• Recurrent Tuberculosis and Associated Factors: A Five - Year Countrywide Study in Uzbekistan

      Gadoev, J; Asadov, D; Harries, AD; Parpieva, N; Tayler-Smith, K; Isaakidis, P; Ali, E; Hinderaker, SG; Ogtay, G; Ramsay, A; et al. (Public Library of Science, 2017-05-04)
      In Uzbekistan, despite stable and relatively high tuberculosis treatment success rates, relatively high rates of recurrent tuberculosis have recently been reported. Recurrent tuberculosis is when a patient who was treated for pulmonary tuberculosis and cured, later develops the disease again. This requires closer analysis to identify possible causes and recommend interventions to improve the situation. Using countrywide data, this study aimed to analyse trends in recurrent tuberculosis cases and describe their associations with socio-demographic and clinical factors.
    • Retention in pre-antiretroviral treatment care in a district of Karnataka, India: how well are we doing?

      Shankar, D; Kumar, A M V; Rewari, B; Kumar, S; Shastri, S; Satyanarayana, S; Ananthakrishnan, R; Nagaraja, S B; Devi, M; Bhargava, N; et al. (International Union Against Tuberculosis and Lung Disease, 2014-12-21)
    • Risk factors associated with loss to follow-up among multidrug-resistant tuberculosis patients in Georgia

      Kuchukhidze, G; Kumar, A M V; de Colombani, P; Khogali, M; Nanava, U; Blumberg, H M; Kempker, R R (International Union Against Tuberculosis and Lung Disease, 2014-10-21)
    • Scale-Up of ART in Malawi Has Reduced Case Notification Rates in HIV-Positive and HIV-Negative Tuberculosis

      Kanyerere, H; Girma, B; Mpunga, J; Tayler-Smith, K; Harries, A D; Jahn, A; Chimbwandira, FM (International Union Against Tuberculosis and Lung Disease, 2016-12-21)
      Setting: For 30 years, Malawi has experienced a dual epidemic of human immunodeficiency virus (HIV) infection and tuberculosis (TB) that has recently begun to be attenuated by the scale-up of antiretroviral therapy (ART). Objective: To report on the correlation between ART scale-up and annual national TB case notification rates (CNR) in Malawi, stratified by HIV-positive and HIV-negative status, from 2005 to 2015. Design: A retrospective descriptive ecological study using aggregate data from national reports. Results: From 2005 to 2015, ART was scaled up in Malawi from 28 470 to 618 488 total patients, with population coverage increasing from 2.4% to 52.2%. During this time, annual TB notifications declined by 35%, from 26 344 to 17 104, and the TB CNR per 100 000 population declined by 49%, from 206 to 105. HIV testing uptake increased from 51% to 92%. In known HIV-positive TB patients, the CNR decreased from a high of 1247/100 000 to 710/100 000, a 43% decrease. In known HIV-negative TB patients, the CNR also decreased, from a high of 66/100 000 to 49/100 000, a 26% decrease. Conclusion: TB case notifications have continued to decline in association with ART scale-up, with the decline seen more in HIV-positive than HIV-negative TB. These findings have programmatic implications for national TB control efforts.
    • Scientific Communication: Reporting on Mental Health Illness (MHI) in Kenya: how well are we doing?

      Gituma, KS; Hussein, S; Mwitari, J; Kizito, W; Edwards, JK; Kihara, AB; Owiti, PO; Tweya, H (African Journals Online, 2016-10)
    • The scourge of tuberculosis and anti-tuberculosis drug resistance in Eastern Europe

      Cox, H; Ford, N (International Union Against Tuberculosis and Lung Disease, 2014-10-21)
    • Screening for tuberculosis in pregnancy: do we need more than a symptom screen? Experience from western Kenya

      Kosgei, R J; Szkwarko, D; Callens, S; Gichangi, P; Temmerman, M; Kihara, A-B; Sitienei, J J; Cheserem, E J; Ndavi, P M; Reid, A J; et al. (2013-12-21)
    • Sex, drugs and prisons: HIV prevention strategies for over 190000 clients in Ukraine

      Denisiuk, O; Smyrnov, P; Kumar, A M V; Achanta, S; Boyko, K; Khogali, M; Naik, B; Zachariah, R (The Union, 2014-06-21)
    • Social Support Programme For Tuberculosis Patients in Armenia: Perceptions of Patients and Doctors

      Davtyan, K; Aghabekyan, S; Davtyan, H; Margaryan, T; Zachariah, R; Acosta, C; Dadu, A; Poghosyan, V; Hayrapetyan, A (World Health Organization, 2015-12)
    • The Structured Operational Research and Training Initiative for public health programmes

      Ramsay, A; Harries, A D; Zachariah, R; Bissel, K; Hinderaker, S G; Edginton, M; Enarson, D A; Satyanarayana, S; Kumar, A M V; Hoa, N B; et al. (The Union, 2014-06-21)
    • Sustained Research Capacity After Completing a Structured Operational Research and Training (SORT IT) Course

      Guillerm, N; dar Berger, S; Bissell, K; Kumar, AMV; Ramsay, A; Reid, AJ; Zachariah, R; Harries, AD (International Union Against Tuberculosis and Lung Disease, 2016-09-21)
    • Ten Tips to Improve the Visibility and Dissemination of Research for Policy Makers and Practitioners

