1
|
Nayiga S, MacPherson EE, Mankhomwa J, Nasuwa F, Pongolani R, Kabuleta R, Kesby M, Dacombe R, Hilton S, Grace D, Feasey N, Chandler CI. "Arming half-baked people with weapons!" Information enclaving among professionals and the need for a care-centred model for antibiotic use information in Uganda, Tanzania and Malawi. Glob Health Action 2024; 17:2322839. [PMID: 38441912 PMCID: PMC10916894 DOI: 10.1080/16549716.2024.2322839] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The overuse of antimicrobial medicines is a global health concern, including as a major driver of antimicrobial resistance. In many low- and middle-income countries, a substantial proportion of antibiotics are purchased over-the-counter without a prescription. But while antibiotics are widely available, information on when and how to use them is not. OBJECTIVE We aimed to understand the acceptability among experts and professionals of sharing information on antibiotic use with end users - patients, carers and farmers - in Uganda, Tanzania and Malawi. METHODS Building on extended periods of fieldwork amongst end-users and antibiotic providers in the three countries, we conducted two workshops in each, with a total of 44 medical and veterinary professionals, policy makers and drug regulators, in December 2021. We carried out extensive documentary and literature reviews to characterise antibiotic information systems in each setting. RESULTS Participants reported that the general public had been provided information on medicine use in all three countries by national drug authorities, health care providers and in package inserts. Participants expressed concern over the danger of sharing detailed information on antibiotic use, particularly that end-users are not equipped to determine appropriate use of medicines. Sharing of general instructions to encourage professionally-prescribed practices was preferred. CONCLUSIONS Without good access to prescribers, the tension between enclaving and sharing of knowledge presents an equity issue. Transitioning to a client care-centred model that begins with the needs of the patient, carer or farmer will require sharing unbiased antibiotic information at the point of care.
Collapse
Affiliation(s)
- Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Eleanor E MacPherson
- Research and Innovation Services, University of Glasgow, Glasgow, UK
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | - John Mankhomwa
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | | | | | - Rita Kabuleta
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Mike Kesby
- School of Geography & Sustainable Development, University of St Andrews, St Andrews, UK
| | - Russell Dacombe
- Research and Innovation Services, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Delia Grace
- Natural Resources Institute, University of Greenwich, Chatham, UK
- International Livestock Research Institute, Nairobi, Kenya
| | - Nicholas Feasey
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
- The School of Medicine, University of St Andrews, St Andrews, UK
| | - Clare I.R. Chandler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
2
|
Ladu AI, Kadaura MU, Dauda M, Baba AS, Jeffery C, Farate A, Adekile A, Bates I, Dacombe R. Bacteraemia Among Patients with Sickle Cell Disease in Nigeria: Association with Spleen Size and Function. Mediterr J Hematol Infect Dis 2023; 15:e2023054. [PMID: 37705518 PMCID: PMC10497316 DOI: 10.4084/mjhid.2023.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Adama I Ladu
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Haematology, Faculty of Basic Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Mairo U Kadaura
- Department of Microbiology, Faculty of Basic Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Mohammed Dauda
- Department of Microbiology, Faculty of Basic Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Abubakar Sadiq Baba
- Department of Microbiology, Faculty of Basic Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Caroline Jeffery
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Abubakar Farate
- Department of Radiology, Faculty of Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Adekunle Adekile
- Department of Paediatrics, Faculty of Medicine, Kuwait University, Kuwait
| | - Imelda Bates
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Russell Dacombe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| |
Collapse
|
3
|
Alhassan Y, Zaizay Z, Dean L, McCollum R, Watson V, Kollie K, Piotrowski H, Hastie O, Parker C, Dacombe R, Theobald S, Taegtmeyer M. Perceived impacts of COVID-19 responses on routine health service delivery in Liberia and UK: cross-country lessons for resilient health systems for equitable service delivery during pandemics. BMC Health Serv Res 2023; 23:304. [PMID: 36991477 PMCID: PMC10057690 DOI: 10.1186/s12913-023-09162-8] [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: 10/13/2022] [Accepted: 02/08/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND COVID-19 has caused significant public health problems globally, with catastrophic impacts on health systems. This study explored the adaptations to health services in Liberia and Merseyside UK at the beginning of the COVID-19 pandemic (January-May 2020) and their perceived impact on routine service delivery. During this period, transmission routes and treatment pathways were as yet unknown, public fear and health care worker fear was high and death rates among vulnerable hospitalised patients were high. We aimed to identify cross-context lessons for building more resilient health systems during a pandemic response. METHODS The study employed a cross-sectional qualitative design with a collective case study approach involving simultaneous comparison of COVID-19 response experiences in Liberia and Merseyside. Between June and September 2020, we conducted semi-structured interviews with 66 health system actors purposively selected across different levels of the health system. Participants included national and county decision-makers in Liberia, frontline health workers and regional and hospital decision-makers in Merseyside UK. Data were analysed thematically in NVivo 12 software. RESULTS There were mixed impacts on routine services in both settings. Major adverse impacts included diminished availability and utilisation of critical health services for socially vulnerable populations, linked with reallocation of health service resources for COVID-19 care, and use of virtual medical consultation in Merseyside. Routine service delivery during the pandemic was hampered by a lack of clear communication, centralised planning, and limited local autonomy. Across both settings, cross-sectoral collaboration, community-based service delivery, virtual consultations, community engagement, culturally sensitive messaging, and local autonomy in response planning facilitated delivery of essential services. CONCLUSION Our findings can inform response planning to assure optimal delivery of essential routine health services during the early phases of public health emergencies. Pandemic responses should prioritise early preparedness, with investment in the health systems building blocks including staff training and PPE stocks, address both pre-existing and pandemic-related structural barriers to care, inclusive and participatory decision-making, strong community engagement, and effective and sensitive communication. Multisectoral collaboration and inclusive leadership are essential.
Collapse
Affiliation(s)
- Yussif Alhassan
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | | | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Rosalind McCollum
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Victoria Watson
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | | | - Helen Piotrowski
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | | | | | - Russell Dacombe
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| |
Collapse
|
4
|
McCollum R, Zaizay Z, Dean L, Watson V, Frith L, Alhassan Y, Kollie K, Piotrowski H, Bates I, Anderson de Cuevas R, Harris R, Chowdhury S, Berrian H, Smith JS, Tate WS, El Hajj T, Ozano K, Hastie O, Parker C, Kollie J, Zawolo G, Ding Y, Dacombe R, Taegtmeyer M, Theobald S. Qualitative study exploring lessons from Liberia and the UK for building a people-centred resilient health systems response to COVID-19. BMJ Open 2022; 12:e058626. [PMID: 35914910 PMCID: PMC9344595 DOI: 10.1136/bmjopen-2021-058626] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION COVID-19 has tested the resilience of health systems globally and exposed existing strengths and weaknesses. We sought to understand health systems COVID-19 adaptations and decision making in Liberia and Merseyside, UK. METHODS We used a people-centred approach to carry out qualitative interviews with 24 health decision-makers at national and county level in Liberia and 42 actors at county and hospital level in the UK (Merseyside). We explored health systems' decision-making processes and capacity to adapt and continue essential service delivery in response to COVID-19 in both contexts. RESULTS Study respondents in Liberia and Merseyside had similar experiences in responding to COVID-19, despite significant differences in health systems context, and there is an opportunity for multidirectional learning between the global south and north. The need for early preparedness; strong community engagement; clear communication within the health system and health service delivery adaptations for essential health services emerged strongly in both settings. We found the Foreign, Commonwealth and Development Office (FCDO) principles to have value as a framework for reviewing health systems changes, across settings, in response to a shock such as a pandemic. In addition to the eight original principles, we expanded to include two additional principles: (1) the need for functional structures and mechanisms for preparation and (2) adaptable governance and leadership structures to facilitate timely decision making and response coordination. We find the use of a people-centred approach also has value to prompt policy-makers to consider the acceptance of service adaptations by patients and health workers, and to continue the provision of 'routine services' for individuals during health systems shocks. CONCLUSION Our study highlights the importance of a people-centred approach, placing the person at the centre of the health system, and value in applying and adapting the FCDO principles across diverse settings.
