High mortality and prevalence of HIV and tuberculosis in adults with chronic cough in Malawi: a cohort study

Nliwasa, Marriott; MacPherson, Peter; Mukaka, Mavuto; Mdolo, Aaron; Mwapasa, Mphatso; Kaswaswa, Kruger; Msefula, Chisomo; Chipungu, Geoffrey; Mwandumba, Henry C.; Corbett, Elizabeth L.

doi:10.5588/ijtld.15.0388

Cited by 13 publications

(17 citation statements)

References 16 publications

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“…In a cohort study investigating the prevalence of HIV and tuberculosis in adults with chronic cough in Malawi, it was found that nearly a third of all TB case in the cohort were not diagnosed previously [20]. Inadequate awareness of the disease was one of the main contributors to delayed diagnosing and treatment seeking [20]. In addition, another study reported that inadequate knowledge about cause and transmission of TB coupled with low self-awareness of personal risk to TB, cultural and traditional beliefs about sources of TB in uenced delayed treatment seeking among adults aged 18 years and older from rural communities in Malawi [21].…”

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confidence: 99%

Determinants of Self-Reported Correct Knowledge About Tuberculosis Transmission Among Men and Women in Malawi: Evidence from a Nationwide Household Survey.

Ntenda

Mussa

Gowelo

et al. 2020

Preprint

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Background: Correct knowledge about transmission of tuberculosis (TB) can influence better health-seeking behaviors, and in turn, it can aid TB prevention in society. Therefore, this study aimed to examine the prevalence and predictors of self-reported correct knowledge about TB transmission among adults in Malawi.Methods: We conducted a secondary analysis of the data obtained from the Malawi Demographic and Health Survey, 2015/16 (MDHS 2015/16). Questions regarding self-reported TB transmission were computed to evaluate the correct knowledge about TB transmission. The factors associated with the correct knowledge about Tb were assessed using univariate and multivariable logistic regression.Results: Overall, the prevalence of correct knowledge about TB transmission in the general population of Malawian adults was 61.5%. Specifically, the prevalence of correct knowledge about TB transmission was 63.6% and 60.8% in men and women, respectively. Those aged 35–44 years, having secondary or high education, belonging to the richest household, being exposed to mass media, being in professional/technical/managerial, having knowledge that “TB can be cured’, and those living in urban areas were significantly associated with correct knowledge about TB transmission.Conclusions: The findings of this study show that if appropriate strategies for TB communication and education to address the rural masses, young individuals, poor individuals, and individuals in the agriculture sector are put it place, can enhance TB prevention in Malawi.

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Section: Read Full Licensementioning

confidence: 99%

Determinants of Self-Reported Correct Knowledge About Tuberculosis Transmission Among Men and Women in Malawi: Evidence from a Nationwide Household Survey.

Ntenda

Mussa

Gowelo

et al. 2020

Preprint

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“…Seven studies reported on the number of participants newly diagnosed with HIV following screening (Table ). At community level, the number of adults with TB symptoms needed to screen to detect one new HIV‐positive individual was 11 in Malawi , 4 in South Africa and 121 in Rwanda . In primary care clinics the NNS was 2 in Malawi and Zimbabwe , 4 in Zambia and 30 in India (Table ) .…”

Section: Resultsmentioning

confidence: 99%

“…Twelve (12/62, 19.4%) studies were conducted at community level, 26/62 (41.9%) at primary care level, 9/62 (14.5%) at hospital level (inpatients) and 15/62 (24.2%) were conducted in mixed settings ( Table 1). Studies at community level were cross-sectional [15][16][17][18][19] and cohort in design (Table 2) [20][21][22]. Studies at primary care level were either diagnostic evaluations [23][24][25][26][27][28][29][30], programme evaluations [31][32][33] or other cross-sectional designs [34][35][36][37].…”

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confidence: 99%

High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a systematic review and meta‐analyses

