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Tuwa A, Okia D, Nantale R, Jaka H, Alunyo JP, Mukunya D, Matovu JK, Kibuule D. Factors associated with uptake of isoniazid preventive therapy among children living with HIV in Mwanza region, Tanzania: a cross-sectional study. BMC Public Health 2024; 24:2221. [PMID: 39148019 PMCID: PMC11325747 DOI: 10.1186/s12889-024-19705-1] [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: 07/03/2023] [Accepted: 08/06/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) is a leading cause of death among children living with HIV (CLHIV). Isoniazid preventive therapy (IPT) reduces the incidence of TB by 70% and mortality by 50% among CLHIV. However, in most developing countries including Tanzania, the uptake of IPT is suboptimal, below the 90% WHO-global uptake target. We assessed the factors associated with IPT uptake among CLHIV in Mwanza region, Tanzania. METHODS This was a multicenter facility-based cross-sectional study among CLHIV aged 1 to 10 years in seven districts of Mwanza region, Tanzania from 1st November 2021 to 20th January 2022. Data were collected using a structured interview-administered questionnaire including information on children and caregivers' demographics, caregivers' health related information and children's clinical information. Our outcome variable was uptake of IPT, defined as initiation on IPT either during the time of the study or within past three years before this study We conducted modified Poisson regression to assess the association between IPT uptake and selected exposures in Stata version 15.0. RESULTS A total of 415 CLHIV were enrolled, the median age of the children was 7 years (Interquartile range: 5-8). The uptake of IPT was 91% (n = 377). The majority of children's caregivers were HIV positive (86%, n = 387) and were aware about IPT (63.6%, n = 264). Factors associated with IPT uptake included; having an employed caregiver [Adjusted Prevalence Ratio (aPR): 1.06 95% Confidence Interval (CI): 1.00-1.13] and attending the ART clinic every month [aPR: 1.00; 95% CI: 0.87-1.00] . CONCLUSIONS The uptake of IPT uptake among CLHIV in Mwanza, Tanzania exceeds the global WHO-target of ≥ 90%. Monthly ART clinic visits could be essential in promoting IPT uptake among CLHIV.
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Affiliation(s)
- Ally Tuwa
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Department of Community and Research, Mwanza College of Health and Allied Sciences- MWACHAS, P.O.BOX 476, Mwanza, Tanzania
| | - David Okia
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Ritah Nantale
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda.
| | - Hyasinta Jaka
- Department of Community and Research, Mwanza College of Health and Allied Sciences- MWACHAS, P.O.BOX 476, Mwanza, Tanzania
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, Catholic University of Health and Allied Sciences-CUHAS, P.O.BOX 1464, Bugando, Mwanza, Tanzania
- Community Health and Development Foundation-CHADF, P.O.BOX 476, Buyombe, Ilemela, Mwanza, Tanzania
| | - Jimmy Patrick Alunyo
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - David Mukunya
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Joseph Kb Matovu
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Dan Kibuule
- Department of Pharmacology and Therapeutics, Busitema University Faculty of Health Sciences, Mbale, Uganda
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Frank TA, Oosthuizen F, Bangalee V. Antibiotic safety among neonates and paediatrics in a public hospital: KwaZulu-Natal. Health SA 2023; 28:2464. [PMID: 38223209 PMCID: PMC10784184 DOI: 10.4102/hsag.v28i0.2464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/11/2023] [Indexed: 01/16/2024] Open
Abstract
Background The World Health Organization (WHO) guidelines recommend the empiric treatment of infections before definitive treatment begins. However, ethical concerns limit the availability of clinical trials in neonates and paediatrics to fully ascertain the safety profile of antibiotics in these populations. Aim This study aimed to quantify the use of antibiotics among neonates and paediatrics and commented on the use, rationale and appropriateness of antibiotics prescribed. Setting A secondary level public sector hospital located in Durban, KwaZulu-Natal. Methods Demographic and treatment information of neonates and paediatrics were collected retrospectively from January 2022 to June 2022. Data were obtained from patient files and extracted for analysis using Microsoft Excel®. Analytical and descriptive statistics were used to analyse patient demographics and treatment variables. Results A total of 568 antibiotics, issued to 389 patients, were reviewed. Penicillins (40.1%), aminoglycosides (24.3%) and combination penicillin-beta-lactam inhibitors (23.3%) were identified as the most frequently prescribed antibiotics for inpatients. Most antibiotics prescribed to inpatients were for complications associated with pre-term birth (66.9%). Combination penicillin-beta-lactam inhibitors (34.7%), penicillins (29.5%) and cephalosporins (29.5%) were the most frequently prescribed antibiotics to outpatients. A correlation was found between the route of administration and the duration of therapy; the intravenous route (63.6%) was preferred over the oral route (36.4%) for administration. Conclusion Many broad-spectrum antibiotics were prescribed, thus increasing the risk of resistance. Antibiotics were being prescribed according to the guidelines; however, there is still a need for therapeutic drug monitoring to ensure the continuation of rational drug use. Contribution There was evidence of rational use of antibiotics in the public hospital (KwaZulu-Natal), in keeping with economic and availability factors.
