1
|
Thekkur P, Thiagesan R, Nair D, Karunakaran N, Khogali M, Zachariah R, Dar Berger S, Satyanarayana S, Kumar AMV, Bochner AF, McClelland A, Ananthakrishnan R, Harries AD. Using timeliness metrics for household contact tracing and TB preventive therapy in the private sector, India. Int J Tuberc Lung Dis 2024; 28:122-139. [PMID: 38454186 DOI: 10.5588/ijtld.23.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Although screening of household contacts (HHCs) of TB patients and provision of TB preventive therapy (TPT) is a key intervention to end the TB epidemic, their implementation globally is dismal. We assessed whether introducing a '7-1-7' timeliness metric was workable for implementing HHC screening among index patients with pulmonary TB diagnosed by private providers in Chennai, India, between November 2022 and March 2023.METHODS This was an explanatory mixed-methods study (quantitative-cohort and qualitative-descriptive).RESULTS There were 263 index patients with 556 HHCs. In 90% of index patients, HHCs were line-listed within 7 days of anti-TB treatment initiation. Screening outcomes were ascertained in 48% of HHCs within 1 day of line-listing. Start of anti-TB treatment, TPT or a decision to receive neither was achieved in 57% of HHC within 7 days of screening. Overall, 24% of screened HHCs in the '7-1-7' period started TPT compared with 16% in a historical control (P < 0.01). Barriers to achieving '7-1-7' included HHC reluctance for evaluation or TPT, refusal of private providers to prescribe TPT and reliance on facility-based screening of HHCs instead of home visits by health workers for screening.CONCLUSIONS Introduction of a timeliness metric is a workable intervention that adds structure to HHC screening and timely management..
Collapse
Affiliation(s)
- P Thekkur
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, The Union South-East Asia Office, New Delhi
| | - R Thiagesan
- Resource Group for Education and Advocacy for Community Health, Chennai, India
| | - D Nair
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, The Union South-East Asia Office, New Delhi
| | - N Karunakaran
- Resource Group for Education and Advocacy for Community Health, Chennai, India
| | - M Khogali
- Institute of Public Health, College of Medicine and Health Sciences, University of the United Arab Emirates, Al Ain, UAE
| | - R Zachariah
- United Nations Children Fund, United Nations Development Programme, World Bank Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland
| | - S Dar Berger
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, The Union South-East Asia Office, New Delhi
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, The Union South-East Asia Office, New Delhi, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India
| | | | | | - R Ananthakrishnan
- Resource Group for Education and Advocacy for Community Health, Chennai, India
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
2
|
Harries AD, Lin Y, Thekkur P, Nair D, Chakaya J, Dongo JP, Luzze H, Chimzizi R, Mubanga A, Timire C, Kavenga F, Satyanarayana S, Kumar AMV, Khogali M, Zachariah R. Why TB programmes should assess for comorbidities, determinants and disability at the start and end of TB treatment. Int J Tuberc Lung Dis 2023; 27:495-498. [PMID: 37353872 DOI: 10.5588/ijtld.23.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Y Lin
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P Thekkur
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - D Nair
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - J Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya, Respiratory Society of Kenya, Nairobi, Kenya
| | - J P Dongo
- The Union-Uganda Office, Kampala, Uganda
| | - H Luzze
- National Leprosy and Tuberculosis Programme, Ministry of Health, Kampala, Uganda
| | - R Chimzizi
- Ministry of Health/USAID STAR Project, Lusaka, Zambia
| | - A Mubanga
- National Tuberculosis Programme, Ministry of Health, Lusaka, Zambia
| | - C Timire
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK, Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - F Kavenga
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India
| | - M Khogali
- Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - R Zachariah
- Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
| |
Collapse
|
3
|
Pal P, Bhatta R, Bhattarai R, Acharya P, Singh S, Harries AD. Antimicrobial resistance in bacteria isolated from the poultry production system in Nepal. Public Health Action 2022; 12:165-170. [PMID: 36561909 PMCID: PMC9716825 DOI: 10.5588/pha.22.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
SETTING Twenty poultry farms in five provinces of Nepal were selected for studying bacterial pathogens and their antimicrobial resistance (AMR) patterns. OBJECTIVE To document the proportion of cloacal swabs collected from 3,230 broiler and 3,230 layer chickens from September to December 2021 that grew isolates of Escherichia coli, Enterococcus spp. and Salmonella spp. along with their AMR patterns. DESIGN This was a cross-sectional descriptive study. RESULTS In broiler birds, Enterococcus spp., Salmonella spp. and E. coli were identified in respectively 36%, 39% and 63% of swabs. In layer birds, Enterococcus spp., Salmonella spp. and E. coli were identified in respectively 31%, 48% and 60% of swabs. For both bird types, there was variation in bacterial prevalence between the regions. For all three bacterial isolates, the lowest antimicrobial resistance was found with amikacin. For the other nine antibiotics tested, >50% of bacterial isolates showed resistance; between 60% and 90% of isolates showed resistance to ciprofloxacin and trimethoprim-sulfamethoxazole. Multidrug resistance ranged from 45% to 46% for Salmonella spp., 37-44% for E. coli and 13-17% for Enterococcus spp. CONCLUSION This study shows that a large proportion of poultry in Nepal are infected with potentially pathogenic bacteria, and these are frequently resistant to commonly used antibiotics. Nepal urgently needs to implement corrective measures.
Collapse
Affiliation(s)
- P. Pal
- Agriculture and Forestry University, Chitwan, Nepal
| | - R. Bhatta
- Agriculture and Forestry University, Chitwan, Nepal
| | - R. Bhattarai
- Agriculture and Forestry University, Chitwan, Nepal
| | - P. Acharya
- Agriculture and Forestry University, Chitwan, Nepal
| | - S. Singh
- Agriculture and Forestry University, Chitwan, Nepal
| | - A. D. Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
4
|
Migliori GB, Wu SJ, Matteelli A, Zenner D, Goletti D, Ahmedov S, Al-Abri S, Allen DM, Balcells ME, Garcia-Basteiro AL, Cambau E, Chaisson RE, Chee CBE, Dalcolmo MP, Denholm JT, Erkens C, Esposito S, Farnia P, Friedland JS, Graham S, Hamada Y, Harries AD, Kay AW, Kritski A, Manga S, Marais BJ, Menzies D, Ng D, Petrone L, Rendon A, Silva DR, Schaaf HS, Skrahina A, Sotgiu G, Thwaites G, Tiberi S, Tukvadze N, Zellweger JP, D Ambrosio L, Centis R, Ong CWM. Clinical standards for the diagnosis, treatment and prevention of TB infection. Int J Tuberc Lung Dis 2022; 26:190-205. [PMID: 35197159 PMCID: PMC8886963 DOI: 10.5588/ijtld.21.0753] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND: Tuberculosis (TB) preventive therapy (TPT) decreases the risk of developing TB disease and its associated morbidity and mortality. The aim of these clinical standards is to guide the assessment, management of TB infection (TBI) and implementation of TPT.METHODS: A panel of global experts in the field of TB care was identified; 41 participated in a Delphi process. A 5-point Likert scale was used to score the initial standards. After rounds of revision, the document was approved with 100% agreement.RESULTS: Eight clinical standards were defined: Standard 1, all individuals belonging to at-risk groups for TB should undergo testing for TBI; Standard 2, all individual candidates for TPT (including caregivers of children) should undergo a counselling/health education session; Standard 3, testing for TBI: timing and test of choice should be optimised; Standard 4, TB disease should be excluded prior to initiation of TPT; Standard 5, all candidates for TPT should undergo a set of baseline examinations; Standard 6, all individuals initiating TPT should receive one of the recommended regimens; Standard 7, all individuals who have started TPT should be monitored; Standard 8, a TBI screening and testing register should be kept to inform the cascade of care.CONCLUSION: This is the first consensus-based set of Clinical Standards for TBI. This document guides clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage TBI.
Collapse
Affiliation(s)
- G B Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - S J Wu
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore City
| | - A Matteelli
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy, WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, Brescia, Italy
| | - D Zenner
- Centre for Global Public Health, Institute for Population Health Sciences, Queen Mary University, London, UK
| | - D Goletti
- Translational Research Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - S Ahmedov
- USAID, Bureau for Global Health, TB Division, Washington, DC, USA
| | - S Al-Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - D M Allen
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore City, Infectious Disease Translational Research Programme, Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, Singapore City
| | - M E Balcells
- Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - A L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - E Cambau
- IAME UMR1137, INSERM, University of Paris, F-75018 Paris; AP-HP-Bichat Hospital, Associate laboratory of National Reference Center for Mycobacteria and Antimycobacterial Resistance, Paris, France
| | - R E Chaisson
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C B E Chee
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore, Singapore
| | - M P Dalcolmo
- Helio Fraga Reference Center, Oswaldo Cruz Foundation Ministry of Health, Rio de Janeiro, Brazil
| | - J T Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Australia, Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - C Erkens
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - S Esposito
- Paediatric Clinic, Pietro Barilla Children´s Hospital, University of Parma, Parma, Italy
| | - P Farnia
- Mycobacteriology Research Center (MRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - J S Friedland
- Institute for Infection and Immunity, St George´s, University of London, London, UK
| | - S Graham
- Department of Paediatrics, Center for International Child Health, University of Melbourne, Melbourne, VIC, Australia, Murdoch Children´s Research Institute, Royal Children´s Hospital, Melbourne, Australia
| | - Y Hamada
- Institute for Global Health, University College London, London, UK
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - A W Kay
- The Global Tuberculosis Program, Texas Children´s Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - A Kritski
- Academic Tuberculosis Program Center, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - S Manga
- Operational Center, Medecins Sans Frontieres (MSF), Paris, France
| | - B J Marais
- Department of Infectious Diseases and Microbiology, The Children´s Hospital at Westmead, Westmead, NSW, Australia, The University of Sydney Institute for Infectious Diseases, Sydney, NSW, Australia
| | - D Menzies
- Montréal Chest Institute, Montréal, QC, Canada, Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montréal, QC, Canada, McGill International Tuberculosis Centre, Montréal, QC, Canada
| | - D Ng
- Infectious Diseases, National Centre for Infectious Diseases, Singapore
| | - L Petrone
- Translational Research Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - A Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias CIPTIR, University Hospital of Monterrey UANL (Universidad Autonoma de Nuevo Leon), Monterrey, Mexico
| | - D R Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Skrahina
- Republican Research and Practical Center for Pulmonology and Tuberculosis, Minsk, Belarus
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - G Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - S Tiberi
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK, Blizard Institute, Queen Mary University of London, London, UK
| | - N Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - J-P Zellweger
- TB Competence Center, Swiss Lung Association, Berne, Switzerland
| | - L D Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - R Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - C W M Ong
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore City, Infectious Disease Translational Research Programme, Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, Singapore City, National University of Singapore Institute for Health Innovation & Technology (iHealthtech), Singapore, Singapore
| |
Collapse
|
5
|
Harries AD, Zellweger JP. Protecting healthcare workers from TB. Int J Tuberc Lung Dis 2022; 26:89-90. [PMID: 35086617 DOI: 10.5588/ijtld.21.0641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - J-P Zellweger
