Prevalence of latent TB infection and TB disease among adolescents in high TB burden countries in Africa: a systematic review protocol

Bunyasi, Erick Wekesa; Schmidt, Bey‐Marrié; Abdullahi, Leila; Mulenga, Humphrey; Tameris, Michèle; Luabeya, Angelique Kany Kany; Shenje, Justin; Scriba, Thomas J.; Geldenhuys, Hennie; Wood, Robin; Hatherill, Mark

doi:10.1136/bmjopen-2016-014609

Cited by 3 publications

(5 citation statements)

References 24 publications

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“…Further, the individuals with the lowest TB risk are those born in a town and move to a rural area. These findings are consistent with TB exposure nearing ~ 90% by 25-30 years old (13), with transmission occurring via community contacts during adolescence and adulthood. We hypothesize that those born in towns who later moved to a rural area benefit from both BCG vaccination and decreased adult exposure thereby overall decreasing their odds of TB.…”

Section: Discussionsupporting

confidence: 85%

“…Controls are patients with suspected TB who have a negative GeneXpert Ultra result and have no history of active pulmonary TB at the time of study enrollment and are largely assumed to be latently infected with M.tb (LTBI). A majority of the population in high TB burden South African suburbs are LTBI, 88% by ages 31-35 (12,13) and studies have consistently shown LTBI in South Africa to be above 75% by age 25, increasing across adulthood (14). Our population-control design relies on population-wide TB exposure, as traditional screening methods, tuberculin skin test (TST) and interferon-gamma release assay (IGRA; e.g., QuantiFERON), are limited both in the concordance and positive predictive value (29,30).…”

Section: Methodsmentioning

confidence: 99%

“…However, in high-incidence populations with well-characterized disease burdens and transmission, population controls greatly improve statistical power (9). In South Africa, TB is community spread moreover than household (10,11) and TB latency increases with age, reaching 80% by age 30 (12)(13)(14)(15), an epidemiological scenario that ensures cases and controls have approximate disease exposure profiles.…”

Section: Introductionmentioning

confidence: 99%

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Strong Effect of Demographic Changes on Tuberculosis Susceptibility in South Africa

Oyageshio,

Myrick,

Saayman

et al. 2023

Preprint

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South Africa is among the world’s top eight TB burden countries, and despite a focus on HIV-TB co-infection, most of the population living with TB are not HIV co-infected. The disease is endemic across the country with 80-90% exposure by adulthood. We investigated epidemiological risk factors for tuberculosis (TB) in the Northern Cape Province, South Africa: an understudied TB endemic region with extreme TB incidence (645/100,000) and the lowest provincial population density. We leveraged the population’s high TB incidence and community transmission to design a case-control study with population-based controls, reflecting similar mechanisms of exposure between the groups. We recruited 1,126 participants with suspected TB from 12 community health clinics, and generated a cohort of 878 individuals (cases =374, controls =504) after implementing our enrollment criteria. All participants were GeneXpert Ultra tested for active TB by a local clinic. We assessed important risk factors for active TB using logistic regression and random forest modeling. Additionally, a subset of individuals were genotyped to determine genome-wide ancestry components. Male gender had the strongest effect on TB risk (OR: 2.87 [95% CI: 2.1-3.8]); smoking and alcohol consumption did not significantly increase TB risk. We identified two interactions: age by socioeconomic status (SES) and birthplace by residence locality on TB risk (OR = 3.05, p = 0.016) – where rural birthplace but town residence was the highest risk category. Finally, participants had a majority Khoe-San ancestry, typically greater than 50%. Epidemiological risk factors for this cohort differ from other global populations. The significant interaction effects reflect rapid changes in SES and mobility over recent generations and strongly impact TB risk in the Northern Cape of South Africa. Our models show that such risk factors combined explain 16% of the variance (r2) in case/control status.

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Section: Discussionsupporting

confidence: 85%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Strong Effect of Demographic Changes on Tuberculosis Susceptibility in South Africa

Oyageshio,

Myrick,

Saayman

et al. 2023

Preprint

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“…To find LTBI-related research articles, we reviewed previous systematic reviews on LTBI to define our search terms [9,10]. We then searched the Web of Science™ (Clarivate Analytics) with the search terms ("latent tuberculosis" OR "LTBI" OR "latent TB") entered under the Topic search field, which searches Title, Abstract, Author Keywords, and Keyword Plus fields [11].…”

