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Baruch Baluku J, Katusabe S, Mutesi C, Bongomin F. Roles and challenges of nurses in tuberculosis care in Africa: A narrative review. J Clin Tuberc Other Mycobact Dis 2023; 31:100366. [PMID: 37077197 PMCID: PMC10106901 DOI: 10.1016/j.jctube.2023.100366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Nurses form the bulk of the health care workforce in Africa although their roles and challenges in tuberculosis (TB) care are not well documented. In this article we discuss roles and challenges of nurses in TB care in Africa. Nurses in Africa are key in TB prevention, diagnosis, treatment initiation, treatment monitoring, and evaluation and documentation of TB treatment outcomes. However, there is little involvement of nurses in TB-related research and policy. Challenges faced by nurses in TB care mostly relate to poor working conditions that compromise their occupational safety and mental health. There is need to expand nursing school curricula on TB to equip nurses with broad skills required for the wide repertoire of roles. Nurses should be equipped with research skills and funding opportunities for nurse-led TB research projects should be easily accessible. Occupational safety of nurses through infrastructural modification of TB units, provision of personal protective equipment and ensuring access to compensation in case a nurse develops active TB is important. Nurses also need psychosocial support given the complexity of caring for people with TB.
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Affiliation(s)
- Joseph Baruch Baluku
- Kiruddu National Referral Hospital, Kampala, Uganda
- Makerere University Lung Institute, Kampala, Uganda
- Corresponding author at: PO Box 26343, Kampala, Uganda.
| | | | | | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Nyarubamba RF, Silumbwe A, Jacobs C, Maritim P, Mdoe P, Zulu JM. Assessment of contextual factors shaping delivery and uptake of isoniazid preventive therapy among people living with HIV in Dar es salaam, Tanzania. BMC Infect Dis 2022; 22:884. [PMID: 36434517 PMCID: PMC9700944 DOI: 10.1186/s12879-022-07867-5] [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: 12/22/2021] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Tuberculosis has remained a leading cause of death among people living with HIV (PLHIV) globally. Isoniazid preventive therapy (IPT) is the recommended strategy by the World Health Organization to prevent TB disease and related deaths among PLHIV. However, delivery and uptake of IPT has remained suboptimal particularly in countries where HIV and TB are endemic such as Tanzania. This study sought to assess contextual factors that shape delivery and uptake of IPT in Dar es Salaam region, Tanzania. METHODOLOGY We employed a qualitative case study design comprising of in-depth interviews with people living with HIV (n = 17), as well as key informant interviews with clinicians (n = 7) and health administrators (n = 7). We used thematic data analysis approach and reporting of the results was guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS Characteristics of IPT such as aligning the therapy to individual patient schedules and its relatively low cost facilitated its delivery and uptake. On the contrary, perceived adverse side effects negatively affected the delivery and uptake of IPT. Characteristics of individuals delivering the therapy including their knowledge, good attitudes, and commitment to meeting set targets facilitated the delivery and uptake of IPT. The process of IPT delivery comprised collective planning and collaboration among various facilities which facilitated its delivery and uptake. Organisational characteristics including communication among units and supportive leadership facilitated the delivery and uptake of IPT. External system factors including HIV stigma, negative cultural and religious values, limited funding as well as shortage of skilled healthcare workers presented as barriers to the delivery and uptake of IPT. CONCLUSION The factors influencing the delivery and uptake of IPT among people living with HIV are multifaceted and exist at different levels of the health system. Therefore, it is imperative that IPT program implementers and policy makers adopt multilevel approaches that address the identified barriers and leverage the facilitators in delivery and uptake of IPT at both community and health system levels.
