A pilot cross-sectional study of non-communicable diseases in TB household contacts.

BACKGROUND: Data on the prevalence of non-communicable diseases (NCDs) in TB household contacts (HHCs) are limited, yet important to inform integrated screening and care for NCD within contact investigations. It is also unclear if screening these contacts reveals more people with NCDs than individuals in the same neighbourhood. METHOD: We conducted a pilot cross-sectional study in South Africa and Tanzania, enrolling adult HHCs of TB and individuals in neighbourhood households (controls). We inquired about known NCD and systematically measured blood pressure, and tested for spot blood glucose and haemoglobin A1c. RESULTS: We enrolled 203 adult contacts of 111 persons with TB and 160 controls. Among contacts, respectively 12.2% (95% CI 8.3-17.6) and 39.7% (95% CI 33.1-46.7) had diabetes and hypertension, compared to 14.1% (95% CI 9.2-21.0) and 44.7% (95% CI 36.9-52.7) among controls. More than half of NCDs were newly identified. We did not find a significant difference in the prevalence of at least one NCD between the two groups (OR 0.85, 95% CI 0.50-1.45, adjusted for age and sex). CONCLUSIONS: We found a high prevalence of undiagnosed NCDs among contacts, suggesting a potential benefit of integrating NCD screening and care within contact investigations. Screening in the same community might similarly find undiagnosed NCDs.

CONTEXTE: Les données sur la prévalence des maladies non transmissibles (NCD, pour l'anglais « non-communicable diseases ¼) chez les contacts familiaux (HHC, pour l'anglais « household contacts ¼) de personnes atteintes de TB sont restreintes, mais elles revêtent une grande importance pour le dépistage et la prise en charge intégrée des NCD dans le cadre des enquêtes sur les contacts. De plus, on ignore si le dépistage de ces contacts permet de détecter davantage de personnes atteintes de NCD par rapport aux les individus résidant dans le même quartier. MÉTHODE: Nous avons réalisé une étude pilote transversale en Afrique du Sud et en Tanzanie, au cours de laquelle nous avons recruté des adultes HHC de personnes atteintes de TB et des individus vivant dans les ménages voisins (témoins). Nous les avons interrogés sur les NCD connues et avons systématiquement mesuré la pression artérielle, ainsi que réalisé des tests de de glycémie et d'hémoglobine glyquée. RÉSULTATS: Un total de 203 contacts adultes de 111 personnes atteintes de TB et 160 témoins ont été répertoriés. Parmi ces contacts, respectivement 12,2% (IC à 95% 8,3­17,6) et 39,7% (IC à 95% 33,1­46,7) souffraient de diabète et d'hypertension, contre 14,1% (IC à 95% 9,2­21,0) et 44,7% (IC à 95% 36,9­52,7) chez les témoins. Plus de la moitié des NCD ont été récemment découvertes. Aucune disparité significative n'a été observée dans la prévalence d'au moins une NCD entre les deux groupes (OR 0,85 ; 95% CI 0,50­1,45, ajusté pour l'âge et le sexe). CONCLUSIONS: Nous avons observé une fréquence élevée de NCDs non diagnostiquées parmi les contacts, ce qui indique qu'il pourrait être potentiellement bénéfique d'inclure le dépistage et les soins des NCD dans les enquêtes sur les contacts. Le dépistage au sein de la même communauté pourrait également révéler des NCD non diagnostiquées.

The effect of medication event reminder monitoring on treatment adherence of TB patients.

BACKGROUND: TB control remains a serious public health problem, compounded by poor treatment adherence, which increases the likelihood of onward transmission. We evaluated the effectiveness of medication event reminder monitoring (MERM) upon treatment adherence in a high TB burden setting.METHODS: We conducted an open-label parallel group randomised controlled trial among pulmonary TB adults. Participants were provided with a MERM device to store their medications. In the intervention arm, the devices were set to provide daily medication intake reminders. Primary outcome was the proportion of patient-months in which at least 6/30 doses were missed. Secondary outcomes included 1) the proportion of patient-months in which at least 14/30 doses were missed, and 2) the proportion of doses missed.RESULTS: Of 2,142 patients screened, 798 (37.3%) met the inclusion criteria and 250 participants were enrolled. The mean ratio (MR) for poor adherence between the intervention and control groups was 0.72 (95% CI 0.55-0.86). The intervention was also associated with a reduction in the proportion of patients missing at least 14/30 doses (MR 0.61, 95% CI 0.54-0.68) and the percentage of total doses missed (MR 0.75, 95% CI 0.68-0.80).CONCLUSION: MERM is effective in improving TB treatment adherence in a resource-limited environment.

Active case-finding in contacts of people with TB.

BACKGROUND: Exposure to people with TB substantially elevates a person's risk of tuberculous infection and TB disease. Systematic screening of TB contacts enables the early detection and treatment of co-prevalent disease, and the opportunity to prevent future TB disease. However, scale-up of contact investigation in high TB transmission settings remains limited.METHODS: We undertook a narrative review to evaluate the evidence for contact investigation and identify strategies that TB programmes may consider when introducing contact investigation and management.RESULTS: Selection of contacts for priority screening depends upon their proximity and duration of exposure, along with their susceptibility to develop TB. Screening algorithms can be tailored to the target population, the availability of diagnostic tests and preventive therapy, and healthcare worker expertise. Contact investigation may be performed in the household or at communal locations. Local contact investigation policies should support vulnerable patients, and ensure that drop-out during screening can be mitigated. Ethical issues should be anticipated and addressed in each setting.CONCLUSION: Contact investigation is an important strategy for TB elimination. While its epidemiological impact will be greatest in lower-transmission settings, the early detection and prevention of TB have important benefits for contacts and their communities.