- TB Competence Centre, Swiss Lung Association, Berne, Switzerland
| |
Collapse
|
6
|
Harries AD, Martinez L, Chakaya JM. Reply to: Climate change and TB: the soil and seed conceptual framework. Public Health Action 2021; 11:109. [PMID: 34159073 PMCID: PMC8202629 DOI: 10.5588/pha.21.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - L Martinez
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - J M Chakaya
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
7
|
Harries AD, Kumar AMV, Satyanarayana S, Thekkur P, Lin Y, Dlodlo RA, Brigden G. TB and COVID-19: measuring key risk factors that affect treatment outcomes. Int J Tuberc Lung Dis 2021; 25:329-331. [PMID: 33762081 DOI: 10.5588/ijtld.21.0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi
| | - P Thekkur
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi
| | - Y Lin
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - G Brigden
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| |
Collapse
|
8
|
Harries AD, Martinez L, Chakaya JM. Tackling climate change: measuring the carbon footprint of preventing, diagnosing and treating TB. Public Health Action 2021; 11:40. [PMID: 33777720 DOI: 10.5588/pha.20.0076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - L Martinez
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - J M Chakaya
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
9
|
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - G Brigden
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J M Chakaya
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
10
|
Mandalakas A, Harries AD. Celebrating the life of Peter Nicholas Kazembe M.D., 1955–2020. Int J Tuberc Lung Dis 2020. [DOI: 10.5588/ijtld.20.0681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A. Mandalakas
- Global Tuberculosis Program, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine and Texas Children´s Hospital, Houston, TX, USA
| | - A. D. Harries
- International Union Against Tuberculosis and Lung Disease, Winchester, UK
| |
Collapse
|
11
|
Koura KG, Harries AD, Fujiwara PI, Dlodlo RA, Sansan EK, Kampoer B, Affolabi D, Combary A, Mbassa V, Gando H, Bangoura A, Assao M, Gning B, Dogo MF, Fiogbé A, Bridgen G. COVID-19 in Africa: community and digital technologies for tuberculosis management. Int J Tuberc Lung Dis 2020; 24:863-865. [PMID: 32912396 DOI: 10.5588/ijtld.20.0412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- K G Koura
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Communauté d´universités et établissements (COMUE) Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France, École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Epidémiologique, Université de Parakou, Parakou, Benin
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - P I Fujiwara
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - E K Sansan
- Alliance Côte d´Ivoire, Abidjan, Côte d´Ivoire
| | - B Kampoer
- Dynamique de la Réponse d´Afrique Francophone sur la TB (DRAF TB), Yaoundé, Cameroon
| | - D Affolabi
- Ministry of Health, National Tuberculosis Programme, Cotonou, Benin
| | - A Combary
- Ministry of Health, National Tuberculosis Programme, Ouagadougou, Burkina Faso
| | - V Mbassa
- Ministry of Health, National Tuberculosis Programme, Yaoundé, Cameroon
| | - H Gando
- Ministry of Health, National Tuberculosis Programme, Bangui, Central African Republic
| | - A Bangoura
- Ministry of Health, National Tuberculosis Programme, Conakry, Guinea
| | - M Assao
- Ministry of Health, National Tuberculosis Programme, Niamey, Niger
| | - B Gning
- Ministry of Health, National Tuberculosis Programme, Dakar, Senegal
| | - M F Dogo
- Ministry of Health, National Tuberculosis Programme, Lomé, Togo, ,
| | - A Fiogbé
- Ministry of Health, National Tuberculosis Programme, Cotonou, Benin
| | - G Bridgen
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| |
Collapse
|
12
|
Goverwa-Sibanda TP, Mupanguri C, Timire C, Harries AD, Ngwenya S, Chikwati E, Mapfuma C, Mushambi F, Tweya H, Ndlovu M. Hepatitis B infection in people living with HIV who initiate antiretroviral therapy in Zimbabwe. Public Health Action 2020; 10:97-103. [PMID: 33134123 DOI: 10.5588/pha.20.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/18/2020] [Indexed: 11/10/2022] Open
Abstract
Setting There is little information about the diagnosis and treatment of hepatitis B virus (HBV) infection in people living with HIV (PLHIV) in Zimbabwe despite recommendations that tenofovir (TDF) + lamivudine (3TC) is the most effective nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) backbone of antiretroviral therapy (ART) in those with dual infection. Objective To determine 1) numbers screened for hepatitis B surface antigen (HBsAg); 2) numbers diagnosed HBsAg-positive along with baseline characteristics; and 3) NRTI backbones used among PLHIV initiating first-line ART at Mpilo Opportunistic Infections Clinic, Bulawayo, Zimbabwe, between October 2017 and April 2019. Design This was a cross-sectional study using routinely collected data. Results Of the 422 PLHIV initiating first-line ART (median age 34 years, IQR 25-43), 361 (85%) were screened for HBV, with 10% being HBsAg-positive. HBsAg positivity was significantly associated with anaemia (adjusted prevalence ratio [aPR] 2.3, 95%CI 1.1-4.7) and elevated ala-nine transaminase levels (aPR 2.9, 95%CI 1.5-5.8). Of 38 PLHIV who were diagnosed HBsAg-positive, 30 (79%) were started on ART based on tenofovir (TDF) and lamivudine (3TC), seven were given abacavir (ABC) + 3TC-based ART and one was given zido vudine (ZDV) + 3TC-based ART. Conclusion In PLHIV, HBV screening worked well, the prevalence of HIV-HBV co-infection was high and most patients received appropriate treatment for both conditions. Recommendations to improve screening, diagnosis and treatment of HIV-HBV co-infection are discussed.
Collapse
Affiliation(s)
- T P Goverwa-Sibanda
- AIDS Healthcare Foundation, Zimbabwe, Harare.,Mpilo Hospital, Ministry of Health and Child Care, Bulawayo, Zimbabwe
| | - C Mupanguri
- National AIDS/TB Programme, Ministry of Health and Child Care, Harare, Zimbabwe
| | - C Timire
- National AIDS/TB Programme, Ministry of Health and Child Care, Harare, Zimbabwe.,National University of Science and Technology, Bulawayo, Zimbabwe.,International Union Against Tuberculosis and Lung Disease (The Union) Zimbabwe, Harare, Zimbabwe
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - S Ngwenya
- Mpilo Hospital, Ministry of Health and Child Care, Bulawayo, Zimbabwe
| | - E Chikwati
- AIDS Healthcare Foundation, Zimbabwe, Harare
| | - C Mapfuma
- National University of Science and Technology, Bulawayo, Zimbabwe
| | - F Mushambi
- Parirenyatwa Group of Hospitals, Ministry of Health and Child Care, Harare, Zimbabwe
| | - H Tweya
- The Union, Paris, France.,The Lighthouse Clinic, Lilongwe, Malawi
| | - M Ndlovu
- Mpilo Hospital, Ministry of Health and Child Care, Bulawayo, Zimbabwe.,National University of Science and Technology, Bulawayo, Zimbabwe
| |
Collapse
|
13
|
Halloran NF, Harries AD, Ghebrehewet S, Cleary P. Factors associated with influenza-like illness in care homes in Cheshire and Merseyside during the 2017-2018 influenza season. Public Health 2020; 187:89-96. [PMID: 32937214 DOI: 10.1016/j.puhe.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 06/29/2020] [Accepted: 07/04/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the study was to identify care home characteristics associated with reported care home influenza outbreaks and factors associated with increased transmission of influenza-like illness (ILI) in care homes in Cheshire and Merseyside during the 2017-2018 influenza season. STUDY DESIGN This is a matched case-control study comparing characteristics between care homes with and without a declared influenza outbreak and a retrospective risk factor analysis of care home residents with ILI. METHODS Routinely collected outbreak surveillance data on symptomatic residents and staff, antiviral prophylaxis and influenza vaccination history, which were reported to Public Health England, were extracted from health protection electronic records. Further care home characteristics were extracted from the Care Quality Commission (CQC) website. Care homes with declared influenza outbreaks were matched with care homes without outbreaks. Chi-squared tests and logistic regression were used to examine associations between care home factors and ILI. RESULTS There were no significant differences in characteristics between 77 care homes with declared influenza outbreaks and 77 matched care homes without outbreaks. Of 2,744 residents from the homes with a declared outbreak, 644 (24%) developed an ILI. The care home risk factors were having a low CQC score and activation of antiviral prophylaxis and the protective factors were having higher numbers of residents, specializing in dementia care and having the highest CQC score. Significantly more cases occurred in residential homes than in nursing homes, in homes with lower CQC scores and in homes where eligible residents were given antiviral prophylaxis. CONCLUSIONS In homes with declared outbreaks, certain characteristics including activation of antiviral prophylaxis were associated with an increased risk of ILI. Further research is needed, particularly focussing on temporality between provision of prophylactic antivirals and the onset of ILI.
Collapse
Affiliation(s)
- N F Halloran
- Cheshire and Merseyside Health Protection Team, Public Health England North West Centre, UK.
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene and Tropical Medicine, London, UK
| | - S Ghebrehewet
- Cheshire and Merseyside Health Protection Team, Public Health England North West Centre, UK
| | - P Cleary
- Field Service, Public Health England North West Centre, UK
| |
Collapse
|
14
|
Harries AD, Martinez L, Chakaya JM. Monitoring the COVID-19 pandemic in sub-Saharan Africa: focusing on health facility admissions and deaths. Int J Tuberc Lung Dis 2020; 24:550-552. [PMID: 32398216 DOI: 10.5588/ijtld.20.0176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - L Martinez
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - J M Chakaya
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya, ,
| |
Collapse
|
15
|
Lin Y, Harries AD, Kumar AMV, Critchley JA, van Crevel R, Owiti P, Dlodlo RA, Kapur A. Tackling diabetes mellitus and tuberculosis: a new Union guide on the management of diabetes-tuberculosis. Int J Tuberc Lung Dis 2020; 23:771-772. [PMID: 31439106 DOI: 10.5588/ijtld.19.0119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Y Lin
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, London School of Hygiene & Tropical Medicine, London, UK
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France, International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, Yenepoya Medical College, Yenepoya (deemed University), Mangaluru, India
| | | | - R van Crevel
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - P Owiti
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark, ,
| |
Collapse
|
16
|
Moomba K, Williams A, Savory T, Lumpa M, Chilembo P, Tweya H, Harries AD, Herce M. Effects of real-time electronic data entry on HIV programme data quality in Lusaka, Zambia. Public Health Action 2020; 10:47-52. [PMID: 32368524 PMCID: PMC7181358 DOI: 10.5588/pha.19.0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/09/2020] [Indexed: 11/10/2022] Open
Abstract
SETTING Human immunodeficiency virus (HIV) clinics in five hospitals and five health centres in Lusaka, Zambia, which transitioned from daily entry of paper-based data records to an electronic medical record (EMR) system by dedicated data staff (Electronic-Last) to direct real-time data entry into the EMR by frontline health workers (Electronic-First). OBJECTIVE To compare completeness and accuracy of key HIV-related variables before and after transition of data entry from Electronic-Last to Electronic-First. DESIGN Comparative cross-sectional study using existing secondary data. RESULTS Registration data (e.g., date of birth) was 100% complete and pharmacy data (e.g., antiretroviral therapy regimen) was <90% complete under both approaches. Completeness of anthropometric and vital sign data was <75% across all facilities under Electronic-Last, and this worsened after Electronic-First. Completeness of TB screening and World Health Organization clinical staging data was also <75%, but improved with Electronic-First. Data entry errors for registration and clinical consultations decreased under Electronic-First, but errors increased for all anthropometric and vital sign variables. Patterns were similar in hospitals and health centres. CONCLUSION With the notable exception of clinical consultation data, data completeness and accuracy did not improve after transitioning from Electronic-Last to Electronic-First. For anthropometric and vital sign variables, completeness and accuracy decreased. Quality improvement interventions are needed to improve Electronic-First implementation.
