TB Control in Humans and Animals in South Africa: A Perspective on Problems and Successes

Meiring, Christina; Helden, Paul D. van; Goosen, Wynand J.

doi:10.3389/fvets.2018.00298

Cited by 20 publications

(16 citation statements)

References 31 publications

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“…This is supported by other studies from Nigeria, calling for improved public communication around TB [65] , [66] , [67] . Mass awareness campaigns have been used sucesfully in South Africa and other settings to create awareness, reduce stigma, and improve case finding [56] , [68] , [69] . Improving accessibility to healthcare facilities with TB testing and treatment could include active case-finding, mobile TB clinics and working with the private sectors to ensure adequate support for referring TB patients for appropriate testing.…”

Section: Discussionmentioning

confidence: 99%

Understanding the gaps in DR-TB care cascade in Nigeria: A sequential mixed-method study

Oga‐Omenka

Boffa

Kuye³

et al. 2020

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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Background Despite the availability of free drug-resistant tuberculosis (DR-TB) care in Nigeria since 2011, the country continues to tackle low case notification and treatment rates. In 2018, 11% of an estimated 21,000 cases were diagnosed and 9% placed on treatment. These low rates are nevertheless a marked improvement from 2015 when only 3.4% were diagnosed and 2.3% placed on treatment of an estimated 29,000 cases. This study describes the Nigerian DR-TB care cascade from 2013 to 2017 and considers factors influencing gaps in care. Methods Our study utilized a mixed-method design. For the quantitative component, we utilized the national diagnosis and treatment databases, as well as the World Health Organization’s estimates for prevalence to construct a 5-year care cascade: numbers of patients at each level of DR-TB care, including incident cases, individuals who accessed testing, were diagnosed, initiated treated and completed treatment in Nigeria between 2013 and 2017. Using retrospective data for patients diagnosed in 2015, we performed the Fisher’s exact test to determine the association between patient (age and gender) and provider/patient (region- north or south) variables, permitting a closer look at the gaps in care revealed across the 5 years. Barriers to care were explored using framework thematic analysis of 57 qualitative interviews and focus group discussions with patients, including 5 cases not initiated on treatment from the 2015 cohort, treatment supporters, community members, healthcare workers and program managers in 2017. Results A 5-year analysis of cascade of care data shows significant, but inadequate, increases in overall numbers of cases accessing care. On average, between 2013 and 2017, 80% of estimated cases did not access testing; 75% of those who tested were not diagnosed; 36% of those diagnosed were not initiated on treatment and 23% of these did not finish treatment. In 2015, children and patients in Northern Nigeria had odds of 0.3 [95% CI 0.1–0.7] and 0.4 [0.3–0.5] of completing treatment once diagnosed; while males were shown to have a 1.34 [95% CI 1.0–1.7] times greater chance of completing treatment after diagnosis. The main themes from qualitative data identified barriers to care along the care cascade at individual, family and community, as well as health systems levels. At the individual level, a lack of awareness of the true cause of disease and the availability of ‘free’ care was a recurring theme. Family interference was found to be a particular challenge for children and women. At the health system level, low index of suspicion, lack of rapid diagnostic tools and human resource shortages appeared to limit patients’ access. Conclusions Any gains in diagnostic technology and shorter regimens are lost with inadequate access to DR-TB services. The biggest losses in the Nigerian cascade happen before treatment initiation. There is a need for urgent action on identified gap...

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Section: Discussionmentioning

confidence: 99%

Understanding the gaps in DR-TB care cascade in Nigeria: A sequential mixed-method study

Oga‐Omenka

Boffa

Kuye³

et al. 2020

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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“…Many European Union countries also were successful to be recognized as officially TB free countries (27). However, BTB control is not practically feasible in low and middle income countries like Ethiopia through test and slaughter method alone due to lack of resources for rigorous testing, tracing, slaughtering of large number of positive cattle, and compensations to farmers (28).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Control Options of Bovine Tuberculosis in Ethiopia Using a Multi-Criteria Decision Analysis

