Should household contacts and other close contacts of a person with active TB be systematically screened for active TB?

Size: px
Start display at page:

Download "Should household contacts and other close contacts of a person with active TB be systematically screened for active TB?"

Transcription

1 Burden of illness or problem DOMAI N Should household contacts and other close contacts of a person with active TB be systematically screened for active TB? Patients: Screening intervention: Comparison: Close contacts of active TB cases Symptom screening, chest X-ray screening, or both Passive case-finding Note: See the systematic reviews for full references to cited papers. Implied purpose: Linked treatment: Reducing TB morbidity, mortality and transmission Treatment of active TB and treatment of TB infection in children aged <5 years CRITERIA J UDGE MEN T E V IDEN CE C OMMENT S Is it frequent? infrequent Infrequent Moderately frequent frequent frequent Across 95 studies in low-income and middle-income countries, the weighted mean prevalence of all types of active TB among household contacts and other close contacts of a person with active TB was 3.1% (95% confidence interval [CI], %), and the weighted-mean prevalence of microbiologically proven TB was 1.2% (95% CI, %). In 108 studies in high-income settings, the weighted-average prevalence of all types of active TB among close contacts or household contacts was 1.4% (95% CI, %). In children aged <5 years in low-income and middle-income countries, the weighted-average prevalence of all types of active TB was 10% (95% CI, %). 1 Across 89 studies, the weighted mean number needed to screen (NNS) for all types of active TB in household contacts was 40 (range, 2 568) (Shapiro 2012). The weighted average NNS ranged from 54 in low-incidence settings to 17 in high-incidence settings (Shapiro 2012). Is it severe? mild mild moderate severe severe* *e.g. life threatening or disabling Hosehold contacts and other close contacts of a person with active TB have a high risk of becoming infected. People who have been recently infected with TB have a higher risk of progressing to active disease in the near future compared with people who have distant latent TB infection. Household contacts who are aged <5 years, have HIV, or have other diseases that impair their immune system are at a particularly high risk of developing active TB, and are also at high risk for poor disease outcomes. 1 Fox G et al. Contact investigation for tuberculosis: a systematic review and meta analysis. European Respiratory Journal, 2013, 4:

2 Confidence In accuracy of the diagnostic test Sensitivity and specificity (based on van t Hoog et al 2012) What is the confidence in the accuracy of the diagnostic test? low Moderate High Outcome Any cough Cough lasting >2 TP FP TN FP Sensiti vity Specifi city weeks Any symptom Chest X-ray (any abnormality) Chest X-ray (TBrelated abnormality) Effect Quality Effect Quality Effect Quality Effect Quality Effect Quality 56% (40 74%) 80% (69 90%) 35% (24 46%) 95% (93 97%) TP, true positive; FP, false positive; TN, true negative. OOO low 77% (68 86%) 68% (50 85%) For further details see the GRADE tables on the accuracy of diagnostic tests. OOO low OOO low 98% (95 100%) 75% (72 79%) O Moderate O Moderate 87% (79 95%) 89% (87 92%)

3 B e n e f i t s a n d h a r m s Modelled yeild of different algorithms based on point estimates from the systematic review of the accuracy of screening tools (van t Hoog et al 2012) and systematic reviews of the accuracy of sputum-smear microscopy 2 and the Xpert MTB/RIF test 3 Overall, are the anticipated desirable effects large? No Yes Screening Chest X-ray: any abnormality Chest X-ray: TB abnormalities Diagnosi Prevalence 0.5% (500/ ) Prevalence 1% (1 000/ ) Prevalence 2% (2 000/ ) s TP FP TN FN TP FP TN FN TP FP TN FN SSM+CD XP SSM+CD XP Cough lasting >2 3 weeks SSM+CD XP Overall, are the anticipated undesirable effects small? No Yes Any symptom 1. Cough lasting >2 3 weeks. 2. Chest X-ray SSM+CD XP SSM + CD XP Any symptom. 2. Chest X-ray SSM + CD XP Overall, is there certainty of the link between the accuracy of the diagnostic test and the consequences? uncertain uncertain Moderately certain Certain certain TP, true positive; FP, false positive; TN, true negative; FN, false negative; SSM, sputum-smear microscopy; XP, Xpert MTB/RIF test; CD, clinical diagnosis. 2 Approaches to improve sputum smear microscopy for tuberculosis diagnosis: expert group meeting report. Geneva, World Health Organization, Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF system. Policy statement. Geneva, World Health Organization, 2011 (WHO/HTM/TB/2011.4).

4 R e s o u r c e s V a l u e s C o n f i d e n c e i n b e n e f i t s a n d h a r m s Direct assessment of outcomes of screening (Kranzer 2012) Diagnostic category Potential effect Summary of findings Effect No. of studies Quality Benefit on case detection Contact tracing contributed 2 to 19% of all cases 5 cross-sectional studies OOO low Benefit on time to diagnosis - 0 studies OOO low Benefit on severity at diagnosis Risk of severe x-ray changes 1 cross sectional OOO True positives at diagnosis RR 0.38 study low Benefit on treatment outcome - 0 studies OOO Benefit on transmission 15% reduction in incidence 22% reduction in 2 cluster RCTs prevalence False negatives Harm from missed diagnosis - Not reviewed - True negatives Benefit from reassurance - Not reviewed - Harm from unnecessary screening - Not reviewed - False positives Harm from unnecessary treatment - Not reviewed - For further details see the GRADE tables. What is the overall confidence in the estimates of effect for benefits and harms? low Moderate High There is VERY LOW QUALITY evidence that investigating contacts could improve case-detection rates for the population where the investigation is carried out. There is VERY LOW QUALITY evidence that investigating contacts could identify cases earlier than passive case-finding. There is LOW QUALITY evidence that investigating contacts may influence the epidemiology of TB. What is the confidence in the values that patients place on the benefits and harms? low Moderate High high In 24 studies (Mitchell 2012) the weighted average of eligible persons who consented to undergo TB screening during investigation of household contacts was 80%; the range was 39 99%; and the median proportion was 85%. Is the cost low relative to the net benefits? No Uncertain Yes No cost effectiveness analysis of contact tracing has been published.

5 Overall balance of consequences Recommendation Undesirable consequences clearly outweigh desirable consequences Undesirable consequences probably outweigh desirable consequences Desirable and undesirable consequences closely balanced or uncertain Desirable consequences probably outweigh undesirable consequences Desirable consequences clearly outweigh undesirable consequences Strongly recommend against Conditionally recommend against Do not make recommendation (use this option very rarely if evidence is too sparse) Conditionally recommend Strongly recommend Proposed recommendation for discussion Household contacts and other close contacts of someone with active TB should be systematically screened for active TB. (This is a strong recommendation with very low quality evidence. ) Remarks Contacts may be investigated either by invitation to a clinic or through a household visit. No empirical data are available on the relative effectiveness and cost effectiveness of each type of investigation. The panel believes that household visits are more effective but also more resource intensive. For details on prioritizing index cases for investigation, operational aspects of contact investigations, and monitoring and evaluating of contact investigation, see WHO s guidelines on contact investigations. 4 Contact investigations should always be done when the index case has any of the following: sputum smear-positive pulmonary TB; proven or suspected multidrug-resistant TB (MDR-TB) or extensively drug-resistant TB (XDR-TB); is a person living with HIV; is a child aged <5 years. In addition, resources permitting, investigations of household contacts and close contacts may be performed for all index cases with pulmonary TB. 4 For those whose screening is positive, whether further diagnostic evaluation is undertaken depends on the profile of the contact and the index case. 4 For individuals who are contacts of a patient with MDR-TB or at high risk of MDR-TB for other reasons, 5 the primary diagnostic test should be the Xpert MTB/RIF test. 6 All persons living with HIV who have signs or symptoms of TB, persons who are seriously ill and suspected of having TB regardless of their HIV status, and persons whose HIV status is unknown who present with strong clinical evidence of HIV infection in settings where there is a high prevalence of HIV should have as their primary diagnostic test an Xpert MTB/RIF test. In settings where there is a high prevalence of HIV, all household contacts and close contacts should be counselled and tested for HIV. When an index case is a person living with HIV, all household contacts should be counselled and tested for HIV. All household contacts and close contacts who have symptoms compatible with active TB should receive counselling and testing for HIV as part of their clinical evaluation. People living with HIV who are household contacts or close contacts of someone with TB and who after an appropriate clinical evaluation have been found not to have active TB should be treated for presumed latent TB infection following WHO s guidelines. 7 Children who are younger than 5 years and who are household contacts or close contacts of someone with TB and who after an appropriate clinical evaluation have been found not to have active TB should be treated for presumed latent TB infection following WHO s guidelines. 3 Contacts should have a nutrition assessment as part of the investigation. If malnutrition is identified, it should be managed according to WHO s recommendations. 8 4 Recommendations for investigating the contacts of persons with infectious tuberculosis in low- and middle-income countries. Geneva, World Health Organization, 2012 (WHO/HTM/TB/2012.9). 5 Guidelines for the programmatic management of drug-resistant tuberculosis: emergency update Geneva, World Health Organization, 2008 (WHO/HTM/TB/ ). 6 Rapid implementation of the Xpert MTB/RIF diagnostic test: technical and operational how-to. Practical considerations. Geneva, World Health Organization, 2011 (WHO/HTM/TB/2011.2). 7 Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings. Geneva, World Health Organization, Guideline: Nutritional care and support for patients with Tuberculosis. WHO 2013 (draft guideline)

