American Journal of Tropical Medicine and Hygiene最新文献

{"title":"Dengue Outbreaks and Antibody Seroprevalence in Buenos Aires.","authors":"Alejandro Macchia, Daniel Ferrante, Cristián Biscayart, Patricia Angeleri, María Belén Bouzas, Lilia Mammana, Fernán González Bernaldo de Quirós","doi":"10.4269/ajtmh.25-0148","DOIUrl":"10.4269/ajtmh.25-0148","url":null,"abstract":"<p><p>Buenos Aires, Argentina, a city with 3.1 million inhabitants, had a minimal prevalence of dengue until 2022, with nearly 25,000 cumulative reported cases. However, consecutive outbreaks in 2023 and 2024 significantly altered the epidemiological landscape, raising concerns about increasing viral circulation and a potential shift from a low-incidence, seasonal pattern toward more sustained transmission in this major urban setting. To assess the aftermath of the largest recorded dengue epidemic in Buenos Aires, we conducted a probabilistic, stratified, multistage serosurvey during the inter-epidemic period from August to October 2024. The study population consisted of 2.4 million adults, and dengue IgG and IgM antibodies were detected using a rapid immunoassay with an enzyme-linked fluorescence assay confirmation. Weighted seroprevalence reached 18.6% (95% CI: 15.6-21.5%) in 2024 (446,735 subjects). This represents a substantial increase in population immunity compared with previous estimates, likely reflecting the exceptional magnitude of the recent epidemic. The highest seropositivity rate was observed in informal settlements (38.1%), as well as in central (20.3%) and southern districts (21.3%), suggesting an uneven distribution of transmission risks. To the best of our knowledge, no previous seroprevalence studies in Argentina have directly assessed population immunity in the aftermath of a large-scale dengue outbreak, making this research particularly relevant. Our findings highlight a rapid shift in dengue virus circulation, underscoring the increasing vulnerability of Buenos Aires to dengue transmission. This surge in seroprevalence signals the need for strengthened vector control, improved surveillance, and targeted public health interventions, particularly in disadvantaged urban areas.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"865-869"},"PeriodicalIF":1.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12493259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Epidemiological Trends and Public Health Challenges of Hepatitis A Virus Infection in Thailand.","authors":"Yong Poovorawan, Sitthichai Kanokudom, Phattharaporn Inma, Pornjarim Nilyanimit, Nasamon Wanlapakorn","doi":"10.4269/ajtmh.25-0083","DOIUrl":"10.4269/ajtmh.25-0083","url":null,"abstract":"<p><p>Hepatitis A virus (HAV) remains a global public health concern, particularly in areas with poor sanitation. Thailand, once hyperendemic, has experienced a significant decline in HAV prevalence over the past five decades because of socioeconomic progress and improved public health measures. The median age of seroprevalence has increased, reflecting a shift to low endemicity. Notably, the most recent 2024 study reveals that the epidemiological pattern of hepatitis A in Thailand now corresponds to a low endemicity classification. Although HAV outbreaks were common from 1984 to 2014, recent cases are largely confined to high-risk groups, such as men who have sex with men and immigrants. However, low HAV vaccination coverage persists because of high costs and exclusion from the Expanded Program on Immunization. Addressing these gaps through improved vaccine access and cost-effectiveness analysis is crucial. This review examines Thailand's changing HAV epidemiology, the impact of public health interventions, and the need for enhanced vaccination strategies to sustain low prevalence, prevent outbreaks, and curb cross-border transmission.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"724-727"},"PeriodicalIF":1.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12493123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrence or Reinfection with Onchocerca lupi in a Child in 2021 and 2024 in New Mexico amid Rising Canine Infections.","authors":"Tania L Kraai, Andres Alarcon, Alexis Lopez, Guilherme G Verocai, Nancy Johnstone McLean, Yvonne Qvarnstrom, Sarah G H Sapp, Paul T Cantey, Walter Dehority","doi":"10.4269/ajtmh.24-0795","DOIUrl":"10.4269/ajtmh.24-0795","url":null,"abstract":"<p><p>Onchocerca lupi is an emerging zoonotic parasite in the southwestern United States that typically involves a single site in the head and neck region and is not known to recur after treatment. Human infection with O. lupi is reported in seven cases in the endemic southwestern United States and others from the Old World. Most U.S. cases involved the head and neck, with several presenting with neuroinvasive cervical disease, which can lead to spinal cord injury and meningitis. Recurrent infection has not been described in humans after surgical intervention and/or anthelmintic therapy; however, one case required revision surgery to excise residual worm fragments and inflammation. We present a case of either relapse or reinfection with O. lupi at a separate anatomic location nearly 3 years after completing treatment.