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Article ; Online: Impact of Community-Wide Tuberculosis Active Case Finding and Human Immunodeficiency Virus Testing on Tuberculosis Trends in Malawi.

Burke, Rachael M / Nliwasa, Marriott / Dodd, Peter J / Feasey, Helena R A / Khundi, McEwen / Choko, Augustine / Nzawa-Soko, Rebecca / Mpunga, James / Webb, Emily L / Fielding, Katherine / MacPherson, Peter / Corbett, Elizabeth L

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2023 Volume 77, Issue 1, Page(s) 94–100

Abstract: Background: Tuberculosis case-finding interventions are critical to meeting World Health Organization End TB strategy goals. We investigated the impact of community-wide tuberculosis active case finding (ACF) alongside scale-up of human immunodeficiency ...

Abstract	Background: Tuberculosis case-finding interventions are critical to meeting World Health Organization End TB strategy goals. We investigated the impact of community-wide tuberculosis active case finding (ACF) alongside scale-up of human immunodeficiency virus (HIV) testing and care on trends in adult tuberculosis case notification rates (CNRs) in Blantyre, Malawi. Methods: Five rounds of ACF for tuberculosis (1-2 weeks of leafleting, door-to-door enquiry for cough and sputum microscopy) were delivered to neighborhoods ("ACF areas") in North-West Blantyre between April 2011 and August 2014. Many of these neighborhoods also had concurrent HIV testing interventions. The remaining neighborhoods in Blantyre City ("non-ACF areas") provided a non-randomized comparator. We analyzed TB CNRs from January 2009 until December 2018. We used interrupted time series analysis to compare tuberculosis CNRs before ACF and after ACF, and between ACF and non-ACF areas. Results: Tuberculosis CNRs increased in Blantyre concurrently with start of ACF for tuberculosis in both ACF and non-ACF areas, with a larger magnitude in ACF areas. Compared to a counterfactual where pre-ACF CNR trends continued during ACF period, we estimated there were an additional 101 (95% confidence interval [CI] 42 to 160) microbiologically confirmed (Bac+) tuberculosis diagnoses per 100 000 person-years in the ACF areas in 3 and a half years of ACF. Compared to a counterfactual where trends in ACF area were the same as trends in non-ACF areas, we estimated an additional 63 (95% CI 38 to 90) Bac + diagnoses per 100 000 person-years in the same period. Conclusions: Tuberculosis ACF was associated with a rapid increase in people diagnosed with tuberculosis in Blantyre.
MeSH term(s)	Adult ; Humans ; Malawi/epidemiology ; Mass Screening ; Tuberculosis/diagnosis ; Tuberculosis/epidemiology ; Cities ; HIV
Language	English
Publishing date	2023-04-24
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciad238
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Article ; Online: Impact of active case-finding for tuberculosis on case-notifications in Blantyre, Malawi: A community-based cluster-randomised trial (SCALE).

Feasey, Helena R A / Khundi, McEwen / Soko, Rebecca Nzawa / Bottomley, Christian / Chiume, Lingstone / Burchett, Helen E D / Nliwasa, Marriott / Twabi, Hussein H / Mpunga, James A / MacPherson, Peter / Corbett, Elizabeth L

PLOS global public health

2023 Volume 3, Issue 12, Page(s) e0002683

Abstract: Active case-finding (ACF) for tuberculosis can help find the "missing millions" with undiagnosed tuberculosis. In a cluster-randomised trial, we investigated impact of ACF on case-notifications in Blantyre, Malawi, where ACF has been intensively ... ...

