Tropical Medicine and Infectious Disease

Research

12 pages, 230 KiB

Open AccessCommunication

Training for Tuberculosis Elimination in Indonesia: Achievements, Reflections, and Potential for Impact

by Stephanie Main, Trisasi Lestari, Rina Triasih, Geoff Chan, Lisa Davidson, Suman Majumdar, Devy Santoso, Sieyin Phung, Janne Laukkala, Steve Graham, Philipp du Cros and Anna Ralph

Trop. Med. Infect. Dis. 2019, 4(3), 107; https://doi.org/10.3390/tropicalmed4030107 - 18 Jul 2019

Cited by 7 | Viewed by 4115

Abstract

Indonesia has the third highest tuberculosis (TB) caseload internationally. A cornerstone for strengthening health systems to respond to TB is a well-trained workforce. In a partnership between Indonesian and Australian institutions, TB training was run during 2018 to strengthen the local capacity to [...] Read more.

Indonesia has the third highest tuberculosis (TB) caseload internationally. A cornerstone for strengthening health systems to respond to TB is a well-trained workforce. In a partnership between Indonesian and Australian institutions, TB training was run during 2018 to strengthen the local capacity to meet End TB strategy targets. This paper aims to report on course design, delivery, training outcomes, and reflections. Seventy-six Indonesian healthcare workers, program staff, researchers, and policy-makers were selected from over 800 applicants. The structure comprised three trainings, each with a pre-course workshop (in Indonesia) to identify learning needs, a two-week block (Australia), and a post-course workshop (Indonesia). The training content delivered was a combination of TB technical knowledge and program/project theory, design, and logic, and the training utilised multiple teaching and learning methods. An innovative element of the training was participant-designed TB workplace projects focusing on context-specific priorities. Evaluation was undertaken using participant surveys and appraisal of the projects. Participants rated the course highly, while success in project implementation varied. Reflections include the importance of involving Indonesian experts in delivery of training, the need to understand participant learning requirements and adapt the training content accordingly, and the challenge of measuring tangible training outputs. Full article

(This article belongs to the Special Issue Tuberculosis Elimination in the Asia-Pacific)

12 pages, 1553 KiB

Open AccessArticle

Strategic Planning for Tuberculosis Control in the Republic of Fiji

by Romain Ragonnet, Frank Underwood, Tan Doan, Eric Rafai, James Trauer and Emma McBryde

Trop. Med. Infect. Dis. 2019, 4(2), 71; https://doi.org/10.3390/tropicalmed4020071 - 24 Apr 2019

Cited by 8 | Viewed by 4564

Abstract

The tuberculosis (TB) health burden in Fiji has been declining in recent years, although challenges remain in improving control of the diabetes co-epidemic and achieving adequate case detection across the widely dispersed archipelago. We applied a mathematical model of TB transmission to the [...] Read more.

The tuberculosis (TB) health burden in Fiji has been declining in recent years, although challenges remain in improving control of the diabetes co-epidemic and achieving adequate case detection across the widely dispersed archipelago. We applied a mathematical model of TB transmission to the TB epidemic in Fiji that captured the historical reality over several decades, including age stratification, diabetes, varying disease manifestations, and incorrect diagnoses. Next, we simulated six intervention scenarios that are under consideration by the Fiji National Tuberculosis Program. Our findings show that the interventions were able to achieve only modest improvements in disease burden, with awareness raising being the most effective intervention to reduce TB incidence, and treatment support yielding the highest impact on mortality. These improvements would fall far short of the ambitious targets that have been set by the country, and could easily be derailed by moderate increases in the diabetes burden. Furthermore, the effectiveness of the interventions was limited by the extensive pool of latent TB infection, because the programs were directed at only active cases, and thus were unlikely to achieve the desired reductions in burden. Therefore, it is essential to address the co-epidemic of diabetes and treat people with latent TB infection. Full article

(This article belongs to the Special Issue Tuberculosis Elimination in the Asia-Pacific)

