Background Tuberculosis (TB) remains a top global health problem and its transmission rate among contacts is higher when they are cohabiting with a person who is sputum smear-positive. Our study aimed to describe the prevalence of TB among student contacts in the university and determine factors associated with TB transmission. Methods We performed a cross-sectional study with an active contact case finding approach among students receiving treatment at Kilifi County Hospital from January 2016 to December 2017. The study was conducted in a public university in Kilifi County, a rural area within the resource-limited context of Kenya. The study population included students attending the university and identified as sharing accommodation or off-campus hostels, or a close social contact to an index case. The index case was defined as a fellow university student diagnosed with TB at the Kilifi County Hospital during the study period. Contacts were traced and tested for TB using GeneXpert. Results Among the 57 eligible index students identified, 51 (89%) agreed to participate. A total of 156 student contacts were recruited, screened and provided a sputum sample. The prevalence of TB (GeneXpert test positive/clinical diagnosis) among all contacts was 8.3% (95% CI 4.5–14%). Among the 8.3% testing positive 3.2% (95% CI 1.0–7.3%) were positive for GeneXpert only. Sharing a bed with an index case was the only factor significantly associated with TB infection. No other demographic or clinical factor was associated with TB infection. Conclusion Our study identified a high level of TB transmission among university students who had contact with the index cases. The study justifies further research to explore the genetic sequence and magnitude of TB transmission among students in overcrowded university in resource limited contexts.

Background Understanding the magnitude of Tuberculosis (TB) transmission among the youth is a global priority as the disease burden shifts to this population. Learning institutions host overcrowded accommodation and classrooms, especially in resource limited contexts. Understanding the global threat of the youth as an infection pool on the wider population is highlighted in the global response to COVID 19. This pilot study aimed to test the feasibility of recruiting university students’ contacts and demonstrate transmission of TB in Pwani University, Kilifi County-Kenya. Materials and Methods A pilot study among Pwani University TB index cases receiving treatment at the Kilifi County Hospital was conducted. Index cases who consented provided information about their household and social contacts. Contacts were identified and screened using a World Health Organization (WHO) symptom-based questionnaire. Their sputum samples were analysed using GeneXpert. Multivariate log-binomial regression was used to determine demographic and clinical characteristics associated with TB infection among contacts with TB index patients. Results A total of 51 index cases were recruited, median (IQR) age of 21 (20–23) years and 31 (61%) were males. 156 contacts were screened, median (IQR) age of 23 (20–23) years, 80 (51%) were males and 76 (49%) were household contacts. Among the 156 TB contacts, 5 participants were confirmed positive for TB: prevalence of 3.2% (95% CI 1.0 to 7.3%). 8/156 (5.1%, (95% CI 2.2 to 10%) contacts, had clinical diagnosed TB despite having a negative GeneXpert result. In total 13/156 contacts had either confirmed or clinical diagnosed TB; 8.3% (95% CI 4.5 to 14%). Sharing a bed with an index case was the only factor significantly associated with TB infection among the five contacts with GeneXpert diagnosed TB. Conclusion Students sleeping in crowded hostels promote TB transmission within universities informing TB control interventions. Collaborating with existing national TB programme systems is a feasible approach to recruit people with active disease and their social contacts. Expansion of this approach to a larger population of students with TB infection may demonstrate the magnitude of TB transmission within universities, and the wider local communities.

Background Tuberculosis (TB) is one of the leading causes of deaths in Africa, monitoring its treatment outcome is essential to evaluate treatment effectiveness. The study aimed to evaluate proportion of poor TB treatment outcomes (PTO) and its determinants during six-months of treatment at Kilifi County, Kenya. Methods We conducted a retrospective analysis of data from the TB surveillance system (TIBU) in Kilifi County, Kenya from 2012 to 2019. The outcome of interest was PTO (lost-to-follow-up (LTFU), death, transferred out, treatment failure, drug resistance) or successful treatment (cured or completed treatment). We performed time-stratified (at three months follow-up) survival regression analyses accounting for sub-county heterogeneity to determine factors associated with PTO. Results We included 14,706 TB patients, their median (IQR) age was 37 (28–50) years and 8,791 (60%) were males. A total of 13,389 (91%) were on first line anti-TB treatment (2RHZE/4RH), 4,242 (29%) were HIV infected and 192 (1.3%) had other underlying medical conditions. During 78,882 person-months of follow-up, 2,408 (16%) patients had PTO: 1,074 (7.3%) deaths, 776 (5.3%) LTFU, 415 (2.8%) transferred out, 103 (0.7%) treatment failure and 30 (0.2%) multidrug resistance. The proportion of poor outcome increased from 7.9% in 2012 peaking at 2018 (22.8%) and slightly declining to 20% in 2019 (trend test P = 0.03). Over two-thirds 1,734 (72%) poor outcomes occurred within first three months of follow-up. In the first three months of TB treatment, overweight ((aHR 0.85 (95%CI 0.73–0.98), HIV infected not on ARVS (aHR 1.72 (95% CI 1.28–2.30)) and year of starting treatment were associated with PTO. However, in the last three months of treatment, elderly age ≥50 years (aHR 1.26 (95%CI 1.02–1.55), a retreatment patient (aHR 1.57 (95%CI 1.28–1.93), HIV infected not on ARVs (aHR 2.56 (95%CI 1.39–4.72), other underlying medical conditions (aHR 2.24 (95%CI 1.41–3.54)) and year of starting treatment were positively associated with PTO while being a female (aHR 0.83 (95%CI 0.70–0.97)) was negatively associated with PTO. Conclusions Over two-thirds of poor outcomes occur in the first three months of TB treatment, therefore greater efforts are needed during this phase. Interventions targeting HIV infected and other underlying medical conditions, the elderly and retreated patients provide an opportunity to improve TB treatment outcome.