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Mbonyinshuti F, Takarinda KC, Ade S, Manzi M, Iradukunda PG, Kabatende J, Habiyaremye T, Kayumba PC. Evaluating the availability of essential drugs for hypertension, diabetes and asthma in rural Rwanda, 2018. Public Health Action 2021; 11:5-11. [PMID: 33777715 DOI: 10.5588/pha.20.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/18/2020] [Indexed: 12/13/2022] Open
Abstract
SETTING Hypertension, diabetes mellitus and asthma are on the rise in developing countries, including Rwanda; there is thus a need to ensure uninterrupted drug availability. OBJECTIVES To assess 1) the frequency and duration of drug stock-outs; 2) lead time duration 3) monthly stock levels; and 4) drug quantities requested vs. quantity delivered for captopril, metformin and inhaled salbutamol between January and December 2018 Kirehe District, Rwanda. DESIGN This was a cross-sectional study using secondary programme data. RESULTS The median annual stock-outs for captopril, metformin and inhaled salbutamol were respectively 4 (IQR 3-4), 3 (IQR 2-3) and 4 (IQR 4-5) at rural health facilities (RHCs); no stock-outs occurred at the district hospital. For all three drugs, the median lead time was 7.5 days (IQR 5.5-11.5) at the hospital vs. 5 days (IQR 3-6) in RHCs. Stock status for captopril was below the 4-week minimum stock level for 2/12 months at the hospital vs. 7/12 months at the RHCs, while metformin and inhaled salbutamol were below the 4-week minimum stock levels for respectively 1/12 and 4/12 months at both hospital and RHCs. Total drug quantities delivered were less than the combined total quantities requested in respectively 8/12, 5/12 and 8/12 months for captopril, metformin and inhaled salbutamol. CONCLUSION There is a need to regularly and effectively monitor drug stock levels and ensure timely and sufficient stock replenishment to avert stock-outs.
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Affiliation(s)
- F Mbonyinshuti
- Human Resource for Health Secretariat, Ministry of Health, Kigali, Rwanda.,College of Business and Economics, African Centre of Excellence in Data Science, University of Rwanda, Kigali, Rwanda.,University of Global Health Equity, Kigali, Rwanda
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France.,AIDS & TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - S Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Faculté de Médecine, Université de Parakou, Parakou, Bénin
| | - M Manzi
- Medical Department, Médecins Sans Frontières, Operational Centre Brussels, MSF-Luxembourg (LuxOR), Luxembourg, Belgium
| | - P G Iradukunda
- Rwanda Food and Drugs Authority, Kigali, Rwanda.,University of London, London School of Hygiene & Tropical Medicine, London, UK
| | - J Kabatende
- Rwanda Food and Drugs Authority, Kigali, Rwanda.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - T Habiyaremye
- Human Resource for Health Secretariat, Ministry of Health, Kigali, Rwanda.,Department of Clinical and Public Health Services, Ministry of Health, Kigali, Rwanda
| | - P C Kayumba
- College of Business and Economics, African Centre of Excellence in Data Science, University of Rwanda, Kigali, Rwanda
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2
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Makelele JPK, Ade S, Takarinda KC, Manzi M, Cuesta JG, Acma A, Yépez MM, Mashako M. Outcomes of cholera and measles outbreak alerts in the Democratic Republic of Congo. Public Health Action 2020; 10:124-130. [PMID: 33134127 DOI: 10.5588/pha.19.0074] [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: 11/23/2019] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
Setting In 1995, a rapid response project for humanitarian and medical emergencies, including outbreak responses, named 'Pool d'Urgence Congo' (PUC), was implemented in the Democratic Republic of Congo by Médecins Sans Frontières. Objective To assess the outcomes of cholera and measles outbreak alerts that were received in the PUC surveillance system between 2016 and 2018. Design This was a retrospective cross-sectional study. Results Overall, 459 outbreak alerts were detected, respectively 69% and 31% for cholera and measles. Of these, 32% were actively detected and 68% passively detected. Most alerts (90%) required no intervention and 10% of alerts had an intervention. There were 25% investigations that were not carried out despite thresholds being met; 17% interventions were not performed, the main reported reason being PUC operational capacity was exceeded. Confirmed cholera and measles outbreaks that met an investigation threshold comprised respectively 90% and 76% of alerts; 59% of measles investigations were followed by a delayed outbreak response of ⩾14 days (n = 10 outbreaks). Conclusion Some alerts for cholera and measles outbreaks that were detected in the PUC system did not lead to a response even when required; the main reported reason was limited operational capacity to respond to all of them.
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Affiliation(s)
- J P K Makelele
- Médecins Sans Frontières-Operational Centre Brussels, Mission DRC, Kinshasa, DR Congo
| | - S Ade
- Faculté de Médecine, Université de Parakou, Parakou, Bénin.,Center for Operational Research, International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - K C Takarinda
- Center for Operational Research, International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - M Manzi
- Médecins Sans Frontières-Operational Centre Brussels, Medical Department, Operational Research Unit (LuOR), MSF Luxembourg
| | - J Gil Cuesta
- Médecins Sans Frontières-Operational Centre Brussels, Medical Department, Operational Research Unit (LuOR), MSF Luxembourg
| | - A Acma
- Médecins Sans Frontières-Operational Centre Brussels, Mission DRC, Kinshasa, DR Congo
| | - M M Yépez
- Médecins Sans Frontières-Operational Centre Brussels, Mission DRC, Kinshasa, DR Congo
| | - M Mashako
- Médecins Sans Frontières-Operational Centre Brussels, Mission DRC, Kinshasa, DR Congo
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3
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Balachandra S, Rogers JH, Ruangtragool L, Radin E, Musuka G, Oboho I, Paulin H, Parekh B, Birhanu S, Takarinda KC, Hakim A, Apollo T. Concurrent advanced HIV disease and viral load suppression in a high-burden setting: Findings from the 2015-6 ZIMPHIA survey. PLoS One 2020; 15:e0230205. [PMID: 32584821 PMCID: PMC7316262 DOI: 10.1371/journal.pone.0230205] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/17/2019] [Accepted: 02/24/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As Zimbabwe approaches epidemic control of HIV, programs now prioritize viral load over CD4 monitoring, making it difficult to identify persons living with HIV (PLHIV) suffering from advanced disease (AD). We present an analysis of cross-sectional ZIMPHIA data, highlighting PLHIV with AD and concurrent viral load suppression (VLS). METHODS ZIMPHIA collected blood specimens for HIV testing from 22,501 consenting adults (ages 15 years and older); 3,466 PLHIV had CD4 and VL results. Household HIV testing used the national serial algorithm, and those testing positive then received point-of-care CD4 enumeration with subsequent VL testing. We used logistic regression analysis to explore factors associated with concurrent AD and VLS (<1000 copies/mL). All analyses were weighted to account for complex survey design. RESULTS Of the 3,466 PLHIV in the survey with CD4 and VL results, 17% were found to have AD (CD4<200cells/mm3). Of all AD patients, 30% had VLS. Concurrent AD and VLS was associated with male sex (aOR 2.45 95%CI 1.61-3.72), older age (35-49 years [aOR 2.46 95%CI 1.03-5.91] and 50+ years [aOR 4.82 95%CI 2.02-11.46] vs 15-24 years), and ART duration (<6 months [aOR 0.46 95%CI 0.29-0.76] and 6-24 months [aOR 2.07 95%CI 1.35-3.17] vs more than 2 years). The relationship between sex and AD is driven by age with significant associations among men aged 25-34, (aOR 3.37 95%CI 1.35-8.41), 35-49 (aOR 5.13 95%CI 2.16-12.18), and 50+ (aOR 12.56 95%CI 4.82-32.72) versus men aged 15-24. CONCLUSIONS The percentage of PLHIV with AD and VLS illustrates the conundrum of decreased support for CD4 monitoring, as these patients may not receive appropriate clinical services for advanced HIV disease. In high-prevalence settings such as Zimbabwe, CD4 monitoring support warrants further consideration to differentiate care appropriately for the most vulnerable PLHIV. Males may need to be prioritized, given their over-representation in this sub-population.
