TB remains a major public health problem in the Philippines, which is among the 30 highest TB-burden countries. While treatment success rates are often used as indicators of programme performance, recurrence rates provide a more objective measure of long-term treatment effectiveness. Currently, the Philippines has limited data on recurrent TB.This cohort from an active TB surveillance study in San Juan, Batangas (2013-2015), was followed up from March 2018 to January 2022. Recurrent TB, defined as an active TB case diagnosed and treated before with anti-TB drugs, was identified using national guidelines. Socio-demographic and clinical data were obtained from interviews and medical records. Incidence rates (per 1,000 person-years) and factors associated with recurrence were analysed using Cox proportional hazards models.A total of 284 individuals were followed up for a median of 7.1 years, during which 71 participants (25%) developed recurrent TB, corresponding to an incidence rate of 38.3 cases per 1,000 person-years. Most recurrent cases were clinically diagnosed (87%) and occurred more than 2 years after the initial episode. Older age and lower socio-economic status were significantly associated with recurrence (P < 0.01).Using pragmatic study design, we found TB recurrence is common in this high-burden setting..
Peer-led education has shown effectiveness in improving adherence and psychosocial outcomes for HIV and chronic disease through shared experience and social learning. Despite its potential, peer involvement remains underutilised in TB care, particularly in low-income settings. Existing studies primarily focus on microbiological cure and treatment completion with minimal attention to patient-reported outcomes such as quality of life, disability, and mental health.The aim of this study is to evaluate the effect of a peer-led educational intervention on treatment success, quality of life, disability, and depression among adults with drug-susceptible pulmonary TB in South Omo and Ari zones, in southern Ethiopia.A cluster randomised controlled trial will be conducted in 30 randomly selected health facilities, enrolling 250 participants. Data will be collected at three time points using structured questionnaires. Mixed-effects logistic regression will assess treatment outcomes. Changes in quality of life, disability, and depression will be analysed using generalised estimating equations. Statistical significance will be set at P < 0.05 with 95% confidence intervals.The study aims to provide evidence on whether peer-led education improves TB treatment and psychosocial outcomes, informing patient-centred TB control strategies in Ethiopia..
Non-adherence to TB treatment is associated with substantially increased mortality risk among children, yet determinants of unsuccessful treatment outcomes remain under-recognised. We examined factors associated with unsuccessful TB treatment outcomes among children and adolescents in Indonesia from 2018 to 2023.We conducted a retrospective cohort study using the National TB Registry, including 509,290 patients aged 0-19 years with evaluated treatment outcomes. Outcomes were classified as successful (cured or treatment completed) or unsuccessful (death, loss to follow-up, or treatment failure). Multivariable logistic regression was used to identify factors associated with unsuccessful outcomes.Adolescents aged 10-19 years had higher odds of unsuccessful treatment compared with children aged 0-4 years (adjusted odds ratio [AOR]: 1.25, 95% confidence interval [CI]: 1.21-1.28). The strongest predictors of unsuccessful outcomes were drug-resistant TB (AOR: 21.90, CI: 8.58-60.10), HIV co-infection (AOR: 3.70, CI: 3.35-4.08), and retreatment status (AOR: 1.98, CI: 1.83-2.14). Marked geographic disparities were observed, with significantly higher odds in Eastern Indonesia (AOR: 2.80, CI: 2.71-2.91).Adolescents and children with drug-resistant TB and HIV co-infection, or those receiving retreatment, face markedly increased risks of unsuccessful outcomes, alongside substantial geographic inequities. Strengthened adherence support and regionally targeted interventions are urgently needed..
Community TB screening using chest X-ray (CXR) is recommended for high-burden settings. The sensitivity of CXR for community screening is regarded high but may be overestimated due to incorporation bias. We conducted a meta-reanalysis of data used to provide more accurate estimates for CXR sensitivity.We considered 23 studies from a published systematic review and meta-analysis where participants were screened for TB using a combination of TB symptoms and CXR and received bacteriological sputum testing as the reference standard. We compared the sensitivity of CXR among symptom screen-positive study participants to that among all study participants.Twenty-one studies were included for the meta-reanalysis. The pooled sensitivity (95% confidence interval) of CXR among symptom screen-positive participants was 86% (83%-90%), lower than the pooled sensitivity based on all study participants (94% [92%-96%]) reported in the original meta-analysis. The pooled difference in sensitivity between the two approaches was 6% (4%-8%).The sensitivity of CXR among symptomatic participants was lower than the published sensitivity, indicating incorporation bias. The sensitivity among symptomatic participants should be considered the realistic maximum sensitivity for community screening; the combined sensitivity for symptomatic and asymptomatic TB is likely lower..