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10 pages, 271 KiB

Open AccessArticle

Molecular Evidence of Drug-Resistant Tuberculosis in the Balimo Region of Papua New Guinea

by Tanya Diefenbach-Elstob, Vanina Guernier, Graham Burgess, Daniel Pelowa, Robert Dowi, Bisato Gula, Munish Puri, William Pomat, Emma McBryde, David Plummer, Catherine Rush and Jeffrey Warner

Trop. Med. Infect. Dis. 2019, 4(1), 33; https://doi.org/10.3390/tropicalmed4010033 - 10 Feb 2019

Cited by 4 | Viewed by 4812

Abstract

Papua New Guinea (PNG) has a high burden of tuberculosis (TB), including drug-resistant TB (DR-TB). DR-TB has been identified in patients in Western Province, although there has been limited study outside the provincial capital of Daru. This study focuses on the Balimo region [...] Read more.

Papua New Guinea (PNG) has a high burden of tuberculosis (TB), including drug-resistant TB (DR-TB). DR-TB has been identified in patients in Western Province, although there has been limited study outside the provincial capital of Daru. This study focuses on the Balimo region of Western Province, aiming to identify the proportion of DR-TB, and characterise Mycobacterium tuberculosis (MTB) drug resistance-associated gene mutations. Sputum samples were investigated for MTB infection using published molecular methods. DNA from MTB-positive samples was amplified and sequenced, targeting the rpoB and katG genes to identify mutations associated with rifampicin and isoniazid resistance respectively. A total of 240 sputum samples were collected at Balimo District Hospital (BDH). Of these, 86 were classified as positive based on the results of the molecular assays. For samples where rpoB sequencing was successful, 10.0% (5/50, 95% CI 4.4–21.4%) were considered rifampicin-resistant through detection of drug resistance-associated mutations. We have identified high rates of presumptive DR-TB in the Balimo region of Western Province, PNG. These results emphasise the importance of further surveillance, and strengthening of diagnostic and treatment services at BDH and throughout Western Province, to facilitate detection and treatment of DR-TB, and limit transmission in this setting. Full article

(This article belongs to the Special Issue Tuberculosis Elimination in the Asia-Pacific)

10 pages, 2454 KiB

Open AccessArticle

Evolution of Tuberculosis/Human Immunodeficiency Virus Services among Different Integrated Models in Myanmar: A Health Services Review

by Myo Su Kyi, Si Thu Aung, Edward McNeil and Virasakdi Chongsuvivatwong

Trop. Med. Infect. Dis. 2019, 4(1), 2; https://doi.org/10.3390/tropicalmed4010002 - 24 Dec 2018

Cited by 2 | Viewed by 3862

Abstract

Myanmar is one of the highly affected countries by tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection. We aimed to review the coverage of TB/HIV integrated services as well as to document the performance of this integrated services. A retrospective program review was [...] Read more.

Myanmar is one of the highly affected countries by tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection. We aimed to review the coverage of TB/HIV integrated services as well as to document the performance of this integrated services. A retrospective program review was conducted using the aggregated data of the National TB Programme (NTP) from 2005 to 2016. In Myanmar, TB/HIV services were initiated in seven townships in 2005. Townships were slowly expanded until 2013. After that, the momentum was increased by increasing the government budget allocation for NTP. In 2016, the whole country was eventually covered by TB/HIV services in different types of integration. Antiretroviral therapy (ART) coverage among HIV-positive TB patients remained low and it was the only significant difference among the three types of integration. Barriers of low ART coverage need to be investigated to reduce the burden of TB/HIV. Full article

(This article belongs to the Special Issue Tuberculosis Elimination in the Asia-Pacific)

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13 pages, 2351 KiB

Open AccessArticle

Is Australia Neglecting the Local Topography When It Comes to Catastrophic Costs and Ending Tuberculosis?

by Krista Watts

Trop. Med. Infect. Dis. 2018, 3(4), 126; https://doi.org/10.3390/tropicalmed3040126 - 19 Dec 2018

Cited by 4 | Viewed by 3020

Abstract

Efforts to eliminate tuberculosis as a public health problem require reductions in mortality, incidence, and the eradication of associated catastrophic costs; however, the question of catastrophic costs is often neglected, particularly in the context of low-incidence settings like Australia. This study reviews the [...] Read more.

