scholarly journals Estimated durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease

2021 ◽  
Author(s):  
Chu-Chang Ku ◽  
Peter MacPherson ◽  
McEwen Khundi ◽  
Rebecca Nzawa ◽  
Helena R.A. Feasey ◽  
...  
Keyword(s):  
Symptom Onset ◽  
People Living With Hiv ◽  
Case Detection ◽  
Care Seeking ◽  
African Countries ◽  
Prevalence Survey ◽  
Initial Care ◽  
Notification Data ◽  
Tuberculosis Disease ◽  
Tuberculosis Prevalence

Ratios of bacteriologically-positive tuberculosis prevalence to notification rates are used to characterise typical durations of tuberculosis disease, but have not accounted for asymptomatic periods prior to careseeking. We developed novel statistical models to estimate progression from initial bacteriological-positivity including smear conversion, symptom onset and initial care-seeking and fitted them to tuberculosis prevalence survey and notification data (one subnational and 11 national datasets) within a Bayesian framework. Asymptomatic tuberculosis duration was in the range 4 – 8 months for African countries; three countries in Asia showed longer durations of > 1 year. Care-seeking typically began half-way between symptom onset and notification. Our method also estimated smear progression rates and case-detection ratios. We found evidence for higher case-detection ratios and much shorter durations of tuberculosis for people living with HIV. To eradicate tuberculosis transmission, greater gains may be achieved by proactively screening people without symptoms through active case finding interventions.

scholarly journals Durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease with a Bayesian analysis of prevalence survey and notification data

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Chu-Chang Ku ◽  
Peter MacPherson ◽  
McEwen Khundi ◽  
Rebecca H. Nzawa Soko ◽  
Helena R. A. Feasey ◽  
...  
Keyword(s):  
People Living With Hiv ◽  
Case Detection ◽  
Care Seeking ◽  
Age Dependence ◽  
Prevalence Survey ◽  
Living With Hiv ◽  
Stratified Analysis ◽  
Notification Data ◽  
Tuberculosis Disease ◽  
Hiv Negative

Abstract Background Ratios of bacteriologically positive tuberculosis (TB) prevalence to notification rates are used to characterise typical durations of TB disease. However, this ignores the clinical spectrum of tuberculosis disease and potentially long infectious periods with minimal or no symptoms prior to care-seeking. Methods We developed novel statistical models to estimate progression from initial bacteriological positivity including smear conversion, symptom onset and initial care-seeking. Case-detection ratios, TB incidence, durations, and other parameters were estimated by fitting the model to tuberculosis prevalence survey and notification data (one subnational and 11 national datasets) within a Bayesian framework using Markov chain Monte Carlo methods. Results Analysis across 11 national datasets found asymptomatic tuberculosis durations in the range 4–8 months for African countries; three countries in Asia (Cambodia, Lao PDR, and Philippines) showed longer durations of > 1 year. For the six countries with relevant data, care-seeking typically began half-way between symptom onset and notification. For Kenya and Blantyre, Malawi, individual-level data were available. The sex-specific durations of asymptomatic bacteriologically-positive tuberculosis were 9.0 months (95% credible interval [CrI]: 7.2–11.2) for men and 8.1 months (95% CrI: 6.2–10.3) for women in Kenya, and 4.9 months (95% CrI: 2.6–7.9) for men and 3.5 months (95% CrI: 1.3–6.2) for women in Blantyre. Age-stratified analysis of data for Kenya showed no strong age-dependence in durations. For Blantyre, HIV-stratified analysis estimated an asymptomatic duration of 1.3 months (95% CrI: 0.3–3.0) for HIV-positive people, shorter than the 8.5 months (95% CrI: 5.0–12.7) for HIV-negative people. Additionally, case-detection ratios were higher for people living with HIV than HIV-negative people (93% vs 71%). Conclusion Asymptomatic TB disease typically lasts around 6 months. We found no evidence of age-dependence, but much shorter durations among people living with HIV, and longer durations in some Asian settings. To eradicate TB transmission, greater gains may be achieved by proactively screening people without symptoms through active case finding interventions

scholarly journals Pulmonary tuberculosis screening in anti-retroviral treated adults living with HIV in Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jill K. Gersh ◽  
Ruanne V. Barnabas ◽  
Daniel Matemo ◽  
John Kinuthia ◽  
Zachary Feldman ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Preventive Therapy ◽  
World Health ◽  
People Living With Hiv ◽  
Tuberculosis Screening ◽  
Hiv Positive Adults ◽  
Health Organization ◽  
A Prospective Study ◽  
Living With Hiv ◽  
Tuberculosis Prevalence

