Dr. Richard Chaisson, Professor of Medicine, Epidemiology and International Health and Director of the Center for Tuberculosis Research at the Johns Hopkins University in Baltimore was the keynote Jan. 19 as part of the Washington Global Health Discovery Series. His talk was on ""What Will It Take To Control TB?"
Video Directly Observed Therapy for HIV and TB patientsKimberly Schafer
Video-Directly Observed Therapy (V-DOT) is a promising solution for monitoring TB and HIV
treatment adherence for binational patients in the U.S.-Mexico border region.
Influenza vaccination and prevention of antimicrobial resistance - Slides by ...WAidid
The lecture presented by Professor Susanna Esposito at AMR 2019 on influenza vaccination and abuse of available antimicrobials.
To learn more, please visit www.waidid.org.
Non tubercular mycobacterial infection following surgery- Dr Keyur BhattDrKeyurBhattMSMRCSEd
Atypical Tuberculosis following surgery or laparoscopy. How to diagnose how to quantify and how to treat.
This is a very important presentation for the discovery and management of atypical tuberculosis infection any surgery.
this can happen after any laparoscopy or any interventional procedures.
This document discusses tuberculosis (TB) outbreaks reported in literature from the 1950s to 2013. It provides details on 186 TB outbreaks reported since 2000 across various settings like schools, hospitals, homeless shelters, and more. Characteristics of outbreaks discussed include their location, magnitude, impact, presence of drug resistance, high-risk populations affected, and environmental factors. Large, ongoing outbreaks involving strains resistant to isoniazid or multiple drugs are also mentioned. The document analyzes trends in recognized TB outbreaks and their characterization to understand transmission dynamics.
Bio303 Lecture 2 Two Old Enemies, TB and LeprosyMark Pallen
In this lecture I will focusing on another of the most serious infectious threats to humanity, tuberculosis, outlining its evolutionary origins, impact on human health and wealth and the steps taken to control and treat this infection. I will also discuss a related mycobacterial infection, leprosy and recent progress in its control.
This document provides an overview of updates to India's National TB Elimination Programme (NTEP), formerly known as the Revised National TB Control Programme (RNTCP). It summarizes global and Indian TB burden statistics. It outlines the evolution of TB control in India and STOP TB strategy goals. It describes the objectives of NTEP, tuberculosis unit structure, case definitions, diagnostic tools including smear microscopy, culture, and molecular tests. Treatment regimens for drug-sensitive TB including the switch to daily fixed-dose combination are explained. Algorithms for diagnosis and treatment of pediatric and drug-resistant TB are presented.
Tuberculosis is a major global health problem caused by the bacterium Mycobacterium tuberculosis. India has a large burden of TB, accounting for over 1.5 million new cases annually. TB is transmitted through the air when people who are sick with pulmonary or laryngeal TB expel bacteria by coughing, sneezing, speaking, or singing. Standard epidemiological indices are used to measure the TB problem in communities and allow international comparisons. These include prevalence and incidence rates of both infection and active disease. Controlling the spread of TB requires prompt diagnosis and effective treatment of infected individuals.
This document provides an overview of the global and Indian tuberculosis burden and the Revised National Tuberculosis Control Programme (RNTCP) in India. Some key points:
- TB is a major global public health issue, with an estimated 8.8 million new cases and 1.1 million deaths in 2010. India accounts for 20% of the global TB burden.
- The goals of RNTCP are to achieve an 85% cure rate for new sputum-positive TB patients and detect 70% of new sputum-positive cases.
- RNTCP implements the DOTS strategy, which involves quality-assured diagnosis, supervised treatment, uninterrupted drug supply, and monitoring through a standardized recording and
Video Directly Observed Therapy for HIV and TB patientsKimberly Schafer
Video-Directly Observed Therapy (V-DOT) is a promising solution for monitoring TB and HIV
treatment adherence for binational patients in the U.S.-Mexico border region.
Influenza vaccination and prevention of antimicrobial resistance - Slides by ...WAidid
The lecture presented by Professor Susanna Esposito at AMR 2019 on influenza vaccination and abuse of available antimicrobials.
To learn more, please visit www.waidid.org.
Non tubercular mycobacterial infection following surgery- Dr Keyur BhattDrKeyurBhattMSMRCSEd
Atypical Tuberculosis following surgery or laparoscopy. How to diagnose how to quantify and how to treat.
This is a very important presentation for the discovery and management of atypical tuberculosis infection any surgery.
this can happen after any laparoscopy or any interventional procedures.
This document discusses tuberculosis (TB) outbreaks reported in literature from the 1950s to 2013. It provides details on 186 TB outbreaks reported since 2000 across various settings like schools, hospitals, homeless shelters, and more. Characteristics of outbreaks discussed include their location, magnitude, impact, presence of drug resistance, high-risk populations affected, and environmental factors. Large, ongoing outbreaks involving strains resistant to isoniazid or multiple drugs are also mentioned. The document analyzes trends in recognized TB outbreaks and their characterization to understand transmission dynamics.
Bio303 Lecture 2 Two Old Enemies, TB and LeprosyMark Pallen
In this lecture I will focusing on another of the most serious infectious threats to humanity, tuberculosis, outlining its evolutionary origins, impact on human health and wealth and the steps taken to control and treat this infection. I will also discuss a related mycobacterial infection, leprosy and recent progress in its control.
This document provides an overview of updates to India's National TB Elimination Programme (NTEP), formerly known as the Revised National TB Control Programme (RNTCP). It summarizes global and Indian TB burden statistics. It outlines the evolution of TB control in India and STOP TB strategy goals. It describes the objectives of NTEP, tuberculosis unit structure, case definitions, diagnostic tools including smear microscopy, culture, and molecular tests. Treatment regimens for drug-sensitive TB including the switch to daily fixed-dose combination are explained. Algorithms for diagnosis and treatment of pediatric and drug-resistant TB are presented.
Tuberculosis is a major global health problem caused by the bacterium Mycobacterium tuberculosis. India has a large burden of TB, accounting for over 1.5 million new cases annually. TB is transmitted through the air when people who are sick with pulmonary or laryngeal TB expel bacteria by coughing, sneezing, speaking, or singing. Standard epidemiological indices are used to measure the TB problem in communities and allow international comparisons. These include prevalence and incidence rates of both infection and active disease. Controlling the spread of TB requires prompt diagnosis and effective treatment of infected individuals.
This document provides an overview of the global and Indian tuberculosis burden and the Revised National Tuberculosis Control Programme (RNTCP) in India. Some key points:
- TB is a major global public health issue, with an estimated 8.8 million new cases and 1.1 million deaths in 2010. India accounts for 20% of the global TB burden.
- The goals of RNTCP are to achieve an 85% cure rate for new sputum-positive TB patients and detect 70% of new sputum-positive cases.
- RNTCP implements the DOTS strategy, which involves quality-assured diagnosis, supervised treatment, uninterrupted drug supply, and monitoring through a standardized recording and
Preventing TB infection in HIV-infected
individuals living in medium and high TB endemic
settings
February 5, 2016
Jeffrey D. Jenks, MD, MPH
UCSD HIV & Global Health Rounds
Latent Tuberculosis: Identification and Treatmentacatanzaro
This document discusses screening and treatment guidelines for latent tuberculosis (TB) infection. It defines latent TB as presence of the TB bacteria without symptoms of active disease. High-risk groups for developing active TB include recent contacts of infectious cases, immunosuppressed individuals, and some medical conditions. Tuberculin skin testing is recommended for diagnosing latent TB, with different induration cut-offs based on risk group. If latent TB is diagnosed, treatment with Isoniazid for 9 months or Rifampin for 4 months is advised along with clinical and laboratory monitoring during therapy.
This document discusses TB/HIV co-infection, providing information on the global epidemiology, pathogenesis, clinical presentation, diagnosis, and management of TB in HIV patients. Some key points:
- TB is the leading cause of death for people living with HIV globally, with Africa disproportionately affected as rates there continue to rise.
- HIV infection increases the risk of developing active TB due to CD4+ T-cell depletion impairing the immune response to M. tuberculosis. This can lead to atypical clinical presentations and difficulties in diagnosis.
