• HIV Testing, Antiretroviral Therapy, and Treatment Outcomes in New Cases of Tuberculosis in Brazil, 2011

      Torrens, A; Bartholomay, P; Silva, S; Khogali, M; Verdonck, K; Bissell, K (Scielo Public Health, 2016-01-01)
      Objective To assess the implementation of HIV-related interventions for patients with tuberculosis (TB), as well as TB treatment outcomes in patients coinfected with HIV in Brazil in 2011. Methods This was a cross-sectional, operational research study of HIV-related interventions among TB cases and the sociodemographic and clinical characteristics of TB-HIV coinfected patients. It also used a retrospective cohort design to determine the association between antiretroviral therapy (ART) and favorable TB treatment outcomes. The source of data was a linkage of 2011 administrative health databases used by the National TB and HIV/AIDS Programs. Results Of 73 741 new cases of TB reported, 63.6% (46 865 patients) were tested for HIV; 10.3% were positive. Of patients with HIV, 45.9% or 3 502 were on ART. TB favorable outcome was achieved in 63.1% or 2 205 coinfected patients on ART and in only 35.4% or 1 459 of those not on ART. On multivariate analysis, the relative risk for the association between ART and TB treatment success was 1.72 (95% Confidence Interval = 1.64-1.81). Conclusions The linkage between national TB and HIV datasets has created a convenient baseline for ongoing monitoring of HIV testing, ART use, and TB treatment outcomes among coinfected patients. The low rates of HIV screening and ART use in 2011 need to be improved. The association between ART and treatment success adds to the evidence supporting timely initiation of ART for all patients with TB-HIV coinfection.
    • Trends in Tuberculosis Notification and Treatment Outcomes in Prisons: a Country-Wide Assessment in El Salvador from 2009-2014

      Ayala, G; Garay, J; Aragon, M; Decroo, T; Zachariah, R (Scielo Public Health, 2016-01-01)
      Objective To describe trends in tuberculosis (TB) notification and treatment outcomes in 25 prisons in El Salvador from 2009-2014 and to determine if a set of interventions introduced in 2011 affected TB case finding and management. Methods This was operational research that utilized a retrospective cohort study of program data from 2009-2014. The package of interventions introduced in 2011 provides staff training, engages inmates in TB case finding, and offers diagnosis through mobile X-ray and Xpert® MTB/RIF. Results Case notification rates per 100 000 prisoners tripled, from 532 in 2009 to 1 688 in 2014-about 50 times that of the general population. Individual data were analyzed for 1 177 patients who started TB treatment, among whom 1 056 (89.7%) cases were bacteriologically-confirmed: 966 (92%) were diagnosed through smear microscopy; 42 (4%) with Xpert® MTB/RIF; and 48 (5%) through cultures. Cumulative treatment success and cure rates were over 95% and 90%, respectively. However, among 113 patients with previously-treated TB, drug sensitivity testing results were available for only 53 (47.%). One patient was diagnosed with mono-drug resistant TB. Conclusions These findings show that TB notification increased exponentially since introduction of the intervention package and that excellent treatment outcomes were sustained. Both are of vital relevance to countries striving for TB elimination. Notification might be improved further by providing systematic TB screening upon prison entry and periodically thereafter. Furthermore, previously-treated TB patients should receive prioritized screening for drug resistance.
    • Tuberculosis Among Indigenous Municipalities in Mexico: Analysis of Case Notification and Treatment Outcomes Between 2009 and 2013

      Romero, BM; Joya, MC; Aviles, MAG; Navarro, RM; Decroo, T; Zachariah, R (Scielo Public Health, 2016-01-01)
      Objective To assess trends in 1) tuberculosis (TB) case notification by year and 2) cumulative treatment outcomes (stratified by type of TB) in relation to the proportion of indigenous population in municipalities in a countrywide study in Mexico for the period 2009-2013. Methods This ecological operational research study used municipality data for the five-year study period. As no single identifier variable existed for indigenous persons, municipalities were categorized into one of three groups based on the proportion of their indigenous population (< 25% ("low"), ≥ 25% to < 50% ("medium"), and ≥ 50% ("high")). TB case notification rates (CNRs) were standardized to a 100 000 population. Result For the first four years of the study period (2009 through 2012), for all new TB cases reported nationally, the municipalities with a high proportion of indigenous people (≥ 50%) had the highest CNRs (ranging from 20.8 to 17.7 over that period). In 2013, however, the CNR in the high proportion municipalities dropped to 16.7, lower than the CNR for that year in the municipalities with a medium proportion of indigenous people (P < 0.001). In the municipalities with low and medium proportions of indigenous people, the CNR hovered between 15.1 and 17.3 over the study period. For the 96 195 new TB cases reported over the study period, the treatment success rate ranged between 81% and 84% for all three municipality groups. For previously treated TB cases, CNRs ranged between 1.0 and 1.7 for all three groups over the study period. The average proportion of previously treated TB cases (of all TB cases) was 9% for the three groups in 2009 but dropped to 8% by 2013. The cumulative treatment success rate for all previously treated cases (a total of 8 763 for the study period) was 64% in municipalities with a low proportion of indigenous people, 61% in those with a medium proportion, and 69% in those with a high proportion. Conclusions Despite the slightly higher CNR in municipalities with predominantly indigenous populations, there were no stark differences in TB burden across the three municipality groups. The authors were unable to confirm if the relatively low CNRs found in this study were a reflection of good TB program performance or if TB cases were being missed. A survey of TB prevalence in indigenous people, with individualized data, is needed to inform targeted TB control strategies for this group in Mexico.