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Lankowski A, Tollefson D, Sánchez H, Cabello R, Hidalgo J, Mathison MN, Molina Y, Duerr A. Acceptability of venue-based HIV testing and prevention interventions for men who have sex with transgender women and transgender women in Lima, Perú: a formative, qualitative study. HIV Res Clin Pract 2024; 25:2331360. [PMID: 38579280] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND Despite being at elevated risk for HIV, men who have sex with transgender women (MSTW) are an overlooked population in the global HIV response. Venue-based HIV interventions have previously had success reaching other HIV priority populations, including transgender women (TW). Similar approaches could be applied for MSTW. OBJECTIVE To evaluate the prospective acceptability of venue-based HIV testing and prevention interventions for MSTW and TW in Lima, Peru. METHODS In this exploratory qualitative study, we conducted in-depth interviews (IDI) and focus group discussions (FGD) with three types of participants: MSTW (7 IDIs, 1 FGD), TW (1 FGD), and owners of social venues frequented by MSTW/TW in Lima (2 IDIs). We elicited participants' attitudes and perceptions related to the following four hypothetical interventions delivered at social venues in Lima: rapid HIV testing; HIV self-test distribution; condom/lubricant distribution; and enrolment in a mobile app supporting HIV prevention. We performed a mixed deductive-inductive thematic analysis using the framework method, then applied the Theoretical Framework of Acceptability to classify the overall acceptability of each intervention. RESULTS Condom/lubricant distribution and app-based HIV prevention information were highly acceptable among all participant types. The two HIV testing interventions had relatively lower acceptability; however, participants suggested this could be overcome if such interventions focused on ensuring discretion, providing access to healthcare professionals, and offering appropriate incentives. CONCLUSIONS Overall, MSTW and TW shared similar favourable attitudes towards venue-based HIV interventions. Venue-based outreach warrants further exploration as a strategy for engaging MSTW and TW in HIV prevention activities.
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Affiliation(s)
- Alexander Lankowski
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Deanna Tollefson
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | | | | | - Mary N Mathison
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Yamilé Molina
- School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Ann Duerr
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Tollefson D, Dasgupta S, Setswe G, Reeves S, Charalambous S, Duerr A. Impact of youth lay health workers on HIV service delivery in South Africa: A pragmatic cluster randomized trial of the Youth Health Africa program. PLoS One 2023; 18:e0294719. [PMID: 38033029 PMCID: PMC10688901 DOI: 10.1371/journal.pone.0294719] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Innovative approaches are needed to increase lay health workers in HIV programs. The Youth Health Africa (YHA) program is a novel approach that places young adults seeking work experience in one-year internships in health facilities to support HIV-related programming (e.g., HIV testing) or administration (e.g., filing). METHODS We implemented a pragmatic, randomized trial among 20 facilities in Ngaka Modiri Molema district in North West province from October 2020-August 2021 to assess impact of YHA interns on HIV testing, treatment initiation, and retention in care. The primary outcome was proportion of patients tested for HIV. Secondary outcomes assessed HIV positivity, initiation in care, retention in care, and HIV testing among males and adolescents/young adults. We conducted an intention-to-treat analysis accounting for variations in baseline outcomes between control and intervention facilities using difference-in-difference and controlled time series approaches. We repeated this using as-treated groupings for sensitivity analyses. RESULTS Fifty interns were placed in 20 facilities; thirty-four interns remained at 18 facilities through August 2021. Compared to control facilities, intervention facilities had a greater improvement in HIV testing (ΔΔ+5.7%, 95% Confidence Interval (CI): -3.7%-15.1%) and treatment initiation (ΔΔ+10.3%, 95% CI: -27.8-48.5%), but these differences were not statistically significant. There was an immediate increase in HIV testing in intervention facilities after program interns were placed, which was not observed in control facilities; this difference was significant (ΔΔ+8.4%, 95% CI: 0.5-16.4%, p = 0.036). There were no other differences in outcomes observed between intervention and control facilities. CONCLUSION This was largely a null trial, but there were signals that program interns may have positive impact on HIV testing and treatment initiation. As implemented in this study, addition of YHA program interns had little impact on facility-based HIV service delivery. A higher number of interns placed per facility may be necessary to affect HIV services. TRIAL REGISTRATION Registration: This trial was registered with the ISRCTN (Registration number: ISRCTN67031403) in October 2022.
