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Gebreegziabher SB, Ashuro AA, Kumssa TH, Teferi MY, Alemayue EA, Datiko DG, Yimer SA, Shagre MB. Tuberculosis preventive treatment uptake among people living with HIV during COVID-19 period in Addis Ababa, Ethiopia: a retrospective data review. BMC Infect Dis 2024; 24:499. [PMID: 38760665 PMCID: PMC11100166 DOI: 10.1186/s12879-024-09403-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 05/13/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Screening for tuberculosis (TB) and providing TB preventive treatment (TPT) along with antiretroviral therapy is key components of human immune deficiency virus (HIV) care. The uptake of TPT during the coronavirus disease 2019 (COVID-19) period has not been adequately assessed in Addis Ababa City Administration. This study aimed at assessing TPT uptake status among People living with HIV (PLHIV) newly initiated on antiretroviral therapy during the COVID-19 period at all public hospitals of Addis Ababa City Administration, Ethiopia. METHODS A retrospective data review was conducted from April-July 2022. Routine District Health Information System 2 database was reviewed for the period from April 2020-March 2022. Proportion and mean with standard deviation were computed. Logistic regression analysis was conducted to assess factors associated with TPT completion. A p-value of < 0.05 was considered statistically significant. RESULTS A total of 1,069 PLHIV, aged 18 years and above were newly initiated on antiretroviral therapy, and of these 1,059 (99.1%) underwent screening for TB symptoms. Nine hundred twelve (86.1%) were negative for TB symptoms. Overall, 78.8% (719) of cases who were negative for TB symptoms were initiated on TPT, and of these 70.5% and 22.8% were completed and discontinued TPT, respectively. Of 719 cases who were initiated on TPT, 334 (46.5%) and 385 (53.5%) were initiated on isoniazid plus rifapentine weekly for three months and Isoniazid preventive therapy daily for six months, respectively. PLHIV who were initiated on isoniazid plus rifapentine weekly for three months were more likely to complete TPT (adjusted odds ratio [AOR],1.68; 95% confidence interval [CI], 1.01, 2.79) compared to those who were initiated on Isoniazid preventive therapy daily for six months. CONCLUSION While the proportion of PLHIV screened for TB was high, TPT uptake was low and far below the national target of achieving 90% TPT coverage. Overall a considerable proportion of cases discontinued TPT in this study. Further strengthening of the programmatic management of latent TB infection among PLHIV is needed. Therefore, efforts should be made by the Addis Ababa City Administration Health Bureau authorities and program managers to strengthen the initiation and completion of TPT among PLHIV in public hospitals.
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Affiliation(s)
| | | | | | | | | | - Daniel Gemechu Datiko
- USAID Eliminate TB Project Health Programs Group Management Sciences for Health, Addis Ababa, Ethiopia
| | - Solomon Abebe Yimer
- Vaccine Research and Development Department, Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
- Faculty of Medicine, Unit for Genome Dynamics, University of Oslo, Oslo, Norway
| | - Mulatu Biru Shagre
- USAID Eliminate TB Project KNCV Tuberculosis Foundation-Ethiopia, Addis Ababa, Ethiopia
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Ribeiro S, Takahashi EM, de Souza KL, Yamamoto TT, Leite RR, Fernandes H, Okuno MFP, Bertolozzi MR, de Figueiredo TMRM, Gonzales RIC, Hino P. Primary Health Care and Tuberculosis Detection during the COVID-19 Pandemic: Crucial Actions for Intensifying Efforts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:540. [PMID: 38791749 PMCID: PMC11121364 DOI: 10.3390/ijerph21050540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Tuberculosis has been considered a global emergency since 1993, and controlling it has become even more challenging since 2020 due to the health and social crisis resulting from the COVID-19 pandemic. This study aimed to identify the impact of the COVID-19 pandemic on tuberculosis case detection activities within primary health Care in the largest city in Brazil. METHODS This is a cross-sectional and analytical study on the provision of tuberculosis detection actions in primary healthcare units during the pandemic period. A descriptive analysis was performed for characterization, and Generalized Mixed Models were used for evaluating associations, with a Bonferroni post hoc test applied. RESULTS The study sample comprised 80 health units in the municipality. There was a moderate alteration level in the provision of consultations for individuals with signs and symptoms of tuberculosis in 2020 (13.8%) and in 2021 (15.1%). Statistical significance (p < 0.05) was found between the pandemic period and detection actions, with a lower alteration level in 2022. CONCLUSIONS Tuberculosis detection activities underwent changes due to the COVID-19 pandemic, mainly in 2020, which was associated with alterations in consultation and case notification provision.
