Revitalizing TB forums: A strategy to accelerate TB elimination

The densely populated urban area is one of the communities that has a high risk of transmission TBC disease. Ulul Azmi Islamic boarding school is located in Cipageran Village. The incidence of pulmonary TBC in Cipageran Village is still high, so the TBC eradication program is one of the priority problems in Cimahi City, including in this village. It is feared that untreated or discontinued TB patients will increase the incidence of multidrug resistant TB (MDR-TB). Finding cases of TB and treating it immediately is very important to support government programs in TB elimination by 2035. The purpose of research is to screening TB disease by physical and microbiology examination to santri of Ulul Azmi Islamic Boarding School. This research is an observational description against the incidence of pulmonary TB at Ulul azmi Islamic Boarding School. The result showed that negative results for TB at santri Ulul Azmi Islamic Boarding School. The students and religious teachers routinely exercise in the sun for 30 minutes after 09.00.

BackgroundResearch pertaining to the community-based prevalence of latent tuberculosis infection (LTBI) is important to understand the magnitude of this infection. This study was conducted to estimate LTBI prevalence and to identify associated risk factors in the Omo Zone of Southern Ethiopia.MethodsA community-based cross-sectional study was conducted in six South Omo districts from May 2015 to February 2016. The sample size was allocated to the study districts proportional to their population sizes. Participants were selected using a multi-stage sampling approach. A total of 497 adult pastoralists were recruited. Blood samples were collected from the study participants and screened for LTBI using a U.S. Food and Drug Administration approved interferon-gamma release assay (IGRA). Logistic regression was used to model the likelihood of LTBI occurrence and to identify risk factors associated with LTBI.ResultsThe prevalence of LTBI was 50.5% (95% CI: 46%, 55%) with no significant gender difference (49.8% among males versus 51.2% among females; Chi-square (χ2) = 0.10; P = 0.41) and marginally non-significant increasing trends with age (44.6% among those below 24 years and 59.7% in the age range of 45-64 years; χ2 = 6.91; P = 0.075). Being residence of the Dasanech District (adjusted odds ratio, AOR = 2.62, 95% CI: 1.30, 5.28; P = 0.007) and having a habit of eating raw meat (AOR = 2.89, 95% CI: 1.09, 7.66; P = 0.033) were significantly associated with an increased odds of being positive for LTBI. A large family size (size of 5 to 10) has significant protective effect against associated a reduced odds of being positive for LTBI compared to a family size of below 5 (AOR = 0.65, 95% CI: 0.42, 0.99; P = 0.045).ConclusionsA high prevalence of LTBI in the South Omo Zone raises the concern that elimination of TB in the pastoral communities of the region might be difficult. Screening for and testing individuals infected with TB, independent of symptoms, may be an effective way to minimize the risk of disease spread.

BackgroundTuberculosis (TB) is the largest cause of mortality due to a single infectious agent. There were ∼9.6 million cases of TB and ∼1.5 million TB deaths in 2014, of which...

AIM: To determine the trap-catch index (an estimate of abundance) of brushtail possum (Trichosurus vulpecula) populations infected with bovine tuberculosis (Tb; Mycobacterium bovis) that must be achieved, and the length of time such an index must be maintained, for Tb to be eliminated from possum populations and adjacent livestock. METHODS: Between 1997–1998 and 2000–2001, trap-catch surveys of possum populations naturally infected with Tb and subjected to population-control measures were undertaken at four forest sites and two farmland sites. At the same time, possum carcasses were collected at these sites and their Tb status determined, and all contiguous cattle and deer herds were Tb-tested and abattoir slaughter data for these herds were interrogated. RESULTS: Trap-catch surveys indicated that numbers of possums on the farmland sites surveyed were usually very low and well below the control targets set (i.e. a 5% trap catch or ∼0.5–1 possum/ha) for the study. In contrast, trap-catch surveys undertaken in forest sites indicated possum numbers were more variable, and often recovered rapidly from control operations to exceed control targets within 1–3 years. The annual rate of recovery of possum populations in half of the forest population surveys undertaken exceeded published intrinsic rates of increase for possums. The overall prevalence of Tb in possum populations was ≤1.9% at 5/6 sites, and was 6.5% at the sixth site. Juvenile possums infected with Tb were trapped within but near the edge of control zones and appeared to represent an immigrant source of infection. Mature infected possums survived control operations apparently by having home ranges in uncontrolled patches within control areas. Infection in possums appeared to be eliminated from one study site by the intensive control undertaken, but elimination at other sites appeared less likely. Levels of Tb in livestock on or adjacent to the study sites fell by at least 50% during the study, and cattle in one area tested clear for the first time in 20 years. CONCLUSIONS: Initial control of possums in forest appeared to achieve national control targets set by the Animal Health Board (AHB), despite trap-catch data often providing misleading population estimates. Such targets were often exceeded within 1–3 years. By comparison, possum control on farmland appeared to maintain populations at very low levels, while control on forest margins maintained populations at intermediate levels. Control was least effective in deep forest where human access was most difficult. Intensive population control measures appeared to have led to a reduced incidence of Tb in livestock at 3/4 sites, and elimination of Tb in livestock at one site. This result supports modelling studies that predict the eradication of Tb from possums through ongoing intensive control and may explain the lower success achieved with earlier less-intensive possum control.

