Publications
170 results found
Saunders MJ, Wingfield T, Tovar MA, et al., 2018, Mobile phone interventions for tuberculosis should ensure access to mobile phones to enhance equity – a prospective, observational cohort study in Peruvian shantytowns, Tropical Medicine and International Health, Vol: 23, Pages: 850-859, ISSN: 1360-2276
Objectives:Mobile phone interventions have been advocated for tuberculosis care, but little is known about access of target populations to mobile phones. We studied mobile phone access among patients with tuberculosis, focusing on vulnerable patients and patients who later had adverse treatment outcomes.Methods:In a prospective cohort study in Callao, Peru, we recruited and interviewed 2584 patients with tuberculosis between 2007 and 2013 and followed them until 2016 for adverse treatment outcomes using national treatment registers. Subsequently, we recruited a further 622 patients between 2016 and 2017. Data were analysed using logistic regression and by calculating relative risks (RR).Results:Between 2007 and 2013, the proportion of the general population of Peru without mobile phone access averaged 7.8% but for patients with tuberculosis was 18% (P < 0.001). Patients without access were more likely to hold a lower socioeconomic position, suffer from food insecurity and be older than 50 years (all P < 0.01). Compared to patients with mobile phone access, patients without access at recruitment were more likely to subsequently have incomplete treatment (20% vs. 13%, RR = 1.5; P = 0.001) or an adverse treatment outcome (29% vs. 23% RR = 1.3; P = 0.006). Between 2016 and 2017, the proportion of patients without access dropped to 8.9% overall, but remained the same (18%) as in 2012 among the poorest third.Conclusion:Access to mobile phones among patients with tuberculosis is insufficient, and rarest in patients who are poorer and later have adverse treatment outcomes. Thus, mobile phone interventions to improve tuberculosis care may be least accessed by the priority populations for whom they are intended. Such interventions should ensure access to mobile phones to enhance equity.
Metcalf T, Soria J, Montano SM, et al., 2018, Evaluation of the GeneXpert MTB/RIF in patients with presumptive tuberculous meningitis, PLoS One, Vol: 13, Pages: 1-15, ISSN: 1932-6203
BackgroundMeningitis caused by Mycobacterium tuberculosis is a major cause of morbidity and mortality worldwide. We evaluated the performance of cerebrospinal fluid (CSF) testing with the GeneXpert MTB/RIF assay versus traditional approaches for diagnosing tuberculosis meningitis (TBM).MethodsPatients were adults (n = 37) presenting with suspected TBM to the Hospital Nacional Dos de Mayo, Lima, Peru, during 12 months until 1st January 2015. Each participant had a single CSF specimen that was divided into aliquots that were concurrently tested for M. tuberculosis using GeneXpert, Ziehl-Neelsen smear and culture on solid and liquid media. Drug susceptibility testing used Mycobacteria Growth Indicator Tube (MGIT 960) and the proportions method.Results81% (30/37) of patients received a final clinical diagnosis of TBM, of whom 63% (19/30, 95% confidence intervals, CI: 44–80%) were HIV-positive. 22% (8/37, 95%CI: 9.8–38%), of patients had definite TBM. Because definite TBM was defined by positivity in any laboratory test, all laboratory tests had 100% specificity. Considering the 30 patients who had a clinical diagnosis of TBM: diagnostic sensitivity was 23% (7/30, 95%CI: 9.9–42%) for GeneXpert and was the same for all culture results combined; considerably greater than 7% (2/30, 95%CI: 0.82–22%) for microscopy; whereas all laboratory tests had poor negative predictive values (20–23%). Considering only the 8 patients with definite TBM: diagnostic sensitivity was 88% (7/8, 95%CI: 47–100%) for GeneXpert; 75% (6/8, 95%CI: 35–97%) for MGIT culture or LJ culture; 50% (4/8, 95%CI 16–84) for Ogawa culture and 25% (2/8, 95%CI: 3.2–65%) for microscopy. GeneXpert and microscopy provided same-day results, whereas culture took 20–56 days. GeneXpert provided same-day rifampicin-susceptibility results, whereas culture-based testing took 32–71 days. 38% (3/8, 95%CI: 8.5–76%) of patients with definite TBM with data h
