Tuberculosis (TB), caused by members of the Mycobacterium tuberculosis complex (MTC), is the leading cause of infectious disease-related mortality worldwide. The standard method for TB diagnosis usually requires long periods of mycobacteria cultivation, leading to delayed diagnosis, inefficient treatment and widespread occurrence of the disease. Therefore, a rapid method for the detection and differentiation of MTC from other mycobacteria is essential for disease diagnosis. Here, we describe the potential of using the type I signal peptidase (lepB) gene as a novel target for TB diagnosis, based on confronting two-pair primers PCR (PCR-CTPP) that can detect MTC and simultaneously differentiate M. bovis. The limit of detection of the developed technique was equivalent to 12–120 bacilli. PCR-CTPP was highly specific to only MTC and M. bovis, and no cross-reaction was detected in 27 DNA of the non-tuberculous mycobacterial and bacterial strains tested. Thirty-nine blinded clinical isolates and 72 sputum samples were used to validate the PCR-CTPP in comparison with the standard mycobacterial culture method. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PCR-CTPP were equal to 95, 100, 100 and 95 %, respectively, when tested with clinical isolates. Furthermore, upon testing with the sputum samples, the sensitivity, specificity, PPV and NPV were observed to be 84, 76, 90 and 67 %, respectively. Hence, this highly sensitive novel technique, which is rapid, easy to conduct and cost-effective, is a potential method for TB diagnosis and epidemiological studies, especially in resource-limited countries with a high TB burden.
We reviewed and analyzed published research concerning efforts to increase regular use of HIV testing services in Thailand. Separate studies suggested that the creation of participatory and creative online spaces for information sharing and promoting community-based testing positively influence levels of HIV testing, including repeat-testing in some cases. Population targeted approaches, using same-day rapid tests, and using diverse locations for testing (medical and non-medical) may improve rates of testing. Thailand shows an example of successful HIV management and reduction. The challenge is to continue towards zero new infections and end an epidemic that is increasingly associated among people with specific risk behaviors. These characteristics make Thailand a case study for consideration by other national HIV programs.
Hepatitis B is a leading cause of morbidity and mortality worldwide. In view of the World Health Organization's 2030 targets, effective screening of chronic infection is crucial. We assessed the prevalence and risk factors of hepatitis B surface antigen in adults presenting for screening. Free-of-charge and anonymous services for simultaneous hepatitis B, hepatitis C, human immunodeficiency virus and syphilis screening and counseling were provided in four facilities in northern Thailand. Analyses were performed separately in clients born before integration in 1992 of hepatitis B vaccine in Thailand's Expanded Program on Immunization and in clients born after. Between October 2015 and August 2020, hepatitis B surface antigen prevalence was 7.2 % (185/2578) in clients born before 1992 (95 % confidence interval [CI] = 6.2%–8.2 %). In the multivariable analysis, characteristics independently associated with a higher risk of infection were being born male (adjusted odds ratio [aOR] = 1.49, 95 % CI = 1.10–2.01) and being part of a hill tribe (aOR = 1.65, 95 % CI = 1.01–2.70). 42 % were unaware of their infection. In clients born in 1992 or after, prevalence was 1.5 % (43/2933) (95 % CI = 1.1%–2.0 %) and characteristics independently associated with a higher risk were being born between 1992 and 1995 (aOR = 1.90, 95 % CI = 1.00–3.61), being born male (aOR = 2.60, 95 % CI = 1.34–5.07), being part of a hill tribe (aOR = 5.09, 95 % CI = 2.52–10.26) and having ever injected drugs (aOR = 4.33, 95 % CI = 1.23–15.24). Risk factor-based screening would miss many chronic hepatitis cases. Screening all adults once in their lifetime may be beneficial until the second generation of immunized infants have reached adult age.