Tuberculosis prevalence survey reveals the high proportion of asymptomatic disease, and points to high-burden households as a site for potential intervention in peri-urban slums of Callao, Peru

The BCG vaccine used in the world for nearly 100 years protects children against the most severe forms of tuberculosis, but its effectiveness in preventing the most commonly occurring tuberculosis and the one burdened with the highest risk of transmission in adults is very diverse. Contraindications for BCG vaccination include HIV infection and other conditions of immunosuppression. Tuberculosis is a global problem difficult to control because of three main reasons: poor diagnostics in developing countries, long-term therapy or discontinuation of treatment resulting in the emergence of drug-resistant mycobacteria, and the availability of a TB vaccine which only protects children from the most severe forms of tuberculosis. BCG has little to no efficacy in preventing the most common adult pulmonary TB. The development of a more effective vaccine against tuberculosis is undoubtedly still a public health priority in order to improve control of the disease throughout the world. Elimination of TB as a global public health goal by 2050 is particularly ambitious and its achievement depends on the development and application of new intervention measures and newly designed vaccines. Currently, 14 newly developed products are undergoing clinical trials. These include a prophylactic vaccine capable of replacing the current BCG, booster vaccines to increase the effects of BCG, and therapeutic vaccines. The aim of the study is to present the current state of knowledge on cutting-edge research into new vaccines against tuberculosis, their efficacy, immunogenicity and potential use in the future.

In March 2017 the Government of India (GoI) announced that the new aim with regard to TB in India was the elimination of TB by 2025. Taking into consideration the various aspects of epidemiology of Tuberculosis, this will require a tremendous effort by all concerned. Tuberculosis is an ancient disease and there is plenty of evidence to support this statement. Most of the understanding about this disease developed during the eighteenth through twentieth century. Workers in this field are too well known to need a mention here. The disease was rampant at one time in the western world and most of these discoveries took place in Europe and USA. These countries also developed a robust notification system which helped to understand the pattern ofdisease.

BackgroundTuberculosis (TB) prevention through the use of preventive treatment is a critical activity in the elimination of TB. In multiple settings, limited staffing has been identified as a barrier to managing preventive treatment for TB contacts. This study aims to determine how health center staffing, service type, and TB caseload affects implementation of isoniazid preventive therapy (IPT) for TB contacts in southern Lima.MethodsWe conducted an ecological study in 2019 in southern Lima, Peru. Through the review of medical records, we identified contacts of TB patients who initiated IPT during 2016–2018, and who were 0–19 years old, the age group eligible for IPT according to Peruvian guidelines. We assessed bivariate associations between health center characteristics (numbers of physicians and nurses, types of services available, annual TB caseload) and IPT initiation and completion using binomial logistic regression.ResultsAmong 977 contacts, 69% took more than a week to start IPT and 41% did not complete IPT. For those who successfully completed IPT, 58% did not complete full medical follow-up. There was no significant difference in IPT completion or adherence based on whether health centers had more physicians and nurses, more comprehensive services, or higher TB caseloads. Among contacts, female sex was associated with delay in initiating IPT (P = 0.005), age 5–19 years old was associated with completion of IPT (P = 0.025) and age < 5 years old was associated with completion of clinical evaluations (P = 0.041).ConclusionsThere are significant gaps in IPT implementation in health centers of southern Lima, Peru, but insufficient staffing of health centers may not be responsible. Further research is needed to identify how IPT implementation can be improved, potentially through improving staff training or monitoring and supervision.Graphic abstract

Tuberculosis (TB) is a major public health problem among Saharia, a particularly vulnerable tribal group residing in remote rural areas in central India. This article presents the findings from the baseline survey among Saharias and provides comprehensive prevalence data of pulmonary TB (PTB) in this marginalised community. A community-based cross-sectional PTB prevalence survey was carried out during January-May 2019 in selected villages using multistage stratified cluster sampling. All eligible adults (≥15years of age) were screened for the symptoms of PTB. Sputum samples were collected and processed for microscopy and culture for Mycobacterium tuberculosis. A total of 20114 eligible individuals were screened for symptoms of PTB. Among these, 3001 (14.9%) individuals reported at least one PTB symptom and sputum was collected from 2890 (96.3%) individuals. Among these, 273 (9.4%) were bacteriologically positive for PTB. The overall prevalence was 1357 per 100000 population. The findings indicate that TB continues to be a major health problem in this marginalised community despite large investments by the government for TB control. This emphasizes the need to look into the causes and barriers in implementation of the TB elimination programme in the community, especially in view of India's TB elimination goal by 2025.

