Impact of WHO 2010 Guidelines on Antiretroviral Therapy Initiation among Patients with HIV-Associated Tuberculosis in Clinics with and without Onsite HIV Services in the Democratic Republic of Congo
Marcel YotebiengMartine TabalaMarie Louise BatumbulaLandry Kipula WenziEmmanuel BasakiEugenie MungoyoRichard MangalaFrieda Behets
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In 2015, tuberculosis ranked as the leading cause of
death from an infectious disease, surpassing HIV/AIDS.(1)
In 2016, an estimated 10.4 million people developed
tuberculosis and 1.7 million died from the disease, 5,000
people dying from it every day, including approximately
1,000 individuals with tuberculosis/HIV coinfection.(1) In
the past decade, the global tuberculosis community has
engaged in activities to successfully attain the Millennium
Development Goal target and other international targets
for halting and reversing increases in tuberculosis incidence
and mortality.(1) However, despite the achievements
made to date, the global incidence of tuberculosis is
declining at a rate of only 1.5% per year, far from the
10% expected.
History of tuberculosis
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We should understand democratic concept from the following five aspects: democracy is that people are host; democracy is that majority respects and protects minority; democracy carries forward individual; democracy needs obligation;and democracy is the mechanism of correcting mistakes to satisfy people.
Obligation
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Primary Mycobacterium tuberculosis transmission is an important driver of the global epidemic of resistance to tuberculosis drugs. A few studies have compared tuberculosis infection in contacts of index cases with different drug-resistant profiles, suggesting that contacts of multidrug-resistant (MDR) tuberculosis cases are at higher risk. Repeated tuberculosis exposure in contacts of MDR tuberculosis patients through recurrent tuberculosis may modify this relationship. We compared tuberculosis infection in household contacts of MDR and drug-susceptible (DS) tuberculosis patients from six cities in southeastern China and investigated whether repeated tuberculosis exposure was a mediating factor. Tuberculosis infection was defined as a tuberculin skin test induration ≥ 10 mm. In all, 111 (28.0%) of 397 household contacts of MDR tuberculosis patients and 165 (24.7%) of 667 contacts of DS tuberculosis index cases were infected with tuberculosis. In a multivariate model not including the previous tuberculosis exposure, contacts of MDR tuberculosis patients had a higher likelihood of tuberculosis infection (adjusted odds ratio [AOR] = 1.37; 95% confidence interval [CI] = 1.01-1.84; P = 0.041). In a separate multivariate model adjusted for the previous tuberculosis exposure, the odds ratio of tuberculosis infection flipped and contacts of MDR cases were now at lower risk for tuberculosis infection (AOR = 0.55; 95% CI = 0.38-0.81; P = 0.003). These findings suggest prior tuberculosis exposure in contacts strongly mediates the relationship between tuberculosis infection and the index drug resistance profile. Prior studies showing lower risk of developing tuberculosis among contacts of MDR tuberculosis patients may be partially explained by a lower rate of tuberculosis infection at baseline.
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Background: Sexual risk behaviour is a global health concern.Unsafe sex practices increase the risk of HIV transmission to sex partners.This study assessed the knowledge of HIV transmission and sexual risk behaviours of patients accessing antiretroviral therapy (ART) in secondary health facility in Nigeria. Methods:In a cross sectional study, a study-specific questionnaire was self-administered to randomly selected 350 out of 5770 patients accessing ART.A midpoint of Likert-type scale was determined; and values above were positive while below were negative.Chi square was used for inferential statistics at 95% confidence interval.Results: Of participants, 57.1% were female and 28.6% aged ≥ 40years old.Knowledge of routes of HIV transmission and risk reduction associated with condom use was negative.Participants had positive attitudes to non-disclosure of HIV sero-status, multiple sex partners and unprotected sexual intercourse.Majority (63.7%) had one sex partner, 16% had >1 sex partners and 12.6% had none.Number of sex partners was associated with sex, marital and occupational status (P<0.05)unlike educational status; 66.2% of those who had one sex partners were married; 56.9% and 46.7% of those who had >1 sex partners were males and retirees respectively.Majority (66.3%) disclosed HIV sero-status to sex partners but only 62.6% knew HIV sero-status of their sex partners.Disclosure was associated with marital status (P<0.05)unlike sex and educational status.Only 28.9% consistently used condom during sexual intercourse; and 67.6% of them were aged >30 years old, while 55.7% were married.Consistent use of condom was associated with marital status and age (P<0.05)unlike educational status. Conclusion:There were poor knowledge of routes of HIV transmission and benefits of condom use.Few participants consistently used condom during sexual intercourse.Majority had one sex partner and disclosed HIV sero-status to sex partners.Ongoing counselling and education should be integrated into HIV prevention strategies.