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Affiliation(s)
- S. Balachandra
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Bluffhill, Harare, Zimbabwe
| | - J. H. Rogers
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Bluffhill, Harare, Zimbabwe
| | - L. Ruangtragool
- PHI/CDC Global Epidemiology Fellowship, U.S. Centers for Disease Control and Prevention, Bluffhill, Harare, Zimbabwe
| | - E. Radin
- ICAP New York, New York, NY, United States of America
| | - G. Musuka
- ICAP Zimbabwe, Avondale, Harare, Zimbabwe
| | - I. Oboho
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - H. Paulin
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - B. Parekh
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - S. Birhanu
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - A. Hakim
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - T. Apollo
- Ministry of Health and Child Care, Harare, Zimbabwe
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4
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Timire C, Sandy C, Ngwenya M, Woznitza N, Kumar AMV, Takarinda KC, Sengai T, Harries AD. Targeted active screening for tuberculosis in Zimbabwe: are field digital chest X-ray ratings reliable? Public Health Action 2019; 9:96-101. [PMID: 31803580 DOI: 10.5588/pha.19.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/12/2019] [Indexed: 11/10/2022] Open
Abstract
SETTING Fifteen purposively selected districts in Zimbabwe in which targeted active screening for tuberculosis (Tas4TB) was conducted among TB high-risk groups (HRGs). There were 230 patients started on TB treatment on the basis of chest X-ray (CXR) results without corresponding bacteriological confirmation. OBJECTIVES To determine 1) the percentage of agreements in digital CXR ratings by medical officers against final ratings by radiologist(s), 2) inter-rater agreement in CXR ratings between medical officers and radiologists, and 3) number (and proportion) of patients belonging to HRGs who were over-treated during Tas4TB. DESIGN This was a cross-sectional study using programme data. RESULTS A total of 168 patients had their CXRs rated by two independent radiologists. Discordances among the radiologists were resolved by a third index radiologist, who provided the final rating. κ scores were 0.01 (field ratings vs. Radiologist A); 0.02 (field ratings vs. Radiologist B); 0.74 (Radiologists A vs. B). The percentage agreement for field and final radiologist rating was 70% (95%CI 64-78). Around 29% (95%CI 23-36) of the patients were potentially over-treated during Tas4TB. CONCLUSION Over a quarter of patients with presumptive TB are potentially over-treated during Tas4TB. Over-treatment is highest among those with previous contact with TB patients. Trainings of radiographers and medical officers may improve CXR ratings.
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Affiliation(s)
- C Timire
- Ministry of Health and Child Care, National AIDS & TB Programme, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - C Sandy
- Ministry of Health and Child Care, National AIDS & TB Programme, Harare, Zimbabwe
| | - M Ngwenya
- World Health Organization, Harare Country Office, Zimbabwe
| | - N Woznitza
- Homerton University Hospital & Canterbury Christ Church University, London, UK
| | - A M V Kumar
- The Union, Paris, France.,The Union, South East-Asia Office, New Delhi, India.,Yenepoya Medical College, Yenepoya (deemed University), Mangaluru, India
| | - K C Takarinda
- Ministry of Health and Child Care, National AIDS & TB Programme, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - T Sengai
- Family AIDS Caring Trust (FACT), Mutare, Zimbabwe
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
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5
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Banamu JK, Lavu E, Johnson K, Moke R, Majumdar SS, Takarinda KC, Commons RJ. Impact of GxAlert on the management of rifampicin-resistant tuberculosis patients, Port Moresby, Papua New Guinea. Public Health Action 2019; 9:S19-S24. [PMID: 31579645 DOI: 10.5588/pha.18.0067] [Citation(s) in RCA: 2] [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: 09/11/2018] [Accepted: 10/23/2018] [Indexed: 11/10/2022] Open
Abstract
Setting GxAlert is an automatic electronic notification service that provides immediate Xpert® MTB/RIF testing results. It was implemented for the notification of patients with rifampicin resistant-tuberculosis (RR-TB) at Port Moresby General Hospital, Port Moresby, Papua New Guinea, in May 2015. Objective To determine if there were differences in pre-treatment attrition, the time to treatment initiation and patient outcomes in the 12 months pre- and post-introduction of GxAlert for RR-TB patients. Design This was a retrospective cohort study. Results The median time from Xpert testing to treatment initiation decreased from 35 days [IQR 13-131] prior to GxAlert to 10 days [IQR 3-29] after GxAlert (P = 0.001), with the cumulative proportion of patients initiating treatment within 30 days increasing from 25% (95%CI 17-37) to 54% (95%CI 44-64; P < 0.001) over these periods. However, our analysis of the time to treatment prior to the introduction of GxAlert suggests that a decrease had already occurred prior to implementation. There was no difference in interim clinical outcomes between the periods. Conclusion Although a decrease in time to treatment initiation cannot be attributed to GxAlert, there was a significant improvement over the 2-year period, suggesting that considerable improvements have been made in timely RR-TB patient management in Port Moresby.
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Affiliation(s)
- J K Banamu
- Central Public Health Laboratory, Port Moresby, Papua New Guinea (PNG)
| | - E Lavu
- Central Public Health Laboratory, Port Moresby, Papua New Guinea (PNG)
| | - K Johnson
- Central Public Health Laboratory, Port Moresby, Papua New Guinea (PNG).,Health and HIV Implementation Services Provider, Port Morseby, PNG
| | - R Moke
- Internal Medicine Division, Port Moresby General Hospital, Port Moresby, PNG
| | - S S Majumdar
- Burnet Institute, Melbourne, Victoria, Australia
| | - K C Takarinda
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R J Commons
- Burnet Institute, Melbourne, Victoria, Australia.,Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
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6
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Kelebi T, Takarinda KC, Commons R, Sissai B, Yowei J, Gale M. Gaps in tuberculosis care in West Sepik Province of Papua New Guinea. Public Health Action 2019; 9:S68-S72. [PMID: 31579653 DOI: 10.5588/pha.18.0057] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/11/2018] [Indexed: 11/10/2022] Open
Abstract
Setting Papua New Guinea (PNG), a low-resource country with a high tuberculosis (TB) burden. Objective To describe the characteristics, treatment outcomes and risk factors for unfavourable outcomes among patients registered for first-line tuberculosis (TB) treatment between 1 January 2014 and 31 December 2016 in West Sepik Province. Design This was a retrospective cohort study of routinely collected programme data. Results Of 1058 cases, 50.7% were male and 38.8% were aged <15 years; 43.1% were extrapulmonary TB cases and 280 (26.5%) were bacteriologically confirmed. No human immunodeficiency virus (HIV) status was recorded for 74.7% of cases. Of 1019 (96.3%) patients with a recorded outcome, 779 (76.4%) were favourable and 240 (23.6%) were unfavourable. On multivariable logistic regression, increasing age was associated with an increased odds of an unfavourable outcome (adjusted OR [aOR] 1.06 per every 5-year increase, 95%CI 1.02-1.11; P = 0.006) and being a retreatment case was associated with a reduced odds of an unfavourable outcome compared to new cases (aOR 0.54, 95%CI 0.31-0.93; P = 0.027). Conclusion This study identified substantial gaps in TB care, including low rates of bacteriological diagnosis and HIV testing, and high rates of loss to follow-up, highlighting the need to strengthen TB control efforts, including support for new cases.