Andre E, Rusumba O, Evans CA, et al., 2018, Patient-led active tuberculosis case-finding in the Democratic Republic of the Congo, Bulletin of the World Health Organization, Vol: 96, Pages: 522-530, ISSN: 0042-9686
Objective To investigate the effect of using volunteer screeners in active tuberculosis case-finding in South Kivu, the Democratic Republicof the Congo, especially among groups at high risk of tuberculosis infection.Methods To identify and screen high-risk groups in remote communities, we trained volunteer screeners, mainly those who had themselvesreceived treatment for tuberculosis or had a family history of the disease. A non-profit organization was created and screeners receivedtraining on the disease and its transmission at 3-day workshops. Screeners recorded the number of people screened, reporting a prolongedcough and who attended a clinic for testing, as well as test results. Data were evaluated every quarter during the 3-year period of theintervention (2014–2016).Findings Acceptability of the intervention was high. Volunteers screened 650434 individuals in their communities, 73418 of whom reporteda prolonged cough; 50 368 subsequently attended a clinic for tuberculosis testing. Tuberculosis was diagnosed in 1 in 151 people screened,costing 0.29 United States dollars (US$) per person screened and US$ 44 per person diagnosed. Although members of high-risk groups withpoorer access to health care represented only 5.1% (33 002/650 434) of those screened, they contributed 19.7% (845/4300) of tuberculosisdiagnoses (1 diagnosis per 39 screened). The intervention resulted in an additional 4300 sputum-smear-positive pulmonary tuberculosisdiagnoses, 42% (4 300/10 247) of the provincial total for that period.Conclusion Patient-led active tuberculosis case-finding represents a valuable complement to traditional case-finding, and should be usedto assist health systems in the elimination of tuberculosis.
Zhang A, Jumbe E, Krysiak R, et al., 2018, Low-cost diagnostic test for susceptible and drug-resistant tuberculosis in rural Malawi, African Journal of Laboratory Medicine, Vol: 7, ISSN: 2225-2002
Background: Rural settings where molecular tuberculosis diagnostics are not currently available need easy-to-use tests that do not require additional processing or equipment. While acid-fast bacilli (AFB) smear is the most common and often only tuberculosis diagnosis test performed in rural settings, it is labour intensive, has less-than-ideal sensitivity, and cannot assess tuberculosis drug susceptibility patterns.Objective: The objective of this study was to determine the feasibility of a multidrug-resistant (MDR) or extensively drug-resistant (XDR)-tuberculosis coloured agar-based culture test (tuberculosis CX-test), which can detect Mycobacterium tuberculosis growth and evaluate for drug susceptibility to isoniazid, rifampicin and a fluoroquinolone (i.e. ciprofloxacin) in approximately 14 days.Method: In this study, 101 participants were enrolled who presented to a rural health clinic in central Malawi. They were suspected of having active pulmonary tuberculosis. Participants provided demographic and clinical data and submitted sputum samples for tuberculosis testing using the AFB smear and tuberculosis CX-test.Results: The results showed a high level of concordance between the AFB smear (12 positive) and tuberculosis CX-test (13 positive); only one sample presented discordant results, with the molecular GeneXpert MTB/RIF® test confirming the tuberculosis CX-test results. The average time to a positive tuberculosis CX-test was 10 days. Of the positive samples, the tuberculosis CX-test detected no cases of drug resistance, which was later confirmed by the GeneXpert MTB/RIF®.Conclusion: These findings demonstrate that the tuberculosis CX-test could be a reliable low-cost diagnostic method for active pulmonary tuberculosis in high tuberculosis burden rural areas.
