Pre-Treatment Loss to Follow-up of Patients with Bacilloscopy-Confirmed Pulmonary Tuberculosis in the National Center for the Fight Against Tuberculosis and Respiratory Diseases in Niamey

Context: Pre-treatment loss of follow-up (PTLFU) represents a major problem that hinders the management of tuberculosis. The objective of this study is to determine the prevalence of lost to follow-up patients diagnosed with smear-positive pulmonary tuberculosis (SPPT) and referred to other TB screening and treatment centers (TBSTC). Method: This was a prospective, descriptive and analytical  study conducted over a six month between March and August 2019, in patients diagnosed with smear-positive pulmonary tuberculosis at NCFATRD and referred to Niamey and Tillaberi centers. The chi-square text was used with a significance level of P ≤ 0.05. Results: 743 patients were diagnosed with SPPT, and 346 were referred to the TBSTC located in Niamey and Tillaberi cities. The prevalence of loss of follow-up before treatment in both Niamey and Tillaberi cities was 14.45% (50/343). Male represented 82% (41) of the cases with a sex ratio of 4.55. The mean age of our patients was 41.04 years. Patients not attending school and those with primary education represented the majority with 30% each. The majority of PTLFU (95.66%) were new cases of TB.  Nearly half (42%) of PTLFU had traveled a distance of 6 to 15 km to get the TB screening. During the phone call follow up, we were able to reach only 12 patients (24%) of which 7 (14%) were deceased. Conclusion : the prevalence of PTLFU is high, therefore there is a need to reinforce the research of lost to follow up patients in order to improve tuberculosis control and management

Pre-treatment Loss to Follow-up in Patients with Confirmed Pulmonary Tuberculosis in Niamey, Niger

Aims and Scope: Pre-treatment loss to follow-up (PTLFU) represents a major problem that hinders the management of tuberculosis. This paper focuses on determining the prevalence of lost to follow-up patients diagnosed with smear-positive pulmonary tuberculosis (SPPT) who are referred to other TB screening and treatment centers (TBSTC). Methods: This was a prospective, descriptive, and analytical study conducted over a six-month period between March and August 2019, in patients diagnosed with smear-positive pulmonary tuberculosis at NCFATRD and referred to Niamey and Tillaberi centers. A chi-square test was used with a significance level of P ≤ 0.05. Findings: 743 patients were diagnosed with SPPT, and 346 were referred to the TBSTC located in Niamey and Tillaberi cities. The prevalence of loss to follow-up before treatment in both Niamey and Tillaberi cities was 14.45% (50/343). Males represented 82% (41) of the cases with a sex ratio of 4.55. The mean age of the patients was 41.04 years. Patients not attending school, as well as those with primary school education, represented the majority of cases, accounting for 30% each. The majority of PTLFU (95.66%) were new cases of TB. Nearly half (42%) of PTLFU had traveled a distance of 6 to 15 km to receive TB screening. During the phone call follow up, only 12 patients (24%) were reached, of whom 7 (14%) were deceased. Conclusion: The prevalence of PTLFU remains high. Therefore, reinforcing the research of lost to follow-up patients is necessary to enhance tuberculosis control and management

Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January–April 2020

Coronavirus disease has disrupted tuberculosis services globally. Data from 33 centers in 16 countries on 5 continents showed that attendance at tuberculosis centers was lower during the first 4 months of the pandemic in 2020 than for the same period in 2019. Resources are needed to ensure tuberculosis care continuity during the pandemic

Evaluating the Effectiveness of a Novel Systematic Screening Approach for Tuberculosis among Individuals Suspected or Recovered from COVID-19: Experiences from Niger and Guinea