Abstract	Active case-finding (ACF) for tuberculosis can help find the "missing millions" with undiagnosed tuberculosis. In a cluster-randomised trial, we investigated impact of ACF on case-notifications in Blantyre, Malawi, where ACF has been intensively implemented following 2014 estimates of ~1,000 per 100,000 adults with undiagnosed TB. Following a pre-intervention prevalence survey (May 2019 to March 2020), constrained randomisation allocated neighbourhoods to either door-to-door ACF (sputum microscopy for reported cough >2 weeks) or standard-of-care (SOC). Implementation was interrupted by COVID-19. Cluster-level bacteriologically-confirmed case-notification rate (CNR) ratio within 91 days of ACF was our redefined primary outcome; comparison between arms used Poisson regression with random effects. Secondary outcomes were 91-day CNR ratios comparing all tuberculosis registrations and all non-ACF registrations. Interrupted time series (ITS) analysis of CNRs in the SOC arm examined prevalence survey impact. (ISRCTN11400592). 72 clusters served by 10 study-supported tuberculosis registration centres were randomised to ACF (261,244 adults, 58,944 person-years follow-up) or SOC (256,713 adults, 52,805 person-years). Of 1,192 ACF participants, 13 (1.09%) were smear-positive. Within 91 days, 113 (42 bacteriologically-confirmed) and 108 (33 bacteriologically-confirmed) tuberculosis patients were identified as ACF or SOC cluster residents, respectively. There was no difference by arm, with adjusted 91-day CNR ratios 1.12 (95% CI: 0.61-2.07) for bacteriologically-confirmed tuberculosis; 0.93 (95% CI: 0.68-1.28) for all tuberculosis registrations; and 0.86 (95%CI: 0.63-1.16) for non-ACF (routinely) diagnosed. Of 7,905 ACF and 7,992 SOC pre-intervention survey participants, 12 (0.15%) and 17 (0.21%), respectively, had culture/Xpert-confirmed tuberculosis. ITS analysis showed no survey impact on SOC CNRs. Despite residual undiagnosed tuberculosis of 150 per 100,000 population, there was no increase in tuberculosis notifications from this previously successful approach targeting symptomatic disease, likely due to previous TB ACF and rapid declines in TB burden. In such settings, future ACF should focus on targeted outreach and demand creation, alongside optimised facility-based screening. Trial Registration: ISRCTN11400592.
Language	English
Publishing date	2023-12-05
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0002683
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Article ; Online: Prevalence of bacteriologically-confirmed pulmonary tuberculosis in urban Blantyre, Malawi 2019-20: Substantial decline compared to 2013-14 national survey.

Feasey, Helena R A / Khundi, McEwen / Nzawa Soko, Rebecca / Nightingale, Emily / Burke, Rachael M / Henrion, Marc Y R / Phiri, Mphatso D / Burchett, Helen E / Chiume, Lingstone / Nliwasa, Marriott / Twabi, Hussein H / Mpunga, James A / MacPherson, Peter / Corbett, Elizabeth L

PLOS global public health

2023 Volume 3, Issue 10, Page(s) e0001911

Abstract: Recent evidence shows rapidly changing tuberculosis (TB) epidemiology in Southern and Eastern Africa, with need for subdistrict prevalence estimates to guide targeted interventions. We conducted a pulmonary TB prevalence survey to estimate current TB ... ...

Abstract	Recent evidence shows rapidly changing tuberculosis (TB) epidemiology in Southern and Eastern Africa, with need for subdistrict prevalence estimates to guide targeted interventions. We conducted a pulmonary TB prevalence survey to estimate current TB burden in Blantyre city, Malawi. From May 2019 to March 2020, 115 households in middle/high-density residential Blantyre, were randomly-selected from each of 72 clusters. Consenting eligible participants (household residents ≥ 18 years) were interviewed, including for cough (any duration), and offered HIV testing and chest X-ray; participants with cough and/or abnormal X-ray provided two sputum samples for microscopy, Xpert MTB/Rif and mycobacterial culture. TB disease prevalence and risk factors for prevalent TB were calculated using complete-case analysis, multiple imputation, and inverse probability weighting. Of 20,899 eligible adults, 15,897 (76%) were interviewed, 13,490/15,897 (85%) had X-ray, and 1,120/1,394 (80%) sputum-eligible participants produced at least one specimen, giving 15,318 complete cases (5,895, 38% men). 29/15,318 had bacteriologically-confirmed TB (189 per 100,000 complete-case (cc) / 150 per 100,000 with inverse weighting (iw)). Men had higher burden (cc: 305 [95% CI:144-645] per 100,000) than women (cc: 117 [95% CI:65-211] per 100,000): cc adjusted odds ratio (aOR) 2.70 (1.26-5.78). Other significant risk factors for prevalent TB on complete-case analysis were working age (25-49 years) and previous TB treatment, but not HIV status. Multivariable analysis of imputed data was limited by small numbers, but previous TB and age group 25-49 years remained significantly associated with higher TB prevalence. Pulmonary TB prevalence for Blantyre was considerably lower than the 1,014 per 100,000 for urban Malawi in the 2013-14 national survey, at 150-189 per 100,000 adults, but some groups, notably men, remain disproportionately affected. TB case-finding is still needed for TB elimination in Blantyre, and similar urban centres, but should focus on reaching the highest risk groups, such as older men.
Language	English
Publishing date	2023-10-20
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0001911
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Article ; Online: Effect of patient-delivered household contact tracing and prevention for tuberculosis: A household cluster-randomised trial in Malawi.

