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[ID] => 1487
[post_author] => 4
[post_date] => 2021-04-07 11:30:48
[post_date_gmt] => 2021-04-07 15:30:48
[post_content] =>
Abstract
SETTING: Pune and Pimpri-Chinchwad Municipal Corporation area, Maharashtra State, India.
OBJECTIVE: To assess the sensitivity and specificity of the Xpert
® MTB/RIF assay among adults with suspected pulmonary tuberculosis (PTB) and with or without diabetes (DM).
DESIGN: As part of a prospective cohort study, we screened 2359 adults presumed to have PTB with no history of TB. All individuals underwent testing for two sputum smears, culture, Xpert, glycated haemoglobin and fasting blood sugar. We calculated sensitivity and specificity of Xpert by comparing it with TB sputum culture result as a gold standard.
RESULTS: Among screened individuals, 483 (20%) were diagnosed with DM and 1153 (49%) with pre-DM; 723 (31%) had no DM. Overall sensitivity of Xpert was 96% (95%CI 95-97) and specificity was 91% (95%CI 89-93). Xpert sensitivity was significantly higher among DM group (98%) than in the 'No DM' (95%;
P < 0.01) and pre-DM (96%;
P < 0.05) groups. Among sputum smear-negative individuals, Xpert sensitivity was higher in the DM group than in the No DM (92% vs. 82%;
P = 0.054) and pre-DM group (92% vs. 82%;
P = 0.037).
CONCLUSION: High sensitivity and specificity of Xpert underscores the need for its rapid scale up for the early detection of TB in settings with a high dual burden of TB and DM.
[post_title] => Assessment of the Xpert assay among adult pulmonary tuberculosis suspects with and without diabetes mellitus
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => assessment-of-the-xpert-assay-among-adult-pulmonary-tuberculosis-suspects-with-and-without-diabetes-mellitus
[to_ping] =>
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[post_modified] => 2021-04-07 11:30:48
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[1] => WP_Post Object
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[ID] => 1486
[post_author] => 4
[post_date] => 2021-04-07 11:27:43
[post_date_gmt] => 2021-04-07 15:27:43
[post_content] =>
Abstract
Global tuberculosis incidence has declined marginally over the past decade, and tuberculosis remains out of control in several parts of the world including Africa and Asia. Although tuberculosis control has been effective in some regions of the world, these gains are threatened by the increasing burden of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis. XDR tuberculosis has evolved in several tuberculosis-endemic countries to drug-incurable or programmatically incurable tuberculosis (totally drug-resistant tuberculosis). This poses several challenges similar to those encountered in the pre-chemotherapy era, including the inability to cure tuberculosis, high mortality, and the need for alternative methods to prevent disease transmission. This phenomenon mirrors the worldwide increase in antimicrobial resistance and the emergence of other MDR pathogens, such as malaria, HIV, and Gram-negative bacteria. MDR and XDR tuberculosis are associated with high morbidity and substantial mortality, are a threat to health-care workers, prohibitively expensive to treat, and are therefore a serious public health problem. In this Commission, we examine several aspects of drug-resistant tuberculosis. The traditional view that acquired resistance to antituberculous drugs is driven by poor compliance and programmatic failure is now being questioned, and several lines of evidence suggest that alternative mechanisms-including pharmacokinetic variability, induction of efflux pumps that transport the drug out of cells, and suboptimal drug penetration into tuberculosis lesions-are likely crucial to the pathogenesis of drug-resistant tuberculosis. These factors have implications for the design of new interventions, drug delivery and dosing mechanisms, and public health policy. We discuss epidemiology and transmission dynamics, including new insights into the fundamental biology of transmission, and we review the utility of newer diagnostic tools, including molecular tests and next-generation whole-genome sequencing, and their potential for clinical effectiveness. Relevant research priorities are highlighted, including optimal medical and surgical management, the role of newer and repurposed drugs (including bedaquiline, delamanid, and linezolid), pharmacokinetic and pharmacodynamic considerations, preventive strategies (such as prophylaxis in MDR and XDR contacts), palliative and patient-orientated care aspects, and medicolegal and ethical issues.