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Affiliation(s)
- Deanna Tollefson
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease & Public Health Science Divisions, Seattle, Washington, United States of America
| | - Sayan Dasgupta
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease & Public Health Science Divisions, Seattle, Washington, United States of America
| | - Geoffrey Setswe
- The Aurum Institute, Implementation Research Division, Parktown, Gauteng, South Africa
- Department of Health Studies, University of South Africa, Pretoria, Gauteng, South Africa
| | - Sarah Reeves
- Youth Health Africa, Parktown, Gauteng, South Africa
| | - Salome Charalambous
- The Aurum Institute, Implementation Research Division, Parktown, Gauteng, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Ann Duerr
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease & Public Health Science Divisions, Seattle, Washington, United States of America
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Tollefson D, Dasgupta S, Setswe G, Reeves S, Churchyard G, Charalambous S, Duerr A. Does a youth intern programme strengthen HIV service delivery in South Africa? An interrupted time-series analysis. J Int AIDS Soc 2023; 26:e26083. [PMID: 37051619 PMCID: PMC10098286 DOI: 10.1002/jia2.26083] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION Since 2018, Youth Health Africa (YHA) has placed unemployed young adults at health facilities across South Africa in 1-year non-clinical internships to support HIV services. While YHA is primarily designed to improve employment prospects for youth, it also strives to strengthen the health system. Hundreds of YHA interns have been placed in programme (e.g. HIV testing and counselling) or administrative (e.g. data and filing) roles, but their impact on HIV service delivery has not been evaluated. METHODS Using routinely collected data from October 2017 to March 2020, we conducted an interrupted time-series analysis to explore the impact of YHA on HIV testing, treatment initiation and retention in care. We analysed data from facilities in Gauteng and North West where interns were placed between November 2018 and October 2019. We used linear regression, accounting for facility-level clustering and time correlation, to compare trends before and after interns were placed for seven HIV service indicators covering HIV testing, treatment initiation and retention in care. Outcomes were measured monthly at each facility. Time was measured as months since the first interns were placed at each facility. We conducted three secondary analyses per indicator, stratified by intern role, number of interns and region. RESULTS Based on 207 facilities hosting 604 interns, YHA interns at facilities were associated with significant improvements in monthly trends for numbers of people tested for HIV, newly initiated on treatment and retained in care (i.e. loss to follow-up, tested for viral load [VL] and virally suppressed). We found no difference in trends for the number of people newly diagnosed with HIV or the number initiating treatment within 14 days of diagnosis. Changes in HIV testing, overall treatment initiation and VL testing/suppression were most pronounced where there were programme interns and a higher number of interns; change in loss to follow-up was greatest where there were administrative interns. CONCLUSIONS Placing interns in facilities to support non-clinical tasks may improve HIV service delivery by contributing to improved HIV testing, treatment initiation and retention in care. Using youth interns as lay health workers may be an impactful strategy to strengthen the HIV response while supporting youth employment.
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Affiliation(s)
- Deanna Tollefson
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Fred Hutchinson Cancer Research CentreVaccine and Infectious Disease & Public Health Science DivisionsSeattleWashingtonUSA
| | - Sayan Dasgupta
- Fred Hutchinson Cancer Research CentreVaccine and Infectious Disease & Public Health Science DivisionsSeattleWashingtonUSA
| | - Geoffrey Setswe
- The Aurum InstituteJohannesburgSouth Africa
- Department of Health StudiesUniversity of South AfricaPretoriaSouth Africa
| | | | | | - Salome Charalambous
- The Aurum InstituteJohannesburgSouth Africa
- School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Ann Duerr
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Fred Hutchinson Cancer Research CentreVaccine and Infectious Disease & Public Health Science DivisionsSeattleWashingtonUSA
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Tollefson D, Ntombela N, Reeves S, Charalambous S, O'Malley G, Setswe G, Duerr A. "They are gaining experience; we are gaining extra hands": a mixed methods study to assess healthcare worker perceptions of a novel strategy to strengthen human resources for HIV in South Africa. BMC Health Serv Res 2023; 23:27. [PMID: 36631794 PMCID: PMC9832700 DOI: 10.1186/s12913-022-09020-z] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Lay health workers (LHWs) can support the HIV response by bridging gaps in human resources for health. Innovative strategies are needed to expand LHW programs in many low- and middle-income countries. Youth Health Africa (YHA) is a novel LHW approach implemented in South Africa that places young adults needing work experience in one-year non-clinical internships at health facilities to support HIV programs (e.g., as HIV testers, data clerks). While research suggests YHA can increase HIV service delivery, we need to understand healthcare worker perceptions to know if this is an acceptable and appropriate approach to strengthen human resources for health and healthcare delivery. METHODS We conducted a convergent mixed methods study to assess healthcare worker acceptance and perceived appropriateness of YHA as implemented in Gauteng and North West provinces, South Africa and identify issues promoting or hindering high acceptability and perceived appropriateness. To do this, we adapted the Johns Hopkins Measure of Acceptability and Appropriateness to survey healthcare workers who supervised interns, which we analyzed descriptively. In parallel, we interviewed frontline healthcare workers who worked alongside YHA interns and conducted an inductive, thematic analysis. We merged quantitative and qualitative results using the Theoretical Framework of Acceptability to understand what promotes or hinders high acceptance and appropriateness of YHA. RESULTS Sixty intern supervisors responded to the survey (91% response rate), reporting an average score of 3.5 for acceptability and 3.6 for appropriateness, on a four-point scale. Almost all 33 frontline healthcare workers interviewed reported the program to be highly acceptable and appropriate. Perceptions that YHA was mutually beneficial, easy to integrate into facilities, and helped facilities be more successful promoted a strong sense of acceptability/appropriateness amongst healthcare workers, but this was tempered by the burden of training interns and limited program communication. Overall, healthcare workers were drawn to the altruistic nature of YHA. CONCLUSION Healthcare workers in South Africa believed YHA was an acceptable and appropriate LHW program to support HIV service delivery because its benefits outweighed its costs. This may be an effective, innovative approach to strengthen human resources for HIV services and the broader health sector.