Collapse
Affiliation(s)
- Rosalind McCollum
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Victoria Watson
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lucy Frith
- Centre for Social Ethics & Policy, School of Law, The University of Manchester, Manchester, UK
| | - Yussif Alhassan
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Karsor Kollie
- Neglected Tropical Disease Programme, Ministry of Health, Monrovia, Liberia
| | - Helen Piotrowski
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Imelda Bates
- Centre for Capacity Research, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Rebecca Harris
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Shahreen Chowdhury
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hannah Berrian
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia, Liberia
| | - John Solunta Smith
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia, Liberia
| | - Wede Seekey Tate
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia, Liberia
| | - Taghreed El Hajj
- Centre for Capacity Research, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Olivia Hastie
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Colleen Parker
- Department of Planning, Policy and M&E, Ministry of Health, Monrovia, Liberia
| | - Jerry Kollie
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia, Liberia
| | - Georgina Zawolo
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia, Liberia
| | - Yan Ding
- Centre for Capacity Research, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Russell Dacombe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Diseases Institute, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
5
|
Fajardo E, Watson V, Kumwenda M, Usharidze D, Gogochashvili S, Kakhaberi D, Giguashvili A, Johnson CC, Jamil MS, Dacombe R, Stvilia K, Easterbrook P, Ivanova Reipold E. Usability and acceptability of oral-based HCV self-testing among key populations: a mixed-methods evaluation in Tbilisi, Georgia. BMC Infect Dis 2022; 22:510. [PMID: 35641908 PMCID: PMC9154030 DOI: 10.1186/s12879-022-07484-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 07/31/2021] [Accepted: 05/18/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hepatitis C virus self-testing (HCVST) is an additional approach that may expand access to HCV testing. We conducted a mixed-methods cross-sectional observational study to assess the usability and acceptability of HCVST among people who inject drugs (PWID), men who have sex with men (MSM) and transgender (TG) people in Tbilisi, Georgia. METHODS The study was conducted from December 2019 to June 2020 among PWID at one harm reduction site and among MSM/TG at one community-based organization. We used a convergent parallel mixed-methods design. Usability was assessed by observing errors made and difficulties faced by participants. Acceptability was assessed using an interviewer-administered semi-structured questionnaire. A subset of participants participated in cognitive and in-depth interviews. RESULTS A total of 90 PWID, 84 MSM and 6 TG were observed performing HCVST. PWID were older (median age 35 vs 24) and had a lower level of education compared to MSM/TG (27% vs 59%). The proportion of participants who completed all steps successfully without assistance was 60% among PWID and 80% among MSM/TG. The most common error was in sample collection and this was observed more often among PWID than MSM/TG (21% vs 6%; p = 0.002). More PWID requested assistance during HCVST compared to MSM/TG (22% vs 8%; p = 0.011). Acceptability was high in both groups (98% vs 96%; p = 0.407). Inter-reader agreement was 97% among PWID and 99% among MSM/TG. Qualitative data from cognitive (n = 20) and in-depth interviews (n = 20) was consistent with the quantitative data confirming a high usability and acceptability. CONCLUSIONS HCVST was highly acceptable among key populations in Georgia of relatively high educational level, and most participants performed HCVST correctly. A significant difference in usability was observed among PWID compared to MSM/TG, indicating that PWID may benefit from improved messaging and education as well as options to receive direct assistance when self-testing for HCV.
Collapse
Affiliation(s)
- Emmanuel Fajardo
- grid.452485.a0000 0001 1507 3147The Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Victoria Watson
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Moses Kumwenda
- grid.419393.50000 0004 8340 2442Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi ,grid.10595.380000 0001 2113 2211College of Medicine, University of Malawi (CoM), Blantyre, Malawi
| | | | | | - David Kakhaberi
- Community-Based Organization Equality Movement, Tbilisi, Georgia
| | - Ana Giguashvili
- National Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Cheryl C. Johnson
- grid.3575.40000000121633745Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S. Jamil
- grid.3575.40000000121633745Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Russell Dacombe
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Ketevan Stvilia
- National Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Philippa Easterbrook
- grid.3575.40000000121633745Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Elena Ivanova Reipold
- grid.452485.a0000 0001 1507 3147The Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
| |
Collapse
|
6
|
Neuman M, Mwinga A, Kapaku K, Sigande L, Gotsche C, Taegtmeyer M, Dacombe R, Maluzi K, Kosloff B, Johnson C, Hatzold K, Corbett EL, Ayles H. Sensitivity and specificity of OraQuick® HIV self-test compared to a 4th generation laboratory reference standard algorithm in urban and rural Zambia. BMC Infect Dis 2022; 22:494. [PMID: 35614397 PMCID: PMC9134574 DOI: 10.1186/s12879-022-07457-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND HIV self-testing (HIVST) has the potential to increase coverage of HIV testing, but concerns exist about intended users' ability to correctly perform and interpret tests, especially in poor communities with low literacy rates. We assessed the clinical performance of the 2016 prototype OraQuick® HIV Self-Test in rural and urban communities in Zambia to assess the sensitivity and specificity of the test compared to the national HIV rapid diagnostic test (RDT) algorithm and a laboratory reference standard using 4th generation enzyme immunoassays and HIV RNA detection. METHODS Participants were recruited from randomly selected rural and urban households and one urban health facility between May 2016 and June 2017. Participants received a brief demonstration of the self-test, and then self-tested without further assistance. The research team re-read the self-test, repeated the self-test, drew blood for the laboratory reference, and conducted RDTs following the national HIV testing algorithm (Determine™ HIV1/2 (Alere) confirmed using Unigold™ HIV1/2 (Trinity Biotech)). Selected participants (N = 85) were videotaped whilst conducting the testing to observe common errors. RESULTS Initial piloting showed that written instructions alone were inadequate, and a demonstration of self-test use was required. Of 2,566 self-test users, 2,557 (99.6%) were able to interpret their result. Of participants who were videoed 75/84 (89.3%) completed all steps of the procedure correctly. Agreement between the user-read result and the researcher-read result was 99.1%. Compared to the RDT algorithm, user-conducted HIVST was 94.1% sensitive (95%CI: 90.2-96.7) and 99.7% specific (95%CI: 99.3-99.9). Compared to the laboratory reference, both user-conducted HIVST (sensitivity 87.5%, 95%CI: 82.70-91.3; specificity 99.7%, 95%CI: 99.4-99.9) and the national RDT algorithm (sensitivity 93.4%, 95%CI: 89.7-96.1%; specificity 100% (95%CI: 99.8-100%) had considerably lower sensitivity. CONCLUSIONS Self-testers in Zambia who used OraQuick® HIV Self-Test achieved reasonable clinical performance compared to the national RDT algorithm. However, sensitivity of the self-test was reduced compared to a laboratory reference standard, as was the national RDT algorithm. In-person demonstration, along with the written manufacturer instructions, was needed to obtain accurate results. Programmes introducing self-care diagnostics should pilot and optimise support materials to ensure they are appropriately adapted to context.
Collapse
Affiliation(s)
- Melissa Neuman
- MRC International Statistics and Epidemiology Group and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Alwyn Mwinga
- Zambart, University of Zambia School of Public Health, Ridgeway Campus, Off Nationalist Road, Lusaka, Zambia
| | - Kezia Kapaku
- Zambart, University of Zambia School of Public Health, Ridgeway Campus, Off Nationalist Road, Lusaka, Zambia
| | - Lucheka Sigande
- Zambart, University of Zambia School of Public Health, Ridgeway Campus, Off Nationalist Road, Lusaka, Zambia
| | - Caroline Gotsche
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Miriam Taegtmeyer
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, L3 5QA, UK
- Tropical Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK
| | - Russell Dacombe
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, L3 5QA, UK
| | - Kwitaka Maluzi
- Zambart, University of Zambia School of Public Health, Ridgeway Campus, Off Nationalist Road, Lusaka, Zambia
| | - Barry Kosloff
- MRC International Statistics and Epidemiology Group and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, University of Zambia School of Public Health, Ridgeway Campus, Off Nationalist Road, Lusaka, Zambia
| | - Cheryl Johnson
- World Health Organization, 20 Avenue Appia, Geneva, Switzerland
| | - Karin Hatzold
- PSI-South Africa, 70, 7th Avenue, Rosebank, Johannesburg, South Africa
| | - Elizabeth L Corbett
- MRC International Statistics and Epidemiology Group and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Unit, Blantyre, Malawi
| | - Helen Ayles
- MRC International Statistics and Epidemiology Group and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, University of Zambia School of Public Health, Ridgeway Campus, Off Nationalist Road, Lusaka, Zambia
| |
Collapse
|
7
|
Begg S, Wright A, Small G, Mosha F, Kirby M, Snetselaar J, Aziz S, Bharmal J, Dacombe R, Bates I. Developing laboratory capacity for Good Laboratory Practice certification: lessons from a Tanzanian insecticide testing facility. Gates Open Res 2020; 4:59. [PMID: 32789289 PMCID: PMC7399503 DOI: 10.12688/gatesopenres.13133.1] [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] [Accepted: 06/02/2020] [Indexed: 01/19/2023] Open
Abstract
Background: With increasing insecticide resistance in malaria-endemic countries there is an urgent need for safe and effective novel vector control products. To improve the capacity of facilities that test insecticides in sub-Saharan Africa, a programme is supporting seven facilities towards Good Laboratory Practice (GLP) certification, the globally recognized standard for quality management system (QMS) for the conduct of non-clinical and environmental studies. The World Health Organization (WHO) GLP Handbook provides guidance on a stepwise approach to implement a GLP compliant QMS. This study assesses auditor GLP checklists and timings outlined in the WHO GLP Handbook in the real-life context of a Tanzanian insecticide-testing facility, evaluating their implementation in this context. Methods and Principle Findings: We conducted document review and semi-structured interviews with staff at all levels of the test facility to explore factors that influenced progress towards GLP certification. We found that while auditor GLP checklists underemphasised computer systems, they were otherwise broadly applicable. Factors that delayed time to completion of GLP certification included the need for extensive infrastructure improvements, the availability of regional expertise related to GLP, the capacity of national and regional external systems and services to meet GLP compliance requirements, and training development required for Standard Operating Procedure implementation. Conclusion: The standards required for full GLP compliance are rigorous, with an expected completion timeline to implementation of 24 months. This study shows that in low and middle-income countries this timeline may be unrealistic due to challenges related to infrastructure development and lack of regional capacity and expertise. We recommend a comprehensive gap analysis when starting a project, including these areas which are beyond those recommended by the WHO GLP Handbook. These challenges can be successfully overcome and the experience in Tanzania provides key lessons for other facilities seeking GLP certification or the development of similar QMS.