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Affiliation(s)
- Tyler A Frank
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Frasia Oosthuizen
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Varsha Bangalee
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Munedzimwe F, Chetty-Makkan CM, Mukora R, Charalambous S, Turner K, Chihota V. "It's about time they taught us": a qualitative study evaluating the barriers to finding and screening child contacts under five at risk for TB in Gauteng Province, South Africa from the provider and caregiver perspectives. BMC Health Serv Res 2023; 23:1415. [PMID: 38102646 PMCID: PMC10722712 DOI: 10.1186/s12913-023-10359-0] [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: 05/04/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Inadequate numbers of children under five years of age who are exposed to tuberculosis (TB) in the home (child contact) are initiated on TB preventive treatment (TPT) in South Africa. We assessed barriers of initiating isoniazid preventive therapy (IPT) in this age group. METHODS We conducted a qualitative study at two primary health clinics in the Ekurhuleni district in Gauteng Province. Between April and July 2019, we enrolled facility managers, TB staff and parents or legal guardians of child contacts (caregivers) attending for care, at the two facilities. Semi-structured questionnaires, facility observations and in-depth interviews using a semi-structured interview guide were used to collect data. Findings from the semi-structured questionnaires with facility staff and facility observations were summarized. Thematic analysis with a deductive approach was used to analyse the data from the in-depth interviews with caregivers. RESULTS Two facility managers took part in the study and were assisted to complete the semi-structured questionnaires by TB staff. Fifteen caregivers aged between 18 and 43 years were interviewed of which 13 (87%) were female. Facility managers and TB staff (facility staff) felt that even though caregivers knew of family members who were on TB treatment, they delayed bringing their children for TB screening and TPT. Facility staff perceived caregivers as not understanding the purpose and benefits of TB prevention strategies such as TPT. Caregivers expressed the desire for their children to be screened for TB. However, caregivers lacked knowledge on TB transmission and the value of TB prevention in children at high risk of infection. CONCLUSION While facility staff perceived caregivers to lack responsibility, caregivers expressed limited knowledge on the value of screening their children for TB as reasons for not accessing TB preventive services. Health education on TB transmission, screening, and TB prevention strategies at a community level, clinics, creches, schools and via media are important to achieve the global end TB goal of early detection and prevention of TB.
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Affiliation(s)
- Fadzai Munedzimwe
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa.
