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Decline in TB mortality in England and Wales, and its association in time with the two World Wars, and the introduction of chemotherapy against TB.
Source publication
The main thrust of the World Health Organization's global tuberculosis (TB) control strategy is to ensure effective and equitable delivery of quality assured diagnosis and treatment of TB. Options for including preventive efforts have not yet been fully considered. This paper presents a narrative review of the historical and recent progress in TB c...
Contexts in source publication
Context 1
... the 20th century, even before the introduction of effective chemotherapy, TB incidence declined steadily in most industrialized countries although it did increase temporarily during the two World Wars (Fig. 2). This was a period of economic growth, social reform, poverty reduction and improved living conditions as well as important advances in medicine and public health. The relative importance of the factors that may have contributed to the decline in TB in the 20th century is still a matter of debate. McKeown and Record (1962) suggested ...
Context 2
... paradigm based mostly on the biological understanding of the disease gradually emerged. It received a final boost with the discovery in the 1940s and 1950s of drugs that could cure the disease (Amrith, 2002). The expanded pharmacopeia of anti-TB drugs in the 1950s and 1960s helped to sustain and perhaps accelerate the decline in TB incidence (Fig. 2). But this was not only a period of rapid medical and health care advances. It was also a time of both rapid economic growth and accelerated welfare reforms in many industrialized countries ( Navarro et al., 2006). Progress in TB control in the industrialized countries over the past centuries was thus brought about by advances on ...
Context 3
... country-level investigations of the impact of DOTS pro- grammes have shown that, after several years of apparent successful implementation (as measured by high case detection and treatment success), incidence is not falling as rapidly as was expected. Vietnam appears to have reached the targets for case detection and treatment success since 1997, but the case notifica- tion rate has remained approximately constant over the last decade (Huong et al., 2006). The explanation for this is unclear. ...
Context 4
... is some evidence that outdoor air pollution is a risk factor for TB (Cohen & Mehta, 2007;Tremblay, 2007). Depression and stress can have negative effect on the cell- mediated immune system and could therefore in theory increase the risk of TB (Prince et al., 2007). In an analysis applied to the 22 High TB Burden Countries (HBC, countries that together suffer 80% of the estimated global TB burden), the population attributable fraction (PAF) for selected TB risk factors for impaired host defence was roughly estimated (Lö nnroth & Raviglione, 2008). ...
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Citations
... Treatment failure or loss to follow-up can result in a longer duration of disease, elevated mortality risks, and the possibility of acquired drug resistance [1]. To avoid these negative outcomes, it is important to implement effective patient-centric strategies to increase the fraction of patients achieving successful TB treatment outcomes [4]. ...
Introduction
Tuberculosis (TB) causes over 1 million deaths annually. Providing effective treatment is a key strategy for reducing TB deaths. In this study, we identified factors associated with unsuccessful treatment outcomes among individuals treated for TB in Brazil.
Methods
We obtained data on individuals treated for TB between 2015 and 2018 from Brazil’s National Disease Notification System (SINAN). We excluded patients with a history of prior TB disease or with diagnosed TB drug resistance. We extracted information on patient-level factors potentially associated with unsuccessful treatment, including demographic and social factors, comorbid health conditions, health-related behaviors, health system level at which care was provided, use of directly observed therapy (DOT), and clinical examination results. We categorized treatment outcomes as successful (cure, completed) or unsuccessful (death, regimen failure, loss to follow-up). We fit multivariate logistic regression models to identify factors associated with unsuccessful treatment.
Results
Among 259,484 individuals treated for drug susceptible TB, 19.7% experienced an unsuccessful treatment outcome (death during treatment 7.8%, regimen failure 0.1%, loss to follow-up 11.9%). The odds of unsuccessful treatment were higher with older age (adjusted odds ratio (aOR) 2.90 [95% confidence interval: 2.62–3.21] for 85-100-year-olds vs. 25-34-year-olds), male sex (aOR 1.28 [1.25–1.32], vs. female sex), Black race (aOR 1.23 [1.19–1.28], vs. White race), no education (aOR 2.03 [1.91–2.17], vs. complete high school education), HIV infection (aOR 2.72 [2.63–2.81], vs. no HIV infection), illicit drug use (aOR 1.95 [1.88–2.01], vs. no illicit drug use), alcohol consumption (aOR 1.46 [1.41–1.50], vs. no alcohol consumption), smoking (aOR 1.20 [1.16–1.23], vs. non-smoking), homelessness (aOR 3.12 [2.95–3.31], vs. no homelessness), and immigrant status (aOR 1.27 [1.11–1.45], vs. non-immigrants). Treatment was more likely to be unsuccessful for individuals treated in tertiary care (aOR 2.20 [2.14–2.27], vs. primary care), and for patients not receiving DOT (aOR 2.35 [2.29–2.41], vs. receiving DOT).
