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John S, Ghosh D, Michael V, Kruger D, Jain R, Dhir K, Mohan S, Bhangu A. Patterns and Outcomes in Pediatric Abdominal Tuberculosis: A Single Centre Cohort Study. J Pediatr Surg 2024; 59:1886-1891. [PMID: 38769032 DOI: 10.1016/j.jpedsurg.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/15/2024] [Accepted: 04/14/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Abdominal tuberculosis presents in a variety of ways. Different testing modalities must be applied in addition to having a high clinical suspicion to diagnose and initiate therapy. Medications have a good response; however, morbidity has been seen following surgical management of complicated presentations like intestinal obstruction and perforation. There is a paucity of studies in the pediatric age group which evaluate response to the different treatment regimen and identify factors associated with poorer outcomes in children with abdominal tuberculosis. METHODS Patient records of 75 children with abdominal tuberculosis at a single center were evaluated using a questionnaire, covering a 14-year period from 2007 to 2021. Demographic features, presenting signs and symptoms, investigations and treatment details were studied. In- person or telephonic follow-up was conducted to identify treatment outcomes. RESULTS Incidence of abdominal TB was 7%, of all TB children with a mean age of 10.1 years. Mesenteric lymph nodes were involved in 67% and small intestine in 33% cases. Surgery was required in 22 children. 85% children completed treatment. Small intestine involvement had higher probability of undergoing surgery. Of the 70 children with complete follow up, 64 were well and 6 children succumbed to the disease. Older age, small intestine involvement and surgery were independently associated with higher mortality. CONCLUSION Intestinal involvement is associated with greater need for surgical intervention and greater mortality. Adolescents have poorer outcomes. Further studies are required focusing on these individual subgroups to understand the patterns of presentation, causes for mortality and prevention. LEVEL OF EVIDENCE Level 5.
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Affiliation(s)
- Susan John
- NIHR Health Research Unit on Global Surgery, India Hub, Christian Medical College, Ludhiana, Punjab, India
| | - Dhruva Ghosh
- NIHR Health Research Unit on Global Surgery, India Hub, Christian Medical College, Ludhiana, Punjab, India; Department of Paediatric Surgery, Christian Medical College, Ludhiana, Punjab, India.
| | - Vishal Michael
- Department of Paediatric Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Deirdre Kruger
- NIHR Health Research Unit on Global Surgery Statistics Hub, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ritu Jain
- NIHR Health Research Unit on Global Surgery, India Hub, Christian Medical College, Ludhiana, Punjab, India
| | - Karan Dhir
- NIHR Health Research Unit on Global Surgery, India Hub, Christian Medical College, Ludhiana, Punjab, India
| | - Sangeetha Mohan
- Department of Microbiology, Christian Medical College, Ludhiana, Punjab, India
| | - Aneel Bhangu
- NIHR Health Research Unit on Global Surgery, University of Birmingham, United Kingdom
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Brooks MB, van de Water BJ, Lecca L, Huang CC, Trevisi L, Contreras C, Galea JT, Calderon R, Yataco R, Murray M, Becerra MC. Tuberculosis treatment loss to follow-up in children exposed at home: A prospective cohort study. J Glob Health 2024; 14:04194. [PMID: 39149829 PMCID: PMC11327892 DOI: 10.7189/jogh.14.04194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024] Open
Abstract
Background Loss to follow-up (LTFU) from tuberculosis (TB) treatment and care is a significant public health problem. It is important to understand what drives LTFU in children - a population whose treatment and management depend on an adult caregiver - to better provide support services to families affected by TB. Methods We conducted a prospective cohort study of household contacts in Lima, Peru (2009-12). Using multilevel logistic regression analysis, we explored individual-level characteristics of children and their adult household members with TB disease to identify risk factors for LTFU among children initiated on treatment for TB. Results A total of 154 child (0-14 years) household contacts were diagnosed with TB and initiated on treatment. While most (n = 133, 86.4%) had a successful outcome, 20 (13.0%) children were LTFU. Six (30.0%) children were LTFU within three months, nine (45.0%) between five to seven months, and three (15.0%) after seven months of treatment being initiated. In univariable analysis, children with index patients above 25 years of age had decreased odds of being LTFU (odds ratio = 0.26; 95% confidence interval = 0.08-0.84) compared to children with index patients 25 years or younger. Conclusions In this cohort, more than 10% of children sick with TB who were exposed to the disease at home were LTFU. An integrated, family-centred TB prevention and management approach may reduce barriers to a child completing their course of TB treatment.
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Affiliation(s)
- Meredith B Brooks
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Leonid Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health / Socios En Salud, Lima, Peru
| | - Chuan-Chin Huang
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Letizia Trevisi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jerome T Galea
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- School of Social Work, University of South Florida, Tampa, Florida, USA
| | | | - Rosa Yataco
- Partners In Health / Socios En Salud, Lima, Peru
| | - Megan Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health / Socios En Salud, Lima, Peru
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health / Socios En Salud, Lima, Peru
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Basile FW, Sweeney S, Singh MP, Bijker EM, Cohen T, Menzies NA, Vassall A, Indravudh P. Uncertainty in tuberculosis clinical decision-making: An umbrella review with systematic methods and thematic analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003429. [PMID: 39042611 PMCID: PMC11265660 DOI: 10.1371/journal.pgph.0003429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/12/2024] [Indexed: 07/25/2024]
Abstract
Tuberculosis is a major infectious disease worldwide, but currently available diagnostics have suboptimal accuracy, particularly in patients unable to expectorate, and are often unavailable at the point-of-care in resource-limited settings. Test/treatment decision are, therefore, often made on clinical grounds. We hypothesized that contextual factors beyond disease probability may influence clinical decisions about when to test and when to treat for tuberculosis. This umbrella review aimed to identify such factors, and to develop a framework for uncertainty in tuberculosis clinical decision-making. Systematic reviews were searched in seven databases (MEDLINE, CINAHL Complete, Embase, Scopus, Cochrane, PROSPERO, Epistemonikos) using predetermined search criteria. Findings were classified as barriers and facilitators for testing or treatment decisions, and thematically analysed based on a multi-level model of uncertainty in health care. We included 27 reviews. Study designs and primary aims were heterogeneous, with seven meta-analyses and three qualitative evidence syntheses. Facilitators for decisions to test included providers' advanced professional qualification and confidence in tests results, availability of automated diagnostics with quick turnaround times. Common barriers for requesting a diagnostic test included: poor provider tuberculosis knowledge, fear of acquiring tuberculosis through respiratory sampling, scarcity of healthcare resources, and complexity of specimen collection. Facilitators for empiric treatment included patients' young age, severe sickness, and test inaccessibility. Main barriers to treatment included communication obstacles, providers' high confidence in negative test results (irrespective of negative predictive value). Multiple sources of uncertainty were identified at the patient, provider, diagnostic test, and healthcare system levels. Complex determinants of uncertainty influenced decision-making. This could result in delayed or missed diagnosis and treatment opportunities. It is important to understand the variability associated with patient-provider clinical encounters and healthcare settings, clinicians' attitudes, and experiences, as well as diagnostic test characteristics, to improve clinical practices, and allow an impactful introduction of novel diagnostics.
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Affiliation(s)
- Francesca Wanda Basile
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sedona Sweeney
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maninder Pal Singh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Else Margreet Bijker
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Department of Paediatrics, Maastricht University Medical Centre, MosaKids Children’s Hospital, Maastricht, the Netherlands
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Nicolas A. Menzies
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pitchaya Indravudh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Lemaire JF, Cohn J, Kakayeva S, Tchounga B, Ekouévi PF, Ilunga VK, Ochieng Yara D, Lanje S, Bhamu Y, Haule L, Namubiru M, Nyamundaya T, Berset M, de Souza M, Machekano R, Casenghi M. Improving TB detection among children in routine clinical care through intensified case finding in facility-based child health entry points and decentralized management: A before-and-after study in Nine Sub-Saharan African Countries. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002865. [PMID: 38315700 PMCID: PMC10843113 DOI: 10.1371/journal.pgph.0002865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
In 2022, an estimated 1.25 million children <15 years of age developed tuberculosis (TB) worldwide, but >50% remained undiagnosed or unreported. WHO recently recommended integrated and decentralized models of care as an approach to improve access to TB services for children, but evidence remains limited. The Catalyzing Paediatric TB Innovation project (CaP-TB) implemented a multi-pronged intervention to improve TB case finding in children in nine sub-Saharan African countries. The intervention introduced systematic TB screening in different facility-based child-health entry-points, decentralisation of TB diagnosis and management, improved sample collection with access to Xpert® MTB/RIF or MTB/RIF Ultra testing, and implementation of contact investigation. Pre-intervention records were compared with those during intervention to assess effect on paediatric TB cascade of care. The intervention screened 1 991 401 children <15 years of age for TB across 144 health care facilities. The monthly paediatric TB case detection rate increased significantly during intervention versus pre-intervention (+46.0%, 95% CI 36.2-55.8%; p<0.0001), with variability across countries. The increase was greater in the <5 years old compared to the 5-14 years old (+53.4%, 95% CI 35.2-71.9%; p<0.0001 versus +39.9%, 95% CI 27.6-52.2%; p<0.0001). Relative contribution of lower-tier facilities to total case detection rate increased from 37% (71.8/191.8) pre-intervention to 50% (139.9/280.2) during intervention. The majority (89.5%) of children with TB were identified through facility-based intensified case-finding and primarily accessed care through outpatient and inpatient departments. In this multi-country study implemented under real-life conditions, the implementation of integrated and decentralized interventions increased paediatric TB case detection. The increase was driven by lower-tier facilities that serve as the primary point of healthcare contact for most patients. The effect was greater in children < 5 years compared to 5-14 years old, representing an important achievement as the TB detection gap is higher in this subpopulation. (Study number NCT03948698).
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Affiliation(s)
| | - Jennifer Cohn
- Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Shirin Kakayeva
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, United States of America
| | - Boris Tchounga
- Elizabeth Glaser Pediatric AIDS Foundation, Yaounde, Cameroon
| | | | - Vicky Kambaji Ilunga
- Elizabeth Glaser Pediatric AIDS Foundation, Kinshasa, République Démocratique du Congo
| | | | - Samson Lanje
- Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho
| | - Yusuf Bhamu
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Leo Haule
- Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania
| | - Mary Namubiru
- Elizabeth Glaser Pediatric AIDS Foundation, Kampala, Uganda
| | | | - Maude Berset
- Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland
| | | | - Rhoderick Machekano
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, United States of America
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Noman MZI, Islam S, Aktar S, Parray AA, Amando DG, Karki J, Atsna Z, Mitra DK, Hossain SAS. Healthcare seeking behavior and delays in case of Drug-Resistant Tuberculosis patients in Bangladesh: Findings from a cross-sectional survey. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001903. [PMID: 38266032 PMCID: PMC10807832 DOI: 10.1371/journal.pgph.0001903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/02/2023] [Indexed: 01/26/2024]
Abstract
The emergence of Drug-Resistant Tuberculosis (DR-TB) has become a major threat globally and Bangladesh is no exception. Delays in healthcare seeking, proper diagnosis and initiation of treatment cause continuous transmission of the resistant tubercule bacilli through the communities. This study aimed to assess the different health care-seeking behaviors and delays among DR-TB patients in Bangladesh. A prospective cross-sectional study was conducted from November to December 2018, among 92 culture positive and registered DR-TB patients in four selected hospitals in Bangladesh. Data were collected through face-to-face interviews with survey questionnaire as well as record reviews. Among the 92 study participants, the median patient delay was 7 (IQR 3, 15) days, the median diagnostic delay was 88 (IQR 36.5, 210), the median treatment delay was 7 (IQR 4,12) days, and the median total delay among DR-TB patients was 108.5 (IQR 57.5, 238) days. 81.32% sought initial care from informal healthcare providers. The majority (68.48%) of the informal healthcare providers were drug sellers while 60.87% of patients sought care from more than four healthcare points before being diagnosed with DR-TB. The initial care seeking from multiple providers was associated with diagnostic and total delays. In Bangladesh, DR-TB cases usually seek care from multiple providers, particularly from informal providers, and among them, alarmingly higher healthcare-seeking related delays were noted. Immediate measures should be taken both at the health system levels and, in the community, to curb transmission and reduce the burden of the disease.
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Affiliation(s)
- Md. Zulqarnine Ibne Noman
- BRAC James P. Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh
- EcoHealth Alliance Bangladesh Programs, Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Shariful Islam
- EcoHealth Alliance Bangladesh Programs, Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Shaki Aktar
- BRAC James P. Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh
- International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Ateeb Ahmad Parray
- BRAC James P. Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh
- Department of International Health, Health Systems Program, The Johns Hopkins University, Baltimore, MD, United States of America
| | - Dennis G. Amando
- BRAC James P. Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh
| | - Jyoti Karki
- BRAC James P. Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh
| | - Zafria Atsna
- BRAC James P. Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh
| | - Dipak Kumar Mitra
- Department of Public Health, North South University, Dhaka, Bangladesh
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Huria L, Lestari BW, Saptiningrum E, Fikri AR, Oga-Omenka C, Kafi MAH, Daniels B, Vasquez NA, Sassi A, Das J, Jani ID, Pai M, Alisjahbana B. Care pathways of individuals with tuberculosis before and during the COVID-19 pandemic in Bandung, Indonesia. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002251. [PMID: 38165843 PMCID: PMC10760687 DOI: 10.1371/journal.pgph.0002251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/27/2023] [Indexed: 01/04/2024]
Abstract
The COVID-19 pandemic is thought to have undone years' worth of progress in the fight against tuberculosis (TB). For instance, in Indonesia, a high TB burden country, TB case notifications decreased by 14% and treatment coverage decreased by 47% during COVID-19. We sought to better understand the impact of COVID-19 on TB case detection using two cross-sectional surveys conducted before (2018) and after the onset of the pandemic (2021). These surveys allowed us to quantify the delays that individuals with TB who eventually received treatment at private providers faced while trying to access care for their illness, their journey to obtain a diagnosis, the encounters individuals had with healthcare providers before a TB diagnosis, and the factors associated with patient delay and the total number of provider encounters. We found some worsening of care seeking pathways on multiple dimensions. Median patient delay increased from 28 days (IQR: 10, 31) to 32 days (IQR: 14, 90) and the median number of encounters increased from 5 (IQR: 4, 8) to 7 (IQR: 5, 10), but doctor and treatment delays remained relatively unchanged. Employed individuals experienced shorter delays compared to unemployed individuals (adjusted medians: -20.13, CI -39.14, -1.12) while individuals whose initial consult was in the private hospitals experienced less encounters compared to those visiting public providers, private primary care providers, and informal providers (-4.29 encounters, CI -6.76, -1.81). Patients who visited the healthcare providers >6 times experienced longer total delay compared to those with less than 6 visits (adjusted medians: 59.40, 95% CI: 35.04, 83.77). Our findings suggest the need to ramp up awareness programs to reduce patient delay and strengthen private provide engagement in the country, particularly in the primary care sector.
