Epidemiologic impact of treatment interventions for tuberculosis control

Background Once thought to be on its way to elimination, tuberculosis (TB) has resurged in recent decades and is now the leading cause of death among infectious diseases globally. Effective TB control will require optimal implementation of treatment interventions in order to maximize the potential benefits not only for individual patients but also at the population level. Methods We conducted three studies using dynamic compartmental models of TB transmission to project the potential impact of shortened duration of first-line TB therapy on TB incidence and mortality (Chapter II), the effect of re-using pyrazinamide in both first- and second-line treatment on the emergence of extensive drug resistance (Chapter III), and the value of treatment scale-up and programmatic improvements in the control of multidrug-resistant (MDR) TB (Chapter IV). Results Contrary to previous studies, we find that shortening the duration of first-line TB therapy is unlikely to yield major reductions in incidence over a time span of 15 years (projected reduction 1.9% with 4-month vs. 6-month treatment). We then demonstrate how the routine use of pyrazinamide in both first- and second-line TB treatment may promote the emergence of extensively drug-resistant TB. In the last study, we find that although scaling up treatment of MDR TB may substantially reduce future prevalence (median reduction in MDR TB prevalence 28.1% over 20 years), combining scale-up with programmatic interventions that improve linkage to care and treatment completion maximizes impact (median reduction 74.5%). Conclusions This work provides valuable guidance in optimizing treatment interventions to achieve population-level impact in global TB control

Monument Des Martyrs Dans La Ville d’Abidjan : Entre Logique Urbaine Et Légitimation Politique (2002 À 2010)

This text handles with the fate of the built monuments to the memory of victims built as martyrs in a context of crisis in Côte d’Ivoire. He is mainly interested in the way the political systems legitimize them since their construction. As regards him "Monument of the martyrs", the results show a kind of legitimization of the power in sync with the mobilization of urban logics. Which passes by the gratitude and the valuation to the deaths set up as martyrs and by the strategies of identification, resistance and identity domination. The article tends to highlight a variability of the fields of use of the monument as social resource and the representations which are associated with it, the links built between such representations and the arrangement of the city during period going from 2002 till 2010. As a matter of fact, the text shows that the legitimization of the monument in the urban dynamics favors rationalities the coherence of which strengthens the public action regarding governance, regarding production of a shape of citizenship, a type of collective identity and spatial markin

Population-level impact of shorter-course regimens for tuberculosis: a model-based analysis.

Despite current control efforts, global tuberculosis (TB) incidence is decreasing slowly. New regimens that can shorten treatment hold promise for improving treatment completion and success, but their impact on population-level transmission remains unclear. Earlier models projected that a four-month regimen could reduce TB incidence by 10% but assumed that an entire course of therapy must be completed to derive any benefit. We constructed a dynamic transmission model of TB disease calibrated to global estimates of incidence, prevalence, mortality, and treatment success. To account for the efficacy of partial treatment, we used data from clinical trials of early short-course regimens to estimate relapse rates among TB patients who completed one-third, one-half, two-thirds, and all of their first-line treatment regimens. We projected population-level incidence and mortality over 10 years, comparing standard six-month therapy to hypothetical shorter-course regimens with equivalent treatment success but fewer defaults. The impact of hypothetical four-month regimens on TB incidence after 10 years was smaller than estimated in previous modeling analyses (1.9% [95% uncertainty range 0.6-3.1%] vs. 10%). Impact on TB mortality was larger (3.5% at 10 years) but still modest. Transmission impact was most sensitive to the proportion of patients completing therapy: four-month therapy led to greater incidence reductions in settings where 25% of patients leave care ("default") over six months. Our findings remained robust under one-way variation of model parameters. These findings suggest that novel regimens that shorten treatment duration may have only a modest effect on TB transmission except in settings of very low treatment completion

Drivers and trajectories of resistance to new first-line drug regimens for tuberculosis.