Abstract Background People living with HIV (PLHIV) who reside in high tuberculosis burden settings remain at risk for tuberculosis disease despite treatment with anti-retroviral therapy and isoniazid preventive therapy (IPT). The performance of the World Health Organization (WHO) symptom screen for tuberculosis in PLHIV receiving anti-retroviral therapy is sub-optimal and alternative screening strategies are needed. Methods We enrolled HIV-positive adults into a prospective study in western Kenya. Individuals who were IPT-naïve or had completed IPT > 6 months prior to enrollment were eligible. We evaluated tuberculosis prevalence overall and by IPT status. We assessed the accuracy of the WHO symptom screen, GeneXpert MTB/RIF (Xpert), and candidate biomarkers including C-reactive protein (CRP), hemoglobin, erythrocyte sedimentation rate (ESR), and monocyte-to-lymphocyte ratio for identifying pulmonary tuberculosis. Some participants were evaluated at 6 months post-enrollment for tuberculosis. Results The study included 383 PLHIV, of whom > 99% were on antiretrovirals and 88% had received IPT, completed a median of 1.1 years (IQR 0.8–1.55) prior to enrollment. The prevalence of pulmonary tuberculosis at enrollment was 1.3% (n = 5, 95% CI 0.4–3.0%): 4.3% (0.5–14.5%) among IPT-naïve and 0.9% (0.2–2.6%) among IPT-treated participants. The sensitivity of the WHO symptom screen was 0% (0–52%) and specificity 87% (83–90%). Xpert and candidate biomarkers had poor to moderate sensitivity; the most accurate biomarker was CRP ≥ 3.3 mg/L (sensitivity 80% (28–100) and specificity 72% (67–77)). Six months after enrollment, the incidence rate of pulmonary tuberculosis following IPT completion was 0.84 per 100 person-years (95% CI, 0.31–2.23). Conclusions In Kenyan PLHIV treated with IPT, tuberculosis prevalence was low at a median of 1.4 years after IPT completion. WHO symptoms screening, Xpert, and candidate biomarkers were insensitive for identifying pulmonary tuberculosis in antiretroviral-treated PLHIV.

scholarly journals An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa

2021 ◽  
Vol 18 (6) ◽  
pp. 3111
Author(s):  
Emmanuel Peprah ◽  
Mari Armstrong-Hough ◽  
Stephanie H. Cook ◽  
Barbara Mukasa ◽  
Jacquelyn Y. Taylor ◽  
...  
Keyword(s):  
Current Evidence ◽  
Chronic Obstructive ◽  
People Living With Hiv ◽  
African Countries ◽  
Obstructive Pulmonary Disease ◽  
Cardiopulmonary Disease ◽  
Current Trends ◽  
Significant Public Health ◽  
Artery Disease ◽  
Living With Hiv

Background: African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2–4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke. Conclusion: We call for a parallel program of implementation research to promote the adoption of evidence-based interventions, which could improve health outcomes for PWH with cardiopulmonary diseases and address the health inequities experienced by PWH in African countries.

An approach to estimating tuberculosis incidence and case detection rate from routine notification data

2015 ◽  
Vol 19 (3) ◽  
pp. 288-294 ◽  
Author(s):  
K. K. Avilov ◽  
A. A. Romanyukha ◽  
S. E. Borisov ◽  
E. M. Belilovsky ◽  
O. B. Nechaeva ◽  
...  
Keyword(s):  
Detection Rate ◽  
Case Detection ◽  
Case Detection Rate ◽  
Tuberculosis Incidence ◽  
Notification Data

HIV and AIDS in Africa

2021 ◽  
Author(s):  
Krista Johnson
Keyword(s):  
Adult Population ◽  
Hiv Prevalence ◽  
Hiv And Aids ◽  
People Living With Hiv ◽  
Prevalence Rates ◽  
African Countries ◽  
Effective Prevention ◽  
Aids Pandemic ◽  
Historical Processes ◽  
Women And Girls

Africa has the largest number of people living with HIV, with an estimated 25.7 million HIV-positive people in Africa by the end of 2018. This figure represents over two-thirds of infected people globally. African women and girls represent a majority of those infected, and Africa is home to three-fourths of all HIV-infected women and girls. Across African countries, there are differences in the sizes and trajectories of HIV epidemics. Southern Africa has the worst epidemic, with the numbers infected still rising in some countries. Prompting a development and governance crisis in many southern African countries, HIV prevalence rates are as high as 20 percent of the adult population in some countries and nearing 50 percent of the adult population in certain communities. East Africa too has been hit hard by HIV, leading to high mortality and morbidity rates in that region as well. In most of West and North Africa, there has been limited spread of HIV, with most countries in these regions having HIV prevalence rates of less than 3 percent. Africa’s encounter with HIV and AIDS began before it was first identified as a medical condition early in the 1980s. However, it was not recognized as an epidemic in most parts of Africa until much later. Framed largely as a public health crisis rather than a developmental one, much of the world’s focus on the AIDS pandemic in Africa has centered on access to treatment, and developing effective prevention strategies that have principally focused on behavior change practices for targeted populations. However, the HIV and AIDS pandemic in Africa did not emerge in a vacuum. It is the consequence of longer historical processes such as massive demographic growth, urbanization, and social change, as well as global inequalities and historical legacies of colonialism and imperialism. In this regard, a historical account of HIV in Africa offers an important corrective to the dominant biomedical response to AIDS in Africa. It is important to take note of longer historical processes that have shaped both the virus and the human response to it.