- Diagnosis is challenging as sputum smear-negative TB is more common in HIV patients. Culture remains the gold standard but newer rapid tests like nucleic acid amplification and
Epidemiology and control of tuberculosis and rntcp programmeJoslita Dsouza
This document discusses tuberculosis epidemiology and control in India through the Revised National Tuberculosis Control Programme (RNTCP). It notes that India accounts for 20% of the global TB burden. The RNTCP was launched in 1992 with goals of achieving an 85% cure rate through directly observed treatment, short course (DOTS) and detecting 70% of estimated cases. It has expanded DOTS treatment and laboratory networks across India. Key achievements include increasing the cure rate to 87% and decreasing the death rate to 4%. Ongoing efforts focus on expanding multidrug resistant TB treatment and strengthening surveillance.
Epidemiology and public health aspects of TB in indiaShyam Ashtekar
This document discusses tuberculosis (TB) in India from an epidemiological and public health perspective. It outlines the history of TB, noting that India shares 50% of the global TB burden. While drugs were developed in the 20th century, TB control programs in India have had limited success in reducing rates. India still sees around 2 million new cases annually. Environmental factors like poverty, overcrowding and malnutrition increase risk. Public health goals aim to reduce childhood TB infection rates by treating active cases and breaking transmission chains. Ongoing challenges include drug-resistant strains and the link between TB and HIV.
Recent advances in diagnosis and treatment of tuberculosisAdeyemiKayode2
The document summarizes recent advances in the diagnosis and treatment of tuberculosis. It discusses how diagnosis has advanced from identifying the bacteria that causes TB to newer molecular diagnostic tests like Xpert MTB/RIF assay and whole genome sequencing that provide faster results. Treatment has advanced from historical non-antibiotic approaches to the current drug cocktail regimen, though drug resistance poses challenges. Advances in understanding drug mechanisms of action and detecting resistance mutations have also occurred.
Pandemics: Dealing with the Unexpected "Scientific Theory and Practical Reality"Department of Health
A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO. Options for the control of Influenza VII Conference - Hong Kong 6 Sept 2010
1) Tuberculosis is a bacterial infection that can spread through the air and infect the lungs and other organs. It remains a major global health problem with 9.6 million new cases in 2014.
2) Drug resistant tuberculosis, including multi-drug resistant (MDR) and extensively drug resistant (XDR) TB, poses a serious threat as it is difficult and expensive to treat, with the potential to be resistant to all major anti-TB drugs.
3) Factors contributing to drug resistant TB include incorrect or incomplete treatment, use of poor quality medicines, and exposure to others with drug resistant TB. Effective treatment the first time and ensuring access to proper diagnosis and treatment are important to stop the emergence of
Counting children with TB - the role of modellingcheweb1
This document provides an overview of a presentation on counting children with tuberculosis (TB) through modeling. The presentation covers several topics: TB epidemiology globally and historically; the natural history of TB infection and disease; the impact of HIV on TB; estimating the burden of pediatric TB, drug-resistant TB, and latent TB infection in children through modeling; and modeling TB mortality in children. Figures and data are presented on various slides to illustrate concepts in TB transmission dynamics and the challenges in measuring disease burden in children.
The Power of Vaccines: ‘getting to zero’ for HIV and TB was an event hosted by the TB/HIV and Prevention Working Groups of the UK Consortium on AIDS and International Development. The meeting was sponsored by Pamela Nash MP and held on Friday, 18th May 2012, in Portcullis House, Westminster. Read more at http://storify.com/PamojaUK/the-power-of-vaccines
http://www.pamoja.uk.com
1. Early detection of HIV-TB co-infection is challenging but important as TB is a leading cause of death among people living with HIV. New diagnostic approaches like Xpert MTB/RIF can improve detection rates.
2. TB is more difficult to diagnose, spreads faster, and is more deadly in people living with HIV. The risk of developing active TB increases with lower CD4 counts.
3. Screening and testing algorithms along with new tests like Xpert MTB/RIF, LF-LAM, and treatment of latent TB are recommended to reduce the high TB mortality among people living with HIV.
This document discusses factors related to the treatment of community-acquired pneumonia (CAP). It notes that Streptococcus pneumoniae is the leading cause of CAP and risk factors for infection include age over 65, comorbidities, and recent antibiotic use. Mortality is higher in CAP patients with COPD, septic shock, or inappropriate initial antibiotic treatment. Early administration of antibiotics within 4 hours is associated with lower mortality. Combination antibiotic therapy is more effective than monotherapy for pneumococcal bacteremia.
The 2015 Global Tuberculosis Report provides an overview of TB epidemiology and programmatic data from countries and regions around the world. It finds that in 2014 there were an estimated 9.6 million new TB cases and 1.5 million TB deaths. While case detection and treatment success rates have improved, global targets for reductions in prevalence and mortality rates by 2015 were not achieved. Drug-resistant TB also remains a major public health problem, with an estimated 480,000 new cases of MDR-TB in 2014. The report calls for increased investment and accelerated progress to end the global TB epidemic.
The document discusses multi-drug resistant tuberculosis (MDR-TB), including its global epidemiology, challenges in diagnosis and treatment, and solutions through programmatic management. It notes that MDR-TB cases are estimated to affect over 600,000 people globally each year, with over 80% of cases located in 22 countries. Successful scale-up of MDR-TB treatment programs has been slow due to challenges with accurate and timely diagnosis, long and toxic treatment regimens, and limited availability of quality second-line drugs. Strengthening laboratory capacity, improving treatment strategies, and sustaining political and financial commitment are keys to addressing these challenges.
An Update on the DOTS Strategy to STOP Tuberculosis in our Lifetimes by Dr. I...Abraham Idokoko
The document is a presentation on tuberculosis (TB) control efforts given by Dr. Abraham Idokoko. It discusses the history of TB, highlighting key discoveries and developments in TB treatment. It provides current statistics on the global burden of TB, noting it infects one person per second and kills three people every minute. The presentation outlines the DOTS strategy for TB control and highlights challenges to achieving targets in Nigeria for stopping TB. It emphasizes the ongoing potential of the DOTS strategy despite its limitations.
Susanna Esposito (president WAidid) - Infections and vaccines in pediatricsWAidid
Slideset presented by professor Susanna Esposito, president WAidid, in occasion of the 25th ECCMID held last April in Copenhagen. The slideset was used to support professor Esposito top paper in paediatric infectious diseases
Global TB burden updates provide information on the TB situation globally and in India. Key points include:
- India accounts for over a quarter of the global TB burden, with an estimated 28 lakh incident cases in 2016 and 4.2 lakh deaths.
- WHO has revised their estimates of India's TB burden upwards based on new evidence, though the trend still shows a decline in incidence and mortality.
- India has achieved the MDG target of reducing prevalence and mortality by 50%, but a huge burden remains, especially among economically productive groups.
- The government of India's strategic vision is to achieve a TB-free India by 2025 through universal access to quality diagnosis and treatment.
- There is an estimated 1 million people worldwide who have TB and HIV co-infection, with a high burden in sub-Saharan Africa and Asia.
- People living with HIV are 26-31 times more likely to develop TB than those without HIV. TB is the most common illness in those with HIV and a major cause of HIV-related death.
- Clinical manifestations of TB in those with HIV depend on immune deficiency level, ranging from typical localized TB to atypical disseminated forms with more advanced HIV disease. Diagnosis involves screening algorithms, radiography, sputum smear microscopy, mycobacterial culture, and molecular and serological tests.
Vikram Paswan proposes researching the factors causing deaths of patients suffering from tuberculosis in India, despite it being curable and treated free of cost. He plans to conduct in-depth interviews with DOTS providers, doctors, patients, and group interviews with medical staff and volunteers using semi-structured questionnaires. Potential findings may include insights into how patients' economic status, gender, and age influence outcomes, along with the effectiveness of the public health care system and roles of private doctors and NGOs in controlling TB. Knowledge and stigma regarding TB symptoms and transmission will also be examined.
The document proposes an elliptic curve cryptographic (ECC) based group key establishment protocol for mobile ad hoc networks. ECC allows for smaller key sizes than traditional public key methods like RSA, making it suitable for resource constrained mobile devices. The proposed Group Key Management Protocol (GKMP) would use ECC to efficiently establish and distribute a shared group key for mobile ad hoc networks, handling changes in network topology like nodes joining or dropping out of the group. The protocol aims to satisfy security requirements for asynchronous and dynamic mobile ad hoc networks in an efficient manner.
