Friday, January 23, 2026

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.

Wednesday, January 21, 2026

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%).


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.


When

The time frame of data collection was not specified.


Where

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


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.


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.


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.


When

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


Where

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


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.


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.

Saturday, January 17, 2026

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.


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.


When

  • Study period: January 2021 to July 2023.

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


Where

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


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.


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.


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.

Differences in the incidence of pulmonary TB based on occupation and educational level

Who

The study included 395 pulmonary tuberculosis (TB) cases recorded in 2021. Participants were categorized by age, sex, occupation, and educational level. Most cases occurred among individuals of productive age (15–50 years; 73.4%), followed by those over 50 years (26.6%). No cases were reported among children aged 0–14 years. Slightly more cases were found in males (53.4%) than females (46.6%).

What

The study examined differences in the incidence of pulmonary TB based on occupation and educational level. The findings showed no statistically significant difference in pulmonary TB incidence by occupation (Chi-square test, p = 0.958). However, there was a statistically significant difference in pulmonary TB incidence by educational level (p = 0.048). The authors concluded that educational level is associated with pulmonary TB incidence, while occupation is not.

When

Data collection and analysis were conducted from March to May 2022, using secondary data from pulmonary TB cases reported in 2021.

Where

The study was carried out in 11 primary health centers (puskesmas) in Kupang City.

Why

The research aimed to address the increasing number of pulmonary TB cases in Kupang City and to determine whether socioeconomic factors, specifically occupation and educational level, were associated with differences in TB incidence.

How

An analytic observational study with a cross-sectional design was used. Secondary data were analyzed using univariate and bivariate analyses, with the Chi-square test applied to assess associations between pulmonary TB incidence and occupation and educational level.

Source: Dewi, N.P.A.N. and Susilawati, N.M., 2024. Hubungan Pekerjaan dan Pendidikan dengan Kejadian TB Paru di Kota Kupang. Inovasi Kesehatan Global, 1(4), pp.139-148.

Thursday, January 15, 2026

Trends in tuberculosis incidence in Southeast Sulawesi

Who

The study population consisted of reported tuberculosis (TB) cases in Southeast Sulawesi Province, Indonesia, based on secondary data from the Provincial Health Office. The analysis included TB cases categorized by sex and age, as well as individuals identified with latent tuberculosis infection (LTBI/ILTB) and those enrolled in tuberculosis preventive therapy (TPT) from 2021 to 2023.


What

The study evaluated trends in tuberculosis incidence, latent TB infection (ILTB), and tuberculosis preventive therapy (TPT). The findings showed a continuous increase in TB cases from 2,087 cases in 2021 to 2,906 cases in 2023. TB cases were consistently higher among males than females and were most prevalent in the 45–54 year age group. Kendari City had the highest number of TB cases, while less densely populated regions reported fewer cases. ILTB cases increased annually, whereas participation in TPT programs declined over time, indicating a gap between detection and prevention efforts.


When

The study analyzed data collected over a three-year period from 2021 to 2023.


Where

The research was conducted in Southeast Sulawesi Province, Indonesia, covering multiple districts and cities, including Kendari City, Bau-Bau City, Muna Regency, and other surrounding regions.


Why

The study aimed to address the increasing burden of tuberculosis in Southeast Sulawesi by evaluating epidemiological trends in TB incidence, ILTB, and TPT implementation. The purpose was to identify demographic and geographic patterns and to assess whether preventive therapy coverage aligned with the rising detection of latent TB infection.


How

This was a quantitative, descriptive observational study using secondary data from the Provincial Health Office of Southeast Sulawesi. An epidemiological trend analysis was applied to examine TB incidence by person (sex and age), place (district/city), and time (year), as well as trends in ILTB and TPT implementation across regions from 2021 to 2023.

Sumber: Lestari, H., 2024. Analisis Epidemiologi Kejadian Tuberkulosis Di Provinsi Sulawesi Tenggara Tahun 2021-2023. Variable Research Journal, 1(02), pp.802-810.