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Affiliation(s)
- Lavanya Huria
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Bony Wiem Lestari
- Tuberculosis Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Eka Saptiningrum
- Tuberculosis Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Auliya Ramanda Fikri
- Tuberculosis Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Charity Oga-Omenka
- McGill International TB Centre, Montreal, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | | | - Benjamin Daniels
- McCourt School of Public Policy, Georgetown University, Washington, DC, United States of America
| | - Nathaly Aguilera Vasquez
- McGill International TB Centre, Montreal, Canada
- School of Human Nutrition, McGill University, Ste. Anne-de-Bellevue, Quebec, Canada
| | - Angelina Sassi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, DC, United States of America
| | - Ira Dewi Jani
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Bachti Alisjahbana
- Tuberculosis Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
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Kerkhoff AD, West NS, Del Mar Castro M, Branigan D, Christopher DJ, Denkinger CM, Nhung NV, Theron G, Worodria W, Yu C, Muyoyeta M, Cattamanchi A. Placing the values and preferences of people most affected by TB at the center of screening and testing: an approach for reaching the unreached. BMC GLOBAL AND PUBLIC HEALTH 2023; 1:27. [PMID: 39239641 PMCID: PMC11376596 DOI: 10.1186/s44263-023-00027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/04/2023] [Indexed: 09/07/2024]
Abstract
To reach the millions of people with tuberculosis (TB) undiagnosed each year, there is an important need to provide people-centered screening and testing services. Despite people-centered care being a key pillar of the WHO END-TB Strategy, there have been few attempts to formally characterize and integrate the preferences of people most affected by TB - including those who have increased exposure to TB, limited access to services, and/or are at increased risk for TB - into new tools and strategies to improve screening and diagnosis. This perspective emphasizes the importance of preference research among people most affected by TB, provides an overview of qualitative preference exploration and quantitative preference elicitation research methods, and outlines how preferences can be applied to improve the acceptability, accessibility, and appropriateness of TB screening and testing services via four key opportunities. These include the following: (1) Defining the most preferred features of novel screening, triage, and diagnostic tools, (2) exploring and prioritizing setting-specific barriers and facilitators to screening and testing, (3) understanding what features of community- and facility-based strategies for improving TB detection and treatment are most valued, and (4) identifying the most relevant and resonant communication strategies to increase individual- and community-level awareness and demand. Preference research studies and translation of their findings into policy/guidance and operationalization have enormous potential to close the existing gaps in detection in high burden settings by enhancing the people-centeredness and reach of screening and diagnostic services to people most affected by TB who are currently being missed and left behind.
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Affiliation(s)
- Andrew D Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
- Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - Nora S West
- Pulmonary, Critical Care Allergy and Sleep Medicine, University of California San Francisco, San Francisco, USA
| | - Maria Del Mar Castro
- Division of Infectious Diseases and Tropical Medicine, Center of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | | | - Claudia M Denkinger
- Division of Infectious Diseases and Tropical Medicine, Center of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
- German Center of Infection Research, Partner Site Heidelberg University Hospital, Heidelberg, Germany
| | - Nguyen Viet Nhung
- University of Medicine and Pharmacy, Vietnam National University Hanoi, Hanoi, Vietnam
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - William Worodria
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
- World Alliance for Lung and Intensive Care in Uganda, Kampala, Uganda
| | - Charles Yu
- Center for Tuberculosis Research, De La Salle Medical and Health Sciences Institute, City of Dasmarinas, The Philippines
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Adithya Cattamanchi
- Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, CA, USA
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Shitol SA, Saha A, Barua M, Towhid KMS, Islam A, Sarker M. A qualitative exploration of challenges in childhood TB patients identification and diagnosis in Bangladesh. Heliyon 2023; 9:e20569. [PMID: 37818012 PMCID: PMC10560773 DOI: 10.1016/j.heliyon.2023.e20569] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023] Open
Abstract
Background As childhood tuberculosis is difficult to identify and diagnose, the experiences of the caregivers and healthcare providers of childhood tuberculosis patients remain a potential area of study. This study aims to illustrate the challenges caregivers and healthcare providers encounter in identifying and diagnosing childhood tuberculosis in two sub-districts of Bangladesh. Methods We conducted semi-structured in-depth interviews with eight caregivers of childhood tuberculosis patients and key informant interviews with 36 healthcare providers from September 2020 to December 2020 from different levels of the tuberculosis control program in Keraniganj (with high childhood tuberculosis cases notification), Faridpur Sadar (with low childhood tuberculosis cases notification), and Dhaka city. Results There is a dearth of understanding among caregivers about childhood tuberculosis. Passive case finding process and focus on cough during community mobilisation contribute to the delay in childhood tuberculosis identification. The stigmatisation that caregivers anticipate and experience has an impact on their mental health and implies that there are misunderstandings about tuberculosis in the community. Furthermore, diagnostic dilemma among healthcare providers accounts for diagnosis delays. Some, but not all, institutions in different geographical locations provide free diagnostic tests and have GeneXpert devices. Conclusions Various factors, including caregivers' knowledge and experience, the process of case finding and community mobilization, healthcare providers' way of service provision and diagnosis, and the unavailability of required logistics at facilities challenge the identification and diagnosis of childhood tuberculosis that need to be minimized for childhood tuberculosis's early identification, diagnosis, treatment initiation, and successful completion of treatment. Awareness should also be raised in the community of childhood tuberculosis.
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Affiliation(s)
- Sharmin Akter Shitol
- James P. Grant School of Public Health, BRAC University, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka-1213, Bangladesh
| | - Avijit Saha
- James P. Grant School of Public Health, BRAC University, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka-1213, Bangladesh
| | - Mrittika Barua
- James P. Grant School of Public Health, BRAC University, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka-1213, Bangladesh
| | | | - Akramul Islam
- Communicable Diseases, Water, Sanitation, and Hygiene (WASH), Integrated Development, And Humanitarian Crisis Management, BRAC, 75 Mohakhali, Dhaka 1212, Bangladesh
| | - Malabika Sarker
- James P. Grant School of Public Health, BRAC University, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka-1213, Bangladesh
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
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Hudson M, Todd H, Nalugwa T, Boccia D, Wingfield T, Shete PB. The impact of social protection interventions on treatment and socioeconomic outcomes of people with tuberculosis and their households: Protocol for a systematic review and meta-analysis. Wellcome Open Res 2023; 8:175. [PMID: 37744729 PMCID: PMC10511851 DOI: 10.12688/wellcomeopenres.18807.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 09/26/2023] Open
Abstract
Background: Tuberculosis (TB) is a leading cause of death due to infectious disease worldwide. People with TB and their households often suffer social and economic losses due to the cost of tuberculosis care. The World Health Organization 2015 End TB strategy called for socioeconomic support through social protection interventions. Social protection has the potential to enable people with TB and their households to break the cycle of TB and poverty, thereby improving both treatment and socioeconomic outcomes. This study aims to evaluate whether people with TB who are recipients of social protection interventions have better treatment and socioeconomic outcomes than those who are not recipients of social protection interventions. Methods: We will systematically review literature published in English between 2012 and 2021 from PubMed, Embase, and Web of Science, and grey literature from Google Scholar and selected, relevant databases. We will include studies that describe a social protection intervention (as defined by the World Bank) and report on TB treatment outcomes and/or socioeconomic outcomes. We will only include studies pertaining to populations in low-and-middle-income countries and/or countries with high TB burden. We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality will be assessed using the Cochrane Risk of Bias for randomized controlled trials and the Newcastle Ottawa Scale for non-randomised controlled studies. If sufficient quantitative data are available, we will perform a meta-analysis of aggregated outcomes. Lastly, we will use the Grading Recommendations Assessment, Development, and Evaluation to describe the overall quality of evidence. Ethics and dissemination: Ethical approval is not required for this systematic review, as all data extraction and analysis will be conducted on published documents. We will disseminate this protocol through conference presentations. The systematic review has been registered prospectively in the PROSPERO database (registration number CRD42022382181).
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Affiliation(s)
- Mollie Hudson
- School of Nursing, University of California, San Francisco, San Francisco, USA
| | - Heather Todd
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Talemwa Nalugwa
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Delia Boccia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Tom Wingfield
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Priya B. Shete
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, USA
- Center for Tuberculosis, University of California, San Francisco, San Francisco, USA
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10
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An Y, Teo AKJ, Huot CY, Tieng S, Khun KE, Pheng SH, Leng C, Deng S, Song N, Nonaka D, Yi S. Barriers to childhood tuberculosis case detection and management in Cambodia: the perspectives of healthcare providers and caregivers. BMC Infect Dis 2023; 23:80. [PMID: 36750767 PMCID: PMC9903406 DOI: 10.1186/s12879-023-08044-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Diagnosis and treatment of tuberculosis (TB) in children remain challenging, particularly in resource-limited settings. Healthcare providers and caregivers are critical in improving childhood TB screening and treatment. This study aimed to determine the barriers to childhood TB detection and management from the perspectives of healthcare providers and caregivers in Cambodia. METHOD We conducted this qualitative study between November and December 2020. Data collection included in-depth interviews with 16 healthcare providers purposively selected from four operational districts and 28 caregivers of children with TB and children in close contact with bacteriologically confirmed pulmonary TB residing in the catchment areas of the selected health centers. Data were analyzed using thematic analyses. RESULTS Mean ages of healthcare providers and caregivers were 40.2 years (standard deviation [SD] 11.9) and 47.9 years (SD 14.6), respectively. Male was predominant among healthcare providers (93.8%). Three-fourths of caregivers were female, and 28.6% were grandparents. Inadequate TB staff, limited knowledge on childhood TB, poor collaboration among healthcare providers in different units on TB screening and management, limited quality of TB diagnostic tools, and interruption of supplies of childhood TB medicines due to maldistribution from higher levels to health facilities were the key barriers to childhood TB case detection and management. Caregivers reported transportation costs to and from health facilities, out-of-pocket expenditure, time-consuming, and no clear explanation from healthcare providers as barriers to childhood TB care-seeking. Aging caregivers with poor physical conditions, lack of collaboration from caregivers, ignorance of healthcare provider's advice, and parent movement were also identified as barriers to childhood TB case detection and management. CONCLUSIONS The national TB program should further invest in staff development for TB, scale-up appropriate TB diagnostic tools and ensure its functionalities, such as rapid molecular diagnostic systems and X-ray machines, and strengthen childhood TB drug management at all levels. These may include drug forecasting, precise drug distribution and monitoring mechanism, and increasing community awareness about TB to increase community engagement.
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Affiliation(s)
- Yom An
- Sustaining Technical and Analytical Resources (STAR), The Public Health Institute (PHI), Phnom Penh, Cambodia. .,School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan. .,School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.
| | - Alvin Kuo Jing Teo
- grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Chan Yuda Huot
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Sivanna Tieng
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Kim Eam Khun
- grid.436334.5School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia ,National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Sok Heng Pheng
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Chhenglay Leng
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | | | - Ngak Song
- United States Agency for International Development, Phnom Penh, Cambodia
| | - Daisuke Nonaka
- grid.267625.20000 0001 0685 5104School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Siyan Yi
- grid.436334.5School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia ,grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore ,grid.513124.00000 0005 0265 4996KHANA Center for Population Health Research, Phnom Penh, Cambodia ,grid.265117.60000 0004 0623 6962Center for Global Health Research, Touro University California, Vallejo, CA USA
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11
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de Guex KP, Augustino D, Mejan P, Gadiye R, Massong C, Lukumay S, Msoka P, Sariko M, Kimathi D, Vinnard C, Xie Y, Mmbaga B, Pfaeffle H, Geba M, Heysell SK, Mduma E, Thomas TA. Roadblocks and resilience: A qualitative study of the impact of pediatric tuberculosis on Tanzanian households and solutions from caregivers. Glob Public Health 2023; 18:2196569. [PMID: 37021699 PMCID: PMC10228591 DOI: 10.1080/17441692.2023.2196569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/24/2023] [Indexed: 04/07/2023]
Abstract
Distinct from quantifying the economic sequelae of tuberculosis (TB) in adults, data are scarce regarding lived experiences of youth and their caregivers seeking and sustaining TB treatment in low income communities. Children ages 4-17 diagnosed with TB and their caregivers were recruited from rural and semi-urban northern Tanzania. Using a grounded theory approach, a qualitative interview guide was developed, informed by exploratory research. Twenty-four interviews were conducted in Kiswahili, audio-recorded and analyzed for emerging and consistent themes. Dominant themes found were socioemotional impacts of TB on households, including adverse effects on work productivity, and facilitators and obstacles to TB care, including general financial hardship and transportation challenges. The median percentage of household monthly income spent to attend a TB clinic visit was 34% (minimum: 1%, maximum: 220%). The most common solutions identified by caregivers to mitigate adverse impacts were transportation assistance and nutrition supplementation. To end TB, healthcare systems must acknowledge the total financial burden shouldered by low wealth families seeking pediatric TB care, provide consultations and medications locally, and increase access to TB-specific communal funds to mitigate burdens such as inadequate nutrition.Trial registration: planned sub-study of the registered prospective study, NCT05283967.Trial registration: ClinicalTrials.gov identifier: NCT05283967.
