scholarly journals Uncovering reasons for treatment initiation delays among children with TB in Lima, Peru

2020 ◽  
Vol 24 (12) ◽  
pp. 1254-1260
Author(s):  
J. Coit ◽  
M. Wong ◽  
J. T. Galea ◽  
M. Mendoza ◽  
H. Marin ◽  
...  
Keyword(s):  
Treatment Initiation ◽  
Complex Interventions ◽  
Diagnostic Tools ◽  
Diagnostic Study ◽  
Burden Of Care ◽  
Structured Interviews ◽  
Tb Treatment ◽  
Pediatric Tb ◽  
Field Workers ◽  
Pediatric Tuberculosis

BACKGROUND: Timely diagnosis and treatment of pediatric tuberculosis (TB) is critical to reducing mortality but remains challenging in the absence of adequate diagnostic tools. Even once a TB diagnosis is made, delays in treatment initiation are common, but for reasons that are not well understood.METHODS: To examine reasons for delay post-diagnosis, we conducted semi-structured interviews with Ministry of Health (MoH) physicians and field workers affiliated with a pediatric TB diagnostic study, and caregivers of children aged 0–14 years who were diagnosed with pulmonary TB in Lima, Peru. Interviews were analyzed using systematic comparative and descriptive content analysis.RESULTS: We interviewed five physicians, five field workers and 26 caregivers with children who initiated TB treatment < 7 days after diagnosis (n = 15) or who experienced a delay of ≥7 days (n = 11). Median time in delay from diagnosis to treatment initiation was 26 days (range 7–117). Reasons for delay included: health systems challenges (administrative hurdles, medication stock, clinic hours), burden of care on families and caregiver perceptions of disease severity.CONCLUSION: Reasons for delay in treatment initiation are complex. Interventions to streamline administrative processes and tools to identify and support families at risk for delays in treatment initiation are urgently needed.

scholarly journals Discovery and Validation of a Three-Cytokine Plasma Signature as a Biomarker for Diagnosis of Pediatric Tuberculosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Nathella Pavan Kumar ◽  
Syed Hissar ◽  
Kannan Thiruvengadam ◽  
Velayuthum V. Banurekha ◽  
N. Suresh ◽  
...  
Keyword(s):  
Plasma Levels ◽  
Validation Cohort ◽  
Diagnostic Study ◽  
Operating Characteristics ◽  
Discovery Cohort ◽  
Roc Curve Analysis ◽  
Immune Biomarkers ◽  
Cytokine Plasma ◽  
Pediatric Tb ◽  
Pediatric Tuberculosis

Pediatric TB poses challenge in diagnosis due to the paucibacillary nature of the disease. We conducted a prospective diagnostic study to identify immune biomarkers of pediatric TB and controls (discovery cohort) and obtained a separate “validation” cohort of confirmed cases of pediatric TB and controls. Multiplex ELISA was performed to examine the plasma levels of cytokines. Discovery and validation cohorts revealed that baseline plasma levels of IFNγ, TNFα, IL-2, and IL-17A were significantly higher in active TB (confirmed TB and unconfirmed TB) in comparison to unlikely TB children. Receiver operating characteristics (ROC) curve analysis revealed that IFNγ, IL-2, TNFα, and IL-17A (in the discovery cohort) and TNFα and IL-17A (in the validation cohort) could act as biomarkers distinguishing confirmed or unconfirmed TB from unlikely TB with the sensitivity and specificity of more than 90%. In the discovery cohort, cytokines levels were significantly diminished following anti-tuberculosis treatment. In both the cohorts, combiROC models offered 100% sensitivity and 98% to 100% specificity for a three-cytokine signature of TNFα, IL-2, and IL-17A, which can distinguish confirmed or unconfirmed TB children from unlikely TB. Thus, a baseline cytokine signature of TNFα, IL-2, and IL-17A could serve as an accurate biomarker for the diagnosis of pediatric tuberculosis.

