The contribution of private health facilities to the urban tuberculosis program of Afghanistan.

SETTING: Although the prevalence of tuberculosis (TB) is generally higher in urban areas than in rural areas, coordination between the private and public sectors for TB control is weak. OBJECTIVE: To share experience from an urban DOTS program in five cities of Afghanistan. DESIGN: An urban DOTS project was designed in 2009 in Kabul, Afghanistan, and later expanded to Kandahar, Jalalabad, Herat, Mazari-i-Sharif, and Paul-i-Khomri cities. RESULTS: In total, 57 public health facilities and 49 private facilities provided DOTS services in the five cities from 2015 to 2018. A total of 28,542 (10.6%) adults (aged ≥15) screened were diagnosed with TB (all forms). The private sector contributed 5,618 (19.7%) of those. Positivity rates among presumptive TB cases in public facilities were 18.9%, 12.5%, 14.4%, and 4.8% in 2015, 2016, 2017, and 2018, respectively. In private facilities, positivity rates were 25.8%, 39.5%, and 27.4% in 2016, 2017, and 2018, respectively. CONCLUSION: The private sector's contribution to case detection was very high and the TB positivity rate among people screened in the private sector was high, which could be due to more selective screening rather than all health facility visitors done by public health facilities.

Prevalence of latent tuberculosis infection among health workers in Afghanistan: A cross-sectional study.

BACKGROUND: About 26% of the world's population may have latent tuberculosis infection (LTBI). Health care workers are a high-risk category because of their professional exposure. METHODS: This cross-sectional study assessed the LTBI burden among health care workers in Afghanistan, a high-TB-burden country. We selected health facilities using a systematic sampling technique and invited all workers at the targeted health facilities to participate. Participants were interviewed about sociodemographic and exposure variables and received tuberculin skin tests for LTBI. RESULTS: Of the 4,648 health care workers invited to participate, 3,686 had tuberculin skin tests. The prevalence of LTBI was found to be 47.2% (1,738 workers). Multivariate analysis showed that a body mass index of ≥ 30 and marriage were associated with an increased risk of LTBI. Underweight (body mass index of ≤ 18 and below) and normal body mass index had no association with increased risk of LTBI. CONCLUSION: LTBI is high among health care workers in Afghanistan. We recommend instituting infection control measures in health facilities and screening workers for timely TB diagnosis.