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Antiretroviral treatment
ANTIRETROVIRAL AGENTS
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The effectiveness of the Diaskintest for detecting tuberculosis in 61 children and young people in the Children's Hospital of Samara city was studied. The most frequent forms of tuberculosis were intrathoracic lymph node tuberculosis (39, 3%) and infiltrative tuberculosis (27,9%).
The Diaskintest® has shown its high diagnostic importance when dealing with local forms of active tuberculosis (88,5%). The negative test result by Diaskintest® does not exclude presence of tuberculosis. The Mantoux test remains important diagnostic test for detecting tuberculosis.
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The risk and timing of tuberculosis among recently exposed close contacts of patients with infectious tuberculosis are not well established.
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Tuberculosis remains a global health problem with an enormous burden of disease, estimated at 10.4 million new cases in 2015. To stop the tuberculosis epidemic, it is critical that we interrupt tuberculosis transmission. Further, the interventions required to interrupt tuberculosis transmission must be targeted to high-risk groups and settings. A simple cascade for tuberculosis transmission has been proposed in which (1) a source case of tuberculosis (2) generates infectious particles (3) that survive in the air and (4) are inhaled by a susceptible individual (5) who may become infected and (6) then has the potential to develop tuberculosis. Interventions that target these events will interrupt tuberculosis transmission and accelerate the decline in tuberculosis incidence and mortality. The purpose of this article is to provide a high-level overview of what is known about tuberculosis transmission, using the tuberculosis transmission cascade as a framework, and to set the scene for the articles in this series, which address specific aspects of tuberculosis transmission.
Global Health
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The understanding of democratic concept should shun five mistaken ideas as follows: Democracy is not seeking decisions for people, nor making decisions for people, but that people decide for themselves; democracy is not majorities overwhelming minorities but majorities respecting and protecting minorities; democracy is not negating individuals but commending individuals; democracy is not only for rights but also for obligations; democracy is not seeking for optimum system of perfection but for guaranteeing satisfactory system of correction.
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History of tuberculosis
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There is considerable variability in the outcome of Mycobacterium tuberculosis infection. We hypothesized that Mycobacterium africanum was less likely than M. tuberculosis to transmit and progress to tuberculosis disease.In a cohort study of patients with tuberculosis and their household contacts in The Gambia, we categorized 1808 HIV-negative tuberculosis contacts according to exposure to M. tuberculosis or M. africanum. Positive skin test results indicated transmission, and development of tuberculosis during 2 years of follow-up indicated progression to disease.Transmission rates were similar, but rates of progression to disease were significantly lower in contacts exposed to M. africanum than in those exposed to M. tuberculosis (1.0% vs. 2.9%; hazard ratio [HR], 3.1 [95% confidence interval {CI}, 1.1-8.7]). Within M. tuberculosis sensu stricto, contacts exposed to a Beijing family strain were most likely to progress to disease (5.6%; HR relative to M. africanum, 6.7 [95% CI, 2.0-22]).M. africanum and M. tuberculosis transmit equally well to household contacts, but contacts exposed to M. africanum are less likely to progress to tuberculosis disease than those exposed to M. tuberculosis. The variable rate of progression by lineage suggests that tuberculosis variability matters in clinical settings and should be accounted for in studies evaluating tuberculosis vaccines and treatment regimens for latent tuberculosis infection.
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