Background: Dolutegravir (DTG) has recently been recommended as a preferred first-line regimen for the treatment of new and treatment experienced HIV infected patients. However, potential drug interactions between DTG and rifampicin remain a clinical and public health concern. Methods:We analyzed HIV and TB treatment outcomes of HIV-infected patients concomitantly receiving rifampicin-and DTG-based regimens under programmatic conditions in Botswana. The outcomes of interest were successful TB treatment and viral load suppression. We used multivariable logistic models to determine predictors for each outcome of interest.Results: A total of 1,225 patients were included in the analysis to evaluate predictors of successful TB outcome. Among patients on DTG and non-DTG regimens, 90.9% and 88.3% achieved favorable TB treatment outcomes, respectively. Of those who received DTG-based regimen; 44% received once-daily dosing and 53% twice-daily dosing. We found that DTG was associated with favorable TB treatment outcome (adjusted odds ratio [aOR] = 1.56; 95% confidence interval [CI] = 1.06, 2.31), after adjusting for age, gender, and CD4 cell counts. High rates of viral load suppression were found across all ART regimen categories (>92% for all). We did not find an independent association between DTG and viral suppression after adjustment of other covariates Conclusions:The use of DTG-based ART regimens in patients coinfected with TB and HIV lead to favorable TB and HIV treatment outcomes, comparable to those achieved with alternative ART regimens. Our results provide reassurance to TB and HIV programs about the overall

Objective: To determine the association between food insecurity and HIV-infection with depression and anxiety among new tuberculosis patients. Design: Our cross-sectional study assessed depression, anxiety, and food insecurity with Patient Health Questionnaire (PHQ9), Zung Anxiety Self-Assessment Scale (ZUNG), and Household Food Insecurity Access Scale, respectively. Poisson regression models with robust variance were used to examine correlates of depression (PHQ9 ≥ 10) and anxiety (ZUNG ≥ 36). Setting: Gaborone, Botswana. Participants: Patients who were newly diagnosed with tuberculosis. Results: Between January and December 2019, we enrolled 180 TB patients from primary health clinics in Botswana. Overall, 99 (55.0%) were HIV-positive, 47 (26.1%), 85 (47.2%), and 69 (38.5%) indicated depression, anxiety, and moderate to severe food insecurity, respectively. After adjusting for potential confounders, food insecurity was associated with a higher prevalence of depression (adjusted prevalence ratio [aPR] = 2.30; 95% confidence interval [CI] = 1.40, 3.78) and anxiety (aPR = 1.41; 95% CI = 1.05, 1.91). Prevalence of depression and anxiety were similar between HIV-infected and -uninfected participants. Estimates remained comparable when restricted to HIV-infected participants. Conclusions: Mental disorders may be affected by food insecurity among new tuberculosis patients, regardless of HIV status.

T uberculosis (TB) is a global health emergency (1). The World Health Organization (WHO) End TB Strategy proposes a 90% reduction in TB incidence and 95% reduction in TB deaths by 2035 compared with 2015 (2). To reach this target, effective interventions are needed to interrupt transmission of Mycobacterium tuberculosis. Contact investigations help prevent M. tuberculosis transmission by identifying and treating persons in close contact with persons with TB disease (3). WHO recommends tuberculosis preventive treatment (TPT) for household members of bacteriologically confirmed pulmonary TB patients to prevent progression to active TB disease (4). Contact investigations are a major tenet of the End TB Strategy but remain ineffective for various reasons (2,5,6). Many TB programs in high-burden areas limit contact investigations to household members (6). Recent studies suggest that such restrictions might miss key exposures in the community (7,8). Targeted, population-based, geographic TB screening is a potential approach to augment contact investigations (9-11) but is resource and time intensive and rarely includes TPT (11,12). We used population-based, molecular epidemiologic data from Botswana to investigate potential use of a neighbor-based approach for contact investigations. The Study During August 2012-April 2016, we enrolled participants treated for TB disease at 30 healthcare facilities in Botswana for a prospective molecular epidemiologic study, Kopanyo. In brief, Kopanyo was designed to explore potential clinical, demographic, geographic, social relationships, and M. tuberculosis genotypic characteristics among persons with TB (13,14). We interviewed enrolled patients by using a standardized questionnaire and abstracted clinical data from medical records (13). We collected and processed sputum samples for culture and genotyped isolates with 24-locus mycobacterial interspersed repetitive unitsvariable-number tandem-repeats by using standard methods (15). We geocoded and validated the primary residence of each enrolled patient (Appendix, https:// wwwnc.cdc.gov/EID/article/26/5/19-1568-App1. pdf). We excluded patients without a validated primary residential geocode and those who resided in locations outside of the study area. The study area included all 11 neighborhoods in Gaborone and 3 villages in the Ghanzi District: Ghanzi, D'Kar, and Kuke. We defined index patients as the first culture-positive pulmonary TB patient identified and started on treatment in a household. We used residence plots to identify nearest neighbors, which we defined as those who lived immediately next door, and next-nearest neighbors, which we defined as those who lived 2 doors away (Figure). We enumerated all subsequent TB cases identified by bacteriologic confirmation and clinical diagnosis within the index home, nearest-neighbor homes, and next-nearest neighbor homes. We defined

Objective: To determine the association between food insecurity and HIV-infection with depression and anxiety among new tuberculosis patients. Design: Our cross-sectional study assessed depression, anxiety, and food insecurity with Patient Health Questionnaire (PHQ9), Zung Anxiety Self-Assessment Scale (ZUNG), and Household Food Insecurity Access Scale, respectively. Poisson regression models with robust variance were used to examine correlates of depression (PHQ9 ≥ 10) and anxiety (ZUNG ≥ 36). Setting: Gaborone, Botswana. Participants: Patients who were newly diagnosed with tuberculosis. Results: Between January and December 2019, we enrolled 180 TB patients from primary health clinics in Botswana. Overall, 99 (55.0%) were HIV-positive, 47 (26.1%), 85 (47.2%), and 69 (38.5%) indicated depression, anxiety, and moderate to severe food insecurity, respectively. After adjusting for potential confounders, food insecurity was associated with a higher prevalence of depression (adjusted prevalence ratio [aPR] = 2.30; 95% confidence interval [CI] = 1.40, 3.78) and anxiety (aPR = 1.41; 95% CI = 1.05, 1.91). Prevalence of depression and anxiety were similar between HIV-infected and -uninfected participants. Estimates remained comparable when restricted to HIV-infected participants. Conclusions: Mental disorders may be affected by food insecurity among new tuberculosis patients, regardless of HIV status.

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