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Affiliation(s)
- Deanna Tollefson
- Department of Global Health, University of Washington, Seattle, USA.
| | - Nasiphi Ntombela
- The Aurum Institute, Implementation Research Division, Parktown, South Africa
| | | | - Salome Charalambous
- The Aurum Institute, Implementation Research Division, Parktown, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Geoffrey Setswe
- The Aurum Institute, Implementation Research Division, Parktown, South Africa
- Department of Health Studies, University of South Africa, Pretoria, South Africa
| | - Ann Duerr
- Department of Global Health, University of Washington, Seattle, USA
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease & Public Health Science Divisions, Seattle, USA
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Beima-Sofie K, Wagner AD, Soi C, Liu W, Tollefson D, Njuguna IN, Ogutu E, Gaitho D, Mburu N, Oluoch G, Mwaura P, Cherutich P, Oyiengo L, John-Stewart GC, Nduati R, Sherr K, Gimbel S. Providing "a beam of light to see the gaps": determinants of implementation of the Systems Analysis and Improvement Approach applied to the pediatric and adolescent HIV cascade in Kenya. Implement Sci Commun 2022; 3:73. [PMID: 35842734 PMCID: PMC9287987 DOI: 10.1186/s43058-022-00304-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Children and adolescents living with HIV have poorer rates of HIV testing, treatment, and virologic suppression than adults. Strategies that use a systems approach to optimize these multiple, linked steps simultaneously are critical to close these gaps. Methods The Systems Analysis and Improvement Approach (SAIA) was adapted and piloted for the pediatric and adolescent HIV care and treatment cascade (SAIA-PEDS) at 6 facilities in Kenya. SAIA-PEDS includes three tools: continuous quality improvement (CQI), flow mapping, and pediatric cascade analysis (PedCAT). A predominately qualitative evaluation utilizing focus group discussions (N = 6) and in-depth interviews (N = 19) was conducted with healthcare workers after implementation to identify determinants of implementation. Data collection and analysis were grounded in the Consolidated Framework for Implementation Research (CFIR). Results Overall, the adapted SAIA-PEDS strategy was acceptable, and the three tools complemented one another and provided a relative advantage over existing processes. The flow mapping and CQI tools were compatible with existing workflows and resonated with team priorities and goals while providing a structure for group problem solving that transcended a single department’s focus. The PedCAT was overly complex, making it difficult to use. Leadership and hierarchy were complex determinants. All teams reported supportive leadership, with some describing in detail how their leadership was engaged and enthusiastic about the SAIA-PEDS process, by providing recognition, time, and resources. Hierarchy was similarly complex: in some facilities, leadership stifled rapid innovation by insisting on approving each change, while at other facilities, leadership had strong and supportive oversight of processes, checking on the progress frequently and empowering teams to test innovative ideas. Conclusion CQI and flow mapping were core components of SAIA-PEDS, with high acceptability and consistent use, but the PedCAT was too complex. Leadership and hierarchy had a nuanced role in implementation. Future SAIA-PEDS testing should address PedCAT complexity and further explore the modifiability of leadership engagement to maximize implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00304-3.
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Affiliation(s)
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, USA.
| | - Caroline Soi
- Department of Global Health, University of Washington, Seattle, USA
| | - Wenjia Liu
- Department of Child, Family & Population Health Nursing, University of Washington, Seattle, USA
| | - Deanna Tollefson
- Department of Global Health, University of Washington, Seattle, USA
| | - Irene N Njuguna
- Department of Global Health, University of Washington, Seattle, USA.,Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Emily Ogutu
- Gangarosa Department of Environmental Health, Emory University, Atlanta, USA
| | - Douglas Gaitho
- Network of AIDS Researchers in Eastern and Southern Africa, Nairobi, Kenya
| | - Nancy Mburu
- Network of AIDS Researchers in Eastern and Southern Africa, Nairobi, Kenya
| | - Geoffrey Oluoch
- Network of AIDS Researchers in Eastern and Southern Africa, Nairobi, Kenya
| | - Peter Mwaura
- Network of AIDS Researchers in Eastern and Southern Africa, Nairobi, Kenya
| | | | | | - Grace C John-Stewart
- Department of Global Health, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, USA.,Department of Pediatrics, School of Medicine, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA
| | - Ruth Nduati
- Network of AIDS Researchers in Eastern and Southern Africa, Nairobi, Kenya.,Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, USA.,Department of Industrial & Systems Engineering, University of Washington, Seattle, USA
| | - Sarah Gimbel
- Department of Global Health, University of Washington, Seattle, USA.,Department of Child, Family & Population Health Nursing, University of Washington, Seattle, USA
