Knowledge of Tuberculosis Among Drug Users)Relationship to Return Rates for Tuberculosis Screening at a Syringe Exchange)

اختصاصی از فی لوو Knowledge of Tuberculosis Among Drug Users)Relationship to Return Rates for Tuberculosis Screening at a Syringe Exchange) دانلود با لینک مستقیم و پر سرعت .

Abstract – Tuberculosis is an important health issue among drug users. We sought to evaluate active
drug users’ (DUs) knowledge of tuberculosis (TB) and to assess the relationship between TB knowledge
and attitudes and tuberculin skin test (TST) return rates at a syringe exchange program. DUs were
recruited at a syringe exchange program in New York City, were interviewed and offered TSTs, and
received $15.00 upon returning for TST reading. The questionnaire evaluated knowledge of TB transmission,
prevention, and treatment. From March 13, 1995 to January 31, 1996, 610 of 650 (94%) of DUs
approached agreed to participate. Of these, 80% had previous TSTs within the past 2 years and 20%
were known to be HIV infected. Almost all knew that TB is contagious and more than two thirds knew that
TB is treatable and that TB preventive therapy existed. However, fewer than half knew that HIV-related
TB could be treated, 30% thought TB could be treated without a medical doctor, and the majority (70%)
thought a reactive TST implied infectivity. The rate of return for TST reading was 93%. In multivariate
analysis, those who knew that HIV-related TB was curable were more likely to return for TST reading
(odds ratio 2.0; 95% confidence interval 1.04 to 3.95; p
5 .03). The high acceptance and return rates
suggest that TB services can be incorporated into syringe exchange programs. However, several important
gaps in TB knowledge existed in this population at high risk of TB, which may impact on adherence
and which support the need for TB education for drug users. © 1999 Elsevier Science Inc. All rights
reserved

Contact tracing and population screening for tuberculosis – who should be assessed?

اختصاصی از فی لوو Contact tracing and population screening for tuberculosis – who should be assessed? دانلود با لینک مستقیم و پر سرعت .

Abstract

Benjamin R. Underwood, Veronica L. C. White, Tim Baker, Malcolm Law
and John C. Moore-Gillon

Background The aim of the study was to investigate the
relative effectiveness of four strategies in detecting and preventing
tuberculosis: contact tracing of smear-positive pulmonary
disease, of smear-negative pulmonary disease and
of non-pulmonary disease, and screening new entrants.
Methods An analysis of patient records and a TB database
was carried out for an NHS Trust-based tuberculosis service
in a socio-economically deprived area. Subjects were contacts
of all patients treated for TB between 1997 and 1999.
New entrants were screened in 1999. Outcomes measured
were numbers of cases of active tuberculosis detected and
numbers of those screened given chemoprophylaxis.
Results A total of 643 contacts of 227 cases of active TB were
seen, and 322 new entrants to the United Kingdom. The highest
proportion of contacts requiring full treatment or chemoprophylaxis
were contacts of smear-positive index cases (33
out of 263 contacts; 12.5 per cent). Tracing contacts of those
with smear-negative pulmonary tuberculosis (12 out of 156;
7.7 per cent) and non-pulmonary disease (14 out of 277;
6.2 per cent) was significantly more effective in identifying
individuals requiring intervention (full treatment or chemoprophylaxis)
than routine screening of new entrants (10 out
of 322; 3.1 per cent).
Conclusions Screening for TB of new entrants to the United
Kingdom is part of the national programme for control and
prevention of TB, whereas tracing contacts of those with
smear-negative and non-pulmonary disease is not. This study
demonstrates that, in our population, the contact-tracing
strategy is more effective than new entrant screening. It is not
likely that the contacts have caught their disease from the
index case, but rather that in high-incidence areas such as
ours such tracing selects extended families or communities at
particularly high risk.
Keywords: tuberculosis, contact tracing, immigrants, cost
effectiveness

From contact investigation to tuberculosis screening of drug addicts and homeless persons in Rotterdam

اختصاصی از فی لوو From contact investigation to tuberculosis screening of drug addicts and homeless persons in Rotterdam دانلود با لینک مستقیم و پر سرعت .

Background: In early 2001 there were indications that tuberculosis (TB) was increasingly becoming a
problem among drug addicts and homeless persons in Rotterdam, after a periodical screening was
discontinued in 1997. A contact investigation around a homeless drug addicted man in Rotterdam
with infectious pulmonary TB is described. Contact investigation: A total of 507 drug addicts, homeless
persons, and staff of facilities for these risk groups were examined with tuberculin skin testing (TST) and
chest radiography. DNA fingerprinting of mycobacteriological cultures through Restricted Fragment
Length Polymorphism methodology and molecular epidemiology investigation through cluster analysis
were performed. Outcome: TST showed an infection prevalence of 29%, especially among staff of services
for drug addicts and homeless persons. Six persons with active intrathoracic TB were identified. Cluster
analysis demonstrated no relation with the initial case but showed intense transmission of TB among
drug addicts and homeless persons in Rotterdam by multiple sources. As a consequence of the findings, a
proposal to the Council of the City of Rotterdam resulted in the re-introduction of a comprehensive TB
screening programme among these risk groups with mobile digital X-ray units (MXUs). Conclusion: This
contact investigation gradually obtained the characteristics of a screening of drug addicts and homeless
persons. Novel technologies, such as MXUs, facilitate appropriate and efficient outreach approaches to
TB control among difficult-to-reach groups. This method and knowledge of individual fingerprints and
clusters of TB patients are indispensable for underpinning proposals for change of local TB control
strategies and convincing local authorities of the rationale.
Keywords: DNA fingerprinting, policy implications, risk groups, screening, tuberculosis

Screening for tuberculosis among 2381 household contacts of sputum-smear-positive cases in The Gambia

اختصاصی از فی لوو Screening for tuberculosis among 2381 household contacts of sputum-smear-positive cases in The Gambia دانلود با لینک مستقیم و پر سرعت .

Dolly Jackson-Sillaha, Philip C. Hill a,∗, Annette Foxa, Roger H. Brookesa,
Simon A. Donkora, Moses D. Lugosa, Stephen R.C. Howiea,
Katherine R. Fielding b, Adama Jallowc, Christian Lienhardtd,
Tumani Corraha, Richard A. Adegbolaa, Keith P. McAdama

Summary Contact investigation is a key component of tuberculosis (TB) control in developed,
but not developing, countries. We aimed to measure the prevalence of TB among household
contacts of sputum-smear-positive TB cases in The Gambia and to assess the sensitivity of an
enzyme-linked immunospot (ELISPOT) assay in this regard. Household contacts of adult smearpositive
TB patients were assessed by questionnaire, purified protein derivative (PPD) skin test,
ELISPOT assay, physical examination, chest X-ray and sputum/gastric aspirate. Thirty-three
TB cases were identified from 2174 of 2381 contacts of 317 adult smear-positive pulmonary
TB patients, giving a prevalence of 1518/100 000. The cases identified tended to have milder
disease than those passively detected. The sensitivity of ESAT-6/CFP-10 ELISPOT test as a
screening test for TB disease was estimated as 71%. Fifty-six per cent of contacts with a PPD
skin test result ≥10mm induration had detectable responses to ESAT-6/CFP-10 by ELISPOT; 11%
with a negative PPD skin test (<10mm) had a positive ESAT-6/CFP-10 response. Active screening
for TB among contacts of TB patients may have a role in TB control in The Gambia. These individuals
are a high-risk group, and the disease identified is less advanced than that found through
passive case detection. An ELISPOT assay was relatively insensitive as a screening test for TB.
© 2007 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights
reserved.