The effectiveness of strategies to improve people's access to treatment for tuberculosis

December 7, 2017, Liverpool School of Tropical Medicine
This photomicrograph reveals Mycobacterium tuberculosis bacteria using acid-fast Ziehl-Neelsen stain; Magnified 1000 X. The acid-fast stains depend on the ability of mycobacteria to retain dye when treated with mineral acid or an acid-alcohol solution such as the Ziehl-Neelsen, or the Kinyoun stains that are carbolfuchsin methods specific for M. tuberculosis. Credit: public domain

In a new Cochrane Review, researchers from Tanzania working with colleagues in LSTM have evaluated the effectiveness of strategies to improve people's access to treatment for tuberculosis (TB).

Every year, miss finding nearly four million people infected with . Evaluating the available evidence on diagnosis-supporting strategies, such as outreach screening, health promotion, outreach clinics, and active case-finding, the authors examined 17 randomized and non-randomized controlled studies to see which interventions were most effective.

While the authors found that there was evidence that house-to-house screening for and specialized diagnostic clinics may increase tuberculosis case detection, this was only where the prevalence of undiagnosed disease is high (> 5 percent), and there was not enough evidence to determine if any of the interventions decreased long-term disease prevalence.

Dr. Francis Mhimbira, Head of the Department of Intervention and Clinical Trials at the Ifakara Health Institute and first author of the review, said: "In our review, we found no evidence reduction in long-term tuberculosis prevalence in areas where tuberculosis case detection interventions were implemented. However, these findings come from only one study, and therefore it is difficult to draw conclusion. More studies have to evaluate the long-term impact of their interventions on tuberculosis prevalence so that health authorities can prioritize their resources effectively and work with the scientific community to provide evidence for the effectiveness of interventions."

While early diagnosis is desired, this could also cause problems that might not be anticipated, such as people not completing because they feel better before the disease is cleared. This is not only a problem for the patient but one that could contribute to drug-susceptible TB becoming more resistant, so Dr. Mhimbira and the team believe that the importance of completing treatment should be emphasized throughout interventions.

Dr. Mhimbira states that more is needed to be able to show the true impact of these interventions: "A guide especially on case definition of tuberculosis based on the standard highly sensitive diagnostic tools should be employed so that we can compare results from many settings. There is a need for political commitment and willingness to make bold decisions to take on interventions with potential to increase tuberculosis case detection and improve tuberculosis treatment outcome."

Explore further: Progression from infection to pulmonary tuberculosis follows distinct timeline

More information: Francis A Mhimbira et al. Interventions to increase tuberculosis case detection at primary healthcare or community-level services, Cochrane Database of Systematic Reviews (2017). DOI: 10.1002/14651858.CD011432.pub2

Related Stories

Progression from infection to pulmonary tuberculosis follows distinct timeline

November 16, 2017
Researchers have uncovered a sequence of biological processes that occur in humans infected with the bacterium Mycobacterium tuberculosis as the infection progresses to pulmonary tuberculosis, according to new research published ...

Little evidence to support TB interventions in real-world, low-resource settings

December 18, 2012
There is little evidence from real world situations in low-and-middle income countries to support the effectiveness and financial value of five interventions* recommended by the World Health Organization (WHO) to control ...

Screening for latent tuberculosis infection recommended for those at increased risk

September 6, 2016
The U.S. Preventive Services Task Force (USPSTF) recommends screening for latent tuberculosis infection in populations at increased risk. People who are considered at increased risk include people who were born in or have ...

Model assesses interventions for bovine tuberculosis in Morocco

February 2, 2017
n many developing countries, a significant fraction of the tuberculosis burden comes potentially from the tuberculosis bacteria carried by animals, essentially cattle. Efforts to reduce the tuberculosis burden, therefore, ...

Multidrug-resistant TB set to increase through 2040

May 11, 2017
(HealthDay)—Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis are expected to increase through 2040, according to a study published online May 9 in The Lancet Infectious Diseases.

HIV: The benefits of prophylaxis of tuberculosis are confirmed

October 11, 2017
A long-term follow-up study in the ANRS TEMPRANO trial confirms that tuberculosis chemoprophylaxis in HIV-infected people is more than ever relevant in resource-limited countries. This prophylactic use of drugs reduces mortality, ...

Recommended for you

A multimodal intervention to reduce one of the most common healthcare-acquired infections

March 16, 2018
Surgical site infections are the most frequent health care-associated infections in developing countries. According to the World Health Organization (WHO), this type of infection can affect up to one-third of surgical patients ...

After infection, herpes lurks in nerve cells, ready to strike—New research reveals what enables the virus to do so

March 15, 2018
Once herpes simplex infects a person, the virus goes into hiding inside nerve cells, hibernating there for life, periodically waking up from its sleep to reignite infection, causing cold sores or genital lesions to recur.

New imaging approach offers unprecedented views of staph infection

March 14, 2018
Eric Skaar, PhD, MPH, marvels at the images on his computer screen—3-D molecular-level views of infection in a mouse. "I'm pretty convinced that these are the most advanced images in infection biology," said Skaar, Ernest ...

Parasitic worms need their intestinal microflora too

March 14, 2018
Scientists at The University of Manchester have cast new light on a little understood group of worm infections, which collectively afflicts 1 in 4 people, mainly children—in the developing the world.

Compound scores key win in battle against antibiotic resistance

March 14, 2018
Researchers at Oregon State University have made a key advance in the fight against drug resistance, crafting a compound that genetically neutralizes a widespread bacterial pathogen's ability to thwart antibiotics.

Helicobacter creates immune system blind spot

March 13, 2018
The gastric bacterium H. pylori colonizes the stomachs of around half the human population and can lead to the development of gastric cancer. It is usually acquired in childhood and persists life-long, despite a strong inflammatory ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.