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DOE OSTI2025

A mixture parameterized biologically based dosimetry model to predict body burdens of polycyclic aromatic hydrocarbons in developmental zebrafish toxicity assays

Polycyclic aromatic hydrocarbons (PAHs) are a group of environmental toxicants found ubiquitously as complex mixtures in human-impacted environments. Developmental zebrafish exposures have been used widely to study PAH toxicity, but most studies report nominal exposure concentrations. Nominal exposure concentrations can be unreliable dose metrics due to differences in toxicant bioavailability resulting from disparate exposure methodologies and chemical properties. Toxicokinetic modeling can predict toxicant tissue doses to facilitate comparison between exposures of different chemicals, methodologies, and biological models. We parameterize a biologically based dosimetry model for developmental zebrafish toxicity assays for 9 PAHs. The model was optimized with measurements from media, tissue, and plastic plate walls throughout a static developmental exposure to a mixture of 10 PAHs of high abundance within the Portland Harbor Superfund Site. Plate binding, volatilization, zebrafish permeability, and tissue—media partitioning coefficients vary widely between PAHs. Model predictions accounted for 83% and 54% of 48 hpf body burdens within a factor of 2 resulting from exposures to mixtures and individual PAHs, respectively. Accounting for solubility significantly improves model performance. Competition for active sites in metabolizing enzymes may change biotransformation kinetics between individual PAH and mixture exposures. Area under the curve estimations of concentrations in zebrafish resulted in altered hazard rankings from nominal exposure concentrations. Future work will be oriented to generalizing the model to other PAHs. This PAH dosimetry model improves the interpretability of developmental zebrafish toxicity assays by providing time-resolved body burdens from nominal exposure concentrations.

63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTAN↗

DOE OSTI2022

Reactive transport modeling for supporting climate resilience at groundwater contamination sites

Abstract. Climate resilience is an emerging issue at contaminated sites and hazardous waste sites, since projected climate shifts (e.g., increased/decreased precipitation) and extreme events (e.g., flooding, drought) could affect ongoing remediation or closure strategies. In this study, we develop a reactive transport model (Amanzi) for radionuclides (uranium, tritium, and others) and evaluate how different scenarios under climate change will influence the contaminant plume conditions and groundwater well concentrations. We demonstrate our approach using a two-dimensional (2D) reactive transport model for the Savannah River Site F-Area, including mineral reaction and sorption processes. Different recharge scenarios are considered by perturbing the infiltration rate from the base case as well as considering cap-failure and climate projection scenarios. We also evaluate the uranium and nitrate concentration ratios between scenarios and the base case to isolate the sorption effects with changing recharge rates. The modeling results indicate that the competing effects of dilution and remobilization significantly influence pH, thus changing the sorption of uranium. At the maximum concentration on the breakthrough curve, higher aqueous uranium concentration implies that sorption is reduced with lower pH due to remobilization. To better evaluate the climate change impacts in the future, we develop the workflow to include the downscaled CMIP5 (Coupled Model Intercomparison Project) climate projection data in the reactive transport model and evaluate how residual contamination evolves through 2100 under four climate Representative Concentration Pathway (RCP) scenarios. The integration of climate modeling data and hydrogeochemistry models enables us to quantify the climate change impacts, assess which impacts need to be planned for, and therefore assist climate resiliency efforts and help guide site management.

54 ENVIRONMENTAL SCIENCES↗

NASA NTRS2014

Advanced Modeling and Uncertainty Quantification for Flight Dynamics; Interim Results and Challenges