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"844-847"},"PeriodicalIF":1.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12493120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An O-Specific Polysaccharide Shigella flexneri 3a Conjugate Vaccine is Immunogenic and Protective against Virulent Keratoconjunctival Challenge in Guinea Pigs.","authors":"Jeshina Janardhanan, Chanchal Wagh, Jibing Yang, Richelle C Charles, Ruchir Kumar Pansuriya, Fahima Chowdhury, Robert W Kaminski, Ashraful Islam Khan, Taufiqur Rahman Bhuiyan, Firdausi Qadri, Pavol Kováč, Peng Xu, Edward T Ryan","doi":"10.4269/ajtmh.25-0269","DOIUrl":"10.4269/ajtmh.25-0269","url":null,"abstract":"<p><p>Shigella infection is a major cause of diarrhea, cognitive and physical stunting, and death in young children in resource-limited settings. A vaccine that is protective against shigellosis is needed. Immune responses that target the O-specific polysaccharide (OSP) of Shigella spp. are protective against shigellosis. We previously reported the development and evaluation of a conjugate vaccine targeting Shigella flexneri (S. flexneri) 3a in mice. Here, we report the evaluation of this vaccine (Shigella conjugate vaccine S. flexneri 3a OSP conjugated to a 52 kiloDalton recombinant fragment of the tetanus toxin heavy chain [SCV-Sf3a OSP:rTTHc]) in a second animal model: the guinea pig. This vaccine induced prominent OSP-, lipopolysaccharide-, and rTTHc-specific Immunoglobulin (Ig)G, IgA, and IgM responses in the sera of vaccinated animals. Shigella conjugate vaccine S. flexneri 3a also induced serum bactericidal functional antibody responses, and vaccinated guinea pigs were protected against a virulent strain of keratoconjunctival challenge in the standard Shigella Sereny assay. These results support the further development of SCV-Sf3a OSP:rTTHc.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"737-743"},"PeriodicalIF":1.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12493252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access and Awareness of Morbidity Management and Disability Prevention for Lower Limb Lymphatic Filariasis in Post-Mass Drug Administration Districts in Southern India.","authors":"Anjali Jog, Arpitha Anbu Deborah, Rohan Michael Ramesh, Kumudha Aruldas, Yuvaraj Baskaran, Judd L Walson, Suma Krishnasastry, Sitara Swarna Rao Ajjampur","doi":"10.4269/ajtmh.25-0180","DOIUrl":"10.4269/ajtmh.25-0180","url":null,"abstract":"<p><p>The Global Program to Eliminate Lymphatic Filariasis (LF) aims to eliminate transmission through mass drug administration (MDA) and manage LF disease through morbidity management and disability prevention (MMDP). In this study, surveys on awareness and access to MMDP and quality of life (QoL) among lower limb LF cases in a censused population in two post-MDA districts in Tamil Nadu were conducted. The prevalence of lower limb LF was 0.11% (165/147,871), with 57.6% in reversible stage 1 and 2 categories, 36.4% in stage 3, and 6.1% in stage 4 and above. Among them, 22.4% reported health worker visits, 11.5% were aware of MMDP camps, and 36.4% received MMDP kits. The life activity (mean score: 48.5; SD: 27.3) and mobility (41.2; 24.2) domains exhibited the poorest QoL scores. In post-MDA districts, strengthening the reach and awareness of MMDP programs in communities, especially for early, reversible stages, is pivotal to halting disease progression and improving QoL.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"839-843"},"PeriodicalIF":1.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12493119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Prevalence of Infection with Opisthorchis viverrini and Intestinal Parasites in Rural Communities in Northeast Thailand Using Stool Examinations and Serological Screening Methods.","authors":"Rutchanee Rodpai, Penchom Janwan, Lakkhana Sadaow, Oranuch Sanpool, Patcharaporn Boonroumkaew, Tassanee Saovana, Pokkamol Laoraksawong, Pewpan M Intapan, Wanchai Maleewong, Weerachai Saijuntha, Tongjit Thanchomnang","doi":"10.4269/ajtmh.25-0258","DOIUrl":"10.4269/ajtmh.25-0258","url":null,"abstract":"<p><p>Helminthiases are common neglected tropical diseases in Thailand; thus, regular surveillance is necessary for their control. Among these helminthiases, the small liver fluke, Opisthorchis viverrini (O. viverrini), which is endemic in northeast Thailand, has been the focus of national control and eradication campaigns in the country for several decades. However, these helminths still exist and raise concerns regarding public health. Stool samples, blood samples, and demographic data were obtained from 307 participants. Stool examination via the formalin-ethyl acetate concentration technique (FECT) and agar plate culture (APC) was