Bonadonna L, Saunders M, Guio H, et al., 2018, Socioeconomic and behavioral factors associated with tuberculosis diagnostic delay in Lima, Peru, American Journal of Tropical Medicine and Hygiene, Vol: 98, Pages: 1614-1623, ISSN: 0002-9637
Early detection and diagnosis of tuberculosis (TB) is a global priority. Prolonged symptom duration prior to TB diagnosis is associated with increased morbidity, mortality and risk of transmission. We aimed to determine socioeconomic and behavioral factors associated with diagnostic delays among patients with TB. Data were collected from 105 patients with TB using a semi-structured interview guide in Lima, Peru. Factors associated with diagnostic delay were analyzed using negative binomial regression. The median delay from when symptoms commenced and the first positive diagnostic sample in public health facilities was 57 days (interquartile range (IQR): 28-126). In multivariable analysis, greater diagnostic delay was independently associated with patient older age; female sex; lower personal income prior to diagnosis; living with fewer people; and having more visits to professional health facilities prior to diagnosis (all p<0.05). Patients who first sought care at a private health facility had more visits overall to professional health facilities prior to diagnosis than those who first sought care from public or insured employee health facilities and had longer diagnostic delay in analysis adjusted for age and sex. Patients with TB were significantly more likely to first self-medicate than to visit professional health facilities prior to diagnosis (p=0.003). Thus, diagnostic delay was prolonged, greatest among older, low-income women and varied according to the type of care sought by individuals when their symptoms commenced. These findings suggest that TB case finding initiatives should target vulnerable groups in informal and private health facilities, where many patients with TB first seek healthcare.
Friedland JS, Proano A, Bui D, et al., 2018, Cough frequency during treatment associated with baseline cavitary volume and proximity to the airway in pulmonary tuberculosis, Chest, Vol: 153, Pages: 1358-1367, ISSN: 0012-3692
Background: Cough frequency, and its duration, is a lab-free biomarker that can be used in low-resource settings and has been associated with transmission and treatment response.Radiological characteristics associated with increased cough frequency may be important in understanding transmission. The relationship between cough frequency and cavitary lung disease has never been studied. Methods: We analyzed 41 human immunodeficiency virus-negative adults with culture- confirmed, drug-susceptible pulmonary tuberculosis throughout treatment. Cough recordings were based on the Cayetano Cough Monitor and sputum samples were evaluated using microscopic-observation drug susceptibility broth culture, among culture-positive samples bacillary burden was assessed by time to positivity. Computerized tomography scans were analyzed by a U.S. board-certified radiologist and an automated-computer algorithm. The algorithm evaluates cavity volume and cavitary proximity to the airway. Computerized tomography scans were taken within one month of treatment initiation. We compared small cavities (≤7-mL) versus large cavities (>7-mL) and cavities located closer to (≤10-mm) and farther (>10-mm) from the airway to cough frequency and cough cessation until treatment day 62.Results: Cough frequency during treatment was two-fold higher in participants with large cavity volumes (Rate Ratio [RR]=1.98, p=0.01) and cavities located closer to the airway (RR=2.44, p=0.001). Comparably, cough ceased three times faster in smaller cavities (adjusted hazard ratio [HR]=2.89, p=0.06) and those farther from the airway (adjusted HR=3.61, p=0.02). Similar results are found for bacillary burden and culture conversion during treatment. Conclusions: Cough frequency during treatment is greater and lasts for longer in patients with larger cavities, especially those closer to the airway
Wingfield T, Tovar MA, Datta S, et al., 2018, Addressing social determinants to end tuberculosis, The Lancet, Vol: 391, Pages: 1129-1132, ISSN: 0140-6736
Saunders MJ, Evans C, Datta S, et al., 2018, Pragmatic tuberculosis prevention policies for primary care in low- and middle-income countries, European Respiratory Journal, Vol: 51, ISSN: 0903-1936
Saunders MJ, Wingfield T, Tovar MA, et al., 2017, Prediction and prevention of tuberculosis in contacts - Authors' reply, Lancet Infectious Diseases, Vol: 17, Pages: 1238-1239, ISSN: 1473-3099
