Full Answer
What is the TB Partnership for Botswana?
The partnership between the U.S. Centers for Disease Control and Prevention (CDC) and the Government of Botswana began in 1995 with the goal of strengthening tuberculosis (TB) prevention and control through public health research.
What is CDC Botswana doing to fight AIDS?
CDC Botswana supports the Ministry of Health and Wellness (MOHW) through the President’s Emergency Plan for AIDS Relief (PEPFAR) Botswana and CDC headquarters.
What is the US government doing to help Botswana?
With support from the U.S. President’s Emergency Plan for AIDS Relief, CDC’s Botswana office continues to support Botswana’s Ministry of Health and Wellness with services including HIV testing, antiretroviral treatment, prevention of mother-to-child transmission of HIV, voluntary medical male circumcision, and TB prevention and control programs.
Why are TB eradication efforts stymied in poor countries?
Drug resistance, and the consequent need for long-term multidrug therapy have stymied TB eradication efforts particularly in poor countries with the highest disease burden.
Why is there no cure for TB?
In most cases, TB is treatable and curable; however, people with TB can die if they do not get proper treatment. Sometimes drug-resistant TB occurs when bacteria become resistant to the drugs used to treat TB. This means that the drug can no longer kill the TB bacteria.
Why is tuberculosis more common in poor countries?
TB is more common in countries where many people live in absolute poverty because people are more likely to: live and work in poorly ventilated and overcrowded conditions, which provide ideal conditions for TB bacteria to spread. suffer from malnutrition and disease – particularly HIV – which reduces resistance to TB.
Which country does not increase risk of TB?
TB low burden countries Canada, the United States of America, Australia & New Zealand also have among the lowest rates. In these countries the incident rate is less than 10 cases per 100,000 population per year.
Why is TB a problem in South Africa?
The country's TB epidemic is driven by a number of factors including low socio-economic status and a high HIV co- infection burden. Additionally, delayed health-seeking behaviour among individuals with TB, as well as a high burden of undiagnosed disease in communities also drive the TB epidemic.
Why TB is called disease of poverty?
TB is often known as “a disease of the poor” because the burden of TB follows a strong socioeconomic gradient both between and within countries, and also within the poorest communities of countries with high TB incidence [2].
How can developing countries prevent tuberculosis?
Three major strategies for controlling TB are BCG vaccination of children, chemoprophylaxis, and case-finding/treatment. Total coverage with BCG can prevent 40%-70% of deaths from TB among children and reduce total TB mortality by approximately 6% (1).
WHO TB high burden countries?
In 2020, the 30 high TB burden countries accounted for 86% of new TB cases. Eight countries account for two thirds of the total, with India leading the count, followed by China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa.
What countries are high risk for TB?
High Risk Countries for Tuberculosis InfectionAfrica.Eastern Mediterranean.Europe.South-East Asia.The Americas.Western Pacific.
Where is tuberculosis most common?
Most of the people who fall ill with TB live in low- and middle-income countries, but TB is present all over the world. About half of all people with TB can be found in 8 countries: Bangladesh, China, India, Indonesia, Nigeria, Pakistan, Philippines and South Africa.
Why is tuberculosis most common in Africa?
The unprecedented growth of the tuberculosis epidemic in Africa is attributable to several factors, the most important being the HIV epidemic. Although HIV is Africa's leading cause of death, tuberculosis is the most common coexisting condition in people who die from AIDS (see radiograph).
Where is TB most prevalent in South Africa?
Stats SA's June 2021 report found TB remained the leading cause of death in the three years from 2016 - 2018. Boffa said a recent prevalence study found that eThekwini in KwaZulu-Natal province has the highest rate of TB in the country at 737 per 100,000 population.
Is South Africa high risk for TB?
With TB incidence in SA remains one of the highest in the world with 834 cases per 100,000 people [20] and these studies demonstrate the potential to improve case detection through systematic screening of persons with DM, however the evidence to support this is lacking.
Why is TB found in developing countries?