6 Burden of illness or problem DOMAIN Should people living with HIV be systematically screened for active TB at each visit to a health facility in all settings? Patients: Screening intervention: Comparison: People with HIV Symptom screening and chest X-ray screening Passive case-finding Note: See the systematic reviews for full references to cited papers. Implied purpose: Linked treatment: Reducing TB morbidity, mortality and transmission Chemotherapy for active TB Chemoprophylaxis for latent TB infection CRITERIA J UDGE MEN T E V IDEN CE C OMMENT S Is it frequent? infrequent Infrequent Moderately frequent frequent frequent The review of the number needed to screen (NNS) found that the average NNS among people with HIV in low-incidence countries is 30 (range, 8 391); in countries with a moderate incidence it is 61 (5 316); in countries with a medium incidence it is 13 (2 120); and in countries with a high incidence it is 10 (3 64) (Shapiro 2012). Is it severe? mild mild moderate severe severe* *e.g. life threatening or disabling TB is responsible for more than one quarter of deaths occurring in people living with HIV. 1 Among people who are HIV-positive, outcomes from treatment for TB are much worse than in other people with TB. 2 Delayed diagnosis of TB in people living with HIV is associated with an increased risk of poor treatment outcomes and death. 3 1 Getahun H et al. HIV infection-associated tuberculosis: the epidemiology and the response. Clinical Infectious Diseases, 2010, 50 (Suppl. 3):S201 S207. Cox JA et al. Autopsy causes of death in HIV-positive individuals in sub-saharan Africa and correlation with clinical diagnoses. AIDS Reviews, 2010, 12: Global tuberculosis control: WHO report Geneva, World Health Organization, Sanchez M et al. Outcomes of TB treatment by HIV Status in national recording systems in Brazil, PLoS One, 2012, 7(3): e33129 (doi: /journal.pone ). Farley JE et al. Outcomes of multi-drug resistant tuberculosis (MDR-TB) among a cohort of South African patients with high HIV prevalence. PLoS ONE, 2011, 6(7): e20436 (doi: /journal.pone ). Gandhi NR et al. Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet, 2006, 368 : Gandhi NR et al. HIV coinfection in multidrug- and extensively drug-resistant tuberculosis results in high early mortality. American Journal of Respiratory and Critical Care Medicine, 2010, 181: Timothy R et al. HIV infection related tuberculosis: clinical manifestations and treatment. Clinical Infectious Diseases, 2010, 50(Suppl. 3):S223 S230. Getahun H et al. Diagnosis of smear negative pulmonary tuberculosis in people with HIV infection or AIDS in resource-constrained settings: informing urgent policy changes. Lancet 2007, 369: Chaisson RE et al.. Tuberculosis in patients with the acquired immunodeficiency syndrome: clinical features, response to therapy, and survival. American Review of Respiratory Disease, 1987, 136:

7 Confidence in accuracy of the diagnostic test A systematic review found that the best symptom-based screening tool for HIV-positive people used four symptoms, and had a sensitivity of 79% and a specificity of 50%. 4 At a 5% prevalence of TB among people living with HIV, the negative predictive value was 97.7% (95% confidence interval, ). Adding abnormal findings on chest X-ray to the screening for four symptoms increased the sensitivity from 79% to 91% but there was a drop in specificity, from 50% to 39%. At a 5% prevalence of TB among people living with HIV, augmenting the symptom-based screening with abnormal findings seen on chest X-ray increased the negative predictive value by a margin of 1% (98.7% versus 97.8%). Adding abnormal findings on chest X-ray to the symptom-based screening at a TB prevalence of 20% among people living with HIV increased the negative predictive value by almost 4% (94.3% versus 90.4%). One study 5 assessed a screening algorithm for HIV-positive children. The presence of cough lasting >2 weeks, fever or failure to thrive had a sensitivity of 95% and specificity 59%. The absence of these symptoms had a negative predictive value of 99%. GRADE table from the guideline on intensified case-finding in people living with HIV. 6 What is the confidence in the accuracy of the diagnostic test? low Moderat e High 4 Getahun H et al. Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies. PLoS Medicine, 2011, 8(1):e (doi: /journal.pmed ). 5 Song R et al. Evaluation of tuberculosis screening approaches among HIV-infected children in Rwanda, 2008 [Abstract no. TUPEB132]. Geneva, International AIDS Society, 2013 ( accessed [ 6 Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings. Geneva, World Health Organization, 2011.

8 R e s o u r c es V a l u e s C o n f i d e n c e i n b e n e f i t s a n d h a r m s B e n e f i t s a n d h a r m s Overall, are the anticipated desirable effects large? Overall, are the anticipated undesirable effects small? Overall, is there certainty about the link between the accuracy of the diagnostic test and the consequences? No No uncertain Yes Yes uncertain Moderately certain Certain certain Impact on case detection No published controlled trial has assessed the impact of screening HIV-positive people on changes in overall case detection. One cross-sectional study in India from a setting with a low prevalence of HIV found that 1% of the total cases detected came from screening people with HIV (Shetty 2008). Impact on time to diagnosis and severity at diagnosis No studies were found. Impact on treatment outcomes No published study has compared treatment outcomes between HIV-positive TB patients detected through screening with outcomes among those detected through other methods. Three studies reported TB treatment outcomes only in cohorts with TB detected through screening. One study from Botswana (Agizew 2010) reported a treatment success rate of 85% and a death rate of 12% in a cohort in which all patients were HIV-positive. One study from Ivory Coast (Koffi 1997) reported a treatment success rate of 74% and a death rate of 26% in a cohort of patients identified through screening in prisons, among whom 30% were HIVpositive (data were not disaggregated by HIV status). One study from South Africa (Kranzer 2012) reported a treatment success rate of 81% and a death rate of 5% in a cohort of patients screened for TB as part of a mobile HIV testing programme; 54% of patients were HIV-positive (data were not disaggregated by HIV status). Impact on epidemiology No published trial has assessed the epidemiological impact of screening for TB specifically in people who are HIV-positive. What is the overall confidence in the estimates of effect for benefits and harms? low Moderate High There is VERY LOW QUALITY direct evidence on the impact of screening on morbidity and transmission specifically among people with HIV. However, TB is a cause of death and suffering among people with HIV, and delayed diagnosis of TB in HIV-positive people is associated with an increased risk of poor outcomes from treatment, including death. It is therefore plausible that screening HIVpositive people for TB will be beneficial. An additional benefit is that screening for active TB can identify people who are eligible for treatment of latent TB infection; treating latent TB infection has been shown to be effective in reducing the incidence of TB and death from TB. What is the confidence in the values that patients place on the benefits and harms? low Moderate High high In 17 studies (Mitchell 2012) the weighted average of eligible persons who consented to undergo TB screening among people living with HIV was 78%; the range was 52 99%; and the median proportion was 83%. Is the cost low relative to the net benefits? No Uncertain Yes No cost effectiveness analysis has been published.

9 Overall balance of consequences Undesirable consequences clearly outweigh desirable consequences Undesirable consequences probably outweigh desirable consequences Desirable and undesirable consequences closely balanced or uncertain Desirable consequences probably outweigh undesirable consequences Desirable consequences clearly outweigh undesirable consequences Recommendation Strongly recommend against Conditionally recommend against Do not make recommendation (use this option very rarely if evidence is too sparse) Conditionally recommend Strongly recommend We decide People living with HIV should be systematically screened for active TB at each visit to a health facility in all settings. This is a strong recommendation with very low quality evidence. Remarks This recommendation is fully consistent with previous WHO guidelines on intensified case finding in people with HIV. 7 7 Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings. Geneva, World Health Organization, 2011.

10 Burden of illness or problem Domain Should systematic screening for active TB be done in miners? Patients: Diagnostic intervention: Comparison: Implied purpose: Linked treatment: People working in mines Chest X-ray Passive case-finding Reducing TB morbidity, mortality and transmission Treatment of active TB Note: See the systematic reviews for full references to cited papers. CRITERIA J UDGE MEN T E V IDEN CE C OMMEN TS Is it frequent? frequen t Infrequ Moderatel ent y frequent frequent freque nt A systematic review of eight studies (Shapiro 2012) of the number needed to screen (NNS) to detect a previously undetected case of TB found that for miners the mean weighted NNS was 87 (range, ); all of the high-incidence countries represented in these studies are known to have a high prevalence of HIV among miners. For low-incidence countries the mean NNS was 48; for moderate-incidence countries, the mean NNS was 154; and for high-incidence countries the mean NNS was 37. Is it severe? mild mild moderat e severe severe * *e.g. life threatening or disabling Exposure to silica dust and silicosis are among the strongest risk factors for TB, with a relative risk of for silicosis, depending on the severity of the disease. 1 Silicosis is common in miners, 2 which is the main reason for the high incidence of TB among them. 3 In some countries, such as those in southern Africa, the prevalence of HIV is high among miners, which further increases their risk of TB and poor outcomes from TB treatment if diagnosis is delayed. The combined increase in risk for silicosis and HIV infection is multiplicative. 4 TB patients with silicosis have an increased risk of death (adjusted relative risk [RR], 3.0; 95% confidence interval [CI], ). 5 1 Barboza CEG et al. Tuberculosis and silicosis: epidemiology, diagnosis and chemotherapy. Jornal Brasileiro de Pneumologia, 2008, 34: Churchyard GJ et al. Silicosis prevalence and exposure-response relations in South African gold miners. Occupational and Environmental Medicine, 2004, 61: Hnizdo E, Murray J. Risk of pulmonary tuberculosis relative to silicosis and exposure to silica dust in South African gold miners. Occupational and Environmental Medicine, 1998, 55: Erratum in: Occupational and Environmental Medicine, 1999, 56: Corbett EL et al. Risk factors for pulmonary mycobacterial disease in South African gold miners. A case-control study. American Journal of Respiratory and Critical Care Medicine, 1999, 159: Cowie RL. The epidemiology of tuberculosis in gold miners with silicosis. American Journal of Respiratory and Critical Care Medicine,1994, 150: te Waternaude JM et al. Tuberculosis and silica exposure in South African gold miners. Occupational and Environmental Medicine, 2006, 63: Corbett EL et al. HIV infection and silicosis: the impact of two potent risk factors on the incidence of mycobacterial disease in South African mines. AIDS, 2000, 14: Churchyard GJ et al. Factors associated with an increased case-fatality rate in HIV-infected and non-infected South African gold miners with pulmonary tuberculosis. International Journal of Tuberculosis and Lung Disease, 2000, 4:

11 Confidence in accuracy of the diagnostic test Though data are scarce on the prevalence of silicosis in most low-income and middle-income settings, it is plausible that silicosis is particularly common in settings where working conditions are poor, such as in many low-income countries. Delayed diagnosis of TB leads to an increased risk of transmission, especially in crowded settings, such as mines, and especially where miners both work and live in crowded conditions. 6 In some middle-income countries, the mining industry attracts migrant workers from countries with a high burden of TB, and there is migratioin into and out of mining communitiies. 7 In theory, mines can amplify TB transmission, leading to increased transmission both within and outside mining communities. Mining is a significant determinant of countrywide variation in the incidence of TB in sub-saharan nations. 8 Sensitivity and specificity (based on van t Hoog et al 2012) What is the confidence in the accuracy of the diagnostic test? low Moderat e High Outcome Any cough Cough lasting >2 TP FP TN FP Sensiti vity Specifi city weeks Any symptom Chest X-ray (any abnormality) Chest X-ray (TBrelated abnormality) Effect Quality Effect Quality Effect Quality Effect Quality Effect Quality 56% (40 74%) 80% (69 35% (24 46%) 95% (93 OOO low 77% (68 86%) 68% (50 85%) OOO low OOO low 98% (95 100%) 75% (72 79%) O Moderate O Moderate 90%) 97%) TP, true positive; FP, false positive; TN, true negative. For further details see the GRADE tables on the accuracy of diagnostic tests. (One study Lewis 2009 evaluating different algorithms for symptom screening in gold miners, reported a sensitivity of <10% for chronic cough, and a sensitivity of 29% for any symptom in a population already undergoing annual screening with chest X-ray.) 87% (79 95%) 89% (87 92%) 6 Godfrey-Faussett P et al. Tuberculosis control and molecular epidemiology in a South African gold-mining community. Lancet,. 2000, 356: Girdler-Brown BV et al. The burden of silicosis, pulmonary tuberculosis and COPD among former Basotho gold miners. American Journal of Industrial Medicine, 2008, 51: Stuckler D et al. Mining and risk of tuberculosis in sub-saharan Africa. American Journal of Public Health, 2011, 101:

12 B ene fits and h a rms Overall, are the anticipated desirable effects large? No Yes Modelled yield of different algorithms based on point estimates from the systematic review of the accuracy of screening tools (van t Hoog et al 2012) and systematic reviews of the accuracy of sputum-smear microscopy 9 and the Xpert MTB/RIF test 10 Screening Chest X-ray: any abnormality Diagnosi Prevalence 0.5% (500/ ) Prevalence 1% (1 000/ ) Prevalence 2% (2 000/ ) s TP FP TN FN TP FP TN FN TP FP TN FN SSM+CD XP Chest X-ray: TB abnormalities SSM+CD XP Overall, are the anticipated undesirable effects small? No Yes Cough lasting >2 3 weeks Any symptom 1. Cough lasting >2 3 weeks. 2. Chest X-ray SSM+CD XP SSM+CD XP SSM + CD XP Any symptom. 2. Chest X-ray SSM + CD XP TP, true positive; FP, false positive; TN, true negative; FN, false negative; SSM, sputum-smear microscopy; XP, Xpert MTB/RIF test; CD, clinical diagnosis. 9 Approaches to improve sputum smear microscopy for tuberculosis diagnosis: expert group meeting report. Geneva, World Health Organization, Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF system. Policy statement. Geneva, World Health Organization, 2011 (WHO/HTM/TB/2011.4).

13 Overall, is there certainty about the link between the accuracy of the diagnostic test and the consequences? uncert Moderatel Certain ncertain ain y certain certain Direct assessment of outcomes of screening (Kranzer 2012) Diagnostic category Potential effect Summary of findings Effect No. of studies Quality Benefit on case detection - 0 studies OOO low Benefit on time to diagnosis - 0 studies OOO low True positives Benefit on severity at diagnosis - 0 studies OOO low Benefit on treatment outcome Fewer deaths (See text) 1 cohort OOO Benefit on transmission - 0 studies OOO low False negatives Harm from missed diagnosis - Not reviewed - True negatives Benefit from reassurance - Not reviewed - Harm from unnecessary screening - Not reviewed - False positives Harm from unnecessary treatment - Not reviewed - Impact on case detection No studies. Impact on time to diagnosis and severity at diagnosis No studies. Impact on treatment outcomes One cohort study (Churchyard 2000) assessing risk factors for case-fatality in HIV-negative miners and HIV-positive miners with TB found that the adjusted relative risk of death (controlling for HIV status, sputum status, treatment category, age, extent of disease, silicosis and drug resistance) was 5.6 (95% CI, ) for people identified through passive case-finding compared with those identified through a routine screening programme using chest X-ray. The adjusted RR for HIV-positive miners was 4.3 (95% CI, ); for HIV-negative miners it was 8.0 (95% CI, ). The case-fatality rate in HIV-negative miners detected through passive case-finding was low (2.0%); the case-fatality rate in those who were screened was even lower (0.4%). The case-fatality rate in HIV-positive miners detected through passive case-finding was high (16%); it was 3% for those who had been screened. Thus, while the reduction in relative risk was higher for HIV-negative miners than it was for HIV-positive miners who had been screened, the absolute decrease in risk was much larger for HIV-positive miners who had been screened. Impact on TB epidemiology No studies. Screening interval

14 R esou rc es V a lues C on fiden ce in b ene fits an d ha rms One randomized controlled trial (Churchyard 2011) compared miners who had 6-monthly screening by chest X-ray with miners who had 12-monthly screening by chest X-ray. There was no difference in the number of cases detected, but miners identified by 6-monthly screening had significantly less extensive disease at the time of diagnosis and a lower case-fatality rate than those identified by 12-monthly screening, although only the reduction in case-fatality rate at 2 months was significantly lower. What is the overall confidence in the estimates of effect for benefits and harms? low Moderate High There is VERY LOW QUALITY evidence that screening for TB among miners reduces the case-fatality rate. There is no evidence from published studies on the impact of screening miners for TB on case detection, delay in diagnosis and severity of disease at diagnosis, or on the epidemiology of TB. What is the confidence in the values that patients place on the benefits and harms? low Moderate High high In six studies (Mitchell 2012) the weighted average of eligible persons who consented to undergo TB screening in miners was 70%; the range was 66 93%; and the median proportion was 84%. Is the cost low relative to the net benefits? No Uncertain Yes No cost or cost effectiveness analysis has been published. Overall balance of consequences Undesirable consequences clearly outweigh desirable consequences Undesirable consequences probably outweigh desirable consequences Desirable and undesirable consequences closely balanced or uncertain Desirable consequences probably outweigh undesirable consequences Desirable consequences clearly outweigh undesirable consequences Recommendation Strongly recommend against Conditionally recommend Against Do not make recommendation (use this option very rarely if evidence is too sparse) Conditionally recommend Strongly recommend

15 Options for recommendation and for discussion Option 1: There is not enough evidence to make a recommendation. Option 2: Systematic screening for active TB should be done in miners. Option 3: Systematic screening for active TB should be done in miners in settings with a moderate-to-high burden (prevalence >100/ ) or where the prevalence of TB in miners is very high (>1%). For options 2 and 3: These are conditional recommendations with very low quality evidence. Remarks Screening miners should be a high priority, particularly in settings with a high prevalence of HIV and a high prevalence of silicosis. It may not be possible to implement this recommendation in resource-constrained settings. However, mining companies tend to be resource-rich and could probably afford to offer screening. When the prevalence of rifampicin resistance in the screened population is <10%, an Xpert MTB/RIF result that is positive for rifampicin should be confirmed by conventional drug-susceptibility testing or line probe assay. 11 In settings with a high prevalence of HIV, counselling and testing for HIV should be offered to all people whose screening is positive for TB. 12 The screening interval should be 1 year. Screening miners for TB should be combined with general health screening. 11 Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF system. Policy statement. Geneva, World Health Organization, 2011 (WHO/HTM/TB/2011.4). 12 Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings. Geneva, World Health Organization, 2011.

16 Burden of illness or problem D O M A Should systematic screening for active TB be done routinely in prisons? Patients: Screening intervention: Comparison: People in prisons Symptom screening or chest X-ray screening, or both Passive case-finding Implied purpose: Linked treatment: Reducing TB morbidity, mortality and transmission Anti-TB chemotherapy Note: See the systematic reviews for full references to cited papers. CRITERIA J UDGE MEN T E V IDEN CE C OMMENT S A systematic review found that the incidence of TB in prisoners averages 23 times higher than in the general population (Baussano et al 2010). This review reported a median incidence of 1943/ population in middle-income and low-income countries, and an incidence of 238/ in high-income countries. Is it frequent? infrequent Infrequent Moderately frequent frequent frequent A systematic review of the number needed to screen (NNS) in different risk groups (Shapiro et al 2012) reported a mean weighted NNS from 44 studies of prisoners in all countries of 315 (range, ). In low-incidence countries the weighted mean NNS was 1180 (range ) ; in medium-incidence countries the weighted mean NNS was 155 (range ); and in countries with a moderate incidence or a high incidence it was 110 (range ). TB transmission rates are high in prisons because there is often a high prevalence of TB among people who are incarcerated, and living conditions are often crowded. Prisons can amplify community transmission of TB. In high-income countries Baussano (2010) estimated that the population-attributable fraction of TB in prisons was 8.5%; in middle-income and low-income countries it was estimated to be 6.3%. Is it severe? mild mild moderate severe severe* *e.g. life threatening or disabling The prevalence of risk factors for poor treatment outcomes may be high in prisons; these risk factors include HIV infection, undernutrition, and drug abuse and alcohol abuse.