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Affiliation(s)
- Kristen Petros de Guex
- University of Virginia, Division of Infectious Diseases and International Health, Charlottesville, USA
| | | | - Paulo Mejan
- Haydom Global Health Research Center, Haydom, Tanzania
| | - Rehema Gadiye
- Haydom Global Health Research Center, Haydom, Tanzania
| | | | | | - Perry Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | | | | | - Yingda Xie
- Rutgers New Jersey Medical School, Division of Infectious Diseases, Newark, USA
| | | | | | - Maria Geba
- University of Virginia, Division of Infectious Diseases and International Health, Charlottesville, USA
| | - Scott K. Heysell
- University of Virginia, Division of Infectious Diseases and International Health, Charlottesville, USA
| | - Estomih Mduma
- Haydom Global Health Research Center, Haydom, Tanzania
| | - Tania A. Thomas
- University of Virginia, Division of Infectious Diseases and International Health, Charlottesville, USA
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12
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Abayneh M, Teressa M. Detection of Mycobacterium tuberculosis using Gene Xpert-MTB/RIF assay among tuberculosis suspected patients at Mizan-Tepi university teaching hospital, southwest Ethiopia: An institution based cross-sectional study. PLoS One 2022; 17:e0277536. [PMID: 36417400 PMCID: PMC9683564 DOI: 10.1371/journal.pone.0277536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Consistently deciding its current extent and chance elements of tuberculosis (TB) in all levels of clinical settings contributes to the anticipation and control exertion of the disease. In Ethiopia, updated information is still needed at every healthcare level and in different risk groups to monitor the national program's performance, which aims to attain the 2035 goal. Hence, this study aimed to generate additional evidence data on the magnitude of Mycobacterium tuberculosis using the Gene Xpert assay among TB-suspected patients at Mizan-Tepi university teaching hospital, southwest Ethiopia. METHODS A cross-sectional descriptive study was conducted from June to September 30, 2021. The required socio-demographic and other risk factor data were collected from a total of 422 suspected TB patients using a structured questionnaire. Approximately 392 pulmonary and 30 extra-pulmonary samples were collected and examined using the Gene Xpert-MTB/RIF assay. The statistical package for social sciences (SPSS) version 25 software was used to analyze the data. RESULTS In this study, Mycobacterium tuberculosis was detected in 12.5% (49/392) of pulmonary samples and 13.3% (4/30) of extra-pulmonary samples, giving an overall TB positivity of 12.6% (53/422). Rifampicin-resistant M. tuberculosis was detected in 3/53 (5.7%). Male sex (AOR: 2.54; 95% CI: 1.210, 5.354), previous contact (AOR: 4.25; 95% CI: 1.790, 10.092), smoking cigarette (AOR: 4.708; 95% CI: 1.004, 22.081), being HIV-positive (AOR: 4.27; 95% CI: 1.606, 11.344), and malnutrition (AOR: 3.55; 95% CI: 1.175, 10.747) were all significantly associated with M. tuberculosis detection using the GeneXpert MTB/RIF assay. CONCLUSION The overall frequency of M. tuberculosis in this study was still significant in different risk groups, despite the proposed strategies, which aimed to reduce TB prevalence to as low as 10 per 100,000 populations by 2035. Early case detection with better diagnostic tools and public health measures are important prevention and control strategies to meet the proposed target and reduce the burden of TB in the country.
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Affiliation(s)
- Mengistu Abayneh
- College of Medical and Health Science, Department of Medical Laboratory Sciences, Mizan-Tepi University, Mizan, Southwest Ethiopia
- * E-mail:
| | - Murtii Teressa
- College of Medical and Health Science, Department of Medicine, Mizan-Tepi University, Mizan, Southwest Ethiopia
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13
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Crea TM, Collier KM, Klein EK, Sevalie S, Molleh B, Kabba Y, Kargbo A, Bangura J, Gbettu H, Simms S, O'Leary C, Drury S, Schieffelin JS, Betancourt TS. Social distancing, community stigma, and implications for psychological distress in the aftermath of Ebola virus disease. PLoS One 2022; 17:e0276790. [PMID: 36322544 PMCID: PMC9629629 DOI: 10.1371/journal.pone.0276790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background The 2013–2016 Ebola virus disease (EVD) epidemic resulted in more infections and deaths than all prior outbreaks in the 40-year history of this virus combined. This study examines how experiences of EVD infection, and preventive measures such as social distancing, were linked to experiences of stigma and social exclusion among those reintegrating into their communities. Methods Key informant interviews (n = 42) and focus group discussions (n = 27) were conducted in districts with a high prevalence of EVD and representing geographical and ethnic diversity (n = 228 participants). The final sample was composed of adults (52%) and children (48%) who were EVD-infected (46%) and -affected (42%) individuals, and community leaders (12%). Data were coded using a Grounded Theory approach informed by Thematic Content Analysis, and analyzed using NVivo. Interrater reliability was high, with Cohen’s κ = 0.80 or higher. Findings Participants described two main sources of EVD-related stress: isolation from the community because of social distancing and other prevention measures such as quarantine, and stigma related to infected or affected status. Participants linked experiences of social isolation and stigma to significant distress and feelings of ostracization. These experiences were particularly pronounced among children. Sources of support included community reintegration over time, and formal community efforts to provide education and establish protection bylaws. Interpretation This study found that social distancing and EVD-related stigma were each prominent sources of distress among participants. These results suggest that isolation because of infection, and the enduring stigmatization of infected individuals and their families, demand coordinated responses to prevent and mitigate additional psychosocial harm. Such responses should include close engagement with community leaders to combat misinformation and promote community reintegration.
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Affiliation(s)
- Thomas M Crea
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, United States of America
| | - K Megan Collier
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, United States of America
| | - Elizabeth K Klein
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, United States of America
| | | | | | - Yusuf Kabba
- Sierra Leone Association of Ebola Survivors, Freetown, Sierra Leone
| | - Abdulai Kargbo
- Sierra Leone Association of Ebola Survivors, Freetown, Sierra Leone
| | | | | | - Stewart Simms
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, United States of America
| | - Clara O'Leary
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, United States of America
| | - Stacy Drury
- School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - John S Schieffelin
- School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Theresa S Betancourt
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, United States of America
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14
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Hennein R, Ggita J, Ssuna B, Shelley D, Akiteng AR, Davis JL, Katamba A, Armstrong-Hough M. Implementation, interrupted: Identifying and leveraging factors that sustain after a programme interruption. Glob Public Health 2022; 17:1868-1882. [PMID: 34775913 PMCID: PMC10570963 DOI: 10.1080/17441692.2021.2003838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
Many implementation efforts experience interruptions, especially in settings with developing health systems. Approaches for evaluating interruptions are needed to inform re-implementation strategies. We sought to devise an approach for evaluating interruptions by exploring the sustainability of a programme that implemented diabetes mellitus (DM) screening within tuberculosis clinics in Uganda in 2017. In 2019, we conducted nine interviews with clinic staff and observed clinic visits to determine their views and practices on providing integrated care. We mapped themes to a social ecological model with three levels derived from the Consolidated Framework for Implementation Research (CFIR): outer setting (i.e. community), inner setting (i.e. clinic), and individuals (i.e. clinicians). Respondents explained that DM screening ceased due to disruptions in the national supply chain for glucose test strips, which had cascading effects on clinics and clinicians. Lack of screening supplies in clinics limited clinicians' opportunities to perform DM screening, which contributed to diminished self-efficacy. However, culture, compatibility and clinicians' beliefs about DM screening sustained throughout the interruption. We propose an approach for evaluating interruptions using the CFIR and social ecological model; other programmes can adapt this approach to identify cascading effects of interruptions and target them for re-implementation.
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Affiliation(s)
- Rachel Hennein
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States
- Yale School of Medicine, New Haven, Connecticut, United States
| | - Joseph Ggita
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Bashir Ssuna
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Donna Shelley
- Department of Public Health Policy and Management, New York University, New York, New York, United States
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Upper Mulago Hill, Kampala, Uganda
| | - J. Lucian Davis
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States
- Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, United States
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, United States
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mari Armstrong-Hough
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Social and Behavioral Sciences, New York University, New York, NY
- Department of Epidemiology, New York University, New York, New York, United States
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15
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Sultana S, Salwa M, Towhid MII, Islam SS, Haque MA. Challenges for tuberculosis control at selected primary healthcare centers in Bangladesh: A mixed-method study. Indian J Tuberc 2022; 69:134-140. [PMID: 35379392 DOI: 10.1016/j.ijtb.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/06/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The national tuberculosis control program in Bangladesh is progressing to end tuberculosis (TB) epidemic by 2035. Despite improved diagnostic and treatment facilities, the disease burden remains high. This mixed-method study aimed to identify existing challenges for successfully implementing the tuberculosis control program in primary healthcare centers (PHCs) of Bangladesh. METHODS Qualitative data were collected by observing six PHCs and interviewing TB patients (n = 12) and healthcare providers (n = 12). Quantitative data were collected by interviewing 94 TB patients. Data were integrated through a narrative approach. RESULTS Mean patient and health system delay were 99.0 (SD = 98.7) and 42.9 (SD = 79.9) days respectively. Patient delay was related to poor care-seeking behavior, unfamiliarity with tuberculosis symptoms, and unavailability of healthcare facilities. About 74 percent of patients sought initial treatment from village doctors or drug vendors. Health system delay was related to inadequate manpower, unskilled staff, and limited diagnostic facilities. Every second patient reported non-adherence to the directly observed treatment short-course (DOTS) guideline. DOTS provider's inaccessibility, inadequate incentive, and unreasonable patient demand lead to non-adherence. Insufficient administrative and structural facilities for infection control were observed at the selected facilities. CONCLUSIONS This study provides an insight into the recent challenges in TB control at PHCs in Bangladesh.
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Affiliation(s)
- Sarmin Sultana
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh.
| | - Marium Salwa
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Muhammad Ibrahim Ibne Towhid
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Syed Shariful Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - M Atiqul Haque
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
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16
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Mmolawa L, Siwelana T, Hanrahan CF, Lebina L, Martinson NA, Dowdy D, Nonyane BAS. Time to care-seeking for TB symptoms. Int J Tuberc Lung Dis 2022; 26:268-275. [PMID: 35197167 PMCID: PMC9636494 DOI: 10.5588/ijtld.21.0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Early presentation to healthcare facilities is critical for early diagnosis and treatment of TB. We studied self-reported time to care-seeking from the onset of TB symptoms among primary healthcare clinic (PHC) attendees in Limpopo Province, South Africa.METHODS: We used data from participants enrolled in a cluster-randomized trial of TB case finding in 56 PHC clinics across two health districts. We fitted log-normal accelerated failure time regression models and we present time ratios (TRs) for potential risk factors.RESULTS: We included 2,160 participants. Among the 1,757 (81%) diagnosed with active TB, the median time to care-seeking was 30 days (IQR 14-60); adults sought care later than children/adolescents (adjusted TR aTR 1.47, 95% CI 1.10-1.96). Among those not diagnosed with TB, the median was 14 days (IQR 7-60); being HIV-positive (aTR 1.57, 95% CI 1.03-2.40); having less than grade 8 education and currently smoking were associated with longer time to care-seeking. In the combined analysis, living with HIV and having underlying active TB was associated with faster care-seeking (TB status x HIV interaction: TR 0.68, 95% CI 0.48-0.96).CONCLUSION: Delay in care-seeking was associated with age, lower education and being a current smoker. TB awareness campaigns targeting these population groups may improve care-seeking behavior and reduce community TB transmission.
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Affiliation(s)
- L Mmolawa
- Perinatal HIV Research Unit, South Africa Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - T Siwelana
- Perinatal HIV Research Unit, South Africa Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - C F Hanrahan
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - L Lebina
- Perinatal HIV Research Unit, South Africa Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - N A Martinson
- Perinatal HIV Research Unit, South Africa Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa, Johns Hopkins University, Center for TB Research, Baltimore, MD, USA
| | - D Dowdy
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, Johns Hopkins University, Center for TB Research, Baltimore, MD, USA
| | - B A S Nonyane
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, Perinatal HIV Research Unit, South Africa Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
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17
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Research Questions and Priorities for Pediatric Tuberculosis: A Survey of Published Systematic Reviews and Meta-Analyses. Tuberc Res Treat 2022; 2022:1686047. [PMID: 35178252 PMCID: PMC8844079 DOI: 10.1155/2022/1686047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Advancing a research agenda designed to meet the specific needs of children is critical to ending pediatric TB epidemic. Systematic reviews are increasingly informing policies in pediatric tuberculosis (TB) care and control. However, there is a paucity of information on pediatric TB research priorities. Methodology. We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library for systematic reviews and meta-analyses on any aspect related to pediatric TB published between 2015 and 2021. We used the UK Health Research Classification System (HRCS) to help us classify the research questions and priorities. Findings. In total, 29 systematic reviews, with 84 research questions, were included in this review. The four most common research topics in the area of detection were 43.33% screening and diagnosis of TB, 23.33% evaluation of treatments and therapeutic interventions, 13.34% TB etiology and risk factors, and 13.34% prevention of disease and conditions and promotion of well-being. The research priorities focused mainly on evaluating TB diagnosis by improving yield through enhanced in specimen collection or preparation and evaluating of bacteriological TB diagnostic tests. Other topics of future research were developing a treatment for TB in children, assessing the use of IPT in reducing TB-associated morbidity, evaluating the prioritization of an IPT-friendly healthcare environment, and providing additional guidance for the use of isoniazid in the prevention of TB in HIV-infected children. Conclusion. There is a need for more systematic reviews on pediatric TB. The review identified several key priorities for future pediatric TB research mainly in the domain of (1) “Detection, screening and diagnosis,” “Development of Treatments and Therapeutic Interventions,” and “Prevention of Disease and Conditions, and Promotion of Well-Being.” These domains are very relevant in the research component of the roadmap towards ending TB in children. It also will serve as an additional action in the WHO End TB strategy.
