To review policies on management of latent tuberculosis infection in countries with low and high burdens of tuberculosis.
We divided countries reporting data to the World Health Organization (WHO) ...Global Tuberculosis Programme into low and high tuberculosis burden, based on WHO criteria. We identified national policy documents on management of latent tuberculosis through online searches, government websites, WHO country offices and personal communication with programme managers. We made a descriptive analysis with a focus on policy gaps and deviations from WHO policy recommendations.
We obtained documents from 68 of 113 low-burden countries and 30 of 35 countries with the highest burdens of tuberculosis or human immunodeficiency virus (HIV)-associated tuberculosis. Screening and treatment of latent tuberculosis infection in people living with HIV was recommended in guidelines of 29 (96.7%) high-burden and 54 (79.7%) low-burden countries. Screening for children aged < 5 years with household tuberculosis contact was the policy of 25 (83.3%) high- and 28 (41.2%) low-burden countries. In most high-burden countries the recommendation was symptom screening alone before treatment, whereas in all low-burden countries it was testing before treatment. Some low-burden countries' policies did not comply with WHO recommendations: nine (13.2%) recommended tuberculosis preventive treatment for travellers to high-burden countries and 10 (14.7%) for patients undergoing abdominal surgery.
Lack of solid evidence on certain aspects of management of latent tuberculosis infection results in national policies which vary considerably. This highlights a need to advance research and develop clear, implementable and evidence-based WHO policies.
Only the tuberculin skin test (TST) and two interferon-γ release assays (IGRAs), QuantiFERON-TB Gold In-Tube and T-SPOT.TB, are currently endorsed by the World Health Organization as tests for ...tuberculosis (TB) infection. While IGRAs are more specific than the TST, they require sophisticated laboratory infrastructure and are costly to perform. However, both types of tests have limited performance to predict development of active TB. Tests with improved predictive performance and operational characteristics are needed.
We reviewed the current landscape of tests for TB infection identified through a web-based survey targeting diagnostic manufacturers globally.
We identified 20 tests for TB infection: 15
tests and five skin tests. 13 of the
tests are whole-blood IGRAs and 14 use early secreted antigenic target 6 (ESAT-6) and culture filtrate protein 10 (CFP-10), with or without additional antigens. 10 of the tests are based on assays other than an ELISA, such as a fluorescent lateral flow assay that requires less manual operation and shorter assay time and hence is more suitable for decentralisation compared with the existing IGRAs. Four of the five skin tests use ESAT-6 and CFP-10 proteins, while the remaining test uses a new antigen that is specific to
complex.
New tests have the potential to improve accuracy, operational characteristics and end-user access to tests for TB infection. However, published data in various populations and settings are limited for most new tests. Evaluation of these new tests in a standardised design would facilitate their endorsement and programmatic scale-up.
The World Health Organization (WHO) recommends tuberculosis (TB) preventive treatment for high-risk groups. Isoniazid preventive therapy (IPT) has been used globally for this purpose for many years, ...including in pregnancy. This review assessed current knowledge about the safety of IPT in pregnancy.
We searched PubMed, Embase, CENTRAL, Global Health Library and HIV and TB-related conference abstracts, until May 15, 2019, for randomised controlled trials (RCTs) and non-randomised studies (NRS) where IPT was administered to pregnant women. Outcomes of interest were: 1) maternal outcomes, including permanent drug discontinuation due to adverse drug reactions, any grade 3 or 4 drug-related toxic effects, death from any cause and hepatotoxicity; and 2) pregnancy outcomes, including
fetal death, neonatal death or stillbirth, preterm delivery/prematurity, intrauterine growth restriction, low birth weight and congenital anomalies. Meta-analyses were conducted using a random-effects model.
After screening 1342 citations, nine studies (of 34 to 51 942 participants) met inclusion criteria. We found an increased likelihood of hepatotoxicity among pregnant women given IPT (risk ratio 1.64, 95% CI 0.78-3.44) compared with no IPT exposure in one RCT. Four studies reported on pregnancy outcomes comparing IPT exposure to no exposure among pregnant women with HIV. In one RCT, adverse pregnancy outcomes were associated with IPT exposure during pregnancy (odds ratio (OR) 1.51, 95% CI 1.09-2.10), but three NRS showed a protective effect.
We found inconsistent associations between IPT and adverse pregnancy outcomes. Considering the grave consequences of active TB in pregnancy, current evidence does not support systematic deferral of IPT until postpartum. Research on safety is needed.