scholarly journals The Kynurenine/Tryptophan Ratio Is a Sensitive Biomarker for the Diagnosis of Pediatric Tuberculosis Among Indian Children

2022 ◽  
Vol 12 ◽  
Author(s):  
Jeffrey A. Tornheim ◽  
Mandar Paradkar ◽  
Henry Zhao ◽  
Vandana Kulkarni ◽  
Neeta Pradhan ◽  
...  
Keyword(s):  
Treatment Response ◽  
Characteristic Curve ◽  
Receiver Operator Characteristic Curve ◽  
Group Differences ◽  
Indian Children ◽  
Tb Treatment ◽  
Potential Biomarker ◽  
Pediatric Tb ◽  
Metabolome Profiling ◽  
Pediatric Tuberculosis

ObjectivesPediatric tuberculosis (TB) remains difficult to diagnose. The plasma kynurenine to tryptophan ratio (K/T ratio) is a potential biomarker for TB diagnosis and treatment response but has not been assessed in children.MethodsWe performed a targeted diagnostic accuracy analysis of four biomarkers: kynurenine abundance, tryptophan abundance, the K/T ratio, and IDO-1 gene expression. Data were obtained from transcriptome and metabolome profiling of children with confirmed tuberculosis and age- and sex-matched uninfected household contacts of pulmonary tuberculosis patients. Each biomarker was assessed as a baseline diagnostic and in response to successful TB treatment.ResultsDespite non-significant between-group differences in unbiased analysis, the K/T ratio achieved an area under the receiver operator characteristic curve (AUC) of 0.667 and 81.5% sensitivity for TB diagnosis. Kynurenine, tryptophan, and IDO-1 demonstrated diagnostic AUCs of 0.667, 0.602, and 0.463, respectively. None of these biomarkers demonstrated high AUCs for treatment response. The AUC of the K/T ratio was lower than biomarkers identified in unbiased analysis, but improved sensitivity over existing commercial assays for pediatric TB diagnosis.ConclusionsPlasma kynurenine and the K/T ratio may be useful biomarkers for pediatric TB. Ongoing studies in geographically diverse populations will determine optimal use of these biomarkers worldwide.

Developing National Genotype-Independent Indicators for Recent Mycobacterium Tuberculosis Transmission Using Pediatric Cases—United States, 2011-2017

2021 ◽  
pp. 003335492098521
Author(s):  
Alexia V. Harrist ◽  
Clinton J. McDaniel ◽  
Jonathan M. Wortham ◽  
Sandy P. Althomsons
Keyword(s):  
United States ◽  
Mycobacterium Tuberculosis ◽  
Statistical Model ◽  
Moving Average ◽  
The United States ◽  
Tuberculosis Transmission ◽  
Average Proportion ◽  
Pediatric Tb ◽  
Case Rate ◽  
Pediatric Tuberculosis

Introduction Pediatric tuberculosis (TB) cases are sentinel events for Mycobacterium tuberculosis transmission in communities because children, by definition, must have been infected relatively recently. However, these events are not consistently identified by genotype-dependent surveillance alerting methods because many pediatric TB cases are not culture-positive, a prerequisite for genotyping. Methods We developed 3 potential indicators of ongoing TB transmission based on identifying counties in the United States with relatively high pediatric (aged <15 years) TB incidence: (1) a case proportion indicator: an above-average proportion of pediatric TB cases among all TB cases; (2) a case rate indicator: an above-average pediatric TB case rate; and (3) a statistical model indicator: a statistical model based on a significant increase in pediatric TB cases from the previous 8-quarter moving average. Results Of the 249 US counties reporting ≥2 pediatric TB cases during 2009-2017, 240 and 249 counties were identified by the case proportion and case rate indicators, respectively. The statistical model indicator identified 40 counties with a significant increase in the number of pediatric TB cases. We compared results from the 3 indicators with an independently generated list of 91 likely transmission events involving ≥2 pediatric cases (ie, known TB outbreaks or case clusters with reported epidemiologic links). All counties with likely transmission events involving multiple pediatric cases were identified by ≥1 indicator; 23 were identified by all 3 indicators. Practice Implications This retrospective analysis demonstrates the feasibility of using routine TB surveillance data to identify counties where ongoing TB transmission might be occurring, even in the absence of available genotyping data.