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Affiliation(s)
- T Kelebi
- West Sepik Provincial Health Authority, Vanimo, West Sepik Province, Papua New Guinea
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France.,AIDS & TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - R Commons
- Burnet Institute, Melbourne, Victoria, Australia.,Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - B Sissai
- West Sepik Provincial Health Authority, Vanimo, West Sepik Province, Papua New Guinea
| | - J Yowei
- West Sepik Provincial Health Authority, Vanimo, West Sepik Province, Papua New Guinea
| | - M Gale
- Burnet Institute, Melbourne, Victoria, Australia
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Harries AD, Timire C, Takarinda KC, Sandy C. Ensuring that Xpert ® MTB/RIF is used to its maximum potential. Int J Tuberc Lung Dis 2019; 23:1043-1044. [PMID: 31615615 DOI: 10.5588/ijtld.19.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - C Timire
- International Union Against Tuberculosis and Lung Disease, Paris, France, Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France, Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - C Sandy
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
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Machekera SM, Wilkinson E, Hinderaker SG, Mabhala M, Zishiri C, Ncube RT, Timire C, Takarinda KC, Sengai T, Sandy C. A comparison of the yield and relative cost of active tuberculosis case-finding algorithms in Zimbabwe. Public Health Action 2019; 9:63-68. [PMID: 31417855 DOI: 10.5588/pha.18.0098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/09/2019] [Indexed: 11/10/2022] Open
Abstract
Setting Ten districts and three cities in Zimbabwe. Objective To compare the yield and relative cost of identifying a case of tuberculosis (TB) using the three WHO-recommended algorithms (WHO2b, symptom inquiry only; WHO2d, chest X-ray [CXR] after a positive symptom inquiry; WHO3b, CXR only) and the Zimbabwe active case finding (ZimACF) algorithm (symptom inquiry plus CXR) to everyone. Design Cross-sectional study using data from the ZimACF project. Results A total of 38 574 people were screened from April to December 2017; 488 (1.3%) were diagnosed with TB using the ZimACF algorithm. Fewer TB cases would have been diagnosed with the WHO-recommended algorithms. This ranged from 7% fewer (34 cases) with WHO3b, 18% fewer (88 cases) with WHO2b and 25% fewer (122 cases) with WHO2d. The need for CXR ranged from 36% (WHO2d) to 100% (WHO3b). The need for bacteriological confirmation ranged from 7% (WHO2d) to 40% (ZimACF). The relative cost per case of TB diagnosed ranged from US$180 with WHO3b to US$565 for the ZimACF algorithm. Conclusion The ZimACF algorithm had the highest case yield, but at a much higher cost per case than the WHO algorithms. It is possible to switch to algorithm WHO3b, but the trade-off between cost and yield needs to be reviewed by the Zimbabwean National TB Programme.
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Affiliation(s)
- S M Machekera
- International Union Against Tuberculosis and Lung Diseases, Harare, Zimbabwe
| | - E Wilkinson
- Institute of Medicine, University of Chester, Chester, UK
| | - S G Hinderaker
- Centre of International Health, University of Bergen, Bergen, Norway
| | - M Mabhala
- Department of Public Health and Wellbeing, University of Chester, Chester, UK
| | - C Zishiri
- International Union Against Tuberculosis and Lung Diseases, Harare, Zimbabwe
| | - R T Ncube
- International Union Against Tuberculosis and Lung Diseases, Harare, Zimbabwe
| | - C Timire
- International Union Against Tuberculosis and Lung Diseases, Harare, Zimbabwe.,Ministry of Health and Child Care, Harare, Zimbabwe
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Diseases, Harare, Zimbabwe.,Ministry of Health and Child Care, Harare, Zimbabwe
| | - T Sengai
- Family AIDS Caring Trust, Mutare, Zimbabwe
| | - C Sandy
- Ministry of Health and Child Care, Harare, Zimbabwe
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9
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Takarinda KC, Choto RC, Mutasa-Apollo T, Chakanyuka-Musanhu C, Timire C, Harries AD. Scaling up isoniazid preventive therapy in Zimbabwe: has operational research influenced policy and practice? Public Health Action 2018; 8:218-224. [PMID: 30775283 DOI: 10.5588/pha.18.0051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/31/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Following the operational research study conducted during the isoniazid preventive therapy (IPT) pilot phase in Zimbabwe, recommendations for improvement were adopted by the national antiretroviral therapy (ART) programme. Objectives: To compare before (January 2013-June 2014) and after the recommendations (July 2014-December 2015), the extent of IPT scale-up and IPT completion rates, and after the recommendations the risk factors for IPT non-completion, in 530 ART clinics. Design: Retrospective cohort study. Results: People living with the human immunodeficiency virus newly initiating IPT increased every quarter (Q), from 585 in Q 1, 2013 to 4246 in Q 4, 2015, with 5648 new IPT initiations in the 18 months before the recommendations compared to 20 513 in the 18 months after the recommendations were made. The number of ART clinics initiating IPT increased from 10 (2%) in Q 1, 2013 to 198 (37%) in Q 4, 2015. Overall IPT completion rates were 89% in the post-recommendation period compared with 81% in the pilot phase (P < 0.001). After adjusting for confounders, being lost to follow-up from clinic review visits 1 year prior to IPT initiation was associated with a higher risk of not completing IPT, while having synchronised IPT and ART resupplies was associated with a lower risk. Conclusions: Implementation of recommendations from the initial operational research study have improved IPT scale-up in Zimbabwe.
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Affiliation(s)
- K C Takarinda
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R C Choto
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - T Mutasa-Apollo
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | | | - C Timire
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Tropical Hygiene & Medicine, London, United Kingdom
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10
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Jokwiro A, Timire C, Harries AD, Gwinji PT, Mulema A, Takarinda KC, Mafaune PT, Sandy C. Has the utilisation of Xpert ® MTB/RIF in Manicaland Province, Zimbabwe, improved with new guidance on whom to test? Public Health Action 2018; 8:124-129. [PMID: 30271728 DOI: 10.5588/pha.18.0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/06/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Manicaland Province, Zimbabwe. Objectives: To compare the utilisation and results of deploying Xpert® MTB/RIF in 13 (one provincial, six district and six rural) hospitals between January and June 2016, when Xpert was recommended only for those with presumptive multidrug-resistant tuberculosis (MDR-TB) and coinfection with human immunodeficiency virus (HIV), and between January and June 2017, when Xpert was recommended for all presumptive TB patients. Design: This was a cross-sectional study. Results: Xpert assays averaged 759 monthly in 2016 and 1430 monthly in 2017 (88% increase). Utilisation of Xpert averaged 22% monthly in 2016 and 42% in 2017 (88% increase). In 2017, utilisation of Xpert was significantly higher in provincial (82%) than in district (51%) and rural (26%) hospitals (P < 0.001). The proportion of successful assays that detected TB decreased significantly from 13% in 2016 to 7% in 2017 (a 46% decrease, P < 0.001); this phenomenon was observed in all types of hospital. The proportion of persons detected with rifampicin-resistant TB was similar between hospitals (4% in 2016 and 3% in 2017). The proportion of registered TB cases with bacteriological confirmation increased from 48% in 2016 to 53% in 2017 (P = 0.04). Conclusion: Xpert use in all presumptive TB patients led to a significant increase in assay numbers and utilisation of Xpert instruments, resulting in more bacteriological confirmation of cases.
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Affiliation(s)
- A Jokwiro
- Ministry of Health and Child Care Zimbabwe, Nyanga District, Nyanga, Zimbabwe
| | - C Timire
- International Union Against Tuberculosis and Lung Disease, Harare, Zimbabwe.,National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - P T Gwinji
- Ministry of Health and Child Care Zimbabwe, Nyanga District, Nyanga, Zimbabwe
| | - A Mulema
- Ministry of Health and Child Care Zimbabwe, Nyanga District, Nyanga, Zimbabwe
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Harare, Zimbabwe
| | - P T Mafaune
- Manicaland Directorate, Ministry of Health and Child Care Zimbabwe, Mutare, Zimbabwe
| | - C Sandy
- National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
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11
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Harries AD, Khogali M, Kumar AMV, Satyanarayana S, Takarinda KC, Karpati A, Olliaro P, Zachariah R. Building the capacity of public health programmes to become data rich, information rich and action rich. Public Health Action 2018; 8:34-36. [PMID: 29946518 DOI: 10.5588/pha.18.0001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/02/2018] [Indexed: 11/10/2022] Open
Abstract
Good quality, timely data are the cornerstone of health systems, but in many countries these data are not used for evidence-informed decision making and/or for improving public health. The SORT IT (Structured Operational Research and Training Initiative) model has, over 8 years, trained health workers in low- and middle-income countries to use data to answer important public health questions by taking research projects through to completion and publication in national or international journals. The D2P (data to policy) training initiative is relatively new, and it teaches health workers how to apply 'decision analysis' and develop policy briefs for policy makers: this includes description of a problem and the available evidence, quantitative comparisons of policy options that take into account predicted health and economic impacts, and political and feasibility assessments. Policies adopted from evidence-based information generated through the SORT IT and D2P approaches can be evaluated to assess their impact, and the cycle repeated to identify and resolve new public health problems. Ministries of Health could benefit from this twin-training approach to make themselves 'data rich, information rich and action rich', and thereby use routinely collected data in a synergistic manner to improve public health policy making and health care delivery.