Preventing TB infection in HIV-infected
individuals living in medium and high TB endemic
settings
February 5, 2016
Jeffrey D. Jenks, MD, MPH
UCSD HIV & Global Health Rounds
Latent Tuberculosis: Identification and Treatmentacatanzaro
This document discusses screening and treatment guidelines for latent tuberculosis (TB) infection. It defines latent TB as presence of the TB bacteria without symptoms of active disease. High-risk groups for developing active TB include recent contacts of infectious cases, immunosuppressed individuals, and some medical conditions. Tuberculin skin testing is recommended for diagnosing latent TB, with different induration cut-offs based on risk group. If latent TB is diagnosed, treatment with Isoniazid for 9 months or Rifampin for 4 months is advised along with clinical and laboratory monitoring during therapy.
This document discusses TB/HIV co-infection, providing information on the global epidemiology, pathogenesis, clinical presentation, diagnosis, and management of TB in HIV patients. Some key points:
- TB is the leading cause of death for people living with HIV globally, with Africa disproportionately affected as rates there continue to rise.
- HIV infection increases the risk of developing active TB due to CD4+ T-cell depletion impairing the immune response to M. tuberculosis. This can lead to atypical clinical presentations and difficulties in diagnosis.
- Diagnosis is challenging as sputum smear-negative TB is more common in HIV patients. Culture remains the gold standard but newer rapid tests like nucleic acid amplification and
Epidemiology and control of tuberculosis and rntcp programmeJoslita Dsouza
This document discusses tuberculosis epidemiology and control in India through the Revised National Tuberculosis Control Programme (RNTCP). It notes that India accounts for 20% of the global TB burden. The RNTCP was launched in 1992 with goals of achieving an 85% cure rate through directly observed treatment, short course (DOTS) and detecting 70% of estimated cases. It has expanded DOTS treatment and laboratory networks across India. Key achievements include increasing the cure rate to 87% and decreasing the death rate to 4%. Ongoing efforts focus on expanding multidrug resistant TB treatment and strengthening surveillance.
Epidemiology and public health aspects of TB in indiaShyam Ashtekar
This document discusses tuberculosis (TB) in India from an epidemiological and public health perspective. It outlines the history of TB, noting that India shares 50% of the global TB burden. While drugs were developed in the 20th century, TB control programs in India have had limited success in reducing rates. India still sees around 2 million new cases annually. Environmental factors like poverty, overcrowding and malnutrition increase risk. Public health goals aim to reduce childhood TB infection rates by treating active cases and breaking transmission chains. Ongoing challenges include drug-resistant strains and the link between TB and HIV.
Recent advances in diagnosis and treatment of tuberculosisAdeyemiKayode2
The document summarizes recent advances in the diagnosis and treatment of tuberculosis. It discusses how diagnosis has advanced from identifying the bacteria that causes TB to newer molecular diagnostic tests like Xpert MTB/RIF assay and whole genome sequencing that provide faster results. Treatment has advanced from historical non-antibiotic approaches to the current drug cocktail regimen, though drug resistance poses challenges. Advances in understanding drug mechanisms of action and detecting resistance mutations have also occurred.
Pandemics: Dealing with the Unexpected "Scientific Theory and Practical Reality"Department of Health
A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO. Options for the control of Influenza VII Conference - Hong Kong 6 Sept 2010
1) Tuberculosis is a bacterial infection that can spread through the air and infect the lungs and other organs. It remains a major global health problem with 9.6 million new cases in 2014.
2) Drug resistant tuberculosis, including multi-drug resistant (MDR) and extensively drug resistant (XDR) TB, poses a serious threat as it is difficult and expensive to treat, with the potential to be resistant to all major anti-TB drugs.
3) Factors contributing to drug resistant TB include incorrect or incomplete treatment, use of poor quality medicines, and exposure to others with drug resistant TB. Effective treatment the first time and ensuring access to proper diagnosis and treatment are important to stop the emergence of
Counting children with TB - the role of modellingcheweb1
This document provides an overview of a presentation on counting children with tuberculosis (TB) through modeling. The presentation covers several topics: TB epidemiology globally and historically; the natural history of TB infection and disease; the impact of HIV on TB; estimating the burden of pediatric TB, drug-resistant TB, and latent TB infection in children through modeling; and modeling TB mortality in children. Figures and data are presented on various slides to illustrate concepts in TB transmission dynamics and the challenges in measuring disease burden in children.
The Power of Vaccines: ‘getting to zero’ for HIV and TB was an event hosted by the TB/HIV and Prevention Working Groups of the UK Consortium on AIDS and International Development. The meeting was sponsored by Pamela Nash MP and held on Friday, 18th May 2012, in Portcullis House, Westminster. Read more at http://storify.com/PamojaUK/the-power-of-vaccines
http://www.pamoja.uk.com
1. Early detection of HIV-TB co-infection is challenging but important as TB is a leading cause of death among people living with HIV. New diagnostic approaches like Xpert MTB/RIF can improve detection rates.
2. TB is more difficult to diagnose, spreads faster, and is more deadly in people living with HIV. The risk of developing active TB increases with lower CD4 counts.
3. Screening and testing algorithms along with new tests like Xpert MTB/RIF, LF-LAM, and treatment of latent TB are recommended to reduce the high TB mortality among people living with HIV.
This document discusses factors related to the treatment of community-acquired pneumonia (CAP). It notes that Streptococcus pneumoniae is the leading cause of CAP and risk factors for infection include age over 65, comorbidities, and recent antibiotic use. Mortality is higher in CAP patients with COPD, septic shock, or inappropriate initial antibiotic treatment. Early administration of antibiotics within 4 hours is associated with lower mortality. Combination antibiotic therapy is more effective than monotherapy for pneumococcal bacteremia.
The 2015 Global Tuberculosis Report provides an overview of TB epidemiology and programmatic data from countries and regions around the world. It finds that in 2014 there were an estimated 9.6 million new TB cases and 1.5 million TB deaths. While case detection and treatment success rates have improved, global targets for reductions in prevalence and mortality rates by 2015 were not achieved. Drug-resistant TB also remains a major public health problem, with an estimated 480,000 new cases of MDR-TB in 2014. The report calls for increased investment and accelerated progress to end the global TB epidemic.
The document discusses multi-drug resistant tuberculosis (MDR-TB), including its global epidemiology, challenges in diagnosis and treatment, and solutions through programmatic management. It notes that MDR-TB cases are estimated to affect over 600,000 people globally each year, with over 80% of cases located in 22 countries. Successful scale-up of MDR-TB treatment programs has been slow due to challenges with accurate and timely diagnosis, long and toxic treatment regimens, and limited availability of quality second-line drugs. Strengthening laboratory capacity, improving treatment strategies, and sustaining political and financial commitment are keys to addressing these challenges.
An Update on the DOTS Strategy to STOP Tuberculosis in our Lifetimes by Dr. I...Abraham Idokoko
The document is a presentation on tuberculosis (TB) control efforts given by Dr. Abraham Idokoko. It discusses the history of TB, highlighting key discoveries and developments in TB treatment. It provides current statistics on the global burden of TB, noting it infects one person per second and kills three people every minute. The presentation outlines the DOTS strategy for TB control and highlights challenges to achieving targets in Nigeria for stopping TB. It emphasizes the ongoing potential of the DOTS strategy despite its limitations.
Susanna Esposito (president WAidid) - Infections and vaccines in pediatricsWAidid
Slideset presented by professor Susanna Esposito, president WAidid, in occasion of the 25th ECCMID held last April in Copenhagen. The slideset was used to support professor Esposito top paper in paediatric infectious diseases
Global TB burden updates provide information on the TB situation globally and in India. Key points include:
- India accounts for over a quarter of the global TB burden, with an estimated 28 lakh incident cases in 2016 and 4.2 lakh deaths.
- WHO has revised their estimates of India's TB burden upwards based on new evidence, though the trend still shows a decline in incidence and mortality.
- India has achieved the MDG target of reducing prevalence and mortality by 50%, but a huge burden remains, especially among economically productive groups.
- The government of India's strategic vision is to achieve a TB-free India by 2025 through universal access to quality diagnosis and treatment.
- There is an estimated 1 million people worldwide who have TB and HIV co-infection, with a high burden in sub-Saharan Africa and Asia.