17 Confidence in accuracy of the diagnostic test Sensitivity and specificity (based on van t Hoog et al 2012) What is the confidence in the accuracy of the diagnostic test? low Moderate High Outcome Any cough Cough lasting >2 TP FP TN Sensiti vity weeks Any symptom Chest x-ray (any abnormality) Chest X-ray (TBrelated abnormality) Effect Quality Effect Quality Effect Quality Effect Quality Effect Quality 56% (40 74%) 80% (69 35% (24 46%) 95% (93 Specifi FP city 90%) 97%) TP, true positive; FP, false positive; TN, true negative. OOO low 77% (68 86%) 68% (50 85%) For further details see the GRADE tables on the accuracy of diagnostic tests. OOO low OOO low 98% (95 100%) 75% (72 79%) O Moderate O Moderate 87% (79 95%) 89% (87 92%)

18 Benefits and harms Overall, are the anticipated desirable effects large? No Yes Modelled yield of different algorithms based on point estimates from the systematic review of the accuracy of screening tools (van t Hoog et al 2012) and systematic reviews of the accuracy of sputum-smear microscopy 1 and the Xpert MTB/RIF test 2 Screening Chest X-ray: any abnormality Diagnosi Prevalence 0.5% (500/ ) Prevalence 1% (1 000/ ) Prevalence 2% (2 000/ ) s TP FP TN FN TP FP TN FN TP FP TN FN SSM+CD XP Chest X-ray: TB abnormalities SSM+CD XP Cough lasting >2 3 weeks SSM+CD XP Overall, are the anticipated undesirable effects small? No Yes Any symptom 1. Cough lasting >2 3 weeks. 2. Chest X-ray SSM+CD XP SSM + CD XP Any symptom. 2. Chest X-ray SSM + CD XP TP, true positive; FP, false positive; TN, true negative; FN, false negative; SSM, sputum-smear microscopy; XP, Xpert MTB/RIF test; CD, clinical diagnosis. Overall, is there certainty about the link between the accuracy of the diagnostic test and the consequences? uncertain uncertain Moderately certain Certain certain 1 Approaches to improve sputum smear microscopy for tuberculosis diagnosis: expert group meeting report. Geneva, World Health Organization, Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF system. Policy statement. Geneva, World Health Organization, 2011 (WHO/HTM/TB/2011.4).

19 Direct assessment of outcomes of screening (Kranzer 2012) Diagnostic category Potential effect Summary of findings Effect No. of studies Quality Benefit on case detection - 0 studies OOO low Benefit on time to diagnosis Delay 3xlonger with passive 1 cross sectional OOO detection study low True positives Benefit on severity at diagnosis Less likely to be smear 1 cross sectional OOO positive at diagnosis study low Benefit on treatment outcome No control group 2 cross sectional studies OOO Benefit on transmission Reduction in incidence over 1 longitudinal study OOO time (10 years) low False negatives Harm from missed diagnosis - Not reviewed - True negatives Benefit from reassurance - Not reviewed - Harm from unnecessary screening - Not reviewed - False positives Harm from unnecessary treatment - Not reviewed - For further details see the GRADE tables. Impact on case detection There are no studies assessing the impact of screening in prisons on overall case detection. Impact on time to diagnosis and severity at diagnosis One study has compared delay in people screened vs. passively detected among various high risk groups in London, including prisoners. The delay to diagnosis was three time longer on average in those detected passively. The data is from a published conference abstract and does not provide disaggregated delay data by risk groups, nor details about study methodology. Impact on treatment outcomes Two studies have reported treatment outcomes among prisoners with TB detected through screening, but no study has compared outcomes between screened and passively detected prisoners. One study from Ivory Coast (Koffi 1997) reported treatment success rate 74% and death rate 26%. The other study, from Malawi (Harrier 2004) reported treatment success rate 61% and death rate 12% while 7% defaulted before treatment started.

20 R e s o u r c es V a l u e s c o n f i d e n c e i n b e n e f i t s a n d h a r m s Impact on TB epidemiology One study from Mongolia 3 reported declining TB incidence in a prison over a ten year period (from about 2,500/100,000 notified cases in prisoners in 2001 to less than 900/100,000 in 2010 across 23 prisons and 16 detention centres with a total of about 6000 prisoners), associated with the introduction of systematic screening at both detention and conviction combined with improved TB management and improved living conditions in the prisons. The national TB notification rate in Mongolia fluctuated between 142 and 194/100,000 during the same time period without any clear downward trend. Results may be interpreted as screening having an effect on reducing transmission and thus reducing incidence within prisons, while this did not have an impact on the national level. This was however not a controlled study, and therefore it was not included in the systematic review by Kranzer (2012). What is the overall confidence in the estimates of effect for benefits and harms? low Moderate High There is VERY LOW QUALITY evidence that screening prisoners could detect cases of TB earlier and affect the epidemiology of TB within prisons. What is the confidence in the values that patients place on the benefits and harms? low Moderate High high In 16 studies (Mitchell 2012) the weighted average of eligible persons who consented to undergo TB screening in prisons was 72%; the range was 18 98%; and the median proportion was 86%. Is the cost low relative to the net benefits? No Uncertain Yes No cost-effectiveness analysis has been published. Overall balance of consequences Undesirable consequences clearly outweigh desirable consequences Undesirable consequences probably outweigh desirable consequences Desirable and undesirable consequences closely balanced or uncertain Desirable consequences probably outweigh undesirable consequences Desirable consequences clearly outweigh undesirable consequences Recommendation Strongly recommend against Conditionally recommend Against Do not make recommendation (use this option very rarely if evidence is too sparse) Conditionally recommend Strongly recommend 3 Yanjindulam et al. Reduction of tuberculosis burden among prisoners in Mongolia: review of case notification, INT J TUBERC LUNG DIS 16(3):

21 Options for recommendations and for discussion Option 1: There is not enough evidence to make a recommendation. Option 2: Screening for active TB at the time a person enters prison should be followed by yearly screening and screening when a prisoner is released; this strategy should be implemented in prisons and other penitentiary institutions in all settings. Option 3: Screening for active TB at the time a person enters prison should be followed by yearly screening and screening when a prisoner is released; this strategy should be implemented in prisons and other penitentiary institutions in moderate to-high burden settings (>100/ ). For options 2 and 3: These are conditional recommendations with very low-quality evidence. Notes: While direct evidence of the impact on morbidity from and transmission of TB from screening prisoners is very weak, there are several reasons to conditionally recommend such screening: prisoners are among the highest risk group for TB in all settings, although the NNS is high in low-burden settings; transmission in prisons is believed to be high, especially where living conditions are crowded; additionally, prisons can amplify transmission. The population-attributable fraction of TB in prisoners has been estimated to be 8.5% in high-income countries, and 6.3% in middle-income and low-income countries; screening in prisons is feasible in many settings, and general health screening is already taking place in many prisons. Remarks It may not be possible to implement these recommendations in resource-constrained settings. When the prevalence of rifampicin resistance in the screened population is <10%, an Xpert MTB/RIF result that is positive for rifampicin should be confirmed by conventional drugsusceptibility testing or line probe assay. 2 In settings with a high prevalence of HIV, counselling and testing for HIV should be offered to all people whose screening for TB is positive. 4 For recommendations on managing TB in prisons and other penitentiary institutions, and for advice on managerial and administrative issues, see Guidelines for the control of tuberculosis in prisons. 5 Screening for TB in prisons and other penitentiary institutions should be combined with general health screening. 4 Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings. Geneva, World Health Organization, Guidelines for the control of tuberculosis in prisons. The Hague, Tuberculosis Coalition for Technical Assistance (TBCTA), 2009.

22 Burden of illness or problem DOMAIN Should systematic screening for active TB be done routinely in settings with a moderate-to-high prevalence of TB (>100/ population) among people seeking care for any reason who: (i) belong to one of the following risk groups for TB people older than 60 years, with previously known or suspected TB, who are undernourished, who smoke, who have chronic obstructive pulmonary disease, who have diabetes, with alcohol or substance abuse disorders, with a disease or undergoing treatment that impairs their immune system, who are pregnant, or who work in health care; or who work in health care. and Patients: Screening intervention: Comparison: Implied purpose: Linked treatment: People living in areas with a moderate to-high prevalence of TB who attend for health-care services and belong to special risk groups Symptom screening or chest X-ray screening, or both Passive case-finding Reducing TB morbidity, mortality and transmission Anti-TB chemotherapy (ii) have not been screened for TB during the preceding 6 12 months? Note: See the systematic reviews for full references to cited papers. CRITERIA J UDGE MEN T E V IDEN CE C OMMENT S In 5 studies from low-incidence countries (Shapiro et al 2012) the average number needed to screen (NNS) in people with diabetes was 1 276; in 5 studies from countries with a medium-to-high incidence it was 40 (Shapiro et al 2012). A systematic review of screening for TB in people with diabetes also reported a lower NNS in settings with a high background prevalence of TB and a tendency towards a lower NNS in people with more severe diabetes (Jeon et al 2010). The NNS for people who abuse drugs or alcohol ranged from 151 in 7 studies from settings with a low-to--moderate incidence to 20 in 2 studies from medium-incidence settings (Shapiro et al 2012); no study has been done in a setting with a high incidence. Is it frequent? infrequent Infrequent Moderately frequent frequent frequent The weighted average NNS for people with a lesion previously identified by chest X-ray was 75 in 3 studies (Shapiro 2012). Recent prevalence surveys have consistently found that the prevalence of active TB increases with age, and the prevalence is higher in people older than years than in the rest of the population (surveys from Bangladesh, China, Myanmar, Pakistan, the Philippines and Viet Nam). Elderly people account for a large proportion of the prevalence, and increase the total burden of TB in countries undergoing rapid demographic transition. However, there are no studies on the yield and impact of screening among elderly people attending health clinics. The incidence of TB in people with previous TB or a lesion seen on chest X-ray is much higher than in the general population. Okada (2012) found that the incidence of smear-positive TB was 0.67%/year in people with an abnormality seen on chest X-ray compared with 0.08%/year in people with a normal chest X-ray at baseline (relative risk, 8). Four studies (Shapiro 2012) looking