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Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - M Khogali
- Vital Strategies, New York, New York, USA
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South-East Asia Office, New Delhi, India
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South-East Asia Office, New Delhi, India
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,AIDS & TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - A Karpati
- Vital Strategies, New York, New York, USA
| | - P Olliaro
- Special Programme for Research and Training in Tropical Disease, World Health Organization, Geneva, Switzerland
| | - R Zachariah
- Special Programme for Research and Training in Tropical Disease, World Health Organization, Geneva, Switzerland.,Operations Research Unit (LuxOR), Médecins sans Frontières, Luxembourg
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12
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Timire C, Takarinda KC, Sandy C, Zishiri C, Kumar AMV, Harries AD. Has TB CARE I sputum transport improved access to culture services for retreatment tuberculosis patients in Zimbabwe? Public Health Action 2018; 8:66-71. [PMID: 29946522 DOI: 10.5588/pha.17.0117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/28/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Retreatment tuberculosis (TB) patients in Zimbabwe are investigated using microscopy, Xpert® MTB/RIF and culture + drug susceptibility testing (CDST). TB CARE I, a sputum transport service using motorcycles, was introduced to transport specimens between peripheral health facilities and laboratories, including National Reference Laboratories (NRLs). Objectives: To compare access to CDST and treatment outcomes among retreatment TB patients in facilities with and those without TB CARE I support. Design: This was a retrospective cohort study. Results: There were 187 patients from TB CARE I-supported facilities and 116 from non-TB CARE I facilities, with no difference in demographic characteristics. Altogether, specimens from 22 (12%) retreatment TB patients had successful CDST from TB CARE I facilities, which was not statistically significantly different from non-supported facilities (n = 14, 12%; P = 0.94). The median number of days from sputum collection to receipt at the NRL was lower in TB CARE I facilities than in non-supported facilities (median 6, interquartile range [IQR] 4-8 vs. median 8, IQR 6-13.5; P = 0.000). Favourable treatment outcomes were documented in 65% of patients under TB CARE I, significantly more than among patients in non-supported facilities (47%, P < 0.01). Conclusion: The process of sputum specimen collection for CDST was not different between TB CARE I and non-TB CARE I-supported health facilities, apart from a slightly shorter time. Ways to improve the current system are discussed.
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Affiliation(s)
- C Timire
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France.,Ministry of Health and Child Care, National TB Control Programme, Harare, Zimbabwe
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France.,Ministry of Health and Child Care, National AIDS Programme, Harare, Zimbabwe
| | - C Sandy
- Ministry of Health and Child Care, National TB Control Programme, Harare, Zimbabwe
| | - C Zishiri
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe
| | - A M V Kumar
- The Union, Paris, France.,The Union, South-East Asia Office, New Delhi, India
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
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13
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Obopile M, Segoea G, Waniwa K, Ntebela DS, Moakofhi K, Motlaleng M, Mosweunyane T, Edwards JK, Namboze J, Butt W, Manzi M, Takarinda KC, Owiti P. Did microbial larviciding contribute to a reduction in malaria cases in eastern Botswana in 2012-2013? Public Health Action 2018; 8:S50-S54. [PMID: 29713595 DOI: 10.5588/pha.17.0012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 09/17/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Larviciding has potential as a component of integrated vector management for the reduction of malaria transmission in Botswana by complementing long-lasting insecticide nets and indoor residual sprays. Objective: To evaluate the susceptibility of local Anopheles to commonly used larvicides. Design: This field test of the efficacy of Bacillus thuringiensis subsp. israliensis vs. Anopheles was performed by measuring larval density before treatment and 24 h and 48 h after treatment in seven sites of Bobirwa district, eastern Botswana, in 2012 and 2013. Vector density and malaria cases were compared between Bobirwa and Ngami (northwestern Botswana), with no larviciding in the control arm. Results: Larviciding reduced larval density by 95% in Bobirwa in 2012, with two cases of malaria, while in 2013 larval density reduction was 81%, with 11 cases. Adult mosquito density was zero for both years in Robelela village (Bobirwa), compared to respectively four and 26 adult mosquitoes per room in Shorobe village (Ngami) in 2012 and 2013. There were no cases of malaria in Robelela in either year, but in Shorobe there were 20 and 70 cases, respectively, in 2012 and 2013. Conclusion: Larviciding can reduce the larval density of mosquitoes and reduce malaria transmission in Botswana. Large-scale, targeted implementation of larviciding in districts at high risk for malaria is recommended.
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Affiliation(s)
- M Obopile
- Botswana University of Agriculture and Natural Resources, Gaborone, Botswana
| | - G Segoea
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - K Waniwa
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - D S Ntebela
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - K Moakofhi
- World Health Organization (WHO) Country Office for Botswana, Gaborone, Botswana
| | - M Motlaleng
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - T Mosweunyane
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | | | - J Namboze
- Inter-Country Support Team, WHO, Harare, Zimbabwe
| | - W Butt
- Inter-Country Support Team, WHO, Harare, Zimbabwe
| | - M Manzi
- Médecins Sans Frontières, Brussels, Belgium
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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14
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Moakofhi K, Edwards JK, Motlaleng M, Namboze J, Butt W, Obopile M, Mosweunyane T, Manzi M, Takarinda KC, Owiti P. Advances in malaria elimination in Botswana: a dramatic shift to parasitological diagnosis, 2008-2014. Public Health Action 2018; 8:S34-S38. [PMID: 29713592 DOI: 10.5588/pha.17.0017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 08/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Malaria elimination requires infection detection using quality assured diagnostics and appropriate treatment regimens. Although Botswana is moving towards malaria elimination, reports of unconfirmed cases may jeopardise this effort. This study aimed to determine the proportion of cases treated for malaria that were confirmed by rapid diagnostic testing (RDT) and/or microscopy. Methods: This was a retrospective descriptive study using routine national data from the integrated disease surveillance and case-based surveillance systems from 2008 to 2014. The data were categorised into clinical and confirmed cases each year. An analysis of the data on cases registered in three districts that reported approximately 70% of all malaria cases was performed, stratified by year, type of reporting health facilities and diagnostic method. Results: During 2008-2014, 50 487 cases of malaria were reported in Botswana, and the proportion of RDT and/or blood microscopy confirmed cases improved from 6% in 2008 to 89% in 2013. The total number of malaria cases decreased by 97% in the same period, then increased by 41% in 2013. Conclusion: This study shows that malaria diagnostic tests dramatically improved malaria diagnosis and consequently reduced the malaria burden in Botswana. The study identified a need to build capacity on microscopy for species identification, parasite quantification and guiding treatment choices.
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Affiliation(s)
- K Moakofhi
- World Health Organization (WHO) Botswana Country Office, Gaborone, Botswana
| | | | - M Motlaleng
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - J Namboze
- Inter-Country Support Team, WHO, Harare, Zimbabwe
| | - W Butt
- Inter-Country Support Team, WHO, Harare, Zimbabwe
| | - M Obopile
- Botswana University of Agriculture and Natural Resources, Gaborone, Botswana
| | - T Mosweunyane
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - M Manzi
- Médecins Sans Frontières, Brussels, Belgium
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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15
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Nghipumbwa MH, Ade S, Kizito W, Takarinda KC, Uusiku P, Mumbegegwi DR. Moving towards malaria elimination: trends and attributes of cases in Kavango region, Namibia, 2010-2014. Public Health Action 2018; 8:S18-S23. [PMID: 29713589 DOI: 10.5588/pha.17.0076] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/09/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Kavango, a 'moderate' transmission risk region located in north-eastern Namibia, borders Angola, a country with higher malaria transmission levels. Objective: To determine 1) the trends in malaria incidence between 2010 and 2014 in Kavango, 2) the socio-demographic and clinical characteristics of confirmed cases in 2014, and 3) associated risk factors of cases classified as imported. Design: This was a retrospective study of malaria case investigation forms conducted in all 52 public health facilities in 2014. Incidence was derived from aggregate routine surveillance data from the Health Information System (HIS). Results: During the 5-year study, incidence fell from 53.6 to 3.6 cases per 1000 population, then increased again to 47.3/1000. Fifty-five per cent of cases were males, and 49% were aged between 5 and 17 years. Of the 2014 cases, 23% were imported, and were associated with higher odds of severe malaria (adjusted odds ratio [aOR] 1.8; 95%CI 1.01-3.29), not having long-lasting insecticide treated nets (aOR 2.1, 95%CI, 1.3-3.4) and not receiving insecticide residual spraying (aOR 3.2, 95%CI, 2.1-5.1). Conclusion: Sporadic outbreaks in the 5-year period posed a threat to malaria elimination. Better targeting of vector control interventions, strong cross-border collaboration and robust health promotion will be key to achieving malaria elimination.