Determinants of transmission prevention behavior among TB patients in Surabaya

Who

The study involved 144 tuberculosis (TB) patients receiving care at three primary healthcare centers. Participants were selected using simple random sampling. No further demographic characteristics (e.g., age, sex) were specified.

What

The study examined determinants influencing TB transmission prevention behavior, focusing on patient knowledge, supportive behavior, and medication adherence.
Results showed that most participants had good knowledge, supportive behavior, medication adherence, and TB transmission prevention behavior. Multiple linear regression analysis demonstrated that all three factors significantly influenced TB transmission prevention behavior (p < 0.05). Each one-point increase in:

  • Knowledge increased prevention behavior by 0.667 points

  • Supportive behavior increased prevention behavior by 0.370 points

  • Medication adherence increased prevention behavior by 0.720 points

The authors concluded that improving patient education, community support, and adherence to treatment is essential for effective TB control.

When

Not specified.

Where

The study was conducted in Surabaya, Indonesia, across three primary healthcare centers.

Why

The research aimed to identify key factors influencing TB transmission prevention in order to help prevent and reduce TB cases, addressing a critical gap in patient-level behavioral determinants of TB control.

How

An observational cross-sectional study design was used. Data were collected through questionnaires and individual interviews. The questionnaire assessed four domains: TB knowledge, supportive behavior, medication adherence, and transmission prevention behavior. Instrument reliability was tested using Cronbach’s alpha, showing acceptable to high reliability (α = 0.611–0.879). Variables were categorized into predefined levels (poor, moderate, good) to aid interpretation. Multiple linear regression analysis (α < 0.05) was applied to evaluate the effects of independent variables on TB transmission prevention behavior.

Source: Juliasih, N.N., Sakinah, L.F., Sari, R.M., Winarso, H., Siahaan, S.C.P. and Gunawan, E.J., 2024. Determinants of transmission prevention behavior among Tuberculosis patients in Surabaya, Indonesia. Infection Prevention in Practice, 6(4), p.100404.

Tuesday, January 13, 2026

Estimating the number of incorrect TB diagnoses in LMIC

Who

  • Population: Individuals evaluated for pulmonary tuberculosis (TB) through routine healthcare services.

  • Setting: 111 low- and middle-income countries (LMICs), representing ~98% of global TB incidence.

  • Data scale: ~22.9 million people evaluated for TB in 2023; ~5.7 million estimated to have TB.

  • Key subgroups: HIV-positive individuals (median 5% across countries) and those tested with rapid diagnostic tests (RDTs).

  • Data source: Aggregate national notification data from the World Health Organization (no individual-level human subjects).


What

  • Main finding: Current TB diagnostic algorithms in LMICs have moderate sensitivity (82.6%) and specificity (88.0%), resulting in substantial diagnostic error.

  • Estimated global burden (2023, assuming 25% TB prevalence among those evaluated):

    • ~1.00 million false-negative TB diagnoses (missed TB cases).

    • ~2.05 million false-positive TB diagnoses (TB diagnosed in people without TB).

  • Clinical diagnosis accounted for:

    • ~22% of true-positive diagnoses.

    • ~75% of false-positive diagnoses.

  • Implication: Large numbers of people are either missed or incorrectly treated, highlighting trade-offs between sensitivity and specificity in TB diagnosis.

  • Counterfactual analyses: Improvements such as full RDT adoption, better clinical algorithms, or more sensitive RDTs could substantially reduce both false-negative and false-positive diagnoses.


When

  • Study year: Diagnostic performance estimated for 2023.

  • Underlying evidence: Sensitivity/specificity inputs drawn from previously published diagnostic accuracy studies (various years; exact dates not specified).


Where

  • Geographic scope: 111 LMICs across all WHO regions.

  • Regional variation: Diagnostic performance varied widely by region, reflecting differences in RDT coverage and reliance on clinical diagnosis.


Why

  • Rationale: There is limited direct evidence on how well real-world TB diagnostic algorithms perform at scale.

