Evaluation of health-related quality of life in patients with tuberculosis who completed treatment in Kiribati.

Objective To examine the health-related quality of life (HRQoL) and related factors among patients with smear-positive and smear-negative pulmonary tuberculosis (TB) within 2 years after completion of directly observed treatment, short course (DOTS), and to compare their HRQoL with a comparison group of community-dwelling individuals without TB in South Tarawa, Kiribati. Methods A cross-sectional questionnaire survey was conducted among 206 pulmonary TB patients who had completed DOTS and 214 individuals without TB, from July to September 2012. HRQoL was measured using the Short Form (36) Health Survey (SF-36). Results The patients with TB had a statistically significantly higher physical component summary (PCS) score and mental component summary (MCS) score on the SF-36 than the comparison group after adjustment for background characteristics. However, the differences did not exceed the 3-point threshold for clinically significant differences. Multiple liner regression showed that older age and presence of persistent symptoms after completion of DOTS were related to a lower PCS score in TB patients. Patients who were smear-positive before DOTS treatment had higher MCS scores than those who were smear-negative. Conclusions Our results suggest the effectiveness of DOTS treatment. Health professionals can enhance HRQoL among posttreatment TB patients by managing their symptoms.

Battling tuberculosis in an island context with a high burden of communicable and non-communicable diseases: epidemiology, progress, and lessons learned in Kiribati, 2000 to 2012.

OBJECTIVES: To examine the epidemiology of tuberculosis (TB) in Kiribati from 2000 to 2012, document lessons learned, and recommend ways to mitigate the burden of TB in Kiribati. METHODS: A descriptive study was performed using data on TB case notifications, prevalence, incidence, mortality, and treatment outcomes from global reports and data files. Progress towards meeting the Millennium Development Goal TB target (to reduce TB incidence by 2015) and the Regional Strategy to Stop Tuberculosis in the Western Pacific 2011-2015 targets (to reduce TB prevalence and mortality by half by 2015 relative to the level in 2000) was examined. RESULTS: TB case notifications and the estimated incidence and prevalence have increased in Kiribati since 2000. From 2000 to 2012, Kiribati reported a total of 3863 TB notifications; in 2012, the case notification rate was 343/100 000 population. The majority (89%) of TB patients complete treatment and/or are cured, and the estimated TB mortality rate has remained relatively stable at around 16/100 000 population. HIV testing of TB patients has increased over recent years from 8% of notifications tested in 2003 to 43% tested in 2012. Of all 818 tests, only four (0.5%) patients were confirmed HIV-positive. Drug-resistant TB has been detected in a small number of cases. CONCLUSIONS: TB rates continue to increase in Kiribati and the 2015 goals for TB control are unlikely to be met. This is probably due to the complex mix of risk factors present in Kiribati, including smoking, diabetes, alcohol use, crowded living, and poverty. A comprehensive approach to address these risk factors is needed to mitigate the burden of TB in Kiribati.

First molecular epidemiology study of Mycobacterium tuberculosis in Kiribati.

Tuberculosis incidence rates in Kiribati are among the highest in the Western Pacific Region, however the genetic diversity of circulating Mycobacterium tuberculosis complex strains (MTBC) and transmission dynamics are unknown. Here, we analysed MTBC strains isolated from culture positive pulmonary tuberculosis (TB) cases from the main TB referral centre between November 2007 and October 2009. Strain genotyping (IS6110 typing, spoligotyping, 24-loci MIRU-VNTR and SNP typing) was performed and demographic information collected. Among 73 MTBC strains analysed, we identified seven phylogenetic lineages, dominated by Beijing strains (49%). Beijing strains were further differentiated in two main branches, Beijing-A (n = 8) and -B (n = 28), that show distinct genotyping patterns and are characterized by specific deletion profiles (Beijing A: only RD105, RD207 deleted; Beijing B: RD150 and RD181 additionally deleted). Many Kiribati strains (59% based on IS6110 typing of all strains) occurred in clusters, suggesting ongoing local transmission. Beijing-B strains and over-crowded living conditions were associated with strain clustering (likely recent transmission), however little evidence of anti-tuberculous drug resistance was observed. We suggest enhanced case finding amongst close contacts and continued supervised treatment of all identified cases using standard first-line drugs to reduce TB burden in Kiribati. Beijing strains can be subdivided in different principle branches that might be associated with differential spreading patterns in the population.