Shortened first-line TB treatment in Brazil: potential cost savings for patients and health services.

BACKGROUND: Shortened treatment regimens for tuberculosis are under development to improve treatment outcomes and reduce costs. We estimated potential savings from a societal perspective in Brazil following the introduction of a hypothetical four-month regimen for tuberculosis treatment. METHODS: Data were gathered in ten randomly selected health facilities in Rio de Janeiro. Health service costs were estimated using an ingredient approach. Patient costs were estimated from a questionnaire administered to 126 patients. Costs per visits and per case treated were analysed according to the type of therapy: self-administered treatment (SAT), community- and facility-directly observed treatment (community-DOT, facility-DOT). RESULTS: During the last 2 months of treatment, the largest savings could be expected for community-DOT; on average USD 17,351-18,203 and USD 43,660-45,856 (bottom-up and top-down estimates) per clinic. Savings to patients could also be expected as the median (interquartile range) patient-related costs during the two last months were USD 108 (13-291), USD 93 (36-239) and USD 11 (7-126), respectively for SAT, facility-DOT and community-DOT. CONCLUSION: Introducing a four-month regimen may result in significant cost savings for both the health service and patients, especially the poorest. In particular, a community-DOT strategy, including treatment at home, could maximise health services savings while limiting patient costs. Our cost estimates are likely to be conservative because a 4-month regimen could hypothetically increase the proportion of patients cured by reducing the number of patients defaulting and we did not include the possible cost benefits from the subsequent prevention of costs due to downstream transmission averted and rapid clinical improvement with less side effects in the last two months

SYPHILIS AND HIV INFECTION: PROZONE EFFECT IN A PATIENT WITH NEUROSYPHILIS

É apresentado um caso de sífilis secundária prolongada com envolvimento neurológico assintomático em um paciente infectado pelo HIV. Paciente do sexo masculino, 26 anos de idade, com diagnóstico de infecção pelo HIV há três anos, apresentando há um ano lesões cutâneas nos pés e nas mãos, alopecia, febre, artralgia, perda ponderal de 8 Kg e VDRL negativo. Durante a internação, o VDRL foi de 1:1024 e VDRL positivo no líquor. Foi tratado com penicilina cristalina com excelente resposta clínica. O diagnóstico de sífilis deve ser considerado nos pacientes infectados pelo HIV com quadro clínico exuberante, mesmo quando o VDRL for negativo. PALAVRAS-CHAVE – Doenças sexualmente transmissíveis; HIV; Neurossífilis; Sífilis. We report a case of prolonged secondary syphilis with asymptomatic neurological involvement in HIV- -infected patient. A 26-year-old male patient who was diagnosed three years earlier with HIV infection presented with skin lesions on the feet and hands, alopecia, fever, arthralgia, weight loss of 8 Kg which began one year before and had a negative VDRL. During hospitalization, his VDRL was 1:1024 and a CSF-VDRL positive. The patient had an excel- lent clinical response to treatment with crystalline penicillin. The syphilis diagnosis should be considered in HIV-infected patients with severe clinical disease, even when the VDRL is negative. KEYWORDS – Sexually transmitted diseases; HIV infections; Neurosyphilis; Syphilis.

Correction: The impact of the Brazilian family health on selected primary care sensitive conditions: A systematic review.

[This corrects the article DOI: 10.1371/journal.pone.0182336.]