  • Problem addressed: The balance between missed TB cases and overdiagnosis is poorly quantified globally, especially where clinical diagnosis is common.

  • Goal: To estimate the true magnitude of false-positive and false-negative TB diagnoses and evaluate how alternative diagnostic strategies could improve outcomes.


How

  • Design: Bayesian mathematical modeling of the TB diagnostic cascade.

  • Inputs:

    • National TB notification data (laboratory-confirmed vs. clinically diagnosed).

    • Published estimates of sensitivity and specificity for smear microscopy, Xpert Ultra RDTs, and clinical diagnosis.

    • Adjustment for HIV status and possible culture-negative TB.

  • Key assumptions:

    • Initial TB prevalence among evaluated individuals ranged from 5–50% (25% base case).

    • No adjustment for under-reporting of TB diagnoses.

  • Analysis:

    • Bayesian inference with Hamiltonian Monte Carlo (5,000 simulations).

    • Country-level estimates pooled to regional and global results.

    • Multiple counterfactual scenarios tested (e.g., full RDT adoption, improved clinical algorithms).

  • Software: R and RStan.


Overall conclusion

The study demonstrates that current TB diagnostic practices result in millions of incorrect diagnoses each year, underscoring the urgent need for improved diagnostic tools and strategies that reduce both missed TB and overdiagnosis.

Source: van Lieshout Titan, A., Dodd, P.J., Cohen, T. and Menzies, N.A., 2026. Estimating the number of incorrect tuberculosis diagnoses in low-and middle-income countries. Nature Medicine, pp.1-8.

 

QuantiFERON-TB Gold Plus CD8+ T cell responses in contacts with TB disease and recent TB infection

Who

  • Participants: Close contacts of pulmonary or laryngeal tuberculosis (TB) cases in Singapore

  • Population size:

    • 22,355 contacts attended screening

    • 19,397 had valid QFT-Plus results

  • Eligibility: Immunocompetent individuals ≥5 years old (QFT-Plus); immunocompromised contacts received T-SPOT.TB; children <5 years received TST

  • Key subgroups:

    • Contacts with TB disease

    • “Stringent Converters” (recent TB infection)

    • All others with TB infection (likely remote infection)


What

  • Study focus: Evaluation of the CD8⁺ T-cell response measured by the QFT-Plus assay for its ability to:

    • Predict active TB disease

    • Identify recent TB infection (TBI)

  • Key findings:

    • TB disease and recent TBI (stringent conversion) were significantly associated with stronger CD8⁺ responses (TB2–TB1 IFN-γ >0.6 IU/mL)

    • TB2 tube responses increased diagnostic sensitivity for TB disease (from 84.6% to 95.2%)

    • Higher IFN-γ levels in TB1 and TB2 tubes were observed in TB disease and recent TBI compared with other TBI cases

  • Conclusion: CD8⁺ IFN-γ responses in QFT-Plus may help identify individuals at higher risk of TB disease or recent infection who could benefit from further investigation or TB preventive treatment (TPT)


When

  • Data collection period: January 2018 to October 2018

  • Relevant program timeline:

    • TPT implemented since 1998

    • QFT-GIT introduced from 2006

    • QFT-Plus used from December 2017


Where

  • Setting: Nationwide TB contact screening in Singapore

  • Clinical site: TB Contact Clinic (TBCC)

  • Laboratory: Tan Tock Seng Hospital Microbiology Laboratory


Why

  • To improve identification of:

    • Individuals with active TB disease

    • Those with recent TB infection, who are at higher risk of progression

  • To assess whether CD8⁺ responses in QFT-Plus add value beyond standard IGRA positivity in a setting with high background TB infection


How

  • Study design: Retrospective observational analysis

  • Testing strategy:

    • Initial and post-window QFT-Plus testing (≥8 weeks after exposure)

    • Chest radiography for IGRA-positive or high-risk contacts

  • Key definitions:

    • Stringent Converters: IFN-γ increase from <0.35 to >0.7 IU/mL, excluding results in the uncertainty zone

    • CD8⁺ response: TB2–TB1 IFN-γ difference >0.6 IU/mL

Source: Chee, C.B.E., Kyi-Win, K., Tan, S. and Wang, Y.T., 2025. QuantiFERON-TB Gold Plus CD8+ T cell responses in contacts with tuberculosis disease and recent tuberculosis infection. Microbiology Spectrum, 13(12), pp.e01353-25.

