Transmission, Comorbidities, and Treatment

1. Smear-Negative TB and Aerosol-Generating Procedures: Transmission Risks Redefined

• Theory: Smear-negative, culture-positive (SmN) TB patients were traditionally seen as less infectious than smear-positive (SmP) ones.
• Key Findings: SmN patients undergoing aerosol-generating procedures (AGPs) had a comparable transmission rate to SmP patients (LTBI: ~15% in both groups); AGPs independently raised transmission risk.
• Conclusion: Infection control protocols should expand to include SmN patients receiving AGPs, with universal LTBI screening and treatment for close contacts.

---

2. Comorbidities and Treatment Customization: The Cost of Non-Standard Regimens

• Theory: Standard TB regimens are optimal, but patient-specific comorbidities (e.g., liver disease) necessitate modifications.
• Key Findings: Only 3.7% received non-standard treatments, mostly due to liver, eye, or metabolic conditions; these patients faced longer durations, more interruptions, and higher loss to follow-up.
• Conclusion: There's a critical need to design validated alternative regimens and proactively plan care for patients with contraindications to standard TB drugs.

---

3. Diabetes and TB: Dual Burden and Its Clinical Consequences

• Theory: Coexisting metabolic disorders such as diabetes impair immune response and may worsen TB outcomes.
• Key Findings:
• Conclusion: Integrated care is essential, with aggressive glycemic management and early DM screening to improve TB outcomes.

---

4. MDR/RR-TB: Treatment Evolution and the COVID-19 Disruption

• Theory: Drug-resistant TB strains are harder to treat and monitor, and service disruptions exacerbate outcomes.
• Key Findings: Shorter, all-oral regimens led to significantly better outcomes (74% success vs. 46%); the COVID-19 pandemic reversed years of progress in treatment success.
• Conclusion: Emphasizes the need for resilient TB programs, all-oral regimens, and decentralized care, especially during global health crises.

---

5. Household Behavior and TB Prevention: Knowledge as the Core Driver

• Theory: Behavioral and cultural determinants at the family level are crucial for TB prevention.
• Key Findings: Poor TB prevention behaviors were strongly linked to low knowledge (Exp(B)=46.9), poor healthcare access, anti-prevention cultural norms, and lack of personal TB experience.
• Conclusion: Effective TB control requires targeted health education, culturally sensitive messaging, and enhanced community-based prevention strategies.

References:

1. Yang, Y.J., Pan, S.C., Lee, M.R., Chung, C.L., Ku, C.P., Liao, C.Y., Tsai, T.Y., Wang, J.Y., Fang, C.T. and Chen, Y.C., 2024. Quantifying the contribution of smear-negative, culture-positive pulmonary tuberculosis to nosocomial transmission. American Journal of Infection Control, 52(7), pp.807-812.
2. Chen, R.T., Liu, C.Y., Lin, S.Y., Shu, C.C. and Sheng, W.H., 2024. The prevalence, clinical reasoning and impact of non-standard anti-tuberculosis regimens at the initial prescription. Scientific Reports, 14(1), p.5631.
3. Viswanathan, V., Devarajan, A., Kumpatla, S., Dhanasekaran, M., Babu, S. and Kornfeld, H., 2023. Effect of prediabetes on tuberculosis treatment outcomes: A study from South India. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 17(7), p.102801.
4. Rima, U.S., Islam, J., Mim, S.I., Roy, A., Dutta, T., Dutta, B. and Ferdaus, F.F., 2024. Co-Infection of Tuberculosis and Diabetes: Implications for Treatment and Management. Asia Pacific Journal of Surgical Advances, 1(2), pp.51-58.
5. Bumbu, L., Vaccher, S., Holmes, A., Sodeng, K., Graham, S.M. and Lin, Y.D., 2024. Drug-resistant TB in Morobe Province, Papua New Guinea, 2012–2021. Public Health Action, 14(4), pp.146-151.
6. Sani, H.A., Hadi, A.J. and Hatta, H., 2025. Key Determinants of Tuberculosis Prevention Behaviors Among Families in Indonesia: A Cross-Sectional Study Analysis. Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 8(2), pp.118-130.

TBC 061