Section: Search Terms Data Source and Study Periodmentioning

confidence: 99%

Global trends and gaps in research related to latent tuberculosis infection

et al. 2020

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Background: There is a global commitment to eliminating tuberculosis (TB). It is critical to detect and treat cases of latent TB infection (LTBI), the reservoir of new TB cases. Our study assesses trends in publication of LTBI-related research. Methods: We used the keywords ("latent tuberculosis" OR "LTBI" OR "latent TB") to search the Web of Science for LTBI-related articles published 1995-2018, then classified the results into three research areas: laboratory sciences, clinical research, and public health. We calculated the proportions of LTBI-related articles in each area to three areas combined, the average rates of LTBI-related to all scientific and TB-related articles, and the average annual percent changes (AAPC) in rates for all countries and for the top 13 countries individually and combined publishing LTBI research. Results: The proportion of LTBI-related articles increased over time in all research areas, with the highest AAPC in laboratory (38.2%/yr), followed by public health (22.9%/yr) and clinical (15.1%/yr). South Africa (rate ratio [RR] = 8.28, 95% CI 5.68 to 12.08) and India (RR = 2.53, 95% CI 1.74 to 3.69) had higher RRs of overall TB-related articles to all articles, but did not outperform the average of the top 13 countries in the RRs of LTBI-related articles to TB-related articles. Italy (RR = 1.95, 95% CI 1.45 to 2.63), Canada (RR = 1.73, 95% CI 1.28 to 2.34), and Spain (RR = 1.53, 95% CI 1.13 to 2.07) had higher RRs of LTBI-related articles to TB-related articles. Conclusions: High TB burden countries (TB incidence > 100 per 100,000 population) published more overall TB-related research, whereas low TB burden countries showed greater focus on LTBI. Given the potential benefits, high TB burden countries should consider increasing their emphasis on LTBI-related research.

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“…Reported adolescent all-TB disease rates (both microbiologically-confirmed and clinically diagnosed) in high TB burden countries in Africa range between 180-679 per 100,000 (2002-2013): [23] 210-341 cases per 100,000 in three South African studies (2002-2013); [24]- [26] 180 cases per 100,000 in one Ugandan study (2009-2011); [27] and 679 cases per 100,000 in one Kenyan study (2010). [28] The relatively lower adolescent TB disease prevalence of 210 cases per 100,000 in the Marais et al South African study [24] could be explained in part by the younger study participants (10-14 years) as compared to the other two South African studies that recruited adolescents aged 10-19 years old.…”

Section: Plos Onementioning

confidence: 99%

Regional changes in tuberculosis disease burden among adolescents in South Africa (2005–2015)

et al. 2020

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Background Adolescents in the Western Cape Province of South Africa had high force of Mycobacterium tuberculosis (MTB) infection (14% per annum) and high TB incidence (710 per 100,000 person-years) in 2005. We describe subsequent temporal changes in adolescent TB disease notification rates for the decade 2005-2015. Method We conducted an analysis of patient-level adolescent (age 10-19 years) TB disease data, obtained from an electronic TB register in the Breede Valley sub-district, Western Cape Province, South Africa, for 2005-2015. Numerators were annual TB notifications (HIVrelated and HIV-unrelated); denominators were midyear population estimates. Period averages of TB rates were obtained using time series modeling. Temporal trends in TB rates were explored using the Mann-Kendall test. Findings The average adolescent TB disease notification rate was 477 per 100,000 for all TB patients (all-TB) and 361 per 100,000 for microbiologically-confirmed patients. The adolescent all-TB rate declined by 45% from 662 to 361 per 100,000 and the microbiologically-confirmed TB rate by 38% from 492 to 305 per 100,000 between 2005-2015, driven mainly by rapid decreases for the period 2005-2009. There was a statistically significant negative temporal trend in both all-TB (per 100,000) (declined by 48%; from 662 to 343; p = 0�028) and microbiologically confirmed TB (per 100,000) (declined by 49%; from 492 to 252; p = 0�027) for 2005-2009, which was not observed for the period 2009-2015 (rose 5%; from 343 to 361; p = 0�764 and rose 21%; from 252 to 305; p = 1�000, respectively).

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Prevalence of latent TB infection and TB disease among adolescents in high TB burden countries in Africa: a systematic review protocol

Cited by 3 publications

References 24 publications

Strong Effect of Demographic Changes on Tuberculosis Susceptibility in South Africa

Strong Effect of Demographic Changes on Tuberculosis Susceptibility in South Africa

Global trends and gaps in research related to latent tuberculosis infection

Regional changes in tuberculosis disease burden among adolescents in South Africa (2005–2015)

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