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Tapela NM, Tshisimogo G, Shatera BP, Letsatsi V, Gaborone M, Madidimalo T, Ovberedjo M, Jibril HB, Tsima B, Nkomazana O, Dryden-Peterson S, Lockman S, Masupe T, Hirschhorn LR, El Halabi S. Integrating noncommunicable disease services into primary health care, Botswana. Bull World Health Organ 2019; 97:142-153. [PMID: 30728620 PMCID: PMC6357568 DOI: 10.2471/blt.18.221424] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 08/02/2018] [Revised: 11/06/2018] [Accepted: 11/12/2018] [Indexed: 12/04/2022] Open
Abstract
Despite the rising burden of noncommunicable diseases, access to quality decentralized noncommunicable disease services remain limited in many low- and middle-income countries. Here we describe the strategies we employed to drive the process from adaptation to national endorsement and implementation of the 2016 Botswana primary healthcare guidelines for adults. The strategies included detailed multilevel assessment with broad stakeholder inputs and in-depth analysis of local data; leveraging academic partnerships; facilitating development of supporting policy instruments; and embedding noncommunicable disease guidelines within broader primary health-care guidelines in keeping with the health ministry strategic direction. At facility level, strategies included developing a multimethod training programme for health-care providers, leveraging on the experience of provision of human immunodeficiency virus care and engaging health-care implementers early in the process. Through the strategies employed, the country’s first national primary health-care guidelines were endorsed in 2016 and a phased three-year implementation started in August 2017. In addition, provision of primary health-care delivery of noncommunicable disease services was included in the country’s 11th national development plan (2017–2023). During the guideline development process, we learnt that strong interdisciplinary skills in communication, organization, coalition building and systems thinking, and technical grasp of best-practices in low- and middle-income countries were important. Furthermore, misaligned agendas of stakeholders, exaggerated by a siloed approach to guideline development, underestimation of the importance of having policy instruments in place and coordination of the processes initially being led outside the health ministry caused delays. Our experience is relevant to other countries interested in developing and implementing guidelines for evidence-based noncommunicable disease services.
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Affiliation(s)
- Neo M Tapela
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | | | | | - Moagi Gaborone
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, United States of America (USA)
| | - Tebogo Madidimalo
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, United States of America (USA)
| | - Martins Ovberedjo
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, United States of America (USA)
| | | | - Billy Tsima
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Scott Dryden-Peterson
- Division of Infectious Diseases, Harvard University, Brigham and Women's Hospital, Boston, USA
| | - Shahin Lockman
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Tiny Masupe
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, USA
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Powis KM, Lockman S, Ajibola G, Hughes MD, Bennett K, Leidner J, Batlang O, Botebele K, Moyo S, van Widenfelt E, Makhema J, Petlo C, Jibril HB, McIntosh K, Essex M, Shapiro RL. Similar HIV protection from four weeks of zidovudine versus nevirapine prophylaxis among formula-fed infants in Botswana. South Afr J HIV Med 2018; 19:751. [PMID: 29707385 PMCID: PMC5913766 DOI: 10.4102/sajhivmed.v19i1.751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/30/2017] [Indexed: 12/17/2022] Open
Abstract
Background The World Health Organization HIV guidelines recommend either infant zidovudine (ZDV) or nevirapine (NVP) prophylaxis for the prevention of intrapartum mother-to-child HIV transmission (MTCT) among formula-fed infants. No study has evaluated the comparative efficacy of infant prophylaxis with twice daily ZDV versus once daily NVP in exclusively formula-fed HIV-exposed infants. Methods Using data from the Mpepu Study, a Botswana-based clinical trial investigating whether prophylactic co-trimoxazole could improve infant survival, retrospective analyses of MTCT events and Division of AIDS (DAIDS) Grade 3 or Grade 4 occurrences of anaemia or neutropenia were performed among infants born full-term (≥ 37 weeks gestation), with a birth weight ≥ 2500 g and who were formula-fed from birth. ZDV infant prophylaxis was used from Mpepu Study inception. A protocol modification mid-way through the study led to the subsequent use of NVP infant prophylaxis. Results Among infants qualifying for this secondary retrospective analysis, a total of 695 (52%) infants received ZDV, while 646 (48%) received NVP from birth for at least 25 days but no more than 35 days. Confirmed intrapartum HIV infection occurred in two (0.29%) ZDV recipients and three (0.46%) NVP recipients (p = 0.68). Anaemia occurred in 19 (2.7%) ZDV versus 12 (1.9%) NVP (p = 0.36) recipients. Neutropenia occurred in 28 (4.0%) ZDV versus 21 (3.3%) NVP recipients (p = 0.47). Conclusions Both ZDV and NVP resulted in low intrapartum transmission rates and no significant differences in severe infant haematologic toxicity (DAIDS Grade 3 or Grade 4) among formula-fed full-term infants with a birthweight ≥ 2500 g.