Saunders MJ, Wingfield T, Tovar MA, et al., 2017, A score to predict and stratify risk of tuberculosis in adult contacts of tuberculosis index cases: a prospective derivation and external validation cohort study, Lancet Infectious Diseases, Vol: 17, Pages: 1190-1199, ISSN: 1473-3099
BACKGROUND: Contacts of tuberculosis index cases are at increased risk of developing tuberculosis. Screening, preventive therapy, and surveillance for tuberculosis are underused interventions in contacts, particularly adults. We developed a score to predict risk of tuberculosis in adult contacts of tuberculosis index cases. METHODS: In 2002-06, we recruited contacts aged 15 years or older of index cases with pulmonary tuberculosis who lived in desert shanty towns in Ventanilla, Peru. We followed up contacts for tuberculosis until February, 2016. We used a Cox proportional hazards model to identify index case, contact, and household risk factors for tuberculosis from which to derive a score and classify contacts as low, medium, or high risk. We validated the score in an urban community recruited in Callao, Peru, in 2014-15. FINDINGS: In the derivation cohort, we identified 2017 contacts of 715 index cases, and median follow-up was 10·7 years (IQR 9·5-11·8). 178 (9%) of 2017 contacts developed tuberculosis during 19 147 person-years of follow-up (incidence 0·93 per 100 person-years, 95% CI 0·80-1·08). Risk factors for tuberculosis were body-mass index, previous tuberculosis, age, sustained exposure to the index case, the index case being in a male patient, lower community household socioeconomic position, indoor air pollution, previous tuberculosis among household members, and living in a household with a low number of windows per room. The 10-year risks of tuberculosis in the low-risk, medium-risk, and high-risk groups were, respectively, 2·8% (95% CI 1·7-4·4), 6·2% (4·8-8·1), and 20·6% (17·3-24·4). The 535 (27%) contacts classified as high risk accounted for 60% of the tuberculosis identified during follow-up. The score predicted tuberculosis independently of tuberculin skin test and index-case drug sensitivity results. In the external validation cohort, 65 (3%)
Rudgard WE, Evans CA, Sweeney S, et al., 2017, Comparison of two cash transfer strategies to prevent catastrophic costs for poor tuberculosis-affected households in low- and middle-income countries: An economic modelling study., PLoS Medicine, Vol: 14, ISSN: 1549-1277
BACKGROUND: Illness-related costs for patients with tuberculosis (TB) ≥20% of pre-illness annual household income predict adverse treatment outcomes and have been termed "catastrophic." Social protection initiatives, including cash transfers, are endorsed to help prevent catastrophic costs. With this aim, cash transfers may either be provided to defray TB-related costs of households with a confirmed TB diagnosis (termed a "TB-specific" approach); or to increase income of households with high TB risk to strengthen their economic resilience (termed a "TB-sensitive" approach). The impact of cash transfers provided with each of these approaches might vary. We undertook an economic modelling study from the patient perspective to compare the potential of these 2 cash transfer approaches to prevent catastrophic costs. METHODS AND FINDINGS: Model inputs for 7 low- and middle-income countries (Brazil, Colombia, Ecuador, Ghana, Mexico, Tanzania, and Yemen) were retrieved by literature review and included countries' mean patient TB-related costs, mean household income, mean cash transfers, and estimated TB-specific and TB-sensitive target populations. Analyses were completed for drug-susceptible (DS) TB-related costs in all 7 out of 7 countries, and additionally for drug-resistant (DR) TB-related costs in 1 of the 7 countries with available data. All cost data were reported in 2013 international dollars ($). The target population for TB-specific cash transfers was poor households with a confirmed TB diagnosis, and for TB-sensitive cash transfers was poor households already targeted by countries' established poverty-reduction cash transfer programme. Cash transfers offered in countries, unrelated to TB, ranged from $217 to $1,091/year/household. Before cash transfers, DS TB-related costs were catastrophic in 6 out of 7 countries. If cash transfers were provided with a TB-specific approach, alone they would be insufficient to prevent DS TB catast
Datta S, Saunders MJ, Tovar MA, et al., 2017, Improving tuberculosis diagnosis: Better tests or better healthcare?, PLoS Medicine, Vol: 14, ISSN: 1549-1277
In a Perspective accompanying Sylvia and colleagues, Carlton Evans and colleagues discuss the challenge of squaring policies around tuberculosis diagnosis with the realities of clinical practice in small villages and low-resource settings.