TB occurs more frequently among low-income people living in overcrowded areas and persons with little schooling (11). Poverty may result in poor nutrition which may be associated with alterations in immune function.
Is poverty a risk factor for TB?
Although poverty is widely recognized as an important risk factor for tuberculosis (TB) disease, the specific proximal risk factors that mediate this association are less clear. The objective of our study was to investigate the mechanisms by which poverty increases the risk of TB.
Why is tuberculosis most common in Africa?
The unprecedented growth of the tuberculosis epidemic in Africa is attributable to several factors, the most important being the HIV epidemic. Although HIV is Africa's leading cause of death, tuberculosis is the most common coexisting condition in people who die from AIDS (see radiograph).
Where in the world is tuberculosis most common?
Global impact of TB TB occurs in every part of the world. In 2020, the largest number of new TB cases occurred in the WHO South-East Asian Region, with 43% of new cases, followed by the WHO African Region, with 25% of new cases and the WHO Western Pacific with 18%.
When did the CDC start working with Botswana?
CDC’s partnership with the Government of Botswana dates to 1995 when the agency began public health research into methods for strengthening tuberculosis (TB) prevention and control.
What is CDC Botswana?
CDC Botswana supports the Ministry of Health and Wellness (MOHW) through the President’s Emergency Plan for AIDS Relief (PEPFAR) Botswana and CDC headquarters. Our implementing partners (IPs) support Botswana’s antiretroviral treatment (ART), prevention of mother-to-child transmission (PMTCT) and TB programs, and work with ...
What is CDC support in Botswana?
CDC support to Botswana includes linkage to and retention in HIV treatment services, as well as quality of these services. The voluntary medical male circumcision (VMMC) program, through static sites and in- and out-of-school campaigns, helps to keep boys and men HIV-free. Our IPs enhance quality services through training, mentoring and supportive supervision and routine, comprehensive site monitoring visits, and remediation plans. CDC supports quality laboratory testing necessary for the diagnosis and treatment of people living with HIV and with TB. Our strategic information support is critical to the development, implementation and dissemination of population-based surveys as well as the quality of national health information systems and PEPFAR monitoring and evaluation systems. Our science program contributes generalizable knowledge related to HIV and TB. CDC supports the MOHW to enhance cervical cancer detection and prevention programs and with the establishment of the Botswana Public Health Institute.
Where was the study conducted in Botswana?
The study was conducted in the four main geographic regions of Botswana—the south-east, central/north-east, north-west (Ngamiland, Chobe), and western (Gantsi, Kgalagadi) to capture a good mix of ethnic groupings. Two health districts from each of these four regions were selected. The aim was to provide a range of study sites distributed across the country. The 8 health districts represent roughly 28.5% of the 28 health districts in Botswana’s health system. The 8 districts were considered as manageable within the resource and time constraints of the study.
What is the knowledge attitude and practice of HIV in Botswana?
The Botswana tuberculosis HIV Knowledge Attitude and Practice study sought to assess knowledge, attitudes and practices of communities on TB and identify sources of their information on this disease and HIV. Specific objectives of the study were to: (a) collect baseline information on the knowledge, attitudes, and practices about tuberculosis treatment seeking and adherence behaviors in Botswana. (b) Identify barriers which discourage people who may have smear positive tuberculosis from testing and getting treatment (e.g. social stigma) and constraints which prevent them from initiating and completing treatment.
What is the CDC doing in Botswana?
As a key implementer of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), CDC works closely with Botswana’s Ministry of Health & Wellness (MOH) to build a robust national HIV response including:
When will Botswana develop a national surveillance system?
CDC supported Botswana to develop National Surveillance Guidelines for human infection with COVID-19 in 2020
How many people with TB will be tested for HIV in 2020?
99% of patients with confirmed TB were tested for HIV as of September 2020
What is the IDSr in Botswana?
Botswana has made significant progress adopting the Integrated Disease Surveillance and Response (IDSR) guidelines to facilitate surveillance and timely response to disease outbreaks. This is in line with the WHO 2005 International Health Regulations. With CDC support, the Field Epidemiology Training Program (FETP) strengthens the public health workforce for real time disease surveillance.