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Affiliation(s)
- Kathleen M Powis
- Massachusetts General Hospital, Departments of Medicine and Pediatrics, United States.,Harvard T. H. Chan School of Public Health, Department of Immunology and Infectious Diseases, United States.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Shahin Lockman
- Harvard T. H. Chan School of Public Health, Department of Immunology and Infectious Diseases, United States.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Brigham and Women's Hospital, Infectious Disease Division, United States
| | | | - Michael D Hughes
- Harvard T. H. Chan School of Public Health, Department of Immunology and Infectious Diseases, United States
| | - Kara Bennett
- Bennett Statistical Consulting, Inc, Ballston Lake, United States
| | - Jean Leidner
- Goodtables Data Consulting, Norman, United States
| | - Oganne Batlang
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | | | - Kenneth McIntosh
- Division of Infectious Diseases, Boston Children's Hospital, United States
| | - Max Essex
- Harvard T. H. Chan School of Public Health, Department of Immunology and Infectious Diseases, United States.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Roger L Shapiro
- Harvard T. H. Chan School of Public Health, Department of Immunology and Infectious Diseases, United States.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
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Powis KM, Souda S, Lockman S, Ajibola G, Bennett K, Leidner J, Hughes MD, Moyo S, van Widenfelt E, Jibril HB, Makhema J, Essex M, Shapiro RL. Cotrimoxazole prophylaxis was associated with enteric commensal bacterial resistance among HIV-exposed infants in a randomized controlled trial, Botswana. J Int AIDS Soc 2018; 20. [PMID: 29119726 PMCID: PMC5810322 DOI: 10.1002/jia2.25021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 10/05/2017] [Indexed: 12/18/2022] Open
Abstract
Introduction Despite declining risk of vertical HIV transmission, prophylactic cotrimoxazole (CTX) remains widely used to reduce morbidity and mortality in the event of HIV infection among exposed infants, with an inherent risk of conferring commensal antimicrobial resistance. Using data from a randomized, placebo‐controlled trial of infant CTX prophylaxis, we sought to quantify emergence of antibiotic resistance. Methods HIV‐exposed uninfected infants enrolled in the Botswana Mpepu study were randomized to prophylactic CTX or placebo between 14 and 34 days of life and continued through 15 months. Stool samples were collected from a subset of participating infants at randomization, three, and six months, and stored at −70°C prior to culture. Specimens that grew Escherichia coli (E. coli) or Klebsiella species (Klebsiella spp.) underwent antibiotic susceptibility testing by Kirby Bauer method using CTX (CTX 1.25/23.75 μg) and Amoxicillin (10 μg) in Mueller Hinton agar. Fisher's exact testing was used to compare prevalence of resistance by randomization arm (CTX/placebo). Results and Discussion A total of 381 stool samples from 220 infants were cultured: 118 at randomization, 151 at three months, and 112 at six‐months. E. coli was isolated from 206 specimens and Klebsiella spp. from 138 specimens. Resistance to CTX was common in both E. coli and Klebsiella spp. at the randomization visit (52.2% and 37.7% respectively) and did not differ by study arm. E. Coli isolates from CTX recipients at three and six months had 94.9% and 84.2% CTX resistance, as compared with 51.4% and 57.5% CTX resistance in isolates from placebo recipients (p=0.01). Klebsiella spp. isolates from CTX recipients had 79.0% and 68.8% CTX resistance at three and six months, as compared with 19.1% and 14.3% in isolates from placebo recipients (p<0.01). Conclusions HIV‐exposed infants randomized to CTX prophylaxis had increased CTX‐resistant commensal gastrointestinal bacteria compared with placebo recipients. Additional research is needed to determine the longer‐term clinical, microbiologic, and public health consequences of antimicrobial resistance selected by infant CTX prophylaxis.
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Affiliation(s)
- Kathleen M Powis
- Massachusetts General Hospital, Departments of Medicine and Pediatrics, Boston, MA, United States.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, United States.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Sajini Souda
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Shahin Lockman
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, United States.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Brigham and Women's Hospital, Infectious Disease Division, Boston, MA, United States
| | | | - Kara Bennett
- Bennett Statistical Consulting, Inc., Ballston Lake, NY, United States
| | - Jean Leidner
- Goodtables Data Consulting, Norman, OK, United States
| | - Michael D Hughes
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Sikhulile Moyo
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | | | - Joseph Makhema
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Max Essex
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, United States.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Roger L Shapiro
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, United States.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
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Abstract
No abstract available.
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Jibril HB, Ifere OA, Odumah DU. An open, comparative evaluation of amoxycillin and amoxycillin plus clavulanic acid ('Augmentin') in the treatment of bacterial pneumonia in children. Curr Med Res Opin 1989; 11:585-92. [PMID: 2612203 DOI: 10.1185/03007998909112675] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
One hundred children with clinically diagnosed bacterial pneumonia were assigned at random to receive treatment with either amoxycillin (250 or 500 mg) or amoxycillin (250 or 500 mg) plus clavulanic acid (62.5 or 125 mg) 3-times daily, dosage and duration of treatment being determined by the severity of the condition. There were no clinically significant differences between the two groups on entry and the mean duration of treatment was 6.8 days in both. By Day 3 of treatment, significant differences in improvement in chest pain, dyspnoea, pyrexia and sputum production were noted in favour of amoxycillin/clavulanic acid. The response to treatment was significantly better in the combination group with an excellent or good response recorded in 60% and 30% of patients, compared with 26% and 36% in the amoxycillin group. Only 2 adverse reactions were reported, 1 case each of skin rash and diarrhoea in the combined group. The overall clinical efficacy rate of 93.8% in amoxycillin/clavulanic acid-treated patients was significantly better than the 60.4% clinical success recorded in the amoxycillin group.
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Affiliation(s)
- H B Jibril
- Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria
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Aikhionbare HA, Suvarnabai PC, Jibril HB. Endogenous creatinine clearance in children with sickle cell anaemia and relationship with age: a preliminary report. East Afr Med J 1988; 65:609-13. [PMID: 3224570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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