Assessing Tuberculosis among Smokers: Secondary Analysis of an Active Case Finding Project

Background: Previous case-control studies and a small number of cohort studies in high-risk populations have found an association between smoking and tuberculosis, but limited studies are available in the general population that predicts association of smoking and TB. Objectives: To investigate the association between smoking and tuberculosis in a cohort of a general population. Methods: Four districts of Punjab province (Lahore, Rawalpindi, Faisalabad and Islamabad) were randomly selected. In routine, household contact investigation is practiced by the National TB Control Programme. For two years from July 2013-June 2015, all people who were living within 50 metres from the household of smear positive TB patients were screened for tuberculosis. Those found presumptive TB were investigated through smear microscopy and those found smear negative;the Xpert MTB/RIF test was done. All the diagnosed TB patients were referred to nearest basic health unit for further treatment and care. Results: A total of 783,043 contacts were screened for tuberculosis, of whom 19,815 (2.53%) were smokers. Smoking was common among men, in diabetic & teenage, elderly age population and in household contact of smear positive TB patients. Smoking was associated with an increased risk of tuberculosis (odds ratio [OR], 2.43;95% confidence interval, 2.27 - 2.60) in household contact of smear positive TB patients. The association was stronger among those greater than 45 years of age (OR, 11.09) than those between 25 - 44 years of age (OR, 5.83) and diabetic persons (OR, 2.0). Conclusions: Smoking was associated with a twofold increased risk of active tuberculosis in a cohort of general population.

Assessing the impact of TB/HIV services integration on TB treatment outcomes and their relevance in TB/HIV monitoring in Ghana

Background:The impact of the human immunodeficiency virus(HIV)on tuberculosis(TB),and the implications for TB and HIV control,is a public health challenge in Ghana-almost a quarter(23%)of all TB cases were HIV positive in 2010.The integration of TB/HIV services has therefore emerged as an essential component of the national response to TB and HIV.The aim is to reduce fragmentation,improve access,enhance efficiency and improve quality of care.Ghana’s TB/HIV policy comprises three linked sets of activities:effective implementation of the Stop TB Strategy for TB control,improved HIV prevention and care,and the implementation of additional TB/HIV activities.Different models of service delivery with increasing integration of TB/HIV activities are expected to provide greater access to more comprehensive care.The objective of this paper is to assess the impact of TB/HIV integration on TB treatment outcomes and to explore the usefulness of TB treatment outcomes as TB/HIV indicators.Methods:A before-and-after study to observe the introduction of TB/HIV activities into TB programmes in three hospitals with different levels of integration was conducted.Anonymised patient data was collated from TB registers from each facility,and analysed to determine if TB treatment outcomes changed significantly after integration.Results:TB treatment success was 50%(95%CI 49-52)prior to,and 69%(95%CI 65-73)after,integration(Χ243.96,p<0.00).Treatment success increased from 43%to 53%at the one-stop shop(OSS),from 69%to 78%at the partially integrated site(PIS)and substantially from 46%to 78%at the referral site(RS)(Χ264.54;p<0.01).Defaults and cases transferred out reduced from 14.3%and 15.3%prior to integration,to 1.4%and 9.0%after integration,respectively,accounting for a significant increase in treatment success.Death rates remained high at 18%in all cases studied and 25%in HIV-associated cases after integration.Conclusion:TB/HIV integration may improve TB treatment success,but its exact impact is difficult to ascertain due to non-specificity and design limitations.TB mortality may be more useful as an indicator for monitoring TB/HIV activities in Ghana.