BackgroundIn response to the influx of displaced Syrians since 2011, the Jordanian National Tuberculosis Program (NTP) implemented a specific Tuberculosis (TB) reduction strategy, including contact-tracing (CT). Contacts of all refugees diagnosed with pulmonary TB (PTB) were registered by the International Organization for Migration and screened for active & latent TB infection (LTBI) in 6 NTP centres.The objectives of this study were to assess prevalence of active TB and LTBI, risk factors for LTBI as well as program performance.MethodsWe performed a retrospective study among contacts (N = 481) of all PTB cases diagnosed between March 2011 and May 2014 (N = 76). CT was performed using verbal screening of TB-related symptoms, tuberculin skin test (TST) and chest X-ray.ResultsLTBI was diagnosed in 24.1% of contacts tested with TST while active TB was diagnosed in 2.1% of contacts. Main risk factors for positive TST included smear-positive index case (IC) (OR: 6.33) and previous TB infection in the family (OR: 4.94). Among children, the risk of LTBI was higher when their IC was a care-giving female (OR: 2.83). Prevalence of active TB was two times higher in children under five (U5 s) (5.3%) compared to adults (2.5%).ConclusionWe found a high prevalence of active TB and LTBI among contacts of PTB cases in the Syrian refugee population, emphasizing the urgent need for host countries to implement CT strategies for refugees. Our results underscore the vulnerability of U5s and contacts of smear-positive IC highlighting the need for specific actions focusing on those groups.

In the past decade, access to antiretroviral therapy (ART) has witnessed a rapid scale-up. This has been made possible by significant donor funding, price reductions facilitated by flexible trade agreements and the standardization of antiretroviral prescription. Currently the global HIV community stands on the cusp of a new chapter in HIV care, that of initiating ART even earlier in the course of the infection, possibly as pre-exposure prophylaxis, or as part of a 'test-and-treat' approach. In this article, the authors provide an overview of the significant advances made in improving access to antiretrovirals in low-resource settings, as well as the challenges facing new approaches to ART in the next decade.

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2016-11-02T18:49:00