23 Confidence in accuracy of the diagnostic test at other disease risk groups in low-incidence settings found an average NNS of 510 (range, ). Is it severe? mild mild moderate severe severe* *e.g. life threatening or disabling People with diabetes, 1 people who are undernourished, 2 people who abuse alcohol, 3 injecting drug users, 4 patients with diseases that impair their immune system, 4 and elderly people 4 all have an increased risk of poor outcomes from TB treatment. Pregnant women with TB have a higher risk of complications for themselves and their infants than other pregnant women. 5 Sensitivity and specificity (based on van t Hoog et al 2012) What is the confidence in the accuracy of the diagnostic test? low Moderate High Outcome Any cough Cough lasting >2 TP FP TN FP Sensiti vity Specifi city weeks Any symptom Chest X-ray (any abnormality) Chest X-ray (TBrelated abnormality) Effect Quality Effect Quality Effect Quality Effect Quality Effect Quality 56% (40 74%) 80% (69 90%) 35% (24 46%) 95% (93 97%) TP, true positive; FP, false positive; TN, true negative. OOO low 77% (68 86%) 68% (50 85%) OOO low OOO low 98% (95 100%) 75% (72 79%) O Moderate O Moderate 87% (79 95%) 89% (87 92%) For further details see the GRADE tables on the accuracy of diagnostic tests. 1 Baker MA et al. Systematic review: the impact of diabetes on tuberculosis treatment outcomes. BMC Medicine, 2011, 9:81 (doi: / ). 2 Hanrahan CF et al. Body mass index and risk of tuberculosis and death. AIDS, 2010, 24: Khan A et al. Lack of weight gain and relapse risk in a large tuberculosis treatment trial. American Journal of Respiratory and Critical Care Medicine, 2006, 174: Krapp F et al., Bodyweight gain to predict treatment outcome in patients with pulmonary tuberculosis in Peru. International Journal of Tuberculosis and Lung Disease, 2008, 12: Zachariah R et al., Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death. Transactions of the Royal Society of Tropical Medicine and Hygiene, 2002, 96: Cegielski JP, McMurray DN. The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals. International Journal of Tuberculosis and Lung Disease, 2004, 8: Rehm J et al. Alcohol consumption, alcohol use disorders and incidence and disease course of tuberculosis (TB) is there a causal connection? BMC Public Health, 2009, 9:450 (doi: / ). 4 Waitt CJ, Squire SB. A systematic review of risk factors for death in adults during and after tuberculosis treatment. International Journal of Tuberculosis and Lung Disease, 2011, 15: Figueroa-Damian R, Arredondo-Garcia JL. Neonatal outcome of children born to women with tuberculosis. Archives of Medical Research, 2001, 32: Bjerkedal T, Bahna SL, Lehmann EH. Course and outcome of pregnancy in women with pulmonary tuberculosis. Scandinavian Journal of Respiratory Diseases, 1975, 56: Nhan-Chang CL, Jones TB. Tuberculosis in pregnancy. Clinical Obstetrics and Gynecology, 2010, 53:

Intensified TB case finding among PLHIV and vulnerable population Identifying contacts Gunta Kirvelaite

Intensified TB case finding among PLHIV and vulnerable population Identifying contacts Gunta Kirvelaite Intensified TB case finding among PLHIV and vulnerable population Identifying contacts Gunta Kirvelaite Riga East Clinical hospital, Centre for tuberculosis and lung diseases. Head of outpatient department.

More information

Guidance on Matching Funds: Tuberculosis Finding the Missing People with TB

Guidance on Matching Funds: Tuberculosis Finding the Missing People with TB February 2017 Guidance on Matching Funds: Tuberculosis Finding the Missing People with TB 1. Background TB is the leading cause of death by infectious disease, killing 1.8 million people in 2015. Each

More information

Systematic screening for active TB operational manual and tool to help prioritization

Systematic screening for active TB operational manual and tool to help prioritization Systematic screening for active TB operational manual and tool to help prioritization Wolfheze 2015 Knut Lönnroth, Global TB Programme, 1 Strong recommendations = Should be screened in all settings 1.

More information

Online Annexes (5-8)

Online Annexes (5-8) 2016 Online Annexes (5-8) to WHO Policy guidance: The use of molecular line probe assay for the detection of resistance to second-line anti-tuberculosis drugs 1 Contents: Annex 5: GRADE summary of findings

More information

Online Annexes (5-8)

Online Annexes (5-8) Online Annexes (5-8) to WHO Policy guidance: The use of molecular line probe assay for the detection of resistance to second-line anti-tuberculosis drugs THE END TB STRATEGY Online Annexes (5-8) to WHO

More information

Assessing the programmatic management of drug-resistant TB

Assessing the programmatic management of drug-resistant TB Assessing the programmatic management of drug-resistant TB a. Review the programmatic management of drug-resistant TB patients with the TB manager. i. What is the size of MDR-TB problem locally? How many

More information

The health of the South African mining workforce: trends, progress and challenges Jill Murray and Zodwa Ndlovu

The health of the South African mining workforce: trends, progress and challenges Jill Murray and Zodwa Ndlovu The health of the South African mining workforce: trends, progress and challenges Jill Murray and Zodwa Ndlovu International Public Health Symposium, University of the Witwatersrand, School of Public Health,

More information

Overview of recent WHO guidelines:

Overview of recent WHO guidelines: Overview of recent WHO guidelines: 1. Systematic screening for active TB 2. Framework on TB and diabetes 3. Nutritional care for people with TB Knut Lönnroth, Global TB Programme, WHO Divonne NSP workshop

More information

Principle of Tuberculosis Control. CHIANG Chen-Yuan MD, MPH, DrPhilos

Principle of Tuberculosis Control. CHIANG Chen-Yuan MD, MPH, DrPhilos Principle of Tuberculosis Control CHIANG Chen-Yuan MD, MPH, DrPhilos Estimated global tuberculosis burden 2015 an estimated 10.4 million incident cases of TB (range, 8.7 million 12.2 million) 142 cases

More information

INTENSIFIED TB CASE FINDING

INTENSIFIED TB CASE FINDING INTENSIFIED TB CASE FINDING My friends call me Intensified Case Finding (ICF) I undertake regularly screening all people with, or at high risk of HIV, for symptoms of TB in health care facilities, communities

More information

The crisis of TB in the mines. Rodney Ehrlich, Centre for Occupational and Environmental Health Research, University of Cape Town

The crisis of TB in the mines. Rodney Ehrlich, Centre for Occupational and Environmental Health Research, University of Cape Town The crisis of TB in the mines Rodney Ehrlich, Centre for Occupational and Environmental Health Research, University of Cape Town The crisis of TB on the mines 1. Current epidemiology 2. Underlying causes

More information

Implementation and scale-up of the Xpert MTB/RIF system for rapid diagnosis of TB and MDR-TB. Global Consultation

Implementation and scale-up of the Xpert MTB/RIF system for rapid diagnosis of TB and MDR-TB. Global Consultation Implementation and scale-up of the Xpert MTB/RIF system for rapid diagnosis of TB and MDR-TB Global Consultation Geneva, 30 November 2010 Mario C. Raviglione, M.D. Director, Stop TB Department WHO, Geneva,

More information

MDR, XDR and Untreatable Tuberculosis and Laboratory Perspectives. Martie van der Walt TUBERCULOSIS EPIDEMIOLOGY & INTERVENTION RESEARCH UNIT

MDR, XDR and Untreatable Tuberculosis and Laboratory Perspectives. Martie van der Walt TUBERCULOSIS EPIDEMIOLOGY & INTERVENTION RESEARCH UNIT TUBERCULOSIS EPIDEMIOLOGY & INTERVENTION RESEARCH UNIT MDR, XDR and Untreatable Tuberculosis and Laboratory Perspectives Martie van der Walt IOM Meeting 15-17 January 2013 introduction 1 min 150 words

More information

Multidrug-Resistant TB

Multidrug-Resistant TB Multidrug-Resistant TB Diagnosis Treatment Linking Diagnosis and Treatment Charles L. Daley, M.D. National Jewish Health University of Colorado Denver Disclosures Chair, Data Monitoring Committee for delamanid

More information

Latent tuberculosis infection

Latent tuberculosis infection Latent tuberculosis infection Updated and consolidated guidelines for programmatic management ANNEX 2 Evidence-to-Decision and GRADE tables Latent tuberculosis infection Updated and consolidated guidelines

More information

Let s Talk TB A Series on Tuberculosis, A Disease That Affects Over 2 Million Indians Every Year

Let s Talk TB A Series on Tuberculosis, A Disease That Affects Over 2 Million Indians Every Year A Series on Tuberculosis, A Disease That Affects Over 2 Million Indians Every Year Madhukar Pai, MD, PhD Author and Series Editor Camilla Rodrigues, MD co-author Abstract Most individuals who get exposed

More information

TB 2015 burden, challenges, response. Dr Mario RAVIGLIONE Director

TB 2015 burden, challenges, response. Dr Mario RAVIGLIONE Director TB 2015 burden, challenges, response Dr Mario RAVIGLIONE Director Addis Ababa, Ethiopia 11-13 November 2015 Overview TB basics TB burden & challenges Response: End TB Strategy DAY 1 What is TB? Definition

More information

The Lancet Infectious Diseases

The Lancet Infectious Diseases Xpert MTB/RIF Ultra for detection of Mycobacterium tuberculosis and rifampicin resistance: a prospective multicentre diagnostic accuracy study Susan E Dorman, Samuel G Schumacher, David Alland et al. 2017

More information

Report on WHO Policy Statements

Report on WHO Policy Statements Report on WHO Policy Statements Christopher Gilpin TB Diagnostics and Laboratory Strengthening Unit Secretariat, Global Laboratory Initiative Stop TB Department, WHO Geneva New Diagnostics Working Group

More information

TB & HIV CO-INFECTION IN CHILDREN. Reené Naidoo Paediatric Infectious Diseases Broadreach Healthcare 19 April 2012

TB & HIV CO-INFECTION IN CHILDREN. Reené Naidoo Paediatric Infectious Diseases Broadreach Healthcare 19 April 2012 TB & HIV CO-INFECTION IN CHILDREN Reené Naidoo Paediatric Infectious Diseases Broadreach Healthcare 19 April 2012 Introduction TB & HIV are two of the leading causes of morbidity & mortality in children

More information

Tuberculosis Epidemiology and Prospects for Control

Tuberculosis Epidemiology and Prospects for Control Tuberculosis Epidemiology and Prospects for Control Chakaya J.M. President, International Union Against Tuberculosis and Lung Disease (The Union) 12 th INTEREST Conference, May 31, 2018, Kigali Rwanda

More information

Latent tuberculosis infection

Latent tuberculosis infection EXECUTIVE SUMMARY Latent tuberculosis infection Updated and consolidated guidelines for programmatic management Executive summary Latent tuberculosis infection (LTBI) is defined as a state of persistent

More information

Twelve-monthly versus six-monthly radiological screening for active case-finding of tuberculosis: a randomised controlled trial

