Community health workers improve contact tracing among immigrants with tuberculosis in Barcelona

Ospina, Jesús E.; Orcau, Àngels; Millet, Joan-Pau; Sánchez, Francesca; Casals, Martí; Caylà, Joan A.

doi:10.1186/1471-2458-12-158

Cited by 47 publications

(38 citation statements)

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“…These factors were not found to be associated with recurrence in the present study, probably due to the incorporation of directly observed therapy (DOT) to the methadone maintenance program and the role of community health workers for follow-up and contact tracing of immigrants [35]. The lower recurrence rate in this study of 341 cases per 100,000 py compared to 530 cases per 100,000 py among the previous 1995–1997 cohort of could also be due to the extension and free access to highly active antiretroviral therapy (HAART) in Spain since 1996 [8].…”

Section: Discussioncontrasting

confidence: 64%

Tuberculosis Recurrence after Completion Treatment in a European City: Reinfection or Relapse?

et al. 2013

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BackgroundTuberculosis (TB) recurrence can be due to reinfection or relapse. The contribution of each to TB incidence and the factors associated with recurrence are not well known. Effectiveness of TB control programs is assessed in part by recurrence rates. The aim of this study was to establish the recurrence rate of TB in Barcelona, the associated risk factors and the role of reinfection.MethodsA population-based retrospective longitudinal study was performed in Barcelona, Spain. TB patients with positive culture results who completed treatment between Jan 1st, 2003 and Dec 31st, 2006 were followed-up until December 31st, 2009 by the TB Control Program. The incidence rate of recurrence was calculated per person-year of follow-up (py). Kaplan-Meier and Cox regression methods were used for the survival analysis by calculating the hazard ratio (HR) with 95% confidence intervals (CI).ResultsOf the 1,823 TB cases identified, 971 fulfilled the inclusion criteria and 13 (1.3%) had recurrent TB. The recurrence rate was 341 cases per 100,000 py, 13 times higher than the TB incidence of the general population. Likelihood of TB recurrence at the 1st, 3rd and 5th year of follow-up was 0.1%, 1.4% and 1.6%, respectively. Factors associated with recurrence were HIV infection (HR: 4.7, CI: 1.4–15.7), living in the inner city district (HR: 3.9, CI: 1.3–11.8) and history of TB treatment (HR: 5.2, CI: 1.7–16.2). Genotyping results of recurrent cases were available for 6 patients (3 reinfections and 3 relapses).ConclusionThe rate of TB recurrence in Barcelona is low and most episodes occur within the first three years. Patients at higher risk of recurrence are co-infected with HIV, living in neighborhoods with high TB incidence or with a history of TB treatment. When available, genotyping results help determine whether the recurrence is due to reinfection or relapse.

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Section: Discussioncontrasting

confidence: 64%

Tuberculosis Recurrence after Completion Treatment in a European City: Reinfection or Relapse?

et al. 2013

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“…In Low and Middle Income Countries (LMIC), including South Africa, children’s health is compromised not only by HIV, but by the cumulative impact of poverty and related deficits from other infectious diseases, malnutrition, and maternal behaviours [2–3]. Yet, community health workers (CHWs) typically target single outcomes, such as HIV testing [4], tuberculosis (TB) adherence [5], securing a child grant [6], or maternal depression [7]. In some LMIC, two to three different CHWs visit a household, each targeting a different health risk, but also replicating some components of the intervention.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of home visits for pregnant mothers and their infants

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Objective To evaluate the effect of home visits by Community Health Workers (CHW) on maternal and infant well-being from pregnancy through the first six months of life for women living with HIV (WLH) and all neighbourhood mothers. Design and Methods In a cluster randomised controlled trial in Cape Town townships, neighbourhoods were randomised within matched pairs to either: 1) Standard Care, comprehensive healthcare at clinics (SC; n=12 neighbourhoods; n=169 WLH; n=594 total mothers), or 2) Philani Intervention Program, home visits by CHW in addition to SC (PIP; n=12 neighbourhoods; n=185 WLH; n=644 total mothers). Participants were assessed during pregnancy (2% refusal) and reassessed at one week (92%) and six months (88%) post-birth. We analysed PIP’s effect on 28 measures of maternal and infant well-being among WLH and among all mothers using random effects regression models. For each group, PIP’s overall effectiveness was evaluated using a binomial test for correlated outcomes. Results Significant overall benefits were found in PIP compared to SC among WLH and among all participants. Secondarily, compared to SC, PIP WLH were more likely to complete tasks to prevent vertical transmission, use one feeding method for 6 months, avoid birth-related medical complications, and have infants with healthy height-for-age measurements. Among all mothers, compared to SC, PIP mothers were more likely to use condoms consistently, breastfeed exclusively for 6 months, and have infants with healthy height-for-age measurements. Conclusions PIP is a model for countries facing significant reductions in HIV funding whose families face multiple health risks.

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“…For effective TB control, services in EU big cities should be acceptable, accessible, adequate, appropriate and geared towards the needs of urban risk groups. In the last decade, innovative TB control activities in EU big cities have been reported, including mobile digital chest X-ray screening [16][17][18][19], the employment of community health workers and peer-educators [20,21], the use of mobile telephone-assisted or video-observed medication monitoring systems [22,23], and the application of molecular epidemiology [24][25][26][27]. Systematic implementation of evidence-based and innovative approaches to improve early case finding, case holding and treatment completion in urban risk groups is urgently needed.…”

Section: Introductionmentioning

confidence: 99%

Tuberculosis control in big cities and urban risk groups in the European Union: a consensus statement

et al. 2014

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In low-incidence countries in the European Union (EU), tuberculosis (TB) is concentrated in big cities, especially among certain urban high-risk groups including immigrants from TB high-incidence countries, homeless people, and those with a history of drug and alcohol misuse. Elimination of TB in European big cities requires control measures focused on multiple layers of the urban population. The particular complexities of major EU metropolises, for example high population density and social structure, create specific opportunities for transmission, but also enable targeted TB control interventions, not efficient in the general population, to be effective or cost effective. Lessons can be learnt from across the EU and this consensus statement on TB control in big cities and urban risk groups was prepared by a working group representing various EU big cities, brought together on the initiative of the European Centre for Disease Prevention and Control. The consensus statement describes general and specific social, educational, operational, organisational, legal and monitoring TB control interventions in EU big cities, as well as providing recommendations for big city TB control, based upon a conceptual TB transmission and control model.

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Community health workers improve contact tracing among immigrants with tuberculosis in Barcelona

Cited by 47 publications

References 5 publications

Tuberculosis Recurrence after Completion Treatment in a European City: Reinfection or Relapse?

Tuberculosis Recurrence after Completion Treatment in a European City: Reinfection or Relapse?

Outcomes of home visits for pregnant mothers and their infants

Tuberculosis control in big cities and urban risk groups in the European Union: a consensus statement

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