As part of the NASA Vehicle Systems Safety Technologies (VSST), Assuring Safe and Effective Aircraft Control Under Hazardous Conditions (Technical Challenge #3), an effort is underway within Boeing Research and Technology (BR&T) to address Advanced Modeling and Uncertainty Quantification for Flight Dynamics (VSST1-7). The scope of the effort is to develop and evaluate advanced multidisciplinary flight dynamics modeling techniques, including integrated uncertainties, to facilitate higher fidelity response characterization of current and future aircraft configurations approaching and during loss-of-control conditions. This approach is to incorporate multiple flight dynamics modeling methods for aerodynamics, structures, and propulsion, including experimental, computational, and analytical. Also to be included are techniques for data integration and uncertainty characterization and quantification. This research shall introduce new and updated multidisciplinary modeling and simulation technologies designed to improve the ability to characterize airplane response in off-nominal flight conditions. The research shall also introduce new techniques for uncertainty modeling that will provide a unified database model comprised of multiple sources, as well as an uncertainty bounds database for each data source such that a full vehicle uncertainty analysis is possible even when approaching or beyond Loss of Control boundaries. Methodologies developed as part of this research shall be instrumental in predicting and mitigating loss of control precursors and events directly linked to causal and contributing factors, such as stall, failures, damage, or icing. The tasks will include utilizing the BR&T Water Tunnel to collect static and dynamic data to be compared to the GTM extended WT database, characterizing flight dynamics in off-nominal conditions, developing tools for structural load estimation under dynamic conditions, devising methods for integrating various modeling elements into a real-time simulation capability, generating techniques for uncertainty modeling that draw data from multiple modeling sources, and providing a unified database model that includes nominal plus increments for each flight condition. This paper presents status of testing in the BR&T water tunnel and analysis of the resulting data and efforts to characterize these data using alternative modeling methods. Program challenges and issues are also presented.

Hyde, David C.↗

NASA NTRS2016

The Evolution of the NASA Commercial Crew Program Mission Assurance Process

In 2010, the National Aeronautics and Space Administration (NASA) established the Commercial Crew Program (CCP) in order to provide human access to the International Space Station and low Earth orbit via the commercial (non-governmental) sector. A particular challenge to NASA has been how to determine that the Commercial Provider's transportation system complies with programmatic safety requirements. The process used in this determination is the Safety Technical Review Board which reviews and approves provider submitted hazard reports. One significant product of the review is a set of hazard control verifications. In past NASA programs, 100% of these safety critical verifications were typically confirmed by NASA. The traditional Safety and Mission Assurance (S&MA) model does not support the nature of the CCP. To that end, NASA S&MA is implementing a Risk Based Assurance process to determine which hazard control verifications require NASA authentication. Additionally, a Shared Assurance Model is also being developed to efficiently use the available resources to execute the verifications.

Mission Assurance↗

DOE OSTI2024

Advancing the Limits of InSAR to Detect Crustal Displacement from Low-Magnitude Earthquakes through Deep Learning

Detecting surface deformation associated with low-magnitude (M w ≤ 5) seismicity using interferometric synthetic aperture radar (InSAR) is challenging due to the subtlety of the signal and the often challenging imaging environments. However, low-magnitude earthquakes are potential precursors to larger seismic events, and thus characterizing the crustal displacement associated with them is crucial for regional seismic hazard assessment. We combine InSAR time-series techniques with a Deep Learning (DL) autoencoder denoiser to detect the magnitude and extent of crustal deformation from the M w = 3.4 Gallina, New Mexico earthquake that occurred on 30 July 2020. Although InSAR alone cannot detect event-related deformation from such a low-magnitude seismic event, application of the DL method reveals maximum displacements as small as (±2.5 mm) in the vicinity of both the fault and earthquake epicenter without prior knowledge of the fault system. This finding improves small-scale displacement discernment with InSAR by an order of magnitude relative to previous studies. We additionally estimate best-fitting fault parameters associated with the observed deformation. The application of the DL technique unlocks the potential for low-magnitude earthquake studies, providing new insights into local fault geometries and potential risks from higher-magnitude earthquakes. This technique also permits low-magnitude event monitoring in areas where seismic networks are sparse, allowing for the possibility of global fault deformation monitoring.

58 GEOSCIENCES↗

NASA NTRS2023

A Data-driven, Physics-based Transport Model of Solar Energetic Particles Accelerated by Coronal Mass Ejection Shocks Propagating through the Solar Coronal and Heliospheric Magnetic Fields

In an effort to develop computational tools for predicting radiation hazards from solar energetic particles (SEPs), we have created a data-driven physics-based particle transport model to calculate the injection, acceleration, and propagation of SEPs from coronal mass ejection (CME) shocks traversing through the solar corona and interplanetary magnetic fields. The model runs on an input of corona and heliospheric plasma and magnetic field configuration from a magnetohydrodynamic model driven by solar photospheric magnetic field measurements superposed with observed CME shocks determined from coronagraph images. SEP source particles are injected at the shock using the result of diffusive shock acceleration formulation from a characteristic obliquity-dependent injection from a heated solar wind thermal tail population. With several advanced computation techniques involving stochastic simulation and integration, the model obtains the particle intensity at any location in interplanetary space through the rigorous solution to the time-dependent 5D focus transport equation in the phase space that includes perpendicular diffusion. We apply the model to the 2011 November 3 CME event. The calculation results reproduce multispacecraft SEP observations at Earth and STEREO-B reasonably well without normalization of particle flux. The observations at STEREO-A can be reproduced by rescaling particle energy or modified energy dependence of particle diffusion coefficients. This circumsolar SEP event seen by spacecraft at Earth, STEREO-A, and STEREO-B at widely separated longitudes can be explained by diffusive shock acceleration by a single CME shock with a moderate speed.