Bonadonna LV, Saunders MJ, Zegarra R, et al., 2017, Why wait? The social determinants underlying tuberculosis diagnostic delay., PLoS ONE, Vol: 12, ISSN: 1932-6203
BACKGROUND: Early detection and diagnosis of tuberculosis remain major global priorities for tuberculosis control. Few studies have used a qualitative approach to investigate the social determinants contributing to diagnostic delay and none have compared data collected from individual, community, and health-system levels. We aimed to characterize the social determinants that contribute to diagnostic delay among persons diagnosed with tuberculosis living in resource-constrained settings. METHODS/PRINCIPLE FINDINGS: Data were collected in public health facilities with high tuberculosis incidence in 19 districts of Lima, Peru. Semi-structured interviews with persons diagnosed with tuberculosis (n = 105) and their family members (n = 63) explored health-seeking behaviours, community perceptions of tuberculosis and socio-demographic circumstances. Focus groups (n = 6) were conducted with health personnel (n = 35) working in the National Tuberculosis Program. All interview data were transcribed and analysed using a grounded theory approach. The median delay between symptom onset and the public health facility visit that led to the first positive diagnostic sample was 57 days (interquartile range 28-126). The great majority of persons diagnosed with tuberculosis distrusted the public health system and sought care at public health facilities only after exhausting other options. It was universally agreed that persons diagnosed with tuberculosis faced discrimination by public and health personnel. Self-medication with medicines bought at local pharmacies was reported as the most common initial health-seeking behaviour due to the speed and low-cost of treatment in pharmacies. Most persons diagnosed with tuberculosis initially perceived their illness as a simple virus. CONCLUSIONS: Diagnostic delay was common and prolonged. When individuals reached a threshold of symptom severity, they addressed their health with the least time-consuming, most economically feasible, and well-kn
Kirwan D, Ugarte-Gil C, Gilman RH, et al., 2017, Histological examination in obtaining a diagnosis in patients with lymphadenopathy in Lima, Peru, American Journal of Tropical Medicine and Hygiene, Vol: 97, Pages: 1271-1276, ISSN: 1476-1645
The differential diagnosis for lymphadenopathy is wide and clinical presentations overlap, making obtaining an accurate diagnosis challenging. We sought to characterize the clinical and radiological characteristics, histological findings, and diagnoses for a cohort of patients with lymphadenopathy of unknown etiology. 121 Peruvian adults with lymphadenopathy underwent lymph node biopsy for microbiological and histopathological evaluation. Mean patient age was 41 years (Interquartile Range 26–52), 56% were males, and 39% were HIV positive. Patients reported fever (31%), weight loss (23%), and headache (22%); HIV infection was associated with fever (P < 0.05) and gastrointestinal symptoms (P < 0.05). Abnormalities were reported in 40% of chest X-rays (N = 101). Physicians suspected TB in 92 patients (76%), lymphoma in 19 patients (16%), and other malignancy in seven patients (5.8%). Histological diagnoses (N = 117) included tuberculosis (34%), hyperplasia (27%), lymphoma (13%), and nonlymphoma malignancy (14%). Hyperplasia was more common (P < 0.001) and lymphoma less common (P = 0.005) among HIV-positive than HIV-negative patients. There was a trend toward reduced frequency of caseous necrosis in samples from HIV-positive than HIV-negative TB patients (67 versus 93%, P = 0.055). The spectrum of diagnoses was broad, and clinical and radiological features correlated poorly with diagnosis. On the basis of clinical features, physicians over-diagnosed TB, and under-diagnosed malignancy. Although this may not be inappropriate in resource-limited settings where TB is the most frequent easily treatable cause of lymphadenopathy, diagnostic delays can be detrimental to patients with malignancy. It is important that patients with lymphadenopathy undergo a full diagnostic work-up including sampling for histological evaluation to obtain an accurate diagnosis.