Joint associations of multiple lifestyle factors with risk of active TB in the population

Who

  • 63,257 Chinese adults (men and women), aged 45–74 years at recruitment

  • Belonged to Hokkien and Cantonese dialect groups

  • Participants of the Singapore Chinese Health Study

  • A subset of 39,528 participants contributed updated lifestyle data at follow-up

  • Participants were born in the first half of the 20th century, many likely exposed to latent tuberculosis infection early in life


What

  • The study examined the joint association of five lifestyle risk factorssmoking, underweight BMI, physical inactivity, daily alcohol consumption, and poor diet quality—with the risk of active tuberculosis (TB).

  • Each individual risk factor was independently associated with higher TB risk.

  • A dose–response relationship was observed: increasing numbers of lifestyle risk factors were associated with stepwise increases in TB risk.

  • Participants with all five risk factors had a ~9-fold higher risk of active TB compared with those with none.

  • The combined effect of all five factors was greater than expected under a purely multiplicative model, suggesting synergistic effects.

  • The association was stronger among participants with diabetes, indicating effect modification.

  • Smoking showed synergistic interactions with alcohol drinking and poor diet quality.

  • Findings support multifactorial prevention strategies targeting lifestyle behaviors to reduce TB risk.


When

  • Baseline recruitment: April 1993 – December 1998

  • Second follow-up: 2006–2010 (mean 12.7 years after baseline)

  • Mean follow-up duration: 18.2 years (SD 5.9)


Where

  • Singapore, among residents living in government housing flats (where ~86% of the population lived during recruitment)


Why

  • Tuberculosis incidence has declined slowly, and effective preventive strategies remain limited.

  • Older adults in Singapore, many with latent TB infection acquired earlier in life, remain at risk of reactivation.

  • The study aimed to clarify how modifiable lifestyle factors jointly influence active TB risk, addressing a gap in population-level prevention evidence.


How

  • Prospective population-based cohort study

  • Lifestyle factors assessed via structured interviewer-administered questionnaires at baseline and follow-up

  • Diet assessed using a validated 165-item food-frequency questionnaire

  • A combined lifestyle risk score (0–5) was constructed, assigning one point per at-risk factor

  • Incident active TB cases identified through mandatory linkage with the National TB Notification Registry

  • Cox proportional hazards models used to estimate hazard ratios, with adjustment for confounders

  • Sensitivity analyses and time-varying covariate analyses confirmed robustness of findings


Overall conclusion:
An increasing number of unhealthy lifestyle factors is associated with a markedly higher risk of active tuberculosis in older Chinese adults, underscoring the importance of integrated, multisectoral lifestyle interventions for TB prevention at the population level.

Source: Li, H., Chee, C.B., Geng, T., Pan, A. and Koh, W.P., 2022. Joint associations of multiple lifestyle factors with risk of active tuberculosis in the population: the Singapore Chinese Health Study. Clinical Infectious Diseases, 75(2), pp.213-220.

Risk factors for TB among close IGRA-negative contacts of persons with infectious TB

Who

  • Study population: Close contacts aged ≥2 years of laboratory-confirmed pulmonary TB patients in Singapore.

  • Sample size: 60,377 unique contacts (62,724 observations) linked to 7,737 index TB cases.

  • Key characteristics: Majority male, predominantly Chinese ethnicity, mostly Singapore residents; 75% of contacts were aged >25 years.

  • Outcome group: 150 contacts (0.3%) who developed active TB disease despite being IGRA-negative.


What

  • Focus: Identification of risk factors for developing active TB disease among IGRA-negative close contacts.