Conclusion
The risk of unsuccessful TB treatment varied systematically according to individual and service-related factors. Concentrating clinical attention on individuals with a high risk of poor treatment outcomes could improve the overall effectiveness of TB treatment in Brazil.
... These include the impact of poverty, inequality, urbanisation, migration, and conflict. Similarly, Lönnroth et al. (2009) discussed how control strategies remain constricted when implemented without addressing the circumstances or risk factors that render one vulnerable to disease. ...
The emergent threat of antimicrobial resistance (AMR) has resulted in debates around the use and preservation of effective antimicrobials. Concerns around AMR reflect a history of increasing dependence on antibiotics to address disease epidemics rooted in profound structural and systemic challenges. In the context of global health, this process, often referred to as pharmaceuticalisation, has commonly occurred within disease programmes, of which lessons are vital for adding nuance to conversations around antimicrobial stewardship. Tuberculosis (TB) is a notable example. A disease which accounts for one-third of AMR globally and remains the leading cause of death from a single infectious agent in many low – and middle-income countries, including South Africa. In this scoping review, we chart TB science in South Africa over 70 years of programming. We reviewed published manuscripts about the programme and critically reflected on the implications of our findings for stewardship. We identified cycles of programmatic responses to new drug availability and the emergence of drug resistance, which intersected with cycles of pharmaceuticalisation. These cycles reflect the political, economic, and social factors influencing programmatic decision-making. Our analysis offers a starting point for research exploring these cycles and drawing out implications for stewardship across the TB and AMR communities.
... Elevated levels of air pollutants are associated with impaired lung function due to oxidative stress, which may cause airway inflammation, inhibit the macrophage function, and increase susceptibility to MTB [58,59]. And HIV impairs the host immune defense against MTB infection and impairs phagocytosis of MTB by macrophage [59], thus PLWHA are more likely to develop TB than general individuals. ...
... Elevated levels of air pollutants are associated with impaired lung function due to oxidative stress, which may cause airway inflammation, inhibit the macrophage function, and increase susceptibility to MTB [58,59]. And HIV impairs the host immune defense against MTB infection and impairs phagocytosis of MTB by macrophage [59], thus PLWHA are more likely to develop TB than general individuals. Furthermore, we found a significant detrimental impact of PM 10 in PLWHA with severe immunodeficiency in present study. ...
Background
Previous studies have shown the association between tuberculosis (TB) and meteorological factors/air pollutants. However, little information is available for people living with HIV/AIDS (PLWHA), who are highly susceptible to TB.
Method
Data regarding TB cases in PLWHA from 2014 to2020 were collected from the HIV antiviral therapy cohort in Guangxi, China. Meteorological and air pollutants data for the same period were obtained from the China Meteorological Science Data Sharing Service Network and Department of Ecology and Environment of Guangxi. A distribution lag non-linear model (DLNM) was used to evaluate the effects of meteorological factors and air pollutant exposure on the risk of TB in PLWHA.
Results
A total of 2087 new or re-active TB cases were collected, which had a significant seasonal and periodic distribution. Compared with the median values, the maximum cumulative relative risk (RR) for TB in PLWHA was 0.663 (95% confidence interval [CI]: 0.507–0.866, lag 4 weeks) for a 5-unit increase in temperature, and 1.478 (95% CI: 1.116–1.957, lag 4 weeks) for a 2-unit increase in precipitation. However, neither wind speed nor PM10 had a significant cumulative lag effect. Extreme analysis demonstrated that the hot effect (RR = 0.638, 95%CI: 0.425–0.958, lag 4 weeks), the rainy effect (RR = 0.285, 95%CI: 0.135–0.599, lag 4 weeks), and the rainless effect (RR = 0.552, 95%CI: 0.322–0.947, lag 4 weeks) reduced the risk of TB. Furthermore, in the CD4(+) T cells < 200 cells/µL subgroup, temperature, precipitation, and PM10 had a significant hysteretic effect on TB incidence, while temperature and precipitation had a significant cumulative lag effect. However, these effects were not observed in the CD4(+) T cells ≥ 200 cells/µL subgroup.
