Tuberculosis among Children and Adolescents at HIV Treatment Centers in Sub-Saharan Africa

Mandalakas, Anna M.; Kay, Alexander; Bacha, Jason; Devezin, Tara; Golin, Rachel; Simon, Katherine; Dhillon, Dilsher; Dlamini, Sandile; DiNardo, Andrew; Matshaba, Mogo; Sanders, Jill; Thahane, Lineo; Amuge, Pauline; Ahmed, Saeed; Sekadde, Moorine Penninah; Fida, Neway; Lukhele, Bhekumusa; Chidah, Nodumo; Damba, David; Mhango, Joseph; Chodota, Moses; Matsoso, Makhorong; Kayabu, Angelina; Wanless, Richard Sebastian; Schutze, Gordon E.

doi:10.3201/eid2612.202245

Cited by 26 publications

(32 citation statements)

References 27 publications

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“…One additional factor that remained significant in the adjusted analyses was being less than 15 years old, which is very much consistent with recent systematic reviews and meta-analyses. In addition, the literature also shows that the risk for TB remains elevated among children compared to the elderly population, even with excellent ART coverage [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence Rate and Risk Factors for Tuberculosis among People Living with HIV: A 2015–2017 Cohort from Tashkent, Uzbekistan

Sadirova

Grigoryan²,

Parpieva

et al. 2021

IJERPH

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People living with the human immunodeficiency virus (PLHIV) have a higher risk of developing active tuberculosis (TB) disease, and TB remains a major cause of death in PLHIV. Uzbekistan is facing a substantial TB epidemic, which increases the risk of PLHIV developing active TB. Our retrospective cohort study aimed to evaluate the incidence rate and assess the risk factors for developing active TB among PLHIV. We collected secondary data extracted from medical charts of all patients, newly diagnosed at the AIDS Center in Tashkent, during the period of 2015–2017. The incidence rate of TB among PLHIV was 5.1 (95% CI: 4.5–6.0) per 1000 person/month. Adjusted regression analysis showed three major risk factors for TB, namely, being less than 15 years old (hazard ratio (HR) 5.83; 95% CI: 3.24–10.50, p value = 0.001),low CD4 count (adjusted hazard ratio(aHR) 21.0; 95% CI: 9.25–47.7, p value < 0.001), and antiretroviral therapy (ART) interruption/not receiving ART (aHR 5.57; 95% CI: 3.46–8.97 and aHR 6.2; 95% CI: 3.75–10.24, p value < 0.001, respectively) were significantly associated with developing active TB among PLHIV. Our findings indicate that taking prescribed ART without interruptions and maintaining CD4cell counts higher than 320 cells/μL are essential to prevent the development of active TB among PLHIV.

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Section: Discussionmentioning

confidence: 99%

Incidence Rate and Risk Factors for Tuberculosis among People Living with HIV: A 2015–2017 Cohort from Tashkent, Uzbekistan

Sadirova

Grigoryan²,

Parpieva

et al. 2021

IJERPH

View full text Add to dashboard Cite

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“…AYA living with HIV (ALHIV) experience more complex barriers and remain more underserved in many areas of HIV care compared to other age groups [44]. Data on TB in ALHIV remain limited, but growing evidence demonstrates that ALHIV also experience excess TB risks [27,29,[43][44][45][46][47][48][49][50][51]. Early initiation of ART reduces the risk of TB disease in ALHIV [45,46].…”

Section: Aya Living With Hivmentioning

confidence: 99%

Tuberculosis in Adolescents and Young Adults: Emerging Data on TB Transmission and Prevention among Vulnerable Young People

2021

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Adolescents and young adults (AYA, ages 10–24 years) comprise a uniquely important but understudied population in global efforts to end tuberculosis (TB), the leading infectious cause of death by a single agent worldwide prior to the COVID-19 pandemic. While TB prevention and care strategies often overlook AYA by grouping them with either children or adults, AYA have particular physiologic, developmental, and social characteristics that require dedicated approaches. This review describes current evidence on the prevention and control of TB among AYA, including approaches to TB screening, dynamics of TB transmission among AYA, and management challenges within the context of unique developmental needs. Challenges are considered for vulnerable groups of AYA such as migrants and refugees; AYA experiencing homelessness, incarceration, or substance use; and AYA living with HIV. We outline areas for needed research and implementation strategies to address TB among AYA globally.

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“…Tuberculosis (TB) remains one of the leading causes of death among children living with human immunodeficiency virus (HIV) and a major cause of antimicrobial resistance [ 1 – 3 ]. Global estimates indicated that 10 million people are newly diagnosed with TB disease on yearly basis, of which 1.2 million are children below 15 years of age.…”

Section: Introductionmentioning

confidence: 99%

Discontinuation of tuberculosis treatment among children in the Kampala Capital City Authority health facilities: a mixed-methods study

2021

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Introduction Discontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death. DTT in children is understudied in Uganda. We examined the level and factors associated with DTT among children at four large health facilities in Kampala Capital City Authority and documented the reasons for DTT from treatment supporters and healthcare provider perspectives. Methods We conducted a retrospective analysis of records for children < 15 years diagnosed and treated for TB between January 2018 and December 2019. We held focus group discussions with treatment supporters and key informant interviews with healthcare providers. We defined DTT as the stoppage of TB treatment for 30 or more consecutive days. We used a stepwise generalized linear model to assess factors independently associated with DTT and content analysis for the qualitative data reported using sub-themes. Results Of 312 participants enrolled, 35 (11.2%) had discontinued TB treatment. The reasons for DTT included lack of privacy at healthcare facilities for children with TB and their treatment supporters, the disappearance of TB symptoms following treatment initiation, poor implementation of the community-based directly observed therapy short-course (CB-DOTS) strategy, insufficient funding to the TB program, and frequent stock-outs of TB drugs. DTT was more likely during the continuation phase of TB treatment compared to the intensive phase (Adjusted odds ratio (aOR), 5.22; 95% Confidence Interval (CI), 1.76–17.52) and when the treatment supporter was employed compared to when the treatment supporter was unemployed (aOR, 3.60; 95% CI, 1.34–11.38). Conclusion Many children with TB discontinue TB treatment and this might exacerbate TB morbidity and mortality. To mitigate DTT, healthcare providers should ensure children with TB and their treatment supporters are accorded privacy during service provision and provide more information about TB symptom resolution and treatment duration versus the need to complete treatment. The district and national TB control programs should address gaps in funding to TB care, the supply of TB drugs, and the implementation of the CB-DOTS strategy.

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Tuberculosis among Children and Adolescents at HIV Treatment Centers in Sub-Saharan Africa

Cited by 26 publications

References 27 publications

Incidence Rate and Risk Factors for Tuberculosis among People Living with HIV: A 2015–2017 Cohort from Tashkent, Uzbekistan

Incidence Rate and Risk Factors for Tuberculosis among People Living with HIV: A 2015–2017 Cohort from Tashkent, Uzbekistan

Tuberculosis in Adolescents and Young Adults: Emerging Data on TB Transmission and Prevention among Vulnerable Young People

Discontinuation of tuberculosis treatment among children in the Kampala Capital City Authority health facilities: a mixed-methods study

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