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Affiliation(s)
- Renatus Fabiano Nyarubamba
- Department of Health Policy and Management, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia. .,Ministry of Health, Community Development, Gender Elderly and Children, Dodoma, Tanzania.
| | - Adam Silumbwe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia. .,Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
| | - Choolwe Jacobs
- grid.12984.360000 0000 8914 5257Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Patricia Maritim
- grid.12984.360000 0000 8914 5257Department of Health Policy and Management, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Paschal Mdoe
- grid.461293.b0000 0004 1797 1065Haydom Lutheran Hospital, Manyara, Tanzania ,grid.5379.80000000121662407Division of Nursing, Midwifery and Social Works, University of Manchester, Faculty of Biology Medicine and Health, Manchester, UK
| | - Joseph Mumba Zulu
- grid.12984.360000 0000 8914 5257Department of Health Policy and Management, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia
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Ticha V, Bimerew M, Phetlhu DR. Perceptions of nurses on TB with HIV adherence counselling skills in a health sub-district, Cape Town: A qualitative study. Health SA 2022; 27:1859. [PMID: 35937422 PMCID: PMC9350481 DOI: 10.4102/hsag.v27i0.1859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/07/2022] [Indexed: 11/01/2022] Open
Abstract
Background: People living with HIV (PLHIV) co-infected with Tuberculosis (TB) account for one in three HIV-related deaths. Retention in care and adherence to medication remain key behaviours that PLHIV co-infected with TB must adopt to achieve better health outcomes. Nevertheless, TB with HIV adherence-counselling services provided by nurses designed to enhance these behaviours remain inadequate. Additionally, limited information is found in the literature on the perceptions of nurses regarding their TB with HIV adherence counselling skills pertaining to PLHIV co-infected with TB.Aim: To explore and describe the perceptions of nurses regarding their TB with HIV adherence counselling skills of PLHIV co-infected with TB.Setting: The study was conducted in a health sub-district of Cape Town.Method: An exploratory, descriptive qualitative design was followed. A total of 14 purposively sampled nurses were interviewed individually. Nurses caring for PLHIV co-infected with TB were included and nurses not offering care to PLHIV co-infected with TB were excluded. All interviews were audio recorded with the participants’ permission followed by verbatim transcriptions. Thematic analysis was done using ATLASti.8 electronic software.Results: It was established that the varied roles of these nurses increased their workload. Nonetheless, despite the gap in their counselling skills, the majority still maintained work expertise, professionalism and empathy towards the patients. Additionally, there were perceived barriers impacting patients’ attendance of their follow up appointments.Conclusion: Based on the findings of this study, there is a need to equip nurses caring for PLHIV co-infected with TB with adherence counselling skills to improve practice.Contribution: The findings were synthesised with results from an in-depth literature review to stand as the backbone for the development of a training programme for nurses to improve adherence counselling.
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Affiliation(s)
- Victoire Ticha
- Department of Nursing, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Million Bimerew
- Department of Nursing, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Deliwe R. Phetlhu
- Department of Nursing, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Kadia BM, Dimala CA, Fongwen NT, Smith AD. Barriers to and enablers of uptake of antiretroviral therapy in integrated HIV and tuberculosis treatment programmes in sub-Saharan Africa: a systematic review and meta-analysis. AIDS Res Ther 2021; 18:85. [PMID: 34784918 PMCID: PMC8594459 DOI: 10.1186/s12981-021-00395-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/23/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Programmes that merge management of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) aim to improve HIV/TB co-infected patients' access to comprehensive treatment. However, several reports from sub-Saharan Africa (SSA) indicate suboptimal uptake of antiretroviral therapy (ART) even after integration of HIV and TB treatment. This study assessed ART uptake, its barriers and enablers in programmes integrating TB and HIV treatment in SSA. METHOD A systematic review was performed. Seven databases were searched for eligible quantitative, qualitative and mixed-methods studies published from March 2004 through July 2019. Random-effects meta-analysis was used to obtain pooled estimates of ART uptake. A thematic approach was used to analyse and synthesise data on barriers and enablers. RESULTS Of 5139 references identified, 27 were included in the review: 23/27 estimated ART uptake and 10/27 assessed barriers to and/or enablers of ART uptake. The pooled ART uptake was 53% (95% CI: 42, 63%) and between-study heterogeneity was high (I2 = 99.71%, p < 0.001). WHO guideline on collaborative TB/HIV activities and sample size were associated with heterogeneity. There were statistically significant subgroup effects with high heterogeneity after subgroup analyses by region, guideline on collaborative TB/HIV activities, study design, and sample size. The most frequently described socioeconomic and individual level barriers to ART uptake were stigma, low income, and younger age group. The most frequently reported health system-related barriers were limited staff capacity, shortages in medical supplies, lack of infrastructure, and poor adherence to or lack of treatment guidelines. Clinical barriers included intolerance to anti-TB drugs, fear of drug toxicity, and contraindications to antiretrovirals. Health system enablers included good management of the procurement, supply, and dispensation chain; convenience and accessibility of treatment services; and strong staff capacity. Availability of psychosocial support was the most frequently reported enabler of uptake at the community level. CONCLUSIONS In SSA, programmes integrating treatment of TB and HIV do not, in general, achieve high ART uptake but we observe a net improvement in uptake after WHO issued the 2012 guidelines on collaborative TB/HIV activities. The recurrence of specific modifiable system-level and patient-level factors in the literature reveals key intervention points to improve ART uptake in these programmes. Systematic review registration: CRD42019131933.