Datta S, Shah L, Gilman RH, et al., 2017, Comparing sputum collection methods for tuberculosis diagnosis: a systematic review, pairwise and network meta-analysis, Lancet Global Health, Vol: 5, Pages: e760-e771, ISSN: 2214-109X
BackgroundThe performance of laboratory tests to diagnose pulmonary tuberculosis is dependent on the quality of the sputum sample tested. The relative merits of sputum collection methods to improve tuberculosis diagnosis are poorly characterised. We therefore aimed to investigate the effects of sputum collection methods on tuberculosis diagnosis.MethodsWe did a systematic review and meta-analysis to investigate whether non-invasive sputum collection methods in people aged at least 12 years improve the diagnostic performance of laboratory testing for pulmonary tuberculosis. We searched PubMed, Google Scholar, ProQuest, Web of Science, CINAHL, and Embase up to April 14, 2017, to identify relevant experimental, case-control, or cohort studies. We analysed data by pairwise meta-analyses with a random-effects model and by network meta-analysis. All diagnostic performance data were calculated at the sputum-sample level, except where authors only reported data at the individual patient-level. Heterogeneity was assessed, with potential causes identified by logistic meta-regression.FindingsWe identified 23 eligible studies published between 1959 and 2017, involving 8967 participants who provided 19 252 sputum samples. Brief, on-demand spot sputum collection was the main reference standard. Pooled sputum collection increased tuberculosis diagnosis by microscopy (odds ratio [OR] 1·6, 95% CI 1·3–1·9, p<0·0001) or culture (1·7, 1·2–2·4, p=0·01). Providing instructions to the patient before sputum collection, during observed collection, or together with physiotherapy assistance increased diagnostic performance by microscopy (OR 1·6, 95% CI 1·3–2·0, p<0·0001). Collecting early morning sputum did not significantly increase diagnostic performance of microscopy (OR 1·5, 95% CI 0·9–2·6, p=0·2) or culture (1·4, 0·9–2·4
Datta S, Sherman JM, Tovar MA, et al., 2017, Sputum microscopy with fluorescein diacetate predicts tuberculosis infectiousness, Journal of Infectious Diseases, Vol: 216, Pages: 514-524, ISSN: 1537-6613
Background.Sputum from patients with tuberculosis contains subpopulations of metabolically active and inactive Mycobacterium tuberculosis with unknown implications for infectiousness.Methods.We assessed sputum microscopy with fluorescein diacetate (FDA, evaluating M. tuberculosis metabolic activity) for predicting infectiousness. Mycobacterium tuberculosis was quantified in pretreatment sputum of patients with pulmonary tuberculosis using FDA microscopy, culture, and acid-fast microscopy. These 35 patients’ 209 household contacts were followed with prevalence surveys for tuberculosis disease for 6 years.Results.FDA microscopy was positive for a median of 119 (interquartile range [IQR], 47–386) bacteria/µL sputum, which was 5.1% (IQR, 2.4%–11%) the concentration of acid-fast microscopy–positive bacteria (2069 [IQR, 1358–3734] bacteria/μL). Tuberculosis was diagnosed during follow-up in 6.4% (13/209) of contacts. For patients with lower than median concentration of FDA microscopy–positive M. tuberculosis, 10% of their contacts developed tuberculosis. This was significantly more than 2.7% of the contacts of patients with higher than median FDA microscopy results (crude hazard ratio [HR], 3.8; P = .03). This association maintained statistical significance after adjusting for disease severity, chemoprophylaxis, drug resistance, and social determinants (adjusted HR, 3.9; P = .02).Conclusions.Mycobacterium tuberculosis that was FDA microscopy negative was paradoxically associated with greater infectiousness. FDA microscopy–negative bacteria in these pretreatment samples may be a nonstaining, slowly metabolizing phenotype better adapted to airborne transmission.