performed, and parasite eggs and larvae were identified microscopically by experienced technicians. Of 307 individuals, 91 (29.6%) were positive for intestinal helminths and protozoans according to FECT and APC testing. Eggs of the O. viverrini species were the most commonly found (16% of participants), followed by Strongyloides stercoralis (14%), hookworms (1%), Taenia spp. (0.7%) and Blastocystis sp. (0.97%). The positive rates of anti-Opisthorchis viverrini IgG antibody, as evaluated via the immunochromatographic test (ICT) and ELISA, were 26.1% and 31.6%, respectively. The differences in positive results between the FECT (O. viverrini egg-positive) and anti-O. viverrini IgG antibody detected via ICT or ELISA were statistically significant (P <0.05). The ICT and ELISA could possibly be used as the screening tools of choice for the diagnosis of human opisthorchiasis to aid in future treatment, prevention, and control measures.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"821-826"},"PeriodicalIF":1.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12493118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasmodium falciparum Genomic Surveillance Reveals a Diversity of Kelch 13 Mutations in Zambia.","authors":"Andrés Aranda-Díaz, Sydney Mwanza, Takalani I Makhanthisa, Sonja B Lauterbach, Faith De Amaral, Mukosha Chisenga, Brighton Mangena, Isobel Routledge, Blaženka Letinić, Bertha Kasonde, Gershom Chongwe, Mulenga C Mwenda, John M Miller, Tricia Hibwato, Chirwa Jacob, Busiku Hamainza, Stephen Bwalya, Japhet Chiwaula, Japhet Matoba, Chadwick Sikaala, John Chimumbwa, Amy Wesolowski, Jennifer L Smith, Jaishree Raman, Moonga Hawela","doi":"10.4269/ajtmh.25-0110","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0110","url":null,"abstract":"<p><p>Antimalarials are central to Zambia's strategies for malaria control and elimination. Antimalarial drug resistance poses a significant threat to the effectiveness of artemisinin-based combination therapies and preventive strategies such as sulfadoxine-pyrimethamine chemoprevention in pregnant women. In this genomic surveillance study, dried blood spots and epidemiological data were collected from confirmed Plasmodium falciparum cases at 61 health facilities across all 10 Zambian provinces from March to July 2023. A total of 2,486 samples were genotyped by using multiplexed amplicon sequencing to identify mutations in 12 genes associated with resistance to seven antimalarial drugs. Several mutations potentially associated with artemisinin partial resistance were identified, including the validated kelch 13 (k13) P574L marker (0.66% adjusted national prevalence) and the candidate k13 P441L marker (1.39%). The distribution of mutations was heterogeneous, with many health facilities reporting resistance markers in more than 5% of infections, and in some instances, up to 46% of infections. The multidrug resistance protein 1 N86 genotype, which is associated with decreased lumefantrine susceptibility, was found in all samples. Very high levels of sulfadoxine-pyrimethamine resistance markers were observed, including dihydropteroate synthetase K540E (93.26%). The variable prevalence of resistance markers underscores the need for routine molecular surveillance to detect emergent resistance and guide malaria control strategies. These results also call for studies designed to help us understand the clinical implications of these mutations and ensure the continued efficacy of antimalarial interventions in Zambia.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Prevalence of Molecular Markers Associated with Artemisinin, Sulfadoxine, and Pyrimethamine Resistance in Northern Namibia.","authors":"Lydia Eloff, Andrés Aranda-Díaz, Isobel Routledge, Amy Wesolowski, Mukosha Chisenga, Brighton Mangena, John Chimumbwa, Chadwick Sikaala, Petrina Uusiku, Stark Katokele, Jaishree Raman, Jennifer Smith, Davis R Mumbengegwi","doi":"10.4269/ajtmh.24-0870","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0870","url":null,"abstract":"<p><p>Artemisinin-based combination therapies are a cornerstone of Namibia's efforts to eliminate malaria. Namibia has experienced a greater than 90% reduction in malaria cases since the introduction of these therapies in 2005. However, their efficacy has not been routinely monitored, with malaria outbreaks regularly reported since 2016. The recent emergence of artemisinin partial resistance in Africa has highlighted the role of malaria molecular surveillance in complementing efficacy studies. This cross-sectional genomic surveillance study was nested within Namibia's routine surveillance system and aimed to determine the prevalence of antimalarial drug resistance markers in northern Namibia. Dried blood spots (DBS) and epidemiological data were collected from patients with confirmed Plasmodium falciparum cases who presented at health facilities in the highest malaria-burden regions (Zambezi, Kavango East, Kavango West, Ohangwena, and Omusati) from