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
| | - C M Chetty-Makkan
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Mukora
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - S Charalambous
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Yale University, New Haven, Connecticut, USA
| | - K Turner
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
| | - V Chihota
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
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Amanya I, Muhoozi M, Aruhomukama D, Ssebagereka A, Mugambe R. Isoniazid preventive therapy completion and factors associated with non-completion among patients on antiretroviral therapy at Kisenyi Health Centre IV, Kampala, Uganda. PLoS One 2023; 18:e0277739. [PMID: 37607176 PMCID: PMC10443854 DOI: 10.1371/journal.pone.0277739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 08/02/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Isoniazid preventive therapy (IPT) is given to HIV patients to reduce the risk of active tuberculosis (TB). However, treatment completion remains suboptimal among those that are initiated. This study aimed to determine the completion level of IPT and the factors associated with non-completion among patients on antiretroviral therapy (ART) at Kisenyi Health Center IV in Kampala, Uganda. METHODS A mixed-methods facility-based retrospective cohort study utilizing routinely collected data from 341 randomly selected HIV patients initiated on IPT was conducted. Data extracted from the registers was used to determine IPT completion. Robust Poisson regression was conducted to determine the associated factors of IPT non-completion, while in-depth interviews were conducted to explore barriers to IPT completion from the patient's perspective. RESULTS A total of 341 patients who started on isoniazid (INH) were retrospectively followed up, with 69% (236/341) being female. Overall IPT completion was 83%. Multivariate analysis revealed the prevalence of IPT non-completion among males was 2.24 times the prevalence among females (aPR 2.24, 95% CI: 1.40-3.58, p = 0.001). The prevalence of IPT non-completion among patients with a non-suppressed HIV viral load was 3.00 times the prevalence among those with a suppressed HIV viral load (aPR 3.00, 95% CI: 1.44-6.65, p = 0.007). The prevalence of IPT non-completion among patients who were married, or cohabiting was 0.31 times the prevalence among those who were single (aPR 0.31, 95% CI: 0.17-0.55, p<0.000). Lack of IPT-related health education, pill burden, distance to the health facility, and patient relocation were reported as barriers to IPT completion. CONCLUSION IPT completion was found to be 83% among the cohort studied. However, lower completion levels persist among males and HIV-virally non-suppressed patients. Lack of IPT-related health education, pill burden, distance to the health facility, and patient relocation were reported as barriers to IPT completion. Interventions that target these groups of people need to be intensified.
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Affiliation(s)
- Ian Amanya
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Brainmann Analytics, Kampala, Uganda
| | - Michael Muhoozi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Dickson Aruhomukama
- Brainmann Analytics, Kampala, Uganda
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Anthony Ssebagereka
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Richard Mugambe
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Adepoju VA, Adelekan A, Agbaje A, Quaitey F, Ademola-Kay T, Udoekpo AU, Sokoya OD. Completion of 6-mo isoniazid preventive treatment among eligible under six children: A cross-sectional study, Lagos, Nigeria. World J Clin Cases 2023; 11:104-115. [PMID: 36687175 PMCID: PMC9846979 DOI: 10.12998/wjcc.v11.i1.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/15/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nigeria is one of the thirty high burden countries with significant contribution to the global childhood tuberculosis epidemic. Tuberculosis annual risk for children could be as high as 4% particularly in high tuberculosis (TB) prevalent communities. Isoniazid (INH) Preventive Therapy has been shown to prevent TB incidence but data on its implementation among children are scarce.
AIM To determine the completion of INH among under six children that were exposed to adults with smear positive pulmonary TB in Lagos, Nigeria.
METHODS This was a hospital-based retrospective cross-sectional review of 265 medical records of eligible children < 6 years old enrolled for INH across 32 private hospitals in Lagos, Nigeria. The study took place between July and September 2020. Data was collected on independent variables (age, gender, type of facility, TB screening, dose and weight) and outcome variables (INH outcome and proportion lost to follow up across months 1-6 of INH treatment).
RESULTS About 53.8% of the participants were female, 95.4% were screened for TB and none was diagnosed of having TB. The participants’ age ranged from 1 to 72 mo with a mean of 36.01 ± 19.67 mo, and 40.2% were between the ages of 1-24 mo. Only 155 (59.2%) of the 262 participants initiated on INH completed the six-month treatment. Cumulatively, 107 (41.0%) children were lost to follow-up at the end of the sixth month. Of the cumulative 107 loss to follow-up while on INH, largest drop-offs were reported at the end of month 2, 52 (49%) followed by 20 (19%), 17 (16%), 11 (10.2%) and 7 (6.5%) at months 3, 4, 5 and 6 respectively. The analysis showed that there was no significant association between age, gender, type of facility and completion of INH treatment (P > 0.005).
