Limitations of conducting community surveys to access the epidemiological impact of TB control programmes on the incidence of TB

Tuberculosis (TB) remains a major health problem in India, and accounts for nearly 20-30% of the global TB burden. A comprehensive review1 in 1993 of the National TB Control Programme (NTP), present in our country for four decades, documented the failure of NTP due to various drawbacks. These included poor management of the TB control programme, over-reliance on X-rays, poor treatment adherence, under-utilization of laboratory services, poor supply of quality drugs, inadequate funding and lack of proper documentation and case reporting. The Revised National Tuberculosis Control Programme (RNTCP), an application of the globally accepted WHO recommended Directly Observed Treatment Short-course (DOTS) strategy, was implemented in 1993 on a pilot basis, rapidly expanded from 1997 and achieved nation-wide coverage in March 2006

Drug resistance in tuberculosis in India

The current global concern in the treatment of tuberculosis (TB) is the emergence of resistance to the two most potent drugs viz., isoniazid and rifampicin. The level of initial drug resistance is an epidemiological indicator to assess the success of the TB control programme. Though drug resistance in TB has frequently been reported from India, most of the available information is localized, sketchy or incomplete. A review of the few authentic reports indicates that there is no clear evidence of an increase in the prevalence of initial resistance over the years. However, a much higher prevalence of acquired resistance has been reported from several regions, though based on smaller numbers of patients. A strong TB control programme and continuous surveillance studies employing standardized methodology and rigorous quality control measures will serve as useful parameters in the evaluation of current treatment policies as well as the management of multidrug resistant (MDR) TB cases

Improving access and quality of care in a TB control programme

Objectives. To use a quality improvement approach to improve access to and quality of tuberculosis (TB) diagnosis and care in Cape Town.Methods. Five HIV/AIDS/sexually transmitted infections/TB (HAST) evaluations were conducted from 2008 to 2010, with interviews with 99 facility managers and a folder review of over 850 client records per evaluation cycle. The data were used in a local quality improvement process: sub-district workshops identified key weaknesses and facility managers drew up action plans. Lessons learnt and successful strategies were shared at quarterly districtwide HIV/TB meetings.Results. Geographical access was good, but there were delays in treatment commencement times. Access for high-risk clients improved significantly with intensified TB case finding made routine in both the HIV counselling and testing and antiretroviral treatment (ART) services (p<0.01 for both). Access for children in contact with an infectious case has improved but is still low (42% investigated and treated). Quality of care was mostly high atbaseline (adherence to treatment protocols 95%). Measurement of body mass index improved from 20% to 62%. The assessment of contraception improved from 27% to 58%. Care for co-infected clients showed improved use of customised HIV stationery and increased assessment for ART eligibility.Conclusions. The HAST audit contributed to the improved TB cure rates by supplementing routine information and involving sub-district managers, facility managers and facility staff in a quality improvement process that identified local opportunities for programme strengthening

Operational research studies in tuberculosis control contributions in the last two decades from Tuberculosis Research Centre, South India

Operational research (OR) provides a scientific and methodical approach that would help to better monitor the TB control programme in addition to routine reporting system in existence. OR should always be closely connected with disease control activities. OR in TB is a public health imperative in this millennium in the wake of multi-drug resistance and HIV in many parts of the world

Mycobacterium tuberculosis genetic diversity and drug resistance conferring mutations in the Democratic Republic of the Congo

Background: The Democratic Republic of the Congo (DRC) belongs to the 22 tuberculosis (TB) high-burden countries and to the 27 high-burden multidrug-resistant (MDR)-TB countries. To date, there are no data on the genetic diversity of Mycobacterium tuberculosis in the DRC.Objective: To describe the genetic diversity and the distribution of drug resistance conferring mutations of clinical M. tuberculosis isolates from the DRC.Design: We analysed consecutive M. tuberculosis single patient isolates cultured in 2010 at the laboratory of the National TB Control Programme in Kinshasa.Setting: National TB Control Programme in Kinshasa, DRC.Results: Isolates from 50 patients with pulmonary TB were analysed, including 45 patients (90%) who failed treatment. All isolates belonged to the Euro-American lineage (main phylogenetic Lineage 4). Six different spoligotype families were observed within this lineage, including LAM (20 patients, 40%), T (15 patients; 30%), U (4 patients; 8%), S (3 patients; 6%), Haarlem (2 patients; 4%), and X (1 patient; 2%). No M. africanum strains were observed. The most frequently detected drug  resistance-conferring mutations were rpoB S531L and katG S315T1. Various other mutations, including previously unreported mutations, were detected.Conclusions: The Euro-American lineage dominates in the DRC, with substantial variation in spoligotype families. This study fills an important gap on the molecular map of M. tuberculosis in sub-Saharan Africa