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Zawedde-Muyanja S, Musaazi J, Castelnuovo B, Cattamanchi A, Katamba A, Manabe YC. Feasibility of a multifaceted intervention to improve treatment initiation among patients diagnosed with TB using Xpert MTB/RIF testing in Uganda. PLoS One 2022; 17:e0265035. [PMID: 35714072 PMCID: PMC9491700 DOI: 10.1371/journal.pone.0265035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND One in five patients diagnosed with TB in Uganda are not initiated on TB treatment within two weeks of diagnosis. We evaluated a multifaceted intervention for improving TB treatment initiation among patients diagnosed with TB using Xpert® MTB/RIF testing in Uganda. METHODS This was a pre-post interventional study at one tertiary referral hospital. The intervention was informed by the COM-B model and included; i) medical education sessions to improve healthcare worker knowledge about the magnitude and consequences of pretreatment loss to follow-up; ii) modified laboratory request forms to improve recording of patient contact information; and iii) re-designed workflow processes to improve timeliness of sputum testing and results dissemination. TB diagnostic process and outcome data were collected and compared from the period before (June to August 2019) and after (October to December 2019) intervention initiation. RESULTS In September 2019, four CME sessions were held at the hospital and were attended by 58 healthcare workers. During the study period, 1242 patients were evaluated by Xpert® MTB/RIF testing at the hospital (679 pre and 557 post intervention). Median turnaround time for sputum test results improved from 12 hours (IQR 4-46) in the pre-intervention period to 4 hours (IQR 3-6) in the post-intervention period. The proportion of patients started on treatment within two weeks of diagnosis improved from 59% (40/68) to 89% (49/55) (difference 30%, 95% CI 14%-43%, p<0.01) while the proportion of patients receiving a same-day diagnosis increased from 7.4% (5/68) to 25% (14/55) (difference 17.6%, 95% CI 3.9%-32.7%, p<0.01). CONCLUSION The multifaceted intervention was feasible and resulted in a higher proportion of patients initiating TB treatment within two weeks of diagnosis.
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Affiliation(s)
- Stella Zawedde-Muyanja
- The Infectious Diseases Institute, College of Health Sciences, Makerere
University, Kampala, Uganda
- * E-mail:
| | - Joseph Musaazi
- The Infectious Diseases Institute, College of Health Sciences, Makerere
University, Kampala, Uganda
| | - Barbara Castelnuovo
- The Infectious Diseases Institute, College of Health Sciences, Makerere
University, Kampala, Uganda
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine and Center for
Tuberculosis, University of California San Francisco, San Francisco, California,
United States of America
| | - Achilles Katamba
- Department of Medicine, School of Medicine, Makerere University College
of Health Sciences, Kampala, Uganda
| | - Yukari C. Manabe
- The Infectious Diseases Institute, College of Health Sciences, Makerere
University, Kampala, Uganda
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins
University School of Medicine, Baltimore, Maryland, United States of
America
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19
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Oonyu L, Kang S, Konlan KD, Kang YA. Isoniazid Preventive Therapy for Tuberculosis in People Living with HIV: A Cross Sectional Study in Butebo, Uganda. Infect Chemother 2022; 54:70-79. [PMID: 35384419 PMCID: PMC8987171 DOI: 10.3947/ic.2021.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/22/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Sunjoo Kang
- Department of Global Health, Graduate School of Public Health Yonsei University, Seoul, Korea
| | - Kennedy Diema Konlan
- Mo-im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute of Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Korea
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20
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Maina T, Willetts A, Ngari M, Osman A. Tuberculosis infection among youths in overcrowded university hostels in Kenya: a cross-sectional study. Trop Med Health 2021; 49:100. [PMID: 34961552 PMCID: PMC8714442 DOI: 10.1186/s41182-021-00391-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) remains a top global health problem and its transmission rate among contacts is higher when they are cohabiting with a person who is sputum smear-positive. Our study aimed to describe the prevalence of TB among student contacts in the university and determine factors associated with TB transmission. Methods We performed a cross-sectional study with an active contact case finding approach among students receiving treatment at Kilifi County Hospital from January 2016 to December 2017. The study was conducted in a public university in Kilifi County, a rural area within the resource-limited context of Kenya. The study population included students attending the university and identified as sharing accommodation or off-campus hostels, or a close social contact to an index case. The index case was defined as a fellow university student diagnosed with TB at the Kilifi County Hospital during the study period. Contacts were traced and tested for TB using GeneXpert. Results Among the 57 eligible index students identified, 51 (89%) agreed to participate. A total of 156 student contacts were recruited, screened and provided a sputum sample. The prevalence of TB (GeneXpert test positive/clinical diagnosis) among all contacts was 8.3% (95% CI 4.5–14%). Among the 8.3% testing positive 3.2% (95% CI 1.0–7.3%) were positive for GeneXpert only. Sharing a bed with an index case was the only factor significantly associated with TB infection. No other demographic or clinical factor was associated with TB infection. Conclusion Our study identified a high level of TB transmission among university students who had contact with the index cases. The study justifies further research to explore the genetic sequence and magnitude of TB transmission among students in overcrowded university in resource limited contexts.
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Affiliation(s)
- Teresia Maina
- Department of Public Health, School of Health and Human Sciences, Pwani University, P.O Box 196-80108, Kilifi, Kenya
| | - Annie Willetts
- Institute of Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Moses Ngari
- Department of Public Health, School of Health and Human Sciences, Pwani University, P.O Box 196-80108, Kilifi, Kenya.,Clinical Research Department, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - Abdullahi Osman
- Department of Public Health, School of Health and Human Sciences, Pwani University, P.O Box 196-80108, Kilifi, Kenya.
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21
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Tran CH, Moore BK, Pathmanathan I, Lungu P, Shah NS, Oboho I, Al-Samarrai T, Maloney SA, Date A, Boyd AT. Tuberculosis treatment within differentiated service delivery models in global HIV/TB programming. J Int AIDS Soc 2021; 24 Suppl 6:e25809. [PMID: 34713974 PMCID: PMC8554213 DOI: 10.1002/jia2.25809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Providing more convenient and patient‐centred options for service delivery is a priority within global HIV programmes. These efforts improve patient satisfaction and retention and free up time for providers to focus on new HIV diagnoses or severe illness. Recently, the coronavirus disease 2019 (COVID‐19) pandemic precipitated expanded eligibility criteria for these differentiated service delivery (DSD) models to decongest clinics and protect patients and healthcare workers. This has resulted in dramatic scale‐up of DSD for antiretroviral therapy, cotrimoxazole and tuberculosis (TB) preventive treatment. While TB treatment among people living with HIV (PLHIV) has traditionally involved frequent, facility‐based management, TB treatment can also be adapted within DSD models. Such adaptations could include electronic tools to ensure appropriate clinical management, treatment support, adherence counselling and adverse event (AE) monitoring. In this commentary, we outline considerations for DSD of TB treatment among PLHIV, building on best practices from global DSD model implementation for HIV service delivery. Discussion In operationalizing TB treatment in DSD models, we consider the following: what activity is being done, when or how often it takes place, where it takes place, by whom and for whom. We discuss considerations for various programme elements including TB screening and diagnosis; medication dispensing; patient education, counselling and support; clinical management and monitoring; and reporting and recording. General approaches include multi‐month dispensing for TB medications during intensive and continuation phases of treatment and standardized virtual adherence and AE monitoring. Lastly, we provide operational examples of TB treatment delivery through DSD models, including a conceptual model and an early implementation experience from Zambia. Conclusions COVID‐19 has catalysed the rapid expansion of differentiated patient‐centred service delivery for PLHIV. Expanding DSD models to include TB treatment can capitalize on existing platforms, while providing high‐quality, routine treatment, follow‐up and patient education and empowerment.
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Affiliation(s)
- Cuc H Tran
- Division ofHIV & Global Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brittany K Moore
- Division ofHIV & Global Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ishani Pathmanathan
- Division ofHIV & Global Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patrick Lungu
- National TB and Leprosy Programme, Ministry of Health, Lusaka, Zambia
| | - N Sarita Shah
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Ikwo Oboho
- Division ofHIV & Global Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Teeb Al-Samarrai
- Office of the Global AIDS Coordinator, U.S. State Department, Washington, DC, USA
| | - Susan A Maloney
- Division ofHIV & Global Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anand Date
- Division ofHIV & Global Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrew T Boyd
- Division ofHIV & Global Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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22
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Teferi MY, El-Khatib Z, Boltena MT, Andualem AT, Asamoah BO, Biru M, Adane HT. Tuberculosis Treatment Outcome and Predictors in Africa: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10678. [PMID: 34682420 PMCID: PMC8536006 DOI: 10.3390/ijerph182010678] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 12/17/2022]
Abstract
This review aimed to summarize and estimate the TB treatment success rate and factors associated with unsuccessful TB treatment outcomes in Africa. Potentially eligible primary studies were retrieved from PubMed and Google Scholar. The risk of bias and quality of studies was assessed using The Joanna Briggs Institute's (JBI) appraisal criteria, while heterogeneity across studies was assessed using Cochran's Q test and I2 statistic. Publication bias was checked using the funnel plot and egger's test. The protocol was registered in PROSPERO, numbered CRD42019136986. A total of 26 eligible studies were considered. The overall pooled estimate of TB treatment success rate was found to be 79.0% (95% CI: 76-82%), ranging from 53% (95% CI: 47-58%) in Nigeria to 92% (95% CI: 90-93%) in Ethiopia. The majority of unsuccessful outcomes were attributed to 48% (95% CI: 40-57%) death and 47% (95% CI: 39-55%) of defaulter rate. HIV co-infection and retreatment were significantly associated with an increased risk of unsuccessful treatment outcomes compared to HIV negative and newly diagnosed TB patients with RR of 1.53 (95% CI: 1.36-1.71) and 1.48 (95% CI: 1.14-1.94), respectively. TB treatment success rate was 79% below the WHO defined threshold of 85% with significant variation across countries. Countries need to explore contextual underlining factors and more effort is required in providing TB preventive treatment, improve case screening and linkage for TB treatment among HIV high-risk groups and use confirmatory TB diagnostic modality. Countries in Africa need to strengthen counseling and follow-up, socio-economic support for patients at high risk of loss to follow-up and poor treatment success is also crucial for successful TB control programs.
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Affiliation(s)
- Melese Yeshambaw Teferi
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa P.O. Box 1005, Ethiopia; (M.T.B.); (A.T.A.); (M.B.); (H.T.A.)
| | - Ziad El-Khatib
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Minyahil Tadesse Boltena
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa P.O. Box 1005, Ethiopia; (M.T.B.); (A.T.A.); (M.B.); (H.T.A.)
| | - Azeb Tarekegn Andualem
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa P.O. Box 1005, Ethiopia; (M.T.B.); (A.T.A.); (M.B.); (H.T.A.)
| | - Benedict Oppong Asamoah
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, 221 00 Lund, Sweden;
| | - Mulatu Biru
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa P.O. Box 1005, Ethiopia; (M.T.B.); (A.T.A.); (M.B.); (H.T.A.)
| | - Hawult Taye Adane
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa P.O. Box 1005, Ethiopia; (M.T.B.); (A.T.A.); (M.B.); (H.T.A.)
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23
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Telisinghe L, Ruperez M, Amofa-Sekyi M, Mwenge L, Mainga T, Kumar R, Hassan M, Chaisson L, Naufal F, Shapiro A, Golub J, Miller C, Corbett E, Burke R, MacPherson P, Hayes R, Bond V, Daneshvar C, Klinkenberg E, Ayles H. Does tuberculosis screening improve individual outcomes? A systematic review. EClinicalMedicine 2021; 40:101127. [PMID: 34604724 PMCID: PMC8473670 DOI: 10.1016/j.eclinm.2021.101127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To determine if tuberculosis (TB) screening improves patient outcomes, we conducted two systematic reviews to investigate the effect of TB screening on diagnosis, treatment outcomes, deaths (clinical review assessing 23 outcome indicators); and patient costs (economic review). METHODS Pubmed, EMBASE, Scopus and the Cochrane Library were searched between 1/1/1980-13/4/2020 (clinical review) and 1/1/2010-14/8/2020 (economic review). As studies were heterogeneous, data synthesis was narrative. FINDINGS Clinical review: of 27,270 articles, 18 (n=3 trials) were eligible. Nine involved general populations. Compared to passive case finding (PCF), studies showed lower smear grade (n=2/3) and time to diagnosis (n=2/3); higher pre-treatment losses to follow-up (screened 23% and 29% vs PCF 15% and 14%; n=2/2); and similar treatment success (range 68-81%; n=4) and case fatality (range 3-11%; n=5) in the screened group. Nine reported on risk groups. Compared to PCF, studies showed lower smear positivity among those culture-confirmed (n=3/4) and time to diagnosis (n=2/2); and similar (range 80-90%; n=2/2) treatment success in the screened group. Case fatality was lower in n=2/3 observational studies; both reported on established screening programmes. A neonatal trial and post-hoc analysis of a household contacts trial found screening was associated with lower all-cause mortality. Economic review: From 2841 articles, six observational studies were eligible. Total costs (n=6) and catastrophic cost prevalence (n=4; range screened 9-45% vs PCF 12-61%) was lower among those screened. INTERPRETATION We found very limited patient outcome data. Collecting and reporting this data must be prioritised to inform policy and practice. FUNDING WHO and EDCTP.