Kaswaswa, Kruger / MacPherson, Peter / Kumwenda, Moses / Mpunga, James / Thindwa, Deus / Nliwasa, Marriott / Mwapasa, Mphatso / Odland, Jon / Tomoka, Tamiwe / Chipungu, Geoffrey / Mukaka, Mavuto / Corbett, Elizabeth L

PloS one

2022 Volume 17, Issue 9, Page(s) e0269219

Abstract: Background: Household contact tracing provides TB screening and TB preventive therapy (TPT) to contacts at high risk of TB disease. However, it is resource intensive, inconvenient, and often poorly implemented. We investigated a novel model aiming to ... ...

Abstract	Background: Household contact tracing provides TB screening and TB preventive therapy (TPT) to contacts at high risk of TB disease. However, it is resource intensive, inconvenient, and often poorly implemented. We investigated a novel model aiming to improve uptake. Methods: Between May and December 2014, we randomised patient with TB who consented to participate in the trial to either standard of care (SOC) or intervention (PACTS) arms. Participants randomised to PACTS received one screening/triage tool (adapted from WHO integrated management of adolescent and adult illnesses [IMAI] guidelines) and sputum pots for each reported household contact. The tool guided participants through symptom screening; TPT (6-months of isoniazid) eligibility; and sputum collection for contacts. Patients randomised to SOC were managed in accordance with national guidelines, that is, they received verbal instruction on who to bring to clinics for investigation using national guidelines. Main outcome and measures: The primary outcome was the proportion of adult contacts receiving treatment for TB within 3 months of randomisation. Secondary outcomes were the proportions of child contacts under age 5 years (U5Y) who were commenced on, and completed, TPT. Data were analyzed by logistic regression with random effects to adjust for household clustering. Results: Two hundred and fourteen index TB participants were block-randomized from two sites (107 PACTS, reporting 418 contacts; and 107 SOC, reporting 420 contacts). Overall, 62.8% of index TB participants were HIV-positive and 52.1% were TB culture-positive. 250 otherwise eligible TB patients declined participation and 6 households (10 PACTS, 6 SOC) were lost to follow-up and were not included in the analysis. By three months, nine contacts (PACTS: 6, [1.4%]; SOC: 3, [0.7%]) had TB diagnosed, with no difference between groups (adjusted odds ratio [aOR]: 2.18, 95% CI: 0.60-7.95). Eligible PACTS contacts (37/96, 38.5%) were more likely to initiate TPT by 3-months compared to SOC contacts (27/101, 26.7%; aOR 2.27, 95% CI: 1.04-4.98). U5Y children in the PACTS arm (47/81 58.0%) were more likely to have initiated TPT before the 3-month visit compared to SOC children (36/89, 41.4%; aOR: 2.31, 95% CI: 1.05-5.06). Conclusions and relevance: A household-centred patient-delivered symptom screen and IPT eligibility assessment significantly increased timely TPT uptake among U5Y children, but did not significantly increase TB diagnosis. This model needs to be optimized for acceptability, given low participation, and investigated in other low resource settings. Clinical trial registration: TRIAL REGISTRATION NUMBER: ISRCTN81659509 https://www.isrctn.com/ISRCTN81659509?q=&filters=conditionCategory:Respiratory,recruitmentCountry:Malawi,ageRange:Mixed&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search. 19 July 2012.
MeSH term(s)	Adolescent ; Adult ; Child ; Child, Preschool ; Contact Tracing ; Family Characteristics ; Humans ; Isoniazid/therapeutic use ; Malawi/epidemiology ; Tuberculosis/diagnosis ; Tuberculosis/epidemiology ; Tuberculosis/prevention & control
Chemical Substances	Isoniazid (V83O1VOZ8L)
Language	English
Publishing date	2022-09-08
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0269219
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Article: Urine Lipoarabinomannan Testing for All HIV Patients Hospitalized in Medical Wards Identifies a Large Proportion of Patients With Tuberculosis at Risk of Death.

