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Win KM, Win Maung HM, Show KL, Aung PL. HIV Testing Among Individuals With Self-reported Tuberculosis in Myanmar: A Secondary Data Analysis of the Demographic Health Survey 2015-16. Asia Pac J Public Health 2024; 36:136-139. [PMID: 38164919 DOI: 10.1177/10105395231221681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
| | | | - Kyaw Lwin Show
- Department of Medical Research, Ministry of Health, Yangon, Myanmar
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2
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Rahayu SR, Susilastuti MS, Saefurrohim MZ, Azam M, Indrawati F, Supriyono M, Miarso D, Safitri BD, Daniswara S, Merzistya AN, Amilia R, Affandi MD, Wahidah N, Isbandi, Wandastuti AD, Laila AK, Muflikhah Z. Lost to Follow-Up among Tuberculosis Patients during the Public-Private Mix Era in Rural Area of Indonesia. Ethiop J Health Sci 2023; 33:115-122. [PMID: 36890941 PMCID: PMC9987293 DOI: 10.4314/ejhs.v33i1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Indexed: 03/10/2023] Open
Abstract
Background Indonesia's national Tuberculosis (TB) strategy is public-private mix (PPM). The PPM aims to treat patients who have lost sight during TB treatment as these patients are TB carriers and at risk of transmitting TB. The purpose of this study was to identify predictive factors for loss to follow-up (LFTU) among TB patients receiving treatment when the PPM was at place in Indonesia. Methods The design of this study was a retrospective cohort study. The data used in this study was sourced from the Tuberculosis Information System (SITB) of Semarang which was recorded routinely during 2020-2021. Univariate analysis, crosstabulation, and logistic regression were performed on 3434 TB patients meeting the minimum variables. Results The participation of health facilities in reporting TB during the PPM era in Semarang reached 97.6% consisting of 37 primary healthcare center (100%), 8 public hospitals (100%), 19 private hospitals (90.5%), and a community-based pulmonary health center (100%). The regression analysis reveal that the predictive factors of LTFU-TB during the PPM are the year of diagnosis (AOR=1.541; p-value=<0.001; 95% CI=1.228-1.934), referral status (AOR=1.562, p-value=0.007; 95% CI=1.130-2160), healthcare and social security insurance ownership (AOR=1.638; p-value=<0.001; 95% CI=1.263-2.124), drugs source (AOR=4.667; p-value=0.035; 95% CI=1.117-19.489). Conclusions The PPM strategy in dealing with LTFU patients should focus on TB patients without Healthcare and Social Security Insurance and who receive TB treatment rather than program drugs.
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Affiliation(s)
- Sri R Rahayu
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| | | | - Muhamad Z Saefurrohim
- Semarang City Health Office, Semarang, Indonesia.,Master of Public Health, Postgraduate, Universitas Negeri Semarang, Indonesia
| | - Mahalul Azam
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| | - Fitri Indrawati
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| | | | - Dani Miarso
- Semarang City Health Office, Semarang, Indonesia
| | | | | | - Aufiena Na Merzistya
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| | - Rizqi Amilia
- Gadjah Mada University Academic Hospital, Yogyakarta
| | - Mustafa D Affandi
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| | - Nur Wahidah
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| | - Isbandi
- Master of Public Health, Postgraduate, Universitas Negeri Semarang, Indonesia
| | - Anggun D Wandastuti
- Master of Public Health, Postgraduate, Universitas Negeri Semarang, Indonesia
| | - Annisa K Laila
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| | - Zuyyinatun Muflikhah
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
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3
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Kim HW, Park S, Min J, Sun J, Shin AY, Ha JH, Park JS, Lee SS, Lipman M, Abubakar I, Stagg HR, Kim JS. Hidden loss to follow-up among tuberculosis patients managed by public-private mix institutions in South Korea. Sci Rep 2022; 12:12362. [PMID: 35859107 PMCID: PMC9300674 DOI: 10.1038/s41598-022-16441-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
In South Korea, public-private mix (PPM) was launched in 2011. This retrospective cohort study sought to determine the rate of loss to follow-up (LTFU) among drug-susceptible tuberculosis (DS-TB) patients in all nationwide PPM institutions, and the risk factors for LTFU. National notification data for DS-TB patients diagnosed between August 2011 and July 2014 in PPM institutions were analysed. Determination of LTFU included detection of instances where patients were transferred out, but when they did not attend at other TB centres in the following two months. Univariable and multivariable competing risk models were used to determine risk factors for LTFU. 73,046 patients with 78,485 records were enrolled. Nominally, 3426 (4.4%) of records were LTFU. However, after linking the multiple records in each patient, the percentage of LTFU was 12.3% (9004/73,046). Risk factors for LTFU were: being foreign-born (3.13 (95% CI 2.77-3.53)), prior LTFU (2.31 (2.06-2.59)) and greater distance between the patient's home and the TB centre (4.27 (4.03-4.53)). 'Transfer-out' was a risk factor in patients managed by treatment centres close to home (1.65 (1.49-1.83)), but protective for those attending centres further (0.77 (0.66-0.89)) or far-away (0.52 (0.46-0.59)) from home. By considering the complete picture of a patient's interactions with healthcare, we identified a much higher level of LTFU than previously documented. This has implications for how outcomes of treatment are reported and argues for a joined-up national approach for the management and surveillance of TB patients, in nations with similar healthcare systems.