Solar energetic particles↗

NASA NTRS2023

Risks of Synchronized Low Yields Are Underestimated in Climate and Crop Model Projections

Simultaneous harvest failures across major crop-producing regions are a threat to global food security. Concurrent weather extremes driven by a strongly meandering jet stream could trigger such events, but so far this has not been quantified. Specifically, the ability of state-of-the art crop and climate models to adequately reproduce such high impact events is a crucial component for estimating risks to global food security. Here we find an increased likelihood of concurrent low yields during summers featuring meandering jets in observations and models. While climate models accurately simulate atmospheric patterns, associated surface weather anomalies and negative effects on crop responses are mostly underestimated in bias-adjusted simulations. Given the identified model biases, future assessments of regional and concurrent crop losses from meandering jet states remain highly uncertain. Our results suggest that model-blind spots for such high-impact but deeply-uncertain hazards have to be anticipated and accounted for in meaningful climate risk assessments.

Atmospheric dynamics↗

NASA NTRSDate not supplied

Airburst & Blast Damage Modeling Sensitivities for Asteroid Impact Risk Assessment

Blast overpressure from a high-energy airburst or surface impact is the primary source of damage from potentially hazardous asteroid strikes. There are many sources of uncertainty in evaluating these potential damage risks, both in the approaches used to model the entry, breakup, and airburst behaviors of diverse asteroid properties, and in the blast modeling approaches used to estimate the ground damage from these very large-scale, high-energy events. In this study, we use NASA’s Probabilistic Asteroid Impact Risk (PAIR) model to investigate trends and sensitivities in asteroid airburst altitudes and the resulting blast damage estimates across a range of asteroid sizes. In particular, we show how uncertainties in asteroid breakup behavior and effective airburst altitudes combine with height-of-burst (HOB) blast damage models to produce key sensitivities and trends in the amount of damage expected from different asteroid sizes and airburst altitudes. We show airburst altitude ranges and probabilities stemming from asteroid entry and breakup modeling uncertainties, compare differences between traditional nuclear-based HOB blast models and simulation-based HOB models for larger asteroid energies, and show how the resulting interplay between likely burst altitudes and optimal burst heights affects blast damage trends across different asteroid sizes. Finally, we combine the relative likelihoods of asteroid sizes, airburst altitudes, and resulting blast damage severity to evaluate what airburst regimes pose the highest overall level of risk (when considering both the relative likelihood and scale of potential damage) for a mid-sized asteroid threat scenario. Results show what asteroid size regimes are most sensitive to airburst and blast modeling uncertainties, provide insight into nonintuitive trends in the size and severity of blast damage expected from different airburst events, and highlight where additional blast modeling studies or refinements may help improve future impact risk estimates

ATAP↗

DOE OSTI2020

Evaluating the Incident Energy of Arcs in Photovoltaic DC Systems: Comparison Between Calculated and Experimental Data

Solar Photovoltaic (PV) systems have permeated the energy generation world at a very high rate, some of the safety codes and standards are still lagging in accurately assessing the hazards and risks associated with PV array arcing energies. Safety professionals and maintenance workers using NFPA 70E have utilized the Doan, Stokes & Oppenlander or Enrique models, meant to determine arc energies in DC power systems using the maximum power method. These methods may lead to an overestimate of energy available in PV systems during a fault. Since PV modules/arrays are non-linear, current limited DC devices, some of these calculation methods may not accurately predict fault energy. This paper will validate current arc energy models for PV systems by comparing experimental and calculated data. Additionally, this data will help modify the current NFPA 70E models related to smaller solar arrays. Understanding where the real safety threshold for DC arc flash in PV systems exists will help maintenance and safety professionals better prepare for a variety of work related activities. This paper will analyze real arc data taken for PV systems <1000VDC and <60amps and compare this to the calculated incident energy models, to include 70E. Thus, using these comparisons, it may be possible to reduce the safety hazard severity and thus relax the PPE requirements for installation and maintenance crews.