scholarly journals Breath can discriminate tuberculosis from other lower respiratory illness in children

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Carly A. Bobak ◽  
Lili Kang ◽  
Lesley Workman ◽  
Lindy Bateman ◽  
Mohammad S. Khan ◽  
...  
Keyword(s):  
Machine Learning ◽  
Lower Respiratory Tract ◽  
Cross Validation ◽  
Pediatric Patients ◽  
Respiratory Illness ◽  
Health Crisis ◽  
Machine Learning Model ◽  
Childhood Tb ◽  
Pediatric Tb ◽  
Pediatric Tuberculosis

AbstractPediatric tuberculosis (TB) remains a global health crisis. Despite progress, pediatric patients remain difficult to diagnose, with approximately half of all childhood TB patients lacking bacterial confirmation. In this pilot study (n = 31), we identify a 4-compound breathprint and subsequent machine learning model that accurately classifies children with confirmed TB (n = 10) from children with another lower respiratory tract infection (LRTI) (n = 10) with a sensitivity of 80% and specificity of 100% observed across cross validation folds. Importantly, we demonstrate that the breathprint identified an additional nine of eleven patients who had unconfirmed clinical TB and whose symptoms improved while treated for TB. While more work is necessary to validate the utility of using patient breath to diagnose pediatric TB, it shows promise as a triage instrument or paired as part of an aggregate diagnostic scheme.

scholarly journals Protocol for the Process Evaluation of a Complex, Statewide Intervention to Reduce Salt Intake in Victoria, Australia

Nutrients ◽  
2018 ◽  
Vol 10 (8) ◽  
pp. 998 ◽  
Author(s):  
Kathy Trieu ◽  
Stephen Jan ◽  
Mark Woodward ◽  
Carley Grimes ◽  
Bruce Bolam ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Complex Disease ◽  
Salt Intake ◽  
Complex Interventions ◽  
Reduction Process ◽  
Population Based ◽  
Structured Interviews ◽  
Salt Reduction ◽  
Campaign Evaluation ◽  
Reduced Salt

Systematic reviews of trials consistently demonstrate that reducing salt intake lowers blood pressure. However, there is limited evidence on how interventions function in the real world to achieve sustained population-wide salt reduction. Process evaluations are crucial for understanding how and why an intervention resulted in its observed effect in that setting, particularly for complex interventions. This project presents the detailed protocol for a process evaluation of a statewide strategy to lower salt intake in Victoria, Australia. We describe the pragmatic methods used to collect and analyse data on six process evaluation dimensions: reach, dose or adoption, fidelity, effectiveness, context and cost, informed by Linnan and Steckler’s framework and RE-AIM. Data collection methods include routinely collected administrative data; surveys of processed foods, the population, food industry and organizations; targeted campaign evaluation and semi-structured interviews. Quantitative and qualitative data will be triangulated to provide validation or context for one another. This process evaluation will contribute new knowledge about what components of the intervention are important to salt reduction strategies and how the interventions cause reduced salt intake, to inform the transferability of the program to other Australian states and territories. This protocol can be adapted for other population-based, complex, disease prevention interventions.

scholarly journals Tuberculosis stigma and perceptions in the US-Mexico border

2013 ◽  
Vol 55 (Supl.4) ◽  
pp. 498 ◽  
Author(s):  
Eva M Moya ◽  
Mark W Lusk
Keyword(s):  
Health Care Access ◽  
El Paso ◽  
Structured Interviews ◽  
Care Access ◽  
Tb Treatment ◽  
Related Stigma ◽  
Health Related ◽  
Mexico Border ◽  
Fear Of Rejection ◽  
The Impact