April to September 2023. Twelve genes associated with resistance to seven antimalarial drugs were genotyped from 264 DBS using multiplexed targeted amplicon sequencing. Multiple kelch 13 mutations associated with artemisinin partial resistance were identified: the P441L candidate marker was the most abundant, at 33.2%, and the P574L and A675V validated markers were observed in 1.2% of samples. The chloroquine resistance transporter C72/V73/M74I/N75E/K76T haplotype was observed in 1% of samples, whereas the multidrug resistance protein 1 N86 genotype, which is associated with reduced susceptibility to lumefantrine, was found in all samples. Although sulfadoxine-pyrimethamine is not used in Namibia, a high proportion of sulfadoxine-pyrimethamine resistance-associated mutations in the dihydropteroate synthase and dihydrofolate reductase genes were observed. In this study, we underscore the need for routine genomic surveillance to monitor emerging drug resistance markers and call for further research to define their clinical implications.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Model-Based Geostatistics to Refine Population-Based Estimates of Trachoma Prevalence: Update from a Technical Consultation.","authors":"Anna Harte, Misaki Sasanami, Clara R Burgert-Brucker, Ana Bakhtiari, Donal Bisanzio, Cristina Jimenez, Anthony W Solomon, George Elia Kabona, Michael Peter Masika, Jeremiah Ngondi, Pearl Anne Ante-Testard, Benjamin F Arnold, Gilbert Baayenda, Pablo Ruiz Cuenca, Peter John Diggle, Dileepa Edirweera, Paul M Emerson, Claudio Fronterre, Katherine Gass, Lucinda Newbury, P J Hooper, Everlyn Kamau, Fikreab Kebede, Irene Kyomuhangi, Thomas M Lietman, Kate McCracken, Mark Minnery, Scott D Nash, Tom Nicholls, Nicholas Olobio, Stephanie L Palmer, Sayed Ataullah Saeedzai, Stephanie Somerville, Cleo Stern, Diana Stukel, Celia Landmann Szwarcwald, Sandra L Talero, Violetta Yevstigneyeva, Amir B Kello, Emma Harding-Esch, Emanuele Giorgi","doi":"10.4269/ajtmh.25-0023","DOIUrl":"10.4269/ajtmh.25-0023","url":null,"abstract":"<p><p>To explore how model-based geostatistics (MBG) could support trachoma elimination efforts, a technical consultation was held on March 4 and 5, 2024 by the Centre for Health Informatics, Computing, and Statistics at Lancaster University, United Kingdom, a WHO Collaborating Centre on Geostatistical Methods for Neglected Tropical Disease Research. The meeting aimed to foster collaboration for sharing insights on using MBG for decision-making; showcase its applications in assessing trachoma elimination status; address challenges, such as setting the probability threshold for elimination and resolving conflicts between survey and MBG evidence; and discuss considerations for integrating MBG into Tropical Data. Participants, including trachoma program managers, experts, academics, donors, and statisticians, reviewed MBG applications, discussed ongoing studies, identified knowledge gaps, and planned future work. This article summarizes the meeting's presentations, discussions, and outcomes, highlighting current conclusions on and research priorities to evaluate MBG's feasibility and utility in trachoma elimination programs.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"930-936"},"PeriodicalIF":1.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12493125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Stigma, Mental Well-Being, and Alcohol Use among People with Tuberculosis in Sub-Saharan Africa: A Call for an Integrated Care Model.","authors":"Jonathan Izudi, Francis Bajunirwe, Adithya Cattamanchi, Nora West","doi":"10.4269/ajtmh.25-0048","DOIUrl":"10.4269/ajtmh.25-0048","url":null,"abstract":"<p><p>Tuberculosis (TB) remains a major public health challenge in sub-Saharan Africa (SSA), with stigma, mental health issues, and alcohol use significantly affecting treatment outcomes. Stigma delays TB diagnosis, reduces treatment adherence, and disrupts care continuity. Mental health conditions, such as depression and anxiety, further undermine adherence, whereas alcohol use accelerates TB disease progression and leads to poor treatment outcomes. Current TB care models in SSA lack integrated support for psychosocial and behavioral health needs. This article advocates for a comprehensive care model that integrates mental health screening, counseling, psychosocial support, alcohol use disorder screening, and harm reduction strategies into TB programs. Effective implementation requires collaboration among TB care providers, mental health specialists, and alcohol use counselors supported by research, provider training, and community engagement. By addressing stigma, mental health, and alcohol use, this model can enhance treatment adherence and outcomes, advancing the WHO's End TB Strategy in SSA.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"720-723"},"PeriodicalIF":1.6,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12493261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}