Collapse
Affiliation(s)
- K Moomba
- Centre for Infectious Diseases Research in Zambia (CIDRZ), Lusaka, Zambia
| | - A Williams
- Operational Centre Brussels, Medical Department, Médecins Sans Frontières - Operational Research Unit (LuxOR), MSF Luxembourg
| | - T Savory
- Centre for Infectious Diseases Research in Zambia (CIDRZ), Lusaka, Zambia
| | - M Lumpa
- Centre for Infectious Diseases Research in Zambia (CIDRZ), Lusaka, Zambia
| | - P Chilembo
- Centre for Infectious Diseases Research in Zambia (CIDRZ), Lusaka, Zambia
| | - H Tweya
- The Lighthouse Clinic, Lilongwe, Malawi
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
| | - M Herce
- Centre for Infectious Diseases Research in Zambia (CIDRZ), Lusaka, Zambia
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
17
|
Lum N, Wai KT, Thar AMC, Show KL, Harries AD, Wann NMA, Hone S, Oo HN. HIV testing and ART initiation in people who inject drugs and are placed on methadone in Kachin State, Myanmar. Public Health Action 2020; 10:27-32. [PMID: 32368521 DOI: 10.5588/pha.19.0063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/07/2020] [Indexed: 11/10/2022] Open
Abstract
Setting People who inject drugs (PWID) enrolled for methadone maintenance therapy (MMT) and never previously tested for human immunodeficiency virus (HIV) in Myitkyina Drug Dependency Treatment Hospital, Myitkyina, Kachin State, Myanmar. Objectives To compare before (2016) and after (2018) adoption of 'Test and Treat' guidelines for antiretroviral therapy (ART): 1) the demographic profile of PWID, 2) HIV testing uptake and ART initiation in those diagnosed HIV-positive, and 3) time taken for events. Design This was a cohort study using secondary programme data. Results In 2016 and 2018, there were respectively 141 and 146 PWID: all were male except for one female and age distribution between the 2 years was similar. In 2018, significantly more PWID were HIV-tested than in 2016 (85% vs. 45%; P ≤ 0.001). Among those tested, the proportions who were HIV-positive were similar (37% in 2016 and 38% in 2018). In 2018, significantly fewer HIV-positive PWID were started on ART than in 2016 (19% vs. 48%; P = 0.01). Median times between enrolment on MMT and HIV testing (2 vs. 1 day) and between being diagnosed HIV-positive and started on ART (31 vs. 17 days) for 2016 and 2018 were not significantly different. Conclusion ART uptake decreased in 2018 compared with 2016, and ways to rectify this are urgently needed.
Collapse
Affiliation(s)
- N Lum
- National AIDS Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - K T Wai
- Department of Medical Research, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - A M C Thar
- Expanded Programme on Immunization, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - K L Show
- Department of Medical Research, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - N M A Wann
- Department of Medical Services, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - S Hone
- National AIDS Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - H N Oo
- National AIDS Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| |
Collapse
|
18
|
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
19
|
Phyo KH, Oo MM, Harries AD, Saw S, Aung TK, Moe J, Thuya SS, Mon YY, Min AC, Naing NN, Kyi MS, Aung ST, Oo HN. High prevalence and incidence of tuberculosis in people living with the HIV in Mandalay, Myanmar, 2011-2017. Int J Tuberc Lung Dis 2020; 23:349-357. [PMID: 30871667 DOI: 10.5588/ijtld.18.0436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Two human immunodeficiency virus (HIV) clinics providing antiretroviral therapy (ART), Mandalay, Myanmar. OBJECTIVE To assess prevalent TB at enrolment, incident TB during follow-up and associated risk factors in adult people living with HIV (PLHIV) between 2011 and 2017. DESIGN Cohort study using secondary data. RESULTS Of 11 777 PLHIV, 2911 (25%) had prevalent TB at or within 6 weeks of enrolment. Independent risk factors for prevalent TB were being male or single/widowed, daily alcohol consumption, CD4 count 200 cells/μl and anaemia. During 6 years follow-up in 8866 PLHIV with no prevalent TB, the rate of new TB was 2.9 per 100 person-years (95%CI 2.6-3.1). Cumulative TB incidence was 9.6%, with 370 (72%) of 517 new TB cases occurring in the first year. Independent risk factors for incident TB were being male and anaemia. Incident TB was highest in the first year of ART, in PLHIV with CD4 counts 200 cells/μl and those not receiving isoniazid preventive therapy (IPT). Incident TB declined with time on ART and rising CD4 counts. CONCLUSION Prevalent and incident TB were high in PLHIV in the Mandalay clinics. Consideration should be given to earlier TB diagnosis using more sensitive diagnostic tools, effective ART and scaling up IPT.
Collapse
Affiliation(s)
- K H Phyo
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - M M Oo
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - A D Harries
- The Union, Paris, France, London School of Hygiene & Tropical Medicine, London, UK
| | - S Saw
- Department of Medical Research, Ministry of Health and Sports, Naypyitaw
| | - T K Aung
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - J Moe
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - S S Thuya
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Y Y Mon
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - A C Min
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - N N Naing
- Medical Superintendent Office, Central Prison Hospital, Mandalay
| | - M S Kyi
- Department of Public Health, Ministry of Health and Sports, Naypyitaw
| | - S T Aung
- National Tuberculosis Programme, Ministry of Health and Sports, Naypyidaw
| | - H N Oo
- National AIDS Programme, Ministry of Health and Sports, Naypyitaw, Myanmar
| |
Collapse
|
20
|
Kyaw NTT, Kumar AMV, Kyaw KWY, Satyanarayana S, Magee MJ, Min AC, Moe J, Aung ZZ, Aung TK, Oo MM, Soe KT, Oo HN, Aung ST, Harries AD. IPT in people living with HIV in Myanmar: a five-fold decrease in incidence of TB disease and all-cause mortality. Int J Tuberc Lung Dis 2020; 23:322-330. [PMID: 30871663 DOI: 10.5588/ijtld.18.0448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Myanmar, a country with a high human immunodeficiency virus-tuberculosis (HIV-TB) burden, where the tuberculin skin test or interferon-gamma release assays are not routinely available for the diagnosis of latent tuberculous infection. OBJECTIVE To assess the effect of isoniazid (INH) preventive therapy (IPT) on the risk of TB disease and mortality among people living with HIV (PLHIV). DESIGN A retrospective cohort study of routinely collected data on PLHIV enrolled into care between 2009 and 2014. RESULTS Of 7177 patients (median age 36 years, interquartile range 31-42; 53% male) included in the study, 1278 (18%) patients received IPT. Among patients receiving IPT, 855 (67%) completed 6 or 9 months of INH. Patients who completed IPT had a significantly lower risk of incident TB than those who never received IPT (adjusted hazard ratio [aHR] 0.21, 95%CI 0.12-0.34) after controlling for potential confounders. PLHIV who received IPT had a significantly lower risk of death than those who never received IPT (PLHIV who completed IPT, aHR 0.25, 95%CI 0.16-0.37; those who received but did not complete IPT, aHR 0.55, 95%CI 0.37-0.82). CONCLUSION Among PLHIV in Myanmar, completing a course of IPT significantly reduced the risk of TB disease, and receiving IPT significantly reduced the risk of death.
Collapse
Affiliation(s)
- N T T Kyaw
- International Union Against Tuberculosis and Lung Disease (The Union), Myanmar Office, Mandalay, Myanmar, Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | | | - K W Y Kyaw
- International Union Against Tuberculosis and Lung Disease (The Union), Myanmar Office, Mandalay, Myanmar
| | | | - M J Magee
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - A C Min
- International Union Against Tuberculosis and Lung Disease (The Union), Myanmar Office, Mandalay, Myanmar
| | - J Moe
- International Union Against Tuberculosis and Lung Disease (The Union), Myanmar Office, Mandalay, Myanmar
| | - Z Z Aung
- National HIV/AIDS Programme, Department of Public Health, Naypyidaw, Myanmar
| | - T K Aung
- International Union Against Tuberculosis and Lung Disease (The Union), Myanmar Office, Mandalay, Myanmar
| | - M M Oo
- International Union Against Tuberculosis and Lung Disease (The Union), Myanmar Office, Mandalay, Myanmar
| | - K T Soe
- Department of Medical Research, Pyin Oo Lwin Branch
| | - H N Oo
- National HIV/AIDS Programme, Department of Public Health, Naypyidaw, Myanmar
| | - S T Aung
- National Tuberculosis Programme, Department of Public Health, Naypyidaw, Myanmar
| | - A D Harries
- The Union, Paris, France, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
21
|
Harries AD, Schwoebel V, Monedero-Recuero I, Aung TK, Chadha S, Chiang CY, Conradie F, Dongo JP, Heldal E, Jensen P, Nyengele JPK, Koura KG, Kumar AMV, Lin Y, Mlilo N, Nakanwagi-Mukwaya A, Ncube RT, Nyinoburyo R, Oo NL, Patel LN, Piubello A, Rusen ID, Sanda T, Satyanarayana S, Syed I, Thu AS, Tonsing J, Trébucq A, Zamora V, Zishiri C, Hinderaker SG, Aït-Khaled N, Roggi A, Caminero Luna J, Graham SM, Dlodlo RA, Fujiwara PI. Challenges and opportunities to prevent tuberculosis in people living with HIV in low-income countries. Int J Tuberc Lung Dis 2020; 23:241-251. [PMID: 30808459 DOI: 10.5588/ijtld.18.0207] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
People living with the human immunodeficiency virus (HIV) (PLHIV) are at high risk for tuberculosis (TB), and TB is a major cause of death in PLHIV. Preventing TB in PLHIV is therefore a key priority. Early initiation of antiretroviral therapy (ART) in asymptomatic PLHIV has a potent TB preventive effect, with even more benefits in those with advanced immunodeficiency. Applying the most recent World Health Organization recommendations that all PLHIV initiate ART regardless of clinical stage or CD4 cell count could provide a considerable TB preventive benefit at the population level in high HIV prevalence settings. Preventive therapy can treat tuberculous infection and prevent new infections during the course of treatment. It is now established that isoniazid preventive therapy (IPT) combined with ART among PLHIV significantly reduces the risk of TB and mortality compared with ART alone, and therefore has huge potential benefits for millions of sufferers. However, despite the evidence, this intervention is not implemented in most low-income countries with high burdens of HIV-associated TB. HIV and TB programme commitment, integration of services, appropriate screening procedures for excluding active TB, reliable drug supplies, patient-centred support to ensure adherence and well-organised follow-up and monitoring that includes drug safety are needed for successful implementation of IPT, and these features would also be needed for future shorter preventive regimens. A holistic approach to TB prevention in PLHIV should also include other important preventive measures, such as the detection and treatment of active TB, particularly among contacts of PLHIV, and control measures for tuberculous infection in health facilities, the homes of index patients and congregate settings.