CONCLUSION This study demonstrated suboptimal INH completion rate among children with only 6 out of 10 children initiated on INH who completed a 6-mo treatment in Lagos, Nigeria. The huge drop-offs in the first 2 mo of INH calls for innovative strategies such as the use of 60-d INH calendar that would facilitate reminder and early engagement of children on INH and their caregivers in care and across the entire period of treatment.
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Affiliation(s)
- Victor Abiola Adepoju
- Department of HIV and Infectious Diseases, Jhpiego Nigeria, Federal Capital Territory, Abuja 900918, Nigeria
| | - Ademola Adelekan
- Department of Research, Bluegate Research Institute, Ibadan 211271, Oyo State, Nigeria
| | - Aderonke Agbaje
- Clinical Services, Institute of Human Virology of Nigeria, Abuja 900918, Nigeria
| | - Femi Quaitey
- Department of HIV and Infectious Diseases, Jhpiego Nigeria, Uyo 520108, AkwaIbom, Nigeria
| | - Tobi Ademola-Kay
- Adolescent and Youth Care, Youth Development and Empowerment Initiative, Lagos 23401, Nigeria
| | - Ann Uduak Udoekpo
- Monitoring and Evaluation, Jhpiego Nigeria, Uyo 520108, AkwaIbom, Nigeria
| | - Olusola Daniel Sokoya
- Lagos State Tuberculosis, Buruli Ulcer and Leprosy Control Program, Ikeja 100001, Lagos, Nigeria
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Montoya I de Manuel-Rimbau A, Nguenha D, Mambuque E, Ehrlich J, Munguambe S, Saavedra B, Matsena T, Chiconela H, Casellas A, López-Varela E, Acacio S, Garcia-Basteiro AL. Initiation and adherence to isoniazid preventive therapy in children under 5 years of age in Manhiça, Southern Mozambique. J Trop Pediatr 2022; 69:7010560. [PMID: 36718019 DOI: 10.1093/tropej/fmad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The WHO recommends preventive treatment for all pediatric contacts of a confirmed TB case, but coverage remains low in many high TB burden countries. We aimed to assess the coverage and adherence of the isoniazid preventive therapy (IPT) program among children under 5 years of age with household exposure to an adult pulmonary TB case in a rural district of Southern Mozambique. The estimated IPT coverage was 11.7%. A longer distance to the health center and lower age of the children hindered IPT initiation. Among patients who started IPT, 12/18 (69.9%) were adherent to the 6-month treatment.
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Affiliation(s)
| | - Dinis Nguenha
- Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique.,Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
| | - Edson Mambuque
- Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique
| | - Joanna Ehrlich
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Shilzia Munguambe
- Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique
| | - Belén Saavedra
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique
| | - Teodimiro Matsena
- Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique
| | - Hélio Chiconela
- Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique.,National Tuberculosis Control Programme, District of Manhiça, Mozambique
| | - Aina Casellas
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Elisa López-Varela
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique
| | - Sozinho Acacio
- Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique
| | - Alberto L Garcia-Basteiro
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
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Calderon JS, Perry KE, Thi SS, Stevens LL. Innovating tuberculosis prevention to achieve universal health coverage in the Philippines. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 29:100609. [PMID: 36605879 PMCID: PMC9808427 DOI: 10.1016/j.lanwpc.2022.100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To contribute to tuberculosis (TB) elimination, TB preventive treatment (TPT) should integrate innovative approaches including tele-contact investigation (TCI), mathematical modelling, and participatory governance. Aligning with the World Health Organisation's primary health care framework, supply is provided by the provincial health system, demand is cultivated by the community, while governance is represented by the governor, who oversees the health leadership structure, local policies, and allocation of resources. A healthy dynamic between these three components is required to achieve universal health coverage (UHC). Because of their potential to integrate health systems and engage communities, primary health care principles underpin an effective approach to TB prevention. First, the provincial health system should connect with the community through TCI to transform the status quo of passive service delivery. Second, community participation should strengthen the linkage between the health system and governance, which ensures that community action plans are aligned with provincial TPT targets. Third, governance should leverage mathematical modelling to allocate resources to those with greatest need. Central to this is a reliable TB information system that should validate a robust mathematical model to measure cost-effectiveness of the intervention. Collectively, this holistic approach to TB prevention could provide a proof-of-concept that investing in primary health care is the key to UHC.