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Arakaki L, Tollefson D, Kharono B, Drain PK. Prevalence of rotavirus among older children and adults with diarrhea: A systematic review and meta-analysis. Vaccine 2021; 39:4577-4590. [PMID: 34244008 DOI: 10.1016/j.vaccine.2021.06.073] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/10/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Older children and adults are susceptible to rotavirus, but the extent to which rotavirus affects this population is not fully understood, hindering accuracy of global rotavirus estimations. OBJECTIVE To determine what proportion of diarrhea cases are due to rotavirus among persons ≥ 5 years old and to estimate this proportion by age strata. METHODS We conducted a systematic review and meta-analysis using the PRISMA guidelines. We included studies that reported on conditional rotavirus prevalence (i.e., percent of diarrhea due to rotavirus) in persons ≥ 5 years old who were symptomatic with diarrhea/gastroenteritis and had laboratory confirmation for rotavirus infection. Studies on nosocomial infections and outbreak investigations were excluded. We collected age group-specific conditional rotavirus prevalence and other variables, such as study geography, study setting, and study type. We calculated pooled conditional rotavirus prevalence, corresponding 95% confidence intervals (95% CI), heterogeneity (I2) estimates, and prediction intervals (PI). RESULTS Sixty-six studies from 32 countries met the inclusion criteria. Conditional rotavirus prevalence ranged from 0% to 30% across the studies. The total pooled prevalence of rotavirus among persons ≥ 5 years old with diarrhea was 7.6% (95% CI: 6.2-9.2%, I2 = 99.6%, PI: 0-24%). The pooled prevalence of rotavirus among older children and adolescents was 8.7% (95% CI: 6.2-11.7%, I2 = 96%, PI:0-27%), among younger adults was 5.4% (95% CI: 1.4-11.8%, I2 = 96%, PI:0-31%), and among older adults was 4.7% (95% CI: 2.8-7.0%, I2 = 96%, PI:0-16%). Pooled conditional rotavirus prevalences did not differ by other variables. CONCLUSION In this systematic review and meta-analysis of rotavirus among persons ≥ 5 years old with diarrhea, we found relatively low pooled conditional rotavirus prevalence compared to what is typically reported for children < 5 years; however, results should be interpreted with caution as the wide prediction intervals suggest large heterogeneity.
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Affiliation(s)
- Lola Arakaki
- University of Washington, Strategic Analysis, Research, and Training (START) Center, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Epidemiology, 3980 15th Ave NE, Seattle, WA 98195, United States.
| | - Deanna Tollefson
- University of Washington, Strategic Analysis, Research, and Training (START) Center, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Global Health, 3980 15th Ave NE, Seattle, WA 98195, United States.
| | - Brenda Kharono
- University of Washington, Strategic Analysis, Research, and Training (START) Center, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Global Health, 3980 15th Ave NE, Seattle, WA 98195, United States.
| | - Paul K Drain
- University of Washington, Strategic Analysis, Research, and Training (START) Center, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Global Health, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Medicine, 1959 NE Pacific St, Seattle, WA 98195, United States.
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Roscoe C, Lockhart C, de Klerk M, Baughman A, Agolory S, Gawanab M, Menzies H, Jonas A, Salomo N, Taffa N, Lowrance D, Robsky K, Tollefson D, Pevzner E, Hamunime N, Mavhunga F, Mungunda H. Evaluation of the uptake of tuberculosis preventative therapy for people living with HIV in Namibia: a multiple methods analysis. BMC Public Health 2020; 20:1838. [PMID: 33261569 PMCID: PMC7708912 DOI: 10.1186/s12889-020-09902-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background In 2016, Namibia had ~ 230,000 people living with HIV (PLHIV) and 9154 new tuberculosis (TB) cases, including 3410 (38%) co-infected cases. TB preventative therapy (TPT), consisting of intensive case finding and isoniazid preventative therapy, is critical to reducing TB disease and mortality. Methods Between November 2014 and February 2015, data was abstracted from charts of PLHIV enrolled in HIV treatment. Fifty-five facilities were purposively selected based on patient volume, type and location. Charts were randomly sampled. The primary outcome was to estimate baseline TPT in PLHIV, using nationally weighted proportions. Qualitative surveys were conducted and summarized to evaluate TPT practices and quantify challenges encountered by health care workers (HCW). Results Among 861 PLHIV sampled, 96% were eligible for TPT services, of which 87.1% were screened for TB at least once. For PLHIV eligible for preventative therapy (646/810; 82.6%), 45.4% (294/646) initiated therapy and 45.7% (139/294) of those completed therapy. The proportion of eligible PLHIV completing TB screening, initiating preventative therapy and then completing preventative therapy was 20.7%. Qualitative surveys with 271 HCW identified barriers to TPT implementation including: lack of training (61.3% reported receiving training on TPT); misunderstandings about timing of TPT initiation (46.7% correctly reported TPT should be started with antiretroviral therapy); and variable screening practices and responsibilities (66.1% of HCWs screened for TB at every encounter). Though barriers were evident, 72.2% HCWs surveyed described their clinical performance as very good, often placing responsibility of difficulties on patients and downplaying challenges like staff shortages and medication stock outs. Conclusions In this study, only 1 in 5 eligible PLHIV completed the TPT cascade in Namibia. Lack of training, irregularities with TB screening and timing of TPT, unclear prescribing and recording responsibilities, and a clinical misperception may have contributed to suboptimal programmatic implementation. Addressing these challenges will be critical with continued TPT scale-up.
