The potential effect of a geographically focused intervention against TB in the USA

Who

• Study population: People aged ≥15 years diagnosed with tuberculosis (TB) in the USA.

• Data source: National TB Surveillance System (NTSS).

• Time period: 2011–2019.

• Key subgroups: Racially and ethnically minoritised populations (Black, Hispanic, Asian, American Indian or Alaska Native [AIAN], and other non-White groups).

• Exclusions: People incarcerated at TB diagnosis (3.9% of racially minoritised cases).

• Intervention-eligible groups: People born outside the USA, people living with HIV, and people experiencing homelessness.

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What

• Objective: To estimate the health impact, cost, cost-effectiveness, and equity effects of a one-time targeted latent tuberculosis infection (LTBI) testing and treatment intervention.

• Key findings:

  • Targeting the top 5% of US counties with the highest TB risk among racially minoritised populations captured 47.4% of all TB cases.

  • The intervention was estimated to avert:

    • 17,359 TB cases

    • 2,700 TB deaths

    • 14,951 QALYs gained over participants’ lifetimes.

  • 94.1% of people with LTBI in intervention counties were racially minoritised.

  • The intervention reduced TB incidence across most racial and ethnic groups and modestly reduced racial and ethnic disparities, especially for Black people.

  • Cost-effectiveness: $86,177 per QALY gained (2022 USD).

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When

• TB surveillance data: 2011–2019.

• Projection period for impact on incidence and disparities: 2026–2040.

• Post-2020 data excluded due to COVID-19–related disruptions in TB diagnosis.

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Where

• Geographic scope: All 50 US states and the District of Columbia.

• Intervention focus: 157 counties (top 5% by a TB risk score combining TB incidence among racially minoritised people and their population share).

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Why

• Rationale: TB incidence remains disproportionately high among racially and ethnically minoritised populations in the USA.

• Policy challenge: Current US guidelines do not allow LTBI testing to be restricted by race or ethnicity, necessitating a strategy that:

  • Reduces disparities,

  • Maximizes population health impact,

  • Remains guideline-concordant and cost-effective.

• Goal: Inform resource allocation and decision making for TB elimination efforts.

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How

• Design: Modeling study combining surveillance data, statistical smoothing, and economic simulation.

• Targeting approach:

  1. County-level targeting: Selected counties with highest TB burden among racially minoritised populations.

  2. Individual-level targeting: Offered LTBI testing to all people with guideline-recommended risk factors, regardless of race or ethnicity.

• LTBI estimation: Back-calculated from TB incidence using published reactivation rates and spatially smoothed generalized additive models.

• Intervention: Interferon gamma release assay testing, followed by 3 months of weekly isoniazid plus rifapentine.

• Analysis:

  • Markov cohort model for lifetime health and economic outcomes.

  • Incremental cost-effectiveness ratios (ICERs) estimated from a TB health services perspective.

  • Quasi-Poisson models projected future TB incidence and disparities.

• Oversight: Analysis of de-identified surveillance data reviewed by the Centers for Disease Control and Prevention, classified as research not involving human participants.

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Overall conclusion

A geographically focused, guideline-concordant LTBI testing and treatment intervention could produce substantial health gains, be moderately cost-effective, and achieve small but meaningful reductions in racial and ethnic TB disparities, supporting its use as a strategic tool for TB elimination in the USA.

Source: Regan, M., Cui, H., Swartwood, N.A., Li, Y., Marks, S.M., Barham, T., Khan, A., Winston, C.A., Cohen, T., Horsburgh, C.R. and Salomon, J.A., 2026. The potential effect of a geographically focused intervention against tuberculosis in the USA: a simulation modelling study. The Lancet Public Health, 11(2), pp.e82-e91.

Socioeconomic Burden, Stigma, and Prevention Strategies in Tuberculosis

The financial consequences of tuberculosis (TB) are broadly classified into direct and indirect costs. Direct costs include medical expenses such as drugs, laboratory tests, physician fees, radiological investigations, and hospitalization. These costs are often high relative to per capita income and place a substantial burden on household finances, particularly in low- and middle-income countries. Indirect costs arise from illness-related loss of income, reduced work capacity, and decreased labor supply due to disability or death. TB also imposes significant pressure on healthcare systems through increased hospital expenditures and welfare costs, although potential revenues could be generated through effective cost recovery for services such as diagnostics, drugs, radiology, and human resources.