Collapse
Affiliation(s)
- Sara Begg
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Alexandra Wright
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Graham Small
- Innovative Vector Control Consortium (IVCC), Liverpool, L3 5QA, UK
| | | | - Matthew Kirby
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- KCMUCo-PAMVERC Test Facility, Moshi, 255, Tanzania
| | - Janneke Snetselaar
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- KCMUCo-PAMVERC Test Facility, Moshi, 255, Tanzania
| | - Salum Aziz
- KCMUCo-PAMVERC Test Facility, Moshi, 255, Tanzania
| | - Jameel Bharmal
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Russell Dacombe
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Imelda Bates
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| |
Collapse
|
8
|
Hemingway C, Baja ES, Dalmacion GV, Medina PMB, Guevara EG, Sy TR, Dacombe R, Dormann C, Taegtmeyer M. Development of a Mobile Game to Influence Behavior Determinants of HIV Service Uptake Among Key Populations in the Philippines: User-Centered Design Process. JMIR Serious Games 2019; 7:e13695. [PMID: 31859673 PMCID: PMC6942189 DOI: 10.2196/13695] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/18/2019] [Accepted: 08/19/2019] [Indexed: 12/19/2022] Open
Abstract
Background Opportunities in digital distribution place mobile games as a promising platform for games for health. However, designing a game that can compete in the saturated mobile games market and deliver persuasive health messages can feel like an insurmountable challenge. Although user-centered design is widely advocated, factors such as the user’s subject domain expertise, budget constraints, and poor data collection methods can restrict the benefits of user involvement. Objective This study aimed to develop a playable and acceptable game for health, targeted at young key populations in the Philippines. Methods Authors identified a range of user-centered design methods to be used in tandem from published literature. The resulting design process involved a phased approach, with 40 primary and secondary users engaged during the initial ideation and prototype testing stages. Selected methods included participatory design workshops, playtests, playability heuristics, and focus group discussions. Subject domain experts were allocated roles in the development team. Data were analyzed using a framework approach. Conceptual frameworks in health intervention acceptability and game design guided the analysis. In-game events were captured through the Unity Analytics service to monitor uptake and game use over a 12-month period. Results Early user involvement revealed a strong desire for online multiplayer gameplay, yet most reported that access to this type of game was restricted because of technical and economic constraints. A role-playing game (RPG) with combat elements was identified as a very appealing gameplay style. Findings guided us to a game that could be played offline and that blended RPG elements, such as narrative and turn-based combat, with match-3 puzzles. Although the game received a positive response during playtests, gameplay was at times perceived as repetitive and predicted to only appeal to casual gamers. Knowledge transfer was predominantly achieved through interpretation of the game’s narrative, highlighting this as an important design element. Uptake of the game was positive; between December 1, 2017, and December 1, 2018, 3325 unique device installs were reported globally. Game metrics provided evidence of adoption by young key populations in the Philippines. Game uptake and use were substantially higher in regions where direct engagement with target users took place. Conclusions User-centered design activities supported the identification of important contextual requirements. Multiple data collection methods enabled triangulation of findings to mediate the inherent biases of the different techniques. Game acceptance is dependent on the ability of the development team to implement design solutions that address the needs and desires of target users. If target users are expected to develop design solutions, they must have adequate expertise and a significant role within the development team. Facilitating meaningful partnerships between health professionals, the games industry, and end users will support the games for health industry as it matures.
Collapse
Affiliation(s)
- Charlotte Hemingway
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Emmanuel S Baja
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Godafreda V Dalmacion
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Paul Mark B Medina
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Ernest Genesis Guevara
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Tyrone Reden Sy
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Russell Dacombe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Claire Dormann
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Tropical Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| |
Collapse
|
9
|
Netongo PM, Domkam I, Kamdem SD, Maloba F, Nji A, Tchoupe E, Bidias A, Namboh B, Kwedi-Nolna S, Athogo-Tiedeu B, Dacombe R, Mbacham W. PO 8574 LESSONS FROM ENGAGING AND TRAINING PRIVATE AND FAITH-BASED HEALTH FACILITIES FOR THE USE OF MALARIA RAPID DIAGNOSTIC TESTS IN CAMEROON. BMJ Glob Health 2019. [DOI: 10.1136/bmjgh-2019-edc.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundBespoke community engagement is critical for success of any intervention. Lessons learned from engaging and training private and faith-based health facility professionals (grouped as informal health professionals [IHPs]) in Cameroon could streamline training and community engagement activities of networks like ALERRT and PANDORA. With the aim of establishing a system for monitoring malaria RDT accuracy in Cameroon, and supported by a WHO/TDR Impact grant, we tested the hypothesis that training IHPs to use follow-up visits and telephone/online support will improve their ability to perform RDT by 80%. This will also improve access to accurate malaria diagnosis and treatment in the communities served by the IHPs.MethodsWe conducted a baseline survey to map target informal health facilities (GPS location, staffing, training on RDT) and challenges through focus group discussions and group questionnaires. We then organised rotation classroom for a three-day enhanced training on early diagnosis and prompt, effective treatment of malaria.ResultsWe found that though informal health facilities constitute approximately 30% of the country’s health system capacity, IHPs were seldom included in regional RDTs training by the National Malaria Control Programme. Also, some IHPs had limited training to deliver health care services and were not registered with the Ministry of Health. Started as common initiative groups, IHFs constitute major access points for health care within communities and could be major players for community engagement within Cameroon as a sizeable population relies on them for accessible care.ConclusionOur method is a feasible and cost-effective health worker-based approach for training and community engagement, which can help ALERRT to anticipate community preparedness for outbreaks in Cameroon and beyond.
Collapse
|
10
|
Bogdanova EN, Mariandyshev AO, Balantcev GA, Eliseev PI, Nikishova EI, Gaida AI, Enarson D, Detjen A, Dacombe R, Phillips PPJ, Squire SB, Gospodarevskaya E. Cost minimization analysis of line probe assay for detection of multidrug-resistant tuberculosis in Arkhangelsk region of Russian Federation. PLoS One 2019; 14:e0211203. [PMID: 30695043 PMCID: PMC6350971 DOI: 10.1371/journal.pone.0211203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/09/2019] [Indexed: 12/02/2022] Open
Abstract
Background The development of new diagnostic tools allows for faster detection of both tuberculosis (TB) and multidrug-resistant (MDR) TB and should lead to reduced transmission by earlier initiation of anti TB therapy. The research conducted in the Arkhangelsk region of the Russian Federation in 2012–14 included economic evaluation of Line Probe Assay (LPA) implementation in MDR-TB diagnostics compared to existing culture-based diagnostics of Löwenstein Jensen (LJ) and BacTAlert. Clinical superiority of LPA was demonstrated and results were reported elsewhere. Study aim The PROVE-IT Russia study aimed to report the outcomes of the cost minimization analysis. Methods Costs of LPA-based diagnostic algorithm (smear positive (SSm+) and for smear negative (SSm-) culture confirmed TB patients by Bactec MGIT or LJ were compared with conventional culture-based algorithm (LJ–for SSm- and SSm+ patients and BacTAlert–for SSm+ patients). Cost minimization analysis was conducted from the healthcare system, patient and societal perspectives and included the direct and indirect costs to the healthcare system (microscopy and drug susceptibility test (DST), hospitalization, medications obtained from electronic medical records) and non-hospital direct costs (patient’s travel cost, additional expenses associated with hospitalization, supplementary medicine and food) collected at the baseline and two subsequent interviews using the WHO-approved questionnaire. Results Over the period of treatment the LPA-based diagnostic corresponded to lesser direct and indirect costs comparing to the alternative algorithms. For SSm+ LPA-based diagnostics resulted in the costs 4.5 times less (808.21 US$) than LJ (3593.81 US$) and 2.5 times less than BacTAlert liquid culture (2009.61 US$). For SSm- LPA in combination with Bactec MGIT (1480.75 US$) vs LJ (1785.83 US$) showed the highest cost minimization compared to LJ (2566.09 US$). One-way sensitivity analyses of the key parameters and threshold analyses were conducted and demonstrated that the results were robust to variations in the cost of hospitalization, medications and length of stay. Conclusion From the perspective of Russian Federation healthcare system, TB diagnostic algorithms incorporating LPA method proved to be both more clinically effective and less expensive due to reduction in the number of hospital days to the correct MDR-TB diagnosis and treatment initiation. LPA diagnostics comparing conventional culture diagnostic algorithm MDR-TB was a cost minimizing strategy for both patients and healthcare system.