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Affiliation(s)
- Hyung Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sohee Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jiyu Sun
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ah Young Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jick Hwan Ha
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Seuk Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Sung-Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Marc Lipman
- UCL-TB, University College London, London, UK
- Division of Medicine, UCL Respiratory, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Helen R Stagg
- Usher Institute, The University of Edinburgh, Edinburgh, UK.
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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4
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Watumo D, Mengesha MM, Gobena T, Gebremichael MA, Jerene D. Predictors of loss to follow-up among adult tuberculosis patients in Southern Ethiopia: a retrospective follow-up study. BMC Public Health 2022; 22:976. [PMID: 35568853 PMCID: PMC9107690 DOI: 10.1186/s12889-022-13390-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Loss to follow-up (LTFU) from tuberculosis (TB) treatment and care is a major public health problem as patients can be infectious and also may develop a multi-drug resistant TB (MDR-TB). The study aimed to assess whether LTFU differs by the distance TB patients travelled to receive care from the nearest health facility. Methods A total of 402 patient cards of TB patients who received care were reviewed from March 1–30, 2020. The Kaplan-Meir curve with the Log-rank test was used to compare differences in LTFU by the distance travelled to reach to the nearest health facility for TB care. The Cox proportional hazard regression model was used to identify predictors. All statistical tests are declared significant at a p-value< 0.05. Results A total of 37 patients were LTFU with the incidence rate of 11.26 per 1000 person-months of observations (PMOs) (95% CI: 8.15–15.53). The incidence rate ratio was 12.19 (95% CI: 5.01–35.73) among the groups compared (those who travelled 10 km or more versus those who travelled less than 10 km). Age ≥ 45 years (aHR = 7.71, 95% CI: 1.72, 34.50), educational status (primary schooling, aHR = 3.54, 95% CI: 1.49, 8.40; secondary schooling, aHR = 2.75, 95% CI: 1.08, 7.03), lack of family support (aHR = 2.80, 95% CI: 1.27, 6.19), nutritional support (aHR = 3.40, 95% CI:1.68, 6.89), ≥ 10 km distance to travel to a health facility (aHR = 6.06, 95% CI: 2.33, 15.81) had significantly predicted LTFU from TB treatment and care. Conclusions LTFU from adult TB care and treatment was 12 times higher among those who travelled ≥10 km to reach a health facility compared to those who travelled less. To retain adult TB patients in care and ensure appropriate treatment, health professionals and other stakeholders should give due attention to the factors that drive LTFU. We suggest identifying concerns of older patients at admission and those who travel long distance and establish social support platforms that could help people to complete TB treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13390-8.