Tuberculosis remains highly stigmatized in many communities, primarily due to fear of transmission, but also because of its strong association with HIV, poverty, low social status, malnutrition, and socially disapproved behaviors. This stigma can lead to social isolation, abandonment by family, exclusion from workplaces or communities, and job loss. Negative and often poorly informed societal perceptions reinforce discrimination against TB patients. Because TB has long been associated with poverty, poor hygiene, and social marginalization, affected individuals may face social disregard. Limited awareness and misinformation contribute significantly to this prejudice, and in some cases, stigma within healthcare settings further compromises access to diagnosis, treatment adherence, and clinical outcomes.

Tuberculosis and malnutrition are closely linked, with malnutrition acting both as a risk factor for infection and as a consequence of disease. Malnutrition is associated with poorer prognosis, increased mortality, and false-negative tuberculin test results, which may delay diagnosis. Nutritional deficiencies can cause secondary immunodeficiency, increasing susceptibility to TB. Conversely, TB reduces appetite, impairs nutrient absorption, alters metabolism, and leads to muscle wasting due to impaired protein utilization. Deficiencies in micronutrients such as zinc, selenium, iron, copper, and vitamins A, C, D, and E further compromise immune function. Low serum vitamin D levels have been observed in patients with active TB and multidrug-resistant TB during treatment. Improving nutritional status and providing adequate supplementation may support recovery and represent an effective strategy for TB control in resource-limited settings.

Since the introduction of antibiotics in the 1940s, tuberculosis has become a treatable disease. Current TB elimination strategies focus on early detection and treatment of active cases to interrupt transmission, alongside screening and treatment of latent TB infection to prevent disease progression.

Bacillus Calmette-Guérin (BCG) vaccination is the most widely administered vaccine worldwide and provides protection against severe forms of TB in young children, particularly miliary and disseminated disease. However, it does not consistently protect against pulmonary TB.

To improve adherence in the treatment of latent TB infection, the World Health Organization has recommended since 2020 a three-month regimen of weekly rifapentine and isoniazid (3HP).

Close contact remains an important route of TB transmission. Even routine parental behaviors such as kissing children may pose a risk when caregivers are infected, highlighting the need for awareness and preventive caution.

Following the introduction of X-rays in 1895, chest radiography became an essential tool for identifying pulmonary TB lesions. From the 1940s onward, radiographic screening enabled earlier detection of active disease, including cases without overt clinical symptoms, allowing timely initiation of treatment and improved disease control.

Source: Varotto, E., Martini, M., Vaccarezza, M., Vittori, V., Mietlińska-Sauter, J., Gelsi, R., Galassi, F.M. and Papa, V., 2025. Historical and Social Considerations upon Tuberculosis. Journal of Preventive Medicine and Hygiene, 66(1), pp.E145-E152.

Global estimates of tuberculosis incidence during pregnancy and postpartum

Background

Tuberculosis (TB) incidence peaks among women of reproductive age (15–49 years), encompassing all individuals who can become pregnant. Pregnancy and the postpartum period are associated with an increased risk of progression to active TB disease compared with non-pregnant periods. Maternal TB is linked to severe adverse outcomes, including low birthweight, preterm birth, stillbirth, maternal mortality, and infant mortality. Postpartum TB, in particular, contributes substantially to maternal and infant deaths, especially among women living with HIV.

Despite these risks, tuberculosis preventive treatment (TPT) is rarely used during pregnancy due to persistent safety concerns, even though it is not contraindicated. TB diagnosis during pregnancy is challenging because TB symptoms (e.g., fatigue, shortness of breath) overlap with normal pregnancy-related changes, and physiological adaptations such as gestational weight gain may mask typical disease manifestations. Furthermore, pregnancy status is not routinely recorded in TB surveillance systems, and TB cases are not systematically captured in maternal health registers, leading to under-recognition of the burden of TB during pregnancy and the postpartum period.

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Who

Women of reproductive age (15–49 years) globally, including both HIV-negative women and women living with HIV.
The study population was derived from global demographic and disease datasets rather than a single cohort. Evidence inputs included six published observational studies (two case–control and four retrospective cohort studies) contributing to the meta-analysis, as well as an additional cohort dataset of women living with HIV from South Africa (the ORCHID trial).