Collapse
Affiliation(s)
- E. N. Bogdanova
- Northern Arctic Federal University, Arkhangelsk, Russian Federation
- * E-mail:
| | | | - G. A. Balantcev
- Northern Arctic Federal University, Arkhangelsk, Russian Federation
| | - P. I. Eliseev
- Northern State Medical University, Arkhangelsk, Russian Federation
| | - E. I. Nikishova
- Arkhangelsk Clinical Antituberculosis Dispensary, Arkhangelsk, Russian Federation
| | - A. I. Gaida
- Arkhangelsk Clinical Antituberculosis Dispensary, Arkhangelsk, Russian Federation
| | - D. Enarson
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A. Detjen
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R. Dacombe
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - S. B. Squire
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - E. Gospodarevskaya
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Deakin University, Melbourne, Australia
| |
Collapse
|
11
|
Molina-Moya B, Abdurrahman ST, Madukaji LI, Gomgnimbou MK, Spinasse L, Gomes-Fernandes M, Gomes HM, Kacimi S, Dacombe R, Bimba JS, Lawson L, Sola C, Cuevas LE, Dominguez J. Genetic characterization of Mycobacterium tuberculosis complex isolates circulating in Abuja, Nigeria. Infect Drug Resist 2018; 11:1617-1625. [PMID: 30319278 PMCID: PMC6171509 DOI: 10.2147/idr.s166986] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Nigeria ranks fourth among the high tuberculosis (TB) burden countries. This study describes the prevalence of drug resistance and the genetic diversity of Mycobacterium tuberculosis in Abuja’s Federal Capital Territory. Materials and methods Two hundred and seventy-eight consecutive sputum samples were collected from adults with presumptive TB during 2013–2014. DNA was extracted from Löwenstein–Jensen cultures and analyzed for the identification of nontuberculous mycobacteria species, detection of drug resistance with line probe assays, and high-throughput spacer oligonucleotide typing (spoligotyping) using microbead-based hybridization. Results Two hundred and two cultures were positive for M. tuberculosis complex, 24 negative, 38 contaminated, and 15 positive for nontuberculous mycobacteria. Five (2.5%) M. tuberculosis complex isolates were resistant to rifampicin (RIF) and isoniazid (multidrug resistant), nine (4.5%) to RIF alone, and 15 (7.4%) to isoniazid alone; two RIF-resistant isolates were also resistant to fluoroquinolones and ethambutol, and one multidrug resistant isolate was also resistant to ethambutol. Among the 180 isolates with spoligotyping results, 164 (91.1%) were classified as lineage 4 (Euro-American), 13 (7.2%) as lineage 5 (West African 1), two (1.1%) as lineage 2 (East Asia), and one (0.6%) as lineage 6 (West African 2). One hundred and fifty-six (86.7%) isolates were grouped in 17 clusters (2–108 isolates/cluster), of which 108 (60.0%) were grouped as L4.6.2/Cameroon (spoligotype international type 61). Conclusion The description of drug resistance prevalence and genetic diversity of M. tuberculosis in this study may be useful for improving TB control in Nigeria.
Collapse
Affiliation(s)
- Barbara Molina-Moya
- Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain, .,CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,
| | | | | | - Michel Kiréopori Gomgnimbou
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Univ. Paris-Sud, Université Paris-Saclay, Gif-sur-Yvette cedex, France.,Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Lizania Spinasse
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Univ. Paris-Sud, Université Paris-Saclay, Gif-sur-Yvette cedex, France
| | - Meissiner Gomes-Fernandes
- Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain, .,CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain, .,CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil
| | - Harrison Magdinier Gomes
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Univ. Paris-Sud, Université Paris-Saclay, Gif-sur-Yvette cedex, France
| | - Sarah Kacimi
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Univ. Paris-Sud, Université Paris-Saclay, Gif-sur-Yvette cedex, France
| | | | | | | | - Christophe Sola
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Univ. Paris-Sud, Université Paris-Saclay, Gif-sur-Yvette cedex, France
| | - Luis E Cuevas
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jose Dominguez
- Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain, .,CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,
| |
Collapse
|
12
|
Dean L, Njelesani J, Mulamba C, Dacombe R, Mbabazi PS, Bates I. Establishing an international laboratory network for neglected tropical diseases: Understanding existing capacity in five WHO regions. F1000Res 2018; 7:1464. [PMID: 31119028 PMCID: PMC6509956 DOI: 10.12688/f1000research.16196.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 11/20/2022] Open
Abstract
Background. Limited laboratory capacity is a significant bottleneck in meeting global targets for the control and elimination of neglected tropical diseases (NTD). Laboratories are essential for providing clinical data and monitoring data about the status and changes in NTD prevalence, and for detecting early drug resistance. Currently NTD laboratory networks are informal and specialist laboratory expertise is not well publicised, making it difficult to share global expertise and provide training, supervision, and quality assurance for NTD diagnosis and research. This study aimed to identify laboratories within five World Health Organisation regions (South-East Asia, Eastern Mediterranean, Americas, Western Pacific and Europe) that provide NTD services and could be regarded as national or regional reference laboratories, and to conduct a survey to document their networks and capacity to support NTD programmes. Methods. Potential NTD reference laboratories were identified through systematic searches, snowball sampling and key informants. Results. Thirty-two laboratories responded to the survey. The laboratories covered 17 different NTDs and their main regional and national roles were to provide technical support and training, research, test validation and standard setting. Two thirds of the laboratories were based in academic institutions and almost half had less than 11 staff. Although greater than 90 per cent of the laboratories had adequate technical skills to function as an NTD reference laboratory, almost all laboratories lacked systems for external verification that their results met international standards. Conclusions. This study highlights that although many laboratories believed they could act as a reference laboratory, only a few had all the characteristics required to fulfil this role as they fell short in the standard and quality assurance of laboratory processes. Networks of high quality laboratories are essential for the control and elimination of disease and this study presents a critical first step in the development of such networks for NTDs.