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Affiliation(s)
- L Telisinghe
- London School of Hygiene and Tropical Medicine, London, UK
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - M Ruperez
- London School of Hygiene and Tropical Medicine, London, UK
| | - M Amofa-Sekyi
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - L Mwenge
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - T Mainga
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - R Kumar
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - M Hassan
- University Hospitals Plymouth NHS Trust, UK
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Egypt
| | - L.H Chaisson
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, USA
| | - F Naufal
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, USA
| | - A.E Shapiro
- Departments of Global Health and Medicine, University of Washington, Seattle, USA
| | - J.E Golub
- Johns Hopkins University School of Medicine, Center for Tuberculosis Research, Baltimore, USA
| | - C Miller
- Global TB programme, World Health Organization, Geneva, Switzerland
| | - E.L Corbett
- London School of Hygiene and Tropical Medicine, London, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - R.M Burke
- London School of Hygiene and Tropical Medicine, London, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - P MacPherson
- London School of Hygiene and Tropical Medicine, London, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - R.J Hayes
- London School of Hygiene and Tropical Medicine, London, UK
| | - V Bond
- London School of Hygiene and Tropical Medicine, London, UK
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | | | - E Klinkenberg
- London School of Hygiene and Tropical Medicine, London, UK
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - H.M Ayles
- London School of Hygiene and Tropical Medicine, London, UK
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
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24
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Teo AKJ, Singh SR, Prem K, Hsu LY, Yi S. Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis. Respir Res 2021; 22:251. [PMID: 34556113 PMCID: PMC8459488 DOI: 10.1186/s12931-021-01841-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Thirty countries with the highest tuberculosis (TB) burden bear 87% of the world's TB cases. Delayed diagnosis and treatment are detrimental to TB prognosis and sustain TB transmission in the community, making TB elimination a great challenge, especially in these countries. Our objective was to elucidate the duration and determinants of delayed diagnosis and treatment of pulmonary TB in high TB-burden countries. METHODS We conducted a systematic review and meta-analysis of quantitative and qualitative studies by searching four databases for literature published between 2008 and 2018 following PRISMA guidelines. We performed a narrative synthesis of the covariates significantly associated with patient, health system, treatment, and total delays. The pooled median duration of delay and effect sizes of covariates were estimated using random-effects meta-analyses. We identified key qualitative themes using thematic analysis. RESULTS This review included 124 articles from 14 low- and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC). The pooled median duration of delays (in days) were-patient delay (LIC/LMIC: 28 (95% CI 20-30); UMIC: 10 (95% CI 10-20), health system delay (LIC/LMIC: 14 (95% CI 2-28); UMIC: 4 (95% CI 2-4), and treatment delay (LIC/LMIC: 14 (95% CI 3-84); UMIC: 0 (95% CI 0-1). There was consistent evidence that being female and rural residence was associated with longer patient delay. Patient delay was also associated with other individual, interpersonal, and community risk factors such as poor TB knowledge, long chains of care-seeking through private/multiple providers, perceived stigma, financial insecurities, and poor access to healthcare. Organizational and policy factors mediated health system and treatment delays. These factors included the lack of resources and complex administrative procedures and systems at the health facilities. We identified data gaps in 11 high-burden countries. CONCLUSIONS This review presented the duration of delays and detailed the determinants of delayed TB diagnosis and treatment in high-burden countries. The gaps identified could be addressed through tailored approaches, education, and at a higher level, through health system strengthening and provision of universal health coverage to reduce delays and improve access to TB diagnosis and care. PROSPERO registration: CRD42018107237.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, #10-01, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Shweta R Singh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, USA
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25
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Dawkins B, Renwick C, Ensor T, Shinkins B, Jayne D, Meads D. What factors affect patients' ability to access healthcare? An overview of systematic reviews. Trop Med Int Health 2021; 26:1177-1188. [PMID: 34219346 DOI: 10.1111/tmi.13651] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This overview aims to synthesise global evidence on factors affecting healthcare access, and variations across low- and middle-income countries (LMICs) vs. high-income countries (HICs); to develop understanding of where barriers to healthcare access lie, and in what context, to inform tailored policies aimed at improving access to healthcare for all who need it. METHODS An overview of systematic reviews guided by a published protocol was conducted. Medline, Embase, Global Health and Cochrane Systematic Reviews databases were searched for published articles. Additional searches were conducted on the Gates Foundation, WHO and World Bank websites. Study characteristics and findings (barriers and facilitators to healthcare access) were documented and summarised. The methodological quality of included studies was assessed using an adapted version of the AMSTAR 2 tool. RESULTS Fifty-eight articles were included, 23 presenting findings from LMICs and 35 presenting findings from HICs. While many barriers to healthcare access occur in HICs as well as LMICs, the way they are experienced is quite different. In HICs, there is a much greater emphasis on patient experience; as compared to the physical absence of care in LMICs. CONCLUSIONS As countries move towards universal healthcare access, evaluation methods that account for health system and wider cultural factors that impact capacity to provide care, healthcare finance systems and the socio-cultural environment of the setting are required. Consequently, methods employed in HICs may not be appropriate in LMICs due to the stark differences in these areas.
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Affiliation(s)
- Bryony Dawkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Tim Ensor
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Bethany Shinkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Jayne
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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26
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van de Water BJ, Meyer TN, Wilson M, Young C, Gaunt B, le Roux KW. TB prevention cascade at a district hospital in rural Eastern Cape, South Africa. Public Health Action 2021; 11:97-100. [PMID: 34159070 DOI: 10.5588/pha.20.0055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Rural Eastern Cape, South Africa. OBJECTIVE To identify steps in the TB preventive care cascade from routinely collected data among TB patients at a district hospital prior to the implementation of a novel TB program. DESIGN This was a retrospective study. We adapted the TB prevention cascade to measure indicators routinely collected at district hospitals for TB using a cascade framework to evaluate outcomes in the cohort of close contacts. RESULTS A total of 1,722 charts of TB patients were reviewed. The majority of patients (87%) were newly diagnosed with no previous episodes of TB. A total of 1,548 (90%) patients identified at least one close contact. A total of 7,548 contacts were identified with a median of 4.9 (range 1-16) contacts per patient. Among all contacts identified, 2,913 (39%) were screened for TB. Only 15 (0.5%) started TB preventive therapy and 122 (4.4%) started TB treatment. Nearly 25% of all medical history and clinical information was left unanswered among the 1,722 TB charts reviewed. CONCLUSION Few close contacts were screened or started on TB preventive therapy in this cohort. Primary care providers for TB care in district health facilities should be informed of best practices for screening and treating TB infection and disease.
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Affiliation(s)
- B J van de Water
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - T N Meyer
- Department of Family Medicine, Walter Sisulu University, Mthatha, South Africa.,Zithulele District Hospital, Eastern Cape Department of Health, Mqunduli, South Africa
| | - M Wilson
- Advance Access and Delivery, Chapel Hill, NC, USA
| | - C Young
- Jabulani Rural Health Foundation, Mqanduli, South Africa
| | - B Gaunt
- Department of Family Medicine, Walter Sisulu University, Mthatha, South Africa.,Zithulele District Hospital, Eastern Cape Department of Health, Mqunduli, South Africa.,Primary Healthcare Directorate, University of Cape Town, Cape Town, South Africa
| | - K W le Roux
- Department of Family Medicine, Walter Sisulu University, Mthatha, South Africa.,Zithulele District Hospital, Eastern Cape Department of Health, Mqunduli, South Africa.,Primary Healthcare Directorate, University of Cape Town, Cape Town, South Africa
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27
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Aduh U, Ewa AU, Sam-Agudu NA, Urhioke O, Kusimo O, Ugwu C, Fadare OA, Anyaike C. Addressing gaps in adolescent tuberculosis programming and policy in Nigeria from a public health perspective. Int J Adolesc Med Health 2021; 33:41-51. [PMID: 33913304 DOI: 10.1515/ijamh-2020-0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/01/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Tuberculosis (TB) is a leading infectious cause of death globally. Of the estimated 10 million people who developed active TB in 2019, 1.8 million (18%) were adolescents and young adults aged 15-24 years. Adolescents have poorer rates of TB screening, treatment initiation and completion compared to adults. Unfortunately, there is relatively less programme, research and policy focus on TB for adolescents aged 10-19 years. This article reviews the scope of health services and the relevant policy landscape for TB case notification and care/treatment, TB/HIV management, and latent TB infection for adolescents in Nigeria. Additionally, it discusses considerations for TB vaccines in this population. CONTENT All Nigeria Federal Ministry of Health policy documents relevant to adolescent health services and TB, and published between 2000 and 2020 underwent narrative review. Findings were reported according to the service areas outlined in the Objectives. SUMMARY AND OUTLOOK Nine policy documents were identified and reviewed. While multiple policies acknowledge the needs of adolescents in public health and specifically in TB programming, these needs are often not addressed in policy, nor in program integration and implementation. The lack of age-specific epidemiologic and clinical outcomes data for adolescents contributes to these policy gaps. Poor outcomes are driven by factors such as HIV co-infection, lack of youth-friendly health services, and stigma and discrimination. Policy guidelines and innovations should include adaptations tailored to adolescent needs. However, these adaptations cannot be developed without robust epidemiological data on adolescents at risk of, and living with TB. Gaps in TB care integration into primary reproductive, maternal-child health and nutrition services should be addressed across multiple policies, and mechanisms for supervision, and monitoring and evaluation of integration be developed to guide comprehensive implementation. Youth-friendly TB services are recommended to improve access to quality care delivered in a patient-centered approach.
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Affiliation(s)
- Ufuoma Aduh
- World Health Organisation, Abuja, Nigeria
- Texila American University, Georgetown, Guyana
| | - Atana Uket Ewa
- Department of Paediatrics, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, USA
| | - Ochuko Urhioke
- National TB and Leprosy Control Programme, Federal Ministry of Health, Abuja, Nigeria
| | | | | | | | - Chukwuma Anyaike
- National TB and Leprosy Control Programme, Federal Ministry of Health, Abuja, Nigeria
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28
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Lee G, Meyer AJ, Kizito S, Katamba A, Davis JL, Armstrong-Hough M. Predictors of evaluation in child contacts of TB patients. Int J Tuberc Lung Dis 2021; 24:847-849. [PMID: 32912391 DOI: 10.5588/ijtld.20.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- G Lee
- Department of Infectious Diseases, Children´s Hospital of Philadelphia, Philadelphia, PA, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - A J Meyer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA, Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala
| | - S Kizito
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - J L Davis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA, Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, CT
| | - M Armstrong-Hough
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Department of Social and Behavioral Sciences and Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA, ,
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Coit J, Wong M, Galea JT, Mendoza M, Marin H, Tovar M, Chiang SS, Lecca L, Franke MF. Uncovering reasons for treatment initiation delays among children with TB in Lima, Peru. Int J Tuberc Lung Dis 2021; 24:1254-1260. [PMID: 33317668 DOI: 10.5588/ijtld.20.0079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND: Timely diagnosis and treatment of pediatric tuberculosis (TB) is critical to reducing mortality but remains challenging in the absence of adequate diagnostic tools. Even once a TB diagnosis is made, delays in treatment initiation are common, but for reasons that are not well understood.METHODS: To examine reasons for delay post-diagnosis, we conducted semi-structured interviews with Ministry of Health (MoH) physicians and field workers affiliated with a pediatric TB diagnostic study, and caregivers of children aged 0-14 years who were diagnosed with pulmonary TB in Lima, Peru. Interviews were analyzed using systematic comparative and descriptive content analysis.RESULTS: We interviewed five physicians, five field workers and 26 caregivers with children who initiated TB treatment < 7 days after diagnosis (n = 15) or who experienced a delay of ≥7 days (n = 11). Median time in delay from diagnosis to treatment initiation was 26 days (range 7-117). Reasons for delay included: health systems challenges (administrative hurdles, medication stock, clinic hours), burden of care on families and caregiver perceptions of disease severity.CONCLUSION: Reasons for delay in treatment initiation are complex. Interventions to streamline administrative processes and tools to identify and support families at risk for delays in treatment initiation are urgently needed.
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Affiliation(s)
- J Coit
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - M Wong
- Socios En Salud Sucursal, Lima, Peru
| | - J T Galea
- School of Social Work, University of South Florida, Tampa, FL, College of Public Health, University of South Florida, Tampa, FL
| | - M Mendoza
- Socios En Salud Sucursal, Lima, Peru
| | - H Marin
- Socios En Salud Sucursal, Lima, Peru
| | - M Tovar
- Socios En Salud Sucursal, Lima, Peru
| | - S S Chiang
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, Center for International Health Research, Rhode Island Hospital, Providence, RI, USA
| | - L Lecca
- Socios En Salud Sucursal, Lima, Peru
| | - M F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Lwin TT, Apidechkul T, Saising J, Upala P, Tamornpark R. Barriers to accessing TB clinics among Myanmar TB patients attending a Thailand‐Myanmar border hospital: a qualitative approach. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-03-2020-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeThis qualitative approach study aimed to understand the barriers to accessing a tuberculosis (TB) clinic in a Thai hospital as experienced by TB patients from Myanmar living on the Thailand-Myanmar border.Design/methodology/approachTwenty-two participants were asked to provide information. In-depth interviews were used to gather the information. Each interview lasted 40 min.FindingsTB patients from Myanmar experience several barriers to accessing TB treatment and care at Mae Sai Hospital, such as language and economic problems, although they are very satisfied with the quality of service and positive attitude of the health care providers. A long waiting time and lack of explanation of the pathogenesis of TB were noted as negative aspects by the patients and their relatives. The medical staff at the TB clinic were negatively affected by the excessive workload and unsuitability of some methods or technologies. Using budgetary subsidies from agencies to fund TB care and treatment was not sustainable. Foreign TB patients are not subsidized by the national universal insurance scheme of Thailand, and sending TB patients back to their home country is sometimes unavoidable.Originality/valueThailand and Myanmar should strengthen their collaboration and develop a system to improve the quality of TB patient care and management for those who are living in poverty and lack education, by focusing on reducing language and economic barriers to accessing health care services including support for medicines and laboratory materials related to TB case management among these populations.
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Singh AR, Kumar A, Shewade HD, Dhingra B. Poor adherence to TB diagnosis guidelines among under-five children with severe acute malnutrition in central India: A missed window of opportunity? PLoS One 2021; 16:e0248192. [PMID: 33711040 PMCID: PMC7954324 DOI: 10.1371/journal.pone.0248192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In India, under-five children with Severe Acute Malnutrition (SAM) are referred to Nutritional Rehabilitation Centers (NRCs). NRCs screen the causes of SAM including tuberculosis (TB). The national TB programme recommends upfront testing with a rapid molecular test if TB is suspected in children. OBJECTIVE We estimated the yield of and adherence to the TB diagnostic guidelines (clinical assessment and assessment for microbiological confirmation) among under-five children with SAM admitted at NRCs (six in district Sagar and four in district Sheopur) of Madhya Pradesh, India in 2017. We also explored the challenges in screening from the health care providers' perspective. METHODS It was an explanatory mixed method study. The NRC records were reviewed This was followed by three key informant interviews and three focus group discussions among staff of NRC and TB programme. Manual descriptive thematic analysis was performed. RESULTS Of 3230, a total of 2665(83%) children underwent Mantoux test, 2438(75%) underwent physical examination, 2277(70%) were asked about the symptoms suggestive of TB, 1220(38%) underwent chest radiograph and 485(15%) were asked for recent contact with TB. A total of 547(17%) underwent assessment for microbiological confirmation. Of 547, a total of 229 gastric aspirate specimens underwent rapid molecular test (24% positive) and 318 underwent sputum microscopy (44% positive). A total of 223 were diagnosed as TB (195 microbiologically and 28 clinically confirmed) and 209 were initiated on anti-TB treatment. The treatment outcome was favourable (cure or treatment completed) for 70(31%) and not recorded for 121(54%). The main perceived challenges in screening for TB were poor team skills, lack of diagnostic facilities and poor understanding of the guidelines due to inadequate training. CONCLUSION Though NRCs provided a unique window of opportunity for the screening and management of TB among under-five children with SAM, the utilization of this opportunity remained suboptimal.