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Affiliation(s)
- Stephanie Ribeiro
- Department of Collective Health, Paulista School of Nursing, Federal University of São Paulo, São Paulo 04024-002, São Paulo, Brazil; (E.M.T.); (H.F.); (M.F.P.O.); (P.H.)
| | - Erika Mayumi Takahashi
- Department of Collective Health, Paulista School of Nursing, Federal University of São Paulo, São Paulo 04024-002, São Paulo, Brazil; (E.M.T.); (H.F.); (M.F.P.O.); (P.H.)
| | - Katia Lacerda de Souza
- Department of Collective Health, Paulista School of Nursing, Federal University of São Paulo, São Paulo 04024-002, São Paulo, Brazil; (E.M.T.); (H.F.); (M.F.P.O.); (P.H.)
| | - Thais Tiemi Yamamoto
- Municipal Health Secretariat of São Paulo, Health Surveillance Coordination, São Paulo 01223-010, São Paulo, Brazil (R.R.L.)
| | - Raquel Russo Leite
- Municipal Health Secretariat of São Paulo, Health Surveillance Coordination, São Paulo 01223-010, São Paulo, Brazil (R.R.L.)
| | - Hugo Fernandes
- Department of Collective Health, Paulista School of Nursing, Federal University of São Paulo, São Paulo 04024-002, São Paulo, Brazil; (E.M.T.); (H.F.); (M.F.P.O.); (P.H.)
| | - Meiry Fernanda Pinto Okuno
- Department of Collective Health, Paulista School of Nursing, Federal University of São Paulo, São Paulo 04024-002, São Paulo, Brazil; (E.M.T.); (H.F.); (M.F.P.O.); (P.H.)
| | - Maria Rita Bertolozzi
- Department of Public Health Nursing, School of Nursing, University of São Paulo, São Paulo 05403-000, São Paulo, Brazil;
| | | | | | - Paula Hino
- Department of Collective Health, Paulista School of Nursing, Federal University of São Paulo, São Paulo 04024-002, São Paulo, Brazil; (E.M.T.); (H.F.); (M.F.P.O.); (P.H.)
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Adusi-Poku Y, Wagaw ZA, Frimpong-Mansoh RP, Asamoah IO, Sorvor F, Afutu FK, Sarpong C, Amoussou-Gohoungo LO, Abdulai FN, Ahmedov S. Bidirectional screening and testing for TB and COVID-19 among outpatient department attendees: outcome of an initial intervention in Ghana. BMC Infect Dis 2023; 23:236. [PMID: 37069571 PMCID: PMC10107550 DOI: 10.1186/s12879-023-08208-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a major public health threat in Ghana. The impact of COVID-19 resulted in a 15% decline of TB case notification in 2020 compared to 2019. To mitigate the impact on TB services, the Ghana National Tuberculosis Programme (NTP) introduced the bidirectional screening and testing for TB and COVID-19 in 2021. OBJECTIVE To evaluate the yield of bidirectional screening and testing for TB and COVID-19 among facility attendees in the Greater Accra region. METHOD We used secondary data obtained from the initial implementation stage of the bidirectional testing for TB and COVID-19 among COVID-19 and/or TB presumed cases in five health facilities in the Greater Accra Region from January to March 2021. To mitigate the impact of COVID-19 on TB services and accelerate TB case detection, the NTP of Ghana introduced bidirectional screening and testing for TB and COVID-19 in Greater Accra Region before scaling up at national level. RESULTS A total of 208 presumed TB or COVID-19 cases were identified: 113 were tested for COVID-19 only, and 94 were tested for both TB and COVID-19, 1 was tested for TB only. Among presumed cases tested for COVID-19, 9.7% (95% CI, 5.6-13.7%) were tested positive. Whilst among the total presumed tested for TB, 13.7% (95% CI, 6.8-20.6%) were confirmed to have TB. Among the total 94 presumed cases tested for both TB and COVID-19, 11.7% (95% CI, 5.2-18.2%) were confirmed to have TB and 13.8% (95% CI, 6.9-20.8%) participants were COVID-19 positive and one participant (1.1%) had both COVID-19 and TB. CONCLUSION Bidirectional screening and testing for TB and COVID-19 shows significant potential for improving overall case detection for the two diseases. The bidirectional screening and testing could be applicable to address a similar respiratory epidemic in the future that might have a masking effect on the response to TB disease.