Metodos Para estimar el numero de ninos elegibles, se obtuvieron valores nacionales para el numero de casos notificados de tuberculosis pulmonar bacteriologicamente confirmada en 2017, la proporcion ...de la poblacion menor de 5 anos en 2017 y el tamano promedio del hogar de fuentes publicadas. Se obtuvieron valores globales para el numero de casos de tuberculosis activa por hogar con un caso indice y para la prevalencia de infeccion de tuberculosis latente entre los ninos menores de 5 anos que estaban en contacto con un caso de tuberculosis en el hogar mediante las revisiones sistematicas, el metanalisis y los modelos de regresion de Poisson. phrase omitted
HIV-associated tuberculosis Hamada, Yohhei; Getahun, Haileyesus; Tadesse, Birkneh Tilahun ...
International Journal of STD & AIDS,
08/2021, Letnik:
32, Številka:
9
Book Review, Journal Article
Recenzirano
Odprti dostop
Tuberculosis (TB) remains a leading cause of morbidity and mortality among people living with HIV. HIV-associated TB disproportionally affects African countries, particularly vulnerable groups at ...risk for both TB and HIV. Currently available TB diagnostics perform poorly in people living with HIV; however, new diagnostics such as Xpert Ultra and lateral flow urine lipoarabinomannan assays can greatly facilitate diagnosis of TB in people living with HIV. TB preventive treatment has been underutilized despite its proven benefits independent of antiretroviral therapy (ART). Shorter regimens using rifapentine can support increased availability and scale-up. Mortality is high in people with HIV-associated TB, and timely initiation of ART is critical. Programs should provide decentralized and integrated TB and HIV care in settings with high burden of both diseases to improve access to services that diagnose TB and HIV as early as possible. The new prevention and diagnosis tools recently recommended by WHO offer an immense opportunity to advance our fight against HIV-associated TB. They should be made widely available and scaled up rapidly supported by adequate funding with robust monitoring of the uptake to advance global TB elimination.
Since 2011, WHO recommends a four-symptom screening rule to exclude active tuberculosis in people living with HIV before starting tuberculosis preventive treatment (ie, absence of current cough, ...weight loss, night sweats, or fever). We assessed the sensitivity and specificity of the screening rule among people living with HIV based on antiretroviral therapy (ART) status and the added contribution of chest radiography.
We did a systematic review and meta-analysis. We searched PubMed, Embase, and the Cochrane Library from Jan 1, 2011, to March 12, 2018, for studies published after the WHO issued recommendations on the use of the four-symptom screening rule. We also searched abstracts from relevant international conferences. We included studies that collected sputum or any specimens (eg, urine, blood, or fine-needle aspirates from lymph nodes) from people with HIV regardless of signs or symptoms. Case-control studies were excluded because they are prone to bias. Active tuberculosis was diagnosed with bacteriological confirmation by culture or Xpert MTB/RIF of any specimens. Two investigators extracted the data, including age, sex, and ART status. We calculated sensitivity, specificity, and 95% CI. When at least four studies were available, we estimated pooled sensitivity and specificity using random and effects bivariate models; otherwise we used univariate random-effects models.
Of 4615 records identified by the search, 21 were included in the review (involving 15 427 people including 1559 with active tuberculosis). 18 eligible studies were included in the final meta-analysis. Seven studies provided data on people receiving ART. The pooled sensitivity of the four-symptom screening rule was lower for 4640 people on ART (51·0%, 95% CI 28·4-73·2) than for 8664 who were ART-naive (89·4%, 83·0-93·5). Pooled specificity for those on ART was 70·7% (95% CI 47·8-86·4) and for ART-naive people was 28·1% (18·6-40·1). On the basis of data from 646 individuals in two studies, the addition of any abnormal chest radiographic findings in people on ART improved sensitivity from 52·2% (95% CI 38·0-66·0) to 84·6% (69·7-92·9) but decreased specificity from 55·5% (95% CI 51·8-59·2) to 29·8% (26·3-33·6).
Our review suggested a lower sensitivity of the WHO four-symptom screening rule among people with HIV who are on ART than in those who are ART naive. The addition of chest radiography could improve the screening rule in people living with HIV who are on ART, provided it does not pose a barrier to preventive treatment.
None.
Metodos Dividimos a los paises que informan datos al Programa Global de Tuberculosis de la Organizacion Mundial de la Salud (OMS) en nivel de tuberculosis bajo y elevado, conforme a los criterios de ...la OMS. Identificamos los documentos de politicas nacionales sobre el tratamiento de la tuberculosis latente a traves de busquedas en linea, sitios web gubernamentales, sedes nacionales de la OMS y comunicacion personal con los administradores del programa. Realizamos un analisis descriptivo enfocado en las desviaciones y los vacios de las politicas con respecto a las recomendaciones de politicas de la OMS. phrase omitted
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