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Affiliation(s)
- Clay Roscoe
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia.
| | - Chris Lockhart
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Michael de Klerk
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Andrew Baughman
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Simon Agolory
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Michael Gawanab
- Ministry of Health and Social Services of Namibia, Directorate of Special Programs, Oshakati, Namibia
| | - Heather Menzies
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Anna Jonas
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Natanael Salomo
- Ministry of Health and Social Services of Namibia, Directorate of Special Programs, Oshakati, Namibia
| | - Negussie Taffa
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - David Lowrance
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | | | | | - Eric Pevzner
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ndapewa Hamunime
- Ministry of Health and Social Services of Namibia, Directorate of Special Programs, Oshakati, Namibia
| | - Farai Mavhunga
- Ministry of Health and Social Services of Namibia, Directorate of Special Programs, Oshakati, Namibia
| | - Helena Mungunda
- Ministry of Health and Social Services of Namibia, Directorate of Special Programs, Oshakati, Namibia
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Horne DJ, Kohli M, Zifodya JS, Schiller I, Dendukuri N, Tollefson D, Schumacher SG, Ochodo EA, Pai M, Steingart KR. Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev 2019; 6:CD009593. [PMID: 31173647 PMCID: PMC6555588 DOI: 10.1002/14651858.cd009593.pub4] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Xpert MTB/RIF (Xpert MTB/RIF) and Xpert MTB/RIF Ultra (Xpert Ultra), the newest version, are the only World Health Organization (WHO)-recommended rapid tests that simultaneously detect tuberculosis and rifampicin resistance in persons with signs and symptoms of tuberculosis, at lower health system levels. A previous Cochrane Review found Xpert MTB/RIF sensitive and specific for tuberculosis (Steingart 2014). Since the previous review, new studies have been published. We performed a review update for an upcoming WHO policy review. OBJECTIVES To determine diagnostic accuracy of Xpert MTB/RIF and Xpert Ultra for tuberculosis in adults with presumptive pulmonary tuberculosis (PTB) and for rifampicin resistance in adults with presumptive rifampicin-resistant tuberculosis. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, Web of Science, Latin American Caribbean Health Sciences Literature, Scopus, the WHO International Clinical Trials Registry Platform, the International Standard Randomized Controlled Trial Number Registry, and ProQuest, to 11 October 2018, without language restriction. SELECTION CRITERIA Randomized trials, cross-sectional, and cohort studies using respiratory specimens that evaluated Xpert MTB/RIF, Xpert Ultra, or both against the reference standard, culture for tuberculosis and culture-based drug susceptibility testing or MTBDRplus for rifampicin resistance. DATA COLLECTION AND ANALYSIS Four review authors independently extracted data using a standardized form. When possible, we also extracted data by smear and HIV status. We assessed study quality using QUADAS-2 and performed meta-analyses to estimate pooled sensitivity and specificity separately for tuberculosis and rifampicin resistance. We investigated potential sources of heterogeneity. Most analyses used a bivariate random-effects model. For tuberculosis detection, we first estimated accuracy using all included studies and then only the subset of studies where participants were unselected, i.e. not selected based on prior microscopy testing. MAIN RESULTS We identified in total 95 studies (77 new studies since the previous review): 86 studies (42,091 participants) evaluated Xpert MTB/RIF for tuberculosis and 57 studies (8287 participants) for rifampicin resistance. One study compared Xpert MTB/RIF and Xpert Ultra on the same participant specimen.Tuberculosis detectionOf the total 86 studies, 45 took place in high tuberculosis burden and 50 in high TB/HIV burden countries. Most studies had low risk of bias.Xpert MTB/RIF pooled sensitivity and specificity (95% credible Interval (CrI)) were 85% (82% to 88%) and 98% (97% to 98%), (70 studies, 37,237 unselected participants; high-certainty evidence). We found similar accuracy when we included all studies.For a population of 1000 people where 100 have tuberculosis on culture, 103 would be Xpert MTB/RIF-positive and 18 (17%) would not have tuberculosis (false-positives); 897 would be Xpert MTB/RIF-negative and 15 (2%) would have tuberculosis (false-negatives).Xpert Ultra sensitivity (95% confidence interval (CI)) was 88% (85% to 91%) versus Xpert MTB/RIF 83% (79% to 86%); Xpert Ultra specificity was 96% (94% to 97%) versus Xpert MTB/RIF 98% (97% to 99%), (1 study, 1439 participants; moderate-certainty evidence).Xpert MTB/RIF pooled sensitivity was 98% (97% to 98%) in smear-positive and 67% (62% to 72%) in smear-negative, culture-positive participants, (45 studies). Xpert MTB/RIF pooled sensitivity was 88% (83% to 92%) in HIV-negative and 81% (75% to 86%) in HIV-positive participants; specificities were similar 98% (97% to 99%), (14 studies).Rifampicin resistance detectionXpert MTB/RIF pooled sensitivity and specificity (95% Crl) were 96% (94% to 97%) and 98% (98% to 99%), (48 studies, 8020 participants; high-certainty evidence).For a population of 1000 people where 100 have rifampicin-resistant tuberculosis, 114 would be positive for rifampicin-resistant tuberculosis and 18 (16%) would not have rifampicin resistance (false-positives); 886 would be would be negative for rifampicin-resistant tuberculosis and four (0.4%) would have rifampicin resistance (false-negatives).Xpert Ultra sensitivity (95% CI) was 95% (90% to 98%) versus Xpert MTB/RIF 95% (91% to 98%); Xpert Ultra specificity was 98% (97% to 99%) versus Xpert MTB/RIF 98% (96% to 99%), (1 study, 551 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS We found Xpert MTB/RIF to be sensitive and specific for diagnosing PTB and rifampicin resistance, consistent with findings reported previously. Xpert MTB/RIF was more sensitive for tuberculosis in smear-positive than smear-negative participants and HIV-negative than HIV-positive participants. Compared with Xpert MTB/RIF, Xpert Ultra had higher sensitivity and lower specificity for tuberculosis and similar sensitivity and specificity for rifampicin resistance (1 study). Xpert MTB/RIF and Xpert Ultra provide accurate results and can allow rapid initiation of treatment for multidrug-resistant tuberculosis.