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Affiliation(s)
- M H Nghipumbwa
- National Vector-Borne Disease Control Programme, Ministry of Health and Social Services, Windhoek, Namibia
| | - S Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France.,National Tuberculosis Programme, Cotonou, Benin
| | - W Kizito
- Kenya Mission, Operational Centre Brussels, Médecins Sans Frontières, Nairobi, Kenya
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France.,AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - P Uusiku
- National Vector-Borne Disease Control Programme, Ministry of Health and Social Services, Windhoek, Namibia
| | - D R Mumbegegwi
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
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16
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Motlaleng M, Edwards J, Namboze J, Butt W, Moakofhi K, Obopile M, Manzi M, Takarinda KC, Zachariah R, Owiti P, Oumer N, Mosweunyane T. Driving towards malaria elimination in Botswana by 2018: progress on case-based surveillance, 2013-2014. Public Health Action 2018; 8:S24-S28. [PMID: 29713590 DOI: 10.5588/pha.17.0019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Reliable information reporting systems ensure that all malaria cases are tested, treated and tracked to avoid further transmission. Botswana aimed to eliminate malaria by 2018, and surveillance is key. This study focused on assessing the uptake of the new malaria case-based surveillance (CBS) system introduced in 2012, which captures information on malaria cases reported in the Integrated Disease Surveillance and Response (IDSR) system. Methods: This was a retrospective descriptive study based on routine data focusing on Ngami, Chobe and Okavango, three high-risk districts in Botswana. Aggregated data variables were extracted from the IDSR and compared with data from the CBS. Results: The IDSR reported 456 malaria cases in 2013 and 1346 in 2014, of which respectively only 305 and 884 were reported by the CBS. The CBS reported 34% fewer cases than the IDSR system, indicating substantial differences between the two systems. The key malaria indicators with the greatest variability among the districts included in the study were case identification number and date of diagnosis. Conclusion: The IDSR and CBS systems are essential for malaria elimination, as shown by the significant gaps in reporting between the two systems. These findings highlight the need for further investigation into these discrepancies. Strengthening the CBS system will help to reach the objective of malaria elimination in Botswana.
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Affiliation(s)
- M Motlaleng
- National Malaria Programme, Ministry of Health, Gaborone, Botswana
| | - J Edwards
- Operational Centre Brussels, Médecins Sans Frontières (MSF), Luxembourg City, Luxembourg
| | - J Namboze
- Inter-Country Support Team, World Health Organization (WHO), Harare, Zimbabwe
| | - W Butt
- Inter-Country Support Team, World Health Organization (WHO), Harare, Zimbabwe
| | - K Moakofhi
- WHO Country Office for Botswana, Gaborone, Botswana
| | - M Obopile
- Botswana University of Agriculture and Natural Resources, Gaborone, Botswana
| | - M Manzi
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R Zachariah
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Operational Centre Brussels, MSF, Luxembourg City, Luxembourg
| | - P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - N Oumer
- National Malaria Programme, Ministry of Health, Gaborone, Botswana
| | - T Mosweunyane
- National Malaria Programme, Ministry of Health, Gaborone, Botswana
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17
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Ncube RT, Takarinda KC, Zishiri C, van den Boogaard W, Mlilo N, Chiteve C, Siziba N, Trinchán F, Sandy C. Age-stratified tuberculosis treatment outcomes in Zimbabwe: are we paying attention to the most vulnerable? Public Health Action 2017; 7:212-217. [PMID: 29201656 DOI: 10.5588/pha.17.0024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/24/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: A high tuberculosis (TB) incidence, resource-limited urban setting in Zimbabwe. Objectives: To compare treatment outcomes among people initiated on first-line anti-tuberculosis treatment in relation to age and other explanatory factors. Design: This was a retrospective record review of routine programme data. Results: Of 2209 patients included in the study, 133 (6%) were children (aged <10 years), 132 (6%) adolescents (10-19 years), 1782 (81%) adults (20-59 years) and 162 (7%) were aged ⩾60 years, defined as elderly. The highest proportion of smear-negative pulmonary TB cases was among the elderly (40%). Unfavourable outcomes, mainly deaths, increased proportionately with age, and were highest among the elderly (adjusted relative risk 3.8, 95%CI 1.3-10.7). Having previous TB, being human immunodeficiency virus positive and not on antiretroviral treatment or cotrimoxazole preventive therapy were associated with an increased risk of unfavourable outcomes. Conclusion: The elderly had the worst outcomes among all the age groups. This may be related to immunosuppressant comorbidities or other age-related diseases mis-classified as TB, as a significant proportion were smear-negative. Older persons need better adapted TB management and more sensitive diagnostic tools, such as Xpert® MTB/RIF.
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Affiliation(s)
- R T Ncube
- International Union Against Tuberculosis and Lung Disease (The Union), Zimbabwe Country Office, Harare, Zimbabwe
| | - K C Takarinda
- Centre for Operations Research, The Union, Paris, France.,AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - C Zishiri
- International Union Against Tuberculosis and Lung Disease (The Union), Zimbabwe Country Office, Harare, Zimbabwe
| | - W van den Boogaard
- Operational Research Unit, Médecins Sans Frontières, Luxembourg City, Luxembourg
| | - N Mlilo
- International Union Against Tuberculosis and Lung Disease (The Union), Zimbabwe Country Office, Harare, Zimbabwe
| | - C Chiteve
- International Union Against Tuberculosis and Lung Disease (The Union), Zimbabwe Country Office, Harare, Zimbabwe
| | - N Siziba
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - F Trinchán
- Bulawayo City Health Department, Bulawayo, Zimbabwe
| | - C Sandy
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
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18
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Aw B, Ade S, Hinderaker SG, Dlamini N, Takarinda KC, Chiaa K, Feil A, Traoré A, Reid T. Childhood tuberculosis in Mauritania, 2010-2015: diagnosis and outcomes in Nouakchott and the rest of the country. Public Health Action 2017; 7:199-205. [PMID: 29201655 DOI: 10.5588/pha.16.0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/25/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: The National Tuberculosis Programme, Mauritania. Objective: To compare the diagnosis and treatment outcomes of childhood tuberculosis (TB) cases (aged <15 years) registered between 2010 and 2015 inside and outside Nouakchott, the capital city. Design: This was a retrospective comparative cohort study. Results: A total of 948 children with TB were registered. The registration rate was 10 times higher in Nouakchott. The proportion of children among all TB cases was higher inside than outside Nouakchott (7.5% vs. 4.6%, P < 0.01). Under-fives represented 225 (24%) of all childhood TB cases, of whom 204 (91%) were registered in Nouakchott. Extra-pulmonary TB was more common in Nouakchott, while smear-negative TB was less common. Treatment success was similar inside and outside Nouakchott (national rate 61%). The principal unsuccessful outcomes were loss to follow-up outside Nouakchott (21% vs. 11%, P < 0.01) while transfers out were more common in the city (25% vs. 14%, P = 0.01). Being aged <5 years (OR 1.2, 95%CI 1.1-1.5) was associated with an unsuccessful outcome. Conclusion: This study indicates problems in the diagnosis and treatment of childhood TB in Mauritania, especially outside the city of Nouakchott. We suggest strengthening clinical diagnosis and management, improving communications between TB treatment centres and health services and pressing the TB world to develop more accurate and easy-to-use diagnostic tools for children.
