Search Results (82)

Background: Tuberculosis (TB) remains the leading cause of death among persons with advanced HIV disease (AHD) in high HIV-burden settings. Digital chest X-ray (dCXR) with computer-aided detection (CAD) is a promising tool to overcome human resource constraints and improve TB case detection. This study evaluates the real-world implementation and performance of dCXR/CAD for TB screening within a specialized AHD clinic in Maputo, Mozambique. Methods: We conducted a retrospective cohort analysis of 487 new AHD patients at Centro de Referência do Alto Maé (CRAM) from October 2023 to September 2024. Of these, 238 underwent dCXR with CAD interpretation. All patients underwent systematic TB screening according to Ministry of Health (MoH) guidelines. Using the recorded diagnosis of TB (bacteriologically confirmed or clinically diagnosed) as the reference standard, we calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the nationally adopted CAD threshold (≥0.5). Results: Among 238 AHD patients screened with CAD, 116 (49%) were diagnosed with TB. At the ≥0.5 threshold, sensitivity was 50% (58/116; 95% CI: 41–59), specificity 92% (112/122; 95% CI: 85–96), PPV 85% (58/68; 95% CI: 75–92), and NPV 65.9% (112/170; 95% CI: 58–73). TB diagnosis rates increased sharply with CAD score: 30% (43/143) in normal, 52% (15/27) in abnormal non-suggestive, and 85% (58/68) in suggestive cases. Bacteriological confirmation was low across all groups (19–26%), reflecting reliance on clinical diagnosis. Conclusions: Integrating dCXR/CAD into AHD care is feasible and identifies a high TB burden. However, at the adopted threshold of ≥0.5, CAD demonstrated high specificity but low sensitivity (50%) in this population, missing half of all TB cases. These findings suggest that CAD functions better as a confirmatory decision-support tool than a standalone screening test in AHD. Threshold optimization for this specific population warrants prospective evaluation. Implementation challenges including fragmented systems and lack of dedicated human resources must be addressed to realize CAD’s full potential in TB programs. Full article

Animal tuberculosis in cattle (TB) has been controlled in many European countries through long-standing eradication programs, yet sporadic breakdowns continue to occur in officially tuberculosis-free (OTF) areas, challenging the sustainability of disease freedom. This study aimed to identify and quantify herd-level and area-level risk factors associated with TB occurrence in Italian OTF regions in order to support risk-based surveillance strategies. A national longitudinal open-cohort study was conducted using data from the Italian Veterinary Information System, including approximately 300,000 herd–year observations from 2022 to 2025. The outcome was the occurrence of at least one TB breakdown per herd–year, analyzed using a discrete-time hazard modeling approach based on a binomial generalized linear mixed model with province-level random effects. The incidence of TB remained very low but increased over time, and significant spatial clustering was observed. Higher TB risk was associated with larger herd size, a previous history of TB, non-OTF herd status, proximity to recent breakdowns, number of animals purchased, transhumance practices, and a shorter time since acquisition of OTF status at provincial level. These findings highlight that, even in disease-free contexts, TB risk is heterogeneous and driven by identifiable factors, supporting the refinement of targeted, risk-based surveillance to maintain OTF status over time. Full article