Collapse
Affiliation(s)
- Laura Dean
- Capacity Research Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Janet Njelesani
- Steinhardt School of Culture, Education, and Human Development, New York University, New York, USA
| | - Charles Mulamba
- Capacity Research Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Russell Dacombe
- Capacity Research Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Pamela S Mbabazi
- Global Working Group on Capacity Strengthening for National NTD Programmes, World Health Organization, Geneva, Switzerland
| | - Imelda Bates
- Capacity Research Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
13
|
Abstract
BACKGROUND Pulmonary tuberculosis is usually diagnosed when symptomatic individuals seek care at healthcare facilities, and healthcare workers have a minimal role in promoting the health-seeking behaviour. However, some policy specialists believe the healthcare system could be more active in tuberculosis diagnosis to increase tuberculosis case detection. OBJECTIVES To evaluate the effectiveness of different strategies to increase tuberculosis case detection through improving access (geographical, financial, educational) to tuberculosis diagnosis at primary healthcare or community-level services. SEARCH METHODS We searched the following databases for relevant studies up to 19 December 2016: the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library, Issue 12, 2016; MEDLINE; Embase; Science Citation Index Expanded, Social Sciences Citation Index; BIOSIS Previews; and Scopus. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, and the metaRegister of Controlled Trials (mRCT) for ongoing trials. SELECTION CRITERIA Randomized and non-randomized controlled studies comparing any intervention that aims to improve access to a tuberculosis diagnosis, with no intervention or an alternative intervention. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for eligibility and risk of bias, and extracted data. We compared interventions using risk ratios (RR) and 95% confidence intervals (CI). We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included nine cluster-randomized trials, one individual randomized trial, and seven non-randomized controlled studies. Nine studies were conducted in sub-Saharan Africa (Ethiopia, Nigeria, South Africa, Zambia, and Zimbabwe), six in Asia (Bangladesh, Cambodia, India, Nepal, and Pakistan), and two in South America (Brazil and Colombia); which are all high tuberculosis prevalence areas.Tuberculosis outreach screening, using house-to-house visits, sometimes combined with printed information about going to clinic, may increase tuberculosis case detection (RR 1.24, 95% CI 0.86 to 1.79; 4 trials, 6,458,591 participants in 297 clusters, low-certainty evidence); and probably increases case detection in areas with tuberculosis prevalence of 5% or more (RR 1.52, 95% CI 1.10 to 2.09; 3 trials, 155,918 participants, moderate-certainty evidence; prespecified stratified analysis). These interventions may lower the early default (prior to starting treatment) or default during treatment (RR 0.67, 95% CI 0.47 to 0.96; 3 trials, 849 participants, low-certainty evidence). However, this intervention may have may have little or no effect on treatment success (RR 1.07, 95% CI 1.00 to 1.15; 3 trials, 849 participants, low-certainty evidence), and we do not know if there is an effect on treatment failure or mortality. One study investigated long-term prevalence in the community, but with no clear effect due to imprecision and differences in care between the two groups (RR 1.14, 95% CI 0.65 to 2.00; 1 trial, 556,836 participants, very low-certainty evidence).Four studies examined health promotion activities to encourage people to attend for screening, including mass media strategies and more locally organized activities. There was some increase, but this could have been related to temporal trends, with no corresponding increase in case notifications, and no evidence of an effect on long-term tuberculosis prevalence. Two studies examined the effects of two to six nurse practitioner educational sessions in tuberculosis diagnosis, with no clear effect on tuberculosis cases detected. One trial compared mobile clinics every five days with house-to-house screening every six months, and showed an increase in tuberculosis cases.There was also insufficient evidence to determine if sustained improvements in case detection impact on long-term tuberculosis prevalence; this was evaluated in one study, which indicated little or no effect after four years of either contact tracing, extensive health promotion activities, or both (RR 1.31, 95% CI 0.75 to 2.30; 1 study, 405,788 participants in 12 clusters, very low-certainty evidence). AUTHORS' CONCLUSIONS The available evidence demonstrates that when used in appropriate settings, active case-finding approaches may result in increase in tuberculosis case detection in the short term. The effect of active case finding on treatment outcome needs to be further evaluated in sufficiently powered studies.
Collapse
Affiliation(s)
- Francis A Mhimbira
- Ifakara Health Institute (IHI)Bagamoyo Research and Training Center (BRTC)PO Box 74BagamoyoTanzania
- Swiss Tropical and Public Health InstituteBaselSwitzerland
- University of BaselBaselSwitzerland
| | - Luis E. Cuevas
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUKL3 5QA
| | - Russell Dacombe
- Liverpool School of Tropical MedicineDepartment of International Public HealthPembroke PlaceLiverpoolUKL3 5QA
| | - Abdallah Mkopi
- Ifakara Health Institute (IHI)Impact Evaluation, Health Systems Interventions & Policy TranslationPO Box 78373Dar es SalaamTanzania
| | - David Sinclair
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUKL3 5QA
| | | |
Collapse
|
14
|
Obasanya J, Lawson L, Edwards T, Olanrewaju O, Madukaji L, Dacombe R, Dominguez J, Molina-Moya B, Adams ER, Cuevas LE. FluoroType MTB system for the detection of pulmonary tuberculosis. ERJ Open Res 2017; 3:00113-2016. [PMID: 28491868 PMCID: PMC5420815 DOI: 10.1183/23120541.00113-2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/07/2016] [Accepted: 03/11/2017] [Indexed: 11/16/2022] Open
Abstract
Diagnosis continues to be a major barrier for the control of tuberculosis (TB), especially in low- and middle-income countries (LMIC) [1]. The number of platforms for the molecular diagnosis of TB have increased in recent years and they can provide test results more rapidly than culture. Molecular assays are increasingly being used as alternative or adjunct methods to culture and smear microscopy, and modern systems seek to partially or fully automate the DNA extraction and amplification steps, increasing their suitability for resource-limited laboratories. One of these platforms, the GeneXpert MTB/RIF (Cepheid, USA), has a sensitivity of roughly 85% compared to culture [2] and has seen significant uptake in developing countries [3]. However, as a fully closed system, the DNA extracted during the process cannot be used for further downstream drug susceptibility testing (DST), which is crucial for patients with suspected drug-resistant TB. FluoroType MTB is a sensitive test for TB but specificity is low compared with fully integrated molecular systemshttp://ow.ly/WhEO30b1luY
Collapse
Affiliation(s)
| | - Lovett Lawson
- Zankli Research Laboratory, Dept of Community Medicine and Primary Healthcare, Bingham University, Karu, Nigeria.,Zankli Medical Center, Abuja, Nigeria
| | - Thomas Edwards
- Research Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Laura Madukaji
- Zankli Research Laboratory, Dept of Community Medicine and Primary Healthcare, Bingham University, Karu, Nigeria
| | - Russell Dacombe
- Research Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jose Dominguez
- Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias (CIBERES), Badalona, Spain
| | - Barbara Molina-Moya
- Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias (CIBERES), Badalona, Spain
| | - Emily R Adams
- Research Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Luis E Cuevas
- Research Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
15
|
Langley I, Squire SB, Dacombe R, Madan J, Lapa e Silva JR, Barreira D, Galliez R, Oliveira MM, Fujiwara PI, Kritski A. Developments in Impact Assessment of New Diagnostic Algorithms for Tuberculosis Control. Clin Infect Dis 2016; 61Suppl 3:S126-34. [PMID: 26409273 DOI: 10.1093/cid/civ580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A modified presentation of the impact assessment framework is proposed that improves accessibility while continuing to provide a checklist of the evidence needed to support policy decisions on the implementation of new tools for the diagnosis of tuberculosis.
Collapse
Affiliation(s)
- Ivor Langley
- Clinical Sciences and Centre for Applied Health Research and Delivery
| | - S Bertel Squire
- Clinical Sciences and Centre for Applied Health Research and Delivery
| | | | - Jason Madan
- Warwick Medical School and Centre for Applied Health Research and Delivery, University of Warwick, United Kingdom
| | | | | | | | - Martha Maria Oliveira
- Rede-TB, Center for Technological Development in Health-Fiocruz, Rio de Janeiro, Brazil
| | - Paula I Fujiwara
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | | |
Collapse
|
16
|
Eliseev P, Balantcev G, Nikishova E, Gaida A, Bogdanova E, Enarson D, Ornstein T, Detjen A, Dacombe R, Gospodarevskaya E, Phillips PPJ, Mann G, Squire SB, Mariandyshev A. The Impact of a Line Probe Assay Based Diagnostic Algorithm on Time to Treatment Initiation and Treatment Outcomes for Multidrug Resistant TB Patients in Arkhangelsk Region, Russia. PLoS One 2016; 11:e0152761. [PMID: 27055269 PMCID: PMC4824472 DOI: 10.1371/journal.pone.0152761] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/18/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the Arkhangelsk region of Northern Russia, multidrug-resistant (MDR) tuberculosis (TB) rates in new cases are amongst the highest in the world. In 2014, MDR-TB rates reached 31.7% among new cases and 56.9% among retreatment cases. The development of new diagnostic tools allows for faster detection of both TB and MDR-TB and should lead to reduced transmission by earlier initiation of anti-TB therapy. STUDY AIM The PROVE-IT (Policy Relevant Outcomes from Validating Evidence on Impact) Russia study aimed to assess the impact of the implementation of line probe assay (LPA) as part of an LPA-based diagnostic algorithm for patients with presumptive MDR-TB focusing on time to treatment initiation with time from first-care seeking visit to the initiation of MDR-TB treatment rather than diagnostic accuracy as the primary outcome, and to assess treatment outcomes. We hypothesized that the implementation of LPA would result in faster time to treatment initiation and better treatment outcomes. METHODS A culture-based diagnostic algorithm used prior to LPA implementation was compared to an LPA-based algorithm that replaced BacTAlert and Löwenstein Jensen (LJ) for drug sensitivity testing. A total of 295 MDR-TB patients were included in the study, 163 diagnosed with the culture-based algorithm, 132 with the LPA-based algorithm. RESULTS Among smear positive patients, the implementation of the LPA-based algorithm was associated with a median decrease in time to MDR-TB treatment initiation of 50 and 66 days compared to the culture-based algorithm (BacTAlert and LJ respectively, p<0.001). In smear negative patients, the LPA-based algorithm was associated with a median decrease in time to MDR-TB treatment initiation of 78 days when compared to the culture-based algorithm (LJ, p<0.001). However, several weeks were still needed for treatment initiation in LPA-based algorithm, 24 days in smear positive, and 62 days in smear negative patients. Overall treatment outcomes were better in LPA-based algorithm compared to culture-based algorithm (p = 0.003). Treatment success rates at 20 months of treatment were higher in patients diagnosed with the LPA-based algorithm (65.2%) as compared to those diagnosed with the culture-based algorithm (44.8%). Mortality was also lower in the LPA-based algorithm group (7.6%) compared to the culture-based algorithm group (15.9%). There was no statistically significant difference in smear and culture conversion rates between the two algorithms. CONCLUSION The results of the study suggest that the introduction of LPA leads to faster time to MDR diagnosis and earlier treatment initiation as well as better treatment outcomes for patients with MDR-TB. These findings also highlight the need for further improvements within the health system to reduce both patient and diagnostic delays to truly optimize the impact of new, rapid diagnostics.