Huerga, Helena / Mathabire Rucker, Sekai Chenai / Bastard, Mathieu / Mpunga, James / Amoros Quiles, Isabel / Kabaghe, Chimwemwe / Sannino, Laura / Szumilin, Elisabeth

Open forum infectious diseases

2020 Volume 8, Issue 2, Page(s) ofaa639

Abstract: Background: Diagnosing tuberculosis (TB), the leading cause of death in people with HIV, remains a challenge in resource-limited countries. We assessed TB diagnosis using a strategy that included systematic urine lipoarabinomannan (LAM) testing for all ... ...

Abstract	Background: Diagnosing tuberculosis (TB), the leading cause of death in people with HIV, remains a challenge in resource-limited countries. We assessed TB diagnosis using a strategy that included systematic urine lipoarabinomannan (LAM) testing for all HIV patients hospitalized in medical wards and 6-month mortality according to LAM results. Methods: This prospective, observational study included adult HIV patients hospitalized in the medical wards of a public district hospital in Malawi regardless of their TB symptoms or CD4 count. Each patient had a clinical examination, and Alere Determine TB-LAM, sputum microscopy, sputum GeneXpert MTB/RIF (Xpert), chest x-ray, and CD4 count were systematically requested. Results: Among 387 inpatients, 54% had a CD4 <200 cells/µL, 64% had presumptive TB, and 90% had ≥1 TB symptom recorded in their medical file. LAM results were available for 99.0% of patients, microscopy for 62.8%, and Xpert for 60.7%. In total, 26.1% (100/383) had LAM-positive results, 48% (48/100) of which were grades 2-4. Any TB laboratory test result was positive in 30.8% (119/387). Among patients with no Xpert result, 28.5% (43/151) were LAM-positive. Cumulative 6-month mortality was 40.1% (151/377): 50.5% (49/97) in LAM-positives and 36.2% (100/276) in LAM-negatives ( Conclusions: In resource-limited hospital medical wards with high TB prevalence, a diagnostic strategy including systematic urine LAM testing for all HIV patients is an easily implementable strategy that identifies a large proportion of patients with TB at risk of death.
Language	English
Publishing date	2020-12-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofaa639
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Article ; Online: Assessing the Impact of COVID-19 on TB and HIV Programme Services in Selected Health Facilities in Lilongwe, Malawi: Operational Research in Real Time.

Thekkur, Pruthu / Tweya, Hannock / Phiri, Sam / Mpunga, James / Kalua, Thokozani / Kumar, Ajay M V / Satyanarayana, Srinath / Shewade, Hemant D / Khogali, Mohammed / Zachariah, Rony / Rusen, I D / Berger, Selma Dar / Harries, Anthony D

Tropical medicine and infectious disease

2021 Volume 6, Issue 2

Abstract: When the COVID-19 pandemic was announced in March 2020, there was concern that TB and HIV programme services in Malawi would be severely affected. We set up real-time monthly surveillance of TB and HIV activities in eight health facilities in Lilongwe to ...