14 SOLAR ENERGY↗

NASA NTRSDate not supplied

Modeling Distributed Situation Awareness in Resilience-based Design of Complex Systems

Human operators play a major role in the resilience of complex systems–while human error is one of the biggest contributors to hazardous events, operators additionally play a critical role in mitigating hazardous events. A key factor underlying this operator resilience is situation awareness–the ability of operators to understand their environment and each other to achieve desired system functions. In contrast to situation awareness-related accident models in the literature, which are largely conceptual in nature, this work proposes the use of a dynamic simulation framework to concretely model both the effects of situation awareness-related human errors and situation awareness-related hazard-mitigating properties using the distributed situation awareness theory. This work then presents specialized model constructs to enable agents’ individual perceptions of the system state and transactions with other agents (and thus distributed situation awareness) to be represented in simulation. To demonstrate this framework, it is then adapted to an aircraft taxiway case study, where it is used to model aircraft conflicts due to lack of vision and poor communications from the air traffic controller. This demonstration shows the potential of using simulation models to rigorously understand situation awareness-related human errors and thus inform the design of resilience.

Resilience Modeling↗

NASA NTRS2021

Developing a Hydrological Monitoring and Sub-Seasonal to Seasonal Forecasting System for South and Southeast Asian River Basins

South and Southeast Asia is subject to significant hydrometeorological extremes, including drought. Under rising temperatures, growing populations, and an apparent weakening of the South Asian monsoon in recent decades, concerns regarding drought and its potential impacts on water and food security are on the rise. Reliable sub-seasonal to seasonal (S2S) hydrological forecasts could, in principle, help governments and international organizations to better assess risk and act in the face of an oncoming drought. Here, we leverage recent improvements in S2S meteorological forecasts and the growing power of Earth Observations to provide more accurate monitoring of hydrological states for forecast initialization. Information from both sources is merged in a South and Southeast Asia sub-seasonal to seasonal hydrological forecasting system (SAHFS-S2S), developed collaboratively with the NASA SERVIR program and end-users across the region. This system applies the Noah-MultiParameterization (NoahMP) Land Surface Model (LSM) in the NASA Land Information System (LIS), driven by downscaled meteorological fields from the Global Data Assimilation System (GDAS) and Climate Hazards InfraRed Precipitation products (CHIRP and CHIRPS) to optimize initial conditions. The NASA Goddard Earth Observing System Model - sub-seasonal to seasonal (GEOS-S2S) forecasts, downscaled using the National Center for Atmospheric Research (NCAR) General Analog Regression Downscaling (GARD) tool and quantile mapping, are then applied to drive 5-km resolution hydrological forecasts to a 9-month forecast time horizon. Results show that the skillful predictions of root zone soil moisture can be made one to two months in advance for forecasts initialized in rainy seasons and up to 8 months when initialized in dry seasons. The memory of accurate initial conditions can positively contribute to forecast skills throughout the entire 9-month prediction period in areas with limited precipitation. This SAHFS-S2S has been operationalized at the International Centre for Integrated Mountain Development (ICIMOD) to support drought monitoring and warning needs in the region.

Yifan Zhou↗

DOE OSTI2024

Modeling PAH Mixture Interactions in a Human In Vitro Organotypic Respiratory Model

One of the most significant challenges in human health risk assessment is to evaluate hazards from exposure to environmental chemical mixtures. Polycyclic aromatic hydrocarbons (PAHs) are a class of ubiquitous contaminants typically found as mixtures in gaseous and particulate phases in ambient air pollution associated with petrochemicals from Superfund sites and the burning of fossil fuels. However, little is understood about how PAHs in mixtures contribute to toxicity in lung cells. To investigate mixture interactions and component additivity from environmentally relevant PAHs, two synthetic mixtures were created from PAHs identified in passive air samplers at a legacy creosote site impacted by wildfires. The primary human bronchial epithelial cells differentiated at the air–liquid interface were treated with PAH mixtures at environmentally relevant proportions and evaluated for the differential expression of transcriptional biomarkers related to xenobiotic metabolism, oxidative stress response, barrier integrity, and DNA damage response. Component additivity was evaluated across all endpoints using two independent action (IA) models with and without the scaling of components by toxic equivalence factors. Both IA models exhibited trends that were unlike the observed mixture response and generally underestimated the toxicity across dose suggesting the potential for non-additive interactions of components. Overall, this study provides an example of the usefulness of mixture toxicity assessment with the currently available methods while demonstrating the need for more complex yet interpretable mixture response evaluation methods for environmental samples.