  • Key findings: Independent risk factors included:

    • Age >25 years

    • Malay ethnicity

    • Diabetes mellitus

    • End-stage renal failure

    • Exposure to smear-positive index cases

    • Family relationship with the index case

    • Exposure in dormitories or nursing homes

  • Implications: IGRA-negative contacts with these risk factors have a substantially higher TB incidence than the general population, suggesting possible false-negative IGRA results and need for enhanced follow-up.


When

  • Study period: January 2014 to December 2022.

  • Follow-up: Median time to TB disease development was 92 weeks after index case notification.


Where

  • Setting: Singapore.

  • Program context: National Tuberculosis Programme (NTBP), using data from the national TB registry.


Why

  • To inform context-specific follow-up strategies for IGRA-negative close contacts, addressing uncertainty about residual TB risk after a negative IGRA result and supporting Singapore’s goal of reducing TB incidence to 10 per 100,000 by 2040.


How

  • Design: Retrospective cohort study.

  • Inclusion criteria: Close contacts with a negative QuantiFERON-TB Gold Plus (QFT-Plus) result at 8 weeks post-exposure.

  • Exclusions: Prior TB treatment or preventive therapy; screening with TB-SPOT only.

  • Analysis:

    • Univariate analyses (chi-square, Fisher’s exact, Mann–Whitney U tests).

    • Multivariable logistic regression including variables with P <0.1 or strong prior evidence.

    • Model performance assessed using ROC curve (AUC = 0.79).

  • Conclusion: Authors recommend reviewing IGRA retesting timing and extending follow-up to 24 months for high-risk IGRA-negative contacts.

Source: Tavitian-Exley, I., Kyaw, W.M., Kang-Yang, L.L., Foo, K., Boudville, I.C., Cutter, J.L. and Ng, D.H.L., 2024. Risk factors for tuberculosis among close IGRA-negative contacts of persons with infectious tuberculosis in Singapore. International Journal of Infectious Diseases, 147, p.107166.

Thursday, January 8, 2026

Time interval for QuantiFERON-TB Gold Plus conversion after last exposure with TB

Who

  • Study population: Close contacts of notified tuberculosis (TB) cases

  • Inclusion criteria:

    • Aged ≥15 years

    • Initial negative QFT within 56 days of last exposure date (LED)

    • Follow-up QFT within 180 days of LED

  • Sample size: 23,236 contacts

  • Demographics:

    • Largest age groups: 30–39 years (23.9%), 20–29 years (20.0%)

    • QFT conversion increased with age, highest in those aged 70–79 years (5.8%)


What

  • Primary finding:

    • 3.5% (804/23,236) of contacts experienced QFT conversion on follow-up

    • Median time to QFT conversion was 10 weeks post-LED (IQR 9–11 weeks)

  • Timing of conversion:

    • 73% converted within ≤10 weeks

    • 27% converted after 10 weeks, up to 25 weeks

  • Clinical outcomes:

    • 45 contacts were diagnosed with active TB disease

    • 69% (31/45) had QFT conversion

    • Some active TB cases were identified only because repeat QFT occurred after 10 weeks

  • Authors’ conclusion:

    • A longer window period (≥10 weeks) is more effective for detecting later QFT conversions

    • Repeating QFT too early may miss TB infection and early active disease


When

  • Study period: 1 January 2018 – 31 December 2022


Where

  • Setting: National TB contact investigation program in Singapore

  • Data source: National TB Registry


Why

  • To determine the optimal timing for repeat QFT testing after TB exposure

  • To address uncertainty around the QFT window period, particularly regarding later conversions that may be clinically significant


How

  • Study design: Retrospective cohort study

  • Exposure reference: Last exposure date (LED) to an infectious TB case

  • Outcome definition:

    • QFT conversion = negative initial QFT → positive follow-up QFT

  • Analysis:

    • Timing of QFT conversion relative to LED

    • Stratification by age and follow-up interval

    • Identification of active TB disease following QFT results


Summary implication:
This large national cohort study demonstrates that while most QFT conversions occur within 10 weeks of TB exposure, over one-quarter occur later. Extending the repeat QFT window to at least 10 weeks post-exposure may improve detection of TB infection and prevent missed diagnoses of active TB, especially in programmatic contact investigations.