Conclusion
For PLWHA in subtropical Guangxi, temperature and precipitation had a significant cumulative effect on TB incidence among PLWHA, while air pollutants had little effect. Moreover, the influence of meteorological factors on the incidence of TB also depends on the immune status of PLWHA.
... The authors of these two studies suggest that these findings may be due to differences in ventilation in the different housing types and social mixing for the study in Zambia [12] or because they looked at latent TB for the study in South Africa [13]. Looking at framework of Lönnroth et al. [41], which we adapted for a study on neighbourhood factors and recurrent TB [31], we see socioeconomic status as an upstream determinant, which affects downstream factors. The downstream factors of neighbourhood TB burden, average household size affect contact with infectious droplets, while gender and age affect impaired host defence. ...
... Our findings reiterate the importance of social factors on TB, as raised by others such as Lönnroth et al. [41] In the context of neighbourhood level analysis, SEI, income, and the Gini index can provide valuable information on the distribution of poverty and inequality between neighbourhoods and their association with TB incidence. Therefore, these measures can be used to identify neighbourhoods particularly vulnerable to TB and to inform targeted interventions aimed at reducing TB incidence in these areas. ...
Objectives
Although the link between poverty and tuberculosis (TB) is widely recognised, limited studies have investigated the association between neighbourhood factors and TB incidence. Since the factors influencing different episodes of TB might be different, this study focused on the first episode of TB disease (first‐episode TB).
Methods
All first episodes in previously linked and geocoded TB notification data from 2007 to 2015 in Cape Town, South Africa, were aggregated at the neighbourhood level and merged with the 2011 census data. We conducted an ecological study to assess the association between neighbourhood incidence of first‐episode TB and neighbourhood factors (total TB burden [all episodes] in the previous year, socioeconomic index, mean household size, mean age, and percentage males) using a negative binomial regression. We also examined the presence of hotspots in neighbourhood TB incidence with the Global Moran's I statistic and assessed spatial dependency in the association between neighbourhood factors and TB incidence using a spatial lag model.
Results
The study included 684 neighbourhoods with a median first‐episode TB incidence rate of 114 (IQR: 0–345) per 100,000 people. We found lower neighbourhood socioeconomic index (SEI), higher neighbourhood total TB burden, lower neighbourhood mean household size, and lower neighbourhood mean age were associated with increased neighbourhood first‐episode TB incidence. Our findings revealed a hotspot of first‐episode TB incidence in Cape Town and evidence of spatial dependency in the association between neighbourhood factors and TB incidence.
Conclusion
Neighbourhood TB burden and SEI were associated with first‐episode TB incidence, and there was spatial dependency in this association. Our findings can inform targeted interventions to reduce TB in high‐risk neighbourhoods, thereby reducing health disparities and promoting health equity.
... Furthermore, compromised field performance of the available diagnostic tests for bTB i.e., low sensitivity and specificity, is also a challenge [92][93][94]. Bovine TB prevalence is primarily concentrated in specific regions where poverty intersects with high population density, a predictable outcome for an illness that thrives in areas with limited resources to prevent bTB transmission [95,96]. ...
... A growing body of research has explored risk factors and quality of life impact associated with TB in different global settings. A systematic review of 25 observational studies found that illiteracy, low income, indoor air pollution, smoking, diabetes, and HIV infection are significant risk factors for TB across multiple countries [15]. The review highlighted socioeconomic disparities as key drivers of TB susceptibility worldwide. ...
Objectives: Tuberculosis (TB) is a significant public health concern in Afghanistan, with a high burden of disease in the western province of Herat. This study explored the risk factors of TB and TB’s impact on the quality of life of patients in Herat.
Methods: A total of 422 TB patients and 514 controls were recruited at Herat Regional Hospital and relevant TB laboratories between October 2020 and February 2021. Data was collected through interviews using a structured questionnaire and the SF-36 questionnaire. Descriptive statistics, chi-square tests, Multivariate General Linear Model, and logistic regression analysis were used to analyze the data.
Results: The results showed that male sex ( p = 0.023), chronic disease ( p = 0.038), lower education levels ( p < 0.001), and worse health status ( p < 0.001) were significantly associated with higher odds of TB infection. The study also found that TB patients had significantly lower quality of life scores in almost all components ( p < 0.05).
Conclusion: This study provides important insights into the specific ways in which TB affects the wellbeing of patients in Afghanistan. The findings highlight the importance of addressing the psychological and social dimensions of TB.
