scholarly journals Latent tuberculosis screening and treatment in HIV: highly acceptable in a prospective cohort study

2021 ◽  
pp. 00442-2021
Author(s):  
Helena A White ◽  
Hajra Okhai ◽  
Amandip Sahota ◽  
John Maltby ◽  
Iain Stephenson ◽  
...  
Keyword(s):  
Latent Tuberculosis ◽  
People Living With Hiv ◽  
Tuberculosis Screening ◽  
Ltbi Screening ◽  
Increased Risk ◽  
Objective Evidence ◽  
Perceived Importance ◽  
Treatment Data ◽  
Latent Tb Infection ◽  
The Individual

BackgroundPeople living with HIV (PLWH) are at increased risk of reactivation of latent TB infection (LTBI). Although UK and international guidelines identify this group as a priority for LTBI screening and treatment, data on attitudes of PLWH to this policy recommendation are lacking.MethodsA five-point, Likert-style questionnaire was administered to PLWH to assess views and intentions towards accepting LTBI screening and treatment. Subsequent Immune Gamma Release Assay (IGRA) testing was offered, and chemoprophylaxis if required. Influencing demographic and psychological associations with planned, and actual, testing and treatment uptake, were assessed using multivariable logistic regression.Results444/716 (62%) patients responded. 417/437 (95.4%) expressed intention to accept LTBI testing. The only significant association was the perceived importance of testing to the individual (aOR 8.98, 95% CI 2.55–31.67). 390/393 (99·2%) accepted appropriate IGRA screening; 41/390 (10·5%) were positive. 397/431 (92.1%) expressed intention to accept chemoprophylaxis, associated with perceived importance of treatment (aOR 3.52, 95% CI 1.46–8.51), a desire to have treatment for LTBI (aOR 1.77, 95% CI 0.99–3.15), and confidence in taking treatment (aOR 3.77, 95% CI 1.84–7.72). Of those offered chemoprophylaxis, 36/37 (97·3%) accepted and 34/36 (94·4%) completed treatment. There were no correlates with actual screening acceptance.ConclusionsLTBI is common amongst PLWH, highlighting the importance of robust screening and treatment programmes. This study shows that screening and treatment for LTBI is highly acceptable to PLWH and provides strong, objective, evidence for policy-makers developing guidelines in this cohort.

Implementation of latent tuberculosis screening in HIV care centres: evaluation in a low tuberculosis incidence setting

2015 ◽  
Vol 144 (4) ◽  
pp. 703-711 ◽  
Author(s):  
C. WYNDHAM-THOMAS ◽  
K. SCHEPERS ◽  
V. DIRIX ◽  
F. MASCART ◽  
J.-P. VAN VOOREN ◽  
...  
Keyword(s):  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Screening Tools ◽  
Hiv Care ◽  
Screening Methods ◽  
Tuberculosis Screening ◽  
Ltbi Treatment ◽  
Ltbi Screening ◽  
Multiple Choice Questionnaire ◽  
Targeted Approach

SUMMARYThe screening and treatment of latent tuberculosis infection (LTBI) to prevent active tuberculosis (TB) is recommended by the WHO in all HIV-infected patients. The aim of this study was to evaluate its implementation within Belgium's HIV care. A multiple-choice questionnaire was sent to 55 physicians working in the country's AIDS reference centres. Response rate reached 62%. Only 20% screened all their HIV-infected patients for LTBI. Screening methods used and their interpretation vary from one physician to another. The main barriers to the implementation of LTBI screening and treatment, as perceived by the participants, are lack of sensitivity of screening tools, risks associated with polypharmacy and toxicity of treatment. The poor coverage of LTBI screening reported here and the inconsistency in methods used raises concern. However, this was not unexpected as, in low-TB incidence countries, who, when and how to screen for LTBI remains unclear and published guidelines show important disparities. Recently, a targeted approach in which only HIV-infected patients at highest risk of TB are screened has been suggested. Such a strategy would limit unnecessary exposure to LTBI treatment. This methodology was approved by 80% of the participants and could therefore achieve greater coverage. Its clinical validation is still pending.

