Assessing the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Selected Health Facilities in Nairobi, Kenya

There was concern that the COVID-19 pandemic would adversely affect TB and HIV programme services in Kenya. We set up real-time monthly surveillance of TB and HIV activities in 18 health facilities in Nairobi so that interventions could be implemented to counteract anticipated declining trends. Aggregate data were collected and reported monthly to programme heads during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data collected during the pre-COVID period (March 2019–February 2020). During the COVID-19 period, there was an overall decrease in people with presumptive pulmonary TB (31.2%), diagnosed and registered with TB (28.0%) and in those tested for HIV (50.5%). Interventions to improve TB case detection and HIV testing were implemented from August 2020 and were associated with improvements in all parameters during the second six months of the COVID-19 period. During the COVID-19 period, there were small increases in TB treatment success (65.0% to 67.0%) and referral of HIV-positive persons to antiretroviral therapy (91.2% to 92.9%): this was more apparent in the second six months after interventions were implemented. Programmatic interventions were associated with improved case detection and treatment outcomes during the COVID-19 period, suggesting that monthly real-time surveillance is useful during unprecedented events

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Challenges and Progress with Diagnosing Pulmonary Tuberculosis in Low- and Middle-Income Countries

Case finding and the diagnosis of tuberculosis (TB) are key activities to reach the World Health Organization&#8217;s End TB targets by 2030. This paper focuses on the diagnosis of pulmonary TB (PTB) in low- and middle-income countries. Sputum smear microscopy, despite its many limitations, remains the primary diagnostic tool in peripheral health facilities; however, this is being replaced by molecular diagnostic techniques, particularly Xpert MTB/RIF, which allows a bacteriologically confirmed diagnosis of TB along with information about whether or not the organism is resistant to rifampicin within two hours. Other useful diagnostic tools at peripheral facilities include chest radiography, urine lipoarabinomannan (TB-LAM) in HIV-infected patients with advanced immunodeficiency, and the loop-mediated isothermal amplification (TB-LAMP) test which may be superior to smear microscopy. National Reference Laboratories work at a higher level, largely performing culture and phenotypic drug susceptibility testing which is complemented by genotypic methods such as line probe assays for detecting resistance to isoniazid, rifampicin, and second-line drugs. Tuberculin skin testing, interferon gamma release assays, and commercial serological tests are not recommended for the diagnosis of active TB. Linking diagnosis to treatment and care is often poor, and this aspect of TB management needs far more attention than it currently receives

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Not AvailableThirty groundnut genotypes (18 of Virginia bunch, 5 Spanish bunch and 7 Virginia runner group) were screened for their relative response to Caryedon serratus using no choice test under laboratory condition (32 to 35 0 C). The results showed that the number of eggs laid by C. serratus ranged from 19.3 to 115.0 and adult emergence varied from 11.0 to 63.7 beetles. Per cent damage to the kernels was highest in ‘GG-20 (80.7%) and lowest in T-28 (7.6 %)’. First three principle components (PC) accounted for approximately 84% observed variation in the data. Breakdown of cumulative variance revealed the contribution of PC 1 and PC 2 and PC 3 were 46, 21 and 17%, respectively towards cumulative variance. The vertex genotypes were GG- 20, AK-303, AK-265, T-28, ALR-1 and ALR-3 of these genotypes, onl y one genotype, T-28 exhibited l ess egg counts, adul ts emergence and % damage while the rest recorded higher values for these traits. Association studies also revealed that genotypes with large seed size may be more susceptible to bruchid infestation.Not Availabl

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Not AvailableThirty groundnut genotypes (18 of Virginia bunch, 5 Spanish bunch and 7 Virginia runner group) were screened for their relative response to Caryedon serratus using no choice test under laboratory condition (32 to 35 0 C). The results showed that the number of eggs laid by C. serratus ranged from 19.3 to 115.0 and adult emergence varied from 11.0 to 63.7 beetles. Per cent damage to the kernels was highest in ‘GG-20 (80.7%) and lowest in T-28 (7.6 %)’. First three principle components (PC) accounted for approximately 84% observed variation in the data. Breakdown of cumulative variance revealed the contribution of PC 1 and PC 2 and PC 3 were 46, 21 and 17%, respectively towards cumulative variance. The vertex genotypes were GG- 20, AK-303, AK-265, T-28, ALR-1 and ALR-3 of these genotypes, onl y one genotype, T-28 exhibited l ess egg counts, adul ts emergence and % damage while the rest recorded higher values for these traits. Association studies also revealed that genotypes with large seed size may be more susceptible to bruchid infestation.Not Availabl