Prevalência de violência sexual em refugiados: uma revisão sistemática

OBJECTIVE: To synthesize data about the prevalence of sexual violence (SV) among refugees around the world. METHODS: A systematic review was conducted from the search in seven bibliographic databases. Studies on the prevalence of SV among refugees and asylum seekers of any country, sex or age, whether in English, French, Spanish and Portuguese, were eligible. RESULTS: Of the 2,906 titles found, 60 articles were selected. The reported prevalence of SV was largely variable (0% to 99.8%). Reports of SV were collected in all continents, with 42% of the articles mentioning it in refugees from Africa (prevalence from 1.3% to 100%). The rape was the most reported SV in 65% of the studies (prevalence from 0% to 90.9%). The main victims were women in 89% of the studies, all the way, especially when still in the countries of origin. The SV was perpetrated particularly by intimate partners, but also by agents of supposed protection. Few studies have reported SV in men and children; the prevalence reached up to 39.3% and 90.9%, respectively. Approximately one-third of the studies (32%) were carried out in refugee camps and more than half (52%) in health services using mental health assessment tools. No study has addressed the most recent migratory crisis. Meta-analysis was not performed due to the methodological heterogeneity of the studies. CONCLUSIONS: SV is a prevalent problem affecting refugees of both sexes, of all ages, throughout the migratory journey, particularly those from Africa. Protection measures are urgently needed, and further studies, with more appropriate tools, may better measure the current magnitude of the problem.OBJETIVO: Sintetizar dados da literatura sobre a prevalência de violência sexual em refugiados. MÉTODOS: Conduzimos uma revisão sistemática a partir da busca em sete bases bibliográficas. Foram elegíveis estudos em inglês, francês, espanhol e português com dados sobre a prevalência de violência sexual em refugiados e requerentes de asilo, de qualquer país, sexo ou idade. RESULTADOS: Dos 2.906 títulos encontrados, 60 artigos foram incluídos. A prevalência foi amplamente variável (0% a 99,8%). Houve relatos de violência sexual em todos os continentes, com 42% dos artigos mencionando-a em refugiados provenientes da África (prevalências de 1,3% a 100%). O estupro foi a ocorrência mais relatada em 65% dos estudos (prevalências de 0% a 90,9%). As principais vítimas foram mulheres em 89% dos estudos, em todo o trajeto, principalmente nos países de origem. A violência foi perpetrada particularmente por parceiros íntimos, mas também por agentes de suposta proteção. Poucos estudos relataram-na em homens e crianças, com prevalências atingindo até 39,3% e 90,9%, respectivamente. Cerca de 1/3 dos estudos (32%) foram realizados em campos de refugiados ou locais de acolhimento, e mais da metade (52%) em serviços de saúde, utilizando instrumentos de avaliação de saúde mental. Nenhum estudo abordou a crise migratória mais recente. Não foi realizada meta-análise devido à heterogeneidade metodológica dos estudos. CONCLUSÕES: A violência sexual é um problema prevalente que atinge refugiados de ambos os sexos, de todas as idades, em particular aqueles provenientes da África, durante todo o percurso migratório. Medidas de proteção são urgentemente necessárias, e novos estudos, com instrumentos mais apropriados, poderão mensurar melhor a magnitude atual do problema

Residual respiratory disability after successful treatment of pulmonary tuberculosis: a systematic review and meta-analysisResearch in context

Summary: Background: Pulmonary tuberculosis (PTB) can result in long-term health consequences, even after successful treatment. We conducted a systematic review and meta-analysis to estimate the occurrence of respiratory impairment, other disability states, and respiratory complications following successful PTB treatment. Methods: We identified studies from January 1, 1960, to December 6, 2022, describing populations of all ages that successfully completed treatment for active PTB and had been assessed for at least one of the following outcomes: occurrence of respiratory impairment, other disability states, or respiratory complications following PTB treatment. Studies were excluded if they reported on participants with self-reported TB, extra-pulmonary TB, inactive TB, latent TB, or if participants had been selected on the basis of having more advanced disease. Study characteristics and outcome-related data were abstracted. Meta-analysis was performed using a random effects model. We adapted the Newcastle Ottawa Scale to evaluate the methodological quality of the included studies. Heterogeneity was assessed using the I2 statistic and prediction intervals. Publication bias was assessed using Doi plots and LFK indices. This study is registered with PROSPERO (CRD42021276327). Findings: 61 studies with 41,014 participants with PTB were included. In 42 studies reporting post-treatment lung function measurements, 59.1% (I2 = 98.3%) of participants with PTB had abnormal spirometry compared to 5.4% (I2 = 97.4%) of controls. Specifically, 17.8% (I2 = 96.6%) had obstruction, 21.3% (I2 = 95.4%) restriction, and 12.7% (I2 = 93.2%) a mixed pattern. Among 13 studies with 3179 participants with PTB, 72.6% (I2 = 92.8%) of participants with PTB had a Medical Research Council dyspnoea score of 1–2 and 24.7% (I2 = 92.2%) a score of 3–5. Mean 6-min walk distance in 13 studies was 440.5 m (I2 = 99.0%) in all participants (78.9% predicted, I2 = 98.9%) and 403.0 m (I2 = 95.1%) among MDR-TB participants in 3 studies (70.5% predicted, I2 = 97.6%). Four studies reported data on incidence of lung cancer, with an incidence rate ratio of 4.0 (95% CI 2.1–7.6) and incidence rate difference of 2.7 per 1000 person-years (95% CI 1.2–4.2) when compared to controls. Quality assessment indicated overall low-quality evidence in this field, heterogeneity was high for pooled estimates of nearly all outcomes of interest, and publication bias was considered likely for almost all outcomes. Interpretation: The occurrence of post-PTB respiratory impairment, other disability states, and respiratory complications is high, adding to the potential benefits of disease prevention, and highlighting the need for optimised management after successful treatment. Funding: Canadian Institutes of Health Research Foundation Grant

Summary of results of included studies for all other health outcomes (n = 7^*).