      Tripathy, JP; Bhatnagar, A; Shewade, HD; Kumar, AMV; Zachariah, R; Harries, AD (International Union Against Tuberculosis and Lung Disease, 2017-03-21)
    • "They Know, They Agree, but They Don't Do"- The Paradox of Tuberculosis Case Notification by Private Practitioners in Alappuzha District, Kerala, India

      Philip, S; Isaakidis, P; Sagili, K D; Meharunnisa, A; Mrithyunjayan, S; Kumar, A M V (Public Library of Science, 2015-04-24)
      Despite being a recognized standard of tuberculosis (TB) care internationally, mandatory TB case notification brings forth challenges from the private sector. Only three TB cases were notified in 2013 by private practitioners compared to 2000 TB cases notified yearly from the public sector in Alappuzha district. The study objective was to explore the knowledge, opinion and barriers regarding TB Notification among private practitioners offering TB services in Alappuzha, Kerala state, India.
    • Three parallel information systems for malaria elimination in Swaziland, 2010-2015: are the numbers the same?

      Zulu, Z; Kunene, S; Mkhonta, N; Owiti, P; Sikhondze, W; Mhlanga, M; Simelane, Z; Geoffroy, E; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2018-04-25)
      Background: To be able to eliminate malaria, accurate, timely reporting and tracking of all confirmed malaria cases is crucial. Swaziland, a country in the process of eliminating malaria, has three parallel health information systems. Design: This was a cross-sectional study using country-wide programme data from 2010 to 2015. Methods: The Malaria Surveillance Database System (MSDS) is a comprehensive malaria database, the Immediate Disease Notification System (IDNS) is meant to provide early warning and trigger case investigations to prevent onward malaria transmission and potential epidemics, and the Health Management Information Systems (HMIS) reports on all morbidity at health facility level. Discrepancies were stratified by health facility level and type. Results: Consistent over-reporting of 9-85% was noticed in the HMIS, principally at the primary health care level (clinic and/or health centre). In the IDNS, the discrepancy went from under-reporting (12%) to over-reporting (32%); this was also seen at the primary care level. At the hospital level, there was under-reporting in both the HMIS and IDNS. Conclusions: There are considerable discrepancies in the numbers of confirmed malaria cases in the HMIS and IDNS in Swaziland. This may misrepresent the malaria burden and delay case investigation, predisposing the population to potential epidemics. There is an urgent need to improve data integrity in order to guide and evaluate efforts toward elimination.
    • Timing of Antiretroviral Therapy and TB Treatment Outcomes in Patients With TB-HIV in Myanmar

      Thi, A M; Shewade, H D; Kyaw, N T T; Oo, M M; Aung, T K; Aung, S T; Oo, H N; Win, T; Harries, A D (International Union Against Tuberculosis and Lung Disease, 2016-06-21)
      Integrated HIV Care programme, Mandalay, Myanmar.
    • Treatment outcomes among drug-susceptible tuberculosis patients in Latvia, 2006–2010

      Lucenko, I; Riekstina, V; Perevoscikovs, J; Mozgis, D; Khogali, M; Gadoev, J; de Colombani, P; Kumar, A M V (International Union Against Tuberculosis and Lung Disease, 2014-10-21)
    • Trends in Outpatient Malaria Cases, Following Mass Long Lasting Insecticidal Nets (LLIN) Distribution in Epidemic Prone and Endemic Areas of Kenya

      Machini, B; Waqo, E; Kizito, W; Edwards, JK; Owiti, PO; Takarinda, KC (African Journals Online, 2016-10)
    • 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.
    • Tuberculosis among migrants in Bishkek, the capital of the Kyrgyz Republic

      Goncharova, O; Denisiuk, O; Zachariah, R; Davtyan, K; Nabirova, D; Acosta, C; Kadyrov, A (International Union Against Tuberculosis and Lung Disease, 2017-09-21)
      Setting: Twenty-two first-line, two second-line and one tertiary health facility in Bishkek, the capital of Kyrgyzstan. Objectives: Among migrants, a marginalised population at risk for acquiring and transmitting tuberculosis (TB), we determined the proportion with TB among all registered TB cases. For those registered at primary-level facilities, we then reported on their demographic and clinical profiles and TB treatment outcomes. Design: This was a retrospective cohort analysis of 2012-2013 programme data. Results: Of 2153 TB patients registered in all health facilities, 969 (45%) were migrants, of whom 454 were registered in first-line facilities. Of these, 27% were cross-border migrants, 50% had infectious TB and 12% had drug-resistant TB. Treatment success was 74% for new cases and 44% for retreatment TB (the World Health Organization target is ⩾85%). Failure in new and retreatment TB patients was respectively 8% and 25%. Twenty-six individuals started on a first-line anti-tuberculosis regimen failed due to multidrug-resistant TB. Eight (25%) of 32 individuals on a retreatment TB regimen also failed. Loss to follow-up was 10% for new and 19% for retreatment TB. Conclusion: Migrants constituted almost half of all TB patients, drug resistance is prevalent and treatment outcomes unsatisfactory. Fostering inter-country collaboration and prioritising rapid TB diagnostics (Xpert® MTB/RIF) and innovative ways forward for improving treatment outcomes is urgent.