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What

The study estimated global and country-specific TB incidence during pregnancy and the postpartum period, stratified by age and HIV status.

Key findings:

• Pregnancy and the postpartum period were associated with increased TB risk compared with non-pregnant periods.

• Among HIV-negative women, the pooled incidence rate ratio (IRR) was 1.34 during pregnancy and 1.91 postpartum.

• Among women living with HIV, TB risk was substantially higher, with IRRs of 5.73 during pregnancy and 3.58 postpartum (based on ORCHID data).

• In 2023, an estimated 239,500 pregnant women and 97,600 postpartum women developed active TB globally, accounting for approximately 9% of TB incidence among women aged ≥15 years.

The authors conclude that TB during pregnancy and postpartum represents a substantial and under-recognised global burden with major implications for maternal, neonatal, and infant health.

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When

Included studies were published between 1996 and 2020, with observation periods spanning 1992 to 2014.
Modelled TB burden estimates were generated for the year 2023.

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Where

The analysis was global, producing country- and region-specific estimates.
Meta-analysis data were drawn from six countries: the Dominican Republic, Malawi, Mongolia, South Africa, Sweden, and the United Kingdom.
The highest estimated TB burden among pregnant and postpartum women occurred in the WHO African Region, followed by the WHO South-East Asia Region.

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Why

The study addressed a critical gap in global TB burden estimation, as routine TB surveillance systems do not disaggregate incidence by pregnancy or postpartum status. Improved estimates are needed to better characterise TB risk during these periods and to inform integrated TB, maternal, and HIV health strategies, particularly in high HIV-prevalence settings.

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How

The authors used a multi-step analytical approach:

• A rapid literature review and meta-analysis using a PECOS framework to estimate IRRs for TB during pregnancy and postpartum.

• Conversion of odds ratios to IRRs when required, with pooling via inverse-variance weighting and heterogeneity assessed using I² and τ² statistics.

• A mathematical modelling framework integrating age- and sex-disaggregated TB incidence data from the World Health Organization, fertility and population data from the UN World Population Prospects 2024, and HIV prevalence data from UNAIDS.

• Estimation of person-time at risk assuming 9 months of pregnancy and 3 months postpartum.

• Disaggregation of TB incidence by HIV status and adjustment using meta-analytic IRRs, with uncertainty propagated across all model inputs.

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Overall Interpretation

Pregnant and postpartum women—particularly those living with HIV—face a markedly elevated risk of tuberculosis. Pregnancy and the postpartum period represent critical but under-addressed windows for TB prevention, screening, and integrated maternal–TB–HIV care at the global level.

Source: Mafirakureva, N., Cartledge, A., Bradshaw, I., Bekker, A., Salazar-Austin, N., Meehan, S.A., Myer, L., Odayar, J., Rangaka, M.X. and Dodd, P.J., 2026. Global estimates of tuberculosis incidence during pregnancy and postpartum: a rapid review and modelling analysis. The Lancet Global Health.

Burden of TB, 1990–2050: a comparative analysis of GBD 2021 and WHO surveillance systems

Who

• Population: Global population, stratified by age, sex, Sociodemographic Index (SDI) quintiles, regions, and countries.

• Geographic focus: Worldwide, with detailed analyses for eight high-burden countries (India, Indonesia, China, Philippines, Pakistan, Nigeria, Bangladesh, Democratic Republic of the Congo) plus Hong Kong SAR, Macau SAR, and Taiwan.

• Data sources:

  • World Health Organization – Global Health Observatory (WHO-GHO)

  • Institute for Health Metrics and Evaluation – Global Burden of Disease (GBD 2021)

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What

• Focus: Comprehensive assessment of global tuberculosis (TB) burden and trends, including TB overall, drug-susceptible TB (DS-TB), latent TB infection (LTBI), multidrug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB).

• Key findings:

  • From 1990 to 2021, global age-standardized rates of TB prevalence, incidence, deaths, and DALYs declined substantially.

  • DS-TB mirrored overall TB declines, while MDR-TB and XDR-TB showed earlier peaks followed by plateauing or renewed increases in some settings.

  • LTBI prevalence declined steadily but remained very high globally.

  • Low-SDI regions consistently bore the highest DALY burdens.