Abstract	When the COVID-19 pandemic was announced in March 2020, there was concern that TB and HIV programme services in Malawi would be severely affected. We set up real-time monthly surveillance of TB and HIV activities in eight health facilities in Lilongwe to see if it was possible to counteract the anticipated negative impact on TB case detection and treatment and HIV testing. Aggregate data were collected monthly during the COVID-19 period (March 2020-February 2021) using an EpiCollect5 application and compared with monthly data collected during the pre-COVID-19 period (March 2019-February 2020); these reports were sent monthly to programme directors. During COVID-19, there was an overall decrease in persons presenting with presumptive pulmonary TB (45.6%), in patients registered for TB treatment (19.1%), and in individuals tested for HIV (39.0%). For presumptive TB, children and females were more affected, but for HIV testing, adults and males were more affected. During COVID-19, the TB treatment success rate (96.1% in pre-COVID-19 and 96.0% during COVID-19 period) and referral of HIV-positive persons to antiretroviral therapy (100% in pre-COVID-19 and 98.6% during COVID-19 period) remained high and largely unchanged. Declining trends in TB and HIV case detection were not redressed despite real-time monthly surveillance.
Language	English
Publishing date	2021-05-19
Publishing country	Switzerland
Document type	Journal Article
ISSN	2414-6366
ISSN (online)	2414-6366
DOI	10.3390/tropicalmed6020081
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Article ; Online: The prevalence of pulmonary tuberculosis among miners from the Karonga, Rumphi, Kasungu and Lilongwe Districts of Malawi in 2019.

Rambiki, Ethel / Dimba, Andrew / Banda, Pilirani / Ng'ambi, Wingston / Banda, Knox / Girma, Belaineh / Shight, Birru / Lwanda, Levi / Dambe, Isaias / Tripathy, Jaya Prasad / Chola, Mumbi / Chanda-Kapata, Pascalina / Mpunga, James / Kathyola, Damson

Malawi medical journal : the journal of Medical Association of Malawi

2021 Volume 32, Issue 4, Page(s) 184–191

Abstract: Introduction: Miners in sub-Saharan Africa have a greater risk of tuberculosis (TB) than any other working population in the world. In spite of the presence of large and vulnerable population of miners in Malawi, no previous study has aimed to assess ... ...

Abstract	Introduction: Miners in sub-Saharan Africa have a greater risk of tuberculosis (TB) than any other working population in the world. In spite of the presence of large and vulnerable population of miners in Malawi, no previous study has aimed to assess the burden of TB among these miners. This study aimed to determine the prevalence of pulmonary tuberculosis (PTB) and health-seeking behaviour (HSB) in a population of miners in Malawi, and a range of associated factors. Our goal was to develop a method to identify missing cases of TB. Methods: We conducted a cross-sectional study in the Karonga, Rumphi, Kasungu and Lilongwe districts of Malawi in 2019. We calculated frequencies, proportions, odds ratios (ORs) and their 95% confidence intervals (95% CIs), and used the chi-square test in STATA version15.1 to investigate the burden and magnitude of PTB in the mining sector. Bivariate and multivariate logistic regression models were also fitted for PTB and HSB. Results: Of the 2400 miners approached, we were able to interview 2013 (84%). Of these, 1435 (71%) were males, 1438 (71%) had known HIV status and 272 (14%) had PTB. Multivariate analysis showed that the miners performing informal mining were 50% more likely to develop PTB compared with those in formal mining (adjusted odds ratio [AOR]=1.50, 95% CI: 1.10-2.05, Conclusion: The prevalence of PTB was higher among miners than in the general population. Consequently, targeted TB screening programmes for miners may represent a suitable strategy to adopt if we are to end TB by 2030. Poor health-seeking behaviours among miners is worrisome and further qualitative research is necessary to understand the barriers to accessing health care in these settings.
MeSH term(s)	Adolescent ; Adult ; Aged ; Cross-Sectional Studies ; Female ; Humans ; Malawi/epidemiology ; Male ; Middle Aged ; Mining ; Occupational Diseases/epidemiology ; Prevalence ; Tuberculosis, Pulmonary/epidemiology ; Young Adult
Language	English
Publishing date	2021-08-24
Publishing country	Malawi
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2491952-4
ISSN	1995-7270 ; 1995-7270
ISSN (online)	1995-7270
ISSN	1995-7270
DOI	10.4314/mmj.v32i4.2
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Article ; Online: The shift in tuberculosis timing among people living with HIV in the course of antiretroviral therapy scale-up in Malawi.