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Affiliation(s)
- David J Horne
- University of WashingtonDepartment of Medicine, Division of Pulmonary and Critical Care Medicine, and Firland Northwest TB CenterSeattleUSA
| | - Mikashmi Kohli
- McGill UniversityDepartment of Epidemiology, Biostatistics and Occupational HealthMontrealCanada
| | - Jerry S Zifodya
- University of WashingtonPulmonary and Critical Care Medicine325 9th Avenue – Campus Box 359762SeattleUSA98104
| | - Ian Schiller
- McGill University Health Centre ‐ Research InstituteDivision of Clinical EpidemiologyMontrealCanada
| | - Nandini Dendukuri
- McGill University Health Centre ‐ Research InstituteDivision of Clinical EpidemiologyMontrealCanada
| | | | | | - Eleanor A Ochodo
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesPO Box 241Cape TownSouth Africa8000
| | - Madhukar Pai
- McGill UniversityDepartment of Epidemiology, Biostatistics and Occupational HealthMontrealCanada
| | - Karen R Steingart
- Department of Clinical Sciences, Liverpool School of Tropical MedicineHonorary Research FellowPembroke PlaceLiverpoolUK
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Agha S, Tollefson D, Paul S, Green D, Babigumira JB. Use of the Fogg Behavior Model to Assess the Impact of a Social Marketing Campaign on Condom Use in Pakistan. J Health Commun 2019; 24:284-292. [PMID: 30945612 DOI: 10.1080/10810730.2019.1597952] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Fogg Behavior Model (FBM) is a new framework which posits that behavior happens when three factors - motivation, ability, and a prompt - occur in the same moment. The FBM categorizes people into four groups based on motivation and ability and posits that those with high motivation and high ability will adopt a behavior when prompted. Two rounds of panel survey data from 617 married men in urban Pakistan were used to test this hypothesis. Multilevel mixed-effects logistic regression was used for the analysis. The results show the relationships between ability, motivation, the prompt and condom use to be as hypothesized by the FBM. After adjustment for a range of variables including fertility desires, education, and household wealth, the odds of condom use among men with high motivation and high ability were 34 times higher than the odds of condom use among men with low motivation and low ability. Moreover, the association between the prompt and condom use operated through increased motivation and ability. The FBM has potential for use in the design and evaluation of behavior change interventions in developing countries.
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Affiliation(s)
- Sohail Agha
- a Bill and Melinda Gates Foundation, Integrated Delivery Team , Seattle , WA , USA
| | - Deanna Tollefson
- b University of Washington, Strategic Analysis, Research, and Training (START) Center , Seattle , WA , USA
| | - Shadae Paul
- b University of Washington, Strategic Analysis, Research, and Training (START) Center , Seattle , WA , USA
| | - Dylan Green
- b University of Washington, Strategic Analysis, Research, and Training (START) Center , Seattle , WA , USA
| | - Joseph B Babigumira
- b University of Washington, Strategic Analysis, Research, and Training (START) Center , Seattle , WA , USA
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Bawa S, McNab C, Nkwogu L, Braka F, Obinya E, Galway M, Mirelman AJ, Hammanyero KI, Safiyanu G, Chukwuji M, Ongwae K, Mkanda P, Corkum M, Hegg L, Tollefson D, Umar S, Audu S, Gunda H, Chinta M, Jean Baptiste AE, Bagana M, Shuaib F. Using the polio programme to deliver primary health care in Nigeria: implementation research. Bull World Health Organ 2018; 97:24-32. [PMID: 30618462 PMCID: PMC6307512 DOI: 10.2471/blt.18.211565] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate a project that integrated essential primary health-care services into the oral polio vaccine programme in hard-to-reach, underserved communities in northern Nigeria. Methods In 2013, Nigeria’s polio emergency operation centre adopted a new approach to rapidly raise polio immunity and reduce newborn, child and maternal morbidity and mortality. We identified, trained and equipped eighty-four mobile health teams to provide free vaccination and primary-care services in 3176 hard-to-reach settlements. We conducted cross-sectional surveys of women of childbearing age in households with children younger than 5 years, in 317 randomly selected settlements, pre- and post-intervention (March 2014 and November 2015, respectively). Findings From June 2014 to September 2015 mobile health teams delivered 2 979 408 doses of oral polio vaccine and dewormed 1 562 640 children younger than 5 years old; performed 676 678 antenatal consultations and treated 1 682 671 illnesses in women and children, including pneumonia, diarrhoea and malaria. The baseline survey found that 758 (19.6%) of 3872 children younger than 5 years had routine immunization cards and 690/3872 (17.8%) were fully immunized for their age. The endline survey found 1757/3575 children (49.1%) with routine immunization cards and 1750 (49.0%) fully immunized. Children vaccinated with 3 or more doses of oral polio vaccine increased from 2133 (55.1%) to 2666 (74.6%). Households’ use of mobile health services in the previous 6 months increased from 509/1472 (34.6%) to 2060/2426(84.9%). Conclusion Integrating routine primary-care services into polio eradication activities in Nigeria resulted in increased coverage for supplemental oral polio vaccine doses and essential maternal, newborn and child health interventions.