Efforts to eliminate tuberculosis as a public health problem require reductions in mortality, incidence, and the eradication of associated catastrophic costs; however, the question of catastrophic costs is often neglected, particularly in the context of low-incidence settings like Australia. This study reviews the financial support provided to those identified as in need, and in receipt, of economic aid from the Victorian Tuberculosis Program. The study design used Epstein’s clinical data mining framework to produce descriptive statistics which were supplemented by clinical collaboration. A consistent one-third of those receiving care from the Program due to a notification of active tuberculosis received emergency financial relief over the study period. Overwhelmingly, funds were used to relieve financial distress, and each year approximately one-third of the expenditure was used to support 2% of those people notified as affected by tuberculosis (or 7–9% of those in receipt of funds). Many of this 2% experienced income loss and expenditure that may be considered catastrophic. Further investigation is needed to better define and understand the nature of catastrophic costs in the context of universal health care and existing low tuberculosis incidence. Full article

(This article belongs to the Special Issue Tuberculosis Elimination in the Asia-Pacific)

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10 pages, 1189 KiB

Open AccessArticle

Trends in Tuberculosis Incidence in the Australian-Born in Victoria: Opportunities and Challenges to Elimination

by Ouli Xie, Ee Laine Tay and Justin Denholm

Trop. Med. Infect. Dis. 2018, 3(4), 112; https://doi.org/10.3390/tropicalmed3040112 - 11 Oct 2018

Viewed by 4299

Abstract

Australia is a low tuberculosis incidence country. In the setting of increasing migration, we aimed to investigate the epidemiology and trends of tuberculosis in the Australian-born population in the state of Victoria between 1992 and 2017. We performed a retrospective descriptive analysis of [...] Read more.

Australia is a low tuberculosis incidence country. In the setting of increasing migration, we aimed to investigate the epidemiology and trends of tuberculosis in the Australian-born population in the state of Victoria between 1992 and 2017. We performed a retrospective descriptive analysis of demographic, clinical and outcome data extracted from a centralized notifiable disease database. The mean incidence of tuberculosis was 1.19 cases per 100,000 population per year with a small but significant reduction of 0.98% per year. The median age of cases decreased from 67.5 years in 1994 to 17 years in 2017. Among 0–14 year-olds, there was an increase from 0.13 cases per 100,000 population in 1996 to 2.15 per 100,000 population in 2017. Data for risk factors were available from 2002 onwards. The most common risk factor in the 0–14 year age group was a household contact with tuberculosis (85.1%), followed by having a parent from a high tuberculosis incidence country (70.2%). We found the rate of tuberculosis in the Australian-born population in Victoria is low. However, there has been an increase in incidence in children, particularly among those with links to countries with high tuberculosis incidence. This could threaten progress towards tuberculosis elimination in Australia. Full article

(This article belongs to the Special Issue Tuberculosis Elimination in the Asia-Pacific)

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8 pages, 551 KiB

Open AccessArticle

‘Know Your Epidemic’: Are Prisons a Potential Barrier to TB Elimination in an Australian Context?

by Nompilo Moyo, Ee Laine Tay and Justin Denholm

Trop. Med. Infect. Dis. 2018, 3(3), 93; https://doi.org/10.3390/tropicalmed3030093 - 31 Aug 2018

Cited by 4 | Viewed by 3816

Abstract

Globally, rates of tuberculosis (TB) cases in prisons are substantially higher than in the general population. The goal of this study was to review TB notifications in Victorian correctional facilities, and consider whether additional interventions towards TB elimination may be useful in this [...] Read more.