... While studies on TB spatial epidemiology have been valuable in identifying TB clusters and their association with population-level disease risks such as poverty, HIV prevalence, substance use, and occupation (11), (12), (13), (14), (15), most of these studies have focused on population-level, neglecting individual-level risk factors. Although population-level risk factors provide valuable insights, they may not accurately capture the nuances and complexities of individual-level social behaviors, exposures, and susceptibilities that contribute to the transmission and clinical progression of MTBC infection. ...
Background
In emerging economies experiencing rapid sociodemographic transitions and historically high tuberculosis (TB) prevalence, effective TB control requires acknowledging the evolving socio-behavioral characteristics of diverse patient populations shaping community-level TB risk. This study aimed to explore the spatial distribution and clustering of shared modifiable clinical and social risk factors for TB in a clinic-based population in Accra, Ghana.
Methods
We prospectively enrolled new and previously treated TB patients between June 2022 and July 2023. At diagnosis, patients provided informed consent to collect their residential coordinates and completed a questionnaire assessing their demographic and modifiable clinical and social risks for TB. We used geospatial scan statistics to describe the spatial distribution of cases and PERMANOVA to examine the correlation between spatial proximity and shared socio-behavioral risks, with a 1.5 square kilometer threshold defining significant residential proximity.
Results
The study population (N = 150) was predominantly male (68.0%) and of working age (80.0% aged 25–64 years), with half the sample engaged in unskilled labor (51.3%). Approximately one-third reported heavy alcohol (36.0%) and recreational drug use (26.7%) in the past year. Fifteen percent were HIV-positive, of whom more than 80% were diagnosed at the time of TB diagnosis. Local Moran's I statistics revealed spatial clusters of TB cases in separate sections of the study area. Unskilled labor, recreational drug use, and a history of cough in patients’ social contacts were significantly associated with residential proximity, explaining 1.26% of the variance in our model (F = 1.89, R^2 = 1.3%, p = 0.004).
Conclusions
Shared modifiable risks, including unskilled labor, recreational drug use, and close contact with TB, exhibited spatial clustering, suggesting their potential to enhance TB disease progression and transmission in this setting. Targeted interventions addressing these socio-behavioral risks within identified hotspots may improve TB control efforts.
... A 2018-2022 DS-TB costing survey reported a SHI coverage of 70% [32], while in a DR-TB costing survey (2020-2022) it was 85% [16]. All available data sources indicate that SHI coverage among people with TB is lower than the general population, which is indicative of their socioeconomic vulnerability [33]. However, this large SHI coverage rate discrepancy may be explained by people with TB not revealing they had SHI coverage, or DTU staff could have also inconsistently recorded an individual's SHI status in the paper TB registers since these data did not have much clinical relevance for TB treatment at the time. ...
Background
Vietnam’s primary mechanism of achieving sustainable funding for universal health coverage (UHC) and financial protection has been through its social health insurance (SHI) scheme. Steady progress towards access has been made and by 2020, over 90% of the population were enrolled in SHI. In 2022, as part of a larger transition towards the increased domestic financing of healthcare, tuberculosis (TB) services were integrated into SHI. This change required people with TB to use SHI for treatment at district-level facilities or to pay out of pocket for services. This study was conducted in preparation for this transition. It aimed to understand more about uninsured people with TB, assess the feasibility of enrolling them into SHI, and identify the barriers they faced in this process.
Methods
A mixed-method case study was conducted using a convergent parallel design between November 2018 and January 2022 in ten districts of Hanoi and Ho Chi Minh City, Vietnam. Quantitative data were collected through a pilot intervention that aimed to facilitate SHI enrollment for uninsured individuals with TB. Descriptive statistics were calculated. Qualitative interviews were conducted with 34 participants, who were purposively sampled for maximum variation. Qualitative data were analyzed through an inductive approach and themes were identified through framework analysis. Quantitative and qualitative data sources were triangulated.
Results
We attempted to enroll 115 uninsured people with TB into SHI; 76.5% were able to enroll. On average, it took 34.5 days to obtain a SHI card and it cost USD 66 per household. The themes indicated that a lack of knowledge, high costs for annual premiums, and the household-based registration requirement were barriers to SHI enrollment. Participants indicated that alternative enrolment mechanisms and greater procedural flexibility, particularly for undocumented people, is required to achieve full population coverage with SHI in urban centers.
Conclusions
Significant addressable barriers to SHI enrolment for people affected by TB were identified. A quarter of individuals remained unable to enroll after receiving enhanced support due to lack of required documentation. The experience gained during this health financing transition is relevant for other middle-income countries as they address the provision of financial protection for the treatment of infectious diseases.