Collapse
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, London School of Hygiene & Tropical Medicine, London, UK
| | - V Schwoebel
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - I Monedero-Recuero
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - T K Aung
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Myanmar Office, Mandalay, Myanmar
| | - S Chadha
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi, India
| | - C-Y Chiang
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - F Conradie
- Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa, Vital Strategies, New York, New York, USA
| | - J-P Dongo
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Uganda Office, Kampala, Uganda
| | - E Heldal
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - P Jensen
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - J P K Nyengele
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, DRC Office, Kinshasa, Democratic Republic of Congo
| | - K G Koura
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Mère et enfant face aux infections tropicales Institut de recherche pour le développement, Université Paris 5, Sorbonne Paris Cité, Paris, France
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi, India
| | - Y Lin
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, China Office, Beijing, China
| | - N Mlilo
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Zimbabwe Office, Harare, Zimbabwe
| | - A Nakanwagi-Mukwaya
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Uganda Office, Kampala, Uganda
| | - R T Ncube
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Zimbabwe Office, Harare, Zimbabwe
| | - R Nyinoburyo
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Uganda Office, Kampala, Uganda
| | - N L Oo
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Myanmar Office, Mandalay, Myanmar
| | - L N Patel
- Vital Strategies, New York, New York, USA
| | - A Piubello
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Damien Foundation, Brussels, Belgium
| | - I D Rusen
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Vital Strategies, New York, New York, USA
| | - T Sanda
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, DRC Office, Kinshasa, Democratic Republic of Congo
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi, India
| | - I Syed
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - A S Thu
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Myanmar Office, Mandalay, Myanmar
| | - J Tonsing
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi, India
| | - A Trébucq
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - V Zamora
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Peru Office, Lima, Peru
| | - C Zishiri
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Zimbabwe Office, Harare, Zimbabwe
| | - S G Hinderaker
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, University of Bergen, Bergen, Norway
| | - N Aït-Khaled
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - A Roggi
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - J Caminero Luna
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Pneumology Department, Dr Negrin General Hospital of Gran Canaria, Las Palmas, Spain
| | - S M Graham
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Zimbabwe Office, Harare, Zimbabwe
| | - P I Fujiwara
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| |
Collapse
|
22
|
Affiliation(s)
- A. D. Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK, ,
| |
Collapse
|
23
|
Sengai T, Timire C, Harries AD, Tweya H, Kavenga F, Shumba G, Tavengerwei J, Ncube R, Zishiri C, Mapfurira MJ, Mandizvidza V, Sandy C. Mobile targeted screening for tuberculosis in Zimbabwe: diagnosis, linkage to care and treatment outcomes. Public Health Action 2019; 9:159-165. [PMID: 32042608 DOI: 10.5588/pha.19.0040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/01/2019] [Indexed: 11/10/2022] Open
Abstract
Setting Targeted active screening for tuberculosis (Tas4TB) using mobile trucks in the community was implemented in 15 high TB burden districts in Zimbabwe. At-risk populations were screened for TB based on symptoms and chest radiography (CXR) results. Those with any positive symptom and/or an abnormal CXR had sputum collected for investigation and diagnosis and were linked to care and treatment if found to have TB. Objective To determine 1) the proportion and characteristics of those screened and diagnosed with TB; 2) the relationship between TB symptoms, CXR and diagnostic yields; and 3) the relationship between initiation of anti-TB treatment and treatment outcomes. Design Cohort study using routinely collected data. Results A total of 39 065 persons were screened, of whom 663 (1.7%) were diagnosed with TB; 126/663 (19.0%) were bacteriologically confirmed. The highest TB diagnostic yields were in symptomatic persons with CXRs suggestive of TB (19.4%), asymptomatic persons with CXRs suggestive of TB (8.4%) and persons at high-risk of TB (3.2%). For all diagnosed TB patients, pre-treatment loss to follow-up was 18.9% and treatment success was 59.9%. Conclusion Tas4TB resulted in high diagnostic yields; however, linkage of diagnosis to care was poor. Reasons for loss to follow-up need to be better understood and rectified.
Collapse
Affiliation(s)
- T Sengai
- Family AIDS Caring Trust, Mutare, Zimbabwe
| | - C Timire
- National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | | | - F Kavenga
- Family AIDS Caring Trust, Mutare, Zimbabwe
| | - G Shumba
- Family AIDS Caring Trust, Mutare, Zimbabwe
| | | | - R Ncube
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - C Zishiri
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - M J Mapfurira
- National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | | | - C Sandy
- National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| |
Collapse
|
24
|
Harries AD, Dlodlo RA, Brigden G, Mortimer K, Jensen P, Fujiwara PI, Castro JL, Chakaya JM. Should we consider a 'fourth 90' for tuberculosis? Int J Tuberc Lung Dis 2019; 23:1253-1256. [PMID: 31753065 DOI: 10.5588/ijtld.19.0471] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The international community has committed to end the tuberculosis (TB) epidemic by 2030. To facilitate the meeting of the global incidence and mortality indicators set by the World Health Organization's End TB Strategy, the Stop TB Partnership launched the three 90-(90)-90 diagnostic and treatment targets in 2014. In this paper, we argue that a 'fourth 90'-Ensuring that 90% of all people successfully completing treatment for TB can have a good health-related quality of life'-should be considered. Many individuals who successfully complete anti-TB treatment are burdened with lifelong comorbidities-human immunodeficiency virus (HIV) and diabetes mellitus, obstructive and restrictive lung disease, involving lung destruction, cavitation, fibrosis and bronchiectasis, that either pre-existed or developed as a result of TB (e.g., chronic pulmonary aspergillosis), permanent disabilities such as hearing loss resulting from second-line anti-TB drugs, and mental health disorders. These need to be identified during TB treatment and appropriate care and support provided after anti-TB treatment is successfully completed. A 'fourth 90' has also been proposed for the UNAIDS 90-90-90 targets similar in scope to what is being suggested here for TB. Adoption by both HIV and TB control programmes would highlight the current focus on integrated person- and family-centred services.
Collapse
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - G Brigden
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - K Mortimer
- International Union Against Tuberculosis and Lung Disease, Paris, France, Liverpool School of Tropical Medicine, Liverpool, UK
| | - P Jensen
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P I Fujiwara
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J L Castro
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J M Chakaya
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya
| |
Collapse
|
25
|
Timire C, Sandy C, Ngwenya M, Woznitza N, Kumar AMV, Takarinda KC, Sengai T, Harries AD. Targeted active screening for tuberculosis in Zimbabwe: are field digital chest X-ray ratings reliable? Public Health Action 2019; 9:96-101. [PMID: 31803580 DOI: 10.5588/pha.19.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/12/2019] [Indexed: 11/10/2022] Open
Abstract
SETTING Fifteen purposively selected districts in Zimbabwe in which targeted active screening for tuberculosis (Tas4TB) was conducted among TB high-risk groups (HRGs). There were 230 patients started on TB treatment on the basis of chest X-ray (CXR) results without corresponding bacteriological confirmation. OBJECTIVES To determine 1) the percentage of agreements in digital CXR ratings by medical officers against final ratings by radiologist(s), 2) inter-rater agreement in CXR ratings between medical officers and radiologists, and 3) number (and proportion) of patients belonging to HRGs who were over-treated during Tas4TB. DESIGN This was a cross-sectional study using programme data. RESULTS A total of 168 patients had their CXRs rated by two independent radiologists. Discordances among the radiologists were resolved by a third index radiologist, who provided the final rating. κ scores were 0.01 (field ratings vs. Radiologist A); 0.02 (field ratings vs. Radiologist B); 0.74 (Radiologists A vs. B). The percentage agreement for field and final radiologist rating was 70% (95%CI 64-78). Around 29% (95%CI 23-36) of the patients were potentially over-treated during Tas4TB. CONCLUSION Over a quarter of patients with presumptive TB are potentially over-treated during Tas4TB. Over-treatment is highest among those with previous contact with TB patients. Trainings of radiographers and medical officers may improve CXR ratings.
Collapse
Affiliation(s)
- C Timire
- Ministry of Health and Child Care, National AIDS & TB Programme, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - C Sandy
- Ministry of Health and Child Care, National AIDS & TB Programme, Harare, Zimbabwe
| | - M Ngwenya
- World Health Organization, Harare Country Office, Zimbabwe
| | - N Woznitza
- Homerton University Hospital & Canterbury Christ Church University, London, UK
| | - A M V Kumar
- The Union, Paris, France.,The Union, South East-Asia Office, New Delhi, India.,Yenepoya Medical College, Yenepoya (deemed University), Mangaluru, India
| | - K C Takarinda
- Ministry of Health and Child Care, National AIDS & TB Programme, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - T Sengai
- Family AIDS Caring Trust (FACT), Mutare, Zimbabwe
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
26
|
Harries AD, Lin Y, Kumar AMV, Satyanarayana S, Zachariah R, Dlodlo RA. How can integrated care and research assist in achieving the SDG targets for diabetes, tuberculosis and HIV/AIDS? Int J Tuberc Lung Dis 2019; 22:1117-1126. [PMID: 30236178 DOI: 10.5588/ijtld.17.0677] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Integrating the management and care of communicable diseases, such as tuberculosis (TB) and human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS), and non-communicable diseases, particularly diabetes mellitus (DM), may help to achieve the ambitious health-related targets of the Sustainable Development Goals (SDG 3.3 and 3.4) by 2030. There are five important reasons to integrate. First, we need to integrate to prevent disease. In sub-Saharan Africa, in particular, HIV infection is the main driver of the TB epidemic, and antiretroviral therapy combined with isoniazid preventive therapy (IPT) can reduce TB case notification rates. In Asia, DM is another important driver of the TB epidemic, and preventing or controlling DM can reduce the risk of TB. Second, we need to integrate to diagnose cases. Between a third to a half of those living with HIV, TB or DM do not know they have the disease, and bi-directional screening, whereby TB patients are screened for HIV and DM or people living with HIV and DM are screened for TB, can help to identify these 'missing cases'. Third, we need to integrate to better treat and manage patients who have a combination of two or more of these diseases, so that treatment success and retention on treatment can be optimised. Fourth, we should integrate to ensure better infection control practices for both TB and HIV infection in health facilities and congregate settings, such as prisons. Finally, we should integrate and learn how to monitor, record and report, particularly in relation to the cascade of events implicit in the HIV/AIDS and TB 90-90-90 targets.
Collapse
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, London School of Hygiene & Tropical Medicine, London, UK
| | - Y Lin
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Beijing, China
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Regional Office, New Delhi, India
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Regional Office, New Delhi, India
| | - R Zachariah
- Medical Department, Operational Research Unit (LuxOR), Médecins Sans Frontières, Brussels Operational Centre, Luxembourg City, Luxembourg
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Bulawayo, Zimbabwe
| |
Collapse
|
27
|
Abstract
Optimal management of combined tuberculosis (TB) and diabetes (DM) is important but challenging in terms of achieving good disease outcomes and avoiding toxicity, drug interactions and other challenges. DM management during anti-tuberculosis treatment, aimed at improving TB treatment outcomes and reducing DM-related morbidity and mortality, consists of glycaemic control and measures to reduce the risk of cardiovascular disease. Metformin, the glucose-lowering drug of choice for TB patients, has no meaningful interaction with rifampicin (RMP), and may reduce TB mortality. Insulin is effective for severe hyperglycaemia, but has several disadvantages that limit its use in TB patients. Cardiovascular risk assessment should be considered in TB-DM patients to guide management in terms of counselling and prescription of antihypertensive, lipid-lowering and anti-platelet treatment. With regard to anti-tuberculosis treatment, DM is associated with an increased risk of drug resistance, lower exposure to anti-tuberculosis drugs, treatment failure and recurrent TB. Patients therefore need careful assessment before, during and possibly after anti-tuberculosis treatment. Although no studies have been performed, anti-tuberculosis treatment may also have to be prolonged or intensified in terms of regimen or drug dosage if DM is present. With regard to service delivery, combined treatment should probably be administered, supervised and monitored as much as possible in a TB clinic. Local circumstances and severity of DM will guide the need for referral of patients to specialised DM care, and continuation of DM care after completion of anti-tuberculosis treatment. More data are also needed for the management of TB-DM patients with human immunodeficiency virus co-infection.