  • Smoking, high alcohol consumption, and elevated fasting plasma glucose were the leading modifiable risk factors for TB-related DALYs.

  • Projections to 2050 suggest continued declines overall, but rising XDR-TB incidence and mortality in some regions (notably Indonesia and the Western Pacific).

  • WHO-GHO and GBD 2021 estimates broadly agreed on totals but diverged in rates and stratification, especially in high-burden countries.

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When

• Historical analysis: 1990–2021

• Comparative database analysis: 2000–2021

• Projections: 1990–2050 (GBD 2019 foresight scenarios)

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Where

• Global scope, with regional analyses across 21 GBD regions.

• Country-level analyses for 204 countries/territories, emphasizing high TB burden settings.

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Why

• To address gaps in understanding:

  • Long-term spatiotemporal trends in TB and its subtypes.

  • Geographic hotspots and vulnerable populations.

  • The contribution of modifiable risk factors to TB-related disability.

  • Systematic discrepancies between WHO-GHO and GBD estimates that affect surveillance, policy-making, and health-system planning.

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How

• Study design: Multidimensional secondary data analysis.

• Data sources & tools:

  • GBD 2021 taxonomy and estimates (DisMod-MR 2.1, CODEm).

  • WHO-GHO TB indicators.

  • GBD Compare, Results Tool, and SCImago Graphica.

• Methods:

  • Age-standardized rates for prevalence, incidence, deaths, and DALYs.

  • Comparative risk assessment using population-attributable fractions (PAFs).

  • SDI-stratified analyses.

  • Joinpoint (linkage-point) regression for trend detection and APC estimation.

  • LOESS smoothing for WHO–GBD trajectory comparisons.

• Outputs: Global, regional, and national trend analyses; risk-factor attribution; future projections; and cross-database concordance assessment.

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Overall interpretation:
The study demonstrates substantial global progress against TB since 1990, but highlights persistent inequities, emerging threats from drug-resistant TB, and important methodological differences between global data systems, underscoring the need for targeted prevention, risk-factor modification, and harmonized surveillance.

Source: Jiang, F., Li, X., Qiao, Q., Zhang, M., Tian, Y., Zhou, S., Li, Y., Ni, R., Liu, Y., Zhang, L. and Gong, W., 2026. Global, regional, and national burden of tuberculosis, 1990–2050: a systematic comparative analysis based on retrospective cross-sectional of GBD 2021 and WHO surveillance systems. International Journal of Surgery, 112(1), pp.250-269.

Assessment of Risk Factors for Death in Older Adult Patients With TB in Japan

Who

• Participants: Older adult patients with tuberculosis (TB)

• Sample size: 126 patients included in final analysis

  • 84 survivors

  • 42 nonsurvivors

• Age: ≥65 years (median age: 84 years)

• Sex: 63 male patients

• Key characteristics: Many patients were underweight (median BMI 19.0 kg/m²) and had relatively preserved oxygenation at admission (median PaO₂/FIO₂ 368.6 mm Hg).

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What

• Focus: Identification of prognostic factors associated with all-cause mortality, TB-related death, and TB-unrelated death in older patients with TB.

• Main findings:

  • Poor performance status (PS > 2), corticosteroid use, and low serum albumin levels (≤2.6 g/dL) were independently associated with increased all-cause mortality.

  • Mortality risk increased stepwise with the number of these risk factors.

  • PS was the strongest predictor of TB-related death.

  • Age, corticosteroid use, and low serum albumin were independently associated with TB-unrelated death.

• Implications: Functional status, immune suppression, and nutritional status are key determinants of prognosis in older patients with TB and should be carefully assessed during treatment.

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When

• Study period: October 2016 to April 2022

• Follow-up duration: 1 year after hospital admission for TB

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Where

• Setting: NHO Ehime Medical Center, Japan

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Why

• Older adults with TB experience high mortality, but prognostic factors—particularly distinguishing TB-related from TB-unrelated deaths—are not well defined.

• The study aimed to address this gap to improve risk stratification and management in this vulnerable population.