[post_title] => The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => the-epidemiology-pathogenesis-transmission-diagnosis-and-management-of-multidrug-resistant-extensively-drug-resistant-and-incurable-tuberculosis
[to_ping] =>
[pinged] =>
[post_modified] => 2021-04-07 11:27:43
[post_modified_gmt] => 2021-04-07 15:27:43
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[2] => WP_Post Object
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[ID] => 1485
[post_author] => 4
[post_date] => 2021-04-07 10:54:19
[post_date_gmt] => 2021-04-07 14:54:19
[post_content] =>
Abstract
Mandatory tuberculosis (TB) notification is an important policy under the End TB Strategy, but little is known about its enforcement especially in high TB incidence countries. We undertook a literature search for selected high-incidence countries, followed by a questionnaire-based survey among key informants in countries with high-, intermediate- and low-TB incidence. Published literature on TB notification in high-incidence countries was limited, but it did illustrate some of the current barriers to notification and the importance of electronic systems to facilitate reporting by private providers. Required survey data were successfully gathered from 40 out of 54 countries contacted. TB is notifiable in 11 out of 15 high-incidence countries, all 16 intermediate-incidence countries, and all nine low-incidence countries contacted. TB case notification by public sector facilities is generally systematised, but few high-incidence countries had systems and tools to facilitate notification from private care providers. In the context of the new End TB Strategy aimed at eventual TB elimination, all countries should have TB on their national list of notifiable diseases. Enhancing the ease of notification by private providers is essential for effective implementation. To that effect, investing in strengthening disease surveillance systems and introducing digital tools to simplify notification are logical ways forward.
[post_title] => Mandatory tuberculosis case notification in high tuberculosis-incidence countries: policy and practice
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => mandatory-tuberculosis-case-notification-in-high-tuberculosis-incidence-countries-policy-and-practice
[to_ping] =>
[pinged] =>
[post_modified] => 2021-04-07 10:54:19
[post_modified_gmt] => 2021-04-07 14:54:19
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://sshiftb.org/?post_type=resources&p=1485
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[3] => WP_Post Object
(
[ID] => 1484
[post_author] => 4
[post_date] => 2021-04-07 10:47:34
[post_date_gmt] => 2021-04-07 14:47:34
[post_content] =>
Abstract
Multidrug-resistant tuberculosis (MDR-TB) challenges TB control efforts because of delays in diagnosis plus its long-term treatment which has toxic effects. Of TB high-incidence countries, India carries the highest burden of MDR-TB cases. We describe policy issues in India concerning MDR-TB diagnosis and management in a careful review of the literature including a systematic review of studies on the prevalence of MDR-TB. Of 995 articles published during 2001–2016 and retrieved from the PubMed, only 20 provided data on the population prevalence of MDR-TB. We further reviewed and describe diagnostic criteria and treatment algorithms in use and endorsed by the Revised National TB Control Program of India. We discuss problems encountered in treating MDR-TB patients with standardized regimens. Finally, we provide realistic suggestions for policymakers and program planners to improve the management and control of MDR-TB in India.
[post_title] => Management and control of multidrug-resistant tuberculosis (MDR-TB): Addressing policy needs for India.
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => management-and-control-of-multidrug-resistant-tuberculosis-mdr-tb-addressing-policy-needs-for-india
[to_ping] =>
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[post_modified] => 2021-04-07 10:47:35
[post_modified_gmt] => 2021-04-07 14:47:35
[post_content_filtered] =>
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[4] => WP_Post Object
(
[ID] => 1483
[post_author] => 4
[post_date] => 2021-04-07 10:34:43
[post_date_gmt] => 2021-04-07 14:34:43
[post_content] =>
Abstract
Multidrug-resistant tuberculosis (MDR-TB), the prevalence of which has increased across the globe in recent years, is a serious threat to public health. Timely diagnosis of MDR-TB, especially among new TB cases, is essential to facilitate appropriate treatment, which can prevent further emergence of drug resistance and its spread in the population. The present case report from India aims to address some operational challenges in diagnosing MDR-TB among new cases and potential measures to overcome them. It argues that even after seven years of implementing the DOTS-Plus program for controlling MDR-TB, India still lacks the technical capacity for rapid MDR-TB diagnosis. The case report underscores an urgent need to explore the use of WHO-endorsed techniques such as Xpert MTB/Rif and commercial assays such as Genotype MTBDR for rapid diagnosis of MDR-TB among new cases. Suitable applications may be found for other TB high-burden countries where MDR-TB is a major concern.