scholarly journals Collaborative TB/HIV activities in the European Region

2020 ◽  
pp. 00721-2020
Author(s):  
Gerard de Vries ◽  
Sarah van de Berg ◽  
Anke van Dam ◽  
Sayohat Hasanova ◽  
Manish Pareek ◽  
...  
Keyword(s):  
World Health Organisation ◽  
Models Of Care ◽  
World Health ◽  
Hiv Care ◽  
European Region ◽  
People Living With Hiv ◽  
Hiv Services ◽  
Ltbi Screening ◽  
Selective Approach ◽  
Latent Tb Infection

IntroductionAn estimated 12% of tuberculosis (TB) patients are coinfected with HIV in the World Health Organisation European Region (Region). Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with integrated people-centred models of care.MethodsWe collected information on the current models of integration of TB and HIV services in the Region via a comprehensive survey among the TB and HIV National Focal Points, and identified challenges and opportunities.ResultsForty-seven of 55 countries (85%) responded. HIV testing in all TB patients and screening for active TB in all people living with HIV (PLHIV) was recommended in 40 (85%) and 34 (72%) respectively. Thirty countries (64%) recommended latent TB infection (LTBI) screening in all PLHIV, while 13 (28%) had a selective approach and 4 countries (9%) did not recommend LTBI screening. In most countries testing for HIV and screening for active TB and LTBI was done by the specialist that is treating the patient, i.e. TB patients were tested for HIV by a TB specialist in 42 countries (89%) and PLHIV were screened for active TB by an HIV specialist in 34 countries (72%).ConclusionTB and HIV care are well integrated in policies of especially high TB and high HIV burden countries. Implementation though needs to be improved. Continuous monitoring of HIV and TB services integration enables assessing the quality of HIV/TB care and to identify where further improvements are needed.

scholarly journals Latent tuberculosis screening before kidney transplantation in the South of Brazil

2021 ◽  
Author(s):  
Gisele Meinerz ◽  
Cynthia Keitel da Silva ◽  
Damaris Mikaela Balin Dorsdt ◽  
Julia Bertoni Adames ◽  
Julio Pasquali Andrade ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Latent Tuberculosis ◽  
Tuberculin Test ◽  
Tuberculosis Screening ◽  
Post Transplant ◽  
Ltbi Screening ◽  
Interferon Gamma Release Assays ◽  
High Incidence ◽  
South Of Brazil

Abstract Background: Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral. Methods: We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019. Results: There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402). Conclusion: In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.

scholarly journals Latent tuberculosis and COVID-19 disease

2021 ◽  
Vol 4 (3) ◽  
pp. e26
Author(s):  
Sruthi Sekaran ◽  
◽  
Ravi Pankajbhai Jagani ◽  
Madeeha Subhan Waleed ◽  
Claudia Samanta Villa Celi ◽  
...  
Keyword(s):  
Latent Tuberculosis ◽  
The Other ◽  
Latent Form ◽  
The World ◽  
Latent Tb ◽  
Immunocompromised State ◽  
Latent Tb Infection ◽  
The Individual ◽  
Available Information ◽  
Healthy Immune System

Since the start of the COVID-19 pandemic in 2020, there has been chaos in the world. With the COVID-19 cases rising, many other medical diseases have been ignored and not prioritized. One of these crucial diseases is Tuberculosis (TB). TB is a highly infectious bacterial respiratory disease. Every year there are millions of cases that are registered all around the world. TB is seen in two forms, an active and a latent form. In both of the states, the individual with TB is immunocompromised. This is of great importance, as COVID-19 is known to readily infect individuals in an immunocompromised state more than those with a healthy immune system. Although a little investigation about coexisting infections with COVID-19 and TB is conducted, it is important to consider many factors that can be beneficial to help treat these patients with both conditions effectively and promptly. A few of these factors are pathophysiological relation, diagnostic measurements, effects of each condition on the other, and approaches to treatment. Through a literature review of available information, we summarized the knowledge regarding the correlation between Latent TB infection and COVID-19 infection. The main objective of this publication is to provide a brief overview of how the two conditions overlap with one another. The article also provides a clinical review of how to approach these two conditions in a scenario where an individual is found to be infected with both Latent TB and COVID-19.

