Delays in TB Diagnosis and Treatment Initiation in Burkina Faso during the COVID-19 Pandemic

The COVID-19 pandemic has significantly disrupted TB services, particularly in low resource settings. In Burkina Faso, a cross-sectional ‘before and after’ study was conducted to assess the impact of COVID-19 on access to TB services. Data was collected in two phases (Phase 1: December 2017–March 2018, and 2: October–December 2020) to estimate and compare various patient and system delays among TB patients before and during COVID-19 and explore changes in treatment seeking behaviors and practices. 331 TB patients were recruited across the two phases. A significant increase in median time between first symptom and contact with TB service (45 days vs. 26 days; p < 0.01) and decrease in median time between first contact and diagnosis, and treatment initiation, respectively, during COVID-19 compared to before. Fewer patients reported using public health centers and more patients reporting using private facilities as the point of first contact following TB symptom onset during the COVID-19 period compared to before. These findings suggest that COVID-19 has created barriers to TB service access and health seeking among symptomatic individuals, yet also led to some efficiencies in TB diagnostic and treatment services. Our findings can be help target efforts along specific points of the TB patient pathway to minimize the overall disruption of COVID-19 and future public health emergencies on TB control in Burkina Faso

Implementation of tuberculosis prevention for exposed children, burkina faso

Objective: To develop and test a simple system for recording and reporting the diagnosis and treatment of latent tuberculosis infection and to compare the effects of passive and active tracing of child contacts on indicators of such infection. Methods: We revised Burkina Faso's latent tuberculosis infection register and quarterly tuberculosis reporting form. Subsequently, coverage of the routine screening of contacts, who were younger than five years, for active tuberculosis and the corresponding percentages of such contacts who, if eligible, initiated preventive therapy were measured, nationwide, between 1 April 2016 and 31 March 2017. In 2016, we evaluated indicators of latent tuberculosis infection in the Hauts-Bassins region before and after community health workers had begun the active tracing of contacts who were younger than five years. Findings: In Burkina Faso, during our study period, 3717 cases of pulmonary tuberculosis and 1166 corresponding contacts who were younger than five years were reported as the result of routine screening and passive contact tracing. The overall contact:index ratio was 0.31 and corresponding screening coverage was 82.0% (956/1166) and proportion of children starting on preventive treatment was 90.5% (852/941). Active tracing in Hauts-Bassins led to a substantially higher contact/index ratio (1.83) and screening coverage (99.3%; 145/146). Conclusion: The newly established recording and reporting system proved feasible and user-friendly and allowed measurement of global indicators of latent tuberculosis infection. Compared with active tracing, passive tracing led to much lower estimates of the numbers of child contacts

Connaissances, attitudes et pratiques des populations face à la tuberculose dans trois régions du Burkina Faso

Au Burkina Faso, le dépistage précoce des cas de la tuberculose (TB) constitue encore un défi malgré l’implication communautaire dansla lutte contre la maladie depuis 2005. Des connaissances et attitudes adéquates face à la tuberculose devraient contribuer à améliorer la détection des cas. L’objectif de notre travail était de décrire les connaissances, attitudes et pratiques des communautésface à la tuberculose. Nous avonsréalisé une analyse des données d’enquête transversale menée en 2012 dans trois régions du Burkina Faso. Les participants ont été choisis selon un échantillonnage en grappe. Nous avons identifié les facteurs associés à la connaissance à partir d’une régression de Cox. Au total 2 261 individus ont été enquêtés. Le sexe féminin était majoritaire (56,2 %). Plus de 85 % des enquêtés ont déclaré avoir déjà entendu parler de la TB. Un tiers (30,4 %) de la population a une bonne connaissance de la tuberculose. Lesfacteurs associés à la connaissance sur la tuberculose sont : le sexe, l’âge, le niveau d’instruction et le lieu de résidence. Pour plus de 96 % de la population enquêtée, le centre de santé est le premier recours en cas de suspicion de symptômes de la tuberculose. Le niveau global de la connaissance de la TB reste faible dansla population générale au Burkina Faso. L’amélioration de la connaissance sur la TB tenant compte des disparités identifiées dans cette étude est nécessaire pour l’atteinte des objectifs en matière de lutte contre la TB au Burkina Faso. Mots-clés : tuberculose, connaissance, pratique, Cox, Burkina Faso.   English Title: Knowledge, attitudes, and practices related to TB among the general population of three regions of Burkina FasoIn Burkina Faso, early detection of tuberculosis(TB) casesremain a challenge despite community involvement in the fight against the disease since 2005. Adequate knowledge and attitudes related to tuberculosis should help improve case detection. The aim of our study was to describe the knowledge, attitudes and practices of communities regarding tuberculosis. We performed an analysis of cross-sectional survey data conductedin 2012 in three regions of Burkina Faso. To select participants, we carried out a three-stage clustersampling. We identified the TB related knowledge associated factorsthrough a Cox regression. A total, 2261 individuals were surveyed. The female was in the majority (56.2 %). Over 85 % of those surveyed said they had heard from TB before. One-third (30.4 %) of the population has a good knowledge of tuberculosis. Factors associated with TB-related knowledge are gender, age, education, and place of residence. For more than 96 % of the population surveyed, the health center is the first resort in case of suspected symptoms of tuberculosis. The overall level of knowledge of TB remainslow in the general population in Burkina Faso. Improving knowledge about TB taking into account the disparities identified in this study is necessary for reaching national goals in Burkina Faso. Keywords: Tuberculosis, knowledge, practices, Cox, Burkina Fas