3D in vitro models↗

DOE OSTI2023

A Data-driven, Physics-based Transport Model of Solar Energetic Particles Accelerated by Coronal Mass Ejection Shocks Propagating through the Solar Coronal and Heliospheric Magnetic Fields

Abstract In an effort to develop computational tools for predicting radiation hazards from solar energetic particles (SEPs), we have created a data-driven physics-based particle transport model to calculate the injection, acceleration, and propagation of SEPs from coronal mass ejection (CME) shocks traversing through the solar corona and interplanetary magnetic fields. The model runs on an input of corona and heliospheric plasma and magnetic field configuration from a magnetohydrodynamic model driven by solar photospheric magnetic field measurements superposed with observed CME shocks determined from coronagraph images. SEP source particles are injected at the shock using the result of diffusive shock acceleration formulation from a characteristic obliquity-dependent injection from a heated solar wind thermal tail population. With several advanced computation techniques involving stochastic simulation and integration, the model obtains the particle intensity at any location in interplanetary space through the rigorous solution to the time-dependent 5D focus transport equation in the phase space that includes perpendicular diffusion. We apply the model to the 2011 November 3 CME event. The calculation results reproduce multispacecraft SEP observations at Earth and STEREO-B reasonably well without normalization of particle flux. The observations at STEREO-A can be reproduced by rescaling particle energy or modified energy dependence of particle diffusion coefficients. This circumsolar SEP event seen by spacecraft at Earth, STEREO-A, and STEREO-B at widely separated longitudes can be explained by diffusive shock acceleration by a single CME shock with a moderate speed.

79 ASTRONOMY AND ASTROPHYSICS↗

NASA NTRS2005

GLOBAL REFERENCE ATMOSPHERIC MODELS FOR AEROASSIST APPLICATIONS

Aeroassist is a broad category of advanced transportation technology encompassing aerocapture, aerobraking, aeroentry, precision landing, hazard detection and avoidance, and aerogravity assist. The eight destinations in the Solar System with sufficient atmosphere to enable aeroassist technology are Venus, Earth, Mars, Jupiter, Saturn, Uranus, Neptune, and Saturn's moon Titan. Engineering-level atmospheric models for five of these targets - Earth, Mars, Titan, Neptune, and Venus - have been developed at NASA's Marshall Space Flight Center. These models are useful as tools in mission planning and systems analysis studies associated with aeroassist applications. The series of models is collectively named the Global Reference Atmospheric Model or GRAM series. An important capability of all the models in the GRAM series is their ability to simulate quasi-random perturbations for Monte Carlo analysis in developing guidance, navigation and control algorithms, for aerothermal design, and for other applications sensitive to atmospheric variability. Recent example applications are discussed.

Duvall, Aleta↗

NASA NTRSDate not supplied

Modeling Distributed Situation Awareness in Resilience-Based Design of Complex Engineered Systems

Resilience Modeling↗

NASA NTRS2008

Electrostatic Charging of Lunar Dust by UV Photoelectric Emissions and Solar Wind Electrons

The ubiquitous presence of dust in the lunar environment with its high adhesive characteristics has been recognized to be a major safety issue that must be addressed in view of its hazardous effects on robotic and human exploration of the Moon. The reported observations of a horizon glow and streamers at the lunar terminator during the Apollo missions are attributed to the sunlight scattered by the levitated lunar dust. The lunar surface and the dust grains are predominantly charged positively by the incident UV solar radiation on the dayside and negatively by the solar wind electrons on the night-side. The charged dust grains are levitated and transported over long distances by the established electric fields. A quantitative understanding of the lunar dust phenomena requires development of global dust distribution models, based on an accurate knowledge of lunar dust charging properties. Currently available data of lunar dust charging is based on bulk materials, although it is well recognized that measurements on individual dust grains are expected to be substantially different from the bulk measurements. In this paper we present laboratory measurements of charging properties of Apollo 11 & 17 dust grains by UV photoelectric emissions and by electron impact. These measurements indicate substantial differences of both qualitative and quantitative nature between dust charging properties of individual micron/submicron sized dust grains and of bulk materials. In addition, there are no viable theoretical models available as yet for calculation of dust charging properties of individual dust grains for both photoelectric emissions and electron impact. It is thus of paramount importance to conduct comprehensive measurements for charging properties of individual dust grains in order to develop realistic models of dust processes in the lunar atmosphere, and address the hazardous issues of dust on lunar robotic and human missions.