Collapse
Affiliation(s)
- R van Crevel
- Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - R Koesoemadinata
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - P C Hill
- Centre for International Health, Department of Preventive and Social Medicine, Faculty of Medicine, University of Otago, Dunedin, New Zealand
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
28
|
Harries AD, Timire C, Takarinda KC, Sandy C. Ensuring that Xpert ® MTB/RIF is used to its maximum potential. Int J Tuberc Lung Dis 2019; 23:1043-1044. [PMID: 31615615 DOI: 10.5588/ijtld.19.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - C Timire
- International Union Against Tuberculosis and Lung Disease, Paris, France, Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France, Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - C Sandy
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| |
Collapse
|
29
|
Harries AD, Chakaya JM. Assessing and managing pulmonary impairment in those who have completed TB treatment in programmatic settings. Int J Tuberc Lung Dis 2019; 23:1044-1045. [DOI: 10.5588/ijtld.19.0168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A. D. Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - J. M. Chakaya
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya
| |
Collapse
|
30
|
Harries AD, Brigden G, Nunn PP. Strengthening and implementing operational research in National TB Programmes: the vital role of the Global Fund. Int J Tuberc Lung Dis 2019; 23:877-878. [DOI: 10.5588/ijtld.19.0347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A. D. Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - G. Brigden
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P. P. Nunn
- Global Infectious Disease Consulting Ltd, London, UK ,
| |
Collapse
|
31
|
Ghebrehewet S, Harries AD, Kliner M, Smith K, Cleary P, Wilkinson E, Stewart A. Adapting the Structured Operational Research Training Initiative (SORT IT) for high-income countries. Public Health Action 2019; 9:69-71. [PMID: 31417856 DOI: 10.5588/pha.18.0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
SORT IT (Structured Operational Research Training InitiaTive) is a successful capacity building programme started 10 years ago to develop operational research skills in low- and middle-income countries. Public Health England (PHE) aims to embed a culture of research in front-line staff, and SORT IT has been adapted to train frontline health protection professionals at PHE North West (PHE NW) to collate, analyse and interpret routinely collected data for evidence-informed decision-making. Six participants from the PHE NW Health Protection team were selected to attend a two-module course in Liverpool, UK, in May and in November 2018. Five participants finished the course with completed papers on characteristics and burden of influenza-like illness in elderly care homes (two papers), use of dried blood spots for blood-borne virus screening in prisons, uptake of meningococcal ACWY (groups A, C, W-135 and Y) vaccine in schoolchildren and fires in waste management sites. The SORT IT course led to 1) new evidence being produced to inform health protection practice, and 2) agreement within PHE NW to continue SORT IT with two courses per year, and 3) showed how a research capacity building initiative for low- and middle-income countries that combines 'learning with doing' can be adapted and used in a high-income country.
Collapse
Affiliation(s)
- S Ghebrehewet
- Cheshire & Merseyside Health Protection Team, Public Health England, North West Centre, Liverpool, UK
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - M Kliner
- Greater Manchester Health Protection Team, Public Health England, North West Centre, Manchester, UK
| | - K Smith
- Cheshire & Merseyside Health Protection Team, Public Health England, North West Centre, Liverpool, UK
| | - P Cleary
- Field Service, Public Health England, Liverpool, UK
| | - E Wilkinson
- Institute of Medicine, University of Chester, Chester, UK
| | - A Stewart
- College of Life and Environmental Science, University of Exeter, Exeter, UK
| |
Collapse
|
32
|
Aye NS, Oo MM, Harries AD, Mon MM, Hone S, Oo HN, Wan NMA. HIV, HBV and HCV in people who inject drugs and are placed on methadone maintenance therapy, Yangon, Myanmar. Public Health Action 2018; 8:202-210. [PMID: 30775281 DOI: 10.5588/pha.18.0050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/17/2018] [Indexed: 01/20/2023] Open
Abstract
Setting: Two drug treatment centres (DTCs) for people who inject drugs (PWID) and are enrolled in methadone maintenance therapy (MMT), Yangon, Myanmar. Objectives: To determine, in PWID enrolled for MMT from 2015 to 2017, 1) testing uptake and results for human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV); 2) risk factors for infection; and 3) retention in care and risk factors for loss to follow-up (LTFU). Design: Cohort study using secondary data. Results: Of 642 PWID, 578 (90.0%) were tested for HIV, HBV and/or HCV. Overall, 404 (69.9%) were infected: 316 (78.2%) had one infection and the remainder had dual/triple infections. Testing uptake was generally better in 2015 and 2016 than in 2017. Prevalence of HIV infection was 15-17%, for HBV it was 4-7%, and for HCV it was 68-76%. Age >30 years, being single and duration of drug use were independent risk factors for infection. Retention in MMT at 6 months was 76% and declined thereafter. Experimental use of drugs and needle sharing were independent risk factors for LTFU. Conclusion: PWID enrolled in MMT in Yangon had high rates of HIV, HBV and HCV, and retention in care declined with time. Ways to improve individual tracing, programmatic retention and linkage to care are needed.
Collapse
Affiliation(s)
- N S Aye
- Department of Medical Research, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - M M Oo
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - M M Mon
- Department of Medical Research, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - S Hone
- National AIDS Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - H N Oo
- National AIDS Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - N M A Wan
- National Drug Abuse Prevention and Control Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| |
Collapse
|
33
|
Takarinda KC, Choto RC, Mutasa-Apollo T, Chakanyuka-Musanhu C, Timire C, Harries AD. Scaling up isoniazid preventive therapy in Zimbabwe: has operational research influenced policy and practice? Public Health Action 2018; 8:218-224. [PMID: 30775283 DOI: 10.5588/pha.18.0051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/31/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Following the operational research study conducted during the isoniazid preventive therapy (IPT) pilot phase in Zimbabwe, recommendations for improvement were adopted by the national antiretroviral therapy (ART) programme. Objectives: To compare before (January 2013-June 2014) and after the recommendations (July 2014-December 2015), the extent of IPT scale-up and IPT completion rates, and after the recommendations the risk factors for IPT non-completion, in 530 ART clinics. Design: Retrospective cohort study. Results: People living with the human immunodeficiency virus newly initiating IPT increased every quarter (Q), from 585 in Q 1, 2013 to 4246 in Q 4, 2015, with 5648 new IPT initiations in the 18 months before the recommendations compared to 20 513 in the 18 months after the recommendations were made. The number of ART clinics initiating IPT increased from 10 (2%) in Q 1, 2013 to 198 (37%) in Q 4, 2015. Overall IPT completion rates were 89% in the post-recommendation period compared with 81% in the pilot phase (P < 0.001). After adjusting for confounders, being lost to follow-up from clinic review visits 1 year prior to IPT initiation was associated with a higher risk of not completing IPT, while having synchronised IPT and ART resupplies was associated with a lower risk. Conclusions: Implementation of recommendations from the initial operational research study have improved IPT scale-up in Zimbabwe.
Collapse
Affiliation(s)
- K C Takarinda
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R C Choto
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - T Mutasa-Apollo
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | | | - C Timire
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Tropical Hygiene & Medicine, London, United Kingdom
| |
Collapse
|
34
|
Jokwiro A, Timire C, Harries AD, Gwinji PT, Mulema A, Takarinda KC, Mafaune PT, Sandy C. Has the utilisation of Xpert ® MTB/RIF in Manicaland Province, Zimbabwe, improved with new guidance on whom to test? Public Health Action 2018; 8:124-129. [PMID: 30271728 DOI: 10.5588/pha.18.0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/06/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Manicaland Province, Zimbabwe. Objectives: To compare the utilisation and results of deploying Xpert® MTB/RIF in 13 (one provincial, six district and six rural) hospitals between January and June 2016, when Xpert was recommended only for those with presumptive multidrug-resistant tuberculosis (MDR-TB) and coinfection with human immunodeficiency virus (HIV), and between January and June 2017, when Xpert was recommended for all presumptive TB patients. Design: This was a cross-sectional study. Results: Xpert assays averaged 759 monthly in 2016 and 1430 monthly in 2017 (88% increase). Utilisation of Xpert averaged 22% monthly in 2016 and 42% in 2017 (88% increase). In 2017, utilisation of Xpert was significantly higher in provincial (82%) than in district (51%) and rural (26%) hospitals (P < 0.001). The proportion of successful assays that detected TB decreased significantly from 13% in 2016 to 7% in 2017 (a 46% decrease, P < 0.001); this phenomenon was observed in all types of hospital. The proportion of persons detected with rifampicin-resistant TB was similar between hospitals (4% in 2016 and 3% in 2017). The proportion of registered TB cases with bacteriological confirmation increased from 48% in 2016 to 53% in 2017 (P = 0.04). Conclusion: Xpert use in all presumptive TB patients led to a significant increase in assay numbers and utilisation of Xpert instruments, resulting in more bacteriological confirmation of cases.
Collapse
Affiliation(s)
- A Jokwiro
- Ministry of Health and Child Care Zimbabwe, Nyanga District, Nyanga, Zimbabwe
| | - C Timire
- International Union Against Tuberculosis and Lung Disease, Harare, Zimbabwe.,National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - P T Gwinji
- Ministry of Health and Child Care Zimbabwe, Nyanga District, Nyanga, Zimbabwe
| | - A Mulema
- Ministry of Health and Child Care Zimbabwe, Nyanga District, Nyanga, Zimbabwe
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Harare, Zimbabwe
| | - P T Mafaune
- Manicaland Directorate, Ministry of Health and Child Care Zimbabwe, Mutare, Zimbabwe
| | - C Sandy
- National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| |
Collapse
|
35
|
Rufu A, Chitimbire VTS, Nzou C, Timire C, Owiti P, Harries AD, Apollo T. Implementation of the 'Test and Treat' policy for newly diagnosed people living with HIV in Zimbabwe in 2017. Public Health Action 2018; 8:145-150. [PMID: 30271732 DOI: 10.5588/pha.18.0030] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/24/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Sixteen mission hospitals in Zimbabwe that are implementing the 'Test and Treat' programme for people living with the human immunodeficiency virus (HIV). Objectives: To assess linkages of HIV diagnosis to care and treatment, time taken from being diagnosed with HIV infection to initiation of antiretroviral therapy (ART) and 3-month programmatic outcomes for those starting ART. Design: Cross-sectional study using secondary data. Results: Among 972 people newly diagnosed with HIV, 915 (94%) enrolled for HIV care and 771 (79%) were initiated on ART. Enrolment in care and initiation on ART on the same day as testing occurred in respectively 864 (89%) and 628 (65%) newly diagnosed patients. Over 80% of those who underwent HIV testing in maternal and child health departments initiated ART on the same day. Of the 144 (16%) people in care who were not initiated on ART, the principal reason in 102 (71%) was being transferred out. Most patients (90%) on ART were retained in care at 3 months, with transfer out accounting for most of the remainder. Conclusion: The 'Test and Treat' approach was feasible and successful in getting newly HIV-infected people initiated early on ART. More research is needed to better understand the processes, benefits and potential risks.