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Affiliation(s)
- Samuel Bawa
- World Health Organization, Nigeria Country Office, UN House, 617/618 Diplomatic Drive, Central Area District, Abuja. 900001, Nigeria
| | | | - Loveday Nkwogu
- World Health Organization, Nigeria Country Office, UN House, 617/618 Diplomatic Drive, Central Area District, Abuja. 900001, Nigeria
| | - Fiona Braka
- World Health Organization, Nigeria Country Office, UN House, 617/618 Diplomatic Drive, Central Area District, Abuja. 900001, Nigeria
| | - Esther Obinya
- United Nations Children's Fund, Nigeria Country Office, Abuja, Nigeria
| | - Michael Galway
- Bill & Melinda Gates Foundation, Seattle, United States of America
| | | | - Kulchumi Isa Hammanyero
- World Health Organization, Nigeria Country Office, UN House, 617/618 Diplomatic Drive, Central Area District, Abuja. 900001, Nigeria
| | - Garba Safiyanu
- United Nations Children's Fund, Nigeria Country Office, Abuja, Nigeria
| | - Martin Chukwuji
- World Health Organization, Nigeria Country Office, UN House, 617/618 Diplomatic Drive, Central Area District, Abuja. 900001, Nigeria
| | | | - Pascal Mkanda
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Lea Hegg
- Bill & Melinda Gates Foundation, Seattle, United States of America
| | - Deanna Tollefson
- Bill & Melinda Gates Foundation, Seattle, United States of America
| | - Sani Umar
- World Health Organization, Kano Office, Kano, Nigeria
| | - Sunday Audu
- World Health Organization, Borno Office, Maiduguri, Nigeria
| | - Hassan Gunda
- World Health Organization, Bauchi Office, Bauchi, Nigeria
| | - Modu Chinta
- World Health Organization, Yobe Office, Damaturu, Nigeria
| | - Anne Eudes Jean Baptiste
- World Health Organization, Nigeria Country Office, UN House, 617/618 Diplomatic Drive, Central Area District, Abuja. 900001, Nigeria
| | - Murtala Bagana
- National Primary Health Care Development Agency, Ministry of Health, Abuja, Nigeria
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Ministry of Health, Abuja, Nigeria
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11
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Cheng S, Tollefson D, He G, Li Y, Guo H, Chai S, Gao F, Gao F, Han G, Ren L, Ren Y, Li J, Wang L, Varma JK, Hu D, Fan H, Zhao F, Bloss E, Wang Y, Rao CY. Evaluating a framework for tuberculosis screening among healthcare workers in clinical settings, Inner Mongolia, China. J Occup Med Toxicol 2018; 13:11. [PMID: 29560021 PMCID: PMC5859509 DOI: 10.1186/s12995-018-0192-y] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 02/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Health care workers are at high risk for tuberculosis (TB). China, a high burden TB country, has no policy on medical surveillance for TB among healthcare workers. In this paper, we evaluate whether China's national TB diagnostic guidelines could be used as a framework to screen healthcare workers for pulmonary TB disease in a clinical setting in China. METHODS Between April-August 2010, healthcare workers from 28 facilities in Inner Mongolia Autonomous Region, China were eligible for TB screening, comprised of symptom check, chest X-ray and tuberculin skin testing. Healthcare workers were categorized as having presumptive, confirmed, or clinically-diagnosed pulmonary TB, using Chinese national guidelines. RESULTS All healthcare workers (N=4347) were eligible for TB screening, of which 4285 (99%) participated in at least one TB screening test. Of the healthcare workers screened, 2% had cough for ≥ 14 days, 3% had a chest X-ray consistent with TB, and 10% had a tuberculin skin test induration ≥ 20 mm. Of these, 124 healthcare workers were identified with presumptive TB (i.e., cough for ≥ 14 days in the past 4 weeks or x-ray consistent with TB). Twelve healthcare workers met the case definition for clinically-diagnosed pulmonary TB, but none were diagnosed with TB during the study period. CONCLUSION A substantial proportion of healthcare workers in Inner Mongolia had signs, symptoms, or test results suggestive of TB disease that could have been identified using national TB diagnostic guidelines as a screening framework. However, achieving medical surveillance in China will require a framework that increases the ease, accuracy, and acceptance of TB screening in the medical community. Routine screening with improved diagnostics should be considered to detect tuberculosis disease among healthcare workers and reduce transmission in health care settings in China.