scholarly journals Systematic review of latent tuberculosis infection research to inform programmatic management in Ireland

2021 ◽  
Author(s):  
James O’Connell ◽  
Eoghan de Barra ◽  
Samuel McConkey
Keyword(s):  
Systematic Review ◽  
Latent Tuberculosis Infection ◽  
Meta Analysis ◽  
Latent Tuberculosis ◽  
Risk Groups ◽  
Tuberculosis Infection ◽  
World Health ◽  
People Living With Hiv ◽  
Knowledge Gaps ◽  
Ltbi Screening

AbstractThe World Health Organisation (WHO) End Tuberculosis (TB) Strategy and the WHO Framework Towards Tuberculosis Elimination in Low Incidence Countries state that latent tuberculosis infection (LTBI) screening and treatment in selected high-risk groups is a priority action to eliminate TB. The European Centre for Disease Prevention and Control (ECDC) advises that this should be done through high-quality programmatic management, which they describe as having six key components. The research aim was to systematically review the literature to identify what is known about the epidemiology of LTBI and the uptake and completion of LTBI screening and treatment in Ireland to inform the programmatic management of LTBI nationally. A systematic literature review was performed according to a review protocol and reported in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Twenty-eight studies were eligible for inclusion and described LTBI screening or treatment performed in one of five contexts, pre-biologic or other immunosuppression screening, people living with HIV, TB case contacts, other vulnerable populations, or healthcare workers. The risk of bias across studies with regard to prevalence of LTBI was generally high. One study reported a complete cascade of LTBI care from screening initiation to treatment completion. This systematic review has described what published research there is on the epidemiology and cascade of LTBI care in Ireland and identified knowledge gaps. A strategy for addressing these knowledge gaps has been proposed.

scholarly journals Prevalence of latent tuberculosis among refugee children in Malaysia

2020 ◽  
Vol 6 (1) ◽  
pp. 00254-2019 ◽  
Author(s):  
Yen Jun Wong ◽  
Shaun Wen Huey Lee
Keyword(s):  
Latent Tuberculosis ◽  
Interferon Γ ◽  
Cross Sectional Study ◽  
Preventive Therapy ◽  
Skin Tests ◽  
Refugee Children ◽  
High Risk Population ◽  
Tuberculosis Screening ◽  
Cross Sectional ◽  
Increased Risk

IntroductionTuberculosis remains one of the top 10 major causes of global mortality, imposing social–economic and medical challenges in Malaysia. Refugees sheltered in Malaysia are a high-risk population but basic health checks upon their arrival, including tuberculosis screening, are not practised. This study aimed to identify the prevalence and risk factors of tuberculosis and latent tuberculosis infection (LTBI) among refugee children in Malaysia.MethodsA cross-sectional study was performed in three refugee schools in the Klang Valley, Malaysia, using tuberculin skin tests or interferon-γ release assays. Participants who tested positive were sent for further examination with chest radiography to confirm the tuberculosis diagnosis.ResultsFrom April 2018 to April 2019, we screened 430 refugee children with a median age of 13.0 years. Most of the children were born in Myanmar (n=274, 63.7%) and Pakistan (n=60, 14.0%). No children were diagnosed with active tuberculosis but 55 of the children (12.8%) were diagnosed with LTBI. Children with LTBI were generally older (OR 3.01, 95% CI 1.71–5.29; p<0.001) than those without LTBI infection. Sex, history of bacille Calmette–Guérin vaccination and country of birth were not associated with increased risk of LTBI.ConclusionThe relatively high LTBI burden among refugee children in this study poses an indication of possible LTBI risk among this population nationwide, and thus would be an important group to target for preventive therapy. This provides a unique opportunity for researchers to further examine and implement well-structured preventive strategies in combating the endemic infectious disease in Malaysia.

scholarly journals Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ineke Spruijt ◽  
Dawit Tesfay Haile ◽  
Susan van den Hof ◽  
Kathy Fiekert ◽  
Niesje Jansen ◽  
...  
Keyword(s):  
The Netherlands ◽  
Asylum Seekers ◽  
Cultural Beliefs ◽  
Latent Tuberculosis ◽  
Treatment Programs ◽  
Ltbi Treatment ◽  
Treatment Cascade ◽  
Ltbi Screening ◽  
Latent Tb Infection ◽  
Asylum Seekers And Refugees

Abstract Background Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs, and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands. Methods We used convenience sampling to interview adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment (November 2016–May 2018). We used a thematic analysis to identify, analyse and report patterns in the data. Results Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment. Conclusion The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.

scholarly journals A differential DNA methylome signature of pulmonary immune cells from individuals converting to latent tuberculosis infection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lovisa Karlsson ◽  
Jyotirmoy Das ◽  
Moa Nilsson ◽  
Amanda Tyrén ◽  
Isabelle Pehrson ◽  
...  
Keyword(s):  
Dna Methylation ◽  
Immune Cells ◽  
Methylation Status ◽  
Latent Tuberculosis ◽  
Metabolic Reprogramming ◽  
Dna Methylome ◽  
Differentially Methylated Genes ◽  
Increased Risk ◽  
Latent Tb ◽  
Latent Tb Infection

AbstractTuberculosis (TB), caused by Mycobacterium tuberculosis, spreads via aerosols and the first encounter with the immune system is with the pulmonary-resident immune cells. The role of epigenetic regulations in the immune cells is emerging and we have previously shown that macrophages capacity to kill M. tuberculosis is reflected in the DNA methylome. The aim of this study was to investigate epigenetic modifications in alveolar macrophages and T cells in a cohort of medical students with an increased risk of TB exposure, longitudinally. DNA methylome analysis revealed that a unique DNA methylation profile was present in healthy subjects who later developed latent TB during the study. The profile was reflected in a different overall DNA methylation distribution as well as a distinct set of differentially methylated genes (DMGs). The DMGs were over-represented in pathways related to metabolic reprogramming of macrophages and T cell migration and IFN-γ production, pathways previously reported important in TB control. In conclusion, we identified a unique DNA methylation signature in individuals, with no peripheral immune response to M. tuberculosis antigen who later developed latent TB. Together the study suggests that the DNA methylation status of pulmonary immune cells can reveal who will develop latent TB infection.

Evaluation of the latent tuberculosis screening and treatment strategy for asylum seekers in Stockholm, Sweden 2015–2018 - a record linkage study of the care cascade

2020 ◽  
pp. 2002255
Author(s):  
Joanna Nederby Öhd ◽  
Maria-Pia Hergens ◽  
Yauheni Luksha ◽  
Charlotte Buxbaum ◽  
Jad Shedrawy ◽  
...  
Keyword(s):  
Host Country ◽  
Record Linkage ◽  
Asylum Seekers ◽  
Latent Tuberculosis ◽  
Linkage Study ◽  
Tuberculosis Screening ◽  
Care Cascade ◽  
High Incidence ◽  
Latent Tb ◽  
Latent Tb Infection

In many countries with low tuberculosis (TB) incidence (<10/100,000) a high proportion of cases originate from latent TB infection (LTBI) reactivation among migrants from high-incidence countries (≥100/100,000) who have been infected before arrival in the host country [1, 2]. Consequently, LTBI screening and management for migrants is an important intervention to reduce TB incidence in those countries [1, 3, 4].

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