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Affiliation(s)
- Yaw Adusi-Poku
- National Tuberculosis Programme, Ghana Health Service, Accra, Ghana
| | - Zeleke Alebachew Wagaw
- National Tuberculosis Programme, Ghana Health Service, Accra, Ghana.
- Sustaining Technical and Analytical Resources (STAR)/USAID, Accra, Ghana.
| | | | - Isaac Opoku Asamoah
- Regional Health Directorate Greater Accra, Ghana Health Service, Accra, Ghana
| | - Felix Sorvor
- National Tuberculosis Programme, Ghana Health Service, Accra, Ghana
| | | | - Charity Sarpong
- Regional Health Directorate Greater Accra, Ghana Health Service, Accra, Ghana
| | | | | | - Sevim Ahmedov
- United States Agency for International Development (USAID), Bureau for Global Health, Washington, USA
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Chanda-Kapata P, Ntoumi F, Kapata N, Lungu P, Mucheleng'anga LA, Chakaya J, Tembo J, Himwaze C, Ansumana R, Asogun D, Mfinanga S, Nyasulu P, Mwaba P, Yeboah-Manu D, Zumla A, Nachega JB. Tuberculosis, HIV/AIDS and Malaria Health Services in sub-Saharan Africa - A Situation Analysis of the Disruptions and Impact of the COVID-19 Pandemic. Int J Infect Dis 2022; 124 Suppl 1:S41-S46. [PMID: 35341998 PMCID: PMC8949686 DOI: 10.1016/j.ijid.2022.03.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The unprecedented and ongoing COVID-19 pandemic has exposed weaknesses in African countries' health systems. The impact of shifted focus on COVID-19 for the past 2 years on routine health services, especially those for the epidemics of Tuberculosis, HIV/AIDS and Malaria, have been dramatic in both quantity and quality. METHODS In this article, we reflect on the COVID-19 related disruptions on the Tuberculosis, HIV/AIDS and Malaria routine health services across Africa. RESULTS The COVID-19 pandemic resulted in disruptions of routine health services and diversion of already limited available resources in sub-Saharan Africa. As a result, disease programs like TB, malaria and HIV have recorded gaps in prevention and treatment with the prospects of reversing gains made towards meeting global targets. The extent of the disruption is yet to be fully quantified at country level as most data available is from modelling estimates before and during the pandemic. CONCLUSIONS Accurate country-level data is required to convince donors and governments to invest more into revamping these health services and help prepare for managing future pandemics without disruption of routine services. Increasing government expenditure on health is a critical part of Africa's economic policy. Strengthening health systems at various levels to overcome the negative impacts of COVID-19, and preparing for future epidemics will require strong visionary political leadership. Innovations in service delivery and technological adaptations are required as countries aim to limit disruptions to routine services.
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Affiliation(s)
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale (FCRM), Brazzaville, Republic of Congo; Institute for Tropical Medicine, University of Tübingen, Germany.
| | - Nathan Kapata
- National Public Health Institute, Ministry of Health, and UNZA-UCLMS Research and Training Program, Lusaka, Zambia.
| | - Patrick Lungu
- University of Zambia, School of Medicine, Department Internal Medicine, Lusaka, Zambia.
| | - Luchenga Adam Mucheleng'anga
- Ministry of Home Affairs, Office of the State Forensic Pathologist, and UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia.
| | - Jeremiah Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya.
| | - John Tembo
- HERPEZ and UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia.
| | - Cordelia Himwaze
- University Teaching Hospital, Department of Pathology and Microbiology; and UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia.
| | - Rashid Ansumana
- Mercy Hospital Research Laboratory, Bo, Freetown, Sierra Leone.
| | - Danny Asogun
- Ambrose Alli University, Ekpoma and Irrua Specialist Teaching Hospital, Nigeria.
| | - Sayoki Mfinanga
- Muhimbili Medical Research Centre National Institute for Medical Research, Dar es Salaam, Tanzania.
| | - Peter Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine; Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Peter Mwaba
- Lusaka Apex Medical University, Faculty of Medicine, and UNZA-UCLMS Research and Training Project, Lusaka, Zambia.
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
| | - Alimuddin Zumla
- Center for Clinical Microbiology, Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom; UNZA-UCLMS Research and Training Program Program, Lusaka, Zambia.
| | - Jean B Nachega
- Department of Medicine and Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa; Depts of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Depts of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
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