Objective This study aimed to identify demographic and clinical factors associated with changeof the anti-TB drug regimen due to adverse drug reactions (ADRs) among new tuberculosis (TB) patients in the upper north and upper northeast regions of Thailand. Methods A cross-sectional study was conducted among new TB patients in the areas of Disease Prevention and Control region 10 (the upper north area) from 1 Oct 2008 to 30 Sep 2013 and region 6 (the upper northeast area) from 1 Oct 2012 to 30 Sep 2013. Demographic and clinical data and the status of changing drug regimen were extracted from the Tuberculosis Clinic Management (TBCM) database. Multivariate logistic regression was used to analyze the association between change of drug regimen and the determinants. Results Records were analyzed of 26,444 and 5,982 new TB patients in the upper north and upper northeast areas of Thailand, respectively. The overall incidence of anti-TB drug regimen change due to ADRs was 2.01%. Multivariate analysis of the study population revealed factors significantly associated with this change, including old age, and being registered in the upper north area, female, human immunodeficiency virus (HIV) co-infected, an anti-retroviral drug user, separate anti-TB tablet user, and having co-morbidities with hypertension, chronic kidney disease, liver disease, and cancer. Conclusions Liver disease was a factor commonly associated with change of drug regimen due to ADRs among new TB patients in the two regional areas. Further clinical trials are needed to discover effective interventions during treatment for the prevention of ADRs among new TB patients with liver disease. Other associated factors should be monitored properly, based on this data analysis of new TB patients in each area.
Early diagnosis is key to achieving the goal of eliminating transmission of HIV and hepatitis B and C. We assessed the uptake, acceptability and interpretability of self-testing using a 3-in-1 rapid diagnostic test (RDT) in facility-based services. Stand-alone testing services were provided free of charge to consenting individuals aged ≥15 years in five facilities in northern Thailand. Clients were invited to choose between self-testing by fingerprick or venepuncture by a healthcare worker (HCW). In each facility, several clients could simultaneously self-test in separate private areas using TriQuik™ (Genlantis, San Diego, CA, USA), a single immunochromatographic cassette detecting HIV-1/2 antibody, hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCAb). An interactive program on a tablet computer was developed to collect socio-demographic, behavioural and satisfaction data and provide information to guide the self-test process, including video instructions, results interpretation and a picture of the cassette for immediate remote review by the HCW. When the HCW interpreted an HIV self-test as positive, the HCW collected blood by venepuncture for immediate confirmation. Between October 2020 and April 2022, 4119 clients presented for testing for the first time as part of the project. Of them, 3462 (84.0%) opted for self-testing. Among self-testers, 1801 (52.0%) were born female, the median age was 27 years (interquartile range, 22-36), 661 (19.1%) belonged to at least one key population and 2124 (61.4%) had never been tested for HIV; 3329 (99.8% of those who answered) reported being "very satisfied" or "satisfied" with the testing process. The proportions of test results interpreted as positive by self-testers among those interpreted as positive by HCWs were 95% for HIV-1/2 antibody, 95% for HBsAg and 78% for HCAb. These proportions were higher than those observed in a previous study evaluating another 3-in-1 RDT for HIV, HBsAg and HCAb, possibly due to the use of video instructions instead of paper-based instructions, lower prevalence and co-infection rates, or lower percentages of clients with low education level. Multiplex self-testing simplified and streamlined the service delivery process and was well accepted. HCW assistance proved to be essential in a limited number of cases.
