The Burden of Bacteriologically Negative TB Diagnosis: A Four-Year Review of Tuberculosis Cases at a Tertiary Facility
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Tuberculosis Research and Treatment publishes original research articles and review articles related to all aspects of tuberculosis, from the immunological basis of disease to translational and clinical research.
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More articlesPrevalence and Predictors of Pulmonary Tuberculosis among Prison Inmates in Sub-Saharan Africa: A Systematic Review and Meta-Analysis
Introduction. Prisoners in Sub-Saharan Africa (SSA) are at a high risk of tuberculosis (TB) infection due to overcrowding and poor ventilation. Consequently, TB is a leading cause of morbidity and mortality in prison, and many inmates face a number of barriers to TB control and had limited information in the region. Thus, the aim of this systematic review and meta-analysis was to estimate the overall pooled prevalence of pulmonary TB and predictors among prison inmates in SSA. Methods. From 2006 to 2019, a systematic review and meta-analysis was conducted using various databases, including PubMed, Embase, Web of Science, and Scopus. The data were extracted in Microsoft Excel using a standardized data extraction format, and the analysis was carried out with STATA version 14. To detect heterogeneity across studies, the and the Cochrane test statistics were computed. To determine the overall prevalence of TB and predictors among prison populations, a random effect meta-analysis model was used. Results. Of the 3,479 retrieved articles, 37studies comprising 72,844 inmates met the inclusion criteria. The pooled prevalence of pulmonary TB among prison inmates in SSA was 7.74% (95% CI: 6.46-8.47). In the subgroup analysis, the highest prevalence was found in the Democratic Republic Congo (DRC) (19.72%) followed by Zambia (11.68%) and then Ethiopia (9.22%). TB/HIV coinfection (OR 4.99 (95% CI: 2.60-9.58)), Body mass index () (OR 3.62 (95% CI: 2.65-6.49)), incarceration (OR 4.52 (95% CI: 2.31-5.68)), and previous TB exposure (OR 2.43 (95% CI: 1.61-3.56)) had higher odds of pulmonary TB among inmates. Conclusion. The prevalence of pulmonary TB among SSA prison inmates was found to be high as compared to total population. TB/HIV coinfection, BMI, incarceration duration, and TB exposure were all predictors with pulmonary tuberculosis in prison inmates. As a result, emphasizing early screening for prisoners at risk of pulmonary TB is an important point to achieving global TB commitments in resource-limited settings.
Antituberculosis Drug Nonadherence and Its Associated Factors: Evidence from Debre Berhan Town, North Shewa Zone, Ethiopia
Introduction. Tuberculosis is a bacterial disease caused by the Mycobacterium tuberculosis. Regardless of many efforts made to control tuberculosis, the disease remains to be a major public health problem. Nonadherence to antituberculosis treatment poses a challenge to the disease treatment as it potentially increases the risk of drug resistance, mortality, relapse, and extended infectiousness. The North Shewa Zone had a poor performed on TB control status, so this study assessed the prevalence of antituberculosis drug nonadherence and its associated factors at governmental health institutions in Debre Berhan town, North Shewa Zone, Ethiopia, 2020. Methods. An institution-based cross-sectional study design was employed. A total of 180 tuberculosis patients were included in the study. The data was entered using EpiData version 3.1 and exported to SPSS version 20.0 for statistical analysis. Bivariable and multivariable logistic regression analyses were computed to determine factor associated with antituberculosis drug nonadherence. Result. Study finding shows that 26.0% respondents were nonadherent to their antituberculosis treatment. Respondents who were married were less likely to be nonadherent than who were single (; , 0.788). Respondents who have primary and secondary education were less likely to be nonadherent than those who had no formal education (; , 0.976). Respondents who experienced drug side effects were two times more likely to be nonadherent than those who did not experience drug side effects (; , 5.615). In addition, respondents who do not screen for HIV were four times more likely to be nonadherent than their counterparts (; , 18.802). Conclusion. The antituberculosis drug nonadherence is high. Marital status, educational status, drug side effects, HIV screening status of the patients, and availability of medication were the variables that influence drug nonadherence. There is a need to strengthen awareness creation and improve quality of the TB treatment services and anti-TB drug availability.
Assessment of Smear-Positive Pulmonary Tuberculosis and Associated Factors among Patients Visiting Health Facilities of Gedeo Zone, Southern Ethiopia: A Cross-Sectional Study
Introduction. Tuberculosis (TB) was one of the top causes of ill health and the leading cause of deaths worldwide until the coronavirus (COVID-19) pandemic. Hence, this study is aimed at assessing the prevalence of sputum smear-positive TB and associated factors among TB-suspected patients attending in Gedeo Zone health facilities, Southern Ethiopia. Methods. A facility-based cross-sectional study was conducted among 220 TB-suspected patients in Gedeo Zone health facilities from July 01 to Sep 30, 2021. Patients were grouped as smear positive if one sputum out of two was positive or two sputum smears became positive. Various descriptive statistics were computed using the SPSS-25, and factors to smear positivity were identified by multivariable logistic regression analysis. Odds ratio at 95% CI and values < 0.05 were considered as indicators of statistical association. Results. The overall prevalence of smear-positive TB in Gedeo Zone health facilities was 18.2%, which is significantly high, and the MTB detection rate of GeneXpert was 29.5%. Contact with a TB patient, cigarette smoking, and previously treatment for TB were factors significantly associated with smear-positive TB. Conclusion. The prevalence rate of smear-positive PTB in the study area was 18.2% and 29.5% by direct sputum AFB and sputum GeneXpert, respectively. As a result, we recommend intervention on the identified associated risk factors and further studies to ascertain risk factors and their magnitude at the community level.