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Not AvailableThirty groundnut genotypes (18 of Virginia bunch, 5 Spanish bunch and 7 Virginia runner group) were screened for their relative response to Caryedon serratus using no choice test under laboratory condition (32 to 350 C). The results showed that the number of eggs laid by C. serratus ranged from 19.3 to 115.0 and adult emergence varied from 11.0 to 63.7 beetles. Per cent damage to the kernels was highest in ‘GG-20 (80.7%) and lowest in T-28 (7.6 %)’. First three principle components (PC) accounted for approximately 84% observed variation in the data. Breakdown of cumulative variance revealed the contribution of PC 1 and PC 2 and PC 3 were 46, 21 and 17%, respectively towards cumulative variance. The vertex genotypes were GG- 20, AK-303, AK-265, T-28, ALR-1 and ALR-3 of these genotypes, only one genotype, T-28 exhibited less egg counts, adults emergence and % damage while the rest recorded higher values for these traits. Association studies also revealed that genotypes with large seed size may be more susceptible to bruchid infestation.Not Availabl

What Are the Barriers for Uptake of Antiretroviral Therapy in HIV-Infected Tuberculosis Patients? A Mixed-Methods Study from Ayeyawady Region, Myanmar

Antiretroviral therapy (ART) coverage among HIV-infected tuberculosis (HIV-TB) patients has been suboptimal in Myanmar and the reasons are unknown. We aimed to assess the ART uptake among HIV-TB patients in public health facilities of Ayeyawady Region from July 2017&ndash;June 2018 and explore the barriers for non-initiation of ART. We conducted an explanatory mixed-methods study with a quantitative component (cohort analysis of secondary programme data) followed by a descriptive qualitative component (thematic analysis of in-depth interviews of 22 providers and five patients). Among 12,447 TB patients, 11,057 (89%) were HIV-tested and 627 (5.7%) were HIV-positive. Of 627 HIV-TB patients, 446 (71%) received ART during TB treatment (86 started on ART prior to TB treatment and rest started after TB treatment). Among the 181 patients not started on ART, 60 (33%) died and 41 (23%) were lost-to-follow-up. Patient-related barriers included geographic and economic constraints, poor awareness, denial of HIV status, and fear of adverse drug effects. The health system barriers included limited human resource, provision of ART on &lsquo;fixed&rsquo; days only, weaknesses in counselling, referral and feedback mechanism, and clinicians&rsquo; reluctance to start ART early due to concerns about immune reconstitution inflammatory syndrome. We urge the national TB and HIV programs to take immediate actions to improve the ART uptake

Extending contact screening within a 50-m radius of an index tuberculosis patient using Xpert MTB/RIF in urban Pakistan: Did it impact treatment outcomes?

Background Pakistan implemented initiatives to detect tuberculosis (TB) patients through extended contact screening (ECS); it improved case detection but treatment outcomes need assessment. Objectives To compare treatment outcomes of pulmonary TB (PTB) patients detected by ECS with those detected by routine passive case finding (PCF). Methods A cohort study using secondary program data conducted in Lahore, Faisalabad and Rawalpindi districts and Islamabad in 2013–15. We used log binomial regression models to assess if ECS was associated with unfavorable treatment outcomes (death, loss-to-follow-up, failure, not evaluated) after adjusting for potential confounders. Results We included 79,431 people with PTB; 4604 (5.8%) were detected by ECS with 4052 (88%) bacteriologically confirmed. In all PTB patients the proportion with unfavorable outcomes was not significantly different in ECS group (9.6%) compared to PCF (9.9%), however, among bacteriologically confirmed patients unfavorable outcomes were significantly lower in ECS (9.9%) than PCF group (11.6%, P = 0.001). ECS was associated with a lower risk of unfavorable outcomes (adjusted relative risk (aRR) 0.90; 95% CI 0.82–0.99) among ‘all PTB’ patients and bacteriologically confirmed PTB patients (aRR 0.91; 95% CI 0.82–1.00). Conclusion In PTB patients detected by ECS the treatment outcomes were not inferior to those detected by PCF