Animal tuberculosis caused by mycobacteria of the Mycobacterium tuberculosis complex (MTBC) represents a significant challenge to both public and animal health. Although eradication programs focus predominantly on cattle, small ruminants, especially goats, may play a relevant role as reservoirs. This study aimed to characterize tuberculosis cases in small ruminants in Portugal diagnosed at the national reference laboratory for Tuberculosis (Instituto Nacional de Investigação Agrária e Veterinária) over the period from April 2012 to July 2023. In this study, samples from 79 animals suspected of TB (64 goats and 15 sheep) were analyzed by integrating histopathology; bacteriology; and, when applicable, PCR results, thereby allowing the distribution by species to be described, MTBC agents to be identified, and diagnostic agreement to be assessed. Of these samples, 29 positive cases (36.7%) were identified, all of them in goats (45.3% of goats tested), whereas no cases were confirmed in sheep. Mycobacterium caprae was the most frequently identified species (89.7%), followed by Mycobacterium bovis (10.3%). Geographic distribution was concentrated in the Alentejo (48.3%) and Norte (44.8%) regions, where 93.1% of cases occurred. Topographical analysis of lesions revealed respiratory tract involvement (lung and/or thoracic lymph nodes) in 82.7% of positive cases, with gross patterns including caseous/caseocalcified lesions (n = 11), necrosis (n = 9), and nodular granulomatous lesions (n = 10). Agreement between histopathology and bacteriology was 81.5%. Parasitic coinfections were observed in 24.1% of positive cases, complicating histopathological interpretation. The results of this study indicate goats, as opposed to sheep, as non-negligible reservoirs of TB, suggesting species-level differences that warrant targeted investigation. The predominance of respiratory lesions and the detection of extensive cavitary forms indicate potential aerogenous transmission with implications for multi-host systems. Diagnostic discordance and parasitic interference reinforce the need for combined testing methodologies. It is therefore advisable to consider the integration of goats into tuberculosis surveillance and control programs, with greater relevance in Alentejo and Norte. Full article

Background/Objectives: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health challenge in the WHO European Region, which reports the highest global proportion of rifampicin-resistant and MDR-TB cases. Whole-genome sequencing (WGS) has emerged as a key tool for improving drug-resistance detection and supporting molecular surveillance. However, the level of genomic implementation across Central and Eastern Europe (CEE) remains insufficiently characterized. This scoping review aimed to evaluate the use of WGS for MDR-TB in CEE countries and to classify implementation maturity using a predefined framework (L0–L4). Methods: A structured search of PubMed/MEDLINE and Web of Science identified original studies published in English between 2015 and 2026 reporting genomic applications in MDR-TB across 13 predefined CEE countries. Data were extracted on sequencing approaches, resistance prediction, transmission analysis, monitoring of new or repurposed drugs, bioinformatic pipelines, and programmatic integration. Countries were categorized according to a five-level maturity model based on documented capacity, scope of application, and integration into national tuberculosis programs (NTPs). Results: Twenty-eight studies were included. WGS was used in 23/28 studies (82.1%), predominantly for genomic resistance prediction (25/28). Transmission analysis was reported in 19/28 studies, with heterogeneous single nucleotide polymorphism (SNP) thresholds and clustering methodologies. Monitoring of resistance to new or repurposed drugs was described in 8/28 studies. No country achieved Level L4 (formally integrated genomic surveillance). Four countries were classified as L3 and nine as L2, while no L0 or L1 settings were identified. Conclusions: Countries in Central and Eastern Europe demonstrate increasing operational use of WGS for MDR-TB, primarily driven by clinical resistance prediction. However, the lack of formal integration into national surveillance systems highlights a persistent gap between technological adoption and structured public health implementation. Strengthening programmatic integration and methodological standardization is essential for advancing genomic surveillance of MDR-TB in the region. Full article

Tuberculosis (TB) remains a major public health challenge in Peru, where interindividual variability in treatment response and drug-induced hepatotoxicity may be influenced by host genetic background. This study aimed to characterize clinically relevant polymorphisms in NAT2, CYP2E1, and SLCO1B1 in a cohort of TB patients from Southern Peru, a genetically underrepresented Andean population. Thirty-five adults receiving first-line therapy (isoniazid and rifampicin) underwent targeted Sanger sequencing of key functional variants among these three genes. NAT2 acetylator phenotypes were predominantly intermediate (68.6%), followed by rapid (20%) and slow (11.4%) profiles, with high minor allele frequencies for rs1041983 and rs1801280. CYP2E1 functional promoter variants were infrequent, whereas SLCO1B1 exhibited notable allelic heterogeneity, suggesting potential variability in rifampicin transport. Comparative analysis with previously reported Peruvian data revealed regional differences in acetylator distribution, supporting population-specific pharmacogenomic stratification. Although clinical toxicity outcomes were not evaluated, the high prevalence of reduced acetylation genotypes suggests a substantial proportion of patients may benefit from genotype-informed isoniazid dosing strategies. These findings provide foundational data for implementing precision medicine approaches using affordable and targeted technologies in TB management within Andean populations and support the integration of pharmacogenomics into national TB control programs. Full article