Wingfield T, Tovar MA, Huff D, et al., 2017, Socioeconomic support to improve initiation of tuberculosis preventive therapy and increase tuberculosis treatment success in Peru: a household-randomised, controlled evaluation, Spring Meeting on Clinician Scientists in Training, Publisher: Elsevier, Pages: S16-S16, ISSN: 0140-6736
Wingfield T, Tovar MA, Huff D, et al., 2017, A randomized controlled study of socioeconomic support to enhance tuberculosis prevention and treatment, Peru, BULLETIN OF THE WORLD HEALTH ORGANIZATION, Vol: 95, Pages: 270-280, ISSN: 0042-9686
Objective To evaluate the impact of socioeconomic support on tuberculosis preventive therapy initiation in household contacts oftuberculosis patients and on treatment success in patients.Methods A non-blinded, household-randomized, controlled study was performed between February 2014 and June 2015 in 32 shantytowns in Peru. It included patients being treated for tuberculosis and their household contacts. Households were randomly assigned to eitherthe standard of care provided by Peru’s national tuberculosis programme (control arm) or the same standard of care plus socioeconomicsupport (intervention arm). Socioeconomic support comprised conditional cash transfers up to 230 United States dollars per household,community meetings and household visits. Rates of tuberculosis preventive therapy initiation and treatment success (i.e. cure or treatmentcompletion) were compared in intervention and control arms.Findings Overall, 282 of 312 (90%) households agreed to participate: 135 in the intervention arm and 147 in the control arm. There were410 contacts younger than 20 years: 43% in the intervention arm initiated tuberculosis preventive therapy versus 25% in the control arm(adjusted odds ratio, aOR: 2.2; 95% confidence interval, CI: 1.1–4.1). An intention-to-treat analysis showed that treatment was successfulin 64% (87/135) of patients in the intervention arm versus 53% (78/147) in the control arm (unadjusted OR: 1.6; 95% CI: 1.0–2.6). Theseimprovements were equitable, being independent of household poverty.Conclusion A tuberculosis-specific, socioeconomic support intervention increased uptake of tuberculosis preventive therapy andtuberculosis treatment success and is being evaluated in the Community Randomized Evaluation of a Socioeconomic Intervention toPrevent TB (CRESIPT) project.
Proano A, Bravard M, Lopez JW, et al., 2017, Dynamics of cough frequency in adults undergoing treatment for pulmonary tuberculosis, Clinical Infectious Diseases, Vol: 64, Pages: 1174-1181, ISSN: 1537-6591
Background.Cough is the major determinant of tuberculosis transmission. Despite this, there is a paucity of information regarding characteristics of cough frequency throughout the day and in response to tuberculosis therapy. Here we evaluate the circadian cycle of cough, cough frequency risk factors, and the impact of appropriate treatment on cough and bacillary load.Methods.We prospectively evaluated human immunodeficiency virus–negative adults (n = 64) with a new diagnosis of culture-proven, drug-susceptible pulmonary tuberculosis immediately prior to treatment and repeatedly until treatment day 62. At each time point, participant cough was recorded (n = 670) and analyzed using the Cayetano Cough Monitor. Consecutive coughs at least 2 seconds apart were counted as separate cough episodes. Sputum samples (n = 426) were tested with microscopic-observation drug susceptibility broth culture, and in culture-positive samples (n = 252), the time to culture positivity was used to estimate bacillary load.Results.The highest cough frequency occurred from 1 pm to 2 pm, and the lowest from 1 am to 2 am (2.4 vs 1.1 cough episodes/hour, respectively). Cough frequency was higher among participants who had higher sputum bacillary load (P < .01). Pretreatment median cough episodes/hour was 2.3 (interquartile range [IQR], 1.2–4.1), which at 14 treatment days decreased to 0.48 (IQR, 0.0–1.4) and at the end of the study decreased to 0.18 (IQR, 0.0–0.59) (both reductions P < .001). By 14 treatment days, the probability of culture conversion was 29% (95% confidence interval, 19%–41%).Conclusions.Coughs were most frequent during daytime. Two weeks of appropriate treatment significantly reduced cough frequency and resulted in one-third of participants achieving culture conversion. Thus, treatment by 2 weeks considerably diminishes, but does not eliminate, the potential for airborne tuberculosis transmission.