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Affiliation(s)
| | | | - Sein Sein Thi
- FHI 360 Asia Pacific Regional Office, Bangkok, Thailand
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Sagili KD, Muniyandi M, Shringarpure K, Singh K, Kirubakaran R, Rao R, Tonsing J, Sachdeva KS, Tharyan P. Strategies to detect and manage latent tuberculosis infection among household contacts of pulmonary TB patients in high TB burden countries - a systematic review and meta-analysis. Trop Med Int Health 2022; 27:842-863. [PMID: 35927930 PMCID: PMC9825928 DOI: 10.1111/tmi.13808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To summarise latent tuberculosis infection (LTBI) management strategies among household contacts of bacteriologically confirmed pulmonary tuberculosis (TB) patients in high-TB burden countries. METHODS PubMed/MEDLINE (NCBI) and Scopus were searched (January 2006 to December 2021) for studies reporting primary data on LTBI management. Study selection, data management and data synthesis were protocol-driven (PROSPERO-CRD42021208715). Primary outcomes were the proportions of LTBI, initiating and completing tuberculosis preventive treatment (TPT). Reported factors influencing the LTBI care cascade were qualitatively synthesised. RESULTS From 3694 unique records retrieved, 58 studies from 23 countries were included. Most identified contacts were screened (median 99%, interquartile range [IQR] 82%-100%; 46 studies). Random-effects meta-analysis yielded pooled proportions for: LTBI 41% (95% confidence interval [CI] 33%-49%; 21,566 tested contacts); TPT initiation 91% (95% CI 79%-97%; 129,573 eligible contacts, 34 studies); TPT completion 65% (95% CI 54%-74%; 108,679 TPT-initiated contacts, 28 studies). Heterogeneity was significant (I2 ≥ 95%-100%) and could not be explained in subgroup analyses. Median proportions (IQR) were: LTBI 44% (28%-59%); TPT initiation 86% (60%-100%); TPT completion 68% (44%-82%). Nine broad themes related to diagnostic testing, health system structure and functions, risk perception, documentation and adherence were considered likely to influence the LTBI care cascade. CONCLUSION The proportions of household contacts screened, detected with LTBI and initiated on TPT, though variable was high, but the proportions completing TPT were lower indicating current strategies used for LTBI management in high TB burden countries are not sufficient.
