Publications by authors named "Silvia S Chiang"

Background: Tuberculosis, even when successfully treated, frequently leads to long-term sequelae, known as post-tuberculosis lung disease (PTLD). Adolescents account for over 1 million incident tuberculosis cases each year, and PTLD in this population may contribute greatly to the global burden of chronic lung disease. However, research to better understand and prevent adolescent PTLD is hampered by uncertainty regarding which tools best assess respiratory disability and lung function in this population.

View Article and Find Full Text PDF

Background: Over 200,000 pregnant people fall ill with tuberculosis (TB) annually. Little is known about the impact of pregnancy on TB outcomes.

Methods: This study used surveillance data from Brazil's Ministry of Health.

View Article and Find Full Text PDF

Background: Approximately 2% of the global population has survived tuberculosis (TB). Increasing evidence indicates that a significant proportion of pulmonary TB survivors develop TB-associated respiratory impairment and disability-commonly referred to as post-TB lung disease-marked by impaired respiratory function, persistent symptoms and activity limitations. However, the prevalence, risk factors and progression of TB-associated respiratory disability throughout the life course are not well understood.

View Article and Find Full Text PDF

Objective: To identify the barriers and facilitators of adolescent-friendly tuberculosis (TB) services among adolescents with drug-susceptible TB (DS-TB), as defined by the WHO's Adolescent-Friendly Services (AFS) framework, in Lima, Peru.

Design: We conducted in-depth interviews using semistructured interview guides. Data were analysed using the framework method, in which themes were mapped onto four of the five dimensions of care in the WHO's AFS framework: accessibility, acceptability, appropriateness and effectiveness.

View Article and Find Full Text PDF

Tuberculosis (TB) remains a major global health challenge. Children, adolescents, and young mothers are high-risk populations for TB with unique challenges and needs. Children are often misdiagnosed or diagnosed too late, resulting in long-term sequelae or mortality, while adolescents, despite having more recognizable adult-type TB and being an important source of community transmission, can be difficult to engage in care as they often fall between pediatric and adult models of care.

View Article and Find Full Text PDF

Introduction: During adolescence, tuberculosis incidence rises, with a greater increase in males compared with females. Tuberculosis notifications and estimates infrequently disaggregate adolescent age groups. Moreover, the factors that drive the increases in overall incidence and the male-to-female (MF) ratio remain unclear.

View Article and Find Full Text PDF

Background: While the immediate effects of pulmonary tuberculosis are well-documented, respiratory impacts persisting beyond treatment, particularly in children and adolescents, are less understood. This systematic review aimed to evaluate the current evidence on tuberculosis-associated respiratory impairment and disability in children and adolescents following tuberculosis treatment.

Methods: We searched MEDLINE, Embase, CENTRAL, Global Index Medicus, and preprints from January 1, 2004, to December 5, 2024, to identify studies enrolling children (0-9 years old) or adolescents (10-19 years old) who completed treatment for microbiologically confirmed or clinically diagnosed pulmonary tuberculosis.

View Article and Find Full Text PDF

Background: There are few data on the treatment of children and adolescents with multidrug-resistant (MDR) or rifampicin-resistant (RR) tuberculosis, especially with more recently available drugs and regimens. We aimed to describe the clinical and treatment characteristics and their associations with treatment outcomes in this susceptible population.

Methods: We conducted a systematic review and individual participant data meta-analysis.

View Article and Find Full Text PDF

Background: Tuberculous meningitis is fatal if untreated and can lead to lifelong neurological sequelae. However, to our knowledge, there are no data on the number of children affected by this disease. We aimed to estimate the global disease burden and attributable mortality of childhood tuberculous meningitis by WHO regions, age groups, treatment status, and HIV status in 2019.

View Article and Find Full Text PDF

Background: Approximately 2% of the global population has survived tuberculosis (TB). Increasing evidence indicates that a significant proportion of pulmonary TB survivors develop TB-associated respiratory disability, commonly referred to as post-TB lung disease (PLTD) and marked by impaired respiratory function, persistent symptoms, and activity limitations. However, the prevalence, risk factors, and progression of TB-associated respiratory disability throughout the life course are not well understood.

View Article and Find Full Text PDF

Adolescents account for an estimated 800,000 incident tuberculosis (TB) cases annually and are at risk for suboptimal adherence to TB treatment. Most studies of adolescent TB treatment adherence have used surveillance data with limited psychosocial information. This prospective cohort study aimed to identify risk factors for suboptimal adherence to rifampicin-susceptible TB treatment among adolescents (10-19 years old) in Lima, Peru.