In India, the private sector diagnoses and treats more patients with TB than the public sector. Gaps in the TB care cascade were observed more among the patients diagnosed in the private sector. The System for TB Elimination in Private Sector (STEPS) model evolved as a solution to address gaps in the quality of care for patients in the private sector by ensuring standards of TB care. STEPS has 3 components: a consortium of private hospitals, a coalition of all professional medical associations, and a STEPS center in each private hospital. STEPS centers act as a single window for notification, linkage for social welfare measures, contact investigation, chemoprophylaxis, direct benefit transfers, and treatment adherence support. STEPS was piloted in 14 districts in the state of Kerala. All 14 districts formed consortiums of private hospital management for policy support and a coalition of professional medical associations for advocacy with doctors. STEPS centers were established in 318 private hospitals. Notification to National TB Elimination Program from the private sector improved by 26% when compared to the previous year. Among the patients notified from the private sector, microbiologically confirmed cases increased by 81%, rifampicin resistance testing at baseline increased by 56%, and the percentage of those informed of their HIV status increased by 95%. The percentage of patients notified from the private sector with their treatment outcome reported improved from 39% (2018) to 99% (2019). The STEPS model demonstrated that a low-cost locally customized private sector engagement model is feasible and is beneficial to society. STEPS could be one of the major solutions for supporting patients reaching the private sector.

Strategic diagnosis- Unraveling Tuberculosis- A comprehensive approach

BACKGROUND: Comorbid mental disorders in patients with TB may exacerbate TB treatment outcomes. We systematically reviewed current evidence on the association between mental disorders and TB outcomes.METHODS: We searched eight databases for studies published from 1990 to 2018 that compared TB treatment outcomes among patients with and without mental disorders. We excluded studies that did not systematically assess mental disorders and studies limited to substance use. We extracted study and patient characteristics and effect measures and performed a meta-analysis using random-effects models to calculate summary odds ratios (ORs) with 95% confidence intervals (CIs).RESULTS: Of 7687 studies identified, 10 were included in the systematic review and nine in the meta-analysis. Measurement of mental disorders and TB outcomes were heterogeneous across studies. The pooled association between mental disorders and any poor outcome, loss to follow-up, and non-adherence were OR 2.13 (95%CI 0.85-5.37), 1.90 (95%CI 0.33-10.91), and 1.60 (95%CI 0.81-3.02), respectively. High statistical heterogeneity was present.CONCLUSION: Our review suggests that mental disorders in TB patients increase the risk of poor TB outcomes, but pooled estimates were imprecise due to small number of eligible studies. Integration of psychological and TB services might improve TB outcomes and progress towards TB elimination.