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Affiliation(s)
| | - Melkamu Merid Mengesha
- Epidemiology and Biostatistics Unit, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Tesfaye Gobena
- Department of Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mathewos Alemu Gebremichael
- Epidemiology and Biostatistics Unit, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Degu Jerene
- KNCV Tuberculosis Foundation, Hague, The Netherlands
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Sunjaya DK, Paskaria C, Herawati DMD, Pramayanti M, Riani R, Parwati I. Initiating a district-based public-private mix to overcome tuberculosis missing cases in Indonesia: readiness to engage. BMC Health Serv Res 2022; 22:110. [PMID: 35078467 PMCID: PMC8789543 DOI: 10.1186/s12913-022-07506-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background District-based public–private mix (DPPM) is a variant of a relatively new PPM strategy of addressing missing cases in the tuberculosis (TB) care cascade in Indonesia. We aimed to determine the readiness of various stakeholders to engage in implementing the DPPM strategy. Methods The research design was sequential exploratory mixed methods. A qualitative study in the first stage was carried out through in-depth interviews, FGD and study documents. Data were analyzed through coding, categorizing, pattern matching and theorizing. The second stage was a survey conducted using instruments built in the first stage. Data were analyzed using Rasch modeling and logistic regression. Results District TB case detection rate (CDR) has improved from 35% (2018) to 104% (2019). The contribution of private hospitals has increased considerably. However, there were almost none from the private primary healthcare facilities. The substantive theory generated indicates that awareness and concern of the TB problem, TB program comprehension and involvement, and institutional support are behind the readiness of facilities to engage the TB program (the readiness to engage). The measurement results indicate the significant correlation of all dimensions on readiness to engage. Concern of the TB problem and institutional support are variables that influence readiness to engage (p < 0.05). Conclusions Engaging private and public facility stakeholders is a challenge for local government. Intervention is through a personalized approach, encourages institutional support of health facilities for the TB program and system approach.
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Affiliation(s)
- Deni Kurniadi Sunjaya
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jalan Eyckman No 38, Bandung, West Java, 40161, Indonesia.
| | - Cindra Paskaria
- Department of Public Health, Faculty of Medicine, Maranatha Christian University, Bandung, Indonesia.,Post Graduate Program, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Dewi Marhaeni Diah Herawati
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jalan Eyckman No 38, Bandung, West Java, 40161, Indonesia
| | | | - Rini Riani
- District Health Office, City of Bandung, Bandung, Indonesia
| | - Ida Parwati
- Departement of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran; Dr. Hasan Sadikin General Hospital, Bandung, 40161, Indonesia
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Aung ST, Nyunt WW, Moe MM, Aung HL, Lwin T. The fourth national tuberculosis prevalence survey in Myanmar. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000588. [PMID: 36962394 PMCID: PMC10021272 DOI: 10.1371/journal.pgph.0000588] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022]
Abstract
Tuberculosis (TB) remains a significant cause of morbidity and mortality in Myanmar. The fourth National TB Prevalence Survey was conducted in 2017-2018 to determine the actual burden of TB not only at the national level but also for three subnational strata (the states, regions other than Yangon, and the Yangon region) and develop a more efficacious country strategy on TB care and control. One hundred and thirty eight clusters were selected by population proportionate sampling. Adult (≥15 years of age) residents having lived for 2 weeks or more in the households of the selected clusters were invited to participate in the survey. The survey participants were screened for TB by a questionnaire and digital chest X-ray (CXR) after providing written informed consent. Individuals with a positive symptom screen and/or chest X-ray suggestive of TB were asked to provide sputum samples to test for Mycobacterium tuberculosis (Mtb) by Ziehl-Neelsen direct light microscopy, Xpert MTB/RIF Ultra (Xpert), and culture (Ogawa media). Bacteriologically confirmed TB cases were defined by an expert panel. Of 75 676 eligible residents, 66 480 (88%) participated, and 10 082 (15%) screened positive for TB. Among these, 322 participants were defined as bacteriologically confirmed TB cases. Cough lasting for two weeks or longer, one of the criteria used for screening for symptoms, could detect only 14% (45/322) of the study cases. The estimated prevalence of bacteriologically confirmed adult pulmonary TB was 468 (95% CI: 391-546) per 100,000. The prevalence was much higher among males, the older age group, urban Yangon and remote villages. In-depth interview with the participants on TB treatment showed that none of them was diagnosed in a TB health centre (primary care facilities). The prevalence of TB in Myanmar is still high due to challenges such as uncontrolled urbanization, an ageing population, migration, and poor access to health facilities in remote areas. New screening and diagnostic tools might help to detect more TB patients. There is a need to lay greater emphasis on multisectoral approaches, decentralization and the integration of basic TB services into primary care facilities.
