Tuberculosis prevalence and associated factors among persons with diabetes mellitus after intensified case finding in three West African countries

Background: To determine the prevalence of tuberculosis (TB) and associated factors in persons with diabetes mellitus (DM) in Benin, Guinea and Senegal.Methods: A cross-sectional study was conducted in the largest DM center in each country. Participants systematically underwent clinical screening and chest radiography. Participants who were symptomatic or with abnormal radiography underwent bacteriological investigations (sputum smear, Xpert MTB/RIF and culture) on sputum. Participants with no TB at enrolment were re-examined for TB six months later. Logistic regression was performed to identify factors associated with TB.Results: There were 5870 DM patients: 1881 (32.0%) in Benin, 1912 (32.6%) in Guinea and 2077 (35.4%) in Senegal. Of these, 114 had bacteriologically-confirmed TB, giving a pooled prevalence of 1.9% (95%CI=1.6-2.3). TB prevalence was 0.5% (95%CI=0.3-1.0), 2.4% (95%CI=1.8-3.2) and 2.8% (95%CI=2.2-3.6), respectively, in Benin, Guinea and Senegal. Factors associated with an increased odds of TB diagnosis were a usual residence in Guinea (aOR=2.62;95%CI=1.19-5.77; p=0.016) or in Senegal (aOR=3.73;95%CI=1.85-7.51; p<0.001), the age group of 35-49 years (aOR=2.30;95%CI=1.11-4.79; p=0.025), underweight (aOR=7.34;95%CI=4.65-11.57; p<0.001) and close contact with a TB case (aOR=2.27;95%CI=1.37-3.76; p=0.002). Obesity was associated with lower odds of TB (aOR=0.20; 95%CI=0.06-0.65; p=0.008).Conclusion: TB is prevalent among DM patients in Benin, Guinea and Senegal and higher than among the general population. The findings support the need for intensified case finding in DM patients in order to ensure systematic early detection of TB during the routine consultation process.

Cascade Variabilities in TB Case Finding among People Living with HIV and the Use of IPT: Assessment in Three Levels of Care in Cross River State, Nigeria

TB is the most common cause of morbidity and mortality in people living with HIV/AIDS (PLHIV) as it accelerates the progression of HIV infection. Every PLHIV is at an annual risk of 10% and a lifetime risk of 50% to acquiring TB and TB is responsible for the death of 30-40% PLHIV. We undertook to assess the WHO recommended intensified TB case finding among PLHIVs in three of levels of ART clinics in cross River State, Nigeria. We used quantitative method to review retrospectively collected routine TB and HIV facility data from University of Calabar Teaching hospital, Calabar; Infectious disease Hospital, Calabar and primary Health Centre, Calabar Municipal ART clinics. The study population for intensified case finding and IPT comprised of available records of HIV- positive patients ≥15 years old seen at the selected facilities for clinical care and treatment from January to December 2016 and January to December 2018. A cohort sampling strategy was used to assess the ICF cascade and IPT uptake. Data collection lasted from 15th to 31st November 2019 in the first phase and had extension to February 2020 due to delayed ethical clearance from the University of Calabar Teaching hospital. Quantitative data was analysed using Stata 13.0 to produce descriptive statistics including frequencies and percentages for categorical variables. Of the 326 PLHIVs (115 females) in the records, 311 had their TB screening recorded (95%). 155(50%) were screen positive while 326(210%) were evaluated for TB in the lab, out of which 182 (56%) were TB confirmed. PLHIVs ages 25-29 years were most affected, with more persons being evaluated for TB before the `test and treat` policy. Of the 207 PLHIVs started on IPT, 103 (99%) started before `test and treat` compared to 102(91%) after policy. IPT uptake was highest among ages 25-29 years. This evaluation shows that intensified case finding among PLHIV is feasible and has a high prospect for TB case finding among PLHIVs. However, critical gaps exist- poor documentation and linkages on the clinical and diagnostic arm of the cascade makes it impossible to estimate yield in a cohort and present the situation of weak clinical interphase with people seeking care.

Health Worker Practices, Facilitators and Barriers towards the Intensified Case-Finding Tuberculosis Screening Tool in Uganda

IntroductionAlthough the Tuberculosis (TB) Intensified Case Finding (ICF) tool was introduced in 2011, only 15.7% of the estimated 35 million people living with HIV were screened for TB in 2013. We explored the facilitators, barriers and health care workers’ practices regarding use of the ICF tool in TB screening.MethodsWe conducted a qualitative study in Jinja, eastern Uganda. We purposively sampled eight (4 private and 4 Government) health facilities (HFs) with the guidance of the District TB and Leprosy Supervisor (DTLS). At each health facility, three health care workers (in-charge TB clinic, a TB focal person & one laboratory technician (total: 24 participants in 8 HFs) were interviewed using a key informant interview guide. Data were collected on how TB was screened and diagnosed in general and when using the ICF tool in particular. Data were audio-recorded, transcribed in verbatim, coded and analyzed using a thematic framework.ResultsThe ICF tool was available in all the 8 HFs; however, only half (12/24) the health workers interviewed at these facilities had ever used it for screening TB. The facilitators to ICF use were all levels of health cadres could use it, with simple, close-ended questions and clear, simple instructions. However, several barriers were identified as hindering the use of the ICF tool. The barriers to the use of the ICF tool are segmented according to the Health System building blocks, Leadership and Governance Barriers (concurrent use of other tools, lack of detailed training), Health Workforce Barriers (Lack of awareness of about the tool, perceived increased workload) and Health Information Management System Barriers (Stock-outs of the ICF tools).DiscussionThe ICF tool was found to be simple and easy to use; however, its use remained low due to a variety of perceived barriers by health workers. There is a need to increase the health care workers’ awareness about the ICF tool to improve its utilization in TB screening.

A Yield and Cost Comparison of TB Contact Investigation and Intensified Case Finding in Uganda

ABSTRACTIntroductionResource constraints in LMICs limit TB contact investigation despite evidence its benefits outweigh costs, with increased efficiency when compared with intensified case finding (ICF). However, there is limited data on the yield and cost per TB case identified in low resource-settings. We compared the yield and cost per TB case identified for ICF and TB-CI in Uganda.MethodsA retrospective cohort study based on data from 12 Ugandan hospitals was done between April and September 2017. Two methods of TB case finding (i.e. ICF and TB-CI) were used. Regarding ICF, patients either self-reported their signs and symptoms or were prompted by health care workers, and those suspected to have TB were requested to produce a sputum sample. On the other hand, TB-CI was done by home-visiting and screening contacts of TB patients for TB; with those found with signs and symptoms requested to produce sputum samples for examination. TB yield was defined as the ratio of diagnoses to tests, and this was computed per method of diagnosis. The costs per TB case identified (medical, personnel, transportation and training) for each diagnosis method were computed using the activity-based approach, from the health care perspective. Cost data were analyzed using Windows Excel.Results454 index clients’ cases and 2,707 of their household contacts were investigated. Thirty-one per cent of contacts (840/2707) were found to be presumptive TB cases. A total of 7,685 tests were done, 6,967 for ICF and 718 for TB-CI. ICF had a yield of 18.62% (1297/6967) at a cost of USD $120.60 to diagnose a case of TB while TB-CI had a yield of 5.29% (38/718) at an average cost of USD $ 877.57 to diagnose a case of TB.ConclusionRegarding case-finding, the yield of TB-CI was four-times lower and seven-times costlier compared to ICF. These findings suggest that ICF can improve TB case detection at a low cost, particularly in high TB prevalent settings.