This finding is mainly important for settings with a high prevalence of MDR TB and underscores the of the need for adopting comprehensive measures to prevent re-infection.
The utility of T-cell based interferon-gamma release assays for the diagnosis of latent tuberculosis infection remains unclear in settings with a high burden of tuberculosis.
These results underscore our need to better screen for and treat depression within Botswana and in other settings with a high prevalence of HIV.
The use of IGRAs in developed countries is rapidly expanding but their performance in settings with a high prevalence of tuberculosis and HIV still requires further research [12], [13].
Consequently, the agenda of maternal immunization with GBS vaccines aimed at either reducing maternal recto-anal colonization, or preventing disease in the newborns through transplacental antibody transfer, needs to be explored in settings with a high burden of GBS disease.
These results raise concern that the increasing global burden of COPD will further enhance the incidence of active TB especially in settings with a high burden of latent TB.
Thus, in settings with a high prevalence of drug resistance, it is mandatory to perform routine DST, not only for all re-treatment cases but also for newly diagnosed cases, in order to guide and tailor treatment accordingly and to avoid resistance amplification and further transmission of resistant strains.
The high rates of MDR TB in the Russian Federation make the introduction of such assays particularly useful and are likely to translate to other settings with a high level of drug resistance or where the additional speed of diagnosis and increased diagnostic sensitivity are of value as in HIV associated tuberculosis.
In addition, the exceptionally high early mortality among TB patients (42% at two months) emphasizes the urgent need for diagnostic methods for smear-negative TB which are more accurate than clinical criteria yet equally rapid and affordable in low-income settings with a high incidence of HIV and TB.
In settings with a high diversity of pneumococcal carriage, serotype replacement may be exacerbated.
The study results are generalisable to most settings with a high TB burden and widely prevalent vitamin D insufficiency.