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Affiliation(s)
- Si Thu Aung
- Department of Public Health, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Wint Wint Nyunt
- National Tuberculosis Reference Laboratory, National Tuberculosis Programme, Ministry of Health and Sports, Yangon, Myanmar
| | - Myat Myat Moe
- National Tuberculosis Programme, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Htin Lin Aung
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Thandar Lwin
- Department of Public Health, Ministry of Health and Sports, Naypyitaw, Myanmar
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7
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Zawedde-Muyanja S, Reuter A, Tovar MA, Hussain H, Loando Mboyo A, Detjen AK, Yuen CM. Provision of Decentralized TB Care Services: A Detect-Treat-Prevent Strategy for Children and Adolescents Affected by TB. Pathogens 2021; 10:1568. [PMID: 34959523 PMCID: PMC8705395 DOI: 10.3390/pathogens10121568] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
In this review, we discuss considerations and successful models for providing decentralized diagnosis, treatment, and prevention services for children and adolescents. Key approaches to building decentralized capacity for childhood TB diagnosis in primary care facilities include provider training and increased access to child-focused diagnostic tools and techniques. Treatment of TB disease should be managed close to where patients live; pediatric formulations of both first- and second-line drugs should be widely available; and any hospitalization should be for as brief a period as medically indicated. TB preventive treatment for child and adolescent contacts must be greatly expanded, which will require home visits to identify contacts, building capacity to rule out TB, and adoption of shorter preventive regimens. Decentralization of TB services should involve the private sector, with collaborations outside the TB program in order to reach children and adolescents where they first enter the health care system. The impact of decentralization will be maximized if programs are family-centered and designed around responding to the needs of children and adolescents affected by TB, as well as their families.
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Affiliation(s)
- Stella Zawedde-Muyanja
- The Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Anja Reuter
- Médecins Sans Frontières, Cape Town 7784, South Africa;
| | - Marco A. Tovar
- Socios En Salud Sucursal Perú, Lima 15001, Peru;
- Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima 15067, Peru
| | - Hamidah Hussain
- Interactive Research and Development Global, Singapore 238884, Singapore;
| | - Aime Loando Mboyo
- Elizabeth Glaser Pediatric AIDS Foundation, Kinshasa B.P. 1002030, Democratic Republic of the Congo;
| | - Anne K. Detjen
- United Nations Children’s Fund, New York, NY 10017, USA;
| | - Courtney M. Yuen
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA;
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Mailu EW, Owiti P, Ade S, Harries AD, Manzi M, Omesa E, Kiende P, Macharia S, Mbithi I, Kamene M. Tuberculosis control activities in the private and public health sectors of Kenya from 2013 to 2017: how do they compare? Trans R Soc Trop Med Hyg 2020; 113:740-748. [PMID: 31334760 PMCID: PMC6907001 DOI: 10.1093/trstmh/trz062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/19/2019] [Accepted: 06/09/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Large numbers of tuberculosis (TB) patients seek care from private for-profit providers. This study aimed to assess and compare TB control activities in the private for-profit and public sectors in Kenya between 2013 and 2017. METHODS We conducted a retrospective cross-sectional study using routinely collected data from the National Tuberculosis, Leprosy and Lung Disease Program. RESULTS Of 421 409 patients registered and treated between 2013 and 2017, 86 894 (21%) were from the private sector. Data collection was less complete in the private sector for nutritional assessment and follow-up sputum smear examinations (p<0.001). The private sector notified less bacteriologically confirmed TB (43.1% vs 52.6%; p<0.001) and had less malnutrition (body mass index <18.5 kg/m2; 36.4% vs 43.3%; p<0.001) than the public sector. Rates of human immunodeficiency virus (HIV) testing and antiretroviral therapy initiation were >95% and >90%, respectively, in both sectors, but more patients were HIV positive in the private sector (39.6% vs 31.6%; p<0.001). For bacteriologically confirmed pulmonary TB, cure rates were lower in the private sector, especially for HIV-negative patients (p<0.001). The private sector had an overall treatment success of 86.3% as compared with the public sector at 85.7% (p<0.001). CONCLUSIONS The private sector is performing well in Kenya although there are programmatic challenges that need to be addressed.