<p>Summary of results of included studies for all other health outcomes (n = 7^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0182336#t003fn002" target="_blank">*</a>}).</p

Flow chart of study selection.

<p>Flow chart of study selection.</p

Summary of results of included studies reporting hospitalization due to primary care sensitive causes^* (n = 13).

<p>Summary of results of included studies reporting hospitalization due to primary care sensitive causes^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0182336#t002fn002" target="_blank">*</a>} (n = 13).</p

Cost-effectiveness of quantiferon®-TB gold-in-tube versus tuberculin skin testing for contact screening and treatment of latent tuberculosis infection in Brazil

Submitted by Luis Guilherme Macena ([email protected]) on 2013-07-22T17:40:44Z No. of bitstreams: 1 journal.pone.0059546.pdf: 465528 bytes, checksum: e15fdd774cf9ffd4c01849bad970d675 (MD5)Made available in DSpace on 2013-07-22T17:40:45Z (GMT). No. of bitstreams: 1 journal.pone.0059546.pdf: 465528 bytes, checksum: e15fdd774cf9ffd4c01849bad970d675 (MD5) Previous issue date: 2013CNPq, FAPERJ, ICOHRTA, CNPq/PIBIC UGFUniversidade Federal do Rio de Janeiro. Programa de Pós-Graduação em Medicina Inter. Rio de Janeiro, RJ, BrasilUniversidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Fernandes Figueira. Rio de Janeiro, RJ, BrasilUniversidade Gama Filho. Rio de Janeiro, RJ, BrasilUniversidade Gama Filho. Rio de Janeiro, RJ, BrasilUniversidade Gama Filho. Rio de Janeiro, RJ, BrasilHospital Santa Casa de Misericórdia do Rio de Janeiro. Laboratório Paschoal Granato. Rio de Janeiro, RJ, BrasilMcGill University. Montreal Chest Institute. Montreal, Quebec, CanadaUniversidade Gama Filho. Rio de Janeiro, RJ, Brasil / McGill University. Montreal Chest Institute. Montreal, Quebec, CanadaBACKGROUND: Latent tuberculosis infection (LTBI) is a reservoir for new TB cases. Isoniazid preventive therapy (IPT) reduces the risk of active TB by as much as 90%, but LTBI screening has limitations. Unlike tuberculin skin testing (TST), interferon-gamma release assays are not affected by BCG vaccination, and have been reported to be cost-effective in low-burden countries. The goal of this study was to perform a cost-effectiveness analysis from the health system perspective, comparing three strategies for LTBI diagnosis in TB contacts: tuberculin skin testing (TST), QuantiFERON®-TB Gold-in-Tube (QFT-GIT) and TST confirmed by QFT-GIT if positive (TST/QFT-GIT) in Brazil, a middle-income, high-burden country with universal BCG coverage. METHODOLOGY/PRINCIPAL FINDINGS: Costs for LTBI diagnosis and treatment of a hypothetical cohort of 1,000 adult immunocompetent close contacts were considered. The effectiveness measure employed was the number of averted TB cases in two years. Health system costs were US$105,096 for TST, US$ 121,054 for QFT-GIT and US$101,948 for TST/QFT-GIT; these strategies averted 6.56, 6.63 and 4.59 TB cases, respectively. The most cost-effective strategy was TST (US$ 16,021/averted case). The incremental cost-effectiveness ratio was US$227,977/averted TB case for QFT-GIT. TST/QFT-GIT was dominated. CONCLUSIONS: Unlike previous studies, TST was the most cost-effective strategy for averting new TB cases in the short term. QFT-GIT would be more cost-effective if its costs could be reduced to US$ 26.95, considering a TST specificity of 59% and US$ 18 considering a more realistic TST specificity of 80%. Nevertheless, with TST, 207.4 additional people per 1,000 will be prescribed IPT compared with QFT