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Affiliation(s)
- Benjamin Momo Kadia
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Christian Akem Dimala
- Department of Medicine, Reading Hospital, Tower Health System, West Reading, PA, USA
- Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Noah T Fongwen
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Africa Centres for Disease Control and Prevention (CDC) Innovation Hub, Africa CDC, Addis Ababa, Ethiopia
| | - Adrian D Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Sy TRL, Padmawati RS, Baja ES, Ahmad RA. Acceptability and feasibility of delegating HIV counseling and testing for TB patients to community health workers in the Philippines: a mixed methods study. BMC Public Health 2019; 19:185. [PMID: 30760257 PMCID: PMC6375216 DOI: 10.1186/s12889-019-6497-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 01/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Philippines has a high burden of TB and HIV, yet the WHO estimates that only 13% of Filipino TB patients know their HIV status. This is partly attributable to the lack of trained HIV counselors and medical technologists (or laboratory technicians) at the primary healthcare level. In Africa where resources and manpower are also scarce, TB/HIV care is already delegated to community health workers. Evidence is scant however about the acceptability and feasibility of engaging community health workers to provide HIV counseling and testing (HCT) among TB patients in the Philippines. The objective of this paper is to describe and assess the acceptability and feasibility of delegating HCT among TB patients to barangay (community) health workers (BHWs) in the Philippines. METHODS Mixed methods study that utilized surveys with patients (n = 89), BHWs (n = 81), and ten focus group discussions with key stakeholders (n = 49) in San Jose del Monte, a city with high HIV prevalence. A facility assessment (n = 17) was done using a modified version of WHO-Service Availability and Readiness Assessment questionnaire to assess feasibility (scale of 1 to 4) while acceptability from the perspective of patients and BHWs was determined using surveys. RESULTS Only 47% of TB patients agreed to receive HIV counseling from BHWs, while 30% agreed to receive HIV testing. Doctors were preferred by patients as HIV counselors, while medical technologists were preferred as HIV test providers. Two out of three BHWs also disagreed to provide HCT but the same number felt that they could provide HCT if additional trainings were given to them. In the group discussions, BHWs preferred to only provide HIV counseling. Stakeholders said that only select BHWs who meet certain criteria should provide HIV counseling. Program managers and stakeholders rated delegation of HCT to BHWs as moderately feasible. CONCLUSIONS Delegation of both HIV counseling and testing among TB patients to BHWs is feasible, but only delegation of HIV counseling is acceptable. Further studies are needed to guide revision of Philippine HCT policies to accommodate lay HIV counselors, and strengthen the mechanisms for delivering integrated TB and HIV services especially at the primary healthcare level.