Frequent HIV testing of at-risk individuals is crucial to detect and treat infections early and prevent transmissions. We assessed the effect of reminders on HIV retesting uptake.The study was conducted within a programme involving four facilities providing free-of-charge HIV, syphilis and hepatitis B and C testing and counselling in northern Thailand. Individuals found HIV negative and identified at risk by counsellors were invited to participate in a three-arm, open-label, randomized, controlled trial comparing: (a) "No Appointment & No Reminder" (control arm); (b) "No Appointment but Reminder": short message service (SMS) sent 24 weeks after the enrolment visit to remind booking an appointment, and sent again one week later if no appointment was booked; and (c) "Appointment & Reminder": appointment scheduled during the enrolment visit and SMS sent one week before appointment to ask for confirmation; if no response: single call made within one business day. The primary endpoint was a HIV retest within seven months after the enrolment visit. The cost of each reminder strategy was calculated as the sum of the following costs in United States dollars (USD): time spent by participants, counsellors and hotline staff; phone calls made; and SMS sent. The target sample size was 217 participants per arm (651 overall).Between April and November 2017, 651 participants were randomized. The proportion presenting for HIV retesting within seven months was 11.2% (24/215) in the control arm, versus 19.3% (42/218) in "No Appointment but Reminder" (p = 0.023) and 36.7% (80/218) in "Appointment & Reminder" (p < 0.001). Differences in proportions compared to the control arm were respectively +8.1% (95% CI: +1.4% to +14.8%) and +25.5% (+17.9% to +33.2%). The incremental cost-effectiveness ratios of "No Appointment but Reminder" and "Appointment & Reminder" compared to the control arm were respectively USD 0.05 and USD 0.14 per participant for each 5% increase in HIV retesting uptake within seven months.Scheduling an appointment and sending a reminder one week before was a simple, easy-to-implement and affordable intervention that significantly increased HIV retesting uptake in these at-risk individuals. The personal phone call to clients probably contributed, and also improved service efficiency.
Objectives This retrospective study aimed to examine the relationship between white blood cell counts and Chalmydial infection of the uterine cervix among young adults in the STI Clinic, Office of Disease Prevention and Control, region 10 Chiang Mai. Methods Two hundred and twenty women, who were aged less than 25 years and attended the STI clinic in 2011 Fiscal year, had their cervical discharge collected and examined in the laboratory by microscopic examination (gram stain) and the In-house PCR Chlamydia test, which already compared to a standard commercial method. The result of the In-house PCR Chlamydia test was acceptable at 95 percent confident interval. The target population was classified into two groups: sex workers (140 people) and non-sex workers (80 people). The white blood cell count in their cervical discharge and the result of the In-house PCR Chlamydia test were examined via Chi-Square tests for a significant correlation in each group. Results A significant correlation between white blood cell count in cervical discharge and Chlamydial cervicitis was presented in the sex worker group; with the cutoff point of the leukocyte count being ≥5 cells/1,000X microscopic power field (p value: < 0.001). Sensitivity of the “white blood cell” gave a positive diagnostic result for Chlamydial cervicitis (at least 5 cells/1,000X microscopic power field) in 74.29 percent of the sex worker group with 72.38 percent specifiity. In contrast, there was no significant relationship between the white blood cell count in cervical discharge and Chlamydial cervicitis among the non-sex worker group. Sensitivity of the “white blood cell” gave a positive diagnostic result for Chlamydial cervicitis (at least 5 cells/1,000X microscopic power field) in 79.17 percent of the non-sex worker group with 41.07 percent specificity. Conclusions The white blood cell count criterion of ≥5 cells/1,000X microscopic power field in a cervical smear provides an alternative diagnostic method for Chlamydial cervicitis detection in sex workers aged less than 25 years.
To exploit immunomagnetic separation combined with PCR with confronting two-pair primers (IMS-PCR-CTPP) as a rapid method for detection of Mycobacterium tuberculosis complex (MTC) and identification of Mycobacterium bovis from sputum specimens.Monoclonal antibody (mAb) against the mycobacterial antigen, 85B (Ag85B), was coupled with magnetic particles for specific immunomagnetic separation (IMS) of Mycobacterium spp. Immunofluorescence assay indicated the capability of mAb to bind to Ag85B in both the recombinant and the native form. The IMS combined with PCR-CTPP targeting the mycobacterial lep B gene was further implemented using 133 sputum samples with acid-fast bacilli grading from negative to 3+. The results showed the sensitivity and specificity of IMS-PCR-CTPP vs gold standard culture method were 89·9 and 88·6% respectively.The IMS-PCR-CTPP method shortens the time for tuberculosis (TB) diagnosis from months to a day. This method is also suitable for investigation of MTC and epidemiological study of Myco. bovis in sputum specimens.This study is the first report emphasizing the combination of IMS and PCR-CTPP for the detection of MTC and simultaneous identification of Myco. bovis from sputum. It could be used for TB diagnosis in resource-limited countries with high TB burden.