et al. 2018

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Introduction HIV and tuberculosis (TB) remain leading causes of preventable death in low‐ and middle‐income countries (LMICs). The World Health Organization (WHO) recommends HIV testing for all individuals with TB symptoms, but implementation has been suboptimal. We conducted a systematic literature review and meta‐analyses to estimate HIV and TB prevalence, and short‐term (two to six months) mortality, among adults with TB symptoms at community‐ and facility level.MethodsWe searched Embase, Global Health and MEDLINE databases, and reviewed conference abstracts for studies reporting simultaneous HIV and TB screening of adults in LMICs published between January 2003 and December 2017. Meta‐analyses were performed to estimate prevalence of HIV, undiagnosed TB and mortality risk at different health system levels.ResultsSixty‐two studies including 260,792 symptomatic adults were identified, mostly from Africa and Asia. Median HIV prevalence was 19.2% (IQR: 8.3% to 40.4%) at community level, 55.7% (IQR: 20.9% to 71.2%) at primary care level and 80.7% (IQR: 73.8% to 84.6%) at hospital level. Median TB prevalence was 6.9% (IQR: 3.3% to 8.4%) at community, 20.5% (IQR: 11.7% to 46.4%) at primary care and 36.4% (IQR: 22.9% to 40.9%) at hospital level. Median short‐term mortality was 22.6% (IQR: 15.6% to 27.7%) among inpatients, 3.1% (IQR: 1.2% to 4.2%) at primary care and 1.6% (95% CI: 0.45 to 4.13, n = 1 study) at community level.ConclusionsAdults with TB symptoms have extremely high prevalence of HIV infection, even when identified through community surveys. TB prevalence and mortality increased substantially at primary care and inpatient level respectively. Strategies to expand symptom‐based TB screening combined with HIV and TB testing for all symptomatic individuals should be of the highest priority for both disease programmes in LMICs with generalized HIV epidemics. Interventions to reduce short‐term mortality are urgently needed.

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“…The high case-fatality rate for tuberculosis, the leading global infectious cause of death in adults1 with approximately 10 million cases and 1.6 million deaths in 2017,2 in part reflects suboptimal diagnostics 3–6. To complement this diagnostic gap, standard algorithms throughout the world include a ‘trial-of-antibiotics’ (figure 1).…”

Section: Introductionmentioning

confidence: 99%

Accuracy and consequences of usingtrial-of-antibioticsfor TB diagnosis (ACT-TB study): protocol for a randomised controlled clinical trial

et al. 2020

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IntroductionOver 40% of global tuberculosis case notifications are diagnosed clinically without mycobacteriological confirmation. Standard diagnostic algorithms include ‘trial-of-antibiotics’—empirical antibiotic treatment given to mycobacteriology-negative individuals to treat infectious causes of symptoms other than tuberculosis, as a ‘rule-out’ diagnostic test for tuberculosis. Potentially 26.5 million such antibiotic courses/year are prescribed globally for the 5.3 million/year mycobacteriology-negative patients, making trial-of-antibiotics the most common tuberculosis diagnostic, and a global-scale risk for antimicrobial resistance (AMR). Our systematic review found no randomised controlled trial (RCT) to support use of trial-of-antibiotic. The RCT aims to determine the diagnostic and clinical value and AMR consequences of trial-of-antibiotics.Methods and analysisA three-arm, open-label, RCT randomising (1:1:1) Malawian adults (≥18 years) seeking primary care for cough into: (a) azithromycin 500 mg one time per day for 3 days or (b) amoxicillin 1 g three times per day for 5 days or (c) standard-of-care (no immediate antibiotic). We will perform mycobacteriology tests (microscopy, Xpert MTB/RIF (Mycobacterium tuberculosis/rifampicin) andMycobacterium tuberculosisculture) at baseline. We will use audiocomputer-assisted self-interview to assess clinical improvement at day 8. First primary outcome will be proportion of patients reporting day 8 improvement out of those with negative mycobacteriology (specificity). Second primary outcome will be day 29 incidence of a composite endpoint of either death or hospitalisation or missed tuberculosis diagnosis. To determine AMR impact we compare proportion of resistant nasopharyngealStreptococcus pneumoniaeisolates on day 29. 400 mycobacteriology-negative participants/arm will be required to detect a ≥10% absolute difference in diagnostic specificity with 80% power. We will estimate measures of effect by comparing outcomes in antibiotic arms (combined and individually) to standard-of-care.Ethics and disseminationThe study has been reviewed and approved by Malawi College of Medicine Research and Ethics Committee, London School of Hygiene & Tropical Medicine (LSHTM) Research Ethics Committee and Regional Committee for Health and Research Ethics – Norway, and Malawi Pharmacy, Medicines and Poisons Board. We will present abstracts at relevant conferences, and prepare a manuscript for publication in a peer-reviewed journal.Trial registration numberThe clinical trial is registered with ClinicalTrials.gov,NCT03545373

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High mortality and prevalence of HIV and tuberculosis in adults with chronic cough in Malawi: a cohort study

Cited by 13 publications

References 16 publications

Determinants of Self-Reported Correct Knowledge About Tuberculosis Transmission Among Men and Women in Malawi: Evidence from a Nationwide Household Survey.

Determinants of Self-Reported Correct Knowledge About Tuberculosis Transmission Among Men and Women in Malawi: Evidence from a Nationwide Household Survey.

High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a systematic review and meta‐analyses

Accuracy and consequences of usingtrial-of-antibioticsfor TB diagnosis (ACT-TB study): protocol for a randomised controlled clinical trial

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