Naik NS, Lee GO, Comina G, et al., 2017, EVALUATION OF A LOW-COST AIR SAMPLING SYSTEM FOR THE DETECTION OF MYCOBACTERIUM TUBERCULOSIS IN COUGHING PATIENTS, 66th Annual Meeting of the American-Society-of-Tropical-Medicine-and-Hygiene (ASTMH), Publisher: AMER SOC TROP MED & HYGIENE, Pages: 578-578, ISSN: 0002-9637
Lee G, Comina G, Hernandez G, et al., 2017, THE ASSOCIATION OF COUGH FREQUENCY WITH THE MICROBIOLOGICAL DYNAMICS OF TUBERCULOSIS IN PATIENTS WITH ACTIVE PULMONARY TUBERCULOSIS, 66th Annual Meeting of the American-Society-of-Tropical-Medicine-and-Hygiene (ASTMH), Publisher: AMER SOC TROP MED & HYGIENE, Pages: 388-388, ISSN: 0002-9637
Proaño A, Xu Z, Caligiuri P, et al., 2017, Computer automated algorithm to evaluate cavitary lesions in adults with pulmonary tuberculosis., J Thorac Dis, Vol: 9, Pages: E93-E96, ISSN: 2072-1439
Williams SN, Wingfield TW, Tovar MA, et al., 2016, Preventing catastrophic costs: Opportunities and barriers for reducing household TB-related costs, 47th Union World Conference on Lung Health, Publisher: International Union Against Tuberculosis and Lung Disease, Pages: S500-S500, ISSN: 1815-7920
Farrell LF, William SW, Bonadonna LB, et al., 2016, How effective are socially-targeted interventions at improving treatment outcomes when integrated into a TB program?, 47th Union World Conference on Lung Health, Publisher: International Union Against Tuberculosis and Lung Disease, ISSN: 1815-7920
Wingfield TW, Tovar MA, Huff DH, et al., 2016, Feedback from TB-affected households’ receiving a socioeconomic intervention in Peruvian shantytowns: an acceptability assessment from the CRESIPT pilot study, 47 Union World Conference on Lung Health, Publisher: International Union Against Tuberculosis and Lung Disease, Pages: S499-S499, ISSN: 1815-7920
Datta SD, Shah LS, Gilman RG, et al., 2016, A meta-analysis comparing different sputum collection methods, 47th Union World Conference on Lung Health, Publisher: International Union Against Tuberculosis and Lung Disease
Ramos ES, Valencia TR, Tovar MA, et al., 2016, Predicting mycobacterial load from the time of positive culture using MODS (microscopic- observation drug-susceptibility assay), 47th Union World Conference on Lung Health, Publisher: International Union Against Tuberculosis and Lung Disease, Pages: S351-S351, ISSN: 1815-7920
Saunders MJ, Tovar MA, Valencia TR, et al., 2016, Body mass index and TB incidence: A consistent dose-response relationship among adult household contacts, 47th Union World Conference on Lung Health, Publisher: International Union Against Tuberculosis and Lung Disease, Pages: S511-S511, ISSN: 1815-7920
Alegria-Flores KA, Wiesen CA, Weiner BJ, et al., 2016, An innovative approach for designing and implementing drug-resistant tuberculosis (DR-TB) treatment adherence interventions, 47th Union World Conference on Lung Health, Publisher: International Union Against Tuberculosis and Lung Disease, Pages: S96-S96, ISSN: 1027-3719
Tovar MA, Wingfield TW, Saunders MS, et al., 2016, Poverty predisposes patients to intermittent adherence to TB treatment, 47th Union World Conference on Lung Health, Publisher: International Union Against Tuberculosis and Lung Disease, Pages: S493-S493, ISSN: 1815-7920
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