Collapse
Affiliation(s)
- Platon Eliseev
- Northern State Medical University, Arkhangelsk, Russian Federation
| | | | - Elena Nikishova
- Arkhangelsk Clinical Antituberculosis Dispensary, Arkhangelsk, Russian Federation
| | - Anastasia Gaida
- Arkhangelsk Clinical Antituberculosis Dispensary, Arkhangelsk, Russian Federation
| | - Elena Bogdanova
- Northern Arctic Federal University, Arkhangelsk, Russian Federation
| | - Donald Enarson
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Tara Ornstein
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Anne Detjen
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Russell Dacombe
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | | | - Gillian Mann
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | | |
Collapse
|
17
|
Klinkenberg E, Assefa D, Rusen ID, Dlodlo RA, Shimeles E, Kebede B, Fiseha D, Tsegaye F, Leimane I, Teklai Y, Dacombe R, Aseffa A. The Ethiopian initiative to build sustainable capacity for operational research: overview and lessons learned. Public Health Action 2015; 4:S2-7. [PMID: 26478509 DOI: 10.5588/pha.14.0051] [Citation(s) in RCA: 4] [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: 05/21/2014] [Accepted: 06/20/2014] [Indexed: 12/17/2022] Open
Abstract
SETTING Programme-based operational research is instrumental for the enhancement of tuberculosis (TB) control. In 2012, the Ethiopian Federal Ministry of Health launched an initiative for capacity building in operational research (OR). OBJECTIVE To develop sustainable capacity for OR in Ethiopia in a multiyear initiative. DESIGN The initiative was developed in collaboration with regional, national and international experts. Teams representing regions in Ethiopia conducted OR addressing national and regional priorities. To make use of local expertise and increase sustainability, a domestic mentor training programme was included. Existing capacity was enhanced through a competitive grant scheme providing TB researchers with financial and technical support. The Ethiopian Tuberculosis Research Advisory Committee was also supported in its functions. Regional ethics review bodies were strengthened or established where they did not exist. RESULTS Fifty-two people were trained and conducted 13 OR projects, of which six have been published to date. In addition, eight protocols were supported through grants. Ethics review bodies were strengthened in all regions. CONCLUSION The initiative trained participants from all regions and succeeded in the completion of all stages of the OR process. The success of the programme can be attributed to the team approach, 'learning while doing', integrated mentorship programme and strong national ownership.
Collapse
Affiliation(s)
- E Klinkenberg
- KNCV Tuberculosis Foundation, The Hague, The Netherlands ; Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - D Assefa
- TB CARE I/KNCV Tuberculosis Foundation, Addis Ababa, Ethiopia
| | - I D Rusen
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - E Shimeles
- TB CARE I/KNCV Tuberculosis Foundation, Addis Ababa, Ethiopia
| | - B Kebede
- Federal Ministry of Health, Addis Ababa
| | - D Fiseha
- TB CARE I/KNCV Tuberculosis Foundation, Addis Ababa, Ethiopia ; Armauer Hansen Research Institute, Addis Ababa ; Tuberculosis Research Advisory Committee, Federal Ministry of Health, Addis Ababa
| | - F Tsegaye
- TB CARE I/KNCV Tuberculosis Foundation, Addis Ababa, Ethiopia ; Armauer Hansen Research Institute, Addis Ababa ; Tuberculosis Research Advisory Committee, Federal Ministry of Health, Addis Ababa
| | - I Leimane
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Y Teklai
- Independent consultant, Addis Ababa, Ethiopia
| | - R Dacombe
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - A Aseffa
- Armauer Hansen Research Institute, Addis Ababa ; Tuberculosis Research Advisory Committee, Federal Ministry of Health, Addis Ababa
| |
Collapse
|
18
|
Obasanya J, Abdurrahman ST, Oladimeji O, Lawson L, Dacombe R, Chukwueme N, Abiola T, Mustapha G, Sola C, Dominguez J, Cuevas LE. Tuberculosis case detection in Nigeria, the unfinished agenda. Trop Med Int Health 2015; 20:1396-402. [PMID: 26084031 DOI: 10.1111/tmi.12558] [Citation(s) in RCA: 5] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Underdetection of TB is a major problem in sub-Saharan Africa. WHO recommends countries should have at least 1 laboratory per 100,000 population. However, this recommendation is not evidence based. METHODS We analysed surveillance data of the Nigerian National TB Control Programme (2008-2012) to describe TB case detection rates, their geographical distribution and their association with the density of diagnostic laboratories and HIV prevalence. RESULTS The median CDR was 17.7 (range 4.7-75.8%) in 2008, increasing to 28.6% (range 10.6-72.4%) in 2012 (P < 0.01). The CDR2012 was associated with the 2008 baseline; however, states with CDR2008 < 30% had larger increases than states with CDR2008 > 30. There were 990 laboratories in 2008 and 1453 in 2012 (46.7% increase, range by state -3% to +118). The state CDR2012 could be predicted by the laboratory density (P < 0.001), but was not associated with HIV prevalence or the proportion of smear-positive cases. CDR2012 and laboratory density were correlated among states having < and > than 1 laboratory per 100,000 population. CONCLUSION There are large variations in laboratory density and CDR across the Nigerian states. The CDR is associated with the laboratory density. A much larger number of diagnostic centres are needed. It is likely that a laboratory density above the recommended WHO guideline would result in even higher case detection, and this ratio should be considered a minimum threshold.
Collapse
Affiliation(s)
- Joshua Obasanya
- National Tuberculosis and Leprosy Control Programme of Nigeria, Abuja, Nigeria
| | - Saddiq T Abdurrahman
- Federal Capital Territory Abuja Tuberculosis And Leprosy Control Programme, Abuja, Nigeria
| | - Olanrewaju Oladimeji
- Zankli Medical Centre, Abuja, Nigeria.,Liverpool School of Tropical Medicine, UK
| | | | | | - Nkem Chukwueme
- National Tuberculosis and Leprosy Control Programme of Nigeria, Abuja, Nigeria
| | - Tubi Abiola
- National Tuberculosis and Leprosy Control Programme of Nigeria, Abuja, Nigeria
| | | | - Christophe Sola
- Microbiology Department, Université Paris-Sud, Orsay, France
| | - Jose Dominguez
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | |
Collapse
|
19
|
Abouyannis M, Dacombe R, Dambe I, Mpunga J, Faragher B, Gausi F, Ndhlovu H, Kachiza C, Suarez P, Mundy C, Banda HT, Nyasulu I, Squire SB. Drug resistance of Mycobacterium tuberculosis in Malawi: a cross-sectional survey. Bull World Health Organ 2014; 92:798-806. [PMID: 25378741 PMCID: PMC4221759 DOI: 10.2471/blt.13.126532] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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] [Received: 07/04/2013] [Revised: 07/31/2014] [Accepted: 08/07/2014] [Indexed: 11/29/2022] Open
Abstract
Objective To document the prevalence of multidrug resistance among people newly diagnosed with – and those retreated for – tuberculosis in Malawi. Methods We conducted a nationally representative survey of people with sputum-smear-positive tuberculosis between 2010 and 2011. For all consenting participants, we collected demographic and clinical data, two sputum samples and tested for human immunodeficiency virus (HIV).The samples underwent resistance testing at the Central Reference Laboratory in Lilongwe, Malawi. All Mycobacterium tuberculosis isolates found to be multidrug-resistant were retested for resistance to first-line drugs – and tested for resistance to second-line drugs – at a Supranational Tuberculosis Reference Laboratory in South Africa. Findings Overall, M. tuberculosis was isolated from 1777 (83.8%) of the 2120 smear-positive tuberculosis patients. Multidrug resistance was identified in five (0.4%) of 1196 isolates from new cases and 28 (4.8%) of 581 isolates from people undergoing retreatment. Of the 31 isolates from retreatment cases who had previously failed treatment, nine (29.0%) showed multidrug resistance. Although resistance to second-line drugs was found, no cases of extensive drug-resistant tuberculosis were detected. HIV testing of people from whom M. tuberculosis isolates were obtained showed that 577 (48.2%) of people newly diagnosed and 386 (66.4%) of people undergoing retreatment were positive. Conclusion The prevalence of multidrug resistance among people with smear-positive tuberculosis was low for sub-Saharan Africa – probably reflecting the strength of Malawi’s tuberculosis control programme. The relatively high prevalence of such resistance observed among those with previous treatment failure may highlight a need for a change in the national policy for retreating this subgroup of people with tuberculosis.
