Household-Contact Investigation for Detection of Tuberculosis in Vietnam

Fox, Greg J.; Nhung, Nguyen Viet; Sy, Dinh Ngoc; Hoa, Nghiem Le Phuong; Anh, Le Thi Ngoc; Anh, Nguyen Thu; Hoa, Nguyen Binh; Dung, Nguyen Huy; Buu, Tran N.; Loi, Nguyen Thi; Nhung, Le T; Hùng, Nguyễn Văn; Lieu, Phan T; Cuong, Nguyen Kim; Cuong, Pham Duc; Bestrashniy, Jessica; Britton, Warwick J.; Marks, Guy B.

doi:10.1056/nejmoa1700209

Cited by 166 publications

(175 citation statements)

References 19 publications

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“…In an early study of INH treatment in patients with fibrotic lung lesions, placebo recipients had a 1.4% cumulative 5‐year TB risk that was decreased by 75% among those receiving 12 months of INH . A study in Vietnam found that active surveillance in household contacts was better than passive surveillance alone for diagnosing future active TB . Successful LTBI treatment strategies have been demonstrated in Thailand among PLWH and in Republic of Korea among people receiving a TNF‐alpha blocker .…”

Section: The Challenge Of Implementing National Tb Elimination Plansmentioning

confidence: 99%

“…57 A study in Vietnam found that active surveillance in household contacts was better than passive surveillance alone for diagnosing future active TB. 73 Successful LTBI treatment strategies have been demonstrated in Thailand among PLWH and in Republic of Korea among people receiving a TNF-alpha blocker. [73][74][75][76] These examples demonstrate that opportunities exist in carefully selected settings to combine robust strategies for diagnosing active TB with LTBI treatment to accelerate declines in TB disease.…”

Section: The Challenge Of Implementing National Tb Elimination Plansmentioning

confidence: 99%

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Latent tuberculosis infection: Opportunities and challenges

et al. 2018

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Diagnosing and treating latent tuberculosis (TB) infection (LTBI) is recognized by the World Health Organization as an important strategy to accelerate the decline in global TB and achieve TB elimination. Even among low-TB burden countries that have achieved high rates of detection and successful treatment for active TB, a number of barriers have prevented implementing or expanding LTBI treatment programmes. Of those infected with TB, relatively few will develop active disease and the current diagnostic tests have a low predictive value. LTBI treatment using isoniazid (INH) has low completion rates due to the long duration of therapy and poor tolerability. Both patients and physicians often perceive the risk of toxicity to be greater than the risk of reactivation TB. As a result, LTBI treatment has had a limited or negligible role outside of countries with high resources and low burden of disease. New tools have emerged including the interferon-gamma release assays that more accurately diagnose LTBI, particularly in people vaccinated with Bacillus Calmette-Guerin (BCG). Shorter, better tolerated treatment using rifamycins are proving safe and effective alternatives to INH. While still imperfect, TB prevention using these new diagnostic and treatment tools appear cost effective in modelling studies in the United States and have the potential to improve TB prevention efforts globally. Continued research to understand the host-organism interactions within the spectrum of LTBI is needed to develop better tools. Until then, overcoming the barriers and optimizing our current tools is essential for progressing toward TB elimination.

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Section: The Challenge Of Implementing National Tb Elimination Plansmentioning

confidence: 99%

Section: The Challenge Of Implementing National Tb Elimination Plansmentioning

confidence: 99%

Latent tuberculosis infection: Opportunities and challenges

et al. 2018

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“…In terms of addressing TB control at a broader, community‐wide level, there have been calls to expand active case‐finding programmes, which aim to decrease the TB burden by identifying undiagnosed cases . However, despite historical success of population‐based interventions including isoniazid preventive therapy and active case‐finding, recent trials have yielded mixed results in high‐burden settings (Table ) . These data suggest that more targeted case‐finding programmes or location‐based environmental or administrative controls might be more effective.…”

Section: Introductionmentioning

confidence: 99%

“…Adapted from Churchyard et al ., with the addition of data from Okada et al . and Fox et al ., with permission…”

