Evidence on the extra-household contacts of TB patients who drive disease transmission is scarce.We conducted a cross-sectional personal social network survey among 300 newly diagnosed index pulmonary TB patients to identify their first-degree extra-household contacts.A significantly higher proportion of neighbourhood (3.5; 95% CI 1.3 to 7.5), occupational (3.2; 95% CI 1.3 to 9.2) and friendship contacts (2.2; 95% CI 0.8 to 4.5) developed TB within 1 y of the index patient's diagnosis than their household contacts (0.7; 95% CI 0.3 to 1.3). Similarly, a higher proportion of extra-household contacts had TB at different time points before the index patient was diagnosed.Extra-household contacts of TB patients could be a potential source of TB or could be at increased risk of TB.
Lack of TB incidence data is an important evidence gap among Saharia-a high TB burden indigenous community in Madhya Pradesh, central India. The present study was undertaken to calculate the incidence of pulmonary tuberculosis in this tribe.To calculate the incidence of pulmonary tuberculosis (PTB) among the Saharia tribal population in Madhya Pradesh, central India.A prospective cohort study was conducted among the Saharia tribal population (aged 15 years and above) of Shivpuri district in Madhya Pradesh state in central India. A total of 9,756 individuals were screened for TB in the baseline TB prevalence survey during 2012-13. All available household members were screened for symptoms suggestive of pulmonary TB (presumptive TB). Two sputum specimens were collected from persons having symptoms suggestive of TB and examined by smear and culture tests. A cohort of all non-TB individuals in the baseline survey was followed-up for one year and re-screened for the sysmptoms of PTB in the year 2014-15. Based on the data collected, the incidence of TB over one year period was estimated per 100,000 population.A total of 9756 and 9044 individuals (≥ 15 years) were screened for symptoms suggestive of PTB during baseline and endline surveys respectively. The sputum specimens of presumptive TB cases were collected and examined by smear and culture tests. The overall incidence of bacteriologically positive (smear and/or culture) PTB over one year period was 1504 (95% Confidence Interval (CI): 1273-1776) per 100,000 in the study population, the incidence of smear-positive PTB was 1106 (95% CI: 910-1343), and the incidence of culture-positive PTB was 1084 (95% CI: 890-1319) per 100,000 population. The incidence for both smear and culture-positive PTB was 686 (95% CI: 535-878) per 100,000 population in the year 2014-15. The incidence of PTB was 2.8 times higher in males compared to females (2259 vs 807 per 100,000) and was positively correlated with age.The findings of the study, the first of its kind in the Saharia tribal population, indicate a high incidence of TB in this tribal community thereby highlighting the urgent need for focused and intensified efforts to achieve the goal of TB elimination in the country.
Tuberculosis (TB) poses formidable challenges to global health at the public health, scientific and political level. The current tools to combat TB are out of the date and not accurate enough to identify many TB infections. Though recent and ongoing advancements in drug therapies offer great promise for saving lives, the unfortunate fact is that they are drug resistant to both first and second line anti-TB medicines. The key challenge in the fight against TB is to innovate and adapt promising innovations to achieve protection and eradication. Making faster and more accurate diagnosis, and effective treatment and widespread use in the developing world where they are needed most, will vastly reduce TB cases worldwide and save millions of lives. New international efforts have now started to address move against TB which is the theme for World TB Day 2011–12. This article attempts to examine the steps on the move against tuberculosis in terms of safe and reliable prevention, development of new tools for diagnosis and drugs for treatment, access of quality care and community outreach activities.
This paper provides information on the association of tobacco smoking and alcohol consumption with pulmonary TB (PTB) in central India. A community based cross-sectional TB prevalence survey was conducted in Jabalpur district of the central Indian state of Madhya Pradesh. The information on tobacco smoking and alcohol consumption was collected from individuals aged ≥15 years. Using logistic regression analysis, the risk factors for PTB were identified. A total of 94 559 individuals provided information on tobacco smoking and alcohol consumption. Persons aged 35–54 years and 55 years and above had, respectively, a 2.19 (95% CI 1.57–3.07) and a 3.26 (95% CI 2.23–4.77) times higher risk of developing PTB compared to persons aged below 35 years. Males had a 2.35 (95% CI 1.66–3.32) times higher risk than females. Tribals (indigenous population) had a 2.32 (95% CI 1.68–3.21) times higher risk than non-tribal population. The adjusted prevalence odds ratio for mild, moderate and heavy tobacco smokers were 2.28, 2.51 and 2.74 respectively as compared to non-smokers. Alcohol consumption was not found to be a risk factor on multivariate analysis. Tobacco smoking is significantly associated with PTB in this central Indian district. Smoking cessation services need to be integrated into the activities of the TB control programme.