Source: Kyaw, W.M., Tay, J.Y., Lim, L.K.Y. and Ng, D.H.L., 2025. Time interval for QuantiFERON-TB Gold Plus conversion after last exposure with tuberculosis. ERJ Open Research, 11(3).

Subclinical disease among people with culture-confirmed pulmonary TB in Singapore

Who

  • Population: Singapore citizens and permanent residents with sputum culture–confirmed pulmonary tuberculosis (TB)

  • Sample size: 18,693 pulmonary TB cases

  • Key characteristics: Subclinical TB patients were older (median age 62–63 years) and predominantly male (~75%). High-risk groups included individuals aged ≥70 years and those with immunocompromising conditions (renal failure, steroid therapy, malignancy, HIV).

  • Exclusions: Patients with extrapulmonary TB

What

  • Focus: Description of the subclinical TB disease spectrum, identification of risk factors, and evaluation of diagnostic methods to improve TB control.

  • Findings:

    • Subclinical TB was common: 41.6% met definition 1 (culture-positive with no cough or cough <2 weeks) and 31.6% met definition 2 (culture-positive with no cough).

    • Most subclinical cases had abnormal chest X-rays (~96%), and a substantial proportion had high sputum smear positivity, indicating potential infectiousness despite minimal symptoms.

    • Subclinical TB was independently associated with older age, male sex, immunocompromising conditions, known TB contact, and positive sputum TB PCR.

    • Diagnostic performance of models was moderate (AUC 0.69–0.72).

  • Implications: Symptom-based screening alone is insensitive; relying solely on culture confirmation may delay diagnosis and increase transmission.

When

  • Study period: January 1, 2004 to December 31, 2023

Where

  • Setting: Singapore, using data from the Singapore National TB Registry

Why

  • To address gaps in TB control by characterizing subclinical TB, which may be missed by symptom-based screening, particularly in moderate-incidence settings, and to inform more effective screening strategies.

How

  • Design: Retrospective registry-based analysis

  • Data sources: Mandatory TB notification data, including demographics, clinical presentation, laboratory results, and treatment outcomes

  • Definitions: Two operational definitions of subclinical TB based on cough duration/absence

  • Analysis: Logistic regression with stepwise forward selection; odds ratios and adjusted odds ratios with 95% confidence intervals; ROC curve analysis to assess model fit

Source: Chew, Y.R., Tay, J.Y., Kyaw, W.M., Chia, P.Y. and Ng, D.H.L., 2025. Subclinical disease among people with culture-confirmed pulmonary tuberculosis in Singapore-a retrospective study. International Journal of Infectious Diseases, 153, p.107768.

Wednesday, January 7, 2026

Prevalence and risk factors of active TB disease in contacts of TB cases in Nigeria

Who

  • Index cases: Patients diagnosed with active tuberculosis (TB) disease attending the Chest/TB clinic of Chukwuemeka Odumegwu Ojukwu University Teaching Hospital.

    • Modal age group: 36–45 years

    • Mean age: 40.49 years

    • Predominantly male

    • 99.2% had pulmonary TB

    • 82.6% were smear-positive

    • 28.1% were HIV-positive

  • Contacts: Individuals identified through index cases, predominantly household contacts.

    • Modal age group: ≤15 years

    • Mean age: 24.01 years

    • Predominantly female


What

  • Study focus: Determination of the prevalence and risk factors of active TB disease among contacts of patients with active TB.

  • Key findings:

    • 17.5% of contacts had at least one symptom suggestive of TB.

    • Active TB disease was detected in 2.7% of contacts.

    • Presence of TB symptoms among contacts was significantly associated with active TB disease (p = 0.000).

  • Conclusion: Contacts of active TB patients have a higher risk of developing active TB compared to the general population. Systematic contact investigation is crucial for early case detection and TB control.