Pendahuluan: Indonesia menjadi salah satu negara dengan beban TBC tertinggi kedua di dunia. Menuju elminasi TBC 2030, pemerintah menyusun kerangka akselerasi program TBC diantaranya berupa active case finding (ACF), sebagai upaya aktif mencari orang berisiko dan bergejala TBC dengan kegiatan pelacakan kontak dan skrining. Skrining menggunakan Chest x-ray (CXR) dinilai lebih sensitif daripada dengan pendekatan gejala, mengingat sebagian besar pasien TBC tidak memiliki gejala khas TBC. Pada tahun 2023 kegiatan ACF di Kota Yogyakarta dikembangkan dengan model adaptasi. Metode: Penelitian ini menggunakan metode deskriptif kuantitatif, menggambarkan hasil kegiatan ACF terdiri dari karakteristik peserta, jenis kelompok sasaran, skrining CXR, pemeriksaan TCM serta kontribusi ACF dalam program penanggulangan TBC. Hasil: Pada ACF dengan model adaptasi, peran Puskesmas dan lintas sektor lebih diutamakan. Kegiatan ACF di lakukan 88 kali dengan total peserta 7.423 orang, terduga TBC yang terjaring 1.403 orang (18.90%) dan 83 kasus TBC baru ditemukan. Peserta terbanyak adalah perempuan (54.41%), berusia 55 - ≤ 65 tahun (23.19%), dan berasal dari masyarakat sekitar lokasi ACF diselenggarakan (56.31%). Prosentase penemuan terduga dan kasus TBC terbanyak dari Puskesmas Pakualaman. Simpulan: ACF dengan model adaptasi di Kota Yogyakarta berkontribusi menemukan 22.92% terduga TBC dan 5.28% kasus TBC dari target yang harus ditemukan. Perlu dilakukan upaya kolaboratif antar sektor untuk memobilisasi kelompok sasaran yang tepat ke lokasi ACF seperti ODHIV, kontak serumah, pasien DM, balita dengan masalah gizi, kelompok laki-laki perokok dan pengguna alkohol. Introduction: Indonesia is one of the countries with the second highest TB burden globally. Towards TB elimination by 2030, the government prepared a framework for accelerating the TB program, including active case finding (ACF), as an active effort to find people at risk and with symptoms of TB through contact tracing and screening activities. Screening using chest X-rays (CXR) is considered more sensitive than the symptom approach, considering that most TB patients do not have typical TB symptoms. In 2023, ACF activities in the City of Yogyakarta will be developed using an adaptation model. Method: Quantitative descriptive research describing the results of ACF activities consists of the characteristics of ACF participants, types of target groups, CXR screening, TCM examination, and ACF's contribution to the TB control program. Results: With the adaptation model, the role of Puskesmas and cross-sectors was prioritized in ACF. ACF was carried out 88 times with 7,423 participants; 1,403 people were suspected of having TB (18.90%), and 83 new TB cases were found. Most participants were women (54.41%), age group 55 - ≤65 years (23.19%), and came from the general public (56.31%). The highest percentage of suspected discoveries and TB cases came from the Pakualaman Health Center. Conclusion: With the adaptation model in Yogyakarta City, ACF contributed to finding 22.92% of suspected TB and 5.28% of TB cases of the target that had to be found. Collaborative efforts between sectors need to be made to mobilize the right target groups for ACF locations, such as PLHIV, household contacts, DM patients, toddlers with nutritional problems, groups of male smokers, and alcohol users.

SUMMARYDrug-resistant tuberculosis (DR-TB) causes substantial morbidity and mortality and has hindered progress toward TB elimination. This slowed progress toward the WHO End TB Strategy's targets was exacerbated by lower TB detection during the COVID-19 pandemic. To inform research and development priorities, we conducted a narrative review of global DR-TB epidemiology and strategies for DR-TB prevention, diagnostics, and treatment. Gaps remain in DR-TB diagnosis, TB drug susceptibility testing (DST), and treatment. The review also shows that DR-TB causes significant post-disease disability, particularly chronic lung disease, impacting quality of life. Newer oral regimens for multidrug-resistant TB are shorter and more effective than traditional regimens. New antibiotics under development may help overcome remaining safety and tolerability issues, while novel advanced therapeutics and precision medicine offer hope to those failing treatment. Emerging diagnostics include rapid DST for second-line drugs, but a paradigm shift is needed to ensure novel DSTs become available as new drugs are introduced. Person-centered research is urgently needed to accelerate the response to DR-TB amidst the global threat of antimicrobial resistance, yet global investment in TB prevention and care currently falls short of need. A holistic approach to interventions to improve DR-TB prevention and care is needed, encompassing all health system components and their interactions, including a One Health approach and consideration of the wider determinants of health.

Tuberculosis or often called TB is an infectious disease caused by Mycobacterium Tuberculosis bacteria which enter the body through breathing. TB is one of the most dangerous diseases in the world. Indonesia is currently ranked second in the country with the highest TB burden in the world after India, with an estimated 969,000 new cases and 144,000 deaths. Of these cases, only 74% or 717,941 were discovered and treated. Thus, there are 251,059 people with TB who have not been treated and are at risk of becoming a source of infection for people around them. Indonesia has signed a joint agreement with world leaders to strive to achieve the elimination of TB by 2030 which is also included in the Sustainable Development Goals in the health sector. As a form of the Indonesian Government's commitment, Presidential Regulation of the Republic of Indonesia Number 67 of 2021 concerning Tuberculosis Management has been issued. This regulation regulates cross-program and cross-sector involvement in efforts to achieve TB elimination by 2030. To support the achievement of TB elimination by 2030 in accordance with the mandate of Presidential Decree 67/2021, commemoration of World TB Day (HTBS) every March 24 is a means for cross-sectors and the community to support TB control efforts. Lecturer Program in carrying out Community Service and supporting the liberation of Indonesia, especially the Makassar area from resistance to the use of Tuberculosis drugs, This activity was carried out with the theme, find tuberculosis, treat it until it is cured