[post_title] => An urgent need for building technical capacity for rapid diagnosis of multidrug-resistant tuberculosis (MDR-TB) among new cases: A case report from Maharashtra, India
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => an-urgent-need-for-building-technical-capacity-for-rapid-diagnosis-of-multidrug-resistant-tuberculosis-mdr-tb-among-new-cases-a-case-report-from-maharashtra-india
[to_ping] =>
[pinged] =>
[post_modified] => 2021-04-07 10:34:43
[post_modified_gmt] => 2021-04-07 14:34:43
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://sshiftb.org/?post_type=resources&p=1483
[menu_order] => 0
[post_type] => resources
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[5] => WP_Post Object
(
[ID] => 1481
[post_author] => 4
[post_date] => 2021-04-07 10:29:28
[post_date_gmt] => 2021-04-07 14:29:28
[post_content] =>
Abstract
Background
Multidrug-resistant TB (MDR-TB) has emerged as a major threat to global TB control efforts in recent years. Facilities for its diagnosis and treatment are limited in many high-burden countries, including India. In hyper-endemic areas like Mumbai, screening for newly diagnosed cases at a higher risk of acquiring MDR-TB is necessary, for initiating appropriate and timely treatment, to prevent its further spread.
Objective
To assess risk factors associated with MDR-TB among Category I, new sputum smear-positive cases, at the onset of therapy.
Materials and Methods
The study applied an unmatched case-control design for 514 patients (106 cases with MDR-TB strains and 408 controls with non-MDR-TB strains). The patients were registered with the Revised National Tuberculosis Control Program (RNTCP) in four selected wards of Mumbai during April 2004-January 2007. Data were collected through semi-structured interviews and drug susceptibility test results.
Results
Multivariate analysis indicated that infection with the Beijing strain (OR = 3.06; 95% C.I. = 1.12-8.38; P = 0.029) and female gender (OR = 1.68; 95% C.I. = 1.02-2.87; P = 0.042) were significant predictors of MDR-TB at the onset of therapy.
Conclusion
The study provides a starting point to further examine the usefulness of these risk factors as screening tools in identifying individuals with MDR-TB, in settings where diagnostic and treatment facilities for MDR-TB are limited.
[post_title] => Risk Factors Associated with MDR-TB at the Onset of Therapy among New Cases Registered with the RNTCP in Mumbai, India
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => risk-factors-associated-with-mdr-tb-at-the-onset-of-therapy-among-new-cases-registered-with-the-rntcp-in-mumbai-india
[to_ping] =>
[pinged] =>
[post_modified] => 2021-04-07 10:29:28
[post_modified_gmt] => 2021-04-07 14:29:28
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://sshiftb.org/?post_type=resources&p=1481
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[6] => WP_Post Object
(
[ID] => 1480
[post_author] => 4
[post_date] => 2021-04-07 10:25:55
[post_date_gmt] => 2021-04-07 14:25:55
[post_content] =>
Abstract
Stigma associated with tuberculosis (TB) is often regarded as a barrier to health seeking and a cause of social suffering. Stigma studies are typically patient-centred, and less is known about the views of communities where patients reside. This study examined community perceptions of TB-related stigma. A total of 160 respondents (80 men and 80 women) without TB in the general population of Western Maharashtra, India, were interviewed using Explanatory Model Interview Catalogue interviews with same-sex and cross-sex vignettes depicting a person with typical features of TB. The study clarified features of TB-related stigma. Concealment of disease was explained as fear of losing social status, marital problems and hurtful behaviour by the community. For the female vignette, heredity was perceived as a cause for stigmatising behaviour. Marital problems were anticipated more for the male vignette. Anticipation of spouse support, however, was more definite for men and conditional for women, indicating the vulnerability of women. Community views acknowledged that both men and women with TB share a psychological burden of unfulfilled social responsibilities. The distinction between public health risks of infection and unjustified social isolation (stigma) was ambiguous. Such a distinction is important for effective community-based interventions for early diagnosis of TB and successful treatment.
