IntroductionBy the summer of 2014, the Syrian crisis resulted in a regional humanitarian emergency with 2.9 million refugees, including 608,000 in Jordan. These refugees access United Nations High Commissioner for Refugees (UNHCR)-sponsored clinics or Jordan Ministry of Health clinics, including tuberculosis diagnosis and treatment. Tuberculosis care in Syria has deteriorated with destroyed health infrastructure and drug supply chain. Syrian refugees may have undiagnosed tuberculosis; therefore, the UNHCR, the International Organization for Migration (IOM), the National Tuberculosis Program (NTP), and the Centers for Disease Control and Prevention developed the Public Health Strategy for Tuberculosis among Syrian Refugees in Jordan. This case study presents that strategy, its impact, and recommendations for other neighboring countries.Case descriptionUNHCR determined that World Health Organization (WHO) criteria for implementing a tuberculosis program in an emergency were met for the Syrian refugees in Jordan. Jordan NTP assessed their tuberculosis program and found that access to Syrian refugees was the one component of their program missing. Therefore, a strategy for tuberculosis control among Syrian refugees was developed. Since that development through work with IOM, UNHCR, and NTP, tuberculosis case detection among Syrian refugees is almost 40 % greater (74 cases/12 months or 1.01/100,000 monthly through June 2014 vs. 56 cases/16 months or 0.73/100,000 monthly through June 2013) using estimated population figures; more than two fold the 2012 Jordan tuberculosis incidence. Additionally, the WHO objective of curing ≥85 % of newly identified infectious tuberculosis cases was met among Syrian refugees.Discussion and evaluationTuberculosis (TB) rates among displaced persons are high, but increased detection is possible. High TB rates were found among Syrian refugees through active screening and will probably persist as the Syrian crisis continues. Active screening can detect tuberculosis early and reduce risk for transmission. However, this strategy needs sustainable funding to continue and all activities have not been realized.ConclusionsInitial assessment found that tuberculosis among Syrian refugees was at a high incidence rate. Through partnership, a cohesive Jordanian tuberculosis strategy was developed for Syrian refugees and it has potential to inform treatment and control efforts for other regional countries impacted by the Syrian crisis.

The burden of tuberculosis (TB) in Jordan is largely unknown due to the paucity of high-quality data, under-reporting, and a lack of good quality vital registration system. This study aimed to assess the characteristics of TB patients in Jordan, determine the TB notification rate and assess the trend of TB notification in Jordan between 2016 and 2020. Methods: This study analyzed the TB Surveillance data in Jordan for the period 2016–2020. The obtained data included information on age, gender, nationality, marital status, date of symptoms onset and date of diagnosis, and site of TB. Results: During the period 2016–2020, a total of 1711 patients (989 women and 722 men) were diagnosed with and treated for tuberculosis. The mean (SD) age of patients was 30.1 (17.2) years. Almost half of them (48.4%) were Jordanians. The majority of non-Jordanian patients were from Syria, Philippines, and Bangladesh. Two thirds of patients (66.0%) had pulmonary TB and 34.0% had extra-pulmonary TB. Almost half (50.7%) of the patients were diagnosed within one month of the symptoms’ onset. The average annual TB notification rate during 2016–2020 was 3.32 per 100,000 pop (4.08 per 100,000 women and 2.64 per 100,000 men). The average annual standardized notification rate was 4.13 per 100,000 pop (4.52 per 100,000 women and 3.52 per 100,000 men). The overall age-standardized notification rate increased from 3.88 per 100,000 pop in 2016 to 4.58 per 100,000 pop in 2019 and declined to 2.46 per 100,000 pop in 2020. The trend in TB notification differed significantly according to gender. While the notification increased in the last three years among women, it decreased significantly among men. Conclusions: While TB notification increased in the last three years among women, it decreased significantly among men. There is a need to ensure that the national TB plans set clear targets for reducing the burden of TB.