Twelve-monthly versus six-monthly radiological screening for active case-finding of tuberculosis: a randomised controlled trial 1 Aurum Institute for Health Research, Johannesburg, South Africa 2 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK 3 Department of Clinical Research,

More information

The epidemiology of tuberculosis

The epidemiology of tuberculosis The epidemiology of tuberculosis Tuberculosis Workshop Shanghai, 12-22 May 28 Philippe Glaziou World Health Organization Outline Epidemiology refresher Estimates of tuberculosis disease burden Notifications

More information

Xpert MTB/Rif What place for TB diagnosis in MSF projects? Francis Varaine, MSF Geneva, 29/11/10

Xpert MTB/Rif What place for TB diagnosis in MSF projects? Francis Varaine, MSF Geneva, 29/11/10 Xpert MTB/Rif What place for TB diagnosis in MSF projects? Francis Varaine, MSF Geneva, 29/11/10 Introduction Excellent performances, rapid results, and easy to use Questions Where and how are we going

More information

Clinical and Public Health Impact of Nucleic Acid Amplification Tests (NAATs) for Tuberculosis

Clinical and Public Health Impact of Nucleic Acid Amplification Tests (NAATs) for Tuberculosis Clinical and Public Health Impact of Nucleic Acid Amplification Tests (NAATs) for Tuberculosis Amit S. Chitnis, MD, MPH; Pennan M. Barry, MD, MPH; Jennifer M. Flood, MD, MPH. California Tuberculosis Controllers

More information

TB facts & figures Microbiology of TB Transmission of TB Infection control in health care settings Special cases Resistant TB Masks

TB facts & figures Microbiology of TB Transmission of TB Infection control in health care settings Special cases Resistant TB Masks 1 TB facts & figures Microbiology of TB Transmission of TB Infection control in health care settings Special cases Resistant TB Masks 2 Page 1 4 NHS Lothian Infection Prevention and Control Study Day On

More information

Kenya Perspectives. Post-2015 Development Agenda. Tuberculosis

Kenya Perspectives. Post-2015 Development Agenda. Tuberculosis Kenya Perspectives Post-2015 Development Agenda Tuberculosis SPEAKERS Anna Vassall Anna Vassall is Senior Lecturer in Health Economics at the London School of Hygiene and Tropical Medicine. She is a health

More information

What Is New in Combination TB Prevention? Lisa J. Nelson Treatment and Care (TAC) Team HIV Department WHO HQ

What Is New in Combination TB Prevention? Lisa J. Nelson Treatment and Care (TAC) Team HIV Department WHO HQ What Is New in Combination TB Prevention? Lisa J. Nelson Treatment and Care (TAC) Team HIV Department WHO HQ Outline Combination prevention for HIV Approaches to TB prevention Individual Household/key

More information

HIV Clinicians Society Conference TB/HIV Treatment Cascade

HIV Clinicians Society Conference TB/HIV Treatment Cascade HIV Clinicians Society Conference-2012 TB/HIV Treatment Cascade Dr Judith Mwansa-Kambafwile Wits Reproductive Health & HIV Institute University of Witwatersrand TB/HIV Treatment Cascade Overview TB stats

More information

Modeling the diagnosis of HIVassociated

Modeling the diagnosis of HIVassociated Modeling the diagnosis of HIVassociated TB: key research questions and data gaps Patrick GT Cudahy, MD Clinical Instructor Yale School of Medicine S L I D E 0 Diagnosis of TB in people living with HIV

More information

Definitions and reporting framework for tuberculosis 2013 revision. Dennis Falzon Global Forum of Xpert MTB/RIF Implementers Annecy 17 April 2013

Definitions and reporting framework for tuberculosis 2013 revision. Dennis Falzon Global Forum of Xpert MTB/RIF Implementers Annecy 17 April 2013 Definitions and reporting framework for tuberculosis 2013 revision Dennis Falzon Global Forum of Xpert MTB/RIF Implementers Annecy 17 April 2013 2-year revision process WHO/HTM/TB/2013.2 2 www.who.int/iris/bitstream/10665/79199/1/9789241505345_eng.pdf

More information

Global epidemiology of drug-resistant tuberculosis. Factors contributing to the epidemic of MDR/XDR-TB. CHIANG Chen-Yuan MD, MPH, DrPhilos

Global epidemiology of drug-resistant tuberculosis. Factors contributing to the epidemic of MDR/XDR-TB. CHIANG Chen-Yuan MD, MPH, DrPhilos Global epidemiology of drug-resistant tuberculosis Factors contributing to the epidemic of MDR/XDR-TB CHIANG Chen-Yuan MD, MPH, DrPhilos By the end of this presentation, participants would be able to describe

More information

2016 Annual Tuberculosis Report For Fresno County

2016 Annual Tuberculosis Report For Fresno County 206 Annual Tuberculosis Report For Fresno County Cases Rate per 00,000 people 206 Tuberculosis Annual Report Fresno County Department of Public Health (FCDPH) Tuberculosis Control Program Tuberculosis

More information

Let s Talk TB. A Series on Tuberculosis, A Disease That Affects Over 2 Million Indians Every Year

Let s Talk TB. A Series on Tuberculosis, A Disease That Affects Over 2 Million Indians Every Year A Series on Tuberculosis, A Disease That Affects Over 2 Million Indians Every Year Lancelot M. Pinto, MD, MSc Author Madhukar Pai, MD, PhD co-author and Series Editor Abstract Nearly 50% of patients with

More information

Epidemiology and diagnosis of MDR-TB in children H Simon Schaaf

Epidemiology and diagnosis of MDR-TB in children H Simon Schaaf Epidemiology and diagnosis of MDR-TB in children H Simon Schaaf Desmond Tutu TB Centre Department of Paediatrics and Child Health, Stellenbosch University, and Tygerberg Children s Hospital (TCH) Definitions

More information

Programmatic management of latent TB infection: Global perspective and updates. Haileyesus Getahun, MD, MPH, PhD.

Programmatic management of latent TB infection: Global perspective and updates. Haileyesus Getahun, MD, MPH, PhD. Programmatic management of latent TB infection: Global perspective and updates Haileyesus Getahun, MD, MPH, PhD. What is latent TB infection? A state of persistent immune response to stimulation by Mycobacterium

More information

Should buprenorphine be covered for maintenance treatment in opioid dependent persons?

Should buprenorphine be covered for maintenance treatment in opioid dependent persons? Prepared by: Silvia Pregno May 13,2012 Patients: people with opioid dependence Should buprenorphine be covered for maintenance treatment in opioid dependent persons? Intervention: buprenorphine Comparison:

More information

Questions and Answers Press conference - Press Centre Room 3 Wednesday 16 August 2006, 14.00hrs

Questions and Answers Press conference - Press Centre Room 3 Wednesday 16 August 2006, 14.00hrs Questions and Answers Press conference - Press Centre Room 3 Wednesday 16 August 2006, 14.00hrs What causes TB? TB is caused by the bacterium Mycobacterium tuberculosis. Although it can cause disease in

More information

Elizabeth A. Talbot MD Assoc Professor, ID and Int l Health Deputy State Epidemiologist, NH GEISELMED.DARTMOUTH.EDU GEISELMED.DARTMOUTH.

Elizabeth A. Talbot MD Assoc Professor, ID and Int l Health Deputy State Epidemiologist, NH GEISELMED.DARTMOUTH.EDU GEISELMED.DARTMOUTH. The image part with relationship ID rid2 was not found in the file. MDR TB Management Review of the Evolution (or Revolution?) Elizabeth A. Talbot MD Assoc Professor, ID and Int l Health Deputy State Epidemiologist,

More information

Guidelines for TB contact tracing in Pacific Island countries and territories

Guidelines for TB contact tracing in Pacific Island countries and territories Guidelines for TB contact tracing in Pacific Island countries and territories Background Tuberculosis (TB) continues to be a public health issue of major significance around the world. The World Health

More information

The United Nations flag outside the Secretariat building of the United Nations, New York City, United States of America

The United Nations flag outside the Secretariat building of the United Nations, New York City, United States of America The United Nations flag outside the Secretariat building of the United Nations, New York City, United States of America Mike Segar / Reuters Executive Summary Context On 26 September 2018, the United Nations

More information

Chapter 1 Overview of Tuberculosis Epidemiology in the United States

Chapter 1 Overview of Tuberculosis Epidemiology in the United States Chapter 1 Overview of Tuberculosis Epidemiology in the United States Table of Contents Chapter Objectives.... 1 Progress Toward TB Elimination in the United States... 3 TB Disease Trends in the United

More information

A household survey on screening practices of household contacts of smear positive tuberculosis patients in Vietnam

A household survey on screening practices of household contacts of smear positive tuberculosis patients in Vietnam Thanh et al. BMC Public Health 2014, 14:713 RESEARCH ARTICLE Open Access A household survey on screening practices of household contacts of smear positive tuberculosis patients in Vietnam Thuy Hoang Thi

More information

: uptake and impact of Xpert MTB/RIF

: uptake and impact of Xpert MTB/RIF Photo: Riccardo Venturi 21-215: uptake and impact of Xpert MTB/RIF Wayne van Gemert WHO Global TB Programme, Geneva Joint Partners Forum for Strengthening and Aligning TB Diagnosis and Treatment 27-3 April

More information

Programmatic management of LTBI : a two pronged approach for ending the TB epidemic. Haileyesus Getahun Global TB Programme WHO/HQ

Programmatic management of LTBI : a two pronged approach for ending the TB epidemic. Haileyesus Getahun Global TB Programme WHO/HQ Programmatic management of LTBI : a two pronged approach for ending the TB epidemic Haileyesus Getahun Global TB Programme WHO/HQ What is latent TB infection? A state of persistent immune response to stimulation

More information

Pilot Summary Report Revisiting the cost-effectiveness of Xpert MTB/RIF: lessons learned from South Africa

Pilot Summary Report Revisiting the cost-effectiveness of Xpert MTB/RIF: lessons learned from South Africa Pilot Summary Report Revisiting the cost-effectiveness of Xpert MTB/RIF: lessons learned from South Africa Background In 2014, 1.5 million people died from tuberculosis (TB), 25% of whom had HIV, and 13%