Objective. To examine the experiences and perspectives on the disease and stigma from the vantage point of the persons affected by TB in El Paso, Texas, and Juárez, México to inform research on health-related stigma and interventions. Materials and methods. Semi-structured interviews to study TB-related stigma and the impact on access and healthseeking behaviors with 30 Mexican-origin adults (18 years and older) undergoing TB treatment. Results. Barriers to accessing health services for TB; emotional distress due to their deteriorated physical and emotional condition; reactions ranging from depression, sadness; doubt, anger, and fear of rejection; distancing, fear of contagion, stigma, and feeling of discriminated against, and isolation from loved ones were reported. Conclusion. Stigma associated with TB is a barrier to health care access and to quality of life in tuberculosis management. Stigma adversely shapes the experience of treatment and recovery. Stigma is not a naturally occurring phenomenon, but something created by people and as such it can be “un-done” by those people as part of a collective which comprises society.

Impact of a dementia-specific program of equine-assisted activities: providers’ perspectives

2019 ◽  
Vol 20 (2) ◽  
pp. 37-47
Author(s):  
Beth Fields ◽  
Wendy Wood ◽  
Rebecca Lassell
Keyword(s):  
Service Providers ◽  
Institutional Care ◽  
Complex Interventions ◽  
Well Being ◽  
Scientific Development ◽  
Structured Interviews ◽  
Content Type ◽  
People With Dementia ◽  
Person With Dementia ◽  
Equine Assisted

Purpose Establishing acceptability of complex interventions to stakeholders is vital in early scientific development. The purpose of this paper is to ascertain the acceptability of a program of equine-assisted activities (EAAP) for people with dementia by elucidating programmatic practices needed to enhance their safety and quality of life (QoL) from the perspectives of service providers. Design/methodology/approach Semi-structured interviews with five providers were analyzed using a basic qualitative approach. Findings Providers perceived the EAAP as acceptable and revealed potential mechanisms of change supporting well-being, including aspects related to the physical and social environment and person with dementia. Linkages identified among the EAAP and its physical and social context support its complexity. Providers explicated program practices that promoted safety and QoL, such as implementing staff trainings and tailoring activities to each person’s preferences and needs. These practices aligned with best dementia care approaches, underscoring that the EAAP is a promising complex intervention that merits further scientific development. Originality/value This work is novel and adds to the literature by illuminating the role of a community-based, animal-assisted program for enhancing the QoL of older adults with dementia residing in institutional care facilities.

scholarly journals Qualitative evaluation of a preventive intervention for the offspring of parents with a history of depression

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Nathalie Claus ◽  
Lisa Marzano ◽  
Johanna Loechner ◽  
Kornelija Starman ◽  
Alessandra Voggt ◽  
...  
Keyword(s):  
Preventive Intervention ◽  
Controlled Trial ◽  
Complex Interventions ◽  
Qualitative Evaluation ◽  
Behavioural Intervention ◽  
Structured Interviews ◽  
Cognitive Behavioural ◽  
Family Based ◽  
Randomised Controlled ◽  
Meta Analyses

Abstract Background Meta-analyses of randomised controlled trials suggest that psychological interventions to reduce children’s risk of depression are effective. Nevertheless, these effects are modest and diminish over time. The Medical Research Council recommends a mixed-methods approach to the evaluation of complex interventions. By gaining a more thorough understanding of participants’ perspectives, qualitative evaluations of preventive interventions could improve their efficacy, longevity and transfer into clinical practice. Methods 18 parents and 22 children who had received a 12-session family- and group-based cognitive-behavioural intervention to prevent youth depression as part of a randomised controlled trial took part in semi-structured interviews or a focus group about aspects which had been perceived as helpful, elements they were still using after the intervention had ended, and suggestions they had for improving the intervention. Results The chance to openly share and discuss their experiences of depression within and between families was considered helpful by both children and parents. Children benefitted the most from learning coping strategies for dealing with stress and many still used them in everyday life. Parents profited mostly from increasing positive family time, but noted that maintaining new routines after the end of the intervention proved difficult. Participants were generally content with the intervention but commented on how tiring and time consuming it was. Conclusions Managing parents’ expectations of family-based interventions in terms of their own mental health needs (versus those of their children) and leaving more room for open discussions may result in interventions which are more appealing to participating families. Increasing intervals between sessions may be one means of improving the longevity of interventions. Trial registration The original RCT this evaluation is a part of was registered under NCT02115880.