BACKGROUND Tuberculosis is ranked among the top 10 causes of death worldwide and is the leading cause of death from a single infectious agent. Tuberculosis knowledge, practices, adherence to treatment, perceived stigma, perceived family and health workers support among patients with tuberculosis are key factors in management of the disease. OBJECTIVE This study aimed to assess tuberculosis- realted knowledge and practices, delay in diagnosis/treatment and reasons for diagnosis/treatment delay, perceived stigma, discrimination and their associated factors, adherence to treatment and its associated factors, perceived family and health workers support, perceived level of satisfaction with healthcare services and impact of COVID-19 among patients with tuberculosis in Jordan. METHODS A cross-sectional study was conducted among patients who were under treatment for tuberculosis in Jordan in 2021. A structed questionnaire was developed, pilot tested and used for data collection. General linear procedure and binary logistic regression models were used to determine association with different variables. RESULTS This study included a total of 452 (201 (44.5%) males and 251 (55.5%) females) patients with TB. About 91.4% (n=413/452) of patients had low to moderate overall TB-related knowledge score and 8.6% had high knowledge score. Almost two-thirds of patients (67.5%, n = 305/452) had perceived a low level of stigma, 61 (13.5%) perceived a moderate level of stigma, and 86 (19.0%) perceived a high level of stigma. About 43.6% (197/ 452) of patients with TB felt they were stigmatized due to their TB status. Of those, almost 64.0% (n=126/197) reported that such feelings towards TB inhibited them from seeking healthcare services. A total of 156 out of 452 (34.5%) patients experienced a high level of discrimination, 33 (7.3%) experienced a moderate level of discrimination, and 263 (58.2%) experienced a low level of discrimination. The majority (84.5%, n=382/452) of patients with TB thought that there was a delay in diagnosis and/or treatment of TB. Overall, 36.9% (n = 167/452) of patients were not adherent to TB medication. CONCLUSIONS Our study showed gaps in TB knowledge and practices, high perceived stigma and discrimination, perceived delay in diagnosis and treatment initiation, non-adherence to anti- TB medications, and high impact of COVID-19 on the management of TB. Efforts should be made to increase public awareness about the symptoms of tuberculosis and to educate them about the importance of seeking early care and the availability and location of diagnostic services. A patient centric approach, where motivational counseling and patient support groups should be adopted.

BACKGROUND Assessing healthcare workers’ (HCWs) TB- related knowledge, attitudes, and practices is essential for strengthening the TB prevention and control program. This study aimed to assess TB related knowledge, attitudes, behaviors, and practices regarding TB among HCWs delivering TB services in Jordan and assess their level of satisfaction. OBJECTIVE This study aimed to assess TB related knowledge, attitudes, behaviors, and practices regarding TB among HCWs delivering TB services in Jordan and assess their level of satisfaction. METHODS A cross-sectional study was conducted among 93 HCWs who provide healthcare services to TB patients in 9 TB centers in four governorates in Jordan during the period of June-November 2021. The study questionnaire included information on demographics, TB-related knowledge, attitudes, practices, perceived stigma, and job satisfaction. RESULTS Almost half (45.4%) of physicians, 74% of nurses, and 76.4% of other HCWs had low to moderate TB-related knowledge score. The majority of HCWs (100% of physicians, 92.6% of nurses, and 93.5% of other HCWs) had a positive attitude toward TB and TB patients. The HCWs’ TB-related self-reported practices were good, fair and poor in 38.7%, 29.0% and 32.3% of HCWs, respectively. Almost one fifth of HCWs reported that they have felt stigmatized because of their work around interacting with TB patients. The mean (SD) HCWs’ job satisfaction score on 100 scale was 21.6 (34.8) for physicians, 42.6 (37.2) for nurses, and 47.7 (38.4) for other HCWs. CONCLUSIONS This study identified important knowledge and practice gaps related to TB among HCWs. Based on those gaps, HCWs should receive high quality, tailored, and regular training. Proper training on the clinical guidelines and on the existing infection prevention and control guidelines is of a paramount importance. Follow up on-job supportive supervisory visits will help to ensure improvement of practices.

BACKGROUND Jordan is considered a low HIV epidemic country with prevalence rates of 0.02% among the general population and 0.05% among key populations at higher risk of HIV exposure. Studies on knowledge, attitudes, and practices (KAP) help design public health policies and plan health interventions targeting community needs. OBJECTIVE This study aimed to assess the HIV/AIDS related knowledge, attitude, practices (KAP), perceived stigma and discrimination, adherence to medication, and satisfaction of health services among People Who Live With HIV/AIDS (PLWHA) in Jordan. METHODS A cross-sectional descriptive study was conducted among PLWHAs in Jordan in 2021. The study included 152 PLWHA who receive services from the Voluntary Counselling and Testing (VCT). Data were collected using a structured questionnaire. RESULTS More than half of the study respondents showed low to moderate HIV/AIDS-related knowledge (n=90, 59.2%), negative attitudes (n=87, 57.3%), and moderate to high levels of stigma (n=86, 57.3%). Almost 28.7% (n=43) of patients had perceived moderate to high level of discrimination. Nonetheless, the majority (89.3%) of PLWHA reported that they were highly satisfied with VCT-offered health services. Overall, 31% (n=47) of the PLWHA were not adherent to medication. Adherence to ART was significantly higher among patients with high level of knowledge, patients who perceived moderate to high discrimination and patients who perceived low impact of stigma on accessing services. CONCLUSIONS More than half of PLWHA in this study had low/moderate knowledge, negative attitudes, and moderate to high levels of stigma. Findings from this study provides evidence-based results for formulating multifaceted interventions and informing decisions at different levels to enhance HIV/AIDS-related knowledge, attitude, and practices, overcome stigma and discrimination.