- People living with HIV are 26-31 times more likely to develop TB than those without HIV. TB is the most common illness in those with HIV and a major cause of HIV-related death.
- Clinical manifestations of TB in those with HIV depend on immune deficiency level, ranging from typical localized TB to atypical disseminated forms with more advanced HIV disease. Diagnosis involves screening algorithms, radiography, sputum smear microscopy, mycobacterial culture, and molecular and serological tests.
Vikram Paswan proposes researching the factors causing deaths of patients suffering from tuberculosis in India, despite it being curable and treated free of cost. He plans to conduct in-depth interviews with DOTS providers, doctors, patients, and group interviews with medical staff and volunteers using semi-structured questionnaires. Potential findings may include insights into how patients' economic status, gender, and age influence outcomes, along with the effectiveness of the public health care system and roles of private doctors and NGOs in controlling TB. Knowledge and stigma regarding TB symptoms and transmission will also be examined.
The document proposes an elliptic curve cryptographic (ECC) based group key establishment protocol for mobile ad hoc networks. ECC allows for smaller key sizes than traditional public key methods like RSA, making it suitable for resource constrained mobile devices. The proposed Group Key Management Protocol (GKMP) would use ECC to efficiently establish and distribute a shared group key for mobile ad hoc networks, handling changes in network topology like nodes joining or dropping out of the group. The protocol aims to satisfy security requirements for asynchronous and dynamic mobile ad hoc networks in an efficient manner.
This document discusses key concepts in survey and experimental design for quantitative research methods. It covers topics such as sampling techniques for surveys, controlling variables in experiments, potential biases in responses, and calculating sample sizes. Experimental designs aim to establish causation by manipulating an independent variable and measuring effects on a dependent variable. Trade-offs exist between internal validity achieved through control and external validity or generalizability of findings.
Qualitative Research Methodology Course Presentationnihonscott
This document provides an overview of a research proposal to compare the use of cultural values and social networks in a local community organization project versus an international donor project for water and sanitation development in Vietnam. The study aims to identify transferable practices that could increase success for future projects by taking a qualitative, actor-oriented approach, using semi-structured interviews and participant observation to examine two cases in the Dong Nai River Basin.
This document outlines a research proposal that examines the effects of the 2009 economic downturn on Emirates Airlines as a high-cost carrier. The proposal includes objectives to identify impacts on high-cost airlines during the recession, compare customer numbers before and after, and provide recommendations. The methodology involves secondary research on aviation data and a questionnaire distributed to Emirates Aviation College students and staff. The analysis section presents survey results on travel habits, class of travel, and opinions on measures airlines could take in a recession. The conclusion finds prices dropped as fewer people traveled. Recommendations include calculating pre- and post-recession rate changes and precisely measuring industry impacts.
This document discusses future research priorities for tuberculosis control post-2015. It outlines the rationale for developing a new global TB strategy after 2015, including addressing challenges like case detection, TB/HIV co-infection, and drug-resistant TB. Six categories of TB research are identified: epidemiology, fundamental research, diagnostics, treatment, vaccines, and operational research. Key areas for future research include developing new diagnostics, drugs, vaccines, and optimizing case detection and treatment delivery. Funding for TB research needs to increase to develop innovative tools and strategies to work towards a world free of TB.
Module: [LIBR_01]_SIGE XIII_Method Prop to Design Radars
Topic: RESEARCH, DEVELOPMENT & INNOVATION
Subject: A Methodology Proposal to Design Radars - Systems Approach
Article by Antonio Sallum Librelato and Osamu Saotome, presented and published during the XIII SIGE. ITA, 27 a 30 de setembro de 2011.
Scope:
Abstract
I. INTRODUCTION
Motivations for the Systems Concepts Research (SCR) method
II. BRIEF DESCRIPTION OF THE SCR METHOD
Principles of SCR
Phases of the SCR
Purposes of SCR
III. NRA - NEEDS AND REQUIREMENTS ANALYSIS
Purposes of NRA
Steps and Tasks of NRA
IV. SCE - SYSTEMS CONCEPTS EXPLORATION
Purposes of SCE
Steps and Tasks of SCE
V. SCD - SYSTEM CONCEPT DEFINITION
Purposes of SCD
Steps and Tasks of SCD
VI. SRAA - SYSTEMS RISKS AND ASSURANCE ANALYSIS
Purposes of SRAA
Steps and Tasks of SRAA
VII. CONCLUSIONS
REFERENCES
Harder-to-treat and more lethal tubercle bacilli continue to emerge across the globe, especially in the African region. Together with HIV, these infectious killers continue to have profound effects on the productive workforce in different countries. The deck is a brief overview of developments in disease management and research, with an emphasis on medications and vaccines.
Tutorial for beginning graduate students. Some guidelines for composing the research proposal for an MS project. Also presents the perspective of advisor and committee.
Tuberculosis is caused by Mycobacterium tuberculosis and can affect many organ systems. DOTS (Directly Observed Treatment Shortcourse) is a global program that helps cure TB by having a health worker directly observe a patient taking their full course of anti-TB medications to ensure compliance and prevent drug resistance. India has a high burden of TB with an estimated 1.96 million new cases and 330,000 deaths annually. DOTS involves a short intensive phase of treatment under direct observation followed by a continuation phase where the first dose of each week is taken under supervision.
This document outlines the agenda and background for a proposal defense on examining the correlations between African American students' beliefs and academic outcomes. The study aims to explore how teachers' beliefs and school cultures affect African American students' attitudes, achievement, discipline referrals, and special education services. It will use a quantitative research design and collect data on students' and teachers' beliefs using instruments measuring stereotype threats, classroom environment, and discipline behaviors.
This proposal discusses solid waste management in three key areas:
1) It defines solid waste and discusses its sources and impacts. Improper management poses risks like bacterial contamination, toxic contamination, and air pollution.
2) It outlines objectives to improve solid waste management including achieving 90% waste collection efficiency within 30 months through monitoring, coordination, and facilitating improved practices.
3) It discusses several solid waste management methods like recycling, composting, and sanitary landfilling and their environmental benefits compared to open dumping and burning. The proposal is presented to a professor and seeks to improve local solid waste management over three years.
The document provides an overview of the key elements that should be included in a research proposal. It discusses the purpose of a research proposal is to convince others that the proposed research project is worthwhile and that the investigator has the competence and work plan to complete it. The main elements that should be included in a research proposal are an introduction section outlining the background, problem statement, objectives, literature review, methodology, ethical considerations, time schedule and references.
Epidemiology of tb with recent advances acknowledged by whoRama shankar
This document provides an overview of tuberculosis epidemiology and recent advances in tuberculosis programs. It discusses the global and national burden of tuberculosis, the evolution of tuberculosis control programs in India including the National Tuberculosis Control Programme and Revised National Tuberculosis Control Programme. It covers diagnosis, treatment, drug-resistant tuberculosis, tuberculosis and HIV coinfection, and recent advances acknowledged by the WHO. The post-2015 tuberculosis strategy in relation to sustainable development goals is also mentioned.
This document provides an overview of the epidemiology of tuberculosis (TB). It discusses the timeline of TB discoveries, current global and regional estimates of TB prevalence and incidence, and trends over time. Key populations affected include those in Asia, women, children, and those coinfected with HIV. Natural history is influenced by agent, host, and social factors like malnutrition, poverty, and crowding. The goals are to describe the distribution of TB and associated risk factors.
MRC/info4africa KZN Community Forum | July 2014 | Dr Elizabeth Spooner | TB i...info4africa
Dr Elizabeth Spooner presented at the MRC/info4africa KZN Community Forum during July 2014. Her presentation was entitled "Tuberculosis in South Africa - Where are We and Where are We Going".
www.slideshare.ne www.slideshare.ne Tuberculosis (TB) is fatal
contagious disease that affects the lungs and other part of body which is a public health problem but curable and preventable disease .
Caused organism : bacteria (Mycobacterium tuberculosis
Human : Mycobacterium tuberculosis
Pulmonary TB
Extra pulmonary TB
Animals : Mycobacterium Bovis
Bovine tuberculosis (TB) is a chronic disease of animals caused by a bacteria called Mycobacterium bovis, (M.bovis) which is closely related to the bacteria that cause human
This document provides a history of tuberculosis (TB) and efforts to control it. It discusses how TB was a major cause of death in Europe and America until antibiotics were developed in the mid-20th century. Major developments in treating and preventing TB are outlined, including the BCG vaccine and various antibiotic treatments. The document also summarizes global strategies to end TB, barriers to achieving targets, and the need for new tools and political/financial commitment to eliminate TB by 2030.