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Affiliation(s)
- Eunice W Mailu
- National Tuberculosis, Leprosy and Lung Disease Program, Ministry of Health, Nairobi, Kenya
| | - Philip Owiti
- National Tuberculosis, Leprosy and Lung Disease Program, Ministry of Health, Nairobi, Kenya.,International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - Serge Ade
- International Union Against Tuberculosis and Lung Diseases, Paris, France.,Faculty of Medicine, University de Parakou, Parakou, Benin
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Diseases, Paris, France.,London School of Hygiene and Tropical Medicine, London, UK
| | - Marcel Manzi
- Medécins Sans Frontières, Luxembourg Operational Research Department, Brussels, Belgium
| | - Eunice Omesa
- National Tuberculosis, Leprosy and Lung Disease Program, Ministry of Health, Nairobi, Kenya
| | - Polly Kiende
- National Tuberculosis, Leprosy and Lung Disease Program, Ministry of Health, Nairobi, Kenya.,Ministry of Health, Kenya Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Stephen Macharia
- National Tuberculosis, Leprosy and Lung Disease Program, Ministry of Health, Nairobi, Kenya
| | - Irene Mbithi
- Kenya Association for the Prevention of Tuberculosis and Lung Diseases, Nairobi, Kenya
| | - Maureen Kamene
- National Tuberculosis, Leprosy and Lung Disease Program, Ministry of Health, Nairobi, Kenya
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Do Thu T, Kumar AMV, Ramaswamy G, Htun T, Le Van H, Nguyen Quang Vo L, Thi Thu TD, Codlin A, Forse R, Crewsell J, Nguyen Thanh H, Nguyen Viet H, Bui Van H, Nguyen Binh H, Nguyen Viet N. An Innovative Public-Private Mix Model for Improving Tuberculosis Care in Vietnam: How Well are We Doing? Trop Med Infect Dis 2020; 5:tropicalmed5010026. [PMID: 32075073 PMCID: PMC7157739 DOI: 10.3390/tropicalmed5010026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/23/2019] [Accepted: 02/10/2020] [Indexed: 11/26/2022] Open
Abstract
To improve tuberculosis (TB) care among individuals attending a private tertiary care hospital in Vietnam, an innovative private sector engagement model was implemented from June to December 2018. This included: (i) Active facility-based screening of all adults for TB symptoms (and chest x-ray (CXR) for those with symptoms) by trained and incentivized providers, with on-site diagnostic testing or transport of sputum samples, (ii) a mobile application to reduce dropout in the care cascade and (iii) enhanced follow-up care by community health workers. We conducted a cohort study using project and routine surveillance data for evaluation. Among 52,078 attendees, 368 (0.7%) had symptoms suggestive of TB and abnormalities on CXR. Among them, 299 (81%) were tested and 103 (34.4%) were diagnosed with TB. In addition, 195 individuals with normal CXR were indicated for TB testing by attending clinicians, of whom, seven were diagnosed with TB. Of the 110 TB patients diagnosed, 104 (95%) were initiated on treatment and 97 (93%) had a successful treatment outcome. Given the success of this model, the National TB Programme is considering to scale it up nationwide after undertaking a detailed cost-effectiveness analysis.
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Affiliation(s)
- Thuong Do Thu
- Vietnam Integrated Center for Tuberculosis and Respirology Research, Vietnam National Lung Hospital, Vietnam Tuberculosis Control Programme, Hanoi 100000, Vietnam; (H.L.V.); (H.N.V.); (H.B.V.); (H.N.B.); (N.N.V.)
- Correspondence: ; Tel.: +84-343007914 (ext. 235); Fax: +84-438326162
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India;
- International Union Against Tuberculosis and Lung Disease, Paris 75006, France
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575018, India
| | - Gomathi Ramaswamy
- National Centre of Excellence and Advanced Research on Anemia Control, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India;
| | - Thurain Htun
- International Union Against Tuberculosis and Lung Disease, Mandalay 05021, Myanmar;
| | - Hoi Le Van
- Vietnam Integrated Center for Tuberculosis and Respirology Research, Vietnam National Lung Hospital, Vietnam Tuberculosis Control Programme, Hanoi 100000, Vietnam; (H.L.V.); (H.N.V.); (H.B.V.); (H.N.B.); (N.N.V.)
| | - Luan Nguyen Quang Vo
- Friends for International Tuberculosis Relief, Ho Chi Minh City 700000, Vietnam; (L.N.Q.V.); (T.D.T.T.); (A.C.); (R.F.)
| | - Thuy Dong Thi Thu
- Friends for International Tuberculosis Relief, Ho Chi Minh City 700000, Vietnam; (L.N.Q.V.); (T.D.T.T.); (A.C.); (R.F.)