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Affiliation(s)
- Karuna Devi Sagili
- International Union Against Tuberculosis and Lung DiseaseSouth East Asia OfficeNew DelhiIndia
| | - Malaisamy Muniyandi
- Indian Council of Medical Research (ICMR)National Institution for Research in TuberculosisChennaiIndia
| | | | - Kavita Singh
- International Union Against Tuberculosis and Lung DiseaseSouth East Asia OfficeNew DelhiIndia
| | | | - Raghuram Rao
- National TB Elimination Program, Central TB DivisionMinistry of HealthNew DelhiIndia
| | - Jamhoih Tonsing
- Technical Advice and Partnerships DepartmentThe Global FundGenevaSwitzerland
| | - Kuldeep Singh Sachdeva
- International Union Against Tuberculosis and Lung DiseaseSouth East Asia OfficeNew DelhiIndia
| | - Prathap Tharyan
- Clinical Epidemiology UnitChristian Medical CentreVelloreIndia
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Jerene D, Assefa D, Tesfaye K, Bayu S, Seid S, Aberra F, Bedru A, Khan A, Creswell J. Effectiveness of women-led community interventions in improving tuberculosis preventive treatment in children: results from a comparative, before-after study in Ethiopia. BMJ Open 2022; 12:e062298. [PMID: 35863840 PMCID: PMC9310159 DOI: 10.1136/bmjopen-2022-062298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Our objective was to evaluate the impact of a service delivery model led by membership-based associations called Iddirs formed by women on tuberculosis preventive treatment (TPT) initiation and completion rates among children. DESIGN Comparative, before-and-after study design. SETTING Three intervention and two control districts in Ethiopia. PARTICIPANTS Children who had a history of close contact with adults with infectious forms of tuberculosis (TB). Child contacts in whom active TB and contraindications to TPT regimens were excluded were considered eligible for TPT. INTERVENTIONS Between July 2020 and June 2021, trained women Iddir members visited households of index TB patients, screened child household contacts for TB, provided education and information on the benefits of TPT, linked them to the nearby health centre and followed them at home for TPT adherence and side effects. Two control zones received the standard of care, which comprised of facility-based provision of TPT to children. We analysed quarterly TPT data for treatment initiation and completion and compared intervention and control zones before and after the interventions and tested for statistical significance using Poisson regression. PRIMARY AND SECONDARY OUTCOME MEASURES There were two primary outcome measures: proportion of eligible children initiated TPT and proportion completed treatment out of those eligible. RESULTS TPT initiation rate among eligible under-15-year-old children (U15C) increased from 28.7% to 63.5% in the intervention zones, while it increased from 34.6% to 43.2% in the control zones, and the difference was statistically significant (p<0.001). TPT initiation rate for U5C increased from 13% (17 out of 131) to 93% (937 out of 1010). Of the U5C initiated, 99% completed treatment; two discontinued due to side effects; three parents refused to continue; and one child was lost to follow-up. CONCLUSION Women-led Iddirs contributed to significant increase in TPT initiation and completion rates. The model of TPT delivery should be scaled-up.
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Affiliation(s)
- Degu Jerene
- TB Elimination and Health Systems Innovation, KNCV Tuberculosis Foundation, Den Haag, The Netherlands
| | - Dawit Assefa
- KNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, Ethiopia
| | | | - Samuel Bayu
- KNCV Tuberculosis Foundation, Ethiopia Office, Addis Ababa, Ethiopia
| | - Samuel Seid
- KNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Fikirte Aberra
- Southern Nations Nationalities and Peoples' Region Health Bureau, Hawassa, Ethiopia
| | - Ahmed Bedru
- KNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Amera Khan
- Innovation & Grants, Stop TB Partnership, Geneva, Switzerland
| | - Jacob Creswell
- Innovation & Grants, Stop TB Partnership, Geneva, Switzerland
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Benoit Vásquez GI, Morrobel AL, Benjumea-Bedoya D, Del Corral-Londoño H. Barriers and facilitators for isoniazid preventive therapy (IPT) administration in children under 5 years of age in the Dominican Republic. BMC Infect Dis 2022; 22:359. [PMID: 35410136 PMCID: PMC8996516 DOI: 10.1186/s12879-022-07333-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 03/17/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Throughout the world tuberculosis (TB) is the second leading cause of death due to an infectious agent. The World Health Organization promotes Isoniazid Preventive Therapy (IPT) in children under 5 years who are contacts of persons diagnosed with smear-positive pulmonary TB (SPPTB). In 2019, 33% of children identified as contacts received IPT globally, while in the Americas 11 countries reached coverages ≥ 75%, only 35% did so in the Dominican Republic (DR). The aim of this study was to identify barriers and facilitators for IPT administration in children under 5 in the Area IV Directorate of Health of the DR's National District. METHODS Descriptive study, using mixed methods and sequential explanatory approach. We characterized children under 5 years who were contacts of a person with SPPTB. Later, semi-structured interviews and content analysis allowed identification of barriers and facilitators for IPT administration in children who were contacts of a person diagnosed with SPPTB, as perceived by relatives and health system personnel. RESULTS A total of 238 children were identified as contacts of 174 persons with SPPTB: 36% of these received IPT while no data on IPT administration was found for 11% of them. The proportion of children who had a tuberculin skin test (TST) done was < 20%. However, those who had the test done had a greater opportunity to receive IPT (OR: 8.12, CI 95%: 1.60-41.35). Barriers identified include socioeconomic conditions of children and families, stigma, lack of information in clinical and follow-up records, lack of coordination between public and private providers and lack of coherence within national regulations. Facilitators include home based care of persons with TB and their contacts, transfer of treatment to a health centre near household, isoniazid availability, provision of information by health-workers and economic support for food and transportation. CONCLUSIONS Incomplete data, lack of use of TST to rule out active TB, socioeconomic and cultural conditions, were barriers for IPT administration. Implementation of a person centred approach to care was found to be the main facilitator for IPT uptake. Administration of IPT depends predominantly on modifiable health system factors. This allows rapid identification of strategies to improve IPT administration.