The Revised National Tuberculosis Control Programme (RNTCP) was initiated in India in 1997 to address the limitations of the previous National Tuberculosis Control Programme. RNTCP follows the WHO recommended DOTS strategy and aims to decrease TB mortality and morbidity. It has a decentralized organizational structure and seeks to achieve at least 90% cure rates for new sputum-positive cases and detect at least 85% of expected new sputum-positive cases. RNTCP relies on sputum testing, DOTS treatment, and engagement with private providers and communities to control TB in India.
The Revised National Tuberculosis Control Programme (RNTCP) was introduced in India in 1997 to address the limitations of the previous National Tuberculosis Control Programme. RNTCP follows the WHO recommended DOTS strategy to control TB, which includes political commitment, quality diagnosis through sputum microscopy, uninterrupted drug supply, directly observed treatment, and monitoring & evaluation. The goal is to reduce TB mortality and morbidity in India through early case detection and ensuring patients complete the full treatment course.
This document discusses tuberculosis (TB) in India from an epidemiological and public health perspective. It outlines the history of TB, noting that India shares 50% of the global TB burden. While drugs were developed in the 20th century, TB control programs in India have had limited success in reducing rates. India still sees around 2 million new cases annually. Environmental factors like poverty, overcrowding and malnutrition increase risk. Public health goals aim to reduce childhood TB infection rates by treating active cases and breaking transmission chains. Ongoing challenges include drug-resistant strains and the link between TB and HIV.
International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)
1) The study investigated the effects of rifampicin, an antibiotic used to treat tuberculosis, on kidney biomarkers and histopathology in albino rats.
2) Rats were given rifampicin at different doses for varying time periods, then kidney biomarkers like urea and creatinine were measured from blood samples.
3) Results showed that urea and creatinine levels increased over time with higher doses of rifampicin, indicating potential kidney damage. Histological examination also revealed inflammation of the glomeruli in kidneys of rats that received the highest dose for longest time period.
This document provides information on tuberculosis (TB), including its history, causative bacteria, epidemiology, pathogenesis, and clinical manifestations. It discusses how Mycobacterium tuberculosis was identified in 1882 and the development of chemotherapy in the 1960s. It notes that one billion people will be newly infected with TB between 2000-2020. The document also examines the natural history of TB infection, primary infection pathogenesis involving alveolar macrophages, and symptoms of respiratory and general involvement in clinical manifestation.
National TB Elimination Programme in India aims to eliminate TB by 2025. TB remains a major public health problem in India, being one of the leading causes of death. In 2019, the estimated TB incidence was 26.4 lakh cases and estimated deaths were 4.45 lakh. There is a large gap between estimated cases and cases notified to the government. Private sector notification is very low. The government's targets are to reduce TB deaths by 90% and cut incidence rate by 80% by 2025 compared to 2015. This will require detecting all TB cases, ensuring treatment completion, preventive measures like contact screening, and building strong public-private partnerships.
This document discusses laboratory diagnosis and transmission of HIV infection. It begins with an introduction to HIV and AIDS, then covers the virus's morphology, epidemiology, modes of transmission, pathogenesis, signs and symptoms, and laboratory diagnosis. Laboratory diagnosis can be qualitative via rapid tests to detect antibodies or quantitative via viral load testing. Diagnosis is important for management and prevention/control efforts like safe sex practices, treatment as prevention, voluntary counseling and testing, and public health education.
The document summarizes successes and challenges in rolling out antiretroviral therapy (ART) in low-income countries. Key successes include increasing ART access through lowered drug prices and expanded treatment guidelines by the WHO. However, challenges remain such as late treatment initiation leading to high mortality, low pediatric diagnosis rates, limited second-line treatment options, and loss to follow up. Ongoing efforts are needed to further scale up and improve ART programs.
This document discusses HIV and hepatitis C, and how treatment has improved outcomes. It presents two case studies of patients with advanced HIV presenting with opportunistic infections who were successfully treated. It also summarizes research showing that early antiretroviral therapy improves survival for patients with HIV/AIDS or opportunistic infections like PCP, and that cure of hepatitis C through direct-acting antivirals reduces mortality and complications like liver cancer. While treatment access has increased globally, challenges remain in testing and treating all those in need.
This document discusses tuberculosis (TB) in children. It covers the causative agent, classification, risk factors, global and local burden, and strategies for management. TB is caused mainly by Mycobacterium tuberculosis and is a major global health problem exacerbated by HIV. In Kenya, TB prevalence was 103,159 in 2012, with 39% co-infected with HIV. The Stop TB strategy aims to reduce the global TB burden by 50% by 2015 through improved detection and treatment programs.
The CDC guidelines outline 6 groups at higher risk for active TB: those with HIV/immunosuppression, immigrants from high prevalence countries, individuals exposed in high-risk environments like homeless shelters or prisons, those with drug resistant TB, babies/young children/elderly/low weight individuals, and substance abusers. Active TB is treated with a multi-drug regimen for 6-9 months while latent TB infection requires treatment to prevent progression to active disease.
Covid-19 Brief Review | A holistic review at pandemic Akhtar Hussain
Presentation holistically and briefly covers the technical aspects of global pandemic. To put things in perspective a comparison woth recent pandemics is also included.
I have tried to make the presentation as rational and unbiased. Though with the ever coming developments daily some things might become redundant even in 10 days only. would love to get suggestions for improvement.
Epidemiology & Control measures for Tuberculosis. AB Rajar
n this Lecture I tried my best to include all essential features about the TB disease. I hope that this will help to undergraduate Medical students for better understanding the Disease.
Similar to "What Will It Take To Control TB?" Richard Chaisson, MD (20)
This document summarizes a needs assessment conducted in Bangkok, Thailand to inform diabetes prevention efforts. Surveys found exercise was the top perceived need, with 28.9% reporting no exercise. However, participants noted a lack of community spaces and access barriers to physical activity. While organizers were concerned about a lack of cooperation and commitment to community-centered programs. The needs assessment identifies structural and participation barriers to address to effectively promote diabetes prevention in the community.
This document summarizes strategies used to undermine public acceptance of climate change science and discusses ways to more effectively engage the public on this issue. It notes that corporate interests have funded front groups and think tanks to manufacture doubt about climate science and make lack of certainty a political issue. As a result, news media often portray climate science as a two-sided controversy when there is actually a scientific consensus. It suggests joining online networks for information and action, developing new communication strategies, and promoting a values-based debate around climate solutions rather than perpetuating manufactured controversies.
The document discusses accountability for global health efforts. It asks if governments of poor countries are accountable for not spending more on domestic health and if so, to whom. It also asks if international organizations like the IMF and World Bank are accountable for policies that discourage health spending and if rich country governments are accountable for not providing more international health aid. It notes challenges to mutual accountability given both national and international responsibilities for health.
Understanding the Effect of the GAVI Initiative on Reported Vaccination Cover...UWGlobalHealth
This document discusses the critical role of health metrics and evaluation in ensuring accountability, transparency and reducing corruption in global health. It provides two examples: tracking childhood immunization coverage shows investments have increased coverage gradually over 20 years but initiatives can lead to over-reporting; India's conditional cash transfer program for facility births increased coverage and likely reduced mortality, but quality issues remain. Overall, independent monitoring of health indicators and evaluation of programs is needed to show resources are having their intended impact.
Foreign funding to NGOs in Nicaragua has undermined their accountability to grassroots organizations and limited their ability to catalyze social change. Due to short-term funding cycles tied to donor priorities, NGOs are more accountable to foreign donors than the communities they are meant to serve. This has contributed to a façade of civil society dominated by urban NGO elites rather than empowered grassroots organizations. As a result, NGOs have had minimal policy impact and have demobilized, rather than empowered, the people. Long-term funding structures that strengthen accountability to local constituencies may help NGOs better support grassroots organizations and social movements.