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How

• Study design: Prospective cohort study

• Inclusion criteria: Patients ≥65 years with bacteriologically confirmed TB, including extrapulmonary TB without pulmonary lesions

• Exclusions: No bacteriological confirmation, prior recent TB treatment, age <65 years, or incomplete data

• Data collected:

  • Demographics, BMI

  • Performance status (ECOG PS)

  • Comorbidities and corticosteroid use

  • Radiographic findings (cavities, pleural effusion)

  • Laboratory data (e.g., lymphocyte count, CRP, serum albumin)

• TB diagnosis: Positive culture from at least one infected site; TRCReady-80 transcription–reverse transcription concerted reaction method

• Outcomes: All-cause mortality, TB-related death, TB-unrelated death

• Analysis:

  • Multivariate Cox proportional hazards models

  • Receiver operating characteristic (ROC) curves for cutoff determination

  • Kaplan–Meier survival analysis with risk stratification

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Key Conclusion

Poor performance status, corticosteroid use, and hypoalbuminemia are strongly associated with mortality in older adults with TB. Comprehensive evaluation of daily functioning, physical capacity, immune status, and nutrition is critical and may directly influence prognosis.

Source: Miyoshi, S., Semba, M., Tanabe, M., Sato, C., Watanabe, A., Ito, R., Kubota, M. and Abe, M., 2025. Assessment of Risk Factors for Death in Older Adult Patients With TB in Japan. CHEST Pulmonary, 3(2).

Spatial Econometric Analysis of the Impact of Health Infrastructure on TBC Patients

Who

• Study population: Aggregated provincial-level data on Tuberculosis (TB) cases and TB incidence across Indonesia.

• Units of analysis: Indonesian provinces (panel data).

• Data sources:

  • Health infrastructure and facilities data from the Ministry of Health Republic of Indonesia

  • Control variables from the Indonesian Bureau of Statistics

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What

• Focus: Examines how health infrastructure and health facilities influence TB cases and TB incidence while accounting for spatial dependence between regions.

• Key findings:

  • TB cases in Indonesia exhibit significant positive spatial autocorrelation, with Moran’s I values ranging from 0.307 to 0.522 (significant at the 1% level), indicating clustering rather than random distribution.

  • TB incidence is spatially concentrated in western Indonesia, particularly on Java Island, with the highest burden in West Java Province.

  • Health infrastructure variables (households with better access to drinking water and sanitation) show no significant direct effect on TB incidence.

  • Health facilities variables (number of doctors, national health insurance participation) and control variables (government healthcare expenditure and population density) have positive direct effects on TB cases.

  • Indirect (spillover) effects are found only for access to drinking water and population density.

• Implication: Spatial dynamics are critical for understanding TB distribution, and policy responses should account for regional clustering and spillover effects.

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When

• Data period: 2017–2021.

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Where

• Geographic setting: Indonesia, with provincial-level spatial analysis and emphasis on Java Island.

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Why

• TB cases may be spatially correlated due to geographic proximity, population movement, and shared environmental and socioeconomic conditions.

• Ignoring spatial autocorrelation can bias estimates of determinants of TB incidence.

• The study addresses the gap in understanding how health infrastructure and facilities affect TB when spatial dependence is explicitly modeled.

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How

• Study design: Quantitative spatial panel study.

• Methods:

  • Moran’s I test to detect spatial autocorrelation in TB cases and independent variables.

  • Spatial econometrics modeling using the General Spatial Panel Model (GNS), including the Spatial Durbin Model with Fixed Effects (SDM-FE).

  • Cluster and spatial pattern mapping using percentile and natural breaks approaches.

• Analytical strategy:

  • Confirm spatial correlation with Moran’s I.

  • Estimate direct and indirect (spillover) effects of health infrastructure, health facilities, and control variables on TB incidence.

Source: Rahmawati, Y., Jamil, I.R., Hidayah, I., Kusumawardani, D. and Wibowo, W., 2026. Spatial Econometric Analysis of the Impact of Health Infrastructure on TBC Patients Study Case in Indonesia Provinces Level. International Review for Spatial Planning and Sustainable Development, 14(1), pp.96-117.

Prevalence and associated factors of TB among DM patients attending public health facilities in Ethiopia

• Who: The study involved diabetic mellitus (DM) patients aged 15 years and older attending selected public health facilities in Ethiopia, with 14,119 DM patients screened for tuberculosis (TB) and 652 symptomatic individuals enrolled; participants were predominantly female, urban residents, and living mainly with type II DM, many with long-standing disease and multiple comorbidities.