Although the estimated tuberculosis (TB) incidence in Gabon is declining, there have been challenges with treatment coverage, HIV status and treatment outcome documentation. Thus, the National TB Program (NTP) conducted an innovative data review at the Nkembo Health Treatment Center in Libreville, which manages more than 70% of Gabonese TB patients. Since our hypothesis was that the Nkembo treatment center was struggling with data mismanagement due to the workload, the objective was to perform a TB data quality review and triangulation exercise at the Nkembo health facility in Libreville, from January to August 2023, and propose recommendations for data improvement. Methods: The study used the data reconciliation method. This is a process that involves comparing and aligning data from multiple sources to ensure consistency, accuracy, and integrity. The primary purpose of data reconciliation is to identify and resolve discrepancies or differences between datasets and make them consistent. Using the “TB onion model”, analysis identified data mismanagement as a key contributor to underreporting. A data review compared TB records to TB registry data and patient folders from January to August 2023 for notification and to the 2022 cohort for treatment results. The study focused on notified TB cases, HIV status and TB treatment outcome documentation. Discrepancies were reconciled, and treatment outcomes re-evaluated. Results: After review, statistically significant increases were observed: +22% for total TB cases (p = 0.0003), +141% for the number of TB cases with known HIV status (p = 0.0017) and +104% for the number of TB cases successfully treated (p = 0.0001), as compared with the previous data. Discussion: This data reconciliation showed the usefulness of triangulation across data sources to improve the completeness of data. Also, current reported data underestimate the number of reported cases, documentation of HIV status, and treatment success. Conclusions: The study shows that data reconciliation can improve TB programmatic data completeness to better reflect program performance. Full article

The Democratic Republic of the Congo faces a high tuberculosis (TB) burden. In 2022, 61% of an estimated 402,000 TB cases were reported (World Health Organization Global tuberculosis report). To enhance case detection, the national TB program (NTP) introduced a program quality and efficiency approach (PQE), integrating systematic TB screening into outpatient departments (OPDs). Observational data of the PQE on the TB care cascade (from screening to treatment) across 70 sites in Kinshasa that initiated PQE during the first quarter of 2023 are presented. Data were collected monthly and validated during supervision visits, and disaggregated by sex, healthcare facility type (public, private, or faith-based), facility level (primary or secondary), and OPD within each facility. In 2024, 639,464 individuals were consulted in various OPDs in the participating facilities, 57% of which were female. The median number needed to screen (NNS) was 22.1, with an interquartile range of [9.5–104.3]. There was a significantly lower NNS observed in general practice and human immunodeficiency virus departments. Throughout the TB care cascade, women were less likely than men to be screened, tested, or treated. These findings, to be interpreted within the context of Kinshasa pilot facilities, provide insights to the NTP for developing PQE implementation research aimed at understanding the reasons for these discrepancies and informing NTP scale-up at the national level. Full article