Collapse
Affiliation(s)
- A Rufu
- Zimbabwe Association of Church-Related Hospitals, Harare, Zimbabwe
| | - V T S Chitimbire
- Zimbabwe Association of Church-Related Hospitals, Harare, Zimbabwe
| | - C Nzou
- Zimbabwe Association of Church-Related Hospitals, Harare, Zimbabwe
| | - C Timire
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - P Owiti
- Academic Model Providing Access to Healthcare, Eldoret, Kenya.,The Union, Paris, France
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - T Apollo
- National AIDS Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| |
Collapse
|
36
|
Gadabu OJ, Ben-Smith A, Douglas GP, Chirwa-Nasasara K, Manjomo RC, Harries AD, Dambula I, Kang'oma S, Chiumia T, Chinsinga FB. Scaling up electronic village registers for measuring vital statistics in rural villages in Malawi. Public Health Action 2018; 8:79-84. [PMID: 29946524 DOI: 10.5588/pha.17.0116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Eighty-three villages without electricity in Mtema Traditional Authority, Lilongwe District, Malawi. Objectives: To describe 1) the expansion of the electronic village register (EVR) to 83 villages in Mtema Traditional Authority, 2) the challenges encountered and changes made to render the system robust and user-friendly, 3) the value propositions developed to increase the system's desirability, and 4) the results of the village register. Design: Descriptive study. Results: After the deployment of the EVR in one village in 2013, the system was extended to 83 villages with modifications to render it more robust and user-friendly. These changes included modifications to the power, connectivity and work stations, better battery security and a single modular electronics panel. Value propositions of the EVR for the village headmen included daily postings of news/sports items and sockets for charging mobile phones and lanterns. Of the 47 559 residents registered, 48% were male, 14% were aged 0-4 years, 43% were aged 15-44 years and 4% were aged ⩾65 years. Between 1 April 2016 and 31 March 2017, 976 births and 177 deaths were recorded. The total equipment cost per village was US$2430. Conclusion: An electronic village birth and death registration system can function in an area with no communication or electricity infrastructure.
Collapse
Affiliation(s)
| | - A Ben-Smith
- Baobab Health Trust, Lilongwe, Malawi.,Center for Health Informatics for the Underserved, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - G P Douglas
- Center for Health Informatics for the Underserved, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - I Dambula
- Central Monitoring and Evaluation Division, Ministry of Health, Lilongwe, Malawi
| | - S Kang'oma
- National Registration Bureau, Ministry of Home Affairs and Internal Security, Lilongwe, Malawi
| | - T Chiumia
- National Registration Bureau, Ministry of Home Affairs and Internal Security, Lilongwe, Malawi
| | - F B Chinsinga
- National Registration Bureau, Ministry of Home Affairs and Internal Security, Lilongwe, Malawi
| |
Collapse
|
37
|
Harries AD, Khogali M, Kumar AMV, Satyanarayana S, Takarinda KC, Karpati A, Olliaro P, Zachariah R. Building the capacity of public health programmes to become data rich, information rich and action rich. Public Health Action 2018; 8:34-36. [PMID: 29946518 DOI: 10.5588/pha.18.0001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/02/2018] [Indexed: 11/10/2022] Open
Abstract
Good quality, timely data are the cornerstone of health systems, but in many countries these data are not used for evidence-informed decision making and/or for improving public health. The SORT IT (Structured Operational Research and Training Initiative) model has, over 8 years, trained health workers in low- and middle-income countries to use data to answer important public health questions by taking research projects through to completion and publication in national or international journals. The D2P (data to policy) training initiative is relatively new, and it teaches health workers how to apply 'decision analysis' and develop policy briefs for policy makers: this includes description of a problem and the available evidence, quantitative comparisons of policy options that take into account predicted health and economic impacts, and political and feasibility assessments. Policies adopted from evidence-based information generated through the SORT IT and D2P approaches can be evaluated to assess their impact, and the cycle repeated to identify and resolve new public health problems. Ministries of Health could benefit from this twin-training approach to make themselves 'data rich, information rich and action rich', and thereby use routinely collected data in a synergistic manner to improve public health policy making and health care delivery.
Collapse
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - M Khogali
- Vital Strategies, New York, New York, USA
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South-East Asia Office, New Delhi, India
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South-East Asia Office, New Delhi, India
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,AIDS & TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - A Karpati
- Vital Strategies, New York, New York, USA
| | - P Olliaro
- Special Programme for Research and Training in Tropical Disease, World Health Organization, Geneva, Switzerland
| | - R Zachariah
- Special Programme for Research and Training in Tropical Disease, World Health Organization, Geneva, Switzerland.,Operations Research Unit (LuxOR), Médecins sans Frontières, Luxembourg
| |
Collapse
|
38
|
Timire C, Takarinda KC, Sandy C, Zishiri C, Kumar AMV, Harries AD. Has TB CARE I sputum transport improved access to culture services for retreatment tuberculosis patients in Zimbabwe? Public Health Action 2018; 8:66-71. [PMID: 29946522 DOI: 10.5588/pha.17.0117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/28/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Retreatment tuberculosis (TB) patients in Zimbabwe are investigated using microscopy, Xpert® MTB/RIF and culture + drug susceptibility testing (CDST). TB CARE I, a sputum transport service using motorcycles, was introduced to transport specimens between peripheral health facilities and laboratories, including National Reference Laboratories (NRLs). Objectives: To compare access to CDST and treatment outcomes among retreatment TB patients in facilities with and those without TB CARE I support. Design: This was a retrospective cohort study. Results: There were 187 patients from TB CARE I-supported facilities and 116 from non-TB CARE I facilities, with no difference in demographic characteristics. Altogether, specimens from 22 (12%) retreatment TB patients had successful CDST from TB CARE I facilities, which was not statistically significantly different from non-supported facilities (n = 14, 12%; P = 0.94). The median number of days from sputum collection to receipt at the NRL was lower in TB CARE I facilities than in non-supported facilities (median 6, interquartile range [IQR] 4-8 vs. median 8, IQR 6-13.5; P = 0.000). Favourable treatment outcomes were documented in 65% of patients under TB CARE I, significantly more than among patients in non-supported facilities (47%, P < 0.01). Conclusion: The process of sputum specimen collection for CDST was not different between TB CARE I and non-TB CARE I-supported health facilities, apart from a slightly shorter time. Ways to improve the current system are discussed.
Collapse
Affiliation(s)
- C Timire
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France.,Ministry of Health and Child Care, National TB Control Programme, Harare, Zimbabwe
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France.,Ministry of Health and Child Care, National AIDS Programme, Harare, Zimbabwe
| | - C Sandy
- Ministry of Health and Child Care, National TB Control Programme, Harare, Zimbabwe
| | - C Zishiri
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe
| | - A M V Kumar
- The Union, Paris, France.,The Union, South-East Asia Office, New Delhi, India
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
39
|
Kasapo CC, Chimzizi R, Simwanza SC, Mzyece J, Chizema E, Mariandyshev A, Lee HY, Harries AD, Kapata N. What happened to patients with RMP-resistant/MDR-TB in Zambia reported as lost to follow-up from 2011 to 2014? Int J Tuberc Lung Dis 2018; 21:887-893. [PMID: 28786797 DOI: 10.5588/ijtld.16.0933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING University Teaching Hospital, Lusaka, and Ndola Central Hospital, Ndola, Zambia, which implemented active tracing of multidrug-resistant tuberculosis (MDR-TB) patients reported as lost to follow-up (LTFU). OBJECTIVE To determine 1) the number of patients treated for MDR-TB between 2011 and 2014; 2) the number, proportion, month when LTFU and characteristics of patients registered as LTFU; and 3) final outcomes observed following active patient tracing. DESIGN Retrospective cohort study. RESULTS Of 184 patients treated for confirmed MDR-TB, 76 (41%) were reported as LTFU. From 2011 to 2014, the proportions reported each year as LTFU were respectively 21%, 47%, 51% and 39%. Of patients who were LTFU, 43 (57%) had stopped attending the clinic during the intensive phase. These patients were predominantly male, aged 15-44 years, had pulmonary disease and had failed previous treatment. Of 57 (75%) patients with known human immunodeficiency virus (HIV) status, 42 (74%) were HIV-positive, 57% of whom were on antiretroviral treatment. After active patient tracing, 29 (38%) patients could not be found and the observed outcome remained LTFU. Of the remaining 47 patients, 29 (62%) were alive and had completed or were still on treatment, 14 (30%) were alive but had stopped treatment and 4 (8%) had died. CONCLUSION Zambia has been underreporting its favourable outcomes for MDR-TB treatment and should continue with active tracing of LTFU patients.
Collapse
Affiliation(s)
- C C Kasapo
- National TB and Leprosy Control Programme, Lusaka, Zambia
| | - R Chimzizi
- National TB and Leprosy Control Programme, Lusaka, Zambia
| | - S C Simwanza
- National TB and Leprosy Control Programme, Lusaka, Zambia
| | - J Mzyece
- National TB and Leprosy Control Programme, Lusaka, Zambia
| | - E Chizema
- Department of Public Health and Research, Ministry of Health, Lusaka, Zambia
| | - A Mariandyshev
- Northern State Medical University, Archangelsk, The Russian Federation
| | - H-Y Lee
- Pingtung Christian Hospital, Pingtung, Taiwan, Luke International, Mzuzu, Malawi
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene & Tropical Medicine, London, UK
| | - N Kapata
- National TB and Leprosy Control Programme, Lusaka, Zambia; Department of Public Health and Research, Ministry of Health, Lusaka, Zambia
| |
Collapse
|
40
|
Abstract
The Sustainable Development Goals aim to end tuberculosis (TB) related deaths, transmission and catastrophic costs by 2030. Multisectorial action to accelerate socio-economic development, a new vaccine and novel diagnostics and medicines for treatment are key advances needed to end TB transmission. Achieving 90-90-90 targets for TB (i.e., 90% of vulnerable populations screened, 90% diagnosed and started on treatment, and at least 90% cured) will help accelerate progress towards reductions in mortality; however, passive case detection strategies, multidrug-resistant TB, human immunodeficiency virus coinfection and outdated pathways to care need to be overcome. Ending the catastrophic costs associated with TB will require expansion of health insurance coverage, comprehensive coverage of TB services, and limited indirect costs by vulnerable and poor populations.
Collapse
Affiliation(s)
- A B Suthar
- South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch, Tygerberg, South Africa
| | - R Zachariah
- Operations Research Unit (LuxOR), Médecins Sans Frontières, Luxembourg
| | - A D Harries
- International Union against Tuberculosis and Lung Disease, Paris, France; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
41
|
Harries AD, Ade S, Burney P, Hoa NB, Schluger NW, Castro JL. Successfully treated but not fit for purpose: paying attention to chronic lung impairment after TB treatment. Int J Tuberc Lung Dis 2018; 20:1010-4. [PMID: 27393532 DOI: 10.5588/ijtld.16.0277] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In 2013, 86% of patients with newly diagnosed tuberculosis (TB) successfully completed treatment and were discharged from care. However, long-term studies in industrialised and resource-poor countries all point to a higher risk of death in TB survivors than in the general population. The likely explanation is chronic restrictive and obstructive lung disease consequent to TB. We call for better linkages between TB control programmes and respiratory medicine services, a better understanding of the burden of respiratory disability at the end of anti-tuberculosis treatment, and political, programmatic, clinical and research action to improve the quality of life of affected patients.