The Power of Numbers- Communities Use Government Budget Data to Advocate for ...UWGlobalHealth
The International Budget Partnership provides concise summaries of documents in 3 sentences or less:
The document outlines the work of the International Budget Partnership (IBP), including building budget literacy, training on fiscal analysis, and monitoring government budgets and expenditures. IBP partners with civil society organizations around the world to increase budget transparency and hold governments accountable. The document also describes IBP's role in providing funding, capacity building, information sharing, and networking opportunities to support its partners' budget work.
Perspectives and Controversies surrounding human rightsUWGlobalHealth
This document discusses the right to health from a human rights perspective. It begins by defining key concepts like health, human rights, and the relationship between health and human rights. It then examines how the right to health is established under international law through conventions like the International Covenant on Economic, Social and Cultural Rights. The document also summarizes commentary on the right to health from the UN Committee on Economic, Social and Cultural Rights. Finally, it discusses some controversies and challenges regarding a human rights-based approach to health, such as issues of universality and developing appropriate indicators.
Politics and Health Reform:Lessons From a Year in Washington, D.C.UWGlobalHealth
This document summarizes the history of health reform efforts in the United States from the late 19th century to 2009. It discusses how a national health insurance system has been proposed since the 1880s but consistently opposed by groups like the AMA and insurance industry. The US now spends over twice as much per capita on healthcare as other OECD countries but has lower life expectancy and more administrative waste. Creating a universal, publicly financed system could reduce costs while improving access and outcomes.
This document discusses health as a societal right. It begins by discussing how health has traditionally been viewed as an individual responsibility but argues that there are no biological reasons why entire populations cannot be healthy. It then explores how health can be considered a societal or human right. The document examines how determinants of health are influenced by societal factors like inequality and poverty rather than just individual behaviors or access to healthcare. Overall, it promotes a view of health as a societal issue that governments should aim to improve and protect for entire populations, rather than just an individual concern.
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1) The US ranks last among seven countries in overall health system performance and ranks last or near last on most measures of health care quality, access, efficiency, and equity.
2) While the US spends much more per capita on health care than other countries, it has poorer population health outcomes and shorter life expectancies.
3) Rising health care costs are consuming an increasing share of family budgets in the US. The percentage of families spending over 10% and over 25% of pre-tax income on health care doubled from 2000 to 2008.
"The Health System and Aid Effectives: Sudan's Experience"UWGlobalHealth
The document summarizes Sudan's health system and aid effectiveness. It provides background on Sudan's location and history as a 4000 year old civilization. It then discusses Sudan's socio-economic context, including its potentially rich natural resources and decentralization of services. The health delivery system is described as providing free healthcare, with increasing expenditures over time. Main health issues are outlined and data is given on international NGO presence and beneficiaries across regions. The document concludes with some of the challenges facing Sudan's health system.
The IHOP program allows medical students to spend 8 weeks in a developing country to learn about global health challenges. Students conduct a community health assessment and partner with local organizations to address health needs. The experience aims to provide cultural immersion and help students understand how to incorporate global health into their careers. Students are responsible for costs of $3,000-$5,000 and must complete assignments while abroad and after returning. Strong applicants have a genuine interest in global health and experience with underserved populations.
The document summarizes health reforms in Mexico from 1943-2004, with a focus on the 2004 reform that established the Health Social Protection System. It overviews declining mortality rates and increasing life expectancy over time. Key aspects of the 2004 reform included establishing universal health care coverage, separating financing from service provision, defining an essential benefits package, and increasing accountability through performance measurement. The reform reorganized Mexico's health system to improve access, quality, and financial protection for all citizens.
The document discusses health care systems and funding in Mozambique. It outlines the various sectors involved in health including public, private, NGOs, and traditional/alternative care. It also describes the types of funding for health care including vertical, horizontal, and diagonal funding. Vertical funding for specific diseases has increased from organizations like PEPFAR, Global Fund, and foundations. While this funding has increased dramatically, questions remain about whether NGOs effectively strengthen health systems or divert resources and can fragment services.
The document summarizes research into how NGOs are implementing a voluntary Code of Conduct for Health Systems Strengthening. Interviews found that while most signatories are aware of the Code and value its principles, they still face challenges adhering to provisions around hiring health workers from ministries of health and matching government salaries. Some promising practices discussed include building workforce capacity through training, advocating for improved public sector opportunities, and coordinating hiring and compensation policies among NGOs. Overall, signatories are committed to the Code's goals but continuing to test practical solutions for balancing them with operational needs.
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The document discusses PATH's approach to collaborating with private sector partners to advance global health technologies. It focuses on PATH bringing expertise in developing country health systems and strategic relationships, while partners contribute product development expertise, intellectual property, and distribution systems. The collaboration aims to improve availability, accessibility, and affordability of important health products for public health programs.
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
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In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
"What Will It Take To Control TB?" Richard Chaisson, MD
1. What Can Be Done to
Control Tuberculosis?
Richard E. Chaisson, MD
Center for Tuberculosis Research
Johns Hopkins University
2. A History of TB Control:
Mission Accomplished?
• 1882 – Koch discovers the tubercle bacillus*
• 1907 – von Pirquet adapts Koch’s tuberculin
• 1919 – Calmette and Guerin produce BCG vaccine
• 1943 – Schatz and Waksman discover streptomycin*
• 1948 – BMRC trial of streptomycin vs bed rest
• 1952 – Development of INH
• 1966 – Development of rifampin
• 1978 – Short-course TB therapy 6 months
*Awarded Nobel Prize
3. Federal Funding for Tuberculosis Research
and Control, 1962 - 1990
BR Bloom and CJL Murray, Science 1992;257:1055-64
4. Reported Tuberculosis Cases in the United States, 1953 - 1999
80000
Number of cases (log scale)
40000
20000
1950 1960 1970 1980 1990 2000
Year of notification
Centers for Disease Control and Prevention
Reported Tuberculosis in the United States, 1999
5. Estimated Global Incidence of Tuberculosis,
1990 - 2005
140
Cases per 135
100,000
130
125
120
1990 1995 2000 2005
WHO 2007
6. WHO Estimates of Global Burden
of Tuberculosis as of December 31, 2008
Estimated Estimated
number of number of
cases deaths
All forms of TB 9.4 million 1.3 million*
MDR-TB 511,000 ~150,000
XDR-TB 50,000 30,000
*excludes 500,000 HIV-TB deaths
7. TB Incidence in Africa, 1990 and 2005
Chaisson and Martinson, N Engl J Med 2008;358:1089
8. XDR TB outbreak in
Tugela Ferry, South Africa
Survival of XDR TB Patients at the
Church of Scotland Hospital (N=53)
1.1
1.0
.9
.8
Proportion Surviving
.7
.6
.5
.4
.3
.2
.1
0.0
-.1
0 30 60 90 120 150 180 210 240
Days since Sputum Collected
Gandhi et al., Lancet 2006; 368:1575-80
9. TB in HIV+ Patients at Chris Hani
Baragwanath Hospital, Soweto, South Africa
– TB admissions 2005-2008:
• 6500-6800 per year
• 18-20 new cases per day
– 85% HIV+
– >90% fully drug susceptible
– Inpatient mortality = 18%
• ~1200 deaths per year from
drug-susceptible TB
Edgington et al., Int J Tuberc Lung Dis 2006;10:1018; ML Wong, pers. comm.; Martinson et al., AIDS. 2007;21:2043 Shah et al., JAIDS
2009, epub
10. Tools to Control of Tuberculosis
What went wrong?
• Failure to apply tools broadly
– Weaknesses in health systems
• Inadequacies of existing tools
– Smear detection of cases ~50%
– Adherence to regimens is very poor
– BCG vaccine does not prevent adult TB
• Changing epidemiological situation
– HIV epidemic and other co-morbidities
– MDR
• Lack of understanding of best
epidemiologic approaches
11. An Epidemiological Model of Tuberculosis in the United States
INFECTED
Step 1
CASES
Infected
Step 4 Cases
Step 2
Step 3
UNINFECTED
Ferebee, SH. Natl Tuberc Assoc Bull 1967;53:4
12. An Epidemiological Model of Tuberculosis in the United States
INFECTED
Interventions to control TB
Step 1 Find and treat cases: Steps 2 and 4
Treat latent TB: Steps 1 and 3
Vaccinate susceptible: Step 2
CASES
Step 4
Step 2
Step 3
UNINFECTED
Ferebee, SH. Natl Tuberc Assoc Bull 1967;53:4
13. The Kolin Study of Tuberculosis Control with
Mass Case Finding and Treatment
Mass case finding
Type 1960 1961 1962 1963 1964
New Cases 46 132 61 88 47
Relapses 29 25 18 13 16
Chronic 29 40 17 11 8
Other 26 26 42 14 20
Total 150 233 138 126 91
Rates per 100,000 Population
“It is concluded from the study that in developed countries priority should be given to
adequate treatment of all persons with active tuberculosis, and to early diagnosis in
persons consulting physicians and in the high-risk populations.”