Globally, rates of tuberculosis (TB) cases in prisons are substantially higher than in the general population. The goal of this study was to review TB notifications in Victorian correctional facilities, and consider whether additional interventions towards TB elimination may be useful in this setting. All patients who were notified with or treated for TB in the Australian state of Victoria from 1 January 2003 to 1 December 2017 were included in this study. Descriptive analysis was performed. Demographic and treatment outcome data for individuals with and without a history of incarceration were reviewed and compared. Of the 5645 TB cases notified during the study period, 26 (0.5%) had a history of being incarcerated in correctional facilities while receiving treatment for TB. There were 73,238 inmates in Victorian correctional facilities over the same study period, meaning that approximately 0.04% of inmates were diagnosed or treated with TB disease in correctional facilities. Incarcerated individuals were more likely to have positive sputum smears and cavitation compared with nonincarcerated people with TB. There was no significant difference in treatment outcomes between the general TB population and those who had a history of incarceration during their treatment. There is a low apparent rate of TB in Victorian prisoners, and prisons do not contribute significantly to TB incidence in Victoria. Overall, TB outcomes do not differ between prisoners and nonprisoners. Ongoing efforts to sustain these lower rates and comparable outcomes in this vulnerable cohort are important for continued progress towards TB elimination. Full article

(This article belongs to the Special Issue Tuberculosis Elimination in the Asia-Pacific)

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11 pages, 231 KiB

Open AccessArticle

Towards TB Elimination in Aotearoa/New Zealand: Key Informant Insights on the Determinants of TB among African Migrants

by Emmanuel Badu, Charles Mpofu and Panteá Farvid

Trop. Med. Infect. Dis. 2018, 3(2), 44; https://doi.org/10.3390/tropicalmed3020044 - 22 Apr 2018

Cited by 5 | Viewed by 4018

Abstract

Migrants living in low incidence countries, including New Zealand (NZ), are disproportionately affected by tuberculosis (TB). This foreign-born group poses important challenges to achieving the national TB elimination targets. Thus, the aim of this study was to contribute to the understandingof factors that [...] Read more.

Migrants living in low incidence countries, including New Zealand (NZ), are disproportionately affected by tuberculosis (TB). This foreign-born group poses important challenges to achieving the national TB elimination targets. Thus, the aim of this study was to contribute to the understandingof factors that influence the incidence of TB among African migrants living in NZ. We employed a semi-structured interview approach to explore the perceptions of NZ-based African community leaders, health professionals and a non-governmental TB support organisation about the wider determinants of TB. The findings, though not completely generalizable, suggest that many NZ-based Africans endure a difficult process of integration, perceive themselves as least susceptible to TB and have low awareness about available health services. Furthermore, the cost of general practitioner (GP) services, mistrust of health professionals, TB stigma and the NZ immigration policy were indicated as important barriers to TB services. Strategies to address TB among migrants must therefore be more holistic and not be centred on a fragmented approach that overemphasises the biomedical approaches, as the incidence of TB is more likely the outcome of a complex interplay of several underlying factors. Full article

(This article belongs to the Special Issue Tuberculosis Elimination in the Asia-Pacific)

Review

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12 pages, 701 KiB

Open AccessReview

The Financial Burden of Tuberculosis for Patients in the Western-Pacific Region

by Kerri Viney, Tauhidul Islam, Nguyen Binh Hoa, Fukushi Morishita and Knut Lönnroth

Trop. Med. Infect. Dis. 2019, 4(2), 94; https://doi.org/10.3390/tropicalmed4020094 - 17 Jun 2019

Cited by 26 | Viewed by 6484

Abstract

The End Tuberculosis (TB) Strategy has the ambitious goal of ending the global TB epidemic by the year 2030, which is aligned to the Sustainable Development Goals. One of three high level indicators of the Strategy is the “catastrophic costs” indicator, which aims [...] Read more.