Collapse
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - S Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France, National Tuberculosis Programme, Cotonou, Benin
| | - P Burney
- National Heart and Lung Institute, Imperial College, London, UK
| | - N B Hoa
- International Union Against Tuberculosis and Lung Disease, Paris, France; National Tuberculosis Control Programme, Hanoi, Viet Nam
| | - N W Schluger
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, Vital Strategies, New York, New York, USA
| | - J L Castro
- International Union Against Tuberculosis and Lung Disease, Paris, France, Vital Strategies, New York, New York, USA
| |
Collapse
|
42
|
Tripathy JP, Shewade HD, Mishra S, Kumar AMV, Harries AD. Cost of hospitalization for childbirth in India: how equitable it is in the post-NRHM era? BMC Res Notes 2017; 10:409. [PMID: 28810897 PMCID: PMC5556367 DOI: 10.1186/s13104-017-2729-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 08/06/2017] [Indexed: 11/24/2022] Open
Abstract
Background and objective Information on out-of-pocket (OOP) expenditure during childbirth in public and private health facilities in India is needed to make rational decisions for improving affordability to maternal care services. We undertook this study to evaluate the OOP expenditure due to hospitalization from childbirth and its impact on households. Methods This is a secondary data analysis of a nationwide household survey by the National Sample Survey Organization in 2014. The survey reported health service utilization and health care related expenditure by income quintiles and type of health facility. The recall period for hospitalization expenditure was 365 days. OOP expenditure amounting to more than 10% of annual consumption expenditure was termed as catastrophic. Results Median expenditure per episode of hospitalisation due to childbirth was US$54. The expenditure incurred was about six times higher among the richest quintile compared to the poorest quintile. Median private sector OOP hospitalization expenditure was nearly nine times higher than in the public sector. Hospitalization in a private sector facility leads to a significantly higher prevalence of catastrophic expenditure than hospitalization in a public sector (60% vs. 7%). Indirect cost (43%) constituted the largest share in the total expenditure in public sector hospitalizations. Urban residence, poor wealth quintile, residing in eastern and southern regions of India and delivery in private hospital were significantly associated with catastrophic expenditure. Conclusions We strongly recommend cash transfer schemes with effective pro-poor targeting to reduce the impact of catastrophic expenditure. Strengthening of public health facilities is required along with private sector regulation.
Collapse
Affiliation(s)
- Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, C-6, Qutub Institutional Area, New Delhi, 110016, India.
| | - Hemant D Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, C-6, Qutub Institutional Area, New Delhi, 110016, India
| | | | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, C-6, Qutub Institutional Area, New Delhi, 110016, India
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
43
|
Phiri NA, Lee HY, Chilenga L, Mtika C, Sinyiza F, Musopole O, Nyirenda R, Yu JKL, Harries AD. Early infant diagnosis and outcomes in HIV-exposed infants at a central and a district hospital, Northern Malawi. Public Health Action 2017; 7:83-89. [PMID: 28695079 DOI: 10.5588/pha.16.0119] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/26/2017] [Indexed: 01/01/2023] Open
Abstract
Setting: Mzuzu Central Hospital (MZCH), Mzuzu, and Chitipa District Hospital (CDH), Chitipa, Malawi. Objective: To compare management and outcomes of human immunodeficiency virus (HIV) exposed infants in early infant diagnosis (EID) programmes at MZCH, where DNA polymerase chain reaction (PCR) testing is performed on site, and CDH, where samples are sent to MZCH, between 2013 and 2014. Design: Retrospective cohort study. Results: Of infants enrolled at MZCH (n = 409) and CDH (n = 176), DNA PCR results were communicated to the children's guardians in respectively 56% and 51% of cases. The median time from sample collection to guardians receiving results was 34 days for MZCH and 56 days for CDH. In both hospitals, only half of the dried blood spot (DBS) samples were collected between 6 and 8 weeks. More guardians from MZCH than CDH received test results within 1 month of sample collection (25% vs. 10%). Among the HIV-positive infants, a higher proportion at MZCH (92%) started antiretroviral therapy than at CDH (46%). The relative risk (RR) of death was higher among infants with late DBS collection (RR 1.3, 95%CI 1.0-1.7) or no collection (RR 5.8, 95%CI 4.6-7.2), and when guardians did not receive test results (RR 8.3, 95%CI 5.7-11.9). Conclusion: EID programmes performed equally poorly at both hospitals, and might be helped by point-of-care DNA PCR testing. Better programme implementation and active follow-up might improve infant outcome and retention in care.
Collapse
Affiliation(s)
- N A Phiri
- Mzuzu Central Hospital, Mzuzu, Malawi.,University of Malawi, College of Medicine, Blantyre, Malawi
| | - H-Y Lee
- Luke International, Mzuzu, Malawi.,Pingtung Christian Hospital, Pingtung, Taiwan
| | - L Chilenga
- Chitipa District Hospital, Chitipa, Malawi
| | - C Mtika
- Mzuzu Central Hospital, Mzuzu, Malawi
| | - F Sinyiza
- Mzuzu Central Hospital, Mzuzu, Malawi
| | - O Musopole
- Northern Zone Health Office, Ministry of Health, Mzuzu, Malawi
| | - R Nyirenda
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - J K-L Yu
- Pingtung Christian Hospital, Pingtung, Taiwan
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
44
|
Chandrasekaran S, Kyaw NTT, Harries AD, Yee IA, Ellan P, Kurusamy T, Yusoff N, Mburu G, Mohammad WMZW, Suleiman A. Enrolment and retention of people who inject drugs in the Needle & Syringe Exchange Programme in Malaysia. Public Health Action 2017; 7:155-160. [PMID: 28695090 DOI: 10.5588/pha.17.0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/21/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Needle and Syringe Exchange Programme (NSEP) implemented by non-governmental organisations in Malaysia. Objectives: To determine enrolment, characteristics and retention in the NSEP of people who inject drugs (PWID) between 2013 and 2015. Design: Retrospective cohort study. Results: There were 20 946 PWID, with a mean age of 38 years. The majority were male (98%) and of Malay ethnicity (92%). Follow-up data were available for 20 761 PWID. Annual retention of newly enrolled PWID for each year was respectively 85%, 87% and 78% for 2013, 2014 and 2015, although annual enrolment over these years declined from 10 724 to 6288 to 3749. Total person-years (py) of follow-up were 27 806, with loss to follow-up of 40 per 100 py. Cumulative probability of retention in NSEP was 66% at 12 months, 45% at 24 months and 26% at 36 months. Significantly higher loss to follow-up rates were observed in those aged 15-24 years or ⩾50 years, females, transgender people and non-Malay ethnic groups. Conclusion: Annual retention of new PWID on NSEP was impressive, although enrolment declined over the 3 years of the study and cumulative loss to follow-up was high. A better understanding of these programmatic outcomes is required.
Collapse
Affiliation(s)
| | - N T T Kyaw
- International Union Against Tuberculosis and Lung Disease, Myanmar Country Office, Mandalay, Myanmar
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - I A Yee
- Malaysian AIDS Council, Kuala Lumpur, Malaysia
| | - P Ellan
- Malaysian AIDS Council, Kuala Lumpur, Malaysia
| | - T Kurusamy
- Malaysian AIDS Council, Kuala Lumpur, Malaysia
| | - N Yusoff
- Malaysian AIDS Council, Kuala Lumpur, Malaysia
| | - G Mburu
- Department of Health Research, Lancaster University, Lancaster, UK
| | - W M Z W Mohammad
- School of Medical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - A Suleiman
- Ministry of Health Malaysia, Putrajaya, Malaysia
| |
Collapse
|
45
|
Mussah VG, Mapleh L, Ade S, Harries AD, Bhat P, Kateh F, Dahn B. Performance-based financing contributes to the resilience of health services affected by the Liberian Ebola outbreak. Public Health Action 2017; 7:S100-S105. [PMID: 28744447 PMCID: PMC5515557 DOI: 10.5588/pha.16.0096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/23/2016] [Indexed: 11/10/2022] Open
Abstract
Setting: The Liberian counties of Bong, with performance-based financing (PBF) for all 36 public primary-care facilities, and Margibi, with no PBF for its 24 public primary-care facilities. Objective: To compare whether specific maternal and child health indicators changed in the two counties during the pre-Ebola (2013), Ebola (2014) and post-Ebola (2015) disease outbreak periods from July to September each year. Design: This was a cross-sectional study. Results: For pregnant women, the numbers of antenatal visits, intermittent preventive malaria treatments, human immunodeficiency virus (HIV) tests and facility-based births with skilled attendants all fell during the Ebola period, with decreases being significantly more marked in Margibi County. Apart from HIV testing, which remained low in both counties, these indicators increased in the post-Ebola period, with increases significantly more marked in Bong than in Margibi. The number of childhood immunisations decreased significantly in Bong in the Ebola period compared with the pre-Ebola period, but increased to above pre-Ebola levels in the post-Ebola period. There were markedly larger decreases in childhood immunisations in Margibi County during the Ebola period, which remained significantly lower in the post-Ebola period compared with Bong County. Conclusion: In a PBF-supported county, selected maternal and childhood health indicators showed less deterioration during Ebola and better recovery post-Ebola than in a non-PBF-supported county.
Collapse
Affiliation(s)
- V G Mussah
- Performance-based Financing Unit, Department of Health Services (DHS), Ministry of Health (MoH), Monrovia, Liberia
| | - L Mapleh
- Fixed Amount Reimbursement Agreement Unit, DHS, MoH, Monrovia, Liberia
| | - S Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France
- National Tuberculosis Control Programme, Cotonou, Benin
- Faculty of Medicine, University of Parakou, Parakou, Benin
| | - A D Harries
- London School of Hygiene & Tropical Medicine, London, UK
| | - P Bhat
- Ministry of Health, Government of Karnataka, Karnataka, India
| | | | | |
Collapse
|
46
|
Samba T, Bhat P, Owiti P, Samuels L, Kanneh PJ, Paul R, Kargbo B, Harries AD. Non-communicable diseases in the Western Area District, Sierra Leone, before and during the Ebola outbreak. Public Health Action 2017; 7:S16-S21. [PMID: 28744434 PMCID: PMC5515558 DOI: 10.5588/pha.16.0086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/26/2016] [Indexed: 12/22/2022] Open
Abstract
Setting: Twenty-seven peripheral health units, five secondary hospitals and one tertiary hospital, Western Area District, Sierra Leone. Objectives: To describe reporting systems, monthly attendances and facility-based patterns of six non-communicable diseases (NCDs) in the pre-Ebola and Ebola virus disease outbreak periods. Design: A cross-sectional study using programme data. Results: Reporting was 89% complete on the six selected NCDs pre-Ebola and 86% during the Ebola outbreak (P < 0.01). Overall, marked declining trends in NCDs were reported during the Ebola period, with a monthly mean of 342 cases pre-Ebola and 164 during the Ebola outbreak. The monthly mean number of cases per disease in the pre-Ebola and Ebola outbreak periods was respectively 228 vs. 85 for hypertension, 43 vs. 27 for cardiovascular diseases, 36 vs. 18 for diabetes and 25 vs. 29 for peptic ulcer disease; this last condition increased during the outbreak. There were higher proportions of NCDs among females during the Ebola outbreak compared with the pre-Ebola period. Except for peptic ulcer disease, the number of patients with NCDs declined by 25% in peripheral health units, 91% in the secondary hospitals and 70% in the tertiary hospital between the pre-Ebola and the Ebola outbreak periods. Conclusion: Comprehensive reporting of NCDs was suboptimal, and declined during the Ebola epidemic. There were decreases in reported attendances for NCDs between the pre-Ebola and the Ebola outbreak periods, which were even more marked in the hospitals. This study has important policy implications.