Collapse
Affiliation(s)
- Michael Abouyannis
- Centre for Applied Health Research & Delivery, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Russell Dacombe
- Centre for Applied Health Research & Delivery, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Isaias Dambe
- National Tuberculosis Control Programme, Lilongwe, Malawi
| | - James Mpunga
- National Tuberculosis Control Programme, Lilongwe, Malawi
| | - Brian Faragher
- Centre for Applied Health Research & Delivery, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Francis Gausi
- National Tuberculosis Control Programme, Lilongwe, Malawi
| | - Henry Ndhlovu
- Research for Equity and Community Health Trust, Lilongwe, Malawi
| | - Chifundo Kachiza
- Tuberculosis Control Assistance Programme, Management Sciences for Health, Lilongwe, Malawi
| | - Pedro Suarez
- Management Sciences for Health, Arlington, United States of America
| | - Catherine Mundy
- Management Sciences for Health, Arlington, United States of America
| | - Hastings T Banda
- Research for Equity and Community Health Trust, Lilongwe, Malawi
| | | | - S Bertel Squire
- Centre for Applied Health Research & Delivery, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| |
Collapse
|
20
|
Abdurrahman ST, Emenyonu N, Obasanya OJ, Lawson L, Dacombe R, Muhammad M, Oladimeji O, Cuevas LE. The hidden costs of installing Xpert machines in a tuberculosis high-burden country: experiences from Nigeria. Pan Afr Med J 2014; 18:277. [PMID: 25489371 PMCID: PMC4258200 DOI: 10.11604/pamj.2014.18.277.3906] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/06/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Since the endorsement of GeneXpert MTB/RIF by the WHO, many countries have embarked on implementing this technology. OBJECTIVE We outline the cost of installing GeneXpert in district hospitals in Abuja, Nigeria. METHODS We prospectively documented costs related to the installation of GeneXpert at five sites. Costs were collected from receipts received from suppliers and normalized to USD 2012 values. RESULTS Costs were often identified after initiating installation for many reasons. Installation varied widely between sites with sufficient space and power supply; sites with insufficient space or power supply and costs not directly associated with site installation. The basic cost for installation was USD 2,621.98 per machine. Sites that required additional space cost close to USD 7,000.00. CONCLUSION Space and power requirements have a significant effect on installation costs. Countries need to carefully consider the placement of Xpert machines based on the quality and size of the available infrastructure.
Collapse
Affiliation(s)
- Saddiq Tsimiri Abdurrahman
- Tuberculosis and Leprosy Control Programme Unit, Department of Public Health and Human Services, Federal Capital Territory, Abuja, Nigeria
| | | | | | | | | | - Muhammad Muhammad
- Tuberculosis and Leprosy Control Programme Unit, Department of Public Health and Human Services, Federal Capital Territory, Abuja, Nigeria
| | - Olanrewaju Oladimeji
- Zankli Medical Centre, Abuja, Nigeria ; Liverpool School of Tropical Medicine, United Kingdom
| | | |
Collapse
|
21
|
Iyer V, Azhar GS, Choudhury N, Dhruwey VS, Dacombe R, Upadhyay A. Infectious disease burden in Gujarat (2005-2011): comparison of selected infectious disease rates with India. Emerg Health Threats J 2014; 7:22838. [PMID: 24647088 PMCID: PMC3962030 DOI: 10.3402/ehtj.v7.22838] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 02/13/2014] [Accepted: 02/17/2014] [Indexed: 11/14/2022]
Abstract
Background India is known to be endemic to numerous infectious diseases. The infectious disease profile of India is changing due to increased human environmental interactions, urbanisation and climate change. There are also predictions of explosive growth in infectious and zoonotic diseases. The Integrated Disease Surveillance Project (IDSP) was implemented in Gujarat in 2004. Methods We analysed IDSP data on seven laboratory confirmed infectious diseases from 2005–2011 on temporal and spatial trends and compared this to the National Health Profile (NHP) data for the same period and with other literature. We chose laboratory cases data for Enteric fever, Cholera, Hepatitis, Dengue, Chikungunya, Measles and Diphtheria in the state since well designed vertical programs do not exist for these diseases. Statistical and GIS analysis was done using appropriate software. Results Our analysis shows that the existing surveillance system in the state is predominantly reporting urban cases. There are wide variations among reported cases within the state with reports of Enteric fever and Measles being less than half of the national average, while Cholera, Viral Hepatitis and Dengue being nearly double. Conclusions We found some limitations in the IDSP system with regard to the number of reporting units and cases in the background of a mixed health system with multiplicity of treatment providers and payment mechanisms. Despite these limitations, IDSP can be strengthened into a comprehensive surveillance system capable of tackling the challenge of reversing the endemicity of these diseases and preventing the emergence of others.
Collapse
Affiliation(s)
- Veena Iyer
- Indian Institute of Public Health, Gandhinagar, Ahmedabad, India;
| | | | | | - Vidwan Singh Dhruwey
- Integrated Disease Surveillance Project, Commissionerate of Health, Medical Services, Medical Education and Research, Government of Gujarat, Gandhinagar, India
| | | | - Ashish Upadhyay
- Indian Institute of Public Health, Gandhinagar, Ahmedabad, India
| |
Collapse
|
22
|
Njelesani J, Dacombe R, Palmer T, Smith H, Koudou B, Bockarie M, Bates I. A systematic approach to capacity strengthening of laboratory systems for control of neglected tropical diseases in Ghana, Kenya, Malawi and Sri Lanka. PLoS Negl Trop Dis 2014; 8:e2736. [PMID: 24603407 PMCID: PMC3945753 DOI: 10.1371/journal.pntd.0002736] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 01/29/2014] [Indexed: 11/23/2022] Open
Abstract
Background The lack of capacity in laboratory systems is a major barrier to achieving the aims of the London Declaration (2012) on neglected tropical diseases (NTDs). To counter this, capacity strengthening initiatives have been carried out in NTD laboratories worldwide. Many of these initiatives focus on individuals' skills or institutional processes and structures ignoring the crucial interactions between the laboratory and the wider national and international context. Furthermore, rigorous methods to assess these initiatives once they have been implemented are scarce. To address these gaps we developed a set of assessment and monitoring tools that can be used to determine the capacities required and achieved by laboratory systems at the individual, organizational, and national/international levels to support the control of NTDs. Methodology and principal findings We developed a set of qualitative and quantitative assessment and monitoring tools based on published evidence on optimal laboratory capacity. We implemented the tools with laboratory managers in Ghana, Malawi, Kenya, and Sri Lanka. Using the tools enabled us to identify strengths and gaps in the laboratory systems from the following perspectives: laboratory quality benchmarked against ISO 15189 standards, the potential for the laboratories to provide support to national and regional NTD control programmes, and the laboratory's position within relevant national and international networks and collaborations. Conclusion We have developed a set of mixed methods assessment and monitoring tools based on evidence derived from the components needed to strengthen the capacity of laboratory systems to control NTDs. Our tools help to systematically assess and monitor individual, organizational, and wider system level capacity of laboratory systems for NTD control and can be applied in different country contexts. Capacity strengthening activities such as technical training for staff, student research project supervision, and equipment provision are being carried out in laboratories worldwide as part of the global effort to control neglected tropical diseases (NTDs). However, these activities often focus on developing the skill sets of an individual and are not being thoroughly monitored and assessed. To address these gaps we developed a set of monitoring and assessment tools that can be used to determine the capacities required and achieved by laboratory systems to support the control of NTDs. The tools simultaneously focus on individuals (e.g., technicians, students, researchers), organisations (e.g., universities, research institutions, clinical facilities), national governments, and international agencies. Using the tools highlighted the strengths and limitations of each laboratory system in addition to the role of the laboratory regionally and internationally. We used the tools in Kenya, Ghana, Malawi and Sri Lanka, and concluded that our tools can be adapted and tailored to use in other countries and laboratories.