Background: Tuberculosis (TB) remains a major public health concern globally, despite sustained declines in incidence in many countries. Kazakhstan has implemented long-term national TB control strategies; however, comprehensive nationwide analyses integrating temporal trends, demographic patterns, and treatment outcomes over the past decade remain limited. Methods: A nationwide retrospective registry-based analysis of programmatic TB treatment episodes was conducted using anonymized data from the national tuberculosis registry of the Ministry of Health of Kazakhstan. All registered TB cases from 1 January 2014 to 31 December 2023 were included. Treatment outcome was analyzed as the final end-of-episode programmatic status (favorable vs. unfavorable). Because the anonymized extract did not contain complete patient-level dates required to derive person-time (treatment initiation and event dates), time-to-event models were not applied; instead, factors associated with unfavorable end-of-treatment outcomes were assessed using multivariable logistic regression and reported as adjusted odds ratios (aORs) with 95% CIs. Unfavorable treatment outcomes were defined as death, treatment failure, loss to follow-up, and not evaluated or not recorded outcome, according to the national TB program outcome definitions. Results: A total of 93,985 TB cases were analyzed. The number of registered cases declined from 16,391 in 2014 to 6548 in 2023, corresponding to a cumulative reduction of 60.1% and an AAPC of −9.7% per year. TB incidence decreased in both sexes, although rates remained consistently higher among men. Over time, the peak incidence shifted toward older age groups, particularly among men. The proportion of new cases increased to 80.1% by 2023, while relapses and treatment failures declined. In multivariable analysis, unfavorable treatment outcomes were independently associated with male sex (aOR 1.25), older age, relapse, treatment after interruption, prior treatment failure, smear-positive disease (aOR 1.60), combined pulmonary and extrapulmonary involvement, and disseminated TB (ICD-10 A19). The risk of unfavorable outcomes increased during 2020–2021 and declined in 2022–2023. Conclusions: Kazakhstan has achieved a substantial and sustained reduction in TB incidence over the past decade. Nevertheless, marked demographic and clinical disparities persist, particularly among men, older patients, smear-positive cases, and individuals with prior or interrupted treatment. Targeted interventions focused on these high-risk groups may further improve treatment outcomes and support continued progress toward TB control. Full article

Background/Objectives: Stool-based GeneXpert testing has become a useful approach for diagnosing pediatric pulmonary tuberculosis (PTB). This study compared two stool-processing methods, centrifugation-based processing (CBP) and simple one-step (SOS), for detecting PTB in children using Xpert MTB/RIF Ultra (Ultra). Methods: Children with presumptive PTB were screened cross-sectionally, and stool samples were collected and tested with Ultra using the CBP method from March 2022 to December 2024 across seven divisions of Bangladesh. A subset of stool samples (n = 281) that tested positive (n = 191) and negative (n = 90) by the CBP method were re-tested again with the same sample by Ultra using the SOS method. The results of the Ultra with SOS-processed stool were compared with the CBP method to evaluate overall agreement and detection efficiency across different bacterial burdens. Results: The SOS method detected 97 of 191 CBP-positive samples, resulting in a positive percentage agreement of 50.8% (95% CI: 43.5–58.1). All 90 Ultra-negative stool were also negative by the SOS method, yielding a negative percentage agreement of 100% (95% CI: 96.0–100.0). Overall agreement between the methods was 66.6% (Kappa: 0.398). The SOS method detected 100% of high- (4/4) and medium- (7/7), 97.3% (36/37) of low-, and 83.3% (35/42) of very-low-bacterial-burden samples, but only 14.9% (15/101) of the trace-detected samples that were identified by the CBP method. Conclusions: Stool testing with Ultra using the SOS processing method missed a significant number of the most prevalent form of child TB—the ‘trace-detected’ category identified by the CBP method. For increased detection of childhood TB nationwide, the national program should prioritize the use of Ultra on stool samples processed by the CBP method. Full article