More information

CMH Working Paper Series

CMH Working Paper Series CMH Working Paper Series Paper No. WG5 : 8 Title Interventions to reduce tuberculosis mortality and transmission in low and middle-income countries: effectiveness, cost-effectiveness, and constraints to

More information

GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG PEOPLE LIVING WITH HIV AND SILICOSIS IN SOUTH AFRICA

GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG PEOPLE LIVING WITH HIV AND SILICOSIS IN SOUTH AFRICA GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG PEOPLE LIVING WITH HIV AND SILICOSIS IN SOUTH AFRICA Page 1 of 17 TABLE OF CONTENT 1 BACKGROUND... 4 2 TB, HIV AND SILICOSIS... 4 2.1 TB PREVENTIVE

More information

ANNUAL TUBERCULOSIS REPORT OREGON Oregon Health Authority Public Health Division TB Program November 2012

ANNUAL TUBERCULOSIS REPORT OREGON Oregon Health Authority Public Health Division TB Program November 2012 ANNUAL TUBERCULOSIS REPORT OREGON 211 Oregon Health Authority Public Health Division TB Program November 212 Page 2 Table of Contents Charts Chart 1 TB Incidence in the US and Oregon, 1985-211... page

More information

Xpert MTB/RIF use for TB diagnosis in TB suspects with no significant risk of drug resistance or HIV infection. Results of Group Work

Xpert MTB/RIF use for TB diagnosis in TB suspects with no significant risk of drug resistance or HIV infection. Results of Group Work Xpert MTB/RIF use for TB diagnosis in TB suspects with no significant risk of drug resistance or HIV infection Results of Group Work DOTS expansion and enhancement Objective This group deals with the majority

More information

Mines and Tuberculosis in Southern Africa. Paula Akugizibwe AIDS and Rights Alliance for Southern Africa (ARASA) SA AIDS Conference, April

Mines and Tuberculosis in Southern Africa. Paula Akugizibwe AIDS and Rights Alliance for Southern Africa (ARASA) SA AIDS Conference, April Mines and Tuberculosis in Southern Africa Paula Akugizibwe AIDS and Rights Alliance for Southern Africa (ARASA) SA AIDS Conference, April 1 2009 Upon this gifted age, in its dark hour, Rains from the sky

More information

TUBERCULOSIS AND HIV/AIDS: A STRATEGY FOR THE CONTROL OF A DUAL EPIDEMIC IN THE WHO AFRICAN REGION. Report of the Regional Director.

TUBERCULOSIS AND HIV/AIDS: A STRATEGY FOR THE CONTROL OF A DUAL EPIDEMIC IN THE WHO AFRICAN REGION. Report of the Regional Director. 30 August 2007 REGIONAL COMMITTEE FOR AFRICA ORIGINAL: ENGLISH Fifty-seventh session Brazzaville, Republic of Congo, 27 31 August Provisional agenda item 7.8 TUBERCULOSIS AND HIV/AIDS: A STRATEGY FOR THE

More information

Contact Tracing and Active Case Finding: Underused Tools to Reduce the Burden of TB in Children

Contact Tracing and Active Case Finding: Underused Tools to Reduce the Burden of TB in Children Contact Tracing and Active Case Finding: Underused Tools to Reduce the Burden of TB in Children Regional TB Symposium Dushanbe, Tajikistan 2013 Dr Clara van Gulik Paediatric TB and HIV advisor Medecins

More information

What is new in WHO-guidelines relevant for childhood TB?

What is new in WHO-guidelines relevant for childhood TB? Photo: Riccardo Venturi What is new in WHO-guidelines relevant for childhood TB? Dr Malgosia Grzemska Coordinator, Technical Support, Stop TB Department World Health Organization, Geneva, Switzerland 12th

More information

IPT IMPLEMENTATION- SWAZILAND EXPERIENCE

IPT IMPLEMENTATION- SWAZILAND EXPERIENCE IPT IMPLEMENTATION- SWAZILAND EXPERIENCE Gugu Mchunu-National TB/HIV coordinator Programmatic Management of Latent TB infection consultation meeting Seoul, Republic of Korea,27-28 APRIL,2016 TB Epidemiology

More information

A Review on Prevalence of TB and HIV Co-infection

A Review on Prevalence of TB and HIV Co-infection Human Journals Review Article May 2015 Vol.:1, Issue:1 All rights are reserved by Jyoti P. Waghmode et al. A Review on Prevalence of TB and HIV Co-infection Keywords: tuberculosis, HIV, co-infection, prevalence

More information

Contact Follow-Up and Treatment of LTBI in Households of Infectious Cases in Pakistan

Contact Follow-Up and Treatment of LTBI in Households of Infectious Cases in Pakistan Contact Follow-Up and Treatment of LTBI in Households of Infectious Cases in Pakistan 17 th Annual Conference, The Union-North American Region, Vancouver, Canada. 28 February 2013 Farhana Amanullah Director

More information

Primary Care and TB Control Dr Helen Booth Consultant Thoracic Physician, UCLH Clinical Lead, Integrated TB NCL-Service

Primary Care and TB Control Dr Helen Booth Consultant Thoracic Physician, UCLH Clinical Lead, Integrated TB NCL-Service Primary Care and TB Control Dr Helen Booth Consultant Thoracic Physician, UCLH Clinical Lead, Integrated TB NCL-Service North Central London TB Service TBService@nhs.net After Action Review Could we have

More information

Ethiopia. Targeted Tuberculosis Case Finding Interventions in Six Mining Shafts in Remote Districts of Oromia Region in Ethiopia PROJECT CONTEXT

Ethiopia. Targeted Tuberculosis Case Finding Interventions in Six Mining Shafts in Remote Districts of Oromia Region in Ethiopia PROJECT CONTEXT Technical BRIEF Photo Credit: Challenge TB Targeted Tuberculosis Case Finding Interventions in Six Mining Shafts in Remote Districts of Oromia Region in Ethiopia PROJECT CONTEXT Ethiopia is the second-most

More information

Tuberculosis in children: gaps and opportunities

Tuberculosis in children: gaps and opportunities Tuberculosis in children: gaps and opportunities Mark Nicol Division of Medical Microbiology and Institute for Infectious Diseases and Molecular Medicine, University of Cape Town and National Health Laboratory

More information

2014 Annual Report Tuberculosis in Fresno County. Department of Public Health

2014 Annual Report Tuberculosis in Fresno County. Department of Public Health 214 Annual Report Tuberculosis in Fresno County Department of Public Health www.fcdph.org Tuberculosis (TB) is a common communicable disease caused by the bacterium Mycobacterium tuberculosis and occasionally

More information

TB: A Supplement to GP CLINICS

TB: A Supplement to GP CLINICS TB: A Supplement to GP CLINICS Chapter 10: Childhood Tuberculosis: Q&A For Primary Care Physicians Author: Madhukar Pai, MD, PhD Author and Series Editor What is Childhood TB and who is at risk? India

More information

TB Situation in Zambia/ TB Infection Control Program. Dr N Kapata Zambia National TB/Leprosy Control Programme Manager

TB Situation in Zambia/ TB Infection Control Program. Dr N Kapata Zambia National TB/Leprosy Control Programme Manager / TB Infection Control Program Dr N Kapata Zambia National TB/Leprosy Control Programme Manager Background Major public health problem Current (2014) notification rate is at 286/ 100,000 population. The

More information

The clinical utility of the urine based lateral flow lipoarabinomannan (LF-LAM) assay in HIV infected adults in Myanmar.

The clinical utility of the urine based lateral flow lipoarabinomannan (LF-LAM) assay in HIV infected adults in Myanmar. The clinical utility of the urine based lateral flow lipoarabinomannan (LF-LAM) assay in HIV infected adults in Myanmar Josh Hanson Background Tuberculosis is the commonest cause of death in HIV infected

More information

Virtual Implementation Evaluation of Tuberculosis diagnostics in Tanzania Ivor Langley, Liverpool School of Tropical Medicine

Virtual Implementation Evaluation of Tuberculosis diagnostics in Tanzania Ivor Langley, Liverpool School of Tropical Medicine Virtual Implementation Evaluation of Tuberculosis diagnostics in Tanzania Ivor Langley, Liverpool School of Tropical Medicine 3rd sector OR and developing countries 27th March 2013, London School of Economics

More information

MODULE SIX. Global TB Institutions and Policy Framework. Treatment Action Group TB/HIV Advocacy Toolkit

MODULE SIX. Global TB Institutions and Policy Framework. Treatment Action Group TB/HIV Advocacy Toolkit MODULE SIX Global TB Institutions and Policy Framework Treatment Action Group TB/HIV Advocacy Toolkit 1 Topics to be Covered Global TB policy and coordinating structures The Stop TB Strategy TB/HIV collaborative

More information

Drug-resistant Tuberculosis

Drug-resistant Tuberculosis page 1/6 Scientific Facts on Drug-resistant Tuberculosis Source document: WHO (2008) Summary & Details: GreenFacts Context - Tuberculosis (TB) is an infectious disease that affects a growing number of

More information

Globally, it is well documented that certain

Globally, it is well documented that certain Surveillance Report Characteristics and treatment outcomes of tuberculosis cases by risk groups, Japan, 2007 2010 Kazuhiro Uchimura, a Jintana Ngamvithayapong-Yanai, a Lisa Kawatsu, a Akihiro Ohkado, a

More information

Certainty assessment of patients Effect Certainty Importance. a standardised 9 month shorter MDR-TB regimen. e f

Certainty assessment of patients Effect Certainty Importance. a standardised 9 month shorter MDR-TB regimen. e f Author(s): STREAM Stage 1 Trial investigators reported for the Guideline Development Group for the WHO treatment guidelines on MDR/RR-TB, 2018 update (6 July 2018) - FINAL RESULTS Question: PICO 1. In

More information

Global, National, Regional

Global, National, Regional Epidemiology of TB: Global, National, Regional September 13, 211 Edward Zuroweste, MD Chief Medical Officer Migrant Clinicians Network Assistant Professor of Medicine Johns Hopkins School of Medicine Epidemiology