Collapse
Affiliation(s)
- Janet Njelesani
- Capacity Research Unit, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Russell Dacombe
- Capacity Research Unit, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tanith Palmer
- Capacity Research Unit, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helen Smith
- Capacity Research Unit, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Benjamin Koudou
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Moses Bockarie
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Imelda Bates
- Capacity Research Unit, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| |
Collapse
|
23
|
Hur YG, Gorak-Stolinska P, Ben-Smith A, Lalor MK, Chaguluka S, Dacombe R, Doherty TM, Ottenhoff TH, Dockrell HM, Crampin AC. Combination of cytokine responses indicative of latent TB and active TB in Malawian adults. PLoS One 2013; 8:e79742. [PMID: 24260295 PMCID: PMC3832606 DOI: 10.1371/journal.pone.0079742] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/24/2013] [Indexed: 12/03/2022] Open
Abstract
Background An IFN-γ response to M. tuberculosis-specific antigens is an effective biomarker for M. tuberculosis infection but it cannot discriminate between latent TB infection and active TB disease. Combining a number of cytokine/chemokine responses to M. tuberculosis antigens may enable differentiation of latent TB from active disease. Methods Asymptomatic recently-exposed individuals (spouses of TB patients) were recruited and tuberculin skin tested, bled and followed-up for two years. Culture supernatants, from a six-day culture of diluted whole blood samples stimulated with M. tuberculosis-derived PPD or ESAT-6, were measured for IFN-γ, IL-10, IL-13, IL-17, TNF-α and CXCL10 using cytokine ELISAs. In addition, 15 patients with sputum smear-positive pulmonary TB were recruited and tested. Results Spouses with positive IFN-γ responses to M. tuberculosis ESAT-6 (>62.5 pg/mL) and TB patients showed high production of IL-17, CXCL10 and TNF-α. Higher production of IL-10 and IL-17 in response to ESAT-6 was observed in the spouses compared with TB patients while the ratios of IFN-γ/IL-10 and IFN-γ/IL-17 in response to M. tuberculosis-derived PPD were significantly higher in TB patients compared with the spouses. Tuberculin skin test results did not correlate with cytokine responses. Conclusions CXCL10 and TNF-α may be used as adjunct markers alongside an IFN-γ release assay to diagnose M. tuberculosis infection, and IL-17 and IL-10 production may differentiate individuals with LTBI from active TB.
Collapse
Affiliation(s)
- Yun-Gyoung Hur
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Patricia Gorak-Stolinska
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anne Ben-Smith
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Karonga Prevention Study, Chilumba, Malawi
| | - Maeve K. Lalor
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Russell Dacombe
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Karonga Prevention Study, Chilumba, Malawi
| | | | - Tom H. Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Hazel M. Dockrell
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Amelia C. Crampin
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Karonga Prevention Study, Chilumba, Malawi
| |
Collapse
|
24
|
Lawson L, Yassin MA, Abdurrahman ST, Parry CM, Dacombe R, Sogaolu OM, Ebisike JN, Uzoewulu GN, Lawson LO, Emenyonu N, Ouoha JO, David JS, Davies PDO, Cuevas LE. Resistance to first-line tuberculosis drugs in three cities of Nigeria. Trop Med Int Health 2011; 16:974-80. [PMID: 21564425 DOI: 10.1111/j.1365-3156.2011.02792.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the levels of resistance to first-line tuberculosis drugs in three cities in three geopolitical zones in Nigeria. METHODS A total of 527 smear-positive sputum samples from Abuja, Ibadan and Nnewi were cultured on BACTEC- MGIT 960. Drug susceptibility tests (DST) for streptomycin, isoniazid, rifampicin and ethambutol were performed on 428 culture-positive samples on BACTEC-MGIT960. RESULTS Eight per cent of the specimens cultured were multi-drug-resistant Mycobacterium tuberculosis (MDR-TB) with varying levels of resistance to individual and multiple first-line drugs. MDR was strongly associated with previous treatment: 5% of new and 19% of previously treated patients had MDR-TB (OR 4.1 (95% CI 1.9-8.8), P = 0.001) and with young adult age: 63% of patients with and 38% without MDR-TB were 25-34 years old (P = 0.01). HIV status was documented in 71%. There was no association between MDR-TB and HIV coinfection (P = 0.9) and gender (P > 0.2 for both). CONCLUSIONS MDR-TB is an emerging problem in Nigeria. Developing good quality drug susceptibility test facilities, routine monitoring of drug susceptibility and improved health systems for the delivery of and adherence to first- and second-line treatment are imperative to solve this problem.
Collapse
Affiliation(s)
- L Lawson
- Zankli Medical Centre, Abuja, Nigeria.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Crampin A, Kasimba S, Mwaungulu NJ, Dacombe R, Floyd S, Glynn JR, Fine PEM. Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients. Trop Med Int Health 2011; 16:811-8. [PMID: 21447058 DOI: 10.1111/j.1365-3156.2011.02763.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. METHODS We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV-positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. RESULTS We recruited 148 spouses of smear-positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear-positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15-5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV-positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV-positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV-positive community controls. Of 54 HIV-positive spouses, 18 completed 6-month IPT. At 2 year follow-up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34-3.29). CONCLUSIONS Spouses are a high-risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short-duration therapy.
Collapse
|
26
|
Ramsay A, Cuevas LE, Mundy CJF, Nathanson CM, Chirambo P, Dacombe R, Squire SB, Salaniponi FML, Munthali S. New policies, new technologies: modelling the potential for improved smear microscopy services in Malawi. PLoS One 2009; 4:e7760. [PMID: 19901989 PMCID: PMC2770123 DOI: 10.1371/journal.pone.0007760] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 09/26/2009] [Indexed: 11/29/2022] Open
Abstract
Background To quantify the likely impact of recent WHO policy recommendations regarding smear microscopy and the introduction of appropriate low-cost fluorescence microscopy on a) case detection and b) laboratory workload. Methodology/Principal Findings An audit of the laboratory register in an urban hospital, Lilongwe, Malawi, and the application of a simple modelling framework. The adoption of the new definition of a smear-positive case could directly increase case detection by up to 28%. Examining Ziehl-Neelsen (ZN) sputum smears for up to 10 minutes before declaring them negative has previously been shown to increase case detection (over and above that gained by the adoption of the new case definition) by 70% compared with examination times in routine practice. Three times the number of staff would be required to adequately examine the current workload of smears using ZN microscopy. Through implementing new policy recommendations and LED-based fluorescence microscopy the current laboratory staff complement could investigate the same number of patients, examining auramine-stained smears to an extent that is equivalent to a 10 minutes ZN smear examination. Conclusions/Significance Combined implementation of the new WHO recommendations on smear microscopy and LED-based fluorescence microscopy could result in substantial increases in smear positive case-detection using existing human resources and minimal additional equipment.
Collapse
Affiliation(s)
- Andrew Ramsay
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Bell DJ, Dacombe R, Graham SM, Hicks A, Cohen D, Chikaonda T, French N, Molyneux ME, Zijlstra EE, Squire SB, Gordon SB. Simple measures are as effective as invasive techniques in the diagnosis of pulmonary tuberculosis in Malawi. Int J Tuberc Lung Dis 2009; 13:99-104. [PMID: 19105886 PMCID: PMC2873674] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
SETTING Detection of smear-positive pulmonary tuberculosis (PTB) cases is vital for tuberculosis (TB) control. Methods to augment sputum collection are available, but their additional benefit is uncertain in resource-limited settings. OBJECTIVE To compare the diagnostic yields using five methods to obtain sputum from adults diagnosed with smear-negative PTB in Malawi. DESIGN Self-expectorated sputum was collected under supervision for microscopy and mycobacterial culture in the study laboratory. Confirmed smear-negative patients provided physiotherapy-assisted sputum and induced sputum, followed the next morning by gastric washing and bronchoalveolar lavage (BAL) samples. RESULTS A total of 150 patients diagnosed with smear-negative PTB by the hospital service were screened; 39 (26%) were smear-positive from supervised self-expectorated sputum examined in the study laboratory. The remaining 111 confirmed smear-negative patients were enrolled in the study; 89% were human immunodeficiency virus positive. Seven additional smear-positive cases were diagnosed using the augmented sputum collection techniques. No differences were observed in the numbers of cases detected using the different methods. Of the 46 smear-positive cases, 44 (95.6%) could be detected from self-expectorated and physiotherapy-assisted samples. CONCLUSIONS For countries such as Malawi, the best use of limited resources to detect smear-positive PTB cases would be to improve the quality of self-expectorated sputum collection and microscopy. The additional diagnostic yield using BAL after induced sputum is limited.
Collapse
Affiliation(s)
- D J Bell
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|