• What: The study found a high TB burden among DM patients, with an overall TB prevalence of 11.2% among TB-presumptive individuals and a point prevalence of 517 per 100,000 among all screened DM patients; pulmonary TB was most common, and younger age, cigarette smoking, contact with TB cases, HIV infection, poor glycemic control, insulin-only treatment, and longer duration of diabetes were independently associated with TB.

• When: Data were collected over a one-year period from January to December 2023.

• Where: The study was conducted in 11 public health facilities across five regions of Ethiopia—Oromia, Southern Ethiopia, Sidama, Addis Ababa, and Dire Dawa—with laboratory confirmation performed at the national reference laboratory.

• Why: The research aimed to address limited national evidence on the epidemiology of TB among diabetic patients in Ethiopia, a setting with high TB endemicity and a rising burden of diabetes, to inform integrated TB–DM screening and prevention strategies.

• How: A multicenter cross-sectional design was used, incorporating symptom-based TB screening, standardized questionnaires, and laboratory diagnostics including smear microscopy, culture, and Xpert MTB/RIF Ultra assays, with multivariable logistic regression applied to identify factors independently associated with TB.

Source: Alemu, A., Seid, G., Diriba, G., Hailu, M., Dange, B., Moga, S., Melese, D., Tadesse, G., Mariam, S.H., Berhe, N. and Gumi, B., 2025. Prevalence and associated factors of tuberculosis among diabetic patients attending public health facilities in Ethiopia: a multicenter study. Archives of Public Health, 83(1), pp.1-15.

Factors associated with medication adherence among pulmonary TB patients in East Kotawaringin Regency

Who

The study involved pulmonary tuberculosis (TB) patients registered at Samuda and Bapinang Primary Health Centers (Puskesmas) in East Kotawaringin Regency, Indonesia. The sample consisted of 33–37 respondents (reported inconsistently), most of whom were male (60.6%), aged 46–55 years (33.3%), with high school education (45.5%), and primarily self-employed (48.5%).

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What

The study examined factors associated with medication adherence among pulmonary TB patients. The findings showed that:

• No significant association was found between education level, occupation, or distance to health facilities and TB medication adherence (p > 0.05).

• Significant associations were found between treatment supporter (PMO) and motivation to recover with medication adherence (p < 0.05).
  Overall, 63.6% of patients demonstrated high adherence to anti-tuberculosis medication.

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When

The time frame of data collection was not specified.

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Where

The study was conducted in the service areas of Samuda and Bapinang Primary Health Centers, East Kotawaringin Regency, Central Kalimantan, Indonesia.

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Why

The research aimed to address the problem of non-adherence to TB treatment, which can lead to treatment failure, drug resistance, and ongoing transmission. Identifying factors related to adherence was intended to inform strategies to improve TB treatment outcomes.

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How

A correlational study design with a cross-sectional approach was used. Purposive sampling selected respondents. Data were collected using structured questionnaires and analyzed through univariate analysis (proportions and central tendency) and bivariate analysis using the Chi-square test, with statistical significance set at p ≤ 0.05. Independent variables included education, occupation, distance to health facilities, PMO, and motivation, while the dependent variable was medication adherence.

Source: Kusmiyani, O.T., Hermanto, H. and Rosela, K., 2024. Analisis faktor yang berhubungan dengan kepatuhan minum obat anti tuberkulosis pada pasien TB paru di Puskesmas Samuda dan Bapinang Kotawaringin Timur. Jurnal Surya Medika, 10(1), pp.139-151.

The epidemiology of pulmonary TB in Indonesia based on SKI 2023 data

Who

The study population consisted of households in Indonesia included in the Indonesian Health Survey (Survei Kesehatan Indonesia, SKI) 2023. The population covered approximately 104,000 households, with a sample size of 345,000 households used for the Basic Health Research (Riskesdas). The analysis examined pulmonary tuberculosis (TB) cases across demographic characteristics such as age, sex, education level, occupation, economic status, and place of residence.

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What

This study analyzed the epidemiology of pulmonary tuberculosis in Indonesia based on SKI 2023 data. The highest TB prevalence was observed among older adults aged 65–74 years (0.59%), followed by those aged 55–64 years (0.51%) and ≥75 years (0.50%). TB prevalence was higher among males (0.38%; 168,439 cases) than females (0.22%; 95,539 cases). Higher prevalence was found among individuals with low educational attainment, particularly elementary school graduates or those with no formal education. By occupation, TB prevalence was highest among fishermen (0.50%), followed by farmers/agricultural laborers (0.41%) and laborers/drivers/domestic workers (0.40%). TB prevalence was also higher among individuals with lower economic status, and cases were more common in urban areas than rural areas. The findings indicate that pulmonary TB in Indonesia disproportionately affects socially and economically vulnerable populations.