[post_title] => Gender and community views of stigma and tuberculosis in rural Maharashtra, India
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => gender-and-community-views-of-stigma-and-tuberculosis-in-rural-maharashtra-india
[to_ping] =>
[pinged] =>
[post_modified] => 2021-04-07 10:25:55
[post_modified_gmt] => 2021-04-07 14:25:55
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://sshiftb.org/?post_type=resources&p=1480
[menu_order] => 0
[post_type] => resources
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[7] => WP_Post Object
(
[ID] => 1479
[post_author] => 4
[post_date] => 2021-04-07 10:24:12
[post_date_gmt] => 2021-04-07 14:24:12
[post_content] =>
Summary
In the context of rising rates of drug-resistant tuberculosis (TB) in India, this communication presents some field observations during screening of new cases registered with the Revised National Tuberculosis Control Programme (RNTCP) in urban and rural areas of Maharashtra, India. It appears that erroneous categorization and treatment that contributes to multiple drug resistance results from a lack of patient screening for previous treatment, ambiguity in categorization and reluctance to disclose a history of anti-tuberculosis treatment. Suggested measures include detailed screening of new cases, computerization of patient records and an empathetic dialogue between patient and health care provider.
[post_title] => Observations on categorization of new TB cases: Implications for controlling drug resistance
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => observations-on-categorization-of-new-tb-cases-implications-for-controlling-drug-resistance
[to_ping] =>
[pinged] =>
[post_modified] => 2021-04-07 10:24:12
[post_modified_gmt] => 2021-04-07 14:24:12
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://sshiftb.org/?post_type=resources&p=1479
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[8] => WP_Post Object
(
[ID] => 1478
[post_author] => 4
[post_date] => 2021-04-07 10:22:29
[post_date_gmt] => 2021-04-07 14:22:29
[post_content] =>
Abstract
Multidrug-resistant tuberculosis (MDR-TB) has emerged as a possible threat to global tuberculosis control efforts in recent years. It is a challenge not only from a public health point of view but also in the context of global economy, especially in the absence of treatment for MDR-TB at national-level programs in developing countries. Biological accounts are insufficient to understand the emergence and dynamics of drug resistance. This article focuses essentially on the need for a holistic perspective, linking biosocial determinants that would probably lead to better insights into MDR-TB control strategies.
[post_title] => Multidrug-resistant tuberculosis (MDR-TB) in India: an attempt to link biosocial determinants
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => multidrug-resistant-tuberculosis-mdr-tb-in-india-an-attempt-to-link-biosocial-determinants
[to_ping] =>
[pinged] =>
[post_modified] => 2021-04-07 10:22:29
[post_modified_gmt] => 2021-04-07 14:22:29
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://sshiftb.org/?post_type=resources&p=1478
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[9] => WP_Post Object
(
[ID] => 1477
[post_author] => 4
[post_date] => 2021-04-07 10:20:00
[post_date_gmt] => 2021-04-07 14:20:00
[post_content] =>
Abstract
Gender-specific patterns of experience, meaning, and behaviour for tuberculosis (TB) require consideration to guide control programmes. To clarify concepts of gender, culture, and TB in a rural endemic population of Maharashtra, India, this study of 80 men and 80 women employed qualitative and quantitative methods of cultural epidemiology, using a locally adapted semi-structured Explanatory Model Interview Catalogue (EMIC) interviews are instruments for cultural epidemiological study of the distribution of illness-related experiences, meanings, and behaviours. This interview queried respondents without active disease about vignettes depicting a man and woman with typical features of TB. Emotional and social symptoms were frequently reported for both vignettes, but more often considered most distressing for the female vignette; specified problems included arranging marriages, social isolation, and inability to care for children and family. Job loss and reduced income were regarded most troubling for the male vignette. Men and women typically identified sexual experience as the cause of TB for opposite-sex vignettes. With wider access to information about TB, male respondents more frequently recommended allopathic doctors and specialty services. Discussion considers the practical significance of gender-specific cultural concepts of TB.