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Affiliation(s)
- Tyrone Reden L. Sy
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, 55281 Indonesia
| | - Retna Siwi Padmawati
- Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, 55281 Indonesia
| | - Emmanuel S. Baja
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila City, Philippines
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila City, Philippines
| | - Riris Andono Ahmad
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, 55281 Indonesia
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, 55281 Indonesia
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Okwen M, Signe J, Macpella SM, Mbibeh L, Cockburn L. Professional collaboration for vision and healthcare in Cameroon. AFRICAN VISION AND EYE HEALTH 2018. [DOI: 10.4102/aveh.v77i1.434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Topp SM, Abimbola S, Joshi R, Negin J. How to assess and prepare health systems in low- and middle-income countries for integration of services-a systematic review. Health Policy Plan 2018; 33:298-312. [PMID: 29272396 PMCID: PMC5886169 DOI: 10.1093/heapol/czx169] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 12/26/2022] Open
Abstract
Despite growing support for integration of frontline services, a lack of information about the pre-conditions necessary to integrate such services hampers the ability of policy makers and implementers to assess how feasible or worthwhile integration may be, especially in low- and middle-income countries (LMICs). We adopted a modified systematic review with aspects of realist review, including quantitative and qualitative studies that incorporated assessment of health system preparedness for and capacity to implement integrated services. We searched Medline via Ovid, Web of Science and the Cochrane library using terms adapted from Dudley and Garner’s systematic review on integration in LMICs. From an initial list of 10 550 articles, 206 were selected for full-text review by two reviewers who independently reviewed articles and inductively extracted and synthesized themes related to health system preparedness. We identified five ‘context’ related categories and four health system ‘capability’ themes. The contextual enabling and constraining factors for frontline service integration were: (1) the organizational framework of frontline services, (2) health care worker preparedness, (3) community and client preparedness, (4) upstream logistics and (5) policy and governance issues. The intersecting health system capabilities identified were the need for: (1) sufficiently functional frontline health services, (2) sufficiently trained and motivated health care workers, (3) availability of technical tools and equipment suitable to facilitate integrated frontline services and (4) appropriately devolved authority and decision-making processes to enable frontline managers and staff to adapt integration to local circumstances. Moving beyond claims that integration is defined differently by different programs and thus unsuitable for comparison, this review demonstrates that synthesis is possible. It presents a common set of contextual factors and health system capabilities necessary for successful service integration which may be considered indicators of preparedness and could form the basis for an ‘integration preparedness tool’.
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Affiliation(s)
- Stephanie M Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4812, Australia.,Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Seye Abimbola
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Rohina Joshi
- The George Institute, University of New South Wales, NSW 2042, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Joel Negin
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
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Akeju OO, Wright SC, Maja TM. Lived experience of patients on tuberculosis treatment in Tshwane, Gauteng province. Health SA 2017. [DOI: 10.1016/j.hsag.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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García-Fernández L, Benites C, Huamán B. [Access barriers to comprehensive care for people affected by tuberculosis and human immunodeficiency virus coinfection in Peru, 2010-2015]. Rev Panam Salud Publica 2017; 41:e23. [PMID: 28591330 PMCID: PMC6660896 DOI: 10.26633/rpsp.2017.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Identify the programmatic barriers that hinder access to comprehensive care of patients with tuberculosis and human immunodeficiency virus (TB/HIV) coinfection. METHODS This is a mixed-method study. Qualitative research was conducted via in-depth interviews with key actors and the quantitative component involved cross-sectional descriptive analysis of programmatic data from 2010-2015 on tuberculosis and HIV programs at health facilities in the cities of Lima and Iquitos. RESULTS Twenty-two key actors in seven establishments were interviewed. The identified barriers were: little or no coordination between tuberculosis and HIV teams, separate management of tuberculosis and HIV cases at different levels of care, insufficient financing, limited or poorly trained human resources, and lack of an integrated information system. It was found that HIV screening in TB patients increased (from 18.8% in 2011 to 95.2% in 2015), isoniazid coverage of HIV patients declined (from 62% to 9%), and the proportion of deaths among TB/HIV coinfection cases averaged 20%. CONCLUSIONS There is poor coordination between HIV and TB health strategies. Management of TB/HIV coinfection is fragmented into different levels of care, which has an impact on comprehensive patient care. As a result of this research, a technical document was prepared to establish joint procedures that should be implemented to improve comprehensive care of TB/HIV coinfection.