Tweya, Hannock / Feldacker, Caryl / Mpunga, James / Kanyerere, Henry / Heller, Tom / Ganesh, Prakash / Nkosi, Dave / Kalulu, Mike / Sinkala, George / Satumba, Thomas / Phiri, Sam

Journal of the International AIDS Society

2019 Volume 22, Issue 4, Page(s) e25240

Abstract: Introduction: Although the use of antiretroviral therapy (ART) reduces HIV-associated tuberculosis (TB), patients living with HIV receiving ART remain at a higher risk of developing TB compared to those without HIV. We investigated the incidence of TB ... ...

Abstract	Introduction: Although the use of antiretroviral therapy (ART) reduces HIV-associated tuberculosis (TB), patients living with HIV receiving ART remain at a higher risk of developing TB compared to those without HIV. We investigated the incidence of TB and the proportion of HIV-associated TB cases among patients living with HIV who are receiving ART. Methods: The study used TB registration and ART programme data collected between 2008 and 2017 from an integrated, public clinic in urban Lilongwe, Malawi. ART initiation was based on either WHO clinical staging or CD4 cell count. The CD4 thresholds for ART initiation eligibility was initially 250 cells/μL then changed to 350 cells/μL in 2011, 500 cells/μL in 2014 and to universal treatment upon diagnosis from 2016. Using TB registration data, we calculated the proportion of TB/HIV patients who were already on ART when they registered for TB treatment by year of TB registration. ART registration data were used to examine TB incidence by calendar year of ART follow-up and by time on ART. Results: The overall proportion of TB/patients living with HIV who started TB treatment while on ART increased from 21% in 2008 to 81% in 2017 but numbers remained relatively constant at 500 TB cases annually. The overall incidence rate of TB among patients on ART was 1.35/100 person-years (95% CI 1.28 to 1.42). The incidence of TB by time on ART decreased from 6.4/100 person-years in the first three months of ART to 0.4/100 person-years after eight years on ART. TB incidence was highest in the first month on ART. The annual rate of TB among patients on ART rapidly decreased each calendar year and stabilized at 1% after 2013. Although the risk of developing TB decreased with year of ART initiation in univariable analysis, there was no significant association after adjusting for sex, age and reason for ART eligibility. Conclusions: The decline in TB incidence over calendar years suggests protective effects of early ART initiation. The high TB incidence within the first month of ART highlights the need for more sensitive tools such as X-ray and GeneXpert to identify patients living with HIV who have clinical and subclinical TB disease at ART initiation.
MeSH term(s)	Adult ; Ambulatory Care Facilities ; Anti-HIV Agents/adverse effects ; Anti-HIV Agents/therapeutic use ; Antitubercular Agents/therapeutic use ; CD4 Lymphocyte Count ; Cross-Sectional Studies ; Female ; HIV Infections/complications ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; HIV Infections/immunology ; Humans ; Incidence ; Malawi/epidemiology ; Male ; Middle Aged ; Retrospective Studies ; Time Factors ; Tuberculosis/drug therapy ; Tuberculosis/epidemiology ; Tuberculosis/etiology
Chemical Substances	Anti-HIV Agents ; Antitubercular Agents
Language	English
Publishing date	2019-05-14
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2467110-1
ISSN	1758-2652 ; 1758-2652
ISSN (online)	1758-2652
ISSN	1758-2652
DOI	10.1002/jia2.25240
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Article ; Online: Feasibility of using Determine TB-LAM to diagnose tuberculosis in HIV-positive patients in programmatic conditions: a multisite study.

Mathabire Rucker, Sekai Chenai / Cossa, Loide / Harrison, Rebecca E / Mpunga, James / Lobo, Sheila / Kisaka Kimupelenge, Patrick / Mandar Kol'Ampwe, Felix / Amoros Quiles, Isabel / Molfino, Lucas / Szumilin, Elisabeth / Telnov, Oleksandr / Ndlovu, Zibusiso / Huerga, Helena

Global health action

2019 Volume 12, Issue 1, Page(s) 1672366

Abstract: ... ...