The End Tuberculosis (TB) Strategy has the ambitious goal of ending the global TB epidemic by the year 2030, which is aligned to the Sustainable Development Goals. One of three high level indicators of the Strategy is the “catastrophic costs” indicator, which aims to determine the proportion of TB-affected households that incur TB-care related costs equivalent to 20% or more of their annual household income. The target is that zero percentage of TB-affected households will incur catastrophic costs related to TB care by the year 2020. In the Western Pacific Region of the World Health Organization, it is a priority to determine the financial burden of TB and then act to mitigate it. To date, eight countries in the Region have conducted nationally representative TB patient cost surveys to determine the costs of TB care. The results from four countries that have completed these surveys (i.e., Fiji, Mongolia, the Philippines, and Vietnam) indicate that between 35% and 70% of TB patients face catastrophic costs related to their TB care. With these results in mind, significant additional efforts are needed to ensure financial risk protection for TB patients, expand Universal Health Coverage, and improve access to social protection interventions. A multi-sectoral approach is necessary to achieve this ambitious goal by the year 2020. Full article

(This article belongs to the Special Issue Tuberculosis Elimination in the Asia-Pacific)

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7 pages, 217 KiB

Open AccessReview

Realizing the World Health Organization’s End TB Strategy (2016–2035): How Can Social Approaches to Tuberculosis Elimination Contribute to Progress in Asia and the Pacific?

by Christopher A. John

Trop. Med. Infect. Dis. 2019, 4(1), 28; https://doi.org/10.3390/tropicalmed4010028 - 5 Feb 2019

Cited by 19 | Viewed by 4557

Abstract

This review article discusses how social approaches to tuberculosis elimination might contribute to realizing the targets stipulated in the World Health Organization’s (WHO) End TB Strategy (2016–2035), with an emphasis on opportunities for progress in Asia and the Pacific. Many factors known to [...] Read more.

This review article discusses how social approaches to tuberculosis elimination might contribute to realizing the targets stipulated in the World Health Organization’s (WHO) End TB Strategy (2016–2035), with an emphasis on opportunities for progress in Asia and the Pacific. Many factors known to advance tuberculosis transmission and progression are pervasive in Asia and the Pacific, such as worsening drug resistance, unregulated private sector development, and high population density. This review article argues that historically successful social solutions must be revisited and improved upon if current worldwide tuberculosis rates are to be sustainably reduced in the long term. For the ambitious targets laid down in the WHO’s End TB Strategy to be met, biomedical innovations such as point-of-care diagnostics and new treatments for multidrug-resistant tuberculosis (MDR-TB) must be implemented alongside economic, social, and environmental interventions. Implementing social, environmental, and economic interventions alongside biomedical innovations and universal healthcare coverage will, however, only be possible if the health and other government sectors, civil society, and at-risk populations unite to work collaboratively in coming years. Full article

(This article belongs to the Special Issue Tuberculosis Elimination in the Asia-Pacific)

Other

Jump to: Research, Review

15 pages, 354 KiB

Open AccessPerspective

How Can Operational Research Help to Eliminate Tuberculosis in the Asia Pacific Region?

by Anthony D. Harries, Ajay M. V. Kumar, Srinath Satyanarayana, Pruthu Thekkur, Yan Lin, Riitta A. Dlodlo and Rony Zachariah

Trop. Med. Infect. Dis. 2019, 4(1), 47; https://doi.org/10.3390/tropicalmed4010047 - 15 Mar 2019

Cited by 9 | Viewed by 4290

Abstract

Broad multi-sectoral action is required to end the tuberculosis (TB) epidemic by 2030 and this includes National TB Programmes (NTPs) fully delivering on quality-assured diagnostic, treatment and preventive services. Large implementation gaps currently exist in the delivery of these services, which can be [...] Read more.

