Clinical Characteristics, Diagnosis, Treatment, and Mortality Rate of TB/COVID-19 Coinfectetd Patients: A Systematic Review

Introduction: Novel coronavirus (COVID-19) and tuberculosis (TB) are the newest and one of the oldest global threats, respectively. In the COVID-19 era, due to the health system's focus on the COVID-19 epidemic, the national TB control program received less attention, leading to a worsening of the global TB epidemic. In this study, we will review the characteristics of TB patients coinfected with COVID-19.Material and Methods: Using Scopus, PubMed/Medline, Embase, and Web of Science databases, a systematic search was performed. Case reports and case series on TB/COVID-19 coinfection published from January 1, 2019 to February 24, 2021 were collected. There were no limitations regarding publication language.Results: Eleven case series and 20 case reports were identified from 18 countries, with the majority them being from India (N = 6) and China (N = 4). Overall, 146 patients (114 men and 32 women) coinfected with TB and COVID-19 enrolled. Smoking (15.1%), diabetes (14.4%), and hypertension (8.9%) were the most frequent comorbidities among these patients. The COVID-19 patients with TB mainly suffered fever (78.8%), cough (63.7%), and respiratory distress (22.6%). Hydroxychloroquine (64.0%) and lopinavir/ritonavir (39.5%) were the most common treatments for them. The mortality rate was 13.0% and the rate of discharged patients was 87.0%.Conclusion: Global prevalence of COVID-19-related deaths is 6.6%. Our results showed that 13.0% of patients with TB/COVID-19 died. Thus, this study indicated that coinfection of TB and COVID-19 can increase the mortality. The respiratory symptoms of TB and COVID-19 are very similar, and this causes them to be misdiagnosed. In addition, TB is sometimes diagnosed later than COVID-19 and the severity of the disease worsens, especially in patients with underlying conditions. Therefore, patients with TB should be screened regularly in the COVID-19 era to prevent the spread of the TB/COVID-19 coinfection.

Drug resistance in tuberculosis- resurvey in Wardha district, India after implementation of revised national TB control program

Level of drug resistance among new TB patients indicates the efficacy of any control programme. A drug resistance survey, as a part of global study in new pulmonary tuberculosis (NPTB) patients, was conducted in Wardha district, India under WHO /IUTLD in 2001, before the implementation of the Revised National Tuberculosis Control Programme (RNTCP) which was implemented in the district in 2002. The present study was conducted in Wardha district in 2014-2015, thirteen years after the implementation of RNTCP, and the drug resistance in isolates from NPTB patients was compared to the results of 2001 survey. The methodology used was same in both the surveys. : In addition to 132 isolates from Wardha, the study also included 112 isolates from adjoining city, Nagpur and total of 244 sputum isolates were subjected to drug sensitivity by standard 1% proportion method on Lowenstein Jensen’s medium. In addition molecular typing of resistant strains was done.: In Wardha, compared to 2001 survey, overall susceptibility to first line drugs washigher (94.7% vs 80.2%); and resistance to streptomycin (3% vs 7.6%) and isoniazid (2.2% vs 15.2%) were significantly lower (p≤ 0.05). MDR was 0.75% against 0.50% in the earlier study but the difference was statistically not significant. Only two MDR isolate were recovered, of which only one was from Wardha.After the implementation of RNTCP in Wardha District, drug resistancein new PTB patients has shown a decline and MDR continues to be low reflecting upon the efficiency of the program.

Are neighbourhoods of tuberculosis cases a high-risk population for active intervention? A protocol for tuberculosis active case finding

Background Indonesia has the second largest tuberculosis (TB) burden globally. Attempts to scale-up TB control efforts have focused on TB households. However, in most high burden settings, considerable Mycobacterium tuberculosis (Mtb) transmission occurs outside TB households. A better understanding of transmission dynamics in an urban setting in Indonesia will be crucial for the TB Control Program in scaling up efforts towards elimination of TB in a more targeted way. Therefore, the study aims to measure TB prevalence and incidence in household contacts and neighbourhoods in the vicinity of known TB cases and to assess their genomic and epidemiological relatedness. Methods and analysis Individuals (~1000) living in the same household as a case diagnosed with pulmonary TB (n = 250) or in a neighbouring household (~4500 individuals) will be screened for TB symptoms and by chest x-ray. Two sputum samples will be collected for microbiological analysis from anyone with a productive cough. Any person found to have TB will be treated by the National TB Control Program. All those with no evidence of TB disease will have a repeat screen at 12 months. Whole-genome sequencing (WGS) and social network analysis (SNA) will be conducted on Index cases and contacts diagnosed with TB.