HIV/AIDS

2020 ◽  
pp. 901-933
Author(s):  
Sarah Fidler ◽  
Timothy E.A. Peto ◽  
Philip Goulder ◽  
Christopher P. Conlon
Keyword(s):  
Large Scale ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
African Countries ◽  
Global Pandemic ◽  
The People ◽  
Reduce Life Expectancy ◽  
Sub Saharan ◽  
Living With Hiv ◽  
The Impact

Since its discovery in 1983, the human immunodeficiency virus (HIV) has been associated with a global pandemic that has affected more than 78 million people and caused more than 39 million deaths. Globally, 36.9 million (34.3–41.4 million) people were living with HIV at the end of 2013. An estimated 0.8% of adults aged 15–49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults living with HIV and accounting for nearly 71% of the people living with HIV worldwide. The impact of HIV in some African countries has been sufficient to reverse population growth and reduce life expectancy into the mid-30s, although HIV incidence has declined in some of these high-prevalence countries. However, there are large-scale HIV epidemics elsewhere (e.g. India, the Russian Federation, and Eastern Europe).

scholarly journals Hyperglycemia and Risk of All-cause Mortality Among People Living With HIV With and Without Tuberculosis Disease in Myanmar (2011–2017)

2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Nang Thu Thu Kyaw ◽  
Srinath Satyanarayana ◽  
Htun Nyunt Oo ◽  
Ajay M V Kumar ◽  
Anthony D Harries ◽  
...  
Keyword(s):  
Hiv Care ◽  
People Living With Hiv ◽  
Spline Regression ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Need To Evaluate ◽  
Glycemic Targets ◽  
Living With Hiv ◽  
The Relationship ◽  
Tuberculosis Disease

Abstract Background There is limited empirical evidence on the relationship between hyperglycemia, tuberculosis (TB) comorbidity, and mortality in the context of HIV. We assessed whether hyperglycemia at enrollment in HIV care was associated with increased risk of all-cause mortality and whether this relationship was different among patients with and without TB disease. Methods We conducted a retrospective analysis of adult (≥15 years) HIV-positive patients enrolled into HIV care between 2011 and 2016 who had random blood glucose (RBG) measurements at enrollment. We used hazards regression to estimate associations between RBG and rate of all-cause mortality. Results Of 25 851 patients, 43% were female, and the median age was 36 years. At registration, the median CD4 count (interquartile range [IQR]) was 162 (68–310) cell/mm3, the median RBG level (IQR) was 88 (75–106) mg/dL, and 6.2% (95% confidence interval [CI], 6.0%–6.5%) had hyperglycemia (RBG ≥140 mg/dL). Overall 29% of patients had TB disease, and 15% died during the study period. The adjusted hazard of death among patients with hyperglycemia was significantly higher (adjusted hazard ratio [aHR], 1.2; 95% CI, 1.1–1.4) than among those with normoglycemia without TB disease, but not among patients with TB disease (aHR, 1.0; 95% CI, 0.8–1.2). Using 4 categories of RBG and restricted cubic spline regression, aHRs for death were significantly increased in patients with RBG of 110–140 mg/dL (categorical model: aHR, 1.3; 95% CI, 1.2–1.4; restricted spline: aHR, 1.1; 95% CI, 1.0–1.1) compared with those with RBG <110 mg/dL. Conclusions Our findings highlight an urgent need to evaluate hyperglycemia screening and diagnostic algorithms and to ultimately establish glycemic targets for PLHIV with and without TB disease.

scholarly journals HCV infection status and care seeking among people living with HIV who use drugs in Vietnam

AIDS Care ◽  
2020 ◽  
Vol 32 (sup2) ◽  
pp. 83-90
Author(s):  
Li Li ◽  
Chunqing Lin ◽  
Li-Jung Liang ◽  
Quang Loc Pham ◽  
Nan Feng ◽  
...  
Keyword(s):  
Hcv Infection ◽  
People Living With Hiv ◽  
Care Seeking ◽  
Infection Status ◽  
Living With Hiv
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