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Affiliation(s)
| | - Amber Kumar
- All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Hemant Deepak Shewade
- The Union South East Asia, New Delhi, India
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Bhavna Dhingra
- All India Institute of Medical Sciences (AIIMS), Bhopal, India
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Alene M, Assemie MA, Yismaw L, Gedif G, Ketema DB, Gietaneh W, Chekol TD. Patient delay in the diagnosis of tuberculosis in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2020; 20:797. [PMID: 33109110 PMCID: PMC7590610 DOI: 10.1186/s12879-020-05524-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022] Open
Abstract
Background Delay in the diagnosis of Tuberculosis (TB) remains a major challenge against achieving effective TB prevention and control. Though a number of studies with inconsistent findings were conducted in Ethiopia; unavailability of a nationwide study determining the median time of patient delays to TB diagnosis is an important research gap. Therefore, this study aimed to determine the pooled median time of the patient delay to TB diagnosis and its determinants in Ethiopia. Methods We followed PRISMA checklist to present this study. We searched from Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library databases for studies. The comprehensive search for relevant studies was done by two of the authors (MA and LY) up to the 10th of October 2019. Risk of bias was assessed using the Newcastle-Ottawa scale adapted for observational studies. Data were pooled and a random effect meta-analysis model was fitted to provide the overall median time of patient delay and its determinants in Ethiopia. Furthermore, subgroup analyses were conducted to investigate how the median time of patient delay varies across different groups of studies. Results Twenty-four studies that satisfied the eligibility criteria were included. Our meta-analysis showed that the median time of the patient delay was 24.6 (95%CI: 20.8–28.4) days. Living in rural area (OR: 2.19, 95%CI: 1.51–3.18), and poor knowledge about TB (OR: 2.85, 95%CI: 1.49–5.47) were more likely to lead to prolonged delay. Patients who consult non-formal health providers (OR: 5.08, 95%CI: 1.56–16.59) had a prolonged delay in the diagnosis of TB. Moreover, the narrative review of this study showed that age, educational level, financial burden and distance travel to reach the nearest health facility were significantly associated with a patient delay in the diagnosis of TB. Conclusions In conclusion, patients are delayed more-than three weeks in the diagnosis of TB. Lack of awareness about TB, consulting non-formal health provider, and being in the rural area had increased patient delay to TB diagnosis. Increasing public awareness about TB, particularly in rural and disadvantaged areas could help to early diagnosis of TB. Supplementary information Supplementary information accompanies this paper at 10.1186/s12879-020-05524-3.
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Affiliation(s)
- Muluneh Alene
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia.
| | | | - Leltework Yismaw
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | - Getnet Gedif
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | | | - Wodaje Gietaneh
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
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Understanding the gaps in DR-TB care cascade in Nigeria: A sequential mixed-method study. J Clin Tuberc Other Mycobact Dis 2020; 21:100193. [PMID: 33102811 PMCID: PMC7578750 DOI: 10.1016/j.jctube.2020.100193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Despite the availability of free drug-resistant tuberculosis (DR-TB) care in Nigeria since 2011, the country continues to tackle low case notification and treatment rates. In 2018, 11% of an estimated 21,000 cases were diagnosed and 9% placed on treatment. These low rates are nevertheless a marked improvement from 2015 when only 3.4% were diagnosed and 2.3% placed on treatment of an estimated 29,000 cases. This study describes the Nigerian DR-TB care cascade from 2013 to 2017 and considers factors influencing gaps in care. Methods Our study utilized a mixed-method design. For the quantitative component, we utilized the national diagnosis and treatment databases, as well as the World Health Organization’s estimates for prevalence to construct a 5-year care cascade: numbers of patients at each level of DR-TB care, including incident cases, individuals who accessed testing, were diagnosed, initiated treated and completed treatment in Nigeria between 2013 and 2017. Using retrospective data for patients diagnosed in 2015, we performed the Fisher’s exact test to determine the association between patient (age and gender) and provider/patient (region- north or south) variables, permitting a closer look at the gaps in care revealed across the 5 years. Barriers to care were explored using framework thematic analysis of 57 qualitative interviews and focus group discussions with patients, including 5 cases not initiated on treatment from the 2015 cohort, treatment supporters, community members, healthcare workers and program managers in 2017. Results A 5-year analysis of cascade of care data shows significant, but inadequate, increases in overall numbers of cases accessing care. On average, between 2013 and 2017, 80% of estimated cases did not access testing; 75% of those who tested were not diagnosed; 36% of those diagnosed were not initiated on treatment and 23% of these did not finish treatment. In 2015, children and patients in Northern Nigeria had odds of 0.3 [95% CI 0.1–0.7] and 0.4 [0.3–0.5] of completing treatment once diagnosed; while males were shown to have a 1.34 [95% CI 1.0–1.7] times greater chance of completing treatment after diagnosis. The main themes from qualitative data identified barriers to care along the care cascade at individual, family and community, as well as health systems levels. At the individual level, a lack of awareness of the true cause of disease and the availability of ‘free’ care was a recurring theme. Family interference was found to be a particular challenge for children and women. At the health system level, low index of suspicion, lack of rapid diagnostic tools and human resource shortages appeared to limit patients’ access. Conclusions Any gains in diagnostic technology and shorter regimens are lost with inadequate access to DR-TB services. The biggest losses in the Nigerian cascade happen before treatment initiation. There is a need for urgent action on identified gaps in the DR-TB cascade in order to improve care continuity at multiple stages, improve health service delivery and facilitate TB control in Nigeria.
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Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: A systematic review. BMC Public Health 2020; 20:1108. [PMID: 32664849 PMCID: PMC7362649 DOI: 10.1186/s12889-020-09169-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 06/25/2020] [Indexed: 02/08/2023] Open
Abstract
Background Immunization to prevent infectious diseases is a core strategy to improve childhood health as well as survival. It remains a challenge for some African countries to attain the required childhood immunization coverage. We aim at identifying individual barriers confronting parents/caretakers, providers, and health systems that hinder childhood immunization coverage in Sub-Saharan Africa. Method This systematic review searched PubMed/MEDLINE, Web of Science and EMBASE. We restricted to published articles in English that focused on childhood immunization barriers in sub-Saharan Africa from January 1988 to December 2019. We excluded studies if: focused on barriers to immunization for children in other regions of the world, studied adult immunization barriers; studies not available on the university library, they were editorial, reports, reviews, supplement, and bulletins. Study designs included were cross-sectional, second-hand data analysis; and case control. Results Of the 2652 items identified, 48 met inclusion criteria. Parents/caretakers were the most common subjects. Nine articles were of moderate and 39 were of high methodological quality. Nine studies analyzed secondary data; 36 used cross-sectional designs and three employed case control method. Thirty studies reported national immunization coverage of key vaccines for children under one, eighteen did not. When reported, national immunization coverage of childhood vaccines is reported to be low. Parents/caretaker’ barriers included lack of knowledge of immunization, distance to access point, financial deprivation, lack of partners support, and distrust in vaccines and immunization programs. Other associated factors for low vaccine rates included the number of off-springs, lifestyle, migration, occupation and parent’s forgetfulness, inconvenient time and language barrier. Barriers at health system level cited by healthcare providers included limited human resources and inadequate infrastructures to maintain the cold chain and adequate supply of vaccines. Conclusion In this review we identified more thoroughly the parents/caretakers’ barriers than those of providers and health systems. Factors that influenced decisions to get children vaccinated were mainly their gender, beliefs, socio-culture factors in the communities in which they live. Thus it is vital that immunization programs consider these barriers and address the people and societies in their communities across sub-Saharan Africa.
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Affiliation(s)
- Joseph Benjamin Bangura
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Shuiyuan Xiao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China. .,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.
| | - Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Feiyun Ouyang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Lei Chen
- Department of Pediatrics, Faculty, Global Health Initiative, Yale University School of Medicine, New Haven, USA
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Oga-Omenka C, Tseja-Akinrin A, Sen P, Mac-Seing M, Agbaje A, Menzies D, Zarowsky C. Factors influencing diagnosis and treatment initiation for multidrug-resistant/rifampicin-resistant tuberculosis in six sub-Saharan African countries: a mixed-methods systematic review. BMJ Glob Health 2020; 5:e002280. [PMID: 32616481 PMCID: PMC7333807 DOI: 10.1136/bmjgh-2019-002280] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Drug-resistant tuberculosis burdens fragile health systems in sub-Saharan Africa (SSA), complicated by high prevalence of HIV. Several African countries reported large gaps between estimated incidence and diagnosed or treated cases. Our review aimed to identify barriers and facilitators influencing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in SSA, which is necessary to develop effective strategies to find the missing incident cases and improve quality of care. METHODS Using an integrative design, we reviewed and narratively synthesised qualitative, quantitative and mixed-methods studies from nine electronic databases: Medline, Global Health, CINAHL, EMBASE, Scopus, Web of Science, International Journal of Tuberculosis and Lung Disease, PubMed and Google Scholar (January 2006 to June 2019). RESULTS Of 3181 original studies identified, 55 full texts were screened, and 29 retained. The studies included were from 6 countries, mostly South Africa. Barriers and facilitators to DR-TB care were identified at the health system and patient levels. Predominant health system barriers were laboratory operational issues, provider knowledge and attitudes and information management. Facilitators included GeneXpert MTB/RIF (Xpert) diagnosis and decentralisation of services. At the patient level, predominant barriers were patients being lost to follow-up or dying due to lengthy diagnostic and treatment delays, negative public sector care perceptions, family, work or school commitments and using private sector care. Some patient-level facilitators were HIV positivity and having more symptoms. CONCLUSION Case detection and treatment for DR -TB in SSA currently relies on individual patients presenting voluntarily to the hospital for care. Specific interventions targeting identified barriers may improve rates and timeliness of detection and treatment.
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Affiliation(s)
- Charity Oga-Omenka
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique, Université de Montréal (CReSP), Montréal, Quebec, Canada
- McGill International TB Centre, Montreal, Quebec, Canada
| | | | - Paulami Sen
- McGill International TB Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Muriel Mac-Seing
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique, Université de Montréal (CReSP), Montréal, Quebec, Canada
| | | | - Dick Menzies
- McGill International TB Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Christina Zarowsky
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique, Université de Montréal (CReSP), Montréal, Quebec, Canada
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Valvi C, Chandanwale A, Khadse S, Kulkarni R, Kadam D, Kinikar A, Joshi S, Lokhande R, Pardeshi G, Garg P, Gupte N, Jain D, Suryavanshi N, Golub JE, Shankar A, Gupta A, Dhumal G, Deluca A, Bollinger RC. Delays and barriers to early treatment initiation for childhood tuberculosis in India. Int J Tuberc Lung Dis 2020; 23:1090-1099. [PMID: 31627774 DOI: 10.5588/ijtld.18.0439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: India accounts for 27% of global childhood tuberculosis (TB) burden. Understanding barriers to early diagnosis and treatment in children may improve care and outcomes.METHODS: A cross-sectional study was performed among 89 children initiated on anti-TB treatment from a public hospital in Pune during 2016, using a structured questionnaire and hospital records. Health care providers (HCPs) were defined as medical personnel consulted about the child's TB symptoms. Time-to-treatment initiation (TTI) was defined as the number of days between onset of TB symptoms and anti-TB treatment initiation. Based on Revised National TB Control Programme recommendations, delayed TTI was defined as >28 days.RESULTS: Sixty-seven (75%) of 89 enrolled children had significant TTI delays (median 51 days, interquartile range [IQR] 27-86). Sixty-six (74%) children visited 1-8 HCPs in the private sector before approaching the public sector. The median HCP delay was 28 days (IQR 10-75). Bacille Calmette-Guérin vaccination (aOR 10.96, P = 0.04) and loss of appetite (aOR 4.44, P = 0.04) were associated with delayed TTI.CONCLUSION: The majority of the children had TTI delays due to delays by HCPs in the private sector. Strengthening HCP competency in TB symptom screening and encouraging early referrals are crucial for rapid scaling up of early treatment initiation in childhood TB.
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Affiliation(s)
- C Valvi
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - A Chandanwale
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - S Khadse
- Rajiv Gandhi Medical College and Chatrapati Shivaji Maharaj Hospital, Kalwa, Thane
| | - R Kulkarni
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - D Kadam
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - A Kinikar
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - S Joshi
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - R Lokhande
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - G Pardeshi
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi
| | - P Garg
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - N Gupte
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - D Jain
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - N Suryavanshi
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - J E Golub
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - A Shankar
- Department of Environmental Health and Engineering
| | - A Gupta
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India, Johns Hopkins University School of Medicine, Baltimore, MD
| | - G Dhumal
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - A Deluca
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - R C Bollinger
- Johns Hopkins University School of Medicine, Baltimore, MD
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Shin H, Ngwira LG, Tucker A, Chaisson RE, Corbett EL, Dowdy D. Patient-incurred cost of inpatient treatment for Tuberculosis in rural Malawi. Trop Med Int Health 2020; 25:624-634. [PMID: 32034984 PMCID: PMC7658961 DOI: 10.1111/tmi.13381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To mitigate the economic burden of tuberculosis (TB), it is important to fully understand the costs of TB treatment from the patient perspective. We therefore sought to quantify the patient-incurred cost of TB treatment in rural Malawi, with specific focus on costs borne by patients requiring inpatient hospitalisation. METHODS We conducted a cross-sectional survey of 197 inpatients and 156 outpatients being treated for TB in rural Malawi. We collected data on out-of-pocket costs and lost wages, including costs to guardians. Costs for inpatient TB treatment were estimated and compared to costs for outpatient TB treatment. We then explored the equity distribution of inpatient TB treatment cost using concentration curves. RESULTS Despite free government services, inpatients were estimated to incur a mean of $137 (standard deviation: $147) per initial TB episode, corresponding to >50% of annual household spending among patients in the lowest expenditure quintile. Non-medical hospitalisation costs accounted for 88% of this total. Patients treated entirely as outpatients incurred estimated costs of $25 (standard deviation: $15) per episode. The concentration curves showed that, among individuals hospitalised for an initial TB episode, poorer patients shouldered a much greater proportion of inpatient TB treatment costs than wealthier ones (concentration index: -0.279). CONCLUSION Patients hospitalised for TB in resource-limited rural Malawi experience devastating costs of TB treatment. Earlier diagnosis and treatment must be prioritised if we are to meet goals of effective TB control, avoidance of catastrophic costs and provision of appropriate patient-centred care in such settings.