Data quality assessment of a South African electronic registry for drug-resistant TB, 2015-2016.

SETTING: Assessment of bedaquiline roll-out in South Africa requires accurate patient data in EDRWeb, a national case-based rifampicin-resistant TB (RR-TB) surveillance register. OBJECTIVE: To ensure EDRWeb data reflect programmatic DR-TB source data, we implemented a data quality improvement initiative. DESIGN: We conducted data quality assessments of EDRWeb data compared to paper patient folders at two South African RR-TB treatment facilities in 2015 and 2016. We assessed 80 patient records before the intervention for completeness of clinically relevant data fields, and 80 different records after the intervention for completeness and concordance. The intervention involved reviewing and updating EDRWeb along with data quality audits with direct feedback to sites. RESULTS: At baseline data completeness per site was lowest for variables related to electrocardiogram (ECG) data, adverse events, and concomitant medications (completeness for these fields ranged from 0% to 80%). Post-intervention data completeness and concordance were high for all fields except those related to ECG data (ECG-related field completeness ranged from 10% to 100%). CONCLUSION: After a data quality initiative, data completeness improved at each site with the exception of ECG data fields. Our findings suggest that data quality interventions may improve patient clinical registries, ultimately enabling better evidence-based decision making for TB programmes.

CONTEXTE: L'évaluation du lancement de la bédaquiline en Afrique du Sud requiert des données précises relatives aux patients sur EDRWeb, notamment grâce à un registre de surveillance national de cas de la TB résistante à la rifampicine (RR-TB). OBJECTIF: Pour s'assurer que les données d'EDRWeb reflètent les sources des données de programme de TB résistante, nous avons mis en œuvre une initiative d'amélioration de la qualité des données. SCHÉMA: Nous avons réalisé des évaluations de qualité des données d'EDRWeb comparés aux dossiers papier des patients dans deux structures de traitement de RR-TB en Afrique du Sud en 2015 et 2016. Nous avons évalué 80 dossiers de patients avant l'intervention pour l'exhaustivité des données des domaines pertinents et 80 autres dossiers après l'intervention à la recherche d'exhaustivité et de concordance. L'intervention a consisté à revoir et à mettre à jour EDRWeb avec des audits de qualité des données directement renvoyés aux sites. RÉSULTATS: Au départ, l'exhaustivité des données dans chaque site était la plus faible en ce qui concerne les variables liées à l'électrocardiogramme (ECG), aux effets secondaires et aux médicaments concomitants ; elle allait de 0% à 80%. L'exhaustivité des données post-intervention et leur concordance ont été élevées pour tous les champs excepté ceux liés aux données de l'ECG qui allaient de 10% to 100%. CONCLUSION: Après une initiative de qualité des données, leur exhaustivité s'est améliorée dans chaque site à l'exception des données relatives à l'ECG. Nos résultats suggèrent que les interventions de qualité des données pourraient améliorer les dossiers cliniques des patients, ce qui permettrait des meilleures prises de décision, basées sur des preuves, pour les programmes TB.

Ototoxicity among multidrug-resistant TB patients: a systematic review and meta-analysis.

BACKGROUND: The use of injectable antibiotics to treat multidrug-resistant TB (MDR-TB) is associated with substantial morbidity due to long-term hearing loss. This systematic review evaluates the incidence of ototoxicity among patients treated for MDR-TB, and the evidence for routine audiometric monitoring to mitigate its severity.METHODS: Studies of ototoxicity among patients with MDR-TB were identified from six databases: PubMed, MEDLINE, Web of Science, Embase, SCOPUS and the Cochrane Library. Meta-analyses were performed to determine the overall incidence of hearing loss, tinnitus and vertigo. The incidence of hearing loss was further stratified by country income status and the injectable agent used during treatment.RESULTS: Among 64 studies from 25 countries including 12 793 patients, 28.3% (95%CI 23.4-33.1) of patients treated with injectables reported hearing loss. Tinnitus and vertigo were experienced by respectively 14.5% (95%CI 10.3-18.7) and 8.1% (95%CI 4.7-11.6) of patients. The incidence of hearing loss was highest among patients treated with amikacin (33.4%, 95%CI 18.2-48.6), and lowest among those treated with capreomycin (2.0%, 95%CI 0-5.5). We found that audiometry was widely used as a method of evaluating hearing loss, and was feasible in a wide range of settings.CONCLUSION: Injectable antibiotics contribute to significant morbidity in patients with MDR-TB. In settings where they are used, routine audiometric monitoring is recommended to prevent irreversible damage.

Chronic hepatitis B increases mortality and complexity among HIV-coinfected patients in South Africa: a cohort study.

OBJECTIVES: To assess the effect of chronic hepatitis B on survival and clinical complexity among people living with HIV following antiretroviral therapy (ART) initiation. METHODS: We evaluated mortality and single-drug substitutions up to 3 years from ART initiation (median follow-up 2.75 years; interquartile range 2-3 years) among patients with and without chronic hepatitis B (CHB) enrolled in a workplace HIV care programme in South Africa. RESULTS: Mortality was increased for CHB patients with hepatitis B virus (HBV) DNA levels > 10 000 copies/mL (adjusted hazard ratio 3.1; 95% confidence interval 1.2-8.0) compared with non-CHB patients. We did not observe a similar difference between non-CHB patients and those with CHB and HBV DNA < 10 000 copies/mL (adjusted hazard ratio 0.70; 95% confidence interval 0.2-2.3). Single-drug substitutions occurred more frequently among coinfected patients regardless of HBV DNA level. CONCLUSIONS: Our findings suggest that CHB may increase mortality and complicate ART management.