Evaluasi Pelaksanaan Program TBC MDR di Dinas Kesehatan Provinsi Sumatera Selatan

MDR TB is a man-made phenomenon that occurs as a result of inadequate treatment of TB patients as well as direct transmission from MDR TB patients. The existence of cases that have not been detected and managed by the MDR TB control program makes this a new challenge in overcoming it. The purpose of this study was to determine how the implementation of the MDR TB control program in South Sumatra using theevaluation model Context, Input, Process, Product (CIPP). This study uses descriptive qualitative research methods, by conducting in- depth interviews. From the results of the research on the Context Evaluation which consisted of the background, objectives and program opportunities in accordance with the Tuberculosis technical rules and guidelines (Permenkes No. 67/2016). In the evaluation of the input of the provision of human resources, program managers, funds and infrastructure are in accordance with the needs of the program in both the province and district / city. In the evaluation process for MDR TB program planning, it has been carried out by involving cross-sector and cross-program and other related agencies, the program target is clear, but there are obstacles to Human Resources at first-level and advanced level health facilities. In the Product Evaluation, the detection and treatment rates for MDR TB cases (obtained, Enrollment rate) werenamely in 2017: 46%, 2018: 36%, 2019: 41%. In general, the implementation of the MDR TB Control Program in South Sumatra Province from context, input, process, has been going well but still needs improvement / improvement, to be able to produce products as expected by Permenkes Number 67 of 2016.

Identification of TB space-time clusters and hotspots in Ouest département, Haiti, 2011–2016

BACKGROUND: Haiti has the highest incidence rate of TB in the Western Hemisphere, with an estimated 170 cases per 100,000 in 2019. Since 2010, control efforts have focused on targeted case-finding activities in urban areas, implementation of rapid molecular diagnostics at high-volume TB centers, and improved reporting. TB analyses are rarely focused on lower geographic units; thus, the major goal was to determine if there were focal areas of TB transmission from 2011 to 2016 at operational geographic levels useful for the National TB Control Program (PNLT).METHODS: We created a geocoder to locate TB cases at the smallest geographic level. Kulldorff’s space-time permutation scan, Anselin Moran’s I, and Getis-Ord Gi* statistics were used to determine the spatial distribution and clusters of TB.RESULTS: With 91% of cases linked using the geocoder, TB clusters were identified each year. Getis-Ord Gi* analysis revealed 14 distinct spatial clusters of high incidences in the Port-au-Prince metropolitan area. One hundred retrospective space-time clusters were detected.CONCLUSION: Our study confirms the presence of TB hotspots in the Ouest département, with most clusters in the Port-au-Prince metropolitan area. Results will help the PNLT and its partners better design case-finding strategies for these areas.

Analysis of Diagnosis Delay on Lung Tuberculosis Patient in Porong Primary Health Care, East Java, Indonesia

Introduction: The duration of diagnosis delay in tuberculosis (TB) control strategy is one of the problems in TB control program. There are a lot of adverse effects, such as increasing the risk of people to become more prone to TB transmission, infectivity period, and worsening the patient’s condition that can furthermore increase the mortality and morbidity numbers. This study aimed to analyze the delay behavior in the society, specifically in Porong, East Java. Methods: The respondents filled a questionnaire, the answer was crosschecked and complemented with the medical record on the clinic. The data collected then were analyzed with binary logistic regression using SPSS.Results: From the total of 22 samples in this study, 11 of them were classified to be delayed (patients checked their symptoms 2 weeks after the symptoms started to appear). Some factors that might have an effect on the patient’s delay were education level, the patient’s knowledge about TB, and occupation that lead to the patient’s business. Meanwhile, factors like age, gender, and the distance between the patient’s house and the health facility might have an insignificant effect.Conclusion: Duration of patient delay contributed significantly to the duration of diagnosis delay, with the median duration of 29 days. Meanwhile, the duration of system delay that was found only ranging at 0-3 days. In this study, however, evidence of the independent factors might have an effect on the patient’s tendencies to delay treatment that had not yet proven by statistical analysis.

Factors associated with unfavorable treatment outcomes in patients with rifampicin-resistant tuberculosis in Colombia 2013–2015: A retrospective cohort study

Background Multidrug- and rifampicin (RMP)-resistant tuberculosis (MDR/RR-TB) requires prolonged and expensive treatment, which is difficult to sustain in the Colombian health system. This requires the joint action of different providers to provide timely health services to people with TB. Identifying factors associated with unfavorable treatment outcomes in patients with MDR/RR-TB who received drug therapy between 2013 and 2015 in Colombia can help guide the strengthening of the national TB control program. Method A retrospective cohort study was conducted with all patients who received treatment for MDR/RR-TB between January 2013 and December 2015 in Colombia who were registered and followed up by the national TB control program. A multivariate logistic regression model was used to estimate the associations between the exposure variables with the response variable (treatment outcome). Results A total of 511 patients with MDR/RR-TB were registered and followed up by the national TB control program in Colombia, of whom 16 (3.1%) had extensive drug resistance, 364 (71.2%) had multidrug resistance, and 131 (25.6%) had RMP monoresistance. The mean age was 39.9 years (95% confidence interval (CI): 38.5–41.3), most patients were male 285 (64.6%), and 299 (67.8%) were eligible for subsidized health services. The rate of unfavorable treatment outcomes in the RR-TB cohort was 50.1%, with rates of 85.7% for patients with extensive drug resistance, 47.6% for patients with multidrug resistance, and 52.6% for patients with RMP monoresistance. The 511 MDR/RR-TB patients were included in bivariate and multivariate analyses, patients age ≥ 60 years (crude odds ratio (ORc) = 2.4, 95% CI 1.1–5.8; adjusted odds ratio (ORa) = 2.7, 95% CI 1.1–6.8) and subsidized health regime affiliation (ORc = 3.6, 95% CI 2.3–5.6; ORa = 3.4, 95% CI 2.0–6.0) were associated with unfavorable treatment outcomes. Conclusion More than 50% of the patients with MDR/RR-TB in Colombia experienced unfavorable treatment outcomes. The patients who were eligible for subsidized care were more likely to experience unfavorable treatment outcomes. Those who were older than 60 years were also more likely to experience unfavorable treatment outcomes.