Immunobiology of Pediatric Tuberculosis: Lessons Learned and Implications for an Improved TB-Vaccine

2017 ◽  
Vol 13 (02) ◽  
pp. 113-121 ◽  
Author(s):  
Mardi Boer ◽  
Deborah Lewinsohn ◽  
Christina Lancioni
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Immune Responses ◽  
Mycobacterial Infection ◽  
Lessons Learned ◽  
Bacillus Calmette Guerin ◽  
Partial Protection ◽  
Young Infants ◽  
Pediatric Tb ◽  
Pediatric Tuberculosis ◽  
Disseminated Disease

AbstractChildren, especially neonates and young infants, are uniquely vulnerable to tuberculosis (TB) and frequently present with primary progressive pulmonary or disseminated disease. There is an urgent need to understand the unique immunobiology of Mycobacterium tuberculosis (Mtb) in young infants and to identify protective infant immune responses. The existing vaccine against TB, Mycobacterium bovis bacillus Calmette–Guérin (M. bovis BCG), provides a partial protection against TB disease and disseminated forms of TB in infants; however, it is unknown how this partial protection is mediated. To end pediatric TB morbidity and mortality, a fully efficacious next-generation TB-vaccine is needed. Here, we focus on our current understanding of TB immunobiology as it pertains to young infants, and we evaluate what BCG-vaccination, as well as recently trialed novel TB-vaccines, has taught us about the immunobiology of mycobacterial infection in this population.

scholarly journals Screening diabetes mellitus patients for pulmonary tuberculosis: a multisite study in Indonesia, Peru, Romania and South Africa

2020 ◽  
Author(s):  
Bachti Alisjahbana ◽  
Susan M McAllister ◽  
Cesar Ugarte-Gil ◽  
Nicolae Mircea Panduru ◽  
Katharina Ronacher ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
South Africa ◽  
Clinical Symptoms ◽  
Economic Status ◽  
World Health ◽  
Diagnostic Tools ◽  
Sputum Smear ◽  
Tb Treatment ◽  
Chest X Ray ◽  
Health Organization

Abstract Background Diabetes mellitus (DM) patients are three times more likely to develop tuberculosis (TB) than the general population. Active TB screening in people with DM is part of a bidirectional approach. The aim of this study was to conduct pragmatic active TB screening among DM patients in four countries to inform policy. Methods DM patients were recruited in Indonesia (n=809), Peru (n=600), Romania (n=603) and South Africa (n=51). TB cases were diagnosed using an algorithm including clinical symptoms and chest X-ray. Presumptive TB patients were examined with sputum smear and culture. Results A total of 171 (8.3%) individuals reported ever having had TB (South Africa, 26%; Indonesia, 12%; Peru, 7%; Romania, 4%), 15 of whom were already on TB treatment. Overall, 14 (0.73% [95% confidence interval 0.40 to 1.23]) TB cases were identified from screening. Poor glucose control, smoking, lower body mass index, education and socio-economic status were associated with newly diagnosed/current TB. Thirteen of the 14 TB cases diagnosed from this screening would have been found using a symptom-based approach. Conclusions These data support the World Health Organization recommendation for routine symptom-based screening for TB in known DM patients in high TB-burden countries. DM patients with any symptoms consistent with TB should be investigated and diagnostic tools should be easily accessible.

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