Styblo et al., Bull WHO 1967;37:819-74
14. World Health Organization Strategies for
Tuberculosis Control, 1974 – present
• Passive case detection and treatment
– DOTS targets added in 1991
• 70% case detection, 85% cure rate
• BCG vaccination of all children at birth
• Isoniazid preventive therapy for young
children exposed to smear-positive cases
(PPD+)
15. Epidemiologic Basis for TB Control
Key Considerations for Strategies
• Where are the seedbeds of tuberculosis?
– Who has latent TB infection?
– Who amongst these is most likely to develop disease?
• Who has active TB and how can they be reached?
– What proportion of cases are detected, and when?
– Is treatment effective in controlling spread?
• Where is TB transmission occurring, and how can
it be curtailed?
– Who are the contacts of cases who become infected?
– What measures can be taken to reduce transmission?
• What can be done to reduce susceptibility?
– Vaccination
– Antiretrovirals
– Control of co-morbidities, e.g., diabetes
16. The Origin of TB Cases:
Prevalence of Risk Factors in Patients with Culture-Confirmed
Pulmonary TB in Baltimore
Characteristic No. (Total = 139) %
Foreign born 12 9%
HIV Infection 31 24%
IDU 28 20%
Diabetes 18 14%
Renal Failure 12 9%
Recent Cancer 8 6%
Steroid Use 7 6%
Oursler et al., CID 2002;34:729-9
17. TB Incidence and Prevalence of Diabetes, 2010 and 2030
Dooley and Chaisson, Lancet Infect Dis, 2009; 9: 737–46
18. Smoking and incident TB in HIV-infected adults
in Soweto, South Africa
Pack Pack
years Incidence IRR years Incidence IRR
6.5 6.7
<1 REF Never REF
(5.9-7.4) (6.0-7.6)
9.0 1.36 7.8 1.15
1-5 Past
(6.8-11.7) (1.01-1.82) (5.8-1.2) (0.9-1.55)
12.8 1.95 10.7 1.59
>5 Current
(9.7-16.7) (1.44-2.60) (8.4-13.4) (1.21-2.05)
Martinson et al CROI 2008
19. Biomedical Tools and Public Health
Control of infectious diseases requires:
- effective biomedical tools (diagnostics,
drugs and vaccines) and
- effective public health strategies for
applying and utilizing the tools at the
population level to reduce disease burden
20. Current Tools for Controlling TB
Target Available tools
Diagnostics Sputum smear, culture, x-rays, (molecular assays)
Drugs Isoniazid, rifampin, PZA, ethambutol, 2nd line
drugs
Vaccine BCG (>10 strains)
21. Current Strategies for Controlling TB
• Passive case finding (DOTS)
– Relying on sputum smear (~50% sensitivity)
– No drug susceptibility testing
– Most cases not diagnosed or effectively treated
• INH preventive therapy
– Rarely used outside US and Europe
• BCG Vaccination
– Most widely used vaccine, but not effective
• Infection control
– Little attention has been paid to controlling
transmission
22. A Platform for Controlling Global Tuberculosis
• FIND the TB that is there
– Passive case detection is not sufficient
• TREAT the TB that is found
– Treatment success is unacceptably low
– Treatment for M/XDR is abysmal
– New drugs and treatment strategies urgently needed
• Prevent the TB that hasn’t occurred yet
– Preventive therapy essential for high risk populations
– Infection (transmission) control critical
– Control susceptibility (antiretrovirals, diabetes control)
– New vaccine essential
23. FIND TB
• Identify TB suspects
– Symptomatic screening in health facilities
– Campaigns to identify prevalent cases
• Community-based active case finding
• Evaluate TB suspects
– Better use of existing technologies
– New technologies
24. Estimated TB case detection rates
in 2008, by WHO region
90
78 78
Case detection rate (%)
80 70
70 65
57
60
47
50
40
30
20
10
0
a
a
R
pe
fic
as
ic
si
EM
ic
ro
ci
fr
A
er
Pa
A
Eu
st
m
Ea
rn
A
te
th
es
u
So
W
WHO 2009 EMR = Eastern Mediterranean Region
25. Routine detection of TB in HIV-infected
patients in Vietnam and Thailand
Diagnosis N detected/N Percent
Any TB 147//1060 14%
Pulmonary only 61/147 42%
Extrapulmonary only 21/147 14%
Both 65/147 44%
Pulmonary Cases
Smear + 47/126 37%
Liquid culture + 124/126 98%
Lymph node aspirates
Smear + 16/52 31%
Culture + 34/82 42%
Monkongdee et al., AJRCCM 2009, epub
26. Outside the HIV Clinic:
Prevalence of Active TB with Case Finding in HIV-Infected
Populations
Setting Time Prevalence of Active TB
Population Studied Period in Population
HIV+ Women in HIV MTCT Soweto 2001 13% OF TST+
Program South 3% overall
(N=438) Africa
Patients in HIV Home Care Phnom 2001 9% of patients
Program (N=441) Penh
Adults in HIV VCT Program Cape 2000-1 8% of HIV+
(N=5000) Town
Adult residents of an urban Cite Soleil 1991-2 6% of HIV+
shantytown Haiti 2% of HIV–
(N=10,900)
Nachega 2003; Kimerling 2002; Coetzee 2005; Desourmeaux 1996
28. Impact of mass radiography on TB case
detection, incidence and survival
• 1945-1948 – USPHS screened 6 million people in
21 communities with CXR
– 85-90% of cases unknown to local health depts.