Abstract	Background
MeSH term(s)	Africa South of the Sahara/epidemiology ; Cross-Sectional Studies ; Feasibility Studies ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Humans ; Interviews as Topic ; Lipopolysaccharides ; Point-of-Care Systems ; Sensitivity and Specificity ; Sputum/microbiology ; Tuberculosis/diagnosis ; Tuberculosis/epidemiology
Chemical Substances	Lipopolysaccharides ; lipoarabinomannan
Language	English
Publishing date	2019-10-15
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2540569-X
ISSN	1654-9880 ; 1654-9716
ISSN (online)	1654-9880
ISSN	1654-9716
DOI	10.1080/16549716.2019.1672366
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Article ; Online: Evaluation of 6-Month Versus Continuous Isoniazid Preventive Therapy for Mycobacterium tuberculosis in Adults Living With HIV/AIDS in Malawi.

Hsieh, Yuli L / Jahn, Andreas / Menzies, Nicolas A / Yaesoubi, Reza / Salomon, Joshua A / Girma, Belaineh / Gunde, Laurence / Eaton, Jeffrey W / Auld, Andrew / Odo, Michael / Kiyiika, Caroline N / Kalua, Thokozani / Chiwandira, Brown / Mpunga, James U / Mbendra, Kuzani / Corbett, Liz / Hosseinipour, Mina C / Cohen, Ted / Kunkel, Amber

Journal of acquired immune deficiency syndromes (1999)

2020 Volume 85, Issue 5, Page(s) 643–650

Abstract: Background: To assist the Malawi Ministry of Health to evaluate 2 competing strategies for scale-up of isoniazid preventive therapy (IPT) among HIV-positive adults receiving antiretroviral therapy.: Setting: Malawi.: Methods: We used a ... ...

Abstract	Background: To assist the Malawi Ministry of Health to evaluate 2 competing strategies for scale-up of isoniazid preventive therapy (IPT) among HIV-positive adults receiving antiretroviral therapy. Setting: Malawi. Methods: We used a multidistrict, compartmental model of the Malawi tuberculosis (TB)/HIV epidemic to compare the anticipated health impacts of 6-month versus continuous IPT programs over a 12-year horizon while respecting a US$10.8 million constraint on drug costs in the first 3 years. Results: The 6-month IPT program could be implemented nationwide, whereas the continuous IPT alternative could be introduced in 14 (of the 27) districts. By the end of year 12, the continuous IPT strategy was predicted to avert more TB cases than the 6-month alternative, although not statistically significant (2368 additional cases averted; 95% projection interval [PI], -1459 to 5023). The 6-month strategy required fewer person-years of IPT to avert a case of TB or death than the continuous strategy. For both programs, the mean reductions in TB incidence among people living with HIV by year 12 were expected to be <10%, and the cumulative numbers of IPT-related hepatotoxicity to exceed the number of all-cause deaths averted in the first 3 years. Conclusions: With the given budgetary constraint, the nationwide implementation of 6-month IPT would be more efficient and yield comparable health benefits than implementing a continuous IPT program in fewer districts. The anticipated health effects associated with both IPT strategies suggested that a combination of different TB intervention strategies would likely be required to yield a greater impact on TB control in settings such as Malawi, where antiretroviral therapycoverage is relatively high.
MeSH term(s)	Adult ; Antitubercular Agents/administration & dosage ; Antitubercular Agents/therapeutic use ; Drug Administration Schedule ; HIV Infections/complications ; Humans ; Incidence ; Isoniazid/administration & dosage ; Isoniazid/therapeutic use ; Malawi/epidemiology ; Tuberculosis, Pulmonary/epidemiology ; Tuberculosis, Pulmonary/prevention & control
Chemical Substances	Antitubercular Agents ; Isoniazid (V83O1VOZ8L)
Language	English
Publishing date	2020-11-23
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	645053-2
ISSN	1944-7884 ; 1077-9450 ; 0897-5965 ; 0894-9255 ; 1525-4135
ISSN (online)	1944-7884 ; 1077-9450
ISSN	0897-5965 ; 0894-9255 ; 1525-4135
DOI	10.1097/QAI.0000000000002497
Database	MEDical Literature Analysis and Retrieval System OnLINE

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