National Tuberculosis Reference Laboratories (NTRLs) are central to tuberculosis (TB) control programs. Between 2018 and 2024, the Republic of Congo, a country of 6 million inhabitants, achieved a transformative strengthening of its TB diagnostic system, coordinated by the NTRL. Strategic investments, supported mainly by international partners, enabled a substantial decentralization of services, expanding the diagnostic network from 38 to 113 diagnostic and testing centers and increasing GeneXpert sites from 3 to 31. The expansion of the diagnostic network and specimen referral system was associated with a reduced structural gap in diagnostic coverage by extending access to GeneXpert testing to a larger number of peripheral and previously underserved centers. Critically, the establishment of a BSL-3 laboratory and the deployment of advanced assays like Xpert MTB/XDR ended the reliance on overseas testing by introducing in-country capacity for multidrug-resistant and pre-extensively drug-resistant TB detection. These systemic improvements were associated with significant positive outcomes, including an annual molecular testing surging from 11,609 in 2022 to over 27,000 in 2024 and bacteriological confirmation rates rising from 34 to 73%. This comprehensive laboratory systems strengthening, which also facilitated cross-programmatic initiatives like HIV and Mpox testing integration, underscores how sustained investment in infrastructure, logistics, and quality management is fundamental to improving case detection, surveillance, and progress toward the WHO End TB Strategy milestones. Full article

Background: Tuberculosis (TB) remains a major global health problem, and the WHO central Africa region continues to bear the heaviest disease burden. Gabon is one of the high-TB-burden countries in the world; however, its national TB program performance remains weak despite financial support from international health agencies. Identifying and mapping high-TB- and multi-drug-resistant-TB (MDR-TB)-burden areas for targeted public health interventions was the objective of this study. Methods: A region-wide mixed method study was carried out, comprising ecological design and a desk review, with the use of medical records from TB diagnosis and care units in 12 health facilities located across the capital Libreville, Republic of Gabon, from 1 January through December 2022. Libreville is the region that bears the heaviest TB burden in Gabon. With the collaboration of the Agency for Space Studies and Observations (AGEOS, Gabon), collected data were transferred to and analyzed using QGIS software in order to develop satellite images. Results: In the Libreville health region, there were 4560 cases diagnosed in 2022, representing 77.9% of all cases in the country, with an annual incidence of 509 per 100,000. Spatial mapping of incident cases by county of residence showed that a large majority of the TB cases diagnosed at the CHUL care center in 2022 were from Nzeng-Ayong (range: 36–50 cases) and Owendo (26–35 cases), whereas higher TB incidence at the Nkembo care center was from Nzeng-Ayong (range: 356–455 cases) and Owendo (256–355 cases), followed by Nkembo, Akebe ville, Akebe Baraka, Akebe Plaine/plateau, Angondje, Angondje village, Charbonnages, Bikele, Pk11, Pk12, Pk9, Mindoube I, Mindoube II (66–255 cases), Sotega, and Nkok (46–65 cases). Other counties accounted for less than 45 TB cases. Considering MDR-TB cases, higher incidence was observed in Pk9 county, which accounted for six cases (14.6%), followed by Owendo, accounting for four (9.7%). Discussion: Findings suggest that Nzeng-Ayong and Owendo are high-TB-burden counties in Libreville, whereas Pk9 and Owendo counties are counties categorized as high-MDR-TB-incidence areas. They should be subject to targeted to public health interventions to enhance TB control in Libreville. Full article

Tuberculosis remains endemic in the Philippines despite decades of biomedical progress under the WHO End TB Strategy. This persistence reflects not a failure of medicine, but of systems that treat tuberculosis as a biomedical issue rather than a social one. While public health programs recognize community factors, stigma is still framed as a problem of awareness rather than a structural outcome of health institutions. Practices of isolation, surveillance, and labeling have normalized fear and exclusion, shaping how communities perceive and respond to the disease. By pathologizing patients rather than confronting inequities, institutions perpetuate the very stigma that hinders diagnosis and treatment. To end tuberculosis, national frameworks, especially in low- and middle-income settings, must become stigma-responsive by embedding social trust, accountability, and equity as measurable goals alongside cure rates. Only then can the End TB Strategy’s promise of universality and dignity be realized. Full article

