zhen Qin, Christina Mergenthaler, Federica Giardina, Ellen-Wien Augustijn, Aurangzaib Quadir Baloch and Abdullah Latif
Trop. Med. Infect. Dis. 2022, 7(1), 13; https://0-doi-org.brum.beds.ac.uk/10.3390/tropicalmed7010013 - 17 Jan 2022
Cited by 3 | Viewed by 4539
Abstract
Pakistan’s national tuberculosis control programme (NTP) is among the many programmes worldwide that value the importance of subnational tuberculosis (TB) burden estimates to support disease control efforts, but do not have reliable estimates. A hackathon was thus organised to solicit the development and [...] Read more.
Pakistan’s national tuberculosis control programme (NTP) is among the many programmes worldwide that value the importance of subnational tuberculosis (TB) burden estimates to support disease control efforts, but do not have reliable estimates. A hackathon was thus organised to solicit the development and comparison of several models for small area estimation of TB. The TB hackathon was launched in April 2019. Participating teams were requested to produce district-level estimates of bacteriologically positive TB prevalence among adults (over 15 years of age) for 2018. The NTP provided case-based data from their 2010–2011 TB prevalence survey, along with data relating to TB screening, testing and treatment for the period between 2010–2011 and 2018. Five teams submitted district-level TB prevalence estimates, methodological details and programming code. Although the geographical distribution of TB prevalence varied considerably across models, we identified several districts with consistently low notification-to-prevalence ratios. The hackathon highlighted the challenges of generating granular spatiotemporal TB prevalence forecasts based on a cross-sectional prevalence survey data and other data sources. Nevertheless, it provided a range of approaches to subnational disease modelling. The NTP’s use and plans for these outputs shows that, limitations notwithstanding, they can be valuable for programme planning. Full article
(This article belongs to the Special Issue New Tools and Approaches to End TB)
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11 pages, 630 KiB  
Article
Can Patient Navigators Help Potential TB Patients Navigate the Diagnostic and Treatment Pathways? An Implementation Research from India
by Tushar Garg, Vikas Panibatla, Joseph P. Carel, Achanta Shanta, Manish Bhardwaj and Miranda Brouwer
Trop. Med. Infect. Dis. 2021, 6(4), 200; https://0-doi-org.brum.beds.ac.uk/10.3390/tropicalmed6040200 - 15 Nov 2021
Viewed by 2544
Abstract
Navigating the Indian health system is a challenge for people with tuberculosis (TB) symptoms. The onus of organizing care is on the patient and their families alone. Factors like gender discrimination and opportunity costs further aggravate this. As a result, people may not [...] Read more.
Navigating the Indian health system is a challenge for people with tuberculosis (TB) symptoms. The onus of organizing care is on the patient and their families alone. Factors like gender discrimination and opportunity costs further aggravate this. As a result, people may not complete the diagnostic and treatment pathway even though they experience poor health. Navigators can aid in the pathway’s completion. We implemented two projects in India—a public sector intervention in Bihar, with a population of 1.02 million, and a private sector intervention in Andhra Pradesh (AP), with a population of 8.45 million. Accredited Social Health Activists (ASHAs) of the public health system in Bihar and local field officers in AP facilitated the patients’ navigation through the health system. In Bihar, ASHAs accompanied community-identified presumptive TB patients to the nearest primary health center, assisted them through the diagnostic process, and supported the patients throughout the TB treatment. In AP, the field officers liaised with the private physicians, accompanied presumptive patients through the diagnosis, counseled and started treatment, and followed-up with the patients during the treatment. Both projects recorded case-based data for all of the patients, and used the yield and historical TB notifications to evaluate the intervention’s effect. Between July 2017 and December 2018, Bihar confirmed 1650 patients, which represented an increase of 94% in public notifications compared to the baseline. About 97% of them started treatment. During the same period in AP, private notifications increased by 147% compared to the baseline, and all 5765 patients started treatment. Patient navigators support the patients in the diagnostic and treatment pathways, and improve their health system experience. This novel approach of involving navigators in TB projects can improve the completion of the care cascade and reduce the loss to follow-up at various stages. Full article
(This article belongs to the Special Issue New Tools and Approaches to End TB)
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10 pages, 1510 KiB  
Article
Patient-Pathway Analysis of Tuberculosis Services in Cameroon
by Collins N. Titahong, Gideon N. Ayongwa, Yvonne Waindim, Dubliss Nguafack, Albert Kuate Kuate, Irene Adeline Goupeyou Wandji, Alison Wringe, Vincent Mbassa, Melissa S. Sander and Ellen M. H. Mitchell
Trop. Med. Infect. Dis. 2021, 6(4), 171; https://0-doi-org.brum.beds.ac.uk/10.3390/tropicalmed6040171 - 22 Sep 2021
Cited by 2 | Viewed by 3177
Abstract
In Cameroon, in 2019, tuberculosis (TB) treatment coverage was estimated at 53%, indicating that almost half of all people sick with TB were not diagnosed or linked to care. To inform strategies to improve access to TB services, we conducted an evaluation of [...] Read more.