... The MATCH Framework proposed by Rood E et al., emphasises using subnational data such as disaggregated notifications and local screening data for deriving granular insights on a subnational scale [8]. Also, the risk of TB transmission, delayed diagnosis and treatment is determined by several contextual factors like population demographics, socio economic conditions, nutritional status, access to health services and environmental conditions, which are important to consider along with notification data [9][10][11]. Therefore, there is value in leveraging data and available technology to make evidence based decisions for routine programmatic activities and improve effectiveness of interventions [12]. ...
... (www.preprints.org) | NOT PEER-REVIEWED | Posted: 28 March 2024 doi:10.20944/preprints202403.0091.v211 ...
Background Nigeria is among the top 5 countries that have the highest gap between people reported as diagnosed and estimated to have developed Tuberculosis (TB). To bridge this gap, there is a need for innovative approaches to identify geographical areas at high risk of TB transmission and targeted Active Case Finding (ACF) interventions. Leveraging community level data together with granular sociodemographic contextual information can unmask local hotspots which could be otherwise missed. This work evaluated if this approach helps to reach communities with higher numbers of undiagnosed TB. Methodology A retrospective analysis of the data generated from an ACF intervention program in 4 south-western states in Nigeria was conducted. Wards (the smallest administrative level in Nigeria) were subdivided into further smaller population clusters. ACF sites and their respective TB screening outputs were mapped to these population clusters. This data was then combined with open-source high resolution contextual data to train a Bayesian inference model. The model predicted TB positivity rates on the community level (population cluster level), and these were visualised on a customised geoportal for use by the local teams to identify communities at high risk of TB transmission and plan ACF interventions. The TB positivity yield (proportion) observed at model-predicted hotspots was compared with the yield obtained at other sites identified based on aggregated notification data. Results The yield in population clusters that were predicted to have high TB positivity rates by the model was at least 1.75 times higher (p-value <0.001) than the yield in other locations in all four states. Conclusion The community level Bayesian predictive model has the potential to guide ACF implementers to high TB positivity areas for finding undiagnosed TB in the communities, thus improving efficiency of interventions.
... In short, the current biomedical approach focused on TB diagnostics and therapeutics is proving insufficient to achieve the END TB strategy goal of TB elimination. Broader strategies including active case finding (ACF) and holistic, person-centered support are required [10][11][12]. ...
Background
The psychosocial consequences of tuberculosis (TB) are key barriers to ending TB globally. We evaluated and compared stigma, depression, and quality of life (QoL) among people with TB diagnosed through active (ACF) and passive (PCF) case-finding in Nepal.
Methods
We prospectively recruited adults with TB diagnosed through ACF and PCF in four districts of Nepal between August 2018 and April 2019. Participants were interviewed at 8–12 weeks (baseline) and 22–26 weeks (follow-up) following treatment initiation. TB stigma was measured using an adapted Van Rie Stigma Scale (0 = no stigma to 30 = highest stigma). Depression was measured using a locally-validated Patient Health Questionnaire (PHQ-9). Mild and major depression were indicated by PHQ-9 scores 5–9 and ≥ 10, respectively. QoL was measured using the EuroQoL 5-Dimension 5-level (EQ-5D-5L) from 0 to 1 (optimal QoL); and self-rated health from 0 to 100 (optimal self-rated health).
Results
We recruited 221 participants (111 ACF; 110 PCF) with a mean age of 48 years (standard deviation [SD] = ± 16), of whom 147/221 (67%) were men. The mean TB stigma score was 12 (SD = 7.3) at baseline and 12 (SD = 6.7) at follow-up. The most commonly perceived elements of TB stigma at baseline were that people with TB experienced guilt (110/221, 50%) and feared disclosure outside their household (114/221, 52%). Self-rated health and EQ-5D-5L scores increased from baseline to follow-up (69.3 to 80.3, p < 0.001; 0.92 to 0.9, p = 0.009). Nearly one-third of participants (68/221, 31%) had mild or major depression at baseline. The proportion of participants with major depression decreased from baseline to follow-up (11.5% vs. 5%, p = 0.012). There was a moderate, significant positive correlation between depression and stigma scores ( r = 0.41, p < 0.001). There were no differences found in TB stigma, self-rated health, QoL, or prevalence of mild/major depression between ACF and PCF participants.
Conclusions
We found a substantial, persistent, and clustered psychosocial impact among adults with TB diagnosed through both ACF and PCF strategies in Nepal. These findings suggest an urgent need to develop effective, evidence-based psychosocial support interventions with the potential to be integrated with existing ACF strategies and routine TB service activities.