Implementasi Program Penanggulangan TB Paru dengan Strategi Directly Observed Treatment Shortcourse di Puskesmas Panyabungan Jae Kabupaten Mandailing Natal

TB cases in Southeast Asia contribute 40% of the world's TB cases and causes the highest mortality in Indonesia. Panyabungan Jae Health Center (PJHC) itself has the highest number of TB cases in Mandailing Natal Regency. This study, therefore, aimed to determine the implementation of the TB Control Program with the Directly Observed Treatment Shortcourse Strategy (DOTS) at PJHC.Qualitative methods with descriptive approach was used for this research. In-depth interviews was conducted with 5 informants in July 2020. The data were analyzed using data reduction, data presentation, and conclusion drawing.The research found that communication between the TB program officer and the DOTS strategy worked well in the PJHC as well as the disposition, resources and bureaucratic structures. Political commitment in the DOTS strategy with cross-sectoral cooperation has an important influence in the handling of TB cases,however village authorities have not played a role in efforts to reduce for number of TB cases. The patients had lack of understanding about TB and some localshad views TB as a disease caused by poison becomes an obstacle in treating patients. TB prevention with the DOTS strategy at the PJHC runs according to standard guidelines, and complemented by the Puskesmas innovation "Tor Tor Libas TB".The MNDHO officersare advised to collaborate with entire stakeholders in overcoming TB by strengthening education in the form of routine counseling to increase public knowledge about TB

The Role of the Tuberculosis (TB) Community in Detecting TB Suspects in Probolinggo Regency, East Java

Indonesia Indonesia is in the third rank of countries with the highest tuberculosis (TB) globally, with TB case detection still below 70%. The strategy in the TB control program to increase TB case detection is community partnership through the TB community. However, the role of this community in detecting TB suspects has never been reported. This study aimed to determine the role of the TB community in detecting TB suspects in the Probolinggo Regency. This research is descriptive qualitative research. The population was all TB community members is 130 people. The sample was a purposive sampling method, consideration until it met the data saturation, namely 29 respondents. The data were collected employing interviewed sheets, then analyzed with thematic content. Data triangulation by Head of Infectious Diseases, the Probolinggo Regency Health and five people from each TB community at Puskesmas. From the interviews, it was found that 23 people (79%) could not invite TB suspects to undergo examination, and 25 people (86%) had conducted counselling but were still unable to explain and convince the community of the importance of medical examinations for TB suspects. It is necessary to increase the capacity of TB community members to improve their roles in detecting TB cases.

Barriers and Facilitators to Implement E-learning in Continuing Medical Education: Evidence From the China-gates Foundation Tuberculosis (TB) Control Program

[Objective] To evaluate the implementation of E-learning continuing medical education (CME) programs, analyse the barriers and facilitators during the implementation process, and provide policy recommendations based on the evidence from the China-Gates Foundation TB Control Program. [Methods] Routine monitoring data were collected through the project office. In-depth interviews, focus group discussion with project management personnel, teachers, and trainees (N=78), and staff survey (baseline N=555, final N=757) were conducted in selected pilot areas at the provincial, municipal, and county/district levels in the three project provinces (Zhejiang, Jilin, and Ningxia). [Results] By the end of June 2019, the national and provincial remote training platforms had organized 98 synchronous learning activities, with an average of 173.2 people (standard deviation, SD=49.8) per online training session, 163.3 people (SD=41.2) per online case discussion. In the pilot area, 64.5% of TB health workforce registered the asynchronous learning platform, and 50.1% obtained their professional certifications. Participants agreed that E-learning CME was more economical, has better content as well as more flexible work schedules. However, the project still faced challenges in terms of unmet learning needs, disorganized governance, insufficient hardware and software, unsupported environment, and lack of incentive mechanisms. [Conclusions] Our results suggested that it’s feasible to conduct large scale E-learning continuing medical education activities in the three project provinces of China. Training content and format are key facilitators of the program implementation, while the matching the supply/demand of training, organizational coordination, internet technology, motivations, and sustainability are key barriers.