Preventing tuberculosis in people at high risk

Background Poverty drives TB rates but the current TB control approach is disproportionately biomedical. In 2015, the World Health Organisation’s End TB Strategy explicitly identified the need to address the social determinants of TB through socioeconomic interventions. However, evidence concerning poverty-reduction and costs-mitigation strategies is limited. My PhD research aimed to address this knowledge gap. Methods During this PhD, I aimed to develop as an independent researcher while addressing the social determinants of TB in impoverished shantytown communities of Callao, Peru, through integrated projects. The research was divided into two phases: 1) Final follow-up, data collection, analysis, and write-up of: a case-control study defining the TB-poverty association; an ecological study assessing poverty-related risk factors for TB infection and disease; and a cohort study identifying TB-related costs of TB-affected families and creating a clinically-relevant catastrophic costs threshold. 2) Conception, design, implementation, data collection, analysis, and write-up of a household-randomized controlled study of a socioeconomic intervention to improve TB cure and prevention. Results The first phase showed that TB remains a disease of people living in poverty, that “free” TB care was expensive for impoverished TB-affected families to afford, and that incurring catastrophic costs explained as many adverse outcomes as multi-drug resistant (MDR) TB. The second phase showed that, in households receiving the TB-specific socioeconomic intervention, TB-affected households were less likely to incur catastrophic costs, household contacts were more likely to start and adhere to TB preventive therapy, and TB patients were more likely to be cured. Conclusion In impoverished Peruvian shantytowns, poverty remains associated with TB and incurring catastrophic TB-related costs predicted adverse TB outcome. A novel TB-specific socioeconomic intervention reduced catastrophic costs and improved TB preventive therapy uptake and TB cure. The impact of the intervention on TB control will now be evaluated during the Community Randomized Evaluation of a Socioeconomic Intervention to Prevent TB (CRESIPT) study.Open Acces

Healthcare workers and coronavirus: behind the stiff upper lip we are highly vulnerable

Much has already been written about the effect of COVID-19 on vulnerable groups, including older people and those with underlying health conditions. Yet there is another vulnerable group that is rarely mentioned in this pandemic: healthcare workers. Although the exact numbers are not yet clear, thousands of healthcare workers worldwide have caught COVID-19 and many have lost their lives

Health, Healthcare Access, and Use of Traditional Versus Modern Medicine in Remote Peruvian Amazon Communities: A Descriptive Study of Knowledge, Attitudes, and Practices

There is an urgent need for healthcare research, funding, and infrastructure in the Peruvian Amazon. We performed a descriptive study of health, health knowledge and practice, and healthcare access of 13 remote communities of the Manatí and Amazon Rivers in northeastern Peru. Eighty-five adults attending a medical boat service were interviewed to collect data on socioeconomic position, health, diagnosed illnesses, pain, healthcare access, and traditional versus modern medicine use. In this setting, poverty and gender inequality were prevalent, and healthcare access was limited by long distances to the health post and long waiting times. There was a high burden of reported pain (mainly head and musculoskeletal) and chronic non-communicable diseases, such as hypertension (19%). Nearly all participants felt that they did not completely understand their diagnosed illnesses and wanted to know more. Participants preferred modern over traditional medicine, predominantly because of mistrust or lack of belief in traditional medicine. Our findings provide novel evidence concerning transitional health beliefs, hidden pain, and chronic non-communicable disease prevalence in marginalized communities of the Peruvian Amazon. Healthcare provision was limited by a breach between health education, knowledge, and access. Additional participatory research with similar rural populations is required to inform regional healthcare policy and decision-making

High prevalence of TB disease in contacts of adults with extrapulmonary TB

UK guidelines no longer recommend routine screening of household contacts of adult patients with extrapulmonary TB (EPTB). From 27 March 2012 to 28 June 2016, we investigated the prevalence of active TB disease in household contacts of 1023 EPTB index cases in North West England, and compared estimates with: published new entrant migrant screening programme prevalence (~147/100 000 person-years); London-based contact screening data (700/100 000 contacts screened); and National Institute for Health and Care Excellence (NICE) new entrant TB screening thresholds (TB prevalence >40/100 000 people). Active TB disease prevalence in EPTB contacts was 440/100 000 contacts screened, similar to UK new entrant screening programmes, London EPTB contact prevalence and >10 times NICE’s threshold for new entrant screening. The decision to no longer recommend routine screening of EPTB contacts should be re-evaluated and cost-effectiveness analyses of screening strategies for EPTB contacts should be performed

Active case finding in tuberculosis-affected households: time to scale up

In 2017, 10 million people developed tuberculosis, of whom approximately 4 million were not diagnosed, treated, or notified to national tuberculosis programmes (NTP).1 Of the remaining 6 million, many experienced substantial delays in accessing and receiving appropriate care.1 This unacceptable situation leads to unnecessary disability and loss of life, and impedes tuberculosis control because of onward transmission at a household and community level. To rectify these shortcomings and eliminate tuberculosis, new strategies are urgently required to enhance tuberculosis case detection

Editorial Biosocial Strategies to Address the Socioeconomic Determinants and Consequences of the TB and COVID-19 Pandemics

Biosocial Strategies to Address the Socioeconomic Determinants and Consequences of the TB and COVID-19 Pandemics