[post_title] => Cultural concepts of tuberculosis and gender among the general population without tuberculosis in rural Maharashtra, India
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
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[to_ping] =>
[pinged] =>
[post_modified] => 2021-04-07 10:20:01
[post_modified_gmt] => 2021-04-07 14:20:01
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[in_the_loop] =>
[post] => WP_Post Object
(
[ID] => 1487
[post_author] => 4
[post_date] => 2021-04-07 11:30:48
[post_date_gmt] => 2021-04-07 15:30:48
[post_content] =>
Abstract
SETTING: Pune and Pimpri-Chinchwad Municipal Corporation area, Maharashtra State, India.
OBJECTIVE: To assess the sensitivity and specificity of the Xpert
® MTB/RIF assay among adults with suspected pulmonary tuberculosis (PTB) and with or without diabetes (DM).
DESIGN: As part of a prospective cohort study, we screened 2359 adults presumed to have PTB with no history of TB. All individuals underwent testing for two sputum smears, culture, Xpert, glycated haemoglobin and fasting blood sugar. We calculated sensitivity and specificity of Xpert by comparing it with TB sputum culture result as a gold standard.
RESULTS: Among screened individuals, 483 (20%) were diagnosed with DM and 1153 (49%) with pre-DM; 723 (31%) had no DM. Overall sensitivity of Xpert was 96% (95%CI 95-97) and specificity was 91% (95%CI 89-93). Xpert sensitivity was significantly higher among DM group (98%) than in the 'No DM' (95%;
P < 0.01) and pre-DM (96%;
P < 0.05) groups. Among sputum smear-negative individuals, Xpert sensitivity was higher in the DM group than in the No DM (92% vs. 82%;
P = 0.054) and pre-DM group (92% vs. 82%;
P = 0.037).
CONCLUSION: High sensitivity and specificity of Xpert underscores the need for its rapid scale up for the early detection of TB in settings with a high dual burden of TB and DM.
[post_title] => Assessment of the Xpert assay among adult pulmonary tuberculosis suspects with and without diabetes mellitus
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => assessment-of-the-xpert-assay-among-adult-pulmonary-tuberculosis-suspects-with-and-without-diabetes-mellitus
[to_ping] =>
[pinged] =>
[post_modified] => 2021-04-07 11:30:48
[post_modified_gmt] => 2021-04-07 15:30:48
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[guid] => https://sshiftb.org/?post_type=resources&p=1487
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[is_author] =>
[is_category] =>
[is_tag] =>
[is_tax] => 1
[is_search] =>
[is_feed] =>
[is_comment_feed] =>
[is_trackback] =>
[is_home] =>
[is_privacy_policy] =>
[is_404] =>
[is_embed] =>
[is_paged] =>
[is_admin] =>
[is_attachment] =>
[is_singular] =>
[is_robots] =>
[is_favicon] =>
[is_posts_page] =>
[is_post_type_archive] => 1
[query_vars_hash:WP_Query:private] => f1434a613b9592a1278f82037c185da6
[query_vars_changed:WP_Query:private] =>
[thumbnails_cached] =>
[stopwords:WP_Query:private] =>
[compat_fields:WP_Query:private] => Array
(
[0] => query_vars_hash
[1] => query_vars_changed
)
[compat_methods:WP_Query:private] => Array
(
[0] => init_query_flags
[1] => parse_tax_query
)
)