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Affiliation(s)
- Grey Idalia Benoit Vásquez
- Administradora de Estancias Infantiles Salud Segura, Santo Domingo, Dominican Republic.
- National Directorate of Epidemiology (DIGEPI), Ministry of Public Health, Santo Domingo, Dominican Republic.
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia.
| | - Ana Lucia Morrobel
- Programa de Control de Tuberculosis, Ministerio de Salud Pública, Santo Domingo, Dominican Republic
| | - Dione Benjumea-Bedoya
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
- Grupo de Investigación en Salud Familiar y Comunitaria. Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Medellín, Colombia
| | - Helena Del Corral-Londoño
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
- Grupo de investigación MICROBA, Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
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11
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An Y, Teo AKJ, Huot CY, Tieng S, Khun KE, Pheng SH, Leng C, Deng S, Song N, Nop S, Nonaka D, Yi S. Knowledge, attitude, and practices regarding childhood tuberculosis detection and management among health care providers in Cambodia: a cross-sectional study. BMC Infect Dis 2022; 22:317. [PMID: 35361143 PMCID: PMC8969333 DOI: 10.1186/s12879-022-07245-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) estimated that 29% of global tuberculosis (TB) and almost 47% of childhood TB cases were not reported to national TB programs in 2019. In Cambodia, most childhood TB cases were reported from health facilities supported by the Global Fund to Fight AIDS, Tuberculosis, and Malaria in 2019. This study aimed to compare the healthcare providers' knowledge, attitude, and practices (KAP) on childhood TB case detection in operational districts (ODs) with high and low childhood TB case detection in Cambodia. METHODS We conducted a cross-sectional study between November and December 2020 among healthcare providers in 10 purposively selected ODs with high childhood TB case detection and 10 ODs with low childhood TB case detection. A total of 110 healthcare providers from referral hospitals (RHs) and 220 from health centers (HCs) were interviewed. We collected information on socio-demographic characteristics, training, and KAP on childhood TB. Pearson's Chi-square or Fisher's exact and Student's t-tests were performed to explore the differences in KAP of healthcare providers from ODs with low vs. high childhood TB detection. RESULTS Of the 330 respondents, 193 were from ODs with high childhood TB case detection, and 66.67% were from HCs. A significantly higher proportion (46.11%) of respondents from ODs with high childhood TB case detection received training on childhood TB within the past two years than those from low childhood TB case detection ODs (34.31%) (p = 0.03). Key knowledge on childhood TB was not significantly different among respondents from ODs with high and low childhood TB case detection. A significantly higher proportion of respondents from ODs with high childhood TB case detection had a good attitude (98.96 vs. 97.08%, p = 0.002) and performed good practices (58.55 vs. 45.26%, p = 0.02) on contact investigation in the community than those from low childhood TB case detection ODs. CONCLUSIONS Healthcare providers from ODs with high childhood TB detection had better attitudes and practices towards childhood TB. The attitudes and practices need to be improved among healthcare providers in ODs with low case detection. Further investment in training and experience sharing on childhood TