Screening for active tuberculosis before isoniazid preventive therapy among HIV-infected West African adults

2017 ◽  
Vol 21 (12) ◽  
pp. 1237-1244 ◽  
Author(s):  
R. Moh ◽  
A. Badjé ◽  
J-B. N'takpé ◽  
G. M. Kouamé ◽  
D. Gabillard ◽  
...  
Keyword(s):  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
World Health ◽  
Open Label ◽  
Clinical Algorithm ◽  
Related Risk ◽  
Immunodeficiency Virus ◽  
Chest X Ray ◽  
Open Label Trial ◽  
Health Organization

SETTING: TEMPRANO was a multicentre, open-label trial in which human immunodeficiency virus (HIV) infected adults with high CD4 counts were randomised into early or deferred antiretroviral therapy (ART) arms with or without 6-month isoniazid preventive therapy (IPT) in a setting where the World Health Organization (WHO) recommends IPT in HIV-infected patients. Despite the WHO recommendation, IPT coverage remains low due to fear of the presence of undiagnosed active TB before prescribing IPT, and the related risk of drug resistance.OBJECTIVE: To report the frequency of undiagnosed TB in patients enrolled for IPT and describe the results of a 1-month buffer period to avoid prescribing IPT for active TB cases.DESIGN: Patients were screened using a clinical algorithm and chest X-ray at Day 0 and started on isoniazid at Month 1 if no sign/symptom suggestive of TB appeared between Day 0 and Month 1.RESULTS: Of 1030 patients randomised into IPT arms. 10% never started IPT at Month 1. Of these, 23 had active TB, including 16 with prevalent TB. Among the 927 patients who started IPT, 6 had active TB, including 1 with prevalent TB. Only 1 patient with active TB received IPT due to the 1-month buffer period between Day 0 and IPT initiation.CONCLUSION: In this study, 1.6% of adults considered free of active TB based on clinical screening at pre-inclusion actually had active TB.

scholarly journals Tuberculosis screening coverage and isoniazid preventive therapy among people living with HIV at Gambella Hospital, southwest Ethiopia: a retrospective study design

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110461
Author(s):  
Mecha Aboma ◽  
Nagasa Dida
Keyword(s):  
Retrospective Study ◽  
Complete Information ◽  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
World Health ◽  
People Living With Hiv ◽  
African Countries ◽  
Tuberculosis Screening ◽  
Southwest Ethiopia ◽  
Health Organization

Objective We aimed to assess the coverage of tuberculosis screening and isoniazid preventive therapy (IPT) among people living with human immunodeficiency virus (PLHIV) at Gambella Hospital, southwest Ethiopia. Methods We conducted a 5-year retrospective study of PLHIV receiving care in an antiretroviral therapy clinic from 1 January 2011 to 30 December 2015. We reviewed a total of 900 medical records of patients with complete information. Result Of the total, 897 (99.7%) PLHIV were screened for tuberculosis, among which 77 (8.6%) were found to be positive for active tuberculosis. Among 820 (91.4%) individuals eligible for IPT, only 545 (66.5%) were provided IPT; 275 (33.5%) eligible PLHIV were not provided IPT. Male sex (adjusted odds ratio [AOR] 1.63) and ages 18–29 years (AOR 0.33) and 30–44 years (AOR 0.31) were significantly associated with the likelihood of tuberculosis infection. Conclusion The present study findings demonstrated that tuberculosis screening for PLHIV at Gambella Hospital was improved in comparison with reports from many African countries and other parts of Ethiopia. Despite this improvement, the implementation rate of IPT was below national and World Health Organization recommendations. Overall, tuberculosis diagnostic approaches and available preventive measures should be strengthened in the study area.

scholarly journals Modelling the performance of isoniazid preventive therapy for reducing tuberculosis in HIV endemic settings: the effects of network structure

2011 ◽  
Vol 8 (63) ◽  
pp. 1510-1520 ◽  
Author(s):  
H. L. Mills ◽  
T. Cohen ◽  
C. Colijn
Keyword(s):  
Network Structure ◽  
Disease Transmission ◽  
Population Level ◽  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
World Health ◽  
Individual Level ◽  
Health Organization ◽  
The Individual ◽  
The Impact

Individuals living with HIV experience a much higher risk of progression from latent M. tuberculosis infection to active tuberculosis (TB) disease relative to individuals with intact immune systems. A several-month daily course of a single drug during latent infection (i.e. isoniazid preventive therapy (IPT)) has proved in clinical trials to substantially reduce an HIV-infected individual's risk of TB disease. As a result of these findings and ongoing studies, the World Health Organization has produced strong guidelines for implementing IPT on a community-wide scale for individuals with HIV at risk of TB disease. To date, there has been limited use of IPT at a community-wide level. In this paper, we present a new co-network model for HIV and TB co-epidemics to address questions about how the population-level impact of community-wide IPT may differ from the individual-level impact of IPT offered to selected individuals. In particular, we examine how the effect of clustering of contacts within high-TB incidence communities may affect the rates of re-infection with TB and how this clustering modifies the expected population-level effects of IPT. We find that populations with clustering of respiratory contacts experience aggregation of TB cases and high numbers of re-infection events. While, encouragingly, the overall population-level effects of community-wide IPT appear to be sustained regardless of network structure, we find that in populations where these contacts are highly clustered, there is dramatic heterogeneity in the impact of IPT: in some sub-regions of these populations, TB is nearly eliminated, while in others, repeated re-infection almost completely undermines the effect of IPT. Our findings imply that as IPT programmes are brought to scale, we should expect local heterogeneity of effectiveness as a result of the complex patterns of disease transmission within communities.

scholarly journals How robust are the results of one of the first positive trials exploring hydroxychloroquine for treatment of COVID-19?

2020 ◽  
Author(s):  
Ronald Chow ◽  
Sameer Elsayed ◽  
Michael Lock
Keyword(s):  
Antiviral Agents ◽  
World Health ◽  
Rt Pcr ◽  
Open Label ◽  
Study Results ◽  
Minimum Number ◽  
Potential Activity ◽  
Coronavirus Infection ◽  
Open Label Trial ◽  
Health Organization

AbstractAn outbreak of a novel human coronavirus infection emerged in Wuhan, China in December 2019. Two months later, the World Health Organization (WHO) announced SARS-CoV-2 as the name for the new virus and COVID-19 for the associated illness. On March 12, 2020, the WHO officially declared COVID-19 as a pandemic. The scientific community has raced to find effective therapeutic agents against the virus. Gautret et al 2020 is among one of the first purportedly positive trials of hydroxychloroquine for the treatment of COVID-19. However, it is imperative that a thorough analysis and understanding of trial data be undertaken prior to making claims about safety and efficacy. Our group assessed the statistical robustness of the trial using the Fragility Index (FI). The FI provides a numerical quantification of a clinical trial’s conclusions. The index is based on iterative statistical calculations to determine the minimum number of events within a trial that would theoretically need to change from positive to negative in order for the trial’s endpoint to convert from significant to non-significant; the higher the index, the more statistically robust the study results. For the Gautret et al trial, one endpoint had an FI of 1, two had indices of 2, and another had an index of 4. The primary endpoint of viral clearance on day 6 had an FI of 4. This indicates that if 4 events were to change from positive to negative, the conclusion of the trial would become mathematically non-significant. This index is comparable to many other published trials of established agents; the median FI across the reported literature appears to be 2. In conclusion, the trial results reported by Gautret et al are statistically robust, assuming that data quality is not compromised; however, the study was an open-label trial with non-homogenous groups, with analysis conducted per-protocol. Additionally, SARS-CoV-2 Reverse Transcriptase-PCR (RT-PCR) testing was not conducted in a systematic way amongst the two groups. Further analyses of this trial and future trials of antiviral agents with potential activity against SARS-CoV-2 should be performed with complementary epidemiologic and statistical techniques to determine whether the trial’s results are clinically important and/or should be explored in depth. Given the statistically robust results reported by Gautret et al, despite the study’s inherent methodological and analytical flaws, hydroxychloroquine should be studied as a potential agent against COVID-19 in larger clinical trials.

scholarly journals Determinants of HIV-1 Late Presentation in Patients Followed in Europe

Pathogens ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 835
Author(s):  
Mafalda N. S. Miranda ◽  
Marta Pingarilho ◽  
Victor Pimentel ◽  
Maria do Rosário O. Martins ◽  
Anne-Mieke Vandamme ◽  
...  
Keyword(s):  
Late Presentation ◽  
World Health ◽  
Prevention Measures ◽  
Demographic Information ◽  
Late Presenters ◽  
Major Threat ◽  
Immunodeficiency Virus ◽  
Mode Of Transmission ◽  
Health Organization ◽  
Hiv 1

To control the Human Immunodeficiency Virus (HIV) pandemic, the World Health Organization (WHO) set the 90-90-90 target to be reached by 2020. One major threat to those goals is late presentation, which is defined as an individual presenting a TCD4+ count lower than 350 cells/mm3 or an AIDS-defining event. The present study aims to identify determinants of late presentation in Europe based on the EuResist database with HIV-1 infected patients followed-up between 1981 and 2019. Our study includes clinical and socio-demographic information from 89851 HIV-1 infected patients. Statistical analysis was performed using RStudio and SPSS and a Bayesian network was constructed with the WEKA software to analyze the association between all variables. Among 89,851 HIV-1 infected patients included in the analysis, the median age was 33 (IQR: 27.0–41.0) years and 74.4% were males. Of those, 28,889 patients (50.4%) were late presenters. Older patients (>56), heterosexuals, patients originated from Africa and patients presenting with log VL >4.1 had a higher probability of being late presenters (p < 0.001). Bayesian networks indicated VL, mode of transmission, age and recentness of infection as variables that were directly associated with LP. This study highlights the major determinants associated with late presentation in Europe. This study helps to direct prevention measures for this population.

scholarly journals Pulmonary tuberculosis screening in anti-retroviral treated adults living with HIV in Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jill K. Gersh ◽  
Ruanne V. Barnabas ◽  
Daniel Matemo ◽  
John Kinuthia ◽  
Zachary Feldman ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Preventive Therapy ◽  
World Health ◽  
People Living With Hiv ◽  
Tuberculosis Screening ◽  
Hiv Positive Adults ◽  
Health Organization ◽  
A Prospective Study ◽  
Living With Hiv ◽  
Tuberculosis Prevalence

Abstract Background People living with HIV (PLHIV) who reside in high tuberculosis burden settings remain at risk for tuberculosis disease despite treatment with anti-retroviral therapy and isoniazid preventive therapy (IPT). The performance of the World Health Organization (WHO) symptom screen for tuberculosis in PLHIV receiving anti-retroviral therapy is sub-optimal and alternative screening strategies are needed. Methods We enrolled HIV-positive adults into a prospective study in western Kenya. Individuals who were IPT-naïve or had completed IPT > 6 months prior to enrollment were eligible. We evaluated tuberculosis prevalence overall and by IPT status. We assessed the accuracy of the WHO symptom screen, GeneXpert MTB/RIF (Xpert), and candidate biomarkers including C-reactive protein (CRP), hemoglobin, erythrocyte sedimentation rate (ESR), and monocyte-to-lymphocyte ratio for identifying pulmonary tuberculosis. Some participants were evaluated at 6 months post-enrollment for tuberculosis. Results The study included 383 PLHIV, of whom > 99% were on antiretrovirals and 88% had received IPT, completed a median of 1.1 years (IQR 0.8–1.55) prior to enrollment. The prevalence of pulmonary tuberculosis at enrollment was 1.3% (n = 5, 95% CI 0.4–3.0%): 4.3% (0.5–14.5%) among IPT-naïve and 0.9% (0.2–2.6%) among IPT-treated participants. The sensitivity of the WHO symptom screen was 0% (0–52%) and specificity 87% (83–90%). Xpert and candidate biomarkers had poor to moderate sensitivity; the most accurate biomarker was CRP ≥ 3.3 mg/L (sensitivity 80% (28–100) and specificity 72% (67–77)). Six months after enrollment, the incidence rate of pulmonary tuberculosis following IPT completion was 0.84 per 100 person-years (95% CI, 0.31–2.23). Conclusions In Kenyan PLHIV treated with IPT, tuberculosis prevalence was low at a median of 1.4 years after IPT completion. WHO symptoms screening, Xpert, and candidate biomarkers were insensitive for identifying pulmonary tuberculosis in antiretroviral-treated PLHIV.

Healthcare Management During a Pandemic: The Other Side of the Coin for the Treatment of Covid-19 Infection

2021 ◽  
Vol 21 ◽  
Author(s):  
Danila De Vito ◽  
Antonio Fusco ◽  
Caterina Benincasa ◽  
Luca Laghi ◽  
Francesco M. Ceruso
Keyword(s):  
Healthcare Systems ◽  
Healthcare Management ◽  
World Health ◽  
Industrialized Countries ◽  
Negative Effects ◽  
Positive Effects ◽  
Worldwide Population ◽  
Related Risk ◽  
The Social ◽  
Health Organization

Background: World Health Organization (WHO) has increasingly improved the guidelines to tackle the spread of Coronavirus Disease 2019 (COVID-19) among the worldwide population. In this context, each country has introduced specific social, healthcare, political and macroeconomic measures to face COVID pandemic locally. Objective: The general aim of this comparative overview is to highlight the most significant effects of COVID-19 pandemic on the main healthcare systems. Also, we critically analyzed the macroeconomic variables and the most promising solutions to improve both healthcare system and its related risk management, taking into specific consideration the most industrialized countries. Method: The main strategy has been built on a renewed concept of the hospital, rebuilding the old concepts of “triage” and “intensive care”. Recently, COVID-19 hospitals have allowed to cater the patients affected by COVID-19. Moreover, the reshaping of several healthcare policies and requirements has led to several positive effects, such as the recruitment of a huge number of human resources in the healthcare systems. Nevertheless, several negative effects have also impacted the communities mostly subjected to infections. Conclusion: Undoubtedly, the national healthcare systems have somehow addressed the people’s needs, trying not to neglect the social, healthcare, economic and political aspects. In our overview, we have reported how the different actions taken in the last months, have resulted in different outcomes.

scholarly journals Analysis of Separability of COVID-19 and Pneumonia in Chest X-ray Images by Means of Convolutional Neural Networks

Proceedings ◽  
2020 ◽  
Vol 54 (1) ◽  
pp. 31
Author(s):  
Joaquim de Moura ◽  
Lucía Ramos ◽  
Plácido L. Vidal ◽  
Jorge Novo ◽  
Marcos Ortega
Keyword(s):  
Neural Networks ◽  
Convolutional Neural Networks ◽  
Clinical Symptoms ◽  
Early Stage ◽  
World Health ◽  
Complete Analysis ◽  
Screening Process ◽  
X Ray ◽  
Chest X Ray ◽  
Health Organization

The new coronavirus (COVID-19) is a disease that is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On 11 March 2020, the coronavirus outbreak has been labelled a global pandemic by the World Health Organization. In this context, chest X-ray imaging has become a remarkably powerful tool for the identification of patients with COVID-19 infections at an early stage when clinical symptoms may be unspecific or sparse. In this work, we propose a complete analysis of separability of COVID-19 and pneumonia in chest X-ray images by means of Convolutional Neural Networks. Satisfactory results were obtained that demonstrated the suitability of the proposed system, improving the efficiency of the medical screening process in the healthcare systems.

Sign in / Sign up

Export Citation Format

Share Document