Section: Introductionmentioning

confidence: 99%

Where is tuberculosis transmission happening? Insights from the literature, new tools to study transmission and implications for the elimination of tuberculosis

et al. 2018

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More than 10 million new cases of tuberculosis (TB) are diagnosed worldwide each year. The majority of these cases occur in low- and middle-income countries where the TB epidemic is predominantly driven by transmission. Efforts to 'end TB' will depend upon our ability to halt ongoing transmission. However, recent studies of new approaches to interrupt transmission have demonstrated inconsistent effects on reducing population-level TB incidence. TB transmission occurs across a wide range of settings, that include households and hospitals, but also community-based settings. While home-based contact investigations and infection control programmes in hospitals and clinics have a successful track record as TB control activities, there is a gap in our knowledge of where, and between whom, community-based transmission of TB occurs. Novel tools, including molecular epidemiology, geospatial analyses and ventilation studies, provide hope for improving our understanding of transmission in countries where the burden of TB is greatest. By integrating these diverse and innovative tools, we can enhance our ability to identify transmission events by documenting the opportunity for transmission-through either an epidemiologic or geospatial connection-alongside genomic evidence for transmission, based upon genetically similar TB strains. A greater understanding of locations and patterns of transmission will translate into meaningful improvements in our current TB control activities by informing targeted, evidence-based public health interventions.

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“…Approaches towards mitigating these factors could involve active case-finding (ACF) 34 . India's 7 recent National Strategic Plan underlines the potential importance of ACF in risk groups such as 8 urban slums 16 , while recent work in Viet Nam has also demonstrated the potential value of 9 screening close contacts of diagnosed TB cases, together with longitudinal followup of these 10 contacts 35 . However, it is also possible for the patient delay to be impacted by measures to 11 improve the demand for TB services; for example, social protection mechanisms 36 could have 12 the secondary effects of encouraging TB symptomatics to come forward for care 37 .…”

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confidence: 99%

Delays, behaviour and transmission: modelling the impact of effective private provider engagement on tuberculosis control in urban India

Arinaminpathy

Deo

Singh

et al. 2018

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2In India, the country with the world's largest burden of tuberculosis (TB), most patients first seek 3 care in the private healthcare sector, which is fragmented and unregulated. Ongoing initiatives 4 are demonstrating effective approaches for engaging with this sector, and form a central part of 5 India's recent National Strategic Plan: here we aimed to address their potential impact on TB 6 transmission in urban settings, when taken to scale. We developed a mathematical model of TB 7 transmission dynamics, calibrated to urban populations in Mumbai and Patna, two major cities 8 in India where pilot interventions are currently ongoing. 10We found that, when taken to sufficient scale to capture 75% of patient-provider interactions, the 11 intervention could reduce incidence by upto 21.3% (95% Bayesian credible interval (CrI) 13.0 -12 32.5%) and 15.8% (95% CrI 7.8 -28.2%) in Mumbai and Patna respectively, between 2018 and 13 2025. There is a stronger impact on TB mortality, with a reduction of up to 38.1% (95% CrI 20.0 14-55.1%) in the example of Mumbai. The incidence impact of this intervention alone may be 15 limited by the amount of transmission that has already occurred by the time a patient first 16 presents for care: model estimates suggest an initial patient delay of 4-5 months before first 17 seeking care, followed by a diagnostic delay of 1-2 months before ultimately initiating TB 18 treatment. Our results suggest that the transmission impact of such interventions could be 19 maximised by additional measures to encourage early uptake of TB services.

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Household-Contact Investigation for Detection of Tuberculosis in Vietnam

Cited by 166 publications

References 19 publications

Latent tuberculosis infection: Opportunities and challenges

Latent tuberculosis infection: Opportunities and challenges

Where is tuberculosis transmission happening? Insights from the literature, new tools to study transmission and implications for the elimination of tuberculosis

Delays, behaviour and transmission: modelling the impact of effective private provider engagement on tuberculosis control in urban India

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