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Affiliation(s)
- Hyejeong Shin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lucky G. Ngwira
- HIV and TB Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, UK
| | - Austin Tucker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Richard E Chaisson
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth L Corbett
- HIV and TB Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Mohammed H, Oljira L, Roba KT, Ngadaya E, Ajeme T, Haile T, Kidane A, Manyazewal T, Fekadu A, Yimer G. Burden of tuberculosis and challenges related to screening and diagnosis in Ethiopia. J Clin Tuberc Other Mycobact Dis 2020; 19:100158. [PMID: 32258437 PMCID: PMC7113623 DOI: 10.1016/j.jctube.2020.100158] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION One-third of tuberculosis (TB) cases in Ethiopia are missing from care for reasons that are not well studied. The aim of this study was to assess TB burden and identify challenges related to TB screening and diagnosis in Ethiopia. METHODS A facility-based cross-sectional study was conducted in seven health facilities selected from two regions and 2 city administrations of Ethiopia using stratified random sampling procedures. The data of 1,059,065 patients were included from outpatient department, HIV clinic, diabetic, and maternal-child health clinics. Data were collected from October to December 2018 using a retrospective review of three years' facility data (2015 to 2017) supplemented by a semi-structured interview with purposively selected health care workers and heads of the health facilities. RESULTS A total of 1,059,065 patients visited the health facilities in three years, of these, 978,480 (92.4%) were outpatients. Of the total, 20,284 (2%) were presumptive TB cases (with 14 days or more cough), 12.2% (2483/20,284) of which had TB. For the type of TB, 604 (24.3%) were smear-positive pulmonary TB (PTB), 789 (31.8%) were smear-negative PTB, 719 (29%) were extra-pulmonary TB, and data were missing for the rest. TB screening was integrated into HIV clinic, outpatient department, diabetic clinic but not with the maternal and child clinics. High patient load, weak TB laboratory specimen referral system, and shortage of TB diagnostic tools including Xpert MTB/RIF assay and chest X-ray, were the major challenges in the screening and diagnosis of TB. CONCLUSION The burden of TB was high in the study setting, and frequent interruption of laboratory reagents and supplies hampered TB screening and diagnostic services. Realizing the END-TB strategy in such resource-limited settings requires sustainable TB diagnostic capacity and improved case detection mechanisms, with national TB programs strongly integrated into the general health care system.
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Key Words
- AFB, acid fast bacilli
- ANC, ant-natal care
- ART, anti-retroviral therapy, DOTS, directly observed treatment, short course
- Diagnosis
- EPTB, extra pulmonary tuberculosis
- Ethiopia
- FMoH, Federal Ministry of Health
- HIV, human immunodeficiency virus
- MDR-TB, multi-drug resistant tuberculosis
- Maternal and child health
- NGOs, non-governmental organizations
- NTB, National TB program
- PFSA, Pharmaceutical Fund and Supply Agency
- PMTCT, prevention mother to child transmission
- PNC, postnatal care
- Screening
- TB, tuberculosis
- Tuberculosis
- WHO, World Health Organization
- Xpert mtb/rif assay
- eHMIS, electronic Health Management Information System
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Affiliation(s)
- Hussen Mohammed
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, P.O. Box 1362, Dire Dawa, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, Dares Saalem, Tanzania
| | - Tigest Ajeme
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, P.O. Box 1362, Dire Dawa, Ethiopia
| | - Tewodros Haile
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Achenef Kidane
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, P.O. Box 1362, Dire Dawa, Ethiopia
- Ohio State Global One Health initiative, Office of International Affairs, The Ohio State University, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, P.O. Box 1362, Dire Dawa, Ethiopia
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, P.O. Box 1362, Dire Dawa, Ethiopia
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Getnet Yimer
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, P.O. Box 1362, Dire Dawa, Ethiopia
- Ohio State Global One Health initiative, Office of International Affairs, The Ohio State University, Addis Ababa, Ethiopia
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Lisboa M, Fronteira I, Mason PH, Martins MDRO. National TB program shortages as potential factor for poor-quality TB care cascade: Healthcare workers' perspective from Beira, Mozambique. PLoS One 2020; 15:e0228927. [PMID: 32059032 PMCID: PMC7021283 DOI: 10.1371/journal.pone.0228927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/26/2020] [Indexed: 11/25/2022] Open
Abstract
Background Mozambique is one of the countries with the deadly implementation gaps in the tuberculosis (TB) care and services delivery. In-hospital delays in TB diagnosis and treatment, transmission and mortality still persist, in part, due to poor-quality of TB care cascade. Objective We aimed to assess, from the healthcare workers’ (HCW) perspective, factors associated with poor-quality TB care cascade and explore local sustainable suggestions to improve in-hospital TB management. Methods In-depth interviews and focus group discussions were conducted with different categories of HCW. Audio-recording and written notes were taken, and content analysis was performed through atlas.ti7. Results Bottlenecks within hospital TB care cascade, lack of TB staff and task shifting, centralized and limited time of TB laboratory services, and fear of healthcare workers getting infected by TB were mentioned to be the main factors associated with implementation gaps. Interviewees believe that task shifting from nurses to hospital auxiliary workers, and from higher and well-trained to lower HCW are accepted and feasible. The expansion and use of molecular TB diagnostic tools are seen by the interviewees as a proper way to fight effectively against both sensitive and MDR TB. Ensuring provision of N95 respiratory masks is believed to be an essential requirement for effective engagement of the HCW on high-quality in-hospital TB care. For monitoring and evaluation, TB quality improvement teams in each health facility are considered to be an added value. Conclusion Shortage of resources within the national TB control programme is one of the potential factors for poor-quality of the TB care cascade. Task shifting of TB care and services delivery, decentralization of the molecular TB diagnostic tools, and regular provision of N95 respiratory masks should contribute not just to reduce the impact of resource scarceness, but also to ensure proper TB diagnosis and treatment to both sensitive and MDR TB.
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Affiliation(s)
- Miguelhete Lisboa
- Centro de Investigação Operacional da Beira (CIOB), Instituto Nacional de Saúde (INS), Beira, Mozambique
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa, Lisbon, Portugal
- * E-mail:
| | - Inês Fronteira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Paul H. Mason
- School of Social Sciences, Monash University, Clayton, Australia
| | - Maria do Rosário O. Martins
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa, Lisbon, Portugal
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Berry KM, Rodriguez CA, Berhanu RH, Ismail N, Mvusi L, Long L, Evans D. Treatment outcomes among children, adolescents, and adults on treatment for tuberculosis in two metropolitan municipalities in Gauteng Province, South Africa. BMC Public Health 2019; 19:973. [PMID: 31331311 PMCID: PMC6647101 DOI: 10.1186/s12889-019-7257-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 06/28/2019] [Indexed: 11/12/2022] Open
Abstract
Background Gauteng Province has the second lowest tuberculosis (TB) incidence rate in South Africa but the greatest proportion of TB/HIV co-infection, with 68% of TB patients estimated to have HIV. TB treatment outcomes are well documented at the national and provincial level; however, knowledge gaps remain on how outcomes differ across detailed age groups. Methods Using data from South Africa’s National Electronic TB Register (ETR), we assessed all-cause mortality and loss to follow-up (LTFU) among patients initiating treatment for TB between 01/2010 and 12/2015 in the metropolitan municipalities of Ekurhuleni Metropolitan Municipality and the City of Johannesburg in Gauteng Province. We excluded patients who were missing age, had known drug-resistance, or transferred into TB care from sites outside the two metropolitan municipalities. Among patients assigned a treatment outcome, we investigated the association between age group at treatment initiation and mortality or LTFU (treatment interruption of ≥2 months) within 10 months after treatment initiation using Cox proportional hazard models and present hazard ratios and Kaplan-Meier survival curves. Results We identified 182,890 children (<10 years), young adolescent (10–14), older adolescent (15–19), young adult (20–24), adult (25–49), and older adult (≥50) TB cases without known drug-resistance. ART coverage among HIV co-infected patients was highest for young adolescents (64.3%) and lowest for young adults (54.0%) compared to other age groups (all over 60%). Treatment success exceeded 80% in all age groups (n = 170,017). All-cause mortality increased with age. Compared to adults, young adults had an increased hazard of LTFU (20–24 vs 25–49 years; aHR 1.43 95% CI: 1.33, 1.54) while children, young adolescents, and older adults had lower hazard of LTFU. Patients with HIV on ART had a lower risk of LTFU, but greater risk of death when compared to patients without HIV. Conclusions Young adults in urban areas of Gauteng Province experience a disproportionate burden of LTFU and low coverage of ART among co-infected patients. This group should be targeted for interventions aimed at improving clinical outcomes and retention in both TB and HIV care.
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Affiliation(s)
- Kaitlyn M Berry
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Carly A Rodriguez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Rebecca H Berhanu
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Health Economics and Epidemiology Research Office, Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Postnet Suite 212, Private Bag X2600, Houghton, Johannesburg, 2041, South Africa
| | - Nazir Ismail
- National Institute for Communicable Diseases, Johannesburg, South Africa.,Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Faculty of Health Sciences, Department of Internal Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Lindiwe Mvusi
- National Department of Health, Tuberculosis Cluster, Pretoria, South Africa
| | - Lawrence Long
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Health Economics and Epidemiology Research Office, Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Postnet Suite 212, Private Bag X2600, Houghton, Johannesburg, 2041, South Africa
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Postnet Suite 212, Private Bag X2600, Houghton, Johannesburg, 2041, South Africa.
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Barriers to access and adherence to tuberculosis services, as perceived by patients: A qualitative study in Mozambique. PLoS One 2019; 14:e0219470. [PMID: 31291352 PMCID: PMC6619801 DOI: 10.1371/journal.pone.0219470] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/24/2019] [Indexed: 01/05/2023] Open
Abstract
Introduction Tuberculosis (TB) continues to be a leading cause of death in Sub-Saharan Africa, including Mozambique. While diagnostic methods and total notifications are improving, significant gaps remain between total numbers of TB cases annually, and the number that are notified. The purpose of this study was to elicit Mozambican patients with drug sensitive TB (DS-TB), TB/HIV and Multi drug resistant tuberculosis (MDR-TB) understanding and assessment of the quality of care for DS-TB, HIV/TB and MDR-TB services in Mozambique, along with challenges to effectively preventing, diagnosing and treating TB. Materials and methods Qualitative data was collected via separate focus group discussions consisting of patients with DS-TB, TB/HIV and MDR-TB at four health centers in Sofala and Manica Province, Mozambique, to describe knowledge on TB, HIV and MDR-TB, and identify barriers to access and adherence to services and their recommendations for improvement. A total of 51 patients participated in 11 discussions. Content analysis was done and main themes were identified. Results Focus groups shared a number of prominent themes. Respondents identified numerous challenges including delays in diagnosis, stigma related with diagnosis and treatment, long waits at health facilities, the absence of nutritional support for patients with TB, the absence of a comprehensive psychosocial support program, and the lack of overall knowledge about TB or multi drug resistant TB in the community. Discussion TB patients in central Mozambique identified many challenges to effectively preventing, diagnosing and treating tuberculosis. Awareness strengthening in the community, continuous quality monitoring and in-service training is needed to increase screening, diagnosis and treatment for TB, HIV/TB and MDR-TB.
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Teo AKJ, Singh SR, Prem K, Hsu LY, Yi S. Delayed diagnosis and treatment of pulmonary tuberculosis in high-burden countries: a systematic review protocol. BMJ Open 2019; 9:e029807. [PMID: 31289094 PMCID: PMC6629411 DOI: 10.1136/bmjopen-2019-029807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/05/2019] [Accepted: 06/12/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Countries identified to bear the highest tuberculosis (TB) incidence account for approximately 85% of the global TB burden. TB is curable, yet nearly 40% of TB cases remained undiagnosed hence delaying treatment and perpetuating transmission. This systematic review aimed to review current evidence on factors associated with delayed diagnosis and treatment of TB in the high TB-burden countries. METHODS AND ANALYSIS This systematic review will incorporate qualitative and observational study designs published between 2008 and 2018. Articles will be retrieved from major databases including PubMed, EMBASE, CINAHL and PsycINFO. Reference lists of key articles, including relevant systematic reviews and meta-analysis, will be screened for additional studies. Two independent reviewers will screen and select studies, extract data and assess the quality and risk of bias of each study. Study-specific estimates will be pooled by meta-analysis, and effect sizes will be presented as OR and their 95% CI. Levels of heterogeneity will be evaluated using chi-square statistic Q and I2. Publication bias will be assessed using forest plots and Egger's tests. Qualitative findings and sample quotes will be extracted. Textual references to the topics of interest will be retrieved and categorised using qualitative thematic analysis. We will triangulate quantitative and qualitative findings for a complete understanding of the reasons for delayed TB diagnosis and treatment. Results will be presented by geographical region. ETHICS AND DISSEMINATION This study will be conducted based on published data. This systematic review may provide insights into the reasons for delayed TB diagnosis in high-burden countries. These findings will also inform future research and key stakeholders in developing interventions to reach these undiagnosed cases effectively. Findings from this review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018107237.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shweta R Singh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Center for Population Health Research, KHANA, Phnom Penh, Cambodia
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Wobudeya E, Jaganath D, Sekadde MP, Nsangi B, Haq H, Cattamanchi A. Outcomes of empiric treatment for pediatric tuberculosis, Kampala, Uganda, 2010-2015. BMC Public Health 2019; 19:446. [PMID: 31035984 PMCID: PMC6489192 DOI: 10.1186/s12889-019-6821-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/15/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Childhood tuberculosis (TB) diagnoses often lack microbiologic confirmation and require empiric treatment. Barriers to empiric treatment include concern for poor outcomes and adverse effects. We thus determined the outcomes of empiric TB treatment from a retrospective cohort of children at a national referral hospital in Kampala, Uganda from 2010 to 2015. METHODS Children were diagnosed clinically and followed through treatment. Demographics, clinical data, outcome and any adverse events were extracted from patient charts. A favorable outcome was defined as a child completing treatment with clinical improvement. We performed logistic regression to assess factors associated with loss to follow up and death. RESULTS Of 516 children, median age was 36 months (IQR 15-73), 55% (95% CI 51-60%) were male, and HIV prevalence was 6% (95% CI 4-9%). The majority (n = 422, 82, 95% CI 78-85%) had a favorable outcome, with no adverse events that required treatment discontinuation. The most common unfavorable outcomes were loss to follow-up (57/94, 61%) and death (35/94, 37%; overall mortality 7%). In regression analysis, loss to follow up was associated with age 10-14 years (OR 2.38, 95% CI 1.15-4.93, p = 0.02), HIV positivity (OR 3.35, 95% CI 1.41-7.92, p = 0.01), hospitalization (OR 4.14, 95% CI 2.08-8.25, p < 0.001), and living outside of Kampala (OR 2.64, 95% CI 1.47-4.71, p = 0.001). Death was associated with hospitalization (OR 4.57, 95% CI 2.0-10.46, p < 0.001), severe malnutrition (OR 2.98, 95% CI 1.07-8.27, p = 0.04), baseline hepatomegaly (OR 4.11, 95% CI 2.09-8.09, p < 0.001), and living outside of Kampala (OR 2.41, 95% CI 1.17-4.96, p = 0.02). CONCLUSIONS Empiric treatment of child TB was effective and safe, but treatment success remained below the 90% target. Addressing co-morbidities and improving retention in care may reduce unfavorable outcomes.