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Affiliation(s)
- Lisset García-Fernández
- Estrategia Sanitaria Nacional de Infecciones de Transmisión Sexual VIH/SIDAEstrategia Sanitaria Nacional de Infecciones de Transmisión Sexual VIH/SIDAPerúEstrategia Sanitaria Nacional de Infecciones de Transmisión Sexual VIH/SIDA. Ministerio de Salud de Perú, Perú.,La correspondencia se debe dirigir a Lisset García-Fernández. Correo electrónico:
| | - Carlos Benites
- Estrategia Sanitaria Nacional de Infecciones de Transmisión Sexual VIH/SIDAEstrategia Sanitaria Nacional de Infecciones de Transmisión Sexual VIH/SIDAPerúEstrategia Sanitaria Nacional de Infecciones de Transmisión Sexual VIH/SIDA. Ministerio de Salud de Perú, Perú.
| | - Byelca Huamán
- Estrategia Sanitaria Nacional de Infecciones de Transmisión Sexual VIH/SIDAEstrategia Sanitaria Nacional de Infecciones de Transmisión Sexual VIH/SIDAPerúEstrategia Sanitaria Nacional de Infecciones de Transmisión Sexual VIH/SIDA. Ministerio de Salud de Perú, Perú.
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Linguissi LSG, Gwom LC, Nkenfou CN, Bates M, Petersen E, Zumla A, Ntoumi F. Health systems in the Republic of Congo: challenges and opportunities for implementing tuberculosis and HIV collaborative service, research, and training activities. Int J Infect Dis 2016; 56:62-67. [PMID: 28341302 DOI: 10.1016/j.ijid.2016.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022] Open
Abstract
The Republic of Congo is on the World Health Organization (WHO) list of 'high burden' countries for tuberculosis (TB) and HIV. TB is the leading cause of death among HIV-infected patients in the Republic of Congo. In this viewpoint, the available data on TB and HIV in the Republic of Congo are reviewed, and the gaps and bottlenecks that the National TB Control Program (NTCP) faces are discussed. Furthermore, priority requirements for developing and implementing TB and HIV collaborative service activities are identified. HIV and TB control programs operate as distinct entities with separate case management plans. The implementation of collaborative TB/HIV activities to evaluate and monitor the management of TB/HIV co-infected individuals remains inefficient in most regions, and these activities are sometimes non-existent. This reveals major challenges that require definition in order to improve the delivery of healthcare. The NTCP lacks adequate resources for optimal implementation of control measures of TB and HIV compliance and outcomes. The importance of aligning and integrating TB and HIV treatment services (including follow-up) and adherence support services through coordinated and collaborative efforts between individual TB and HIV programs is discussed. Aligning and integrating TB and HIV treatment services through coordinated and collaborative efforts between individual TB and HIV programs is required. However, the WHO recommendations are generic, and health services in the Republic of Congo need to tailor their TB and HIV programs according to the availability of resources and operational feasibility. This will also open opportunities for synergizing collaborative TB/HIV research and training activities, which should be prioritized by the donors supporting the TB/HIV programs.
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Affiliation(s)
- Laure Stella Ghoma Linguissi
- Fondation Congolaise pour la Recherche Médicale, Cité OMS, villa D6, Djoué, Brazzaville, Republic of Congo; Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Labiogene, Université de Ouagadougou, Ouaga, Burkina Faso
| | - Luc Christian Gwom
- Chantal Biya International Reference Centre, Yaoundé, Cameroon; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Celine Nguefeu Nkenfou
- Chantal Biya International Reference Centre, Yaoundé, Cameroon; Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Matthew Bates
- UNZA-UCLMS Project, University Teaching Hospital, Lusaka, Zambia
| | - Eskild Petersen
- Institute of Clinical Medicine, University of Aarhus, Denmark; The Royal Hospital, Muscat, Oman
| | - Alimuddin Zumla
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK; National Institute of Health Research Biomedical Research Centre at UCL Hospitals, London, UK
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale, Cité OMS, villa D6, Djoué, Brazzaville, Republic of Congo; Faculty of Sciences and Techniques, University Marien Ngouabi, Brazzaville, Republic of Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany.
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Implementation of Tuberculosis Intensive Case Finding, Isoniazid Preventive Therapy, and Infection Control ("Three I's") and HIV-Tuberculosis Service Integration in Lower Income Countries. PLoS One 2016; 11:e0153243. [PMID: 27073928 PMCID: PMC4830552 DOI: 10.1371/journal.pone.0153243] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/27/2016] [Indexed: 11/19/2022] Open
Abstract
SETTING World Health Organization advocates for integration of HIV-tuberculosis (TB) services and recommends intensive case finding (ICF), isoniazid preventive therapy (IPT), and infection control ("Three I's") for TB prevention and control among persons living with HIV. OBJECTIVE To assess the implementation of the "Three I's" of TB-control at HIV treatment sites in lower income countries. DESIGN Survey conducted between March-July, 2012 at 47 sites in 26 countries: 6 (13%) Asia Pacific, 7 (15%), Caribbean, Central and South America, 5 (10%) Central Africa, 8 (17%) East Africa, 14 (30%) Southern Africa, and 7 (15%) West Africa. RESULTS ICF using symptom-based screening was performed at 38% of sites; 45% of sites used symptom-screening plus additional diagnostics. IPT at enrollment or ART initiation was implemented in only 17% of sites, with 9% of sites providing IPT to tuberculin-skin-test positive patients. Infection control measures varied: 62% of sites separated smear-positive patients, and healthcare workers used masks at 57% of sites. Only 12 (26%) sites integrated HIV-TB services. Integration was not associated with implementation of TB prevention measures except for IPT provision at enrollment (42% integrated vs. 9% non-integrated; p = 0.03). CONCLUSIONS Implementation of TB screening, IPT provision, and infection control measures was low and variable across regional HIV treatment sites, regardless of integration status.
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Tuberculosis control in prisons: current situation and research gaps. Int J Infect Dis 2016; 32:111-7. [PMID: 25809766 DOI: 10.1016/j.ijid.2014.12.029] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 12/12/2014] [Accepted: 12/16/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) in penitentiary services (prisons) is a major challenge to TB control. This review article describes the challenges that prison systems encounter in TB control and provides solutions for the more efficient use of limited resources based on the three pillars of the post-2015 End TB Strategy. This paper also proposes research priorities for TB control in prisons based on current challenges. METHODS Articles (published up to 2011) included in a recent systematic review on TB control in prisons were further reviewed. In addition, relevant articles in English (published 1990 to May 2014) were identified by searching keywords in PubMed and Google Scholar. Article bibliographies and conference abstracts were also hand-searched. RESULTS Despite being a serious cause of morbidity and mortality among incarcerated populations, many prison systems encounter a variety of challenges that hinder TB control. These include, but are not limited to, insufficient laboratory capacity and diagnostic tools, interrupted supply of medicines, weak integration between civilian and prison TB services, inadequate infection control measures, and low policy priority for prison healthcare. CONCLUSIONS Governmental commitment, partnerships, and sustained financing are needed in order to facilitate improvements in TB control in prisons, which will translate to the wider community.
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TB and HIV in the Central African region: current knowledge and knowledge gaps. Infection 2013; 42:281-94. [PMID: 24311148 DOI: 10.1007/s15010-013-0568-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/27/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE Reliable and comprehensive data on the HIV/AIDS and TB co-pandemics from Central Africa remain scarce. This systematic review provides a comprehensive overview on current and past research activities in the region and provides a basis for future research work to close knowledge gaps. METHODS The scientific literature was searched for publications meeting the following search terms: "tuberculosis" or "HIV" or "acquired immunodeficiency syndrome", combined with "Central Africa", or the names of individual countries within the region. Original studies, reviews and case series were included, and a selection of relevant articles was made. RESULTS Most research in the field of HIV and TB has been conducted in Cameroon, where the epidemics have been described fairly well. The Democratic Republic of Congo ranked second on the amount of publications, despite the civil wars over the past several decades. Very little has been published on HIV and TB in the other countries, possibly due to the poor infrastructure of health care systems, lack of scientific capacity building or shortage of laboratory equipment. CONCLUSIONS Despite the relatively high burden of HIV and TB in the Central African region, the amount of research activities on these topics is limited. A better understanding of the co-epidemics in this region is urgently needed. The occurrence of opportunistic infections, treatment complications and drug resistance in TB and HIV need to be better described; the failure of public health systems needs to be understood, and research infrastructure needs to be developed. Only then will it be possible to turn the tide against the HIV and TB epidemics in this region.
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