Background: The treatment for MDR-TB characterized by rigorous treatment regimen for long duration, higher incidence of adverse side effects, lower cure rate, and high treatment costs. This could lead to number of psychosocial problems that influence treatment adherence. MDR-TB patients registered under DOTS Plus programme during the period of 2013-2014 in Chennai and Madurai districts, of Tamilnadu were included for this study.Objective: To understand the psychosocial issues facing MDR-TB patients, who are diagnosed and registered for treatment under DOTS plus programme.Methodology: This study used Focus Group Discussions with people with MDR-TB. Focus Group Discussions were focused on physical, psychological, social and economical challenges which MDR-TB patients faced during their treatment.Results: Most of the study participants did not disclose their TB status, even to their family members. The majority of patients were not aware of the diagnosis of MDR-TB and long duration of treatment. Stigma from family, community and health providers has been experienced by the majority of patients. Patients and their families were afraid of losing economic stability which was already precarious owing to the disease. This fear has often generated a great deal of stress.Conclusion: Study finding indicates that there is a significant psychological, social, and financial impact of MDR-TB that has a direct impact on quality of life of MDR-TB patients and their families. There is a need for psychosocial intervention model (strategies) for MDR-TB patients and their caregivers to mitigate the negative effects.SAARC J TUBER LUNG DIS HIV/AIDS, 2017; XIV(1), page: 14-21
To measure the economic impacts of the longer pre-XDR-TB treatment regimen and the shorter BEAT-TB India regimen.In the current study, the economic impacts of the current 18-month pre-XDR-TB treatment regimen and the 6-9 month BEAT-TB regimen were evaluated using an economic model via a decision tree analysis from a societal perspective. The incremental costs and quality-adjusted life years (QALYs) gained from the introduction of the BEAT-TB regimen for pre-XDR-TB patients were estimated.For a cohort of 1000 pre-XDR-TB patients, we found that the BEAT-TB India regimen yielded higher undiscounted life years (40,548 vs. 21,009) and more QALYs gained (27,633 vs. 15,812) than the 18-month regimen. The BEAT-TB India regimen was found to be cost-saving, with an incremental cost of USD -128,651 when compared to the 18-month regimen. The current analysis did not consider the possibility of reduced TB recurrence after use of the BEAT-TB regimen, so it might have under-estimated the benefits.As a lower-cost intervention with improved health outcomes, the BEAT-TB India regimen is dominant when compared to the 18-month regimen.
Abstract Climate factors such as dew point temperature, relative humidity and atmospheric temperature may be crucial for the spread of tuberculosis. This study was conducted for the first time to investigate the relationship of climatic factors with TB occurrence in an Indian setting. Daily tuberculosis notification data during 2008–2015 were generated from the National Treatment Elimination Program, and analogous daily climatic data were obtained from the Regional Meteorological Centre at Chennai city, Tamil Nadu, India. The decomposition method was adopted to split the series into deterministic and non-deterministic components, such as seasonal, non-seasonal, trend and cyclical, and non-deterministic climate factors. A generalized linear model was used to assess the relation independently. TB disease progression from latent stage infection to active was supported by higher dew point temperature and moderate temperature. It had a significant association with TB progression in the summer and monsoon seasons. The relative humidity may be favored in the winter and post-monsoon. The water tiny dew droplets may support the TB bacterium to recuperate in the environment.
Background Disclosure of tuberculosis (TB) status by patients is a critical step in their treatment cascade of care. There is a lack of systematic assessment of TB disclosure patterns and its positive outcomes which happens dynamically over the disease period of individual patients with their family and wider social network relations. Methods This prospective observational study was conducted in Chennai Corporation treatment units during 2019–2021. TB patients were recruited and followed-up from treatment initiation to completion. Information on disease disclosures made to different social members at different time points, and outcomes were collected and compared. Bivariate and multi variate analysis were used to identify the patients and contact characteristics predictive of TB disclosure status. Results A total of 466 TB patients were followed-up, who listed a total of 4039 family, extra familial and social network contacts of them. Maximum disclosures were made with family members (93%) and half of the relatives, occupational contacts and friendship contacts (44–58%) were disclosed within 15 days of treatment initiation. Incremental disclosures made during the 150–180 days of treatment were highest among neighbourhood contacts (12%), and was significantly different between treatment initiation and completion period. Middle aged TB patients (31 years and 46–55 years) were found less likely to disclose (AOR 0.56 and 0.46 respectively; p<0.05) and illiterates were found more likely to disclose their TB status (AOR 3.91; p<0.05). Post the disclosure, family contacts have mostly provided resource support (44.90%) and two third of all disclosed contacts have provided emotional support for TB patients (>71%). Conclusion Findings explain that family level disclosures were predominant and disclosures made to extra familial network contacts significantly increased during the latter part of treatment. Emotional support was predominantly received by TB patients from all their contacts post disclosure. Findings could inform in developing interventions to facilitate disclosure of disease status in a beneficial way for TB patients.
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