View Article and Find Full Text PDF

We conducted a comparative cross-sectional study to compare the prevalence of exposure to workplace violence and intimate partner violence (IPV) in 125 female sex workers (FSWs) and 125 age-matched control women working in other professions (non-FSWs) and their children in El Alto, Bolivia. Violence exposure was assessed using the Demographic Health Survey Domestic Violence Module. To determine associations between work type and violence exposure, we conducted multivariate logistic regression.

View Article and Find Full Text PDF

Objectives: To understand the perspectives of adolescents (10-19 years old), their caregivers and healthcare providers regarding factors that impact adherence to tuberculosis (TB) treatment among adolescents.

Design: We conducted in-depth interviews using semistructured interview guides based on the World Health Organization (WHO)'s Five Dimensions of Adherence framework, which conceptualises adherence as being related to the health system, socioeconomic factors, patient, treatment and condition. We applied framework thematic analysis.

View Article and Find Full Text PDF

Background:: Despite being a preventable and treatable disease, tuberculosis (TB) is a leading cause of death among young people globally. Each year, an estimated 1.8 million adolescents and young adults (AYAs; 10–24 years old) develop TB.

View Article and Find Full Text PDF
Article Synopsis
  • Global efforts to eliminate tuberculosis must focus on the specific challenges faced by children (0-9 years) and adolescents/young adults (10-24 years) in sticking to treatment.
  • A narrative review was conducted to identify social factors that affect treatment adherence in these age groups, highlighting that research in this area is still in the early stages.
  • The study found multiple influencing factors at different levels, indicating the need for tailored interventions to better support children and young adults in completing their TB treatment.
View Article and Find Full Text PDF

Objectives: Patients with tuberculosis (TB) generally are instructed to isolate at the beginning of treatment in order to prevent disease transmission. The duration of isolation varies and may be prolonged (ie, lasting 1 month or more). Few studies have examined the impact of isolation during TB treatment on adolescents, who may be more vulnerable to its negative effects.

View Article and Find Full Text PDF

Background: Before August 2021, the only regimen recommended by the World Health Organization (WHO) to treat pediatric drug-susceptible tuberculous meningitis was a 12-month regimen consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide (2HRZE/10HR). The comparative effectiveness of shorter regimens is unknown.

Methods: To inform a WHO guideline update, we undertook a systematic review and meta-analysis to evaluate outcomes from regimens of 6- to less than 12-months' duration that included, at a minimum, isoniazid, rifampicin, and pyrazinamide.

View Article and Find Full Text PDF

The multisystem inflammatory syndrome in children (MIS-C) is a known complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the pediatric population. Recent studies have demonstrated high efficacy of a two-dose vaccine series in preventing MIS-C among adolescents. To date, such studies have only included children exposed to SARS-CoV-2 prior to the emergence of the Omicron variant (B.

View Article and Find Full Text PDF

Although World Health Organization guidelines emphasize contact investigation for tuberculosis (TB)-exposed children, data that support chest radiography as a useful tool are lacking. We evaluated the diagnostic and prognostic information of chest radiography in children exposed to TB and measured the efficacy of isoniazid preventive therapy (IPT) in those with relevant radiographic abnormalities. Between September 2009 and August 2012, we enrolled 4,468 TB-exposed children who were screened by tuberculin skin testing, symptom assessment, and chest radiography.

View Article and Find Full Text PDF

We reviewed autopsy data from general hospitals in Lviv, Ukraine to understand pediatric mortality due to tuberculosis (TB). We identified 14 (0.6%) of 2345 autopsied children with unrecognized or untreated TB.

View Article and Find Full Text PDF
Article Synopsis
  • - The estimated burden of tuberculosis (TB) among children and young adolescents is 1.1 million, but only 400,000 receive treatment, highlighting significant care gaps.
  • - Recent advancements in data collection and burden estimates for pediatric TB have occurred, yet many data gaps still exist at both global and national levels, hindered by insufficient surveillance and research.
  • - To better address pediatric TB, there is a need for improved methods of data collection that focus on specific areas such as TB-HIV, multi-drug resistant TB, and extra-pulmonary forms, while leveraging current efforts to close existing gaps.
View Article and Find Full Text PDF

The health needs of adolescents and young adults (AYAs) have been neglected in tuberculosis (TB) care, control, and research. AYAs, who are distinct from younger children and older adults, undergo dynamic physical, psychological, emotional, cognitive, and social development. Five domains of adolescent well-being are crucial to a successful transition between childhood and adulthood: (1) Good health; (2) connectedness and contribution to society; (3) safety and a supportive environment; (4) learning, competence, education, skills, and employability; and (5) agency and resilience.

View Article and Find Full Text PDF