Spoligotypes, MIRU-VNTR patterns and clonal complex identification of the <i>M. bovis</i> strains isolated in Burkina Faso.

1<p><b>▪</b>, presence of spacer; <b>□</b>, absence of spacer.</p>2<p>MIRU-VNTR loci: ETR A, ETR B, ETR C, ETR D, ETR E, QUB-11a, QUB-11b, QUB-3232, QUB-26, QUB-4156, MIRU 2, MIRU 10, MIRU 16, MIRU 20, MIRU 23, MIRU 24, MIRU 26, MIRU 27, MIRU 39, MIRU 40, Mtub 04, Mtub 21, Mtub 29, Mtub 30, Mtub 34, Mtub 39. NA = Not Available.</p>3<p>Af1 = African 1 clonal complex, Af5 = putative African 5 clonal complex.</p><p>Spoligotypes, MIRU-VNTR patterns and clonal complex identification of the <i>M. bovis</i> strains isolated in Burkina Faso.</p

UPGMA tree based on the MIRU-VNTR (26 loci) and spoligotyping data.

<p>1, SB number = name of spoligotype based on <a href="http://www.Mbovis.org" target="_blank">http://www.Mbovis.org</a> database nomenclature; 2, RDAf1 = Genomic deletion specific to Af1 clonal complex; 3, The MIRU-VNTR patterns are detailed in <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003142#pntd-0003142-t002" target="_blank">table 2</a>.</p

Socio-demographic informations about hosts and <i>M. bovis</i> isolates.

a<p>specific to human hosts,</p>b<p>bovine study,</p>c<p>nationwide survey,</p>d<p>regional study.</p><p>Socio-demographic informations about hosts and <i>M. bovis</i> isolates.</p

Allelic diversity of the 26 MIRU-VNTR loci in <i>M. bovis</i> isolates from humans and livestock in Burkina Faso.^*

<p>*Excluding one strain of the putative African 5 clonal complex that hasn't MIRU-VNTR data.</p><p>Af1 = African 1 clonal complex, Af5 = putative African 5 clonal complex.</p><p>Allelic diversity of the 26 MIRU-VNTR loci in <i>M. bovis</i> isolates from humans and livestock in Burkina Faso.^{<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003142#nt108" target="_blank">*</a>}</p

Priority Activities in Child and Adolescent Tuberculosis to Close the Policy-Practice Gap in Low- and Middle-Income Countries

Over the past 15 years, and despite many difficulties, significant progress has been made to advance child and adolescent tuberculosis (TB) care. Despite increasing availability of safe and effective treatment and prevention options, TB remains a global health priority as a major cause of child and adolescent morbidity and mortality—over one and a half million children and adolescents develop TB each year. A history of the global public health perspective on child and adolescent TB is followed by 12 narratives detailing challenges and progress in 19 TB endemic low and middle-income countries. Overarching challenges include: under-detection and under-reporting of child and adolescent TB; poor implementation and reporting of contact investigation and TB preventive treatment services; the need for health systems strengthening to deliver effective, decentralized services; and lack of integration between TB programs and child health services. The COVID-19 pandemic has had a significant negative impact on case detection and treatment outcomes. Child and adolescent TB working groups can address country-specific challenges to close the policy–practice gaps by developing and supporting decentral ized models of care, strengthening clinical and laboratory diagnosis, including of multidrug-resistant TB, providing recommended options for treatment of disease and infection, and forging strong collaborations across relevant health sectors