When

  • Not specified.


Where

  • Chest/TB clinic of Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, southeastern Nigeria.


Why

  • To address the increased risk of active TB disease among contacts of TB patients and to support TB control efforts through early identification of previously undiagnosed cases, particularly in high TB burden settings.


How

  • Study design: Cross-sectional study.

  • Sampling: Consecutive enrollment of all diagnosed active TB patients and their identified contacts.

  • Data collection:

    • In-depth interviews with index cases to identify contacts.

    • Interviewer-administered questionnaires for both index cases and contacts.

  • Screening and diagnosis:

    • Clinical screening of contacts for cardinal TB symptoms (e.g., prolonged cough, fever, weight loss, night sweats; failure to thrive in children).

    • Laboratory testing using Xpert MTB/RIF Ultra assay on sputum samples (adults) or stool samples (children unable to produce sputum).

Source: Njelita, I.A., Nwachukwu, C.C., Eyisi, I.G., Ezenyeaku, C.A. and Okeke, H.N., 2025. Prevalence and risk factors of active tuberculosis disease in contacts of tuberculosis cases treated in a teaching hospital in southeast Nigeria: a cross-sectional study. International Journal of Healthcare Sciences, 13(1), pp.80-89.

Tuesday, January 6, 2026

The Role of Youths in Within-Household Tuberculosis Transmission

Who

  • Participants:

    • Index patients: 2,771 individuals aged 15–60 years with microbiologically confirmed pulmonary TB.

    • Household contacts (HHCs): 10,745 contacts aged 0–60 years (participants >60 excluded).

  • Key subgroups:

    • Index patients categorized as Youth (15–24 years) or Adults (25–60 years).

    • HHCs categorized as Children (0–14 years), Youth (15–24 years), and Adults (25–60 years).


What

  • Main findings:

    • Child household contacts exposed to youth index patients had a lower prevalence of TB infection at enrollment compared with those exposed to adult index patients (adjusted PRR = 0.77; 95% CI: 0.67–0.87).

    • Index patient age was not associated with the incidence of TB infection among household contacts over 12 months.

    • Children and youth contacts had significantly lower incidence of TB infection than adult contacts, regardless of index patient age.

    • Whole-genome sequencing (WGS) showed a lower proportion of genetically linked transmission pairs for youth index patients compared with adults, though this difference was not statistically significant.

  • Interpretation:

    • Youths appear to contribute less to within-household TB transmission than adults, suggesting that their transmission risk may occur more often outside the household.


When

  • Study period: September 2009 to August 2012.

  • Follow-up duration: 12 months after household enrollment.


Where

  • Setting: Lima, Peru.

  • Healthcare context: 106 public health centers serving approximately 3 million people.


Why

  • To determine whether the age of TB index patients, particularly youth (15–24 years), influences the risk of TB transmission to household contacts, with a focus on children as a marker of recent transmission.

  • To address gaps in understanding age-specific transmission dynamics and inform targeted TB control strategies.


How

  • Study design: Prospective household cohort study.

  • TB infection assessment:

    • Baseline tuberculin skin test (TST) to measure prevalence.

    • Repeat TSTs at 6 and 12 months to measure incidence.

  • TB disease classification:

    • Co-prevalent TB (≤14 days after enrollment) vs secondary TB (>14 days).

  • Transmission confirmation:

    • Whole-genome sequencing of Mycobacterium tuberculosis isolates to assess genetic linkage between index and secondary cases.

  • Analysis:

    • Multivariable regression and survival analyses adjusting for demographic, behavioral, socioeconomic, and nutritional factors.

Source: Brooks, M.B., Lecca, L., Becerra, M.C., Calderon, R.I., Contreras, C.C., Jimenez, J., Yataco, R.M., Zhang, Z., Murray, M.B. and Huang, C.C., 2025. The Role of Youths in Within-Household Tuberculosis Transmission: A Household Contact Cohort Study. Clinical Infectious Diseases, p.ciaf490.

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