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When

The study was conducted in December 2024, using secondary data collected from the Indonesian Health Survey 2023.

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Where

The study was conducted in Indonesia, with analysis comparing urban and rural areas nationwide.

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Why

The research aimed to address the need for updated epidemiological evidence on pulmonary TB in Indonesia, particularly to understand how TB prevalence varies by population characteristics and place of residence, in order to inform public health planning and TB control strategies.

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How

This was a descriptive observational study using secondary data from SKI 2023. The sampling method applied was systematic sampling with implicit stratification. Data were analyzed descriptively to assess TB prevalence according to individual characteristics (person) and geographic setting (place).

Source: Handayani, L., 2024. Studi Epidemiologi Tuberkulosis Paru (TB) di Indonesia: Temuan Survey Kesehatan Indonesia (SKI) 2023. Jurnal Kendari Kesehatan Masyarakat, 4(1), pp.59-67.

Comparison of Individual Regimen Containing Bedaquiline with Delamanid and Bedaquiline without Delamanid on Efficacy and Safety in MDR-TB Patients

Who

• Participants: 103 patients with multidrug-resistant tuberculosis (MDR-TB).

• Groups:

  • 26 patients received bedaquiline (Bdq) with delamanid

  • 77 patients received Bdq without delamanid

• Key characteristics: Diabetes mellitus was significantly more common in the Bdq–delamanid group (61.5% vs. 29.9%).

• Exclusions: Patients with baseline QTc >470 ms, hypoalbuminemia, electrolyte disturbances, hyperthyroidism, HIV, renal failure, or heart disease treated with furosemide/digoxin.

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What

• Focus: Comparison of efficacy (AFB sputum conversion and culture conversion) and safety (QTc interval prolongation) between Bdq-containing regimens with vs. without delamanid.

• Findings:

  • No statistically significant differences in AFB conversion, culture conversion, or QTc interval changes between groups.

  • Time to AFB and culture conversion was numerically faster in the Bdq–delamanid group, but not significant.

  • QTc prolongation incidence was lower in the Bdq–delamanid group, but also not significant.

• Conclusion: Regimens containing Bdq with delamanid demonstrated similar efficacy and safety compared with Bdq regimens without delamanid.

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When

• Study period: January 2021 to July 2023.

• Follow-up: Clinical, microbiological, and QTc data monitored up to the 6th month of treatment.

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Where

• Setting: Dr. Soetomo General Academic Hospital, Indonesia.

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Why

• To evaluate whether adding delamanid to Bdq-based individualized MDR-TB regimens improves treatment outcomes or increases cardiac risk, particularly when drugs from Groups A and B are limited or cannot be used.

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How

• Design: Observational analytic study with a retrospective approach.

• Sampling: Convenience sampling of complete medical records.

• Diagnostics: MDR-TB confirmed using GeneXpert MTB/RIF, line probe assays, and MGIT 960 culture-based drug susceptibility testing.

• Outcomes measured:

  • AFB sputum conversion

  • Mycobacterium tuberculosis culture conversion

  • QTc interval changes and QTc prolongation (≥470 ms)

• Analysis: Comparative statistical analysis between the two treatment groups across monthly evaluations.

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Overall interpretation:
An individualized MDR-TB regimen containing bedaquiline with delamanid provides comparable efficacy and safety to regimens without delamanid. Delamanid may be a preferred Group C option when drugs from Groups A and B are unavailable or unsuitable.

Sumber: Soedarsono, S., Mertaniasih, N.M., Kusmiati, T., Permatasari, A., Subay, S. and Adiono, S.H., 2024. Comparison of Individual Regimen Containing Bedaquiline with Delamanid and Bedaquiline without Delamanid on Efficacy and Safety in Multidrug-resistant Tuberculosis Patients: Implementation in Dr. Soetomo General Academic Hospital, Indonesia. The International Journal of Mycobacteriology, 13(2), pp.140-146.