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Affiliation(s)
- Shiming Cheng
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Deanna Tollefson
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
| | - Guangxue He
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Yuan Li
- U.S. Centers for Disease Control and Prevention (CDC), Beijing, China
| | - Hui Guo
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Shua Chai
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
- U.S. Centers for Disease Control and Prevention (CDC), Beijing, China
| | - Fangfang Gao
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Fei Gao
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Guoxin Han
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Liping Ren
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Yulin Ren
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Jianbo Li
- Ulanqab General Hospital, No.157, Jiefang Road, Jining District, Ulanqab, Inner Mongolia 012000 People’s Republic of China
| | - Lixia Wang
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Jay K. Varma
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
- U.S. Centers for Disease Control and Prevention (CDC), Beijing, China
| | - Dongmei Hu
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Haiying Fan
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Fei Zhao
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Emily Bloss
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
| | - Yu Wang
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Carol Y. Rao
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
- U.S. Centers for Disease Control and Prevention (CDC), Beijing, China
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12
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Tollefson D, Ngari F, Mwakala M, Gethi D, Kipruto H, Cain K, Bloss E. Under-reporting of sputum smear-positive tuberculosis cases in Kenya. Int J Tuberc Lung Dis 2018; 20:1334-1341. [PMID: 27725044 DOI: 10.5588/ijtld.16.0156] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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
BACKGROUND Although an estimated three million tuberculosis (TB) cases worldwide are missed by national TB programs annually, the level of under-reporting of diagnosed cases in high TB burden settings is largely unknown. OBJECTIVE To quantify and describe under-reporting of sputum smear-positive TB cases in Kenya. DESIGN A national-level retrospective TB inventory study was conducted. All sputum smear-positive TB cases diagnosed by public or private laboratories during 1 April-30 June 2013 were extracted from laboratory registers in 73 randomly sampled subcounties and matched to TB cases in the national TB surveillance system (TIBU). Bivariate and multivariate analyses were conducted. RESULTS In the subcounties sampled, 715 of 3409 smear-positive TB cases in laboratory registers were not found in TIBU. The estimated level of under-reporting of smear-positive TB cases in Kenya was 20.7% (95%CI 18.4-23.0). Under-reporting was greatest in subcounties with a high TB burden. Unreported cases were more likely to be patients aged ⩾55 years, have scanty smear results, and be diagnosed at large facilities, private facilities, and facilities in high TB burden regions. CONCLUSION In Kenya, one fifth of smear-positive TB cases diagnosed during the study period went unreported, suggesting that the true TB burden is higher than reported. TB surveillance in Kenya should be strengthened to ensure all diagnosed TB cases are reported.
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Affiliation(s)
- D Tollefson
- US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - F Ngari
- National Tuberculosis, Leprosy, and Lung Disease Program, Nairobi, Kenya
| | - M Mwakala
- National Tuberculosis, Leprosy, and Lung Disease Program, Nairobi, Kenya
| | - D Gethi
- Kenya Medical Research Institute, Kisumu, Kenya
| | - H Kipruto
- World Health Organization, Nairobi, Kenya
| | | | - E Bloss
- US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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Abstract
BACKGROUND The burden of tuberculosis (TB) in the estimated 370 million indigenous peoples worldwide is unknown. OBJECTIVE To conduct a literature review to summarize the TB burden in indigenous peoples, identify gaps in current knowledge, and provide the foundation for a research agenda prioritizing indigenous health within TB control. METHODS A systematic literature review identified articles published between January 1990 and November 2011 quantifying TB disease burden in indigenous populations worldwide. RESULTS Among the 91 articles from 19 countries included in the review, only 56 were from outside Australia, Canada, New Zealand and the United States. The majority of the studies showed higher TB rates among indigenous groups than non-indigenous groups. Studies from the Amazon generally reported the highest TB prevalence and incidence, but select populations from South-East Asia and Africa were found to have similarly high rates of TB. In North America, the Inuit had the highest reported TB incidence (156/100000), whereas the Metis of Canada and American Indians/Alaska Natives experienced rates of <10/100000. New Zealand's Maori and Pacific Islanders had higher TB incidence rates than Australian Aborigines, but all were at greater risk of developing TB than non-indigenous groups. CONCLUSION Where data exist, indigenous peoples were generally found to have higher rates of TB disease than non-indigenous peoples; however, this burden varied greatly. The paucity of published information on TB burden among indigenous peoples highlights the need to implement and improve TB surveillance to better measure and understand global disparities in TB rates.
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Affiliation(s)
- D Tollefson
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Chilian WM, Tollefson D. Blood urea levels and erythrocyte fragility to isosmotic urea during hibernation and activity of Spermophilus tridecimlineatus. Comp Biochem Physiol A Comp Physiol 1976; 54:433-5. [PMID: 7398 DOI: 10.1016/0300-9629(76)90045-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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