TB remains a major global health challenge causing significant morbidity and mortality. Miliary TB, a severe form of the disease, remains poorly characterised in large cohorts, and often has poor outcomes, especially in high-prevalence resource-poor settings.This retrospective cohort study characterises diagnostic and clinical features of miliary TB in 84 confirmed cases over 9 years (2014-2022) across East London, UK. Demographic, clinical, microbiological, biochemical, and imaging data were collected retrospectively from electronic health records of all consecutive patients diagnosed with miliary TB at a large hospital trust.The central nervous system (CNS) was the most common site of extra-pulmonary spread after intra- and extra-thoracic lymph nodes. Neurological symptoms were unreliable indicators of CNS involvement, supporting routine magnetic resonance imaging (MRI) brain for all miliary TB patients regardless of symptoms, given its superior sensitivity over lumbar puncture and computed tomography (CT) brain. Admission hyponatraemia, thrombocytopaenia, and lymphopaenia all predicted increased duration of hospital stay, supporting their use as biomarkers of disease severity.Routine MRI brain should be considered for all miliary TB patients, and admission hyponatraemia robustly predicts increased disease severity. These findings help inform clinical decision making and guidelines for the management of miliary TB..
New near-point-of-care, swab-based molecular tests for TB offer substantial operational advantages including improved accessibility and cost. However, early data suggest some loss of sensitivity: in particular, these tests tend to miss the lowest-positive molecular signals, such as ‘trace’ Xpert MTB/RIF Ultra sputum test results. Recent cohort studies suggest most trace signals represent TB disease, even if not currently confirmable by culture. However, the underdiagnosis arising from reduced sensitivity will be greatest in populations with mild disease, where immediate clinical and transmission risks may be lowest and benefits of expanded access may be greatest. Altered test characteristics may also alter empiric TB treatment practices, with variable effects on over-diagnosis. The improved access and yield offered by near-point-of-care platforms and swab specimens are likely to justify these tradeoffs, more than offsetting detrimental effects on case detection in most contexts. Implementation strategies are proposed to mitigate potential harms.
Adherence to TB treatment is crucial for successful outcomes. While facility-based directly observed therapy (FB-DOT) is a common strategy, recognition of its limitations has spurred the development of flexible approaches. We have compared the effectiveness of alternative adherence-enhancing strategies with FB-DOT.We searched three databases and four registries from June 2013 to May 2025. We included comparative studies evaluating interventions designed to improve adherence to TB treatment in people aged 15 years or older, excluding adherence to multiple therapies. Meta-analyses were conducted for treatment success, treatment completion, cure rate, and loss to follow-up.Twenty-five studies involving 19,103 participants were included. Self-administered treatment and reminder-based interventions achieved treatment success comparable to FB-DOT. Community-based DOT showed similar cure and completion rates but was effective at reducing loss to follow-up (71% reduction). Video-supported treatment and digital adherence technologies demonstrated neutral effects across treatment outcomes. Multicomponent strategies showed heterogeneous results.Alternative adherence strategies can offer improvements over FB-DOT in specific contexts. However, their variable effectiveness limits universal implementation. Adherence support, community engagement, and social determinants should guide programmatic design and implementation.
Recent trends and treatment outcomes of TB among people living with HIV (PLHIV) have been understudied in Korea.Using the nationwide K-TB-N cohort, we identified individuals with TB registered between 2011 and 2022. Among 373,812 TB cases, 931 had TB-HIV co-infection. TB treatment outcomes were compared between PLHIV and the general population using propensity score matching. Multivariable Cox proportional hazards models, including stratified and sensitivity analyses, were used to identify factors associated with death during TB treatment among PLHIV.Most of TB-HIV patients were males (91.9%), under 60 years old (82.1%), and approximately 90% received antiretroviral therapy (ART). The number of TB-HIV cases declined from 120 in 2011 to 35 in 2022. Lost to follow-up and not evaluated outcomes decreased over time, whereas mortality remained stable at 10%-20%. The overall TB treatment success rate was 76.9% and mortality was higher than general population. Mortality was associated with older age and comorbidity burden, whereas ART showed a protective association only when initiated before TB diagnosis.TB incidence among PLHIV in South Korea has declined over the past decade, but mortality during TB treatment remains high, driven largely by host-related factors including age and comorbidities..
TB and mental health integration is an essential element of people-centred care. To assess its feasibility, the WHO conducted demonstration pilots in Ghana, Kenya, and Pakistan. A four-phase implementation process was developed and implemented, with engagement of key stakeholders at the national and sub-national levels. Each country implemented a tailored approach. Ghana identified three facilities representing different levels of care. Kenya implemented in two counties with existing mental health infrastructure. Pakistan implemented across an entire district with sub-optimal TB outcomes. Across all sites, TB and mental health integration was recognised as essential and feasible to improve people-centred care.
Two-month smear conversion has been adopted instead of cultures to predict unfavourable bacteriological outcomes in TB treatment. However, this approach is limited by lower sensitivity and specificity.In absence of early-stage biomarkers of treatment response, we investigated the association between bacteriological outcome and microscopy data with auramine and fluorescein diacetate stains at baseline and during the first 2 weeks of treatment in the context of the OneRIF trial. This is a secondary analysis of data collected during the OneRIF trial.Failure or relapse occurred in 15 patients of 321 treated with double-dose R. Only quantitative baseline auramine significantly predicted failure or relapse: for every 100 bacilli per field increase, there was 5% higher odds of having an unfavourable bacteriological outcome.While quantitative baseline auramine predicted having an unfavourable bacteriological outcome, considering our small data we could not identify any added value in implementing quantitative bacillary load in the first 2 weeks of treatment. These findings should be interpreted with caution as we were limited by the relatively low number of failure and relapse.