Trend of Childhood TB Notifications in Nigeria

Background: Childhood tuberculosis (CTB) accounted for 10% of the total global tuberculosis (TB) burden in 2017.  During the same year, CTB accounted for only 6% of the total TB cases notified by the National TB control programme (NTP) in Nigeria giving credence to the widely held belief that, over the past few years, clinicians and public health officials in the country may have given more attention to the diagnosis and treatment of TB in adults compared to children, resulting in under reporting of the true burden of the disease.  Thus this study assessed the trend of childhood TB notifications in Nigeria, from 2012 to 2016.Methods: Retrospective record review of childhood TB cases notified by the NTP between January 1, 2012 and December 31, 2016.  Results: A total of 27,793 CTB cases, representing 5.8% of all forms of TB cases, were notified and treated during the study period. This proportion is more or less similar for every year within the period under review.Conclusion: The case notification rate of TB among children has plateaued within the period under review.  Efforts should be made to improve CTB detection, reporting and notification into the NTP Monitoring & Evaluation (M&E) system. Keywords: Tuberculosis, World Health Organization, Bauchi, Childhood TB, National TB Control Programme, Caregivers, Quality of Life, Monitoring and Evaluation, Northeastern Nigeria

Tuberculosis control strategies: Challenges to health management research

The rapid expansion of RNTCP implementation in this vast and diverse county with quality maintenance demands proactive involvement of policy makers, programme managers, researchers and health functionaries. Mid-term goal for the programme have to be defined. Problems in achieving these objectives have to be identified and a research agenda needs to be formulated to answer the constrains identified. Research, by being linked to the constrains and objectives, will always be relevant to TB control programme and the findings would influence policy and practice. Operational research should become an integral component of the programme management

Improvement of Tuberculosis Laboratory Capacity on Pemba Island, Zanzibar: A Health Cooperation Project.

Low-income countries with high Tuberculosis burden have few reference laboratories able to perform TB culture. In 2006, the Zanzibar National TB Control Programme planned to decentralize TB diagnostics. The Italian Cooperation Agency with the scientific support of the "L. Spallanzani" National Institute for Infectious Diseases sustained the project through the implementation of a TB reference laboratory in a low-income country with a high prevalence of TB. The implementation steps were: 1) TB laboratory design according to the WHO standards; 2) laboratory equipment and reagent supplies for microscopy, cultures, and identification; 3) on-the-job training of the local staff; 4) web- and telemedicine-based supervision. From April 2007 to December 2010, 921 sputum samples were received from 40 peripheral laboratories: 120 TB cases were diagnosed. Of all the smear-positive cases, 74.2% were culture-positive. During the year 2010, the smear positive to culture positive rate increased up to 100%. In March 20, 2010 the Ministry of Health and Social Welfare of Zanzibar officially recognized the Public Health Laboratory- Ivo de Carneri as the National TB Reference Laboratory for the Zanzibar Archipelago. An advanced TB laboratory can represent a low cost solution to strengthen the TB diagnosis, to provide capacity building and mid-term sustainability

Diagnosis of tuberculosis in Ghana: The role of laboratory training

Objectives: The laboratory is considered the cornerstone of tuberculosis (TB) control programme. International review of Ghana’s programme in the late nineties identified the laboratory services as the weakestcomponent. Sputum smear microscopy (SSM) being the main method of diagnosing pulmonary TB in Ghana, the training objectives were to: (i) strengthen the knowledge and skills of laboratory personnel on SSM(ii) impart necessary techniques in biosafety and (iii) introduce a Quality Assurance (QA) system in order to strengthen SSM services.Methods: Personnel were selected for training during a nationwide situation analysis of SSM centres in 2000/2001. Four training sessions on SSM/QA were held between 2001/2004.Results: A total of 80 personnel were trained: 10 regional TB coordinators and 70 laboratory personnel. The participants upon return to their respective regions also organized training within their districts. This approach resulted in another 100 district TB coordinators and 200 laboratory personnel being trained. Improvement in smear preparation, staining and reading ability of the participants were observed during the post-test and subsequent visit to their respective laboratories. The training has led to strengthening of TB laboratory services in the country and has contributed to increase in case detection from 10,745 in 2000 to 11,827 in2004 and 14,022 in 2008. It was observed during the post-training follow-up and quarterly supervision visits that morale of the personnel was high.Conclusion: Continuous training and re-training of laboratory personnel on SSM and QA at regular intervals do play an important role for effective and efficient TB control programme

HIV/TB: When is it safe to start HAART?

South Africa has the fourth highest burden of tuberculosis (TB) worldwide after China, India and Indonesia and has the highest TB notification rate of any country. The World Health Organization (WHO) estimated that in 2006 South Africa had 303 114 incident TB cases; of these patients, 32% were tested for HIV and 53% were found to be HIV infected.1 HIV testing of TB cases has been encouraged by the WHO and testing has resulted in identification of increasing numbers of HIV-infected individuals in the TB control programme. The success of this policy has been demonstrated in the Cape Town Gugulethu antiretroviral clinic, where referrals directly from the local TB clinics have increased from 15% to 30% within the past 2 years. The national TB control programme has therefore become an increasingly important pathway to HIV care and access to highly active antiretroviral therapy (HAART). An additional 15 - 20% of patients in the Gugulethu programme have a diagnosis of TB made during the HAART screening period, further increasing the number of individuals on TB medication who require HAART. Mortality after referral is very high. The HIV/TB case mortality has been reported to be as high as 16 - 35%2 prior to the introduction of HAART, with both HIV and TB contributing to this mortality. Optimal timing of HAART is currently unknown and there is an urgent need for development of evidence-based protocols for HAART initiation and immune reconstitution disease (IRD) management. Southern African Journal of HIV Medicine Vol. 9 (4) 2008: pp. 18-2