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Affiliation(s)
- B Aw
- Programme National de Lutte contre la, Tuberculose et la Lèpre, Nouakchott, Mauritanie
| | - S Ade
- Université de Parakou, Parakou, Bénin.,Programme National contre la Tuberculose, Cotonou, Bénin.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | | | - N Dlamini
- National Malaria Control Programme, Ministry of Health, Mbabane, Swaziland
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France.,AIDS & TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - K Chiaa
- Programme National de Lutte contre la, Tuberculose et la Lèpre, Nouakchott, Mauritanie
| | - A Feil
- Centre Hospitalier National de Nouakchott, Mauritanie.,Faculté de Médecine, Université de Nouakchott, Nouakchott, Mauritanie
| | - A Traoré
- Programme National de Lutte contre la, Tuberculose et la Lèpre, Nouakchott, Mauritanie
| | - T Reid
- Operational Research Unit (LuxOR), Medical Department, Operational Centre Brussels, Médecins Sans Frontières Luxembourg
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19
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Camara BS, Delamou AM, Diro E, El Ayadi A, Béavogui AH, Sidibé S, Grovogui FM, Takarinda KC, Kolié D, Sandouno SD, Okumura J, Baldé MD, Van Griensven J, Zachariah R. Influence of the 2014-2015 Ebola outbreak on the vaccination of children in a rural district of Guinea. Public Health Action 2017; 7:161-167. [PMID: 28695091 DOI: 10.5588/pha.16.0120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/24/2017] [Indexed: 12/24/2022] Open
Abstract
Setting: All health centres in Macenta District, rural Guinea. Objective: To compare stock-outs of vaccines, vaccine stock cards and the administration of various childhood vaccines across the pre-Ebola, Ebola and post-Ebola virus disease periods. Design: This was an ecological study. Results: Similar levels of stock-outs were observed for all vaccines (bacille Calmette-Guérin [BCG], pentavalent, polio, measles, yellow fever) in the pre-Ebola and Ebola periods (respectively 2760 and 2706 facility days of stock-outs), with some variation by vaccine. Post-Ebola, there was a 65-fold reduction in stock-outs compared to pre-Ebola. Overall, 24 facility-months of vaccine stock card stock-outs were observed during the pre-Ebola period, which increased to 65 facility-months of stock-outs during the Ebola outbreak period; no such stock-out occurred in the post-Ebola period. Apart from yellow fever and measles, vaccine administration declined universally during the peak outbreak period (August-November 2014). Complete cessation of vaccine administration for BCG and a prominent low for polio (86% decrease) were observed in April 2014, corresponding to vaccine stock-outs. Post-Ebola, overall vaccine administration did not recover to pre-Ebola levels, with the highest gaps seen in polio and pentavalent vaccines, which had shortages of respectively 40% and 38%. Conclusion: These findings highlight the need to sustain vaccination activities in Guinea so that they remain resilient and responsive, irrespective of disease outbreaks.
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Affiliation(s)
- B S Camara
- Department of Public Health, Gamal University of Conakry, Conakry, Guinea
| | - A M Delamou
- Department of Public Health, Gamal University of Conakry, Conakry, Guinea.,Woman and Child Health Research Centre, Institute of Tropical Medicine, Antwerp, Belgium
| | - E Diro
- University of Gondar, Gondar, Ethiopia
| | - A El Ayadi
- Bixby Center for Global Reproductive Health, University of California, San Francisco, California, USA
| | - A H Béavogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forecariah, Guinea
| | - S Sidibé
- Department of Public Health, Gamal University of Conakry, Conakry, Guinea
| | - F M Grovogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forecariah, Guinea
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - D Kolié
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forecariah, Guinea
| | - S D Sandouno
- Department of Public Health, Gamal University of Conakry, Conakry, Guinea
| | - J Okumura
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - M D Baldé
- Department of Gynecology-Obstetrics, Gamal University of Conakry, Conakry, Guinea
| | - J Van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - R Zachariah
- Médecins Sans Frontières, Brussels Operational Centre (LuxOR), Luxembourg
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20
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Dörnemann J, van den Boogaard W, Van den Bergh R, Takarinda KC, Martinez P, Bekouanebandi JG, Javed I, Ndelema B, Lefèvre A, Khalid GG, Zuniga I. Where technology does not go: specialised neonatal care in resource-poor and conflict-affected contexts. Public Health Action 2017; 7:168-174. [PMID: 28695092 DOI: 10.5588/pha.16.0127] [Citation(s) in RCA: 6] [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] [Received: 12/22/2016] [Accepted: 04/01/2017] [Indexed: 12/22/2022] Open
Abstract
Setting: Although neonatal mortality is gradually decreasing worldwide, 98% of neonatal deaths occur in low- and middle-income countries, where hospital care for sick and premature neonates is often unavailable. Médecins Sans Frontières Operational Centre Brussels (MSF-OCB) managed eight specialised neonatal care units (SNCUs) at district level in low-resource and conflict-affected settings in seven countries. Objective: To assess the performance of the MSF SNCU model across different settings in Africa and Southern Asia, and to describe the set-up of eight SNCUs, neonate characteristics and clinical outcomes among neonates from 2012 to 2015. Design: Multicentric descriptive study. Results: The MSF SNCU model was characterised by an absence of high-tech equipment and an emphasis on dedicated nursing and medical care. Focus was on the management of hypothermia, hypoglycaemia, feeding support and early identification/treatment of infection. Overall, 11 970 neonates were admitted, 41% of whom had low birthweight (<2500 g). The main diagnoses were low birthweight, asphyxia and neonatal infections. Overall mortality was 17%, with consistency across the sites. Chances of survival increased with higher birthweight. Conclusion: The standardised SNCU model was implemented across different contexts and showed in-patient outcomes within acceptable limits. Low-tech medical care for sick and premature neonates can and should be implemented at district hospital level in low-resource settings.
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Affiliation(s)
- J Dörnemann
- Medical Department, Médecins Sans Frontières (MSF) Operational Centre Brussels, Brussels, Belgium
| | - W van den Boogaard
- Medical Department, Médecins Sans Frontières (MSF) Operational Centre Brussels, Brussels, Belgium
| | - R Van den Bergh
- Medical Department, Médecins Sans Frontières (MSF) Operational Centre Brussels, Brussels, Belgium
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France.,AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - P Martinez
- Department of Pediatrics, The Permanente Medical Group, Inc, San Rafael, California, USA.,MSF, New York, New York, USA
| | | | | | - B Ndelema
- Department of Obstetric Fistula, Ministry of Public Health and the Fight Against AIDS, Gitega, Burundi
| | - A Lefèvre
- Medical Department, Médecins Sans Frontières (MSF) Operational Centre Brussels, Brussels, Belgium
| | | | - I Zuniga
- Medical Department, Médecins Sans Frontières (MSF) Operational Centre Brussels, Brussels, Belgium
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Takarinda KC, Choto RC, Harries AD, Mutasa-Apollo T, Chakanyuka-Musanhu C. Routine implementation of isoniazid preventive therapy in HIV-infected patients in seven pilot sites in Zimbabwe. Public Health Action 2017; 7:55-60. [PMID: 28775944 PMCID: PMC5526481 DOI: 10.5588/pha.16.0102] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/05/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Seven pilot sites in Zimbabwe implementing 6 months of isoniazid preventive therapy (IPT) for people living with the human immunodeficiency virus (PLHIV). Objectives: To determine, among PLHIV started on IPT, the completion rates for a 6-month course of IPT and factors associated with non-adherence. Design: A retrospective cohort study. Results: Of 578 patients, 466 (81%) completed IPT. Of the 112 patients who failed to complete IPT, 69 (60%) were lost to follow-up, 30 (27%) stopped treatment with no documented reasons, 8 (7%) developed toxicity/adverse reactions, 5 (5%) were documented as having drug stock-outs and the remainder transferred out or refused to continue treatment. Currently being on antiretroviral therapy (ART) (aOR 0.09, 95%CI 0.03-0.28) and receiving a ⩾2 month supply of isoniazid at the start of treatment were associated with a lower risk of not completing IPT, while missing clinic visits prior to starting IPT (aOR 5.25, 95%CI 2.10-13.14) was associated with a higher risk of non-completion. Conclusion: IPT completion rates in seven pilot sites of Zimbabwe were comparatively high, showing that IPT roll-out in public health facilities is feasible. Enhanced adherence counselling or active tracing among pre-ART patients and those with a history of loss to follow-up may improve IPT completion rates, along with synchronising IPT and ART resupplies.