– TB mortality decreased significantly
• 1950’s – USPHS used mass x-ray on ships, trains,
airplanes and dog sleds to screen Alaskan natives
– Tuberculosis mortality declined
• 665/100,000 in 1950
• 116/100,000 in 1957
Golub et al., Active case finding of tuberculosis: historical perspective and future prospects. IJTLD
2005;9:1183
30. A cluster-randomized trial of door-to-door active
case finding for TB in Rio de Janeiro
(14 clusters, 58,587 residents)
Analysis Time Household Pamphlet Rate ratio
Case Finding Only (95% CI)
TB incidence TB incidence
Intervention only 9.34/1000 py 6.04/1000 py 1.55 (1.10, 1.99)
Intervention plus 5.16/1000 py 4.93/1000 py 1.05 (0.56, 1.54)
60 days
Post-intervention Pre-intervention Rate ratio
TB incidence TB incidence (95% CI)
Entire Study 4.5/1000 py 3.4/1000 py 1.3 (0.97, 1.77)
Miller et al., IJTLD in press
31. Availability of culture and drug susceptibility
testing in TB/HIV high-burden countries
Country Culture Drug Susceptibility Testing
N of Labs N per 5 million N of Labs N per 10 million
South Africa 15 1.5 10 2.1
Nigeria 2 0.1 1 0.1
Ethiopia 1 0.1 1 0.1
DR Congo 1 0.1 1 0.2
Kenya 5 0.7 1 0.3
Tanzania 3 0.4 1 0.2
Uganda 3 0.5 2 0.6
Zimbabwe 1 0.4 1 0.7
Mozambique 1 0.2 1 0.5
Cambodia 3 1.0 1 0.7
WHO Global TB Report, 2009
32. New TB Diagnostic Tools
• LED fluorescent microscopy
• Liquid culture (e.g. MGIT)
• Capilia TB
– Rapid strip test that detects a TB-specific antigen from
culture
• Molecular assays (e.g. Cepheid GeneXpert,
Hain GenoType MTBDRplus)
– Rapid detection
of TB and drug-resistance
33. Impact of Improving Case Finding and Treatment on
Tuberculosis Control: A Mathematical Model
1000
TB Incidence, per 100,000
900
800
700
600
0.0%
500 -1.0%
-0.3%
400 -2.1%
-1.5%
300 -0.3%
-2.8% -1.8%
200 -0.7%
-3.4% -2.5% -1.0%
100 -11.2% -2.9% -1.4%
-0.8% -0.7% -4.2%
0 -0.6% -4.6% -3.3%
0 20 40 60 80 100
Year/Case Detection Rate (%)
Increase CDR to 70% immediately, then hold
Hold CDR constant constant
Increase CDR by 1%/year 22 High burden countries
Increase CDR by 2%/year
Dowdy and Chaisson, Bull WHO 2009: 87:296–304
34. TREAT TB
• Assure treatment completion for all patients
• Prevent the emergence of drug resistance
• Manage co-morbidities
– HIV, diabetes, ESRD, IDU
• New drugs to improve therapy
– M/XDR TB treatment
– Treatment-shortening regimens
37. Results of DOTS: Health Center-Based versus
Community-Based using CHWs
DOTS at Health Center DOTS CHWs
N= 565 N=331
Non-slum Patients Slum Patients Slum Patients
Cure, all cases 272/355 (77%) 165/210 (78%) 288/331 (87%)
Cure, new cases 236/289 (82%) 138/164 (84%) 230/261 (88%)
Cure, new smear +
106/134 (79%) 82/98 (84%) 135/153 (88%)
cases
Cure, retreatment
36/66 (55%) 27/46 (59%) 58/70 (83%)
cases
Abandoned 39/355 (11%) 27/210 (13%) 16/331 (5%)
Cavalcante et al., Int J TB Lung Dis 2007;11:544-9
38. New Drugs for TB
• Fluoroquinolones
– Moxifloxacin
• Rifapentine
• TMC 207 (ATP synthase inhibitor)
– In Phase 2 trials for MDR TB in Africa
• Nitroimidazopyrans
– PA-824
– OPC-67683
• Phase 2 trial for MDR TB beginning in January 2008
• Diamines (SQ-109)
– Phase 1 studies complete, awaiting Phase 2
• Oxazolidinones
• >12 other new compounds in development
39. Moxifloxacin vs. Ethambutol as 4th Drug in Initial
Phase of TB Therapy:
Culture Conversion by Week
MOX EMB
100
0.02
0.14
80 0.30
0.01 0.01
% Culture 60 0.0001
Negative 40 0.001
0.04
20
0
0 1 2 3 4 5 6 7 8
Week of Treatment
Conde et al., Lancet 2009; 373:1183-9
40. Bactericidal activity of daily regimens in
mice
8
R10H25Z150
RIF10 INH PZA
7
Log10 CFU per lung
R10M100Z150
RIF10 MOX PZA
6
2 logs P10M100Z150
RPT10 MOX PZA
5
4
3 4
2 logs
1
0
0 2 4 6 8 10 12 14 16
Weeks
Rosenthal et al., PLoS Medicine 2007;4(12):e344
41. TMC 207 for MDR TB
Culture conversion at 2 months
8.7%
culture
negative
47.5%
culture
p = 0.003 negative
Diacon et al., N Engl J Med 2009;360:2397
42. PREVENT TB
• TB preventive therapy for high-risk
individuals without active TB
• Contact evaluation and treatment
• Prevention of nosocomial transmission
44. TB Rates in the 6 Years After 1-year of Treatment
with INH or Placebo in the Bethel Trial
16
14
TB per 1,000 PY
12
10
Placebo
8
INH
6
4
2
0
1 2 3 4 5 6
Year After Randomization
Cumulative reduction 5.1% 2.1% = 60%
GW Comstock, Ferebee SH, Hammes LM.. Am Rev Respir Dis 1967;95:935-43.
45. Efficacy of IPT in HIV+ Adults: Risk
of TB
• 11 randomised trials with 8,130 HIV+ participants
overall reduction in TB = 36%, reduction PPD+ = 62%
Relative Risk (Fixed)
95% CI
1.0
Reference
0.64
TB incidence
0.95
Death
Woldehanna and Volmink, Cochrane Review 2006
46. TB screening, treatment and IPT 2002-2008
By 2008, 1 out of 4 estimated HIV positive TB
patients were identified and put on TB treatment
1200.0
59
2002
1000.0 2003
2004
Thousands of patients
2005
800.0 2006
71 2007
600.0 2008
400.0 44
14 77 63
200.0
84 58
17 28
59 7 63 3 72 28 3 26 10 25 42
0.0
Screened for TB Diagnosed with TB IPT
Data for 2008 is preliminary and does not include data from European region
49. New paradigms
• What can be done now to control TB in
communities with high burdens of TB?
• How can multiple interventions be
combined to yield maximal effects?
50. CREA E
Mission
To organize, implement and evaluate novel
public health strategies to reduce tuberculosis
incidence in populations with high rates of HIV
and TB co-infection.
Funded by the Bill and Melinda Gates Foundation
51. The CREATE Portfolio of
Population-Level Studies
Study Intervention Design (N)
Mass TB preventive Cluster randomized
therapy for S.A. gold trial
miners (~60,000)
Intensified TB case Community
finding, contact randomized trial
evaluations in Zambia (~1.2 million)
and S.A.
Preventive therapy and Phased
ARVs for HIV patients implementation trial
in Rio de Janeiro (15,000)
52.
53. Prevalence of INH resistance after
receiving IPT vs. controls without IPT
7/58 (12.1%) First
episodes
12/200 (6.0%)
32/270 (11.8%)
1/13 (7.7%) Retreatment
episodes
14/75 (18.7%)
van Halsema, IAS 2009
54. ZAMSTAR
• 24 communities in South Africa and
Zambia
• Designed to reduce TB prevalence through
– improved TB case finding by increased access
to TB diagnostics for symptomatic persons
– Household interventions for families of TB
patients, which include HIV testing and
treatment, TB screening, and IPT for contacts
of TB cases
PIs: P. Godfrey-Faussett, H. Ayles,
N. Beyers
55.
56. ZAMSTAR
Preliminary Results
• Baseline population surveys
– TB prevalence 900/100,000 in Zambia and
2,200/100,000 in South Africa!
• Enhanced Case Finding
– 15-26% of all TB cases in intervention
communities detected by ECF
• Household evaluations
– >2-5% of households have secondary TB case
– ~50% contacts HIV tested
• HIV prevalence high - ~50%
• >50% HIV+ started on ART
57. The THRio Study:
A Clinic - Randomized Trial of INH
Preventive Therapy in HIV+ Patients
• 29 HIV clinics randomized to time that IPT
program initiated
• TB rates compared pre- and post- intervention
29
4 Control
Clinic 3 Follow-up
2 Intervention
1
1 2 3 4 5 30 36 42
Month
58. TB Rates by ART and INH
Treatment Status, 2003-2005
Exposure Person- TB Incidence Rate Percent
category Years Cases (per 100 PYs) Reduction
No Rx 3,865 155 4.01 (3.40-4.69) -
ART only 11,627 221 1.90 (1.66-2.17) 52%
IPT only 395 5 1.27 (0.41-2.95) 68%
Both 1,253 10 0.80 (0.38-1.47) 80%
Total 17,140 391 2.28 (2.06-2.52)
Golub et al., AIDS 2007;21:1441-8
59. Tools and Strategies for Reducing the
Global Burden of TB
• Improved diagnostics ( case finding)
– Better tests
– Campaigns to find prevalent cases
• Improved therapy ( treatment completion)
– Shorter duration regimens to assure adherence
– New drugs for MDR/XDR TB
• Prevention
– INH preventive therapy
– Reduction of susceptibility (ART, diabetes, smoking)
– Effective vaccine
• Combination of approaches essential
60. Lessons from Tuberculosis Control for
Communicable Disease Control
• Good biomedical tools are essential but not
sufficient for disease control
• Understanding the epidemiology and
dynamics of the disease is essential for
targeting interventions
• Trials of control that measure population
level impacts are important
• It ain’t over till it’s over!
61. With thanks to…
Jonathan Golub Neil Martinson
Ann Miller Peter Godfrey-Faussett
Solange Cavalcante Gavin Churchyard
Betina Durovni Liz Corbett
Jacques Grosset Eric Nuermberger
Larry Moulton The CREATE Team
Marcus Conde Generous funders - BMGF
David Dowdy NIH, CDC, FDA