More information

Overview of the Presentation

Overview of the Presentation Overview of the Presentation Definitions(TBCase, MDR-TB & XDR-TB) Global Tuberculosis (TB,HIV/TB,MDR & XDR)Scenario & Trend Risk factor for TB Natural history of TB Types of TB & Trends of Extra Pulmonary

More information

The New WHO guidelines on intensified TB case finding and Isoniazid preventive therapy and operational considerations

The New WHO guidelines on intensified TB case finding and Isoniazid preventive therapy and operational considerations Workshop to accelerate the implementation of the Three Is for HIV/TB and earlier initiation of ART in Southern Africa, March 14-18, 2011, Johannesburg, South Africa. The New WHO guidelines on intensified

More information

9. Screening in Special Situations

9. Screening in Special Situations 9. Screening in Special Situations Screening is the practice of identifying a condition or illness, which could benefit from early diagnosis, preventative or curative intervention. 318 Screening should

More information

Online Annexes (2-4)

Online Annexes (2-4) Online Annexes (2-4) to WHO Policy update: The use of molecular line probe assays for the detection of resistance to isoniazid and rifampicin THE END TB STRATEGY Online Annexes (2-4) to WHO Policy update:

More information

Annual surveillance report 2015

Annual surveillance report 2015 Annual surveillance report 215 Acknowledgements The Public Health Agency Northern Ireland gratefully acknowledges all those who contributed to this report, including; physicians, nurses, microbiologists,

More information

EPIDEMIOLOGY OF TUBERCULOSIS AND the IMPACT ON CHILDREN

EPIDEMIOLOGY OF TUBERCULOSIS AND the IMPACT ON CHILDREN EPIDEMIOLOGY OF TUBERCULOSIS AND the IMPACT ON CHILDREN Anneke C. Hesseling Professor in Paediatrics and Child Health Director: Desmond Tutu TB center Stellenbosch University 11 September 11 th International

More information

Downloaded from:

Downloaded from: van Halsema, CL; Fielding, KL; Chihota, VN; Lewis, JJ; Churchyard, GJ; Grant, AD (2012) Trends in drug-resistant tuberculosis in a gold-mining workforce in South Africa, 2002-2008. The international journal

More information

TB control. Assumptions. Reality. Symptomatic patients seek care. Patients and professionals don t recognise symptoms

TB control. Assumptions. Reality. Symptomatic patients seek care. Patients and professionals don t recognise symptoms Dr Al Story TB control Assumptions Symptomatic patients seek care Patients self administer treatment Active Case Finding (ACF) is too resource intensive Patients are hard-to-reach Reality Patients and

More information

2015 Annual Report Tuberculosis in Fresno County. Department of Public Health

2015 Annual Report Tuberculosis in Fresno County. Department of Public Health 215 Annual Report Tuberculosis in Fresno County Department of Public Health www.fcdph.org Number of Cases Rate per 1, Population 215 Tuberculosis Annual Report Fresno County Department of Public Health

More information

TB IN EMERGENCIES. Disease Control in Humanitarian Emergencies (DCE)

TB IN EMERGENCIES. Disease Control in Humanitarian Emergencies (DCE) TB IN EMERGENCIES Department of Epidemic and Pandemic Alert and Response (EPR) Health Security and Environment Cluster (HSE) (Acknowledgements WHO Stop TB Programme WHO/STB) 1 Why TB? >33% of the global

More information

Tuberculosis. New TB diagnostics. New drugs.new vaccines. Dr: Hussein M. Jumaah CABM Mosul College of Medicine 23/12/2012

Tuberculosis. New TB diagnostics. New drugs.new vaccines. Dr: Hussein M. Jumaah CABM Mosul College of Medicine 23/12/2012 Tuberculosis New TB diagnostics. New drugs.new vaccines Dr: Hussein M. Jumaah CABM Mosul College of Medicine 23/12/2012 Tuberculosis (TB )is a bacterial disease caused by Mycobacterium tuberculosis (occasionally

More information

C R E A E. Consortium to Respond Effectively to the AIDS-TB Epidemic. An International Research Partnership

C R E A E. Consortium to Respond Effectively to the AIDS-TB Epidemic. An International Research Partnership C R E A E Consortium to Respond Effectively to the AIDS-TB Epidemic An International Research Partnership Supported by the Bill and Melinda Gates Foundation http://www.tbhiv-create.org Overview What is

More information

UvA-DARE (Digital Academic Repository) Tuberculosis case finding in South Africa Claassens, M.M. Link to publication

UvA-DARE (Digital Academic Repository) Tuberculosis case finding in South Africa Claassens, M.M. Link to publication UvA-DARE (Digital Academic Repository) Tuberculosis case finding in South Africa Claassens, M.M. Link to publication Citation for published version (APA): Claassens, M. M. (2013). Tuberculosis case finding

More information

INTEGRATION OF PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES AND TUBERCULOSIS: A CASE FOR ACTION

INTEGRATION OF PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES AND TUBERCULOSIS: A CASE FOR ACTION INTEGRATION OF PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES AND TUBERCULOSIS: A CASE FOR ACTION Global commitments to prevent and control noncommunicable diseases and to end the global tuberculosis

More information

Antiretroviral therapy for adults and adolescents KEY MESSAGES. HIV/AIDS Department BACKGROUND

Antiretroviral therapy for adults and adolescents KEY MESSAGES. HIV/AIDS Department BACKGROUND KEY MESSAGES New WHO Recommendations: Antiretroviral therapy for adults and adolescents The World Health Organization (WHO) is revising its guidelines on antiretroviral therapy (ART) for adults and adolescents.

More information

TB Epidemiology. Richard E. Chaisson, MD Johns Hopkins University Center for Tuberculosis Research

TB Epidemiology. Richard E. Chaisson, MD Johns Hopkins University Center for Tuberculosis Research This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this

More information

TB Program and Epidemic aka B2B

TB Program and Epidemic aka B2B TB Program and Epidemic aka B2B Nulda Beyers On behalf of DTTC BOD Workshop 30 September2013 Trend in tuberculosis incidence, selected countries in Africa 1400 1200 Rate per 100,000 1000 800 600 400 200

More information

Latent Tuberculosis Infections Controversies in Diagnosis and Management Update 2016

Latent Tuberculosis Infections Controversies in Diagnosis and Management Update 2016 Latent Tuberculosis Infections Controversies in Diagnosis and Management Update 2016 Randy Culpepper, MD, MPH Deputy Heath Officer/Medical Director Frederick County Health Department March 16, 2016 2 No

More information

EXPERT GROUP MEETING REPORT

EXPERT GROUP MEETING REPORT Using the Xpert MTB/RIF assay to detect pulmonary and extrapulmonary tuberculosis and rifampicin resistance in adults and children DRUG-RESISTANCE TB/HIV RAPID TB TEST TUBERCULOSIS ACCURACY RECOMMENDATIONS

More information

Essential Mycobacteriology Laboratory Services in the Era of MDR- and XDR-TB: A TB Controller s Perspective

Essential Mycobacteriology Laboratory Services in the Era of MDR- and XDR-TB: A TB Controller s Perspective Essential Mycobacteriology Laboratory Services in the Era of MDR- and XDR-TB: A TB Controller s Perspective James Watt, MD, MPH Acting Chief, Tuberculosis Control Branch California Department of Public

More information

Information Note. WHO call for patient data on the treatment of multidrug- and rifampicin resistant tuberculosis

Information Note. WHO call for patient data on the treatment of multidrug- and rifampicin resistant tuberculosis Information Note WHO call for patient data on the treatment of multidrug- and rifampicin resistant tuberculosis In order to ensure that the upcoming comprehensive revision of WHO policies on treatment

More information

4.5. How to test - testing strategy HBV Decision-making tables PICO 3

4.5. How to test - testing strategy HBV Decision-making tables PICO 3 World Health Organization Global Hepatitis Programme 4.5. How to test - testing strategy HBV Decision-making tables PICO 3 Testing strategy to diagnose chronic HBV infection through detection of HBsAg:

More information

TB prevention studies in PLHIV: recent updates and what can they tell us for the future?

TB prevention studies in PLHIV: recent updates and what can they tell us for the future? TB prevention studies in PLHIV: recent updates and what can they tell us for the future? Richard E. Chaisson, MD Center for AIDS Research Center for TB Research Johns Hopkins University TB/HIV Working

More information

Annex 2. GRADE glossary and summary of evidence tables

Annex 2. GRADE glossary and summary of evidence tables WHO/HTM/TB/2011.6b. GRADE glossary and summary of evidence tables GRADE glossary Absolute effect The absolute measure of intervention effects is the difference between the baseline risk of an outcome (for

More information

Supplementary appendix

Supplementary appendix Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Churchyard GJ, Stevens WS, Mametja LD, et al.

More information

Costing of the Sierra Leone National Strategic Plan for TB

Costing of the Sierra Leone National Strategic Plan for TB Costing of the Sierra Leone National Strategic Plan for TB 2016-2020 Introduction The Government of Sierra Leone established the National Leprosy Control Programme in 1973 with support from the German

More information

Revised National Tuberculosis Control Programme (RNTCP) Dr.Kishore Yadav J Assistant Professor

Revised National Tuberculosis Control Programme (RNTCP) Dr.Kishore Yadav J Assistant Professor Revised National Tuberculosis Control Programme (RNTCP) Dr.Kishore Yadav J Assistant Professor Global scenario*: Burden of TB Incidence : 9.6 million (58% SEAR and Western Pacific) Deaths : 1.5 million

More information

Helping TB patients quit smoking: the potential impact, WHO recommendations and country experience

Helping TB patients quit smoking: the potential impact, WHO recommendations and country experience Helping TB patients quit smoking: the potential impact, WHO recommendations and country experience Dr Dongbo Fu Prevention of Noncommunicable Diseases World Health Organization 1 Outline Why national TB

More information

The Scaling-up of TB/HIV Collaborative Activities in the Asia-Pacific

The Scaling-up of TB/HIV Collaborative Activities in the Asia-Pacific Health System Strengthening and Sustaining the Response The Scaling-up of TB/HIV Collaborative Activities in the Asia-Pacific Jintana Ngamvithayapong-Yanai, Ph.D. On behalf of TB/HIV Working Group, the

More information