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Affiliation(s)
- K C Takarinda
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R C Choto
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - T Mutasa-Apollo
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
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Takarinda KC, Harries AD, Sandy C, Mutasa-Apollo T, Zishiri C. Declining tuberculosis case notification rates with the scale-up of antiretroviral therapy in Zimbabwe. Public Health Action 2016; 6:164-168. [PMID: 27695678 DOI: 10.5588/pha.16.0029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/24/2016] [Indexed: 01/17/2023] Open
Abstract
Setting: Zimbabwe has a human immunodeficiency virus (HIV) driven tuberculosis (TB) epidemic, with antiretroviral therapy (ART) scaled up in the public sector since 2004. Objective: To determine whether national ART scale-up was associated with annual national TB case notification rates (CNR), stratified by disease type and category, between 2000 and 2013. Design: This was a retrospective study using aggregate data from global reports. Results: The number of people living with HIV and retained on ART from 2004 to 2013 increased from 8400 to 665 299, with ART coverage increasing from <0.5% to 48%. TB CNRs, all types and categories, increased from 2000 to 2003, and declined thereafter from 2004 to 2013. The decreases in annual TB notifications between the highest rates (before 2004) and lowest rates (2013) were all forms of TB (56%), new TB (60%), previously treated TB (53%), new smear-positive pulmonary TB (PTB) (40%), new smear-negative/smear-unknown PTB (58%) and extra-pulmonary TB (58%). Conclusion: Significant declines in TB CNRs were observed during ART scale-up, especially for smear-negative PTB and extra-pulmonary TB. These encouraging national trends support the continued scale-up of ART for people living with HIV as a way of tackling the twin epidemics of HIV/acquired immune-deficiency syndrome and TB in Zimbabwe.
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Affiliation(s)
- K C Takarinda
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe ; International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - C Sandy
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - T Mutasa-Apollo
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
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Matyanga CMJ, Takarinda KC, Owiti P, Mutasa-Apollo T, Mugurungi O, Buruwe L, Reid AJ. Outcomes of antiretroviral therapy among younger versus older adolescents and adults in an urban clinic, Zimbabwe. Public Health Action 2016; 6:97-104. [PMID: 27358802 DOI: 10.5588/pha.15.0077] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/04/2016] [Indexed: 11/10/2022] Open
Abstract
SETTING A non-governmental organisation-supported clinic offering health services including antiretroviral therapy (ART). OBJECTIVE To compare ART retention between younger (age 10-14 years) vs. older (age 15-19 years) adolescents and younger (age 20-29 years) vs. older (age ⩾30 years) adults and determine adolescent- and adult-specific attrition-associated factors among those initiated on ART between 2010 and 2011. DESIGN Retrospective cohort study. RESULTS Of 110 (7%) adolescents and 1484 (93%) adults included in the study, no differences in retention were observed between younger vs. older adolescents at 6, 12 and 24 months. More younger adolescents were initiated with body mass index <16 kg/m(2) compared with older adolescents (64% vs. 47%; P = 0.04). There were more females (74% vs. 52%, P < 0.001) and fewer patients initiating ART with CD4 count ⩽350 cells/mm(3) (77% vs. 81%, P = 0.007) among younger vs. older adults. Younger adults demonstrated more attrition than older adults at all time-points. No attrition risk factors were observed among adolescents. Attrition-associated factors among adults included being younger, having a lower CD4 count and advanced human immunodeficiency virus disease at initiation, and initiation on a stavudine-based regimen. CONCLUSION Younger adults demonstrated greater attrition and may require more attention. We were unable to demonstrate differences in attrition among younger vs. older adolescents. Loss to follow-up was the main reason for attrition across all age groups. Overall, earlier presentation for ART care appears important for improved ART retention among adults.
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Affiliation(s)
- C M J Matyanga
- Pharmaceutical Technology Department, Harare Institute of Technology, Harare, Zimbabwe
| | - K C Takarinda
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe ; International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - T Mutasa-Apollo
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - O Mugurungi
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - L Buruwe
- Pharmaceutical Technology Department, Harare Institute of Technology, Harare, Zimbabwe
| | - A J Reid
- Medical Department, Médecins Sans Frontières, Operational Centre Brussels, MSF-Luxembourg, Luxembourg
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Takarinda KC, Harries AD, Mutasa-Apollo T. Critical considerations for adopting the HIV 'treat all' approach in Zimbabwe: is the nation poised? Public Health Action 2016; 6:3-7. [PMID: 27051603 DOI: 10.5588/pha.15.0072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/14/2016] [Indexed: 12/31/2022] Open
Abstract
While the advent of antiretroviral therapy (ART) has increased survival and reduced the number of acquired immune-deficiency syndrome (AIDS) related deaths among people living with the human immunodeficiency virus (HIV) virus (PLHIV), HIV/AIDS remains a global health problem and sub-Saharan Africa continues to bear the greatest burden of disease. There are also major challenges in the HIV response: as of December 2013, only 36% of PLHIV globally were on ART, and for every individual started on ART there were two new PLHIV diagnosed. This has led to considerable debate around adopting an HIV 'treat all' approach aimed at greatly escalating the number of PLHIV initiated and retained on ART, regardless of CD4 cell count or World Health Organization (WHO) clinical stage, with the intended goal of achieving viral suppression which should in turn reduce HIV transmission, morbidity and mortality in affected individuals. This paper examines the issues being discussed in Zimbabwe, a low-income country with a high burden of HIV/AIDS, about the implications and opportunities of adopting an HIV 'treat all' approach, along with pertinent operational research questions that need to be answered to move the agenda forward. These discussions are timely, given the recent WHO recommendations advising ART for all PLHIV, regardless of CD4 cell count.
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Affiliation(s)
- K C Takarinda
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe ; Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A D Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France ; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - T Mutasa-Apollo
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
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Phuong NTM, Nhung NV, Hoa NB, Thuy HT, Takarinda KC, Tayler-Smith K, Harries AD. Management and treatment outcomes of patients enrolled in MDR-TB treatment in Viet Nam. Public Health Action 2016; 6:25-31. [PMID: 27051608 DOI: 10.5588/pha.15.0068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/21/2015] [Indexed: 11/10/2022] Open
Abstract
SETTING The programmatic management of drug-resistant tuberculosis (TB) in Viet Nam has been rapidly scaled up since 2009. OBJECTIVES To document the annual numbers of patients enrolled for multidrug-resistant tuberculosis (MDR-TB) treatment during 2010-2014 and to determine characteristics and treatment outcomes of patients initiating treatment during 2010-2012. DESIGN A retrospective cohort study using national reports and data from the national electronic data system for drug-resistant TB. RESULTS The number of patients enrolled annually for MDR-TB treatment increased from 97 in 2010 to 1522 in 2014. The majority of patients were middle-aged men who had pulmonary disease and had failed a retreatment regimen; 77% had received ⩾2 courses of TB treatment. Favourable outcomes (cured and treatment completed) were attained in 73% of patients. Unfavourable outcomes included loss to follow-up (12.5%), death (8%) and failure (6.3%). Having had ⩾2 previous treatment courses and being human immunodeficiency virus-positive were associated with unfavourable outcomes. CONCLUSION Increasing numbers of patients are being treated for MDR-TB each year with good treatment outcomes under national programme management in Viet Nam. However, there is a need to increase case detection-currently at 30% of the estimated 5100 MDR-TB cases per year, reduce adverse outcomes and improve monitoring and evaluation.
