Prevalence and risk factors of multidrug-resistant tuberculosis in Cubal, Angola: a prospective cohort study

Aznar, María Luisa; Rando-Segura, Ariadna; Moreno, María Milagros; Soley, Mateu Espasa; Igual, Elena Sulleiro; Bocanegra, Cristina; Olivas, Eva Gil; Eugénio, A Ninda; Zacarias, Adriano; Katimba, Domingos; Étienne, Gabriel; Peña, Jacobo Mendioroz; García, Maria Teresa López; Suñé, Tomás Pumarola; Tórtola, Teresa; Romero, Israel Molina

doi:10.5588/ijtld.18.0231

Cited by 11 publications

(5 citation statements)

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“…Our results are consistent with previous global analyses suggesting that males with TB are no more at risk of MDR/RR-TB than females, while reinforcing the observation that this risk is strongly modified by setting [5,20]. Indeed, some setting-specific studies suggest an increased risk of MDR/RR-TB (in varying forms) among males [21][22][23][24][25][26], while suggest an increased risk among females [27][28][29][30][31][32], and still others find no evidence that sex is a factor [33][34][35][36][37].…”

Section: Discussionsupporting

confidence: 92%

The risk of multidrug- or rifampicin-resistance in males versus females with tuberculosis

et al. 2020

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Men are at an increased risk of Tuberculosis disease compared to women. Several risk factors for multidrug-resistant (MDR) or rifampicin-resistant (RR) TB disease are also more common in men, hence male TB patients may have a higher relative risk of MDR/RR-TB than female TB patients.We used sex-disaggregated data of TB patients reported to the World Health Organization for 106 countries to calculate male-to-female (M:F) risk ratios of having MDR/RR-TB.There was no evidence of either sex being more at risk of MDR/RR-TB in 81%(86/106) of countries, with an overall random-effects weighted M:F risk ratio of 1.04[95% confidence interval 0.97–1.11]. In 12%(13/106) of countries there was evidence that men were more at risk, while in 7%(7/106) women were more at risk. The risk of having TB that was MDR/RR increased for men compared to women as MDR/RR-TB incidence increased, and was higher for men than women in the Former Soviet Union, where the risk ratio was 1.16[1.06–1.28]. Conversely, the risk increased for women compared to men as GDP increased, and was higher for women than men in countries where the majority of TB burden was found in the foreign-born population, where the risk ratio was 0.84[0.75–0.94].In general, the risk of MDR/RR-TB, among those with TB, is the same for men as for women. However, men in higher MDR/RR-TB burden countries, particularly the Former Soviet Union, face an increased risk that their infection is MDR/RR-TB, highlighting the need for a gender-differentiated approach to TB case-finding and care.

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Section: Discussionsupporting

confidence: 92%

The risk of multidrug- or rifampicin-resistance in males versus females with tuberculosis

et al. 2020

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“…As a result of these measures, nearly nine out of 10 symptomatic contacts had microbiological tuberculosis testing; microbiological confirmation reached its maximum; the high burden of tuberculosis was confirmed among younger contacts; and first-line drug resistance could be assessed. 19 Although the sustainability of some activities in the enhanced contact-tracing period may be compromised, the recent acceptance of stool sample molecular testing for tuberculosis diagnosis could be an easier approach to evaluate children, especially during community-based case finding. 20 This approach would allow an initial and quicker assessment of stool and save on the costs and time of gastric or nasopharyngeal aspirates.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis contact tracing, Angola

Martínez-Campreciós,

Gil,

Aixut

et al. 2024

Bull World Health Organ

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Objective To assess the outcomes of a contact-tracing programme to increase the diagnosis of tuberculosis in Cubal, Angola and offer preventive treatment to high-risk groups. Methods A health centre-based contact-tracing programme was launched in Hospital Nossa Senhora da Paz in March 2015 and we followed the programme until 2022. In that time, staffing and testing varied which we categorized as four periods: medical staff reinforcement, 2015–2017, with a doctor seconded from Vall d’Hebron University Hospital, Spain; routine staff, 2017–2021, with no external medical support; community directly observed treatment (DOT), 2018–2019 with community worker support; and enhanced contact tracing, 2021–2022, with funding that allowed free chest radiographs, molecular and gastric aspirate testing. We assessed differences in contacts seen each month, and testing and treatment offered across the four periods. Findings Overall, the programme evaluated 1978 contacts from 969 index cases. Participation in the programme was low, although it increased significantly during the community DOT period. Only 16.6% (329/1978) of contacts had a chest radiograph. Microbiological confirmation increased to 72.2% (26/36) after including molecular testing, and 10.1% (200/1978) of contacts received treatment for tuberculosis. Of 457 contacts younger than 5 years, 36 (7.9%) received preventive tuberculosis treatment. Half of the contacts were lost to follow-up before a final decision was taken on treatment. Conclusion Contact tracing increased the diagnosis of tuberculosis although engagement with the programme was low and loss to follow-up was high. Participation increased during community DOT. Community-based screening should be explored to improve participation and diagnosis.

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“…Health systems’ structural problems certainly affects TB management [ 56 , 57 ]. Evidence shows that Angola presents a probably higher multidrug resistance than estimated by WHO [ 58 ]; as does Guinea-Bissau [ 59 ]. TB burden in children following active contact-tracing of adult TB patients for both countries is worrisome [ 60 ]; in a cohort of 124 children contact of TB adult patients in Luanda, 56.5% had active TB and 20% were HIV positive [ 61 ].…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis and Migrant Pathways in an Urban Setting: A Mixed-Method Case Study on a Treatment Centre in the Lisbon Metropolitan Area, Portugal

Ribeiro

Gonçalves

Havik

et al. 2022

IJERPH

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Tuberculosis (TB) is an infectious disease associated with poverty. In the European Union TB tends to concentrate in urban settings. In Lisbon, previous studies revealed, the presence of migrant populations from a high endemic country, is one of the risk factors contributing to TB. To better understand TB in foreign-born individuals in the Lisbon Metropolitan Area, a mixed-method case study was undertaken on a TB treatment centre in a high-risk part of urban Portugal. Quantitatively, annual TB cases were analysed from 2008 to 2018, dividing foreign-origin cases into recent migrants and long-term migrants. Qualitatively, we explored recent migrants’ reasons, experiences and perceptions associated with the disease. Our results showed that foreign-born individuals accounted for 45.7% of cases, mainly originated from Angola, Guinea-Bissau, and Cabo Verde. TB in recent migrants increased over the years for Angola and Guinea-Bissau, while for Cabo Verde TB cases were due to migrants residing in Portugal for more than 2 years. Recent migrants’ reasons to travel to Portugal were to study, to live and work, tourism, and seeking better healthcare. Visiting family and friends, historical links and common language were key drivers for the choice of country. Recent migrants and long-term migrants may present distinct background profiles associated with diagnosed TB.

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Prevalence and risk factors of multidrug-resistant tuberculosis in Cubal, Angola: a prospective cohort study

Cited by 11 publications

References 0 publications

The risk of multidrug- or rifampicin-resistance in males versus females with tuberculosis

The risk of multidrug- or rifampicin-resistance in males versus females with tuberculosis

Tuberculosis contact tracing, Angola

Tuberculosis and Migrant Pathways in an Urban Setting: A Mixed-Method Case Study on a Treatment Centre in the Lisbon Metropolitan Area, Portugal

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