Evidence suggests that the COVID-19 pandemic negatively impacts tuberculosis (TB) activities. As TB and COVID-19 have similar symptoms, we assessed the effectiveness of integrated TB/COVID-19 screening in Guinea and Niger. From May to December 2020, TB screening was offered to symptomatic patients after a negative COVID-19 PCR test or after recovery from COVID-19 in Guinea. From December 2020 to March 2021, all presumptive COVID-19 patients with respiratory symptoms were tested simultaneously for COVID-19 and TB in Niger. We assessed the TB detection yield and used micro-costing to estimate the costs associated with both screening algorithms. A total of 863 individuals (758 in Guinea, and 105 in Niger), who were mostly male (60%) and with a median age of 34 (IQR: 26–45), were screened for TB. Reported symptoms were cough ≥2 weeks (49%), fever (45%), and weight loss (30%). Overall, 61 patients (7%) tested positive for COVID-19 (13 in Guinea, 48 in Niger) and 43 (4.9%) were diagnosed with TB disease (35 or 4.6% in Guinea, and 8 or 7.6% in Niger). The cost per person initiating TB treatment was USD $367 in Guinea and$566 in Niger. Overall, the yield of both approaches was high, and the cost was modest. Optimizing integrated COVID-19/TB screening may support maintaining TB detection during the ongoing pandemic

Relationship between patient sex and anatomical sites of extrapulmonary tuberculosis in Mali

Background: Contribution of host factors in mediating susceptibility to extrapulmonary tuberculosis is not well understood. Objective: To examine the influence of patient sex on anatomical localization of extrapulmonary tuberculosis. Methods: We conducted a retrospective cross-sectional study in Mali, West Africa. Hospital records of 1,304 suspected cases of extrapulmonary tuberculosis, available in TB Registry of a tertiary tuberculosis referral center from 2019 to 2021, were examined. Results: A total of 1,012 (77.6%) were confirmed to have extrapulmonary tuberculosis with a male to female ratio of 1.59:1. Four clinical forms of EPTB predominated, namely pleural (40.4%), osteoarticular (29.8%), lymph node (12.5%), and abdominal TB (10.3%). We found sex-based differences in anatomical localization of extrapulmonary tuberculosis, with males more likely than females to have pleural TB (OR: 1.51; 95% CI [1.16 to 1.98]). Conversely, being male was associated with 43% and 41% lower odds of having lymph node and abdominal TB, respectively (OR: 0.57 and 0.59). Conclusion: Anatomical sites of extrapulmonary tuberculosis differ by sex with pleural TB being associated with male sex while lymph node and abdominal TB are predominately associated with female sex. Future studies are warranted to understand the role of sex in mediating anatomical site preference of tuberculosis

Mycobacterium africanum (Lineage 6) shows slower sputum smear conversion on tuberculosis treatment than Mycobacterium tuberculosis (Lineage 4) in Bamako, Mali.

ObjectiveAncestral M. tuberculosis complex lineages such as M. africanum are underrepresented among retreatment patients and those with drug resistance. To test the hypothesis that they respond faster to TB treatment, we determined the rate of smear conversion of new pulmonary tuberculosis patients in Bamako, Mali by the main MTBc lineages.MethodsBetween 2015 and 2017, we conducted a prospective cohort study of new smear positive pulmonary tuberculosis patients in Bamako. Confirmed MTBc isolates underwent genotyping by spoligotyping for lineage classification. Patients were followed at 1 month (M), 2M and 5M to measure smear conversion in auramine (AR) and Fluorescein DiAcetate (FDA) vital stain microscopy.ResultAll the first six human MTBc lineages were represented in the population, plus M. bovis in 0.8% of the patients. The most widely represented lineage was the modern Euro-American lineage (L) 4, 57%, predominantly the T family, followed by L6 (M. africanum type 2) in 22.9%. Ancestral lineages 1, 5, 6 and M. bovis combined amounted to 28.8%. Excluding 25 patients with rifampicin resistance, smear conversion, both by AR and FDA, occurred later in L6 compared to L4 (HR 0.80 (95% CI 0.66-0.97) for AR, and HR 0.81 (95%CI 0.68-0.97) for FDA). In addition we found that HIV negative status, higher BMI at day 0, and patients with smear grade at baseline ≤ 1+ were associated with earlier smear conversion.ConclusionThe six major human lineages of the MTBc all circulate in Bamako. Counter to our hypothesis, we found that patients diseased with modern M. tuberculosis complex L4 respond faster to TB treatment than those with M. africanum L6

Gauging the impact of the COVID-19 pandemic on tuberculosis services: a global study

10.1183/13993003.01786-2021Eur Respir