Tobacco Smoking and Tuberculosis Treatment Outcomes: A Prospective Cohort Study in Georgia

Objective To assess the effect of tobacco smoking on the outcome of tuberculosis treatment in Tbilisi, Georgia. Methods We conducted a prospective cohort study of adults with laboratory-confirmed tuberculosis from May 2011 to November 2013. History of tobacco smoking was collected using a standardized questionnaire adapted from the global adult tobacco survey. We considered tuberculosis therapy to have a poor outcome if participants defaulted, failed treatment or died. We used multivariable regressions to estimate the risk of a poor treatment outcome. Findings Of the 591 tuberculosis patients enrolled, 188 (31.8%) were past smokers and 271 (45.9%) were current smokers. Ninety (33.2%) of the current smokers and 24 (18.2%) of the participants who had never smoked had previously been treated for tuberculosis (P \u3c 0.01). Treatment outcome data were available for 524 of the participants, of whom 128 (24.4%) – including 80 (32.9%) of the 243 current smokers and 21 (17.2%) of the 122 individuals who had never smoked – had a poor treatment outcome. Compared with those who had never smoked, current smokers had an increased risk of poor treatment outcome (adjusted relative risk, aRR: 1.70; 95% confidence interval, CI: 1.00–2.90). Those who had ceased smoking more than two months before enrolment did not have such an increased risk (aRR: 1.01; 95% CI: 0.51–1.99). Conclusion There is a high prevalence of smoking among patients with tuberculosis in Georgia and smoking increases the risk of a poor treatment outcome

High utility of contact investigation for latent and active tuberculosis case detection among the contacts: a retrospective cohort study in Tbilisi, Georgia, 2010-2011.

The study was conducted at the National Center for Tuberculosis and Lung Diseases (NCTBLD) in Tbilisi, Georgia.To assess the utility of contact investigation for tuberculosis (TB) case detection. We also assessed the prevalence and risk factors for active TB disease and latent TB infection (LTBI) among contacts of active pulmonary TB cases.A retrospective cohort study was conducted among the contacts of active pulmonary TB cases registered in 2010-2011 at the NCTBLD in Tbilisi, Georgia. Contacts of active TB patients were investigated according to an "invitation model": they were referred to the NCTBLD by the index case; were queried about clinical symptoms suggestive of active TB disease; tuberculin skin testing and chest radiographs were performed. Demographic, laboratory, and clinical data of TB patients and their contacts were abstracted from existing records up to February 2013.869 contacts of 396 index cases were enrolled in the study; a median of 2 contacts were referred per index case. Among the 869 contacts, 47 (5.4%) were found to have or developed active TB disease: 30 (63.8%) were diagnosed with TB during the baseline period (co-prevalent cases) and 17 (36.2%) developed active TB disease during the follow-up period (mean follow up of 21 months) (incident TB cases). The incidence rate of active TB disease among contacts was 1126.0 per 100,000 person years (95% CI 655.7-1802.0 per 100,000 person-years). Among the 402 contacts who had a tuberculin skin test (TST) performed, 52.7% (95% CI 47.7-57.7%) had LTBI.A high prevalence of LTBI and active TB disease was found among the contacts of TB cases in Tbilisi, Georgia. Our findings demonstrated that an "invitation" model of contact investigation was an effective method of case detection. Therefore, contact investigation should be scaled up in Georgia

Relationships between Body Mass Index, Adiposity Distribution and Treatment Outcomes among Patients with Tuberculosis from the Country of Georgia

The relationship of low BMI and an increase in BMI with TB treatment outcomes is not well characterized. Assessing adiposity distribution in addition to BMI may improve the characterization of the metabolic status of patients with TB. This dissertation aimed to determine the association of body composition with TB treatment outcomes among patients with TB. Study 1 aimed to assess the association of baseline BMI with TB treatment outcomes among adult patients with drug-resistant TB. We also examined whether these associations differed by baseline glycemic status. We used log-binomial models to estimate risk ratios (RR). Compared to individuals with normal BMI, patients with BMI2 were significantly more likely to remain sputum culture positive after two months of treatment (aRR=1.25; 95%CI: 1.06-1.49). The risk of non-conversion by month two was significantly higher among patients with low BMI and hyperglycemia than those with normal BMI and euglycemia (RR=1.54, 95% CI:1.23-1.92). The risk of poor TB treatment outcomes was significantly higher among patients with normal/high BMI and hyperglycemia than those with normal BMI and euglycemia (RR=1.28, 95% CI: 1.03-1.59). Study 2 assessed whether lack of weight gain during the initial months of treatment was associated with all-cause mortality. We used competing-risk Cox proportional hazard models to estimate hazard ratios (HR). Among adults with normal baseline BMI, weight loss compared to weight gain was associated with an increased risk of death during TB treatment (aHR=5.0; 95%CI 1.2, 19.9). Among adults with low baseline BMI, no change in BMI compared to an increase in BMI was associated with an increased rate of all-cause post-TB mortality (aHR=6.1; 95% CI: 1.5, 24.5). Study 3 aimed to determine the association between adiposity distribution (fat mass (FM)/fat-free mass (FFM)) and the prevalence of metabolic disorders among patients with drug-sensitive TB. We used multinomial logistic models to estimate odds ratios (OR). Initial high FM/FFM was significantly associated with hyperglycemia (aOR: 16.2; 95% CI: 1.5, 92.7). This dissertation studies provide valuable information that can be used to prioritize the development of targeted interventions that simultaneously address weight, adipose distribution, and metabolic disease among people with TB

Active incident TB among contacts by age, gender and their index cases' characteristics, Tbilisi, Georgia, 2010–2011.

1<p>index cases>17 years of age.</p><p><b>Abbreviations</b>: AFB – Acid-fast bacilli; SS – sputum smear; MDR – Multidrug-resistant.</p><p>Active incident TB among contacts by age, gender and their index cases' characteristics, Tbilisi, Georgia, 2010–2011.</p

Contact investigation study flow, Tbilisi, Georgia, 2010–2011.

<p>Contact investigation study flow, Tbilisi, Georgia, 2010–2011.</p

Active Co-prevalent and incident TB among contacts by age, gender and their index cases' characteristics, Tbilisi, Georgia, 2010–2011.

1<p>index cases>17 years of age.</p><p><b>Abbreviations</b>: AFB – Acid-fast bacilli; SS – sputum smear; MDR – Multidrug-resistant.</p><p>Active Co-prevalent and incident TB among contacts by age, gender and their index cases' characteristics, Tbilisi, Georgia, 2010–2011.</p

Socio-demographic and clinical characteristics of index tuberculosis (TB) cases, Tbilisi, Georgia, 2010–2011.

1<p>index cases>17 years of age.</p><p><b>Abbreviations:</b> AFB–Acid-fast bacilli; SS–sputum smear; MDR–Multidrug-resistant</p><p>Socio-demographic and clinical characteristics of index tuberculosis (TB) cases, Tbilisi, Georgia, 2010–2011.</p

Active TB disease among contacts, Tbilisi, Georgia, 2010–2011.

<p>Active TB disease among contacts, Tbilisi, Georgia, 2010–2011.</p