Why is TB a fundamental problem?
A fundamental problem in the treatment of tuberculosis (TB) is the long duration of therapy required for cure. The recalcitrance of Mycobacterium tuberculosis(MTB) to eradication is thought to result from its achieving a nonreplicating (dormant) state in the host. Because virtually all classes of antibiotics require bacterial replication for their action, the nonreplicating state is thought to render MTB phenotypically resistant to otherwise bactericidal antibiotics.
How does drug resistance affect TB?
In the absence of an effective vaccine, TB eradication is dependent on curing infected individuals who are either contagious or may become contagious after reactivation of latent infection. The relative lack of protective immunity provided by natural infection makes control all the more dependent on complete bacterial eradication from the population, since individuals who are cured of TB remain vulnerable to reinfection [18,19]. Drug resistance, and the consequent need for long-term multidrug therapy have stymied TB eradication efforts particularly in poor countries with the highest disease burden. Poor adherence to therapy also has led to an alarming increase in multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains [20], which are associated with high morbidity and mortality [21,22]. Hence the critical need for new drugs to shorten treatment of drug-sensitive TB, and to treat MDR- and XDR-TB.
What is the nonreplicating state of tuberculosis?
tuberculosisin the host, that renders the bacteria phenotypically resistant to killing by both host immune mechanisms and antibiotics.
How long does it take to cure MTB?
Treatment of MTB with isoniazid (INH), a drug that targets cell wall synthesis, causes a 3-log reduction in broth culture in two hours [9,10], whereas more than 14 days of therapy are required to achieve a 3-log reduction in viable bacterial counts in the sputum during active TB [11,12] and several months of treatment are required to eradicate latent TB (Table 1). The role of pyrazinamide in shortening TB therapy to six months may also suggest the existence of a nonreplicating population in vivo, as, unlike other anti-TB drugs, pyrazinamide is more active against nonreplicating than actively replicating MTB in vitro [13,14]. Phenotypic antibiotic resistance likely accounts for the need for longer antibiotic therapy in many bacterial infections, presenting a universal obstacle to the treatment of infectious diseases ([15–17] and Table 1).
Why is multidrug therapy needed?
MTB can exhibit genetic resistance that is heritable and fixed, as well as phenotypic, reversible resistance to administered antibiotics. The presence of genetic drug resistance in some or all of the infecting bacteria dictates the need for multidrug therapy [2,4]. The greater the bacterial burden, the more likely that it contains genetically resistant mutants [5]. Therapy failure due to genetic resistance is related to the frequency of preexisting resistant mutants and their enrichment by selective pressures imposed by inadequate therapy [4]. Simultaneous use of multiple anti-TB drugs makes it less likely that a mutant resistant to a single agent will survive.
Is streptomycin effective for TB?
Soon after the discovery of streptomycin it became clear that while many patients with TB treated with this drug initially improved dramatically, most developed streptomycin-resistant strains so that there was little improvement in mortality over untreated patients [1]. The development of new antibiotics led to the realization that there were two requisites for effective cure: treatment with multiple antibiotics and long therapy [2]. Indeed, the minimum length of treatment and number of drugs required for cure has been more carefully tested for TB than for most infectious diseases (see [3] and Table S1).
Is MTB phenotypic or phenotypic?
MTB also exhibits phenotypic drug resistance. In patients who relapse early after appropriate multidrug therapy, the bacteria remain genetically susceptible to the initial antibiotics and cure is achieved by additional treatment with the same regimen [6,7]. This phenomenon may be due to a subpopulation of nonreplicating bacteria that survives until antituberculous therapy is stopped and causes relapse as it resumes growth in the absence of antibiotics. Long-term antibiotic treatment may cure the infection by eradicating these bacterial populations as they periodically leave the nonreplicating state. Further supporting this theory of MTB's development of a nonreplicating and therefore phenotypically resistant state in vivo is the observed discrepancy between in vitro and in vivo antibiotic killing [8].
