Abstract
Children exposed to active TB, particularly within the household, have an increased risk of developing TB disease. In Tajikistan, a high-priority country for TB, the national policy is that all children <7 years who have been in contact with an active TB case should be screened and given isoniazid preventive therapy (IPT), if not contraindicated. Currently, little information is available on whether this policy is being followed. We aimed to identify the trends in paediatric TB, characteristics and treatment outcomes of paediatric TB, and coverage of contact tracing and IPT delivery in the country.
We undertook a retrospective cohort study of notified paediatric TB cases and household contacts in Dushanbe, Tajikistan from 2009 to 2013 to investigate trends in, and characteristics and outcomes of childhood TB cases, contact tracing and the proportion of eligible paediatric contacts who received IPT. During the study period, 380 paediatric TB cases were notified, of which 218 (57%) treatment records were available for analysis.
The majority of cases (N=138; 63%) were in the age group of 7–14 years. One hundred thirty-seven cases (63%) had extrapulmonary TB, of which 78 cases had hilar lymph node TB, 20 had peripheral lymph node TB, 19 had tuberculous pleurisy, 10 had bone TB, 8 had intestinal TB and 2 had TB meningitis. Successful treatment outcomes were registered in 94% of cases. Household contacts of 157 (72%) analysed paediatric TB cases were investigated; 61 households were identified with smear-positive pulmonary TB; 44 (76%) out of58 eligible children (<7 years) received IPT.
We found successful treatment outcomes, contact tracing and IPT coverage. However, strategies could be developed to further scale up active case finding and national protocols, including data linkages, to routinely monitor and evaluate the quality of contact tracing.
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Abstract
Despite good progress made in the fight against tuberculosis (TB), the disease remains a major public health threat worldwide. Comorbid diseases that increase the risk of developing active TB and have a negative impact on final treatment outcomes include HIV and diabetes mellitus. The effect of other conditions such as peptic ulcer and asthma/chronic obstructive pulmonary disease (together defined as COPD for this study) on TB is not clear. There is also little information in Uzbekistan about the interaction between these comorbidities and TB. This study was therefore carried out to assess the characteristics and treatment outcomes of TB patients with these specific comorbid conditions. This was a descriptive study of a cohort of patients with newly diagnosed pulmonary TB with specific comorbidities in the Samarkand region, Uzbekistan, from 2012 to 2013. There were 1260 patients with newly diagnosed TB, of whom 193 (15%) had comorbidities: diabetes (n = 116, 9%), HIV (n = 27, 2%), COPD (n = 29, 2%) or peptic ulcer (n = 22, 2%). Diabetes, COPD and peptic ulcer disease were mainly found in patients aged 55 years and above, while HIV coinfection was mainly found in patients aged 25–54 years. Clinical characteristics were fairly similar between those with and without comorbidities. Compared with those who had no comorbidities, patients with comorbidities had significantly reduced treatment success (78% versus 92%), a higher rate of death (9% versus 2%) and higher treatment failure (2% versus <1%). In conclusion, more attention needs to be paid to a systematic and timely approach to the screening and treatment of comorbidities in TB patients, to improve treatment outcomes and reduce mortality.
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Abstract
The performance of the tuberculosis (TB) programme should be judged on the basis of detected TB cases recorded in the laboratory register and not just those placed on treatment and recorded in the TB treatment register. We examined the performance of the TB programme in this regard in Kyrgyzstan in 2012.
This retrospective cohort study included all sputum smear-positive pulmonary TB cases registered in the TB laboratory register (584 persons). Data variables on geographical region, TB diagnosis, TB treatment and outcomes were sourced from various registers. We analysed (1) initial lost to follow-up (LTFU) between urban and rural areas; (2) time of starting treatment after diagnosis; (3) treatment outcomes of laboratory-registered and treatment-registered patients.
Of 584 patients diagnosed with new smear-positive pulmonary TB in two cities and eight rural districts, 59 (10%) were not traced in the patient TB treatment register and considered as initial LTFU. Rural areas had significantly higher initial LTFU (13%) compared with urban areas (8%). The mean time to initiating treatment among those who were entered in the TB register was 14 days (range 8–28 days). When all TB cases included in the laboratory register were used as the denominator, the overall treatment success rate reduced from 75% to 67% (a drop of 8%).
Reporting on TB programme outcomes without including initial LTFU tends to exaggerate TB programme performance. Concerted efforts are needed to limit initial LTFU and accelerate progress towards ending TB as a public health problem.
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