| | - Andrew Codlin
- Friends for International Tuberculosis Relief, Ho Chi Minh City 700000, Vietnam; (L.N.Q.V.); (T.D.T.T.); (A.C.); (R.F.)
| | - Rachel Forse
- Friends for International Tuberculosis Relief, Ho Chi Minh City 700000, Vietnam; (L.N.Q.V.); (T.D.T.T.); (A.C.); (R.F.)
| | | | - Hoi Nguyen Thanh
- Haiphong International General Hospital, Haiphong 180000, Vietnam;
| | - Hai Nguyen Viet
- Vietnam Integrated Center for Tuberculosis and Respirology Research, Vietnam National Lung Hospital, Vietnam Tuberculosis Control Programme, Hanoi 100000, Vietnam; (H.L.V.); (H.N.V.); (H.B.V.); (H.N.B.); (N.N.V.)
| | - Huy Bui Van
- Vietnam Integrated Center for Tuberculosis and Respirology Research, Vietnam National Lung Hospital, Vietnam Tuberculosis Control Programme, Hanoi 100000, Vietnam; (H.L.V.); (H.N.V.); (H.B.V.); (H.N.B.); (N.N.V.)
| | - Hoa Nguyen Binh
- Vietnam Integrated Center for Tuberculosis and Respirology Research, Vietnam National Lung Hospital, Vietnam Tuberculosis Control Programme, Hanoi 100000, Vietnam; (H.L.V.); (H.N.V.); (H.B.V.); (H.N.B.); (N.N.V.)
- International Union Against Tuberculosis and Lung Disease, Paris 75006, France
- Hanoi Medical University, Hanoi 100000, Vietnam
| | - Nhung Nguyen Viet
- Vietnam Integrated Center for Tuberculosis and Respirology Research, Vietnam National Lung Hospital, Vietnam Tuberculosis Control Programme, Hanoi 100000, Vietnam; (H.L.V.); (H.N.V.); (H.B.V.); (H.N.B.); (N.N.V.)
- Hanoi Medical University, Hanoi 100000, Vietnam
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Chaves Torres NM, Quijano Rodríguez JJ, Porras Andrade PS, Arriaga MB, Netto EM. Factors predictive of the success of tuberculosis treatment: A systematic review with meta-analysis. PLoS One 2019; 14:e0226507. [PMID: 31881023 PMCID: PMC6934297 DOI: 10.1371/journal.pone.0226507] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/27/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To produce pooled estimates of the global results of tuberculosis (TB) treatment and analyze the predictive factors of successful TB treatment. METHODS Studies published between 2014 and 2019 that reported the results of the treatment of pulmonary TB and the factors that influenced these results. The quality of the studies was evaluated according to the Newcastle-Ottawa quality assessment scale. A random effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) in February 2019 under number CRD42019121512. RESULTS A total of 151 studies met the criteria for inclusion in this review. The success rate for the treatment of drug-sensitive TB in adults was 80.1% (95% CI: 78.4-81.7). America had the lowest treatment success rate, 75.9% (95% CI: 73.8-77.9), and Oceania had the highest, 83.9% (95% CI: 75.2-91.0). In children, the success rate was 84.8% (95% CI: 77.7-90.7); in patients coinfected with HIV, it was 71.0% (95% CI: 63.7-77.8), in patients with multidrug-resistant TB, it was 58.4% (95% CI: 51.4-64.6), in patients with and extensively drug-resistant TB it was 27.1% (12.7-44.5). Patients with negative sputum smears two months after treatment were almost three times more likely to be successfully treated (OR 2.7; 1.5-4.8), whereas patients younger than 65 years (OR 2.0; 1.7-2.4), nondrinkers (OR 2.0; 1.6-2.4) and HIV-negative patients (OR 1.9; 1.6-2.5 3) were two times more likely to be successfully treated. CONCLUSION The success of TB treatment at the global level was good, but was still below the defined threshold of 85%. Factors such as age, sex, alcohol consumption, smoking, lack of sputum conversion at two months of treatment and HIV affected the success of TB treatment.
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Affiliation(s)
- Ninfa Marlen Chaves Torres
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Medicine, Nueva Granada Military University, Bogotá, D.C., Colombia
| | | | | | - María Belen Arriaga
- Gonzalo Moniz Institute, Gonzalo Cruz Foundation, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
| | - Eduardo Martins Netto
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
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