Drug Resistance in Tuberculous Lymphadenitis: Molecular Characterization
Background. Drug-resistant tuberculosis (TB) epidemic in high-TB-incidence countries, particularly Ethiopia, remains a significant challenge. As a result, we investigated the drug resistance, common gene mutation, and molecular characterization of mycobacterial isolates from patients with suspected tuberculous lymphadenitis (TBLN). Methodology. A cross-sectional study of 218 FNA samples from TBLN patients inoculated on Lowenstein-Jensen media was carried out. The culture isolates were identified as MTB by polymerase chain reaction (PCR) and the difference-9 (RD9) test region. In addition, the GenoType MTBDRplus assay tested the first and second-line MTB drugs, and the spoligotyping strain-dependent polymorphism test was determined. Results. Among the 50 culture-positive isolates, 14% (7/50) had drug resistance caused by a gene mutation. Out of these, 4 (8%) isolates were mono-resistant to isoniazid drug, which is caused by a gene mutation in katG in the region of interrogated at codon 315 in the amino acid sequence of S315T1, and 3 (6%) isolates were resistant to both rifampicin and isoniazid drugs. The mutation was observed for katG (at codon 315 with a change in the sequence of amino acid S315T) and rpoB (at codon 530–533 with a change in the sequence of amino acid S531L (S450L)) genes. The most prevalent spoligotypes were orphan and SIT53 strains. Conclusion. The predominance of INH mono-resistance poses a critical risk for the potential development of MDR-TB, as INH mono-resistance is a typical pathway to the occurrence of MDR-TB. The orphan and SIT53 (T) strains were the most common in the study area, and a drug-resistant strain caused by a common gene mutation could indicate the transmission of clonal-resistant strains in the community.
Patient- and Health-System-Related Barriers to Treatment Adherence for Patients with Drug-Resistant Tuberculosis in the Philippines: A Mixed-Methods Study
Purpose. In the Philippines, drug-resistant tuberculosis (DRTB) is a growing concern. Healthcare workers face challenges in retaining patients with DRTB in care. This study intends to understand their perspectives on the factors that influence patient treatment outcomes and to propose potential programmatic solutions for strengthening care services for the patients. Methods. A mixed-methods study was conducted in the Philippines between December 2017 and March 2018 to understand the major barriers for healthcare workers to provide quality care to DRTB patients across the care continuum. In the quantitative phase, healthcare workers participated in an online survey; in the qualitative phase, in-depth interviews were conducted with a select number of the survey respondents to better understand their survey responses. Results. 272 healthcare workers participated in the survey, and of those, 11 were interviewed. Survey results identified economic constraints, patient perceptions of care, family-related concerns, and limited accessibility to healthcare services as the major patient-related barriers across the care continuum. Major health-system-related barriers were insufficient human resources, lack of financial and political support, and limited knowledge about DRTB by healthcare providers. Interviews revealed more elaborate, contextualized, and nuanced aspects of each of the major challenges. The elaborated patient-related barriers included expenses needed during treatment (e.g., transportation); fear of being stigmatized by family, community, or healthcare staff; worries about adverse drug reactions from medication; a lack of family support; and the location of patients’ homes. The health-system-related barriers revealed through interviews included the limited capacities of facility staff to provide DRTB care due to insufficient human resources; the shortage of funds to support treatment completion (e.g., transportation allowance and food package for patients, service vehicles and mobile phone costs for outreach actions at the facility level); and discrimination by healthcare staff against patients with DRTB attributed to the staff’s limited knowledge and experiences of treating the patients. Conclusion. This study identified the main barriers for DRTB facility staff in the Philippines from the perspectives of providers. Further exploration of the barriers and best practices in facilities may be useful for improving DRTB care in the Philippines.
Topic Analysis and Mapping of Tuberculosis Research Using Text Mining and Co-Word Analysis
Tuberculosis is still one of the most severe progressive diseases; it severely limits the social and economic development of many countries. In the present study, the topic trend of scientific publications on tuberculosis has been examined using text mining techniques and co-word analysis with an analytical approach. The statistical population of the study is all global publications related to tuberculosis. In order to extract the data, the Scopus citation database was used for the period 1900 to 2022. The main keywords for the search strategy were chosen through consultation with thematic specialists and using MESH. Python programming language and VOSviewer software were applied to analyze data. The results showed four main topics as follows: “Clinical symptoms” (41.8%), “Diagnosis and treatment” (28.1%), “Bacterial structure, pathogenicity and genetics” (22.3%), and “Prevention” (7.84%). The results of this study can be helpful in the decision of this organization and knowledge of the process of studies on tuberculosis and investment and development of programs and guidelines against this disease.