Background: Tuberculosis (TB) remains a public health concern in Saudi Arabia, where primary care physicians play a crucial role in early detection and infection control. This study assessed physicians’ knowledge, attitudes, and practices (KAP) regarding TB infection control in Riyadh. Methods: A cross-sectional survey was conducted among 205 physicians in primary healthcare centers using a validated electronic questionnaire. Knowledge scores were classified as good (≥8/14 correct) or poor (<8). Descriptive statistics and chi-square/t-tests were applied. Results: The mean knowledge score was 8.5 (SD = 2.1); 57.1% of physicians demonstrated good knowledge. Knowledge was significantly associated with specialization (p = 0.049), position (p = 0.031), and monthly patient load (p = 0.031). While 92.7% correctly identified airborne transmission, only 30.7% knew when a TB patient becomes noninfectious. Most participants (80%) had not received TB-related training in the past year. Conclusions: Primary care physicians in Riyadh show moderate knowledge and positive attitudes, but important gaps remain in diagnostic clarity and infection control timelines. Strengthening continuous medical education and integrating TB-specific modules into the Saudi national TB control program are essential to standardize practices and improve patient outcomes. Full article

Background and Objectives: This study aimed to evaluate the treatment outcomes of adults with pulmonary drug-susceptible tuberculosis (DS-TB) in Lithuania over 22 years, and to examine associations between treatment outcomes, various risk factors, and temporal trends. Materials and Methods: A retrospective cohort analysis was conducted using data from the National Tuberculosis Information System from 2000 to 2021. A total of 18,697 adult patients with DS-TB were included. Patients were grouped into three time periods: Period I (2000–2007), Period II (2008–2015), and Period III (2016–2021). Treatment outcomes were categorized as successful (treatment completed with recovery) or unsuccessful (patients who encountered treatment failure, died during treatment, or converted to drug-resistant tuberculosis). Associations with individual risk factors, including smoking, alcohol use, comorbidities, and sociodemographic variables, were analyzed. Results: Treatment success rates improved steadily across the study periods: 82.3% in Period I, 84.4% in Period II, and 87.6% in Period III. Mortality rates declined over time but remained substantial: 17.1%, 15.2%, and 12.0% in Periods I, II, and III, respectively. Non-lethal treatment failures decreased slightly (0.6%, 0.4%, and 0.4%). Multivariate analysis identified significant associations between treatment failure and multiple risk factors, including low BMI, male gender, unemployment, homelessness, smoking, alcohol and substance use, and comorbid conditions such as cancer, cardiovascular disease, chronic lung disease, diabetes mellitus, HIV, and renal failure. Conclusions: Treatment outcomes for DS-TB in Lithuania have improved over the past two decades; however, certain modifiable risk factors—such as low BMI, homelessness, substance use, and comorbidities—remain strongly linked to treatment failure. To further improve outcomes, targeted interventions such as nutritional support, housing programs, and integrated addiction services should be prioritized for high-risk groups within national TB control efforts. Full article

Drug-resistant Mycobacterium tuberculosis remains a significant global public health threat. While whole-genome sequencing (WGS) holds immense promise for understanding transmission dynamics and drug resistance mechanisms, its integration into routine surveillance remains limited. Additionally, insights from WGS are increasingly contributing to vaccine discovery by identifying novel antigenic targets and understanding pathogen evolution. The COVID-19 pandemic catalyzed an unprecedented expansion of genomic capacity in many low- and middle-income countries (LMICs), with public health institutions acquiring next-generation sequencing (NGS) platforms and developing local expertise in real-time pathogen surveillance. This hard-won capacity now represents a transformative opportunity to accelerate TB control enabling rapid detection of drug-resistant strains and high-resolution mapping of transmission networks that are critical for timely, targeted interventions. Furthermore, the integration of machine learning with genomic and clinical data offers a powerful avenue to improve the prediction of drug resistance and to tailor patient-specific TB management strategies. This article examines the practical challenges, emerging opportunities, and policy considerations necessary to embed genomic epidemiology within national TB control programs, particularly in high-burden, resource-constrained settings. Full article