Collapse
Affiliation(s)
- T Samba
- Western Area District Health Management Team, Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - P Bhat
- Ministry of Health, Government of Karnataka, Bengaluru, India
| | - P Owiti
- Academic Model Providing Access to Health Care (AMPATH), Eldoret, Kenya
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - L Samuels
- Western Area District Health Management Team, Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - P J Kanneh
- Western Area District Health Management Team, Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - R Paul
- Western Area District Health Management Team, Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | | | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
47
|
Gamanga AH, Owiti P, Bhat P, Harries AD, Kargbo-Labour I, Koroma M. The Ebola outbreak: effects on HIV reporting, testing and care in Bonthe district, rural Sierra Leone. Public Health Action 2017; 7:S10-S15. [PMID: 28744433 PMCID: PMC5515556 DOI: 10.5588/pha.16.0087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/20/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: All public health facilities in Bonthe District, rural Sierra Leone. Objective: To compare, in the periods before and during the Ebola virus disease outbreak, 1) the submission and completeness of monthly human immunodeficiency virus (HIV) reports, and 2) the uptake of HIV testing and care for pregnant women and the general population. Design: A cross-sectional study using routine programme data. Results: Of the 627 HIV reports expected in each period, 406 (65%) were submitted in the pre-Ebola period and 376 (60%) during the Ebola outbreak (P = 0.08), of which respectively 318 (78%) and 335 (89%) had complete information (P < 0.001). In the pre-Ebola period, 5012 pregnant women underwent testing for HIV, of whom 25 were HIV-positive, compared to 4254 during the Ebola period, of whom 21 were HIV-positive (P < 0.001). Of those who were HIV-positive, respectively 14 (56%) and 21 (100%) received antiretroviral prophylaxis or antiretroviral therapy (ART) (P < 0.001). In the general population, 5770 persons underwent HIV testing pre-Ebola vs. 3095 in the Ebola period (P < 0.001); of those who tested positive for HIV, respectively 62% (33/53) and 81% (33/41) were started on ART (P = 0.06). Conclusion: There was suboptimal reporting on HIV/acquired immune-deficiency disease syndrome activities before and during the Ebola virus disease outbreak. HIV testing decreased during the Ebola outbreak, while the uptake of prevention of mother-to-child transmission and ART increased. Pre-emptive actions are needed to maintain the levels of HIV testing in any future outbreak.
Collapse
Affiliation(s)
- A H Gamanga
- Bonthe Government Hospital, Ministry of Health and Sanitation (MoHS), Bonthe Sherbro Island, Bonthe District, Sierra Leone
| | - P Owiti
- Academic Model Providing Access to Health Care (AMPATH), Eldoret, Kenya
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P Bhat
- Ministry of Health, Government of Karnataka, Mangalore, India
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - M Koroma
- MoHS, Mattru Jong, Bonthe District, Sierra Leone
| |
Collapse
|
48
|
Bah OM, Kamara HB, Bhat P, Harries AD, Owiti P, Katta J, Foray L, Kamara MI, Kamara BO. The influence of the Ebola outbreak on presumptive and active tuberculosis in Bombali District, Sierra Leone. Public Health Action 2017; 7:S3-S9. [PMID: 28744432 DOI: 10.5588/pha.16.0093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/12/2016] [Indexed: 11/10/2022] Open
Abstract
Setting: Bombali District, rural Sierra Leone. Objective: To compare the number of patients with presumptive tuberculosis (TB), the number of patients registered with TB (including testing for the human immunodeficiency virus [HIV] and initiation on antiretroviral therapy [ART]) and treatment outcomes during the pre-Ebola, Ebola and post-Ebola disease outbreak periods between 2013 and 2016. Design: This was a cross-sectional study and retrospective cohort analysis of treatment outcomes. Results: The mean monthly number of patients with presumptive TB before, during and post-Ebola was respectively 169, 145 and 210. The mean monthly number of registered TB cases was respectively 57, 57 and 96. Smear-positive TB was the most frequent type of TB, at 75%, 66% and 77%. The proportion of TB patients tested for HIV was 82% pre-Ebola, 74% Ebola and 99% post-Ebola. The proportion of HIV-positive patients with TB initiated on ART was respectively 46%, 85% and 100%. Treatment success among TB patients was 71% in the pre-Ebola period and 89% in the Ebola period (P < 0.001). Conclusion: During the Ebola outbreak, there were decreases in the number of presumptive TB patients and in the proportions of patients diagnosed with smear-positive TB and tested for HIV. The initiation of ART in HIV-infected TB patients and treatment outcomes remained acceptable. Pre-emptive actions are needed to maintain adequate control activities in future outbreaks.
Collapse
Affiliation(s)
- O M Bah
- Makeni Regional Hospital, Makeni, Bombali District, Sierra Leone
| | - H B Kamara
- Makeni Regional Hospital, Makeni, Bombali District, Sierra Leone
| | - P Bhat
- Ministry of Health, Government of Karnataka, Bengaluru, India
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - P Owiti
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Academic Model Providing Access to Health Care (AMPATH), Eldoret, Kenya
| | - J Katta
- National Tuberculosis Control Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - L Foray
- National Tuberculosis Control Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - M I Kamara
- Makeni Regional Hospital, Makeni, Bombali District, Sierra Leone
| | - B O Kamara
- Makeni Regional Hospital, Makeni, Bombali District, Sierra Leone
| |
Collapse
|
49
|
Konwloh PK, Cambell CL, Ade S, Bhat P, Harries AD, Wilkinson E, Cooper CT. Influence of Ebola on tuberculosis case finding and treatment outcomes in Liberia. Public Health Action 2017; 7:S62-S69. [PMID: 28744441 PMCID: PMC5515566 DOI: 10.5588/pha.16.0097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/09/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: National Leprosy and Tuberculosis (TB) Control Programme, Liberia. Objectives: To assess TB case finding, including human immunodeficiency virus (HIV) associated interventions and treatment outcomes, before (January 2013-March 2014), during (April 2014-June 2015) and after (July-December 2015) the Ebola virus disease outbreak. Design: A cross-sectional study and retrospective cohort analysis of outcomes. Results: The mean quarterly numbers of individuals with presumptive TB and the proportion diagnosed as smear-positive were: pre-Ebola (n = 7032, 12%), Ebola (n = 6147, 10%) and post-Ebola (n = 6795, 8%). For all forms of TB, stratified by category and age group, there was a non-significant decrease in the number of cases from the pre-Ebola to the Ebola and post-Ebola periods. There were significant decreases in numbers of cases with smear-positive pulmonary TB (PTB) from the pre-Ebola period (n = 855), to the Ebola (n = 640, P < 0.001) and post-Ebola (n = 568, P < 0.001) periods. The proportions of patients tested for HIV, found to be HIV-positive and started on antiretroviral therapy decreased as follows: pre-Ebola (respectively 72%, 15% and 34%), Ebola (69%, 14% and 30%) and post-Ebola (68%, 12% and 26%). Treatment success rates among TB patients were: 80% pre-Ebola, 69% Ebola (P < 0.001) and 73% post-Ebola (P < 0.001). Loss to follow-up was the main contributing adverse outcome. Conclusion: The principal negative effects of Ebola were the significant decreases in diagnoses of smear-positive PTB, the declines in HIV testing and antiretroviral therapy uptake and poor treatment success. Ways to prevent these adverse effects from recurring in the event of another Ebola outbreak need to be found.
Collapse
Affiliation(s)
- P K Konwloh
- National Leprosy & Tuberculosis Control Programme, Ministry of Health, Monrovia, Liberia
| | - C L Cambell
- National Leprosy & Tuberculosis Control Programme, Ministry of Health, Monrovia, Liberia
| | - S Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France
- National Tuberculosis Control Programme, Cotonou, Benin
- Faculty of Medicine, University of Parakou, Parakou, Benin
| | - P Bhat
- Ministry of Health, Government of Karnataka, Bangalore, India
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
| | - E Wilkinson
- Institute of Medicine, University of Chester, Chester, UK
| | - C T Cooper
- National Leprosy & Tuberculosis Control Programme, Ministry of Health, Monrovia, Liberia
| |
Collapse
|
50
|
Owiti P, Keter A, Harries AD, Pastakia S, Wambugu C, Kirui N, Kasera G, Momanyi R, Masini E, Some F, Gardner A. Diabetes and pre-diabetes in tuberculosis patients in western Kenya using point-of-care glycated haemoglobin. Public Health Action 2017; 7:147-154. [PMID: 28695089 PMCID: PMC5493097 DOI: 10.5588/pha.16.0114] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/19/2017] [Indexed: 12/19/2022] Open
Abstract
Setting: The tuberculosis (TB) clinics of five health facilities in western Kenya. Objective: To assess the prevalence and associated determinants of diabetes mellitus (DM) and pre-diabetes hyperglycaemia among adult TB patients using point-of-care DCA Vantage glycated haemoglobin (HbA1c) devices. Design: This was a cross-sectional study. Results: Of 454 patients, 272 (60%) were males, the median age was 34 years, 175 (39%) were co-infected with the human immunodeficiency virus (HIV), and the median duration of anti-tuberculosis treatment was 8 weeks; 180 (40%) patients reported at least one classical symptom suggestive of DM. The prevalence of DM (HbA1c ⩾6.5%) was 5.1% (95%CI 3.2-7.5), while that of pre-diabetes (HbA1c 5.7-6.4%) was 37.5% (95%CI 33.1-42.2). The number needed to screen (NNS) was 19.6 for DM and 2.7 for pre-diabetes. Combined, 42.6% (95%CI 38.0-47.3) of the patients had either pre-diabetes or DM (NNS 2.3). Seven of the 23 patients with DM knew their prior DM status. Higher rates of DM were associated with age ⩾40 years and a family history of DM, but not obesity, type of TB, HIV status or suggestive symptoms. Conclusions: High rates of pre-diabetes and DM were found in adult TB patients. This study supports the need for routine screening of all patients with TB for DM in Kenya.
Collapse
Affiliation(s)
- P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A Keter
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
| | - S Pastakia
- Purdue University College of Pharmacy, West Lafayette, Indiana, USA
- Moi University School of Medicine, Eldoret, Kenya
| | | | - N Kirui
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - G Kasera
- Ministry of Health, Nairobi, Kenya
| | - R Momanyi
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - E Masini
- Ministry of Health, Nairobi, Kenya
| | - F Some
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University School of Medicine, Eldoret, Kenya
| | - A Gardner
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University School of Medicine, Eldoret, Kenya
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Indiana University School of Medicine, Bloomington, Indiana, USA
| |
Collapse
|