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Affiliation(s)
- N T M Phuong
- Viet Nam National Tuberculosis Control Programme, Hanoi, Viet Nam
| | - N V Nhung
- Viet Nam National Tuberculosis Control Programme, Hanoi, Viet Nam
| | - N B Hoa
- Viet Nam National Tuberculosis Control Programme, Hanoi, Viet Nam ; International Union Against Tuberculosis and Lung Disease, Paris, France
| | - H T Thuy
- Viet Nam National Tuberculosis Control Programme, Hanoi, Viet Nam
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - K Tayler-Smith
- Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit, Luxembourg
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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Dlodlo RA, Hwalima ZE, Sithole S, Takarinda KC, Tayler-Smith K, Harries AD. Are HIV-positive presumptive tuberculosis patients without tuberculosis getting the care they need in Zimbabwe? Public Health Action 2015; 5:217-21. [PMID: 26767174 DOI: 10.5588/pha.15.0036] [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] [Received: 07/05/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
SETTING Emakhandeni Clinic provides decentralised and integrated tuberculosis (TB) and human immunodeficiency virus (HIV) care in Bulawayo, Zimbabwe. OBJECTIVES To compare HIV care for presumptive TB patients with and without TB registered in 2013. DESIGN Retrospective cohort study using routine programme data. RESULTS Of 422 registered presumptive TB patients, 26% were already known to be HIV-positive. Among the remaining 315 patients, 255 (81%) were tested for HIV, of whom 190 (75%) tested HIV-positive. Of these, 26% were diagnosed with TB and 71% without TB (3% had no TB result recorded). For the 134 patients without TB, antiretroviral treatment (ART) eligibility data were recorded for 42 (31%); 95% of these were ART eligible. Initiation of cotrimoxazole preventive therapy (CPT) and ART was recorded for respectively 88% and 90% of HIV-positive patients with TB compared with respectively 40% and 38% of HIV-positive patients without TB (P < 0.001). CONCLUSION Presumptive TB patients without TB had a high HIV positivity rate and, for those with available data, most were ART eligible. Unlike HIV-positive patients diagnosed with TB, CPT and ART uptake for these patients was poor. A 'test and treat' approach and better service linkages could be life-saving for these patients, especially in southern Africa, where there are high burdens of HIV and TB.
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Affiliation(s)
- R A Dlodlo
- International Union Against Tuberculosis and Lung Disease, Bulawayo, Zimbabwe
| | - Z E Hwalima
- Health Services Department, City of Bulawayo, Bulawayo, Zimbabwe
| | - S Sithole
- Health Services Department, City of Bulawayo, Bulawayo, Zimbabwe
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Bulawayo, Zimbabwe ; AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - K Tayler-Smith
- Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit, MSF-Luxembourg, Luxembourg
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Bulawayo, Zimbabwe ; London School of Hygiene & Tropical Medicine, London, UK
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Harries AD, Kumar AMV, Satyanarayana S, Lin Y, Takarinda KC, Tweya H, Reid AJ, Zachariah R. Communicable and non-communicable diseases: connections, synergies and benefits of integrating care. Public Health Action 2015; 5:156-7. [PMID: 26393110 DOI: 10.5588/pha.15.0030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/16/2015] [Indexed: 12/14/2022] Open
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - A M V Kumar
- The Union South-East Asia Regional Office, New Delhi, India
| | | | - Y Lin
- The Union China Office, Beijing, China
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; AIDS and TB Department, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | - H Tweya
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Lighthouse Trust, Lilongwe, Malawi
| | - A J Reid
- Médecins Sans Frontières, Operational Research Unit, Brussels Operational Centre, Luxembourg
| | - R Zachariah
- Médecins Sans Frontières, Operational Research Unit, Brussels Operational Centre, Luxembourg
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Takarinda KC, Harries AD, Mutasa-Apollo T, Sandy C, Murimwa T, Mugurungi O. ART uptake, its timing and relation to anti-tuberculosis treatment outcomes among HIV-infected TB patients. Public Health Action 2012; 2:50-5. [PMID: 26392951 PMCID: PMC4463041 DOI: 10.5588/pha.12.0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 07/02/2012] [Indexed: 11/10/2022] Open
Abstract
SETTING All public health facilities in two provinces of Zimbabwe. OBJECTIVE To determine, among tuberculosis (TB) patients with human immunodeficiency virus (HIV) registered in 2010, 1) the proportion started on antiretroviral treatment (ART), 2) the timing of ART in relation to the start of anti-tuberculosis treatment, and 3) whether timing of ART influenced anti-tuberculosis treatment outcomes. DESIGN Retrospective cohort study. RESULTS Of the 2655 HIV-positive TB patients, 1115 (42%) were documented as receiving ART. Of these, 178 (16%) started ART prior to anti-tuberculosis treatment. Of those who started after anti-tuberculosis treatment, 17% started within 2 weeks, 43% between 2 and 8 weeks and 40% after 8 weeks. Treatment success in the cohort was 82%, with 14% deaths before completion of anti-tuberculosis treatment. Not receiving ART during anti-tuberculosis treatment was associated with lower anti-tuberculosis treatment success (adjusted RR 0.70, 95%CI 0.53-0.91) and more deaths (adjusted RR 3.43, 95%CI 2.2-5.36). There were no differences in TB treatment outcomes by timing of ART initiation. CONCLUSION ART uptake is low given the improved treatment outcomes in those put on ART during anti-tuberculosis treatment. Better integration of HIV and TB services is needed to ensure increased coverage and earlier ART uptake.
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Affiliation(s)
- K C Takarinda
- AIDS & TB Unit, Ministry of Health & Child Welfare, Harare, Zimbabwe ; Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - T Mutasa-Apollo
- AIDS & TB Unit, Ministry of Health & Child Welfare, Harare, Zimbabwe
| | - C Sandy
- AIDS & TB Unit, Ministry of Health & Child Welfare, Harare, Zimbabwe
| | - T Murimwa
- AIDS & TB Unit, Ministry of Health & Child Welfare, Harare, Zimbabwe
| | - O Mugurungi
- AIDS & TB Unit, Ministry of Health & Child Welfare, Harare, Zimbabwe
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Takarinda KC, Harries AD, Srinath S, Mutasa-Apollo T, Sandy C, Mugurungi O. Treatment outcomes of new adult tuberculosis patients in relation to HIV status in Zimbabwe. Public Health Action 2011; 1:34-9. [PMID: 26392934 DOI: 10.5588/pha.11.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 09/15/2011] [Indexed: 11/10/2022] Open
Abstract
SETTING All public health facilities in Chitungwiza District, Zimbabwe. OBJECTIVE To determine, in new tuberculosis (TB) patients registered in 2009, 1) the proportion of persons human immunodeficiency virus (HIV) tested, stratified by age, sex and type of TB, and 2) treatment outcomes in relation to type of TB and HIV status. DESIGN Retrospective cohort study. RESULTS Of 1800 TB patients, 1100 (61%) were tested, of whom 877 (80%) were HIV-positive and 75 (9%) were documented as receiving antiretroviral treatment (ART). HIV testing and HIV positivity were similar between patients with different types of TB. Overall, the treatment success rate was 70%, and 17% had transferred out. Being HIV-positive on ART was associated with better treatment success and lower transfer out; age ≥55 years was associated with poor treatment success and higher death rates. Defaulting was more common in those who did not undergo smear testing or in extra-pulmonary TB patients, while deaths were higher in males. CONCLUSION In a Zimbabwe district, less than two thirds of TB patients were tested. Better treatment success was observed in patients documented as HIV-positive and on ART. Important lessons for improved TB control include increasing HIV testing uptake for better access to ART, more comprehensive recording practices on ART and better reporting on true outcomes of transfer-out patients.
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Affiliation(s)
- K C Takarinda
- AIDS and TB Unit, Ministry of Health and Child Welfare, Harare, Zimbabwe
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - S Srinath
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, Delhi, India
| | - T Mutasa-Apollo
- AIDS and TB Unit, Ministry of Health and Child Welfare, Harare, Zimbabwe
| | - C Sandy
- AIDS and TB Unit, Ministry of Health and Child Welfare, Harare, Zimbabwe
| | - O Mugurungi
- AIDS and TB Unit, Ministry of Health and Child Welfare, Harare, Zimbabwe
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