Abbas, Mian M.↗

NASA NTRS2016

The NASA Commercial Crew Program (CCP) Mission Assurance Process

In 2010, NASA established the Commercial Crew Program in order to provide human access to the International Space Station and low earth orbit via the commercial (non-governmental) sector. A particular challenge to NASA has been how to determine the commercial providers transportation system complies with Programmatic safety requirements. The process used in this determination is the Safety Technical Review Board which reviews and approves provider submitted Hazard Reports. One significant product of the review is a set of hazard control verifications. In past NASA programs, 100 percent of these safety critical verifications were typically confirmed by NASA. The traditional Safety and Mission Assurance (SMA) model does not support the nature of the Commercial Crew Program. To that end, NASA SMA is implementing a Risk Based Assurance (RBA) process to determine which hazard control verifications require NASA authentication. Additionally, a Shared Assurance Model is also being developed to efficiently use the available resources to execute the verifications. This paper will describe the evolution of the CCP Mission Assurance process from the beginning of the Program to its current incarnation. Topics to be covered include a short history of the CCP; the development of the Programmatic mission assurance requirements; the current safety review process; a description of the RBA process and its products and ending with a description of the Shared Assurance Model.

Commercial Crew Program↗

DOE OSTI2023

Incidence and predictors of tuberculosis among children receiving antiretroviral therapy in the Wolaita Zone: A retrospective cohort study

Tuberculosis is the leading cause of morbidity and mortality among children living with the human immunodeficiency virus (HIV), mainly in sub-Saharan Africa, including Ethiopia. Tuberculosis remains a significant health concern for HIV-positive children in Ethiopia. There is a paucity of data on the incidence and predictors of tuberculosis among children living with HIV on antiretroviral therapy in the Wolaita zone. Hence, this study aimed to assess the incidence and predictors of tuberculosis among children living with HIV on antiretroviral therapy in the Wolaita zone between January 2010 to December 2020. A retrospective cohort study was conducted among 389 children receiving antiretroviral therapy in Wolaita zone health facilities between January 2010 to December 2020. The checklist was adapted from the standardized antiretroviral treatment (ART) follow-up form currently used by the institutions’ ART clinics. The Kaplan-Meier survival function and Log-rank were used to estimate the survival for each categorical variable to compare the survival between different exposure groups. Both bivariable and multivariable parametric survival Gompertz models were fitted to identify predictors of tuberculosis among HIV-positive children. The association was summarized using an adjusted hazard ratio (AHR), and statistical significance was declared at 95% CI and p-value < 0.05. The goodness of the model fit was assessed using a Cox-Snell residual plot. The incidence rate of tuberculosis among children living with HIV was 3.5 (95% CI 2.7–4.5) per 100 child years. World Health Organization clinical stage III or IV (AHR = 2.31, 95% CI [1.26, 4.22]), hemoglobin level <10 g/dL (AHR = 2.87, 95% CI [1.51, 5.45]), fair or poor ART adherence (AHR = 4.4, 95% CI[2.18, 9.05]), underweight (AHR = 2.55, 95% CI [1.45, 4.51]), age >10 years (AHR = 3.62; 95% CI [1.29, 10.0]), and cotrimoxazole preventive therapy (AHR = 0.23; 95% CI [0.08, 0.60]) were among the independent predictors of TB occurrence. The incidence of tuberculosis among children on ART was high. HIV-positive children presenting with advanced disease staging (III and IV), anemia, “fair” and “poor” ART adherence, underweight, age above ten years, and not receiving cotrimoxazole preventive therapy were at higher risk of TB. Therefore, counseling on ART adherence, early diagnosis, and prompt treatment of anemia and malnutrition are recommended to avert tuberculosis.

60 APPLIED LIFE SCIENCES↗