Transmission and Control

1. TB Transmission and Control in Healthcare Settings

• Environmental Risks: Elevated TB transmission risks due to inadequate ventilation and poor environmental cleaning, especially in crowded outpatient areas.
• Healthcare Visits: Increased TB incidence correlates with higher frequency of health care visits and exposure to untreated TB patients.
• Infection Control: Implementation of enhanced infection control measures in internal medicine, family medicine, and pulmonology including cough officer screening, germicidal ultraviolet systems, and improved ventilation.

2. Chronic Conditions and TB Management

• Diabetes: Diabetic patients exhibit higher risks of TB treatment failure, death, and recurrence; better outcomes are achieved with enhanced management programs.
• Hypertension: Hypertensive TB patients face higher mortality rates; use of non-DHP-CCBs shows beneficial effects in reducing the TB bacillary load.

3. Occupational and Special Population Risks

• Healthcare Workers: Higher TB incidence among healthcare workers, yet with better outcomes due to rapid diagnosis and less treatment delay.
• Dialysis Patients: Elevated TB risk due to factors like smoking and brief dialysis duration; positive QFT-GIT tests indicate high TB risk.

4. Environmental and Societal TB Risk Factors

• Air Pollution: Ambient air pollution, particularly fine particles and traffic-related pollutants, poses a higher risk for TB, needing further investigation.
• Tobacco and Indoor Pollution: Smoking and use of solid fuels significantly increase the risk of TB and other respiratory diseases.

5. Economic and Health Policy Implications

• Economic Benefits: TB service expansions lead to reduced patient-incurred costs and net cost savings in India and China.
• Policy Considerations: Effective implementation of TB services requires new funding and careful planning due to variations in intervention effectiveness.

6. Global Health Strategies and Outcomes

• Global Gains: Substantial improvements in health outcomes following expanded access to TB care in regions like India, China, and South Africa.
• Country-Specific Interventions: Targeted interventions in high-burden countries like South Africa, China, and India are critical for meeting global TB control targets.

References

1. Menzies, N.A., Gomez, G.B., Bozzani, F., Chatterjee, S., Foster, N., Baena, I.G., Laurence, Y.V., Qiang, S., Siroka, A., Sweeney, S. and Verguet, S., 2016. Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models. The Lancet global health, 4(11), pp.e816-e826.
2. Houben, R.M., Menzies, N.A., Sumner, T., Huynh, G.H., Arinaminpathy, N., Goldhaber-Fiebert, J.D., Lin, H.H., Wu, C.Y., Mandal, S., Pandey, S. and Suen, S.C., 2016. Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models. The Lancet Global Health, 4(11), pp.e806-e815.
3. Hamada, Y., Lugendo, A., Ntshiqa, T., Kubeka, G., Lalashowi, J.M., Mwastaula, S., Ntshamane, K., Sabi, I., Wilson, S., Copas, A. and Velen, K., 2024. A pilot cross-sectional study of non-communicable diseases in TB household contacts. IJTLD OPEN, 1(4), pp.154-159.
4. Lin, H.H., Murray, M., Cohen, T., Colijn, C. and Ezzati, M., 2008. Effects of smoking and solid-fuel use on COPD, lung cancer, and tuberculosis in China: a time-based, multiple risk factor, modelling study. The Lancet, 372(9648), pp.1473-1483.
5. Pan, S.C., Chen, C.C., Chiang, Y.T., Chang, H.Y., Fang, C.T. and Lin, H.H., 2016. Health care visits as a risk factor for tuberculosis in Taiwan: a population-based case–control study. American journal of public health, 106(7), pp.1323-1328.
6. Shu, C.C., Hsu, C.L., Wei, Y.F., Lee, C.Y., Liou, H.H., Wu, V.C., Yang, F.J., Lin, H.H., Wang, J.Y., Chen, J.S. and Yu, C.J., 2016. Risk of tuberculosis among patients on dialysis: the predictive value of serial interferon-gamma release assay. Medicine, 95(22), p.e3813.
7. Chidambaram, V., Gupte, A., Wang, J.Y., Golub, J.E. and Karakousis, P.C., 2021. The impact of hypertension and use of calcium channel blockers on tuberculosis treatment outcomes. Clinical Infectious Diseases, 73(9), pp.e3409-e3418.
8. Lo, H.Y., Yang, S.L., Lin, H.H., Bai, K.J., Lee, J.J., Lee, T.I. and Chiang, C.Y., 2016. Does enhanced diabetes management reduce the risk and improve the outcome of tuberculosis?. The International Journal of Tuberculosis and Lung Disease, 20(3), pp.376-382.
9. Lai, T.C., Chiang, C.Y., Wu, C.F., Yang, S.L., Liu, D.P., Chan, C.C. and Lin, H.H., 2016. Ambient air pollution and risk of tuberculosis: a cohort study. Occupational and environmental medicine, 73(1), pp.56-61.
10. Pan S-C, Chen Y-C, Wang J-Y, Sheng W-H, Lin H-H, Fang C-T, et al. (2015) Tuberculosis in Healthcare Workers: A Matched Cohort Study in Taiwan. PLoS ONE 10(12): e0145047.

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