BACKGROUND: New first-line drug regimens for treatment of tuberculosis (TB) are in clinical trials: emergence of resistance is a key concern. Because population-level data on resistance cannot be collected in advance, epidemiological models are important tools for understanding the drivers and dynamics of resistance before novel drug regimens are launched. METHODS: We developed a transmission model of TB after launch of a new drug regimen, defining drug-resistant TB (DR-TB) as resistance to the new regimen. The model is characterized by (1) the probability of acquiring resistance during treatment, (2) the transmission fitness of DR-TB relative to drug-susceptible TB (DS-TB), and (3) the probability of treatment success for DR-TB versus DS-TB. We evaluate the effect of each factor on future DR-TB prevalence, defined as the proportion of incident TB that is drug-resistant. RESULTS: Probability of acquired resistance was the strongest predictor of the DR-TB proportion in the first 5 years after the launch of a new drug regimen. Over a longer term, however, the DR-TB proportion was driven by the resistant population's transmission fitness and treatment success rates. Regardless of uncertainty in acquisition probability and transmission fitness, high levels (>10%) of drug resistance were unlikely to emerge within 50 years if, among all cases of TB that were detected, 85% of those with DR-TB could be appropriately diagnosed as such and then successfully treated. CONCLUSIONS: Short-term surveillance cannot predict long-term drug resistance trends after launch of novel first-line TB regimens. Ensuring high treatment success of drug-resistant TB through early diagnosis and appropriate second-line therapy can mitigate many epidemiological uncertainties and may substantially slow the emergence of drug-resistant TB

Building a Systematic Online Living Evidence Summary of COVID-19 Research

Throughout the global coronavirus pandemic, we have seen an unprecedented volume of COVID-19 researchpublications. This vast body of evidence continues to grow, making it difficult for research users to keep up with the pace of evolving research findings. To enable the synthesis of this evidence for timely use by researchers, policymakers, and other stakeholders, we developed an automated workflow to collect, categorise, and visualise the evidence from primary COVID-19 research studies. We trained a crowd of volunteer reviewers to annotate studies by relevance to COVID-19, study objectives, and methodological approaches. Using these human decisions, we are training machine learning classifiers and applying text-mining tools to continually categorise the findings and evaluate the quality of COVID-19 evidence

Decolonising global health in the time of COVID-19

The persistent influence of coloniality both from external actors and from within threatens the response to COVID-19 in Africa. This essay presents historical context for the colonial inheritance of modern global health and analyses two controversies related to COVID-19 that illustrate facets of coloniality: comments made by French researchers regarding the testing of BCG vaccine in Africa, and the claims by Madagascar’s president Andry Rajoelina that the country had developed an effective traditional remedy named Covid-Organics. Leveraging both historical sources and contemporary documentary sources, I demonstrate how the currents of exploitation, marginalisation, pathologisation and saviourism rooted in coloniality are manifested via these events. I also discuss responses to coloniality, focussing on the misuse and co-optation of pan-Africanist rhetoric. In particular, I argue that the scandal surrounding Covid-Organics is a reflection of endogenised coloniality, whereby local elites entrench and benefit from inequitable power structures at the intersubjective (rather than trans-national) scale. I conclude with a reflection on the need for equity as a guiding principle to dismantle global health colonialism

Reseaux de solidarite et developpement du secteur informel feminin en cote d’ivoire : etude de cas des femmes entrepreneures a bouaké

Les femmes développent de plus en plus de stratégies entrepreneuriales pouvant faciliter le développement et la pérennité de leurs petites unités économiques. En dépit des niveaux très faibles du capital humain, matériel et financier, elles parviennent à devenir d'importantes entrepreneures par des stratégies de mutualisation tout aussi innovantes qu’hybrides. Ces systèmes de solidarité font l’objet de cet article. Il vise, notamment, à comprendre et analyser le processus de transformation de ces activités informelles en lien avec les différentes formes de solidarités auxquelles participent les promotrices. Pour ce faire, une enquête mixte (qualitative et quantitative) a été conduite auprès d’un échantillon aléatoire simple de 96 femmes revendiquant une réussite économique dans leurs activités à Bouaké. A terme, l’analyse des données empiriques au moyen de la démarche interactionniste suggère : (i) les déterminants des choix des réseaux par les femmes; (ii) l’accompagnement des activités par ces réseaux; (iii) la sécurisation de celles-ci par la pérennisation des activités et ; (iv) les tensions inhérentes aux relations interpersonnelles au sein des réseaux de solidarité.   Women are developing more and more entrepreneurial strategies that can facilitate the development and sustainability of their small economic units. Despite the very low levels of human, material and financial capital, they manage to become important entrepreneurs through mutualization strategies that are as innovative as they are hybrids. These solidarity systems are the subject of this paper. It aims, in particular, to understand and analyze the transformation process of these informal activities in connection with the different forms of solidarity in which the promoters participate. To do this, a mixed survey (qualitative and quantitative) was conducted with a simple random sample of 96 women claiming economic success in their activities in Bouaké. Ultimately, the analysis of empirical data using the interactionist approach suggests: (i) the determinants of network choices by women; (ii) the support of activities by these networks; (iii) securing them through the sustainability of activities and; (iv) the tensions inherent in interpersonal relationships within solidarity networks