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Affiliation(s)
- Eric Wobudeya
- Directorate of Pediatrics & Child Health, Mulago National Referral Hospital, P.O. Box 23491, Kampala, Uganda.
| | - Devan Jaganath
- Division of Pediatric Infectious Diseases, University of California, 550 16th St. 4th floor, San Francisco, CA, 94158, USA
| | - Moorine Penninah Sekadde
- National TB and Leprosy Program (NTLP), Plot 6, Lourdel Road, Nakasero, P. O. Box 7272, Kampala, Uganda
| | - Betty Nsangi
- USAID RHITES-EC, University Research Co. LLC, Plot 40, Ntinda II Road, PO Box 28745, Kampala, Uganda
| | - Heather Haq
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California, 1001 Potrero Ave, SFGH 5, San Francisco, CA, 94110, USA.,Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco, USA.,Curry International Tuberculosis Center, University of California, San Francisco, USA
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Sulistyono RE, Susanto T, Tristiana RD. Barriers in Tuberculosis Treatment in Rural Areas (Tengger, Osing and Pandalungan) in Indonesia Based on Public Health Center Professional Workers Perspectives: a Qualitative Research. JURNAL NERS 2019. [DOI: 10.20473/jn.v14i1.10270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Tuberculosis (TB) is still one of the main health problems in Indonesia. Various efforts have been made by the government to handle the TB problem in Indonesia, one of which is implementing a direct observed therapy short course (DOTS) program. However, the handling of TB disease in Indonesia, especially in rural areas is still not optimal. This study aims to explore barriers to the handling of TB in rural areas from the perspective of public health center professionals.Methods: This study is a qualitative research with a phenomenological approach. Sampling was done by purposive sampling with a sample of 8 participants. Data is collected through focus group discussions. Thematic analysis is carried out using colaizi step.Results: This study obtained two themes. Theme 1 is the barriers in the aspect of TB patients and Theme 2, which is barriers from the aspect of health care facilities.Conclusion: This study obtained two themes. Theme 1 is the barriers in the aspect of TB patients and Theme 2, which is barriers from the aspect of health care facilities.
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Nelson KN, Shah NS, Mathema B, Ismail N, Brust JCM, Brown TS, Auld SC, Omar SV, Morris N, Campbell A, Allana S, Moodley P, Mlisana K, Gandhi NR. Spatial Patterns of Extensively Drug-Resistant Tuberculosis Transmission in KwaZulu-Natal, South Africa. J Infect Dis 2018; 218:1964-1973. [PMID: 29961879 PMCID: PMC6217717 DOI: 10.1093/infdis/jiy394] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 06/26/2018] [Indexed: 12/29/2022] Open
Abstract
Background Transmission is driving the global drug-resistant tuberculosis (TB) epidemic; nearly three-quarters of drug-resistant TB cases are attributable to transmission. Geographic patterns of disease incidence, combined with information on probable transmission links, can define the spatial scale of transmission and generate hypotheses about factors driving transmission patterns. Methods We combined whole-genome sequencing data with home Global Positioning System coordinates from 344 participants with extensively drug-resistant (XDR) TB in KwaZulu-Natal, South Africa, diagnosed from 2011 to 2014. We aimed to determine if genomically linked (difference of ≤5 single-nucleotide polymorphisms) cases lived close to one another, which would suggest a role for local community settings in transmission. Results One hundred eighty-two study participants were genomically linked, comprising 1084 case-pairs. The median distance between case-pairs' homes was 108 km (interquartile range, 64-162 km). Between-district, as compared to within-district, links accounted for the majority (912/1084 [84%]) of genomic links. Half (526 [49%]) of genomic links involved a case from Durban, the urban center of KwaZulu-Natal. Conclusions The high proportions of between-district links with Durban provide insight into possible drivers of province-wide XDR-TB transmission, including urban-rural migration. Further research should focus on characterizing the contribution of these drivers to overall XDR-TB transmission in KwaZulu-Natal to inform design of targeted strategies to curb the drug-resistant TB epidemic.
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Affiliation(s)
- Kristin N Nelson
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - N Sarita Shah
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barun Mathema
- Mailman School of Public Health, Columbia University, New York, New York
| | - Nazir Ismail
- National Institute for Communicable Diseases, Johannesburg
- University of Pretoria, South Africa
| | - James C M Brust
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Tyler S Brown
- Infectious Diseases Division, Massachusetts General Hospital, Boston
| | - Sara C Auld
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Natashia Morris
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg
| | - Angie Campbell
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Salim Allana
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Pravi Moodley
- National Health Laboratory Service, University of KwaZulu-Natal, Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Koleka Mlisana
- National Health Laboratory Service, University of KwaZulu-Natal, Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Neel R Gandhi
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
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Ogbo FA, Ogeleka P, Okoro A, Olusanya BO, Olusanya J, Ifegwu IK, Awosemo AO, Eastwood J, Page A. Tuberculosis disease burden and attributable risk factors in Nigeria, 1990-2016. Trop Med Health 2018; 46:34. [PMID: 30262990 PMCID: PMC6156953 DOI: 10.1186/s41182-018-0114-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/04/2018] [Indexed: 12/18/2022] Open
Abstract
Background According to the World Health Organization, Nigeria is one of the countries with a high burden of tuberculosis (TB) worldwide. Improving the burden of TB among HIV-negative people would require comprehensive and up-to-date data to inform targeted policy actions in Nigeria. The study aimed to describe the incidence, prevalence, mortality, disability-adjusted life years (DALYs) and risk factors of tuberculosis in Nigeria between 1990 and 2016. Methods This study used the most recent data from the global burden of disease study 2016. TB deaths were estimated using the Cause of Death Ensemble model, while TB incidence, prevalence and DALYs, as well as years of life lost and years of life lived with disability were calculated in the DisMod-MR 2.1, a Bayesian meta-regression tool. Using a comparative risk assessment approach, TB burden attributable to risk factors was estimated in a spatial-temporal Gaussian Process Regression tool. Results In 2016, the prevalence of TB among HIV-negative people was 27% (95% uncertainty interval [95% UI] 23–31%) in Nigeria. TB incidence rate (new and relapse cases) was 158 per 100,000 people (95% UI; 128-193), while the total number of TB mortality was 39,933 deaths (95% UI; 30,488-55,039) in 2016. Between 2000 and 2016, the age-standardised prevalence and incidence rates of TB-HIV negative decreased by 20.0 and 87.6%, respectively. The age-standardised mortality rate also dropped by 191.6% over the same period. DALYs due to TB among HIV-negative Nigerians was high but varied across the age groups. Of the risk factors studied, alcohol use accounted for the highest number of TB deaths and DALYs, followed by diabetes and smoking in 2016. Conclusion The study shows an improving trend in TB disease burden among HIV-negative individuals in Nigeria from 1990 to 2016. Despite this progress, this study suggests that additional efforts are still needed to ensure that Nigeria is not left behind in the current global strategy to end TB disease. Reducing TB disease burden in the country will require a multipronged approach that includes increased funding, health system strengthening and improved TB surveillance, as well as preventive efforts for alcohol use, smoking and diabetes. Electronic supplementary material The online version of this article (10.1186/s41182-018-0114-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Felix Akpojene Ogbo
- 1Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, New South Wales Australia.,Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - Pascal Ogeleka
- Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - Anselm Okoro
- 3Society for Family Health, Justice Ifeyinwa Nzeako House, 8 Port Harcourt Crescent Area 11, Garki, Abuja, Nigeria
| | - Bolajoko O Olusanya
- 4Centre for Healthy Start Initiative, 286A Corporation Drive, Dolphin Estate, Ikoyi, Lagos, Nigeria
| | - Jacob Olusanya
- 4Centre for Healthy Start Initiative, 286A Corporation Drive, Dolphin Estate, Ikoyi, Lagos, Nigeria
| | - Ifegwu K Ifegwu
- Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - Akorede O Awosemo
- Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - John Eastwood
- 5Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, New South Wales 2170 Australia.,6School of Women's and Children's Health, The University of New South Wales, Kensington, Sydney, New South Wales 2052 Australia.,7School of Public Health, The University of Sydney, Sydney, New South Wales 2006 Australia.,8School of Public Health, Griffith University, Queensland, Gold Coast, 4222 Australia.,Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Rd, Croydon, New South Wales 2132 Australia
| | - Andrew Page
- 1Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, New South Wales Australia
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Pardeshi G, Deluca A, Agarwal S, Kishore J. Tuberculosis patients not covered by treatment in public health services: findings from India's National Family Health Survey 2015-16. Trop Med Int Health 2018; 23:886-895. [PMID: 29851437 DOI: 10.1111/tmi.13086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Half of the TB patients in India seek care from private providers resulting in incomplete notification, varied quality of care and out-of-pocket expenditure. The objective of this study was to describe the characteristics of TB patients who remain outside the coverage of treatment in public health services. METHODS Cross-sectional data from National Family Health Survey-4 (2015-16) were analysed using logistic regression analysis. TB treatment was the dependent variable. Sociodemographic factors and place where households generally seek treatment were independent variables. RESULTS Prevalence of self-reported TB was 308.17/100 000 population (95% CI: 309.44-310.55/100 000 population) and 38.8% (95% CI: 36.5-41.1%) of TB patients were outside care of public health services - 3.3% did not seek treatment and 35.3% accessed treatment from private sector. Factors associated with not seeking treatment were age <10 years [OR = 3.43; 95% CI (1.52-7.77); P = 0.00]; no/preschool education [OR = 1.82; 95% CI (1.10-3.34); P = 0.02]; poorest wealth index [OR = 1.86; 95% CI (1.01-3.34); P = 0.04] and household's general rejection of the public sector when seeking health care [OR = 1.69; 95% CI (1.69-2.26); P = 0.00]. Factors associated with seeking treatment from private providers were female sex [OR = 1.29; 95% CI (1.11-1.50); P = 0.001], younger age of the patient [OR = 2.39; 95% CI (1.62-3.53); P = 0.00], higher education [OR = 1.82; 95% CI (1.11-2.98); P = 0.02] and household's general rejection of the public sector when seeking health care [OR = 4.56; 95% CI (3.95-5.27); P = 0.00]. Patients from households reporting 'poor quality of care' as the reason for not generally preferring public health services were more likely (OR = 1.48, 95% CI = 1.19-1.65; P = 00) to access private treatment. CONCLUSION The study provides insights for efforts to involve the private health sector for accurate surveillance and patient groups requiring targeted interventions for linking them to the national programme.
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Affiliation(s)
- Geeta Pardeshi
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Andrea Deluca
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sutapa Agarwal
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Jugal Kishore
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Evans D, Schnippel K, Govathson C, Sineke T, Black A, Long L, Berhanu R, Rosen S. Treatment initiation among persons diagnosed with drug resistant tuberculosis in Johannesburg, South Africa. PLoS One 2017; 12:e0181238. [PMID: 28746344 PMCID: PMC5529007 DOI: 10.1371/journal.pone.0181238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In South Africa, roughly half of the drug-resistant TB cases diagnosed are reported to have been started on treatment. We determined the proportion of persons diagnosed with rifampicin resistant (RR-) TB who initiated treatment in Johannesburg after the introduction of decentralized RR-TB care in 2011. METHODS We retrospectively matched adult patients diagnosed with laboratory-confirmed RR-TB in Johannesburg from 07/2011-06/2012 with records of patients initiating RR-TB treatment at one of the city's four public sector treatment sites (one centralized, three decentralized). Patients were followed from date of diagnosis until the earliest of RR-TB treatment initiation, death, or 6 months' follow-up. We report diagnostic methods and outcomes, proportions initiating treatment, and median time from diagnosis to treatment initiation. RESULTS 594 patients were enrolled (median age 34 (IQR 29-42), 287 (48.3%) female). Diagnosis was by GenoType MTBDRplus (Hain-Life-Science) line probe assay (LPA) (281, 47.3%), Xpert MTB/RIF (Cepheid) (258, 43.4%), or phenotypic drug susceptibility testing (DST) (30, 5.1%) with 25 (4.2%) missing a diagnosis method. 320 patients (53.8%) had multi-drug resistant TB, 158 (26.6%) rifampicin resistant TB by Xpert MTB/RIF, 102 (17.2%) rifampicin mono-resistance, and 14 (2.4%) extensively drug-resistant TB. 256/594 (43.0%) patients initiated treatment, representing 70.7% of those who were referred for treatment (362/594). 338/594 patients (57.0%) did not initiate treatment, including 104 (17.5%) who died before treatment was started. The median time from sputum collection to treatment initiation was 33 days (IQR 12-52). CONCLUSION Despite decentralized RR-TB treatment, fewer than half the patients diagnosed in Johannesburg initiated appropriate treatment. Offering treatment at decentralized sites alone is not sufficient; improvements in linking patients diagnosed with RR-TB to effective treatment is essential.
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Affiliation(s)
- Denise Evans
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Kathryn Schnippel
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Right to Care, Johannesburg, South Africa
- Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline Govathson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tembeka Sineke
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Black
- Wits Reproductive Health and HIV Institute, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rebecca Berhanu
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States of America
| | - Sydney Rosen
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
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