et al. 2020

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Bovine tuberculosis (BTB) is a zoonotic bacterial infection caused by Mycobacterium bovis and is characterized by the development of granulomatous lesions in the lymph nodes, lungs and other tissues. It poses serious public health impacts and food security challenges to the agricultural sector in terms of dairy and meat productions. In Ethiopia, BTB has been considered as a priority disease because of its high prevalence in urban and peri-urban dairy farms. However, there has not been any national control program in the country. Thus, in order to initiate BTB control program in the country, information on control options is needed to tailor the best option for the Ethiopian situation. The objective of this study was to identify, evaluate and rank various BTB control options in Ethiopia using a multi-criteria decision analysis based on preference ranking organization method for enrichment evaluations (PROMETHEE) approach while accounting for the stakeholders' preferences. Control options were evaluated under two scenarios: with (scenario 1) and without (scenario 2) bacillus Calmette–Guérin (BCG) vaccination. Nine potential control options were identified that include combinations of three control options (1) test and slaughter with or without government support, (2) test and segregation, and (3) BCG vaccination. Under scenario 1, BCG vaccination, BCG vaccination and test and slaughter with partial compensation by government, and BCG vaccination and test and slaughter with full compensation by government were the top three ranked control options. Under scenario 2, test and slaughter with full compensation by government was the preferred control option, followed by test and segregation supported by test and slaughter with full government compensation, and test and slaughter with half compensation by government. Irrespective of the variability in the weighting by the stakeholders, the sensitivity analysis showed the robustness of the ranking method. In conclusion, the study demonstrated that BCG vaccination, and test and slaughter with full compensation by government were the two most preferred control options under scenarios 1 and 2, respectively. National level discussions were strongly recommended for further concretization and implementation of these control measures.

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“…Overall, the study highlighted the challenges involved in bovine tuberculosis control and the need for consideration of technical and social aspects for effective disease control (Borja et al 2018 ). In another study, Meiring et al ( 2018 ) used the implemented strategies employed for human TB control in South Africa as an example to explain and compare the feasibility of applying these strategies in bovine tuberculosis control. The authors explained that the mitigation of human TB incidence in this high burden country has been accomplished by increasing awareness of tuberculosis in public and antimicrobial therapy where both elements are lacking for bovine tuberculosis.…”

Section: Tackling M Bovis Infection At Human–animmentioning

confidence: 99%

“…The authors addressed a number of determinants such as lack of movement restrictions and proper monitoring of animals, inadequacy of veterinary resources and mandatory testing program or bovine tuberculosis, point-of-care diagnostic testing for cattle and the prevalence of bovine tuberculosis in wildlife may be responsible for the persistence of disease. The authors suggested that multisector collaborations are much needed to control bovine tuberculosis (Meiring et al 2018 ).…”

Section: Tackling M Bovis Infection At Human–animmentioning

confidence: 99%

Occupational exposure and challenges in tackling M. bovis at human–animal interface: a narrative review

Devi

Lee²,

Yan

et al. 2021

Int Arch Occup Environ Health

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Zoonotic tuberculosis caused by Mycobacterium bovis (M. bovis) , a member of Mycobacterium tuberculosis complex (MTBC) has increasingly gathered attention as a public health risk, particularly in developing countries with higher disease prevalence. M. bovis is capable of infecting multiple hosts encompassing a number of domestic animals, in particular cattle as well as a broad range of wildlife reservoirs. Humans are the incidental hosts of M. bovis whereby its transmission to humans is primarily through the consumption of cattle products such as unpasteurized milk or raw meat products that have been contaminated with M. bovis or the transmission could be due to close contact with infected cattle. Also, the transmission could occur through aerosol inhalation of infective droplets or infected body fluids or tissues in the presence of wound from infected animals. The zoonotic risk of M. bovis in humans exemplified by miscellaneous studies across different countries suggested the risk of occupational exposure towards M. bovis infection, especially those animal handlers that have close and unreserved contact with cattle and wildlife populations These animal handlers comprising of livestock farmers, abattoir workers, veterinarians and their assistants, hunters, wildlife workers as well as other animal handlers are at different risk of contracting M. bovis infection, depending on the nature of their jobs and how close is their interaction with infected animals. It is crucial to identify the underlying transmission risk factors and probable transmission pathways involved in the zoonotic transmission of M. bovis from animals to humans for better designation and development of specific preventive measures and guidelines that could reduce the risk of transmission and to protect these different occupational-related/populations at risk. Effective control and disease management of zoonotic tuberculosis caused by M. bovis in humans are also hindered by various challenges and factors involved at animal–human interface. A closer look into factors affecting proper disease control and management of M. bovis are therefore warranted. Hence, in this narrative review, we have gathered a number of different studies to highlight the risk of occupational exposure to M. bovis infection and addressed the limitations and challenges underlying this context. This review also shed lights on various components and approaches in tackling M. bovis infection at animal–human interface.

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TB Control in Humans and Animals in South Africa: A Perspective on Problems and Successes

Cited by 20 publications

References 31 publications

Understanding the gaps in DR-TB care cascade in Nigeria: A sequential mixed-method study

Understanding the gaps in DR-TB care cascade in Nigeria: A sequential mixed-method study

Evaluation of the Control Options of Bovine Tuberculosis in Ethiopia Using a Multi-Criteria Decision Analysis

Occupational exposure and challenges in tackling M. bovis at human–animal interface: a narrative review

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