Trends of tuberculosis case detection, mortality and co-infection with HIV in Ghana: A retrospective cohort study

Osei, Eric; Oppong, Samuel A.; Der, Joyce

doi:10.1371/journal.pone.0234878

Cited by 13 publications

(22 citation statements)

References 37 publications

(46 reference statements)

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“…This enables us to explain the differences in the time trend of the TB cases across the regions. We refer to Equation (7) as Model I, Equation (9) as Model II and Equation (10) as Model III. Results are reported for experiments that involve adjustment and non-adjustment of covariates.…”

Section: Data Analysis and Resultsmentioning

confidence: 99%

“…Ghana as a developing country in Africa, has been affected by the respiratory disease and currently has challenges eradicating TB. The country implemented policies called Directly Observe Therapy (DOT) and National Tuberculosis Programmes (NTPs) in 1994, to detect and treat TB [1,[7][8][9]. The implementation of the NTP led to 100% DOTs coverage in 2005 with more TB cases detected for treatment every year after.…”

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confidence: 99%

“…Hence, TB has gained considerable attention as a topic of research among researchers from diverse backgrounds. The authors in [8,9,14] have studied the dynamics of TB indicators as well as risk factors of TB in Ghana. Osei et.…”

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confidence: 99%

“…al. [8,9] studied trends of TB detection and treatment outcomes using the logistic regression to assess the relationship between patients and disease characteristics. Further, Osei et.…”

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confidence: 99%

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Spatio-temporal Characteristics of Tuberculosis in Ghana

Iddrisu

Amikiya

Bukari

2021

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Background: Recent global reports show that the number of Tuberculosis (TB) cases or deaths is declining, however, the rate of decline is not adequate to meet the World Health Organization's (WHO's) mitigation. TB remains a public health problem in Ghana with a significant economic and health burden on citizens and health infrastructure. Aims: Consequently, there is a need for further studies about the disease aimed at accelerating the rate of decline in cases. Methods: In this article, we study the spatio-temporal characteristics of TB in Ghana, using data obtained from Ghana National Tuberculosis Programme (NTP) for the 10 regions of Ghana, collected over a six-year period. Bayesian spatial and space-time regression models are used to map the risk of TB infections across the nation, in time and space. The study also examines some baseline predictors of TB infections to ascertain their effects on the TB risk. Results: Our study results showed that hot-spots of TB cases are observed in the Upper East, Upper West, Volta, Western, and Central regions and low risk in the Northern, Ashanti, Greater Accra, Brong Ahafo, Eastern and Western regions. We observed clustering of risk between neighboring regions. TB cure rate, TB success rate, knowledge about TB, awareness that TB is airborne, HIV prevalence, percentage of literacy, high income are important predictors of TB detection across the 10 regions of Ghana. Conclusions: Most regions in Ghana have similar TB risk. Efforts for more TB cases detection should be encouraged to increase TB success and cure rate which will lead to substantial decrease in TB spread. There is the need for provision of adequate health facilities with easy access to these facilities irrespective of your income status to bridge the gap between TB cases among the poor and the rich. TB cases are expected to grow exponentially in countries with low success and cure rate. Finally, for a substantial TB cases reduction, there is the need to adopt measures that will increase TB cases detection, TB success and cure rates, TB awareness, knowledge about how TB spread as well adequate health facilities with easy access.

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Section: Data Analysis and Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

“…al. [8,9] studied trends of TB detection and treatment outcomes using the logistic regression to assess the relationship between patients and disease characteristics. Further, Osei et.…”

mentioning

confidence: 99%

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Spatio-temporal Characteristics of Tuberculosis in Ghana

Iddrisu

Amikiya

Bukari

2021

Preprint

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“…In 2020, the World Health Organisation (WHO) ranked tuberculosis (TB) as the leading cause of death from a single infectious agent, ranking above HIV [ 3 ]. Notwithstanding the advancement in chemoprophylaxis and chemotherapy for TB, reduction of TB mortality and incidence remains a challenge [ 4 ]. TB-associated mortality is 2 to 3-fold higher in HIV co-infected than in HIV negative patients.…”

Section: Introductionmentioning

confidence: 99%

Immune correlates of Mycobacterium Tuberculosis patients in Zambia stratified by HIV serostatus and level of immunity-a cross-sectional analytical laboratory based study

et al. 2022

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Background People living with HIV (PLHIV) co-infected with tuberculosis (TB) have a distinct clinical presentation and poorer treatment outcomes compared to HIV-seronegative TB patients. Excluding low CD4 count, innate immune factors associated with TB are not fully elucidated. We, therefore, characterised and compared the expression of IL-6, TNF-α, IFN-γ, and IL-10 in whole blood of treatment naïve TB patients stimulated with heat-killed Mycobacterium tuberculosis stratified by HIV status and the level of CD4 count. Results We recruited 39 HIV seropositive and 31 HIV seronegative TB patients. Median (IQR) age was 35(28–42) years and 31(25–36) years respectively, and a majority had pulmonary tuberculosis i.e. 38(95%) and 30(97%), respectively. The two groups were significantly different in the distribution of CD4 count, 563 [465–702.5 cells/mm3] vs 345 [157–483 cell/mm3] in HIV negative vs HIV positive respectively p = <0.001. Post stimulation, the expression of IL-6 in HIV negative TB patients was significantly higher than in the HIV positive 16,757366 [8,827–23,686 pg/ml] vs. 9,508 [5,514–15,008 pg/ml], respectively; p = 0.0360. TNF-α and IFN-γ were highly expressed in HIV negative TB patients compared to the HIV positive though not statistically significant. We only observed higher expression of IL-6 in HIV negative patients in comparison to the HIV positive when stratified by level of CD4 counts as < 500 and ≥ 500 cell/mm3 for both cohorts. 21,953 [8,990–24,206 pg/ml] vs 9,505 [5,400–15,313 pg/ml], p value = 0.0585 in patients with CD4 count < 500 cell/mm3 and 13,168 [7,087–22,584 pg/ml] vs 10,413 [7,397–14,806 pg/ml], p value = 0.3744 for patients with CD4 count of ≥ 500 cell/mm3 respectively. We found a positive pairwise correlation between TNF-α -alpha and IL-6 in both HIV positive and HIV negative patients, r = 0.61 (95% CI 0.36–0.72; p < 0.0001) and r = 0.48 (95% CI 0.15–0.68; p = 0.005) respectively. The IFNγ/IL-10 ratio was higher in HIV negative when compared to HIV positive individuals, 0.052 [0.0–0.28] vs 0.007 [0–0.32] respectively; p = 0.05759. IL-6 independently reduced the probability of TB/HIV, Adjusted odds ratio 0.99, p value 0.007. Conclusions This study suggests that HIV seronegative TB patients have a higher pro-inflammatory response to MTB than HIV seropositive TB patients. Further, it also shows that the level of CD4 influences immunomodulation. The findings suggest that the difference in cytokine expression may be responsible for the distinct patterns of TB presentation between HIV positive and HIV negative patient.

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