In Cameroon, in 2019, tuberculosis (TB) treatment coverage was estimated at 53%, indicating that almost half of all people sick with TB were not diagnosed or linked to care. To inform strategies to improve access to TB services, we conducted an evaluation of the alignment between patient-initiated care-seeking behavior and spatial and institutional allocation of TB services. Data sources included the Cameroon Demographic and Health Survey (2018), the Health Facility List (2017), and routinely collected TB surveillance data. Data visualization was performed in Tableau and QGIS. The pathway analysis showed that only an estimated 9% of people attended a health facility providing TB services at initial care-seeking, with access varying from <3% to 16% across the ten regions of the country. While 72% of government and 56% of private hospitals (Level 2 facilities) provide TB services, most Cameroonians (87%) initially chose primary care (Level 1) or informal private sector sites (Level 0) without TB services. The gaps were greatest in regions with the highest prevalence of poverty, a significant determinant for TB. These results indicate that access may be improved by expanding TB services at both public and private facilities across the country, prioritizing regions with the greatest gaps. Full article
(This article belongs to the Special Issue New Tools and Approaches to End TB)
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14 pages, 910 KiB  
Article
Early Evaluation of an Ultra-Portable X-ray System for Tuberculosis Active Case Finding
by Luan Nguyen Quang Vo, Andrew Codlin, Thuc Doan Ngo, Thang Phuoc Dao, Thuy Thi Thu Dong, Huong Thi Lan Mo, Rachel Forse, Thao Thanh Nguyen, Cong Van Cung, Hoa Binh Nguyen, Nhung Viet Nguyen, Van Van Nguyen, Ngan Thi Tran, Giang Hoai Nguyen, Zhi Zhen Qin and Jacob Creswell
Trop. Med. Infect. Dis. 2021, 6(3), 163; https://0-doi-org.brum.beds.ac.uk/10.3390/tropicalmed6030163 - 04 Sep 2021
Cited by 11 | Viewed by 5250
Abstract
X-ray screening is an important tool in tuberculosis (TB) prevention and care, but access has historically been restricted by its immobile nature. As recent advancements have improved the portability of modern X-ray systems, this study represents an early evaluation of the safety, image [...] Read more.
X-ray screening is an important tool in tuberculosis (TB) prevention and care, but access has historically been restricted by its immobile nature. As recent advancements have improved the portability of modern X-ray systems, this study represents an early evaluation of the safety, image quality and yield of using an ultra-portable X-ray system for active case finding (ACF). We reported operational and radiological performance characteristics and compared image quality between the ultra-portable and two reference systems. Image quality was rated by three human readers and by an artificial intelligence (AI) software. We deployed the ultra-portable X-ray alongside the reference system for community-based ACF and described TB care cascades for each system. The ultra-portable system operated within advertised specifications and radiologic tolerances, except on X-ray capture capacity, which was 58% lower than the reported maximum of 100 exposures per charge. The mean image quality rating from radiologists for the ultra-portable system was significantly lower than the reference (3.71 vs. 3.99, p < 0.001). However, we detected no significant differences in TB abnormality scores using the AI software (p = 0.571), nor in any of the steps along the TB care cascade during our ACF campaign. Despite some shortcomings, ultra-portable X-ray systems have significant potential to improve case detection and equitable access to high-quality TB care. Full article
(This article belongs to the Special Issue New Tools and Approaches to End TB)
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