Broad multi-sectoral action is required to end the tuberculosis (TB) epidemic by 2030 and this includes National TB Programmes (NTPs) fully delivering on quality-assured diagnostic, treatment and preventive services. Large implementation gaps currently exist in the delivery of these services, which can be addressed and closed through the discipline of operational research. This paper outlines the TB disease burden and disease-control programme implementation gaps in the Asia-Pacific region; discusses the key priority areas in diagnosis, treatment and prevention where operational research can be used to make a difference; and finally provides guidance about how best to embed operational research within a TB programme setting. Achieving internationally agreed milestones and targets for case finding and treatment requires the NTP to be streamlined and efficient in the delivery of its services, and operational research provides the necessary evidence-based knowledge and support to allow this to happen. Full article

(This article belongs to the Special Issue Tuberculosis Elimination in the Asia-Pacific)

7 pages, 579 KiB

Open AccessMeeting Report

Action towards Universal Health Coverage and Social Protection for Tuberculosis Care and Prevention: Workshop on the End TB Strategy Pillar 2 in the Western Pacific Region 2017

by Kyung Hyun Oh, Kalpeshsinh Rahevar, Nobuyuki Nishikiori, Kerri Viney, Hongjo Choi, Olivia Biermann, Hee Jin Kim, Chanly Nou, Samoeun Kim, Ge Zhu, Hui Zhang, Caihong Xu, Soth Bounmala, Maytry Senchanthixay, Enkhtamir Purevdorj, Ulzii-orshikh Khaltar, Ronald Paguirigan, Hansel Amoguis, Vu Xuan Phu and Dang Xuan Khang

Trop. Med. Infect. Dis. 2019, 4(1), 3; https://doi.org/10.3390/tropicalmed4010003 - 24 Dec 2018

Cited by 10 | Viewed by 6345

Abstract

Although the End TB Strategy highlights that major global progress towards universal health coverage (UHC) and social protection are fundamental to achieving the global targets for reductions in tuberculosis (TB) incidence and deaths, there is still a long way to go to achieve [...] Read more.

Although the End TB Strategy highlights that major global progress towards universal health coverage (UHC) and social protection are fundamental to achieving the global targets for reductions in tuberculosis (TB) incidence and deaths, there is still a long way to go to achieve them in low- and middle-income countries. A workshop on the End TB Strategy Pillar 2 in the Western Pacific Region focusing on action towards UHC and social protection was held between 27 and 29 November in 2017 at the Korean Institute of Tuberculosis in Cheonju, Republic of Korea. The workshop brought together key personnel from national TB programmes and other stakeholders or researchers with experience in this topic from six countries with a high burden of TB in the region. During the workshop, participants shared country experiences, best practices, and challenges in achieving UHC and enhancing social protection in the context of TB service delivery, and also explored policy options to address the challenges, to be applied in their respective countries. This report describes the content of the meeting and the conclusions and recommendations arising from the meeting. Full article

(This article belongs to the Special Issue Tuberculosis Elimination in the Asia-Pacific)

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5 pages, 175 KiB

Open AccessCommentary

Tuberculosis Elimination in the Asia-Pacific Region and the WHO Ethics Guidance

by Justin T. Denholm, Diego S. Silva, Erlina Burhan and Richard E. Chaisson

Trop. Med. Infect. Dis. 2018, 3(4), 115; https://doi.org/10.3390/tropicalmed3040115 - 31 Oct 2018

Cited by 1 | Viewed by 2976

Abstract

The World Health Organization has produced ethical guidance on implementation of the End TB strategy, which must be considered in local context. The Asia-Pacific Region has important distinctive characteristics relevant to tuberculosis, and engagement with the ethical implications raised is essential. This paper [...] Read more.

The World Health Organization has produced ethical guidance on implementation of the End TB strategy, which must be considered in local context. The Asia-Pacific Region has important distinctive characteristics relevant to tuberculosis, and engagement with the ethical implications raised is essential. This paper highlights key ethical considerations for the tuberculosis elimination agenda in the Asia-Pacific Regions and suggests that further programmatic work is required to ensure such challenges are addressed in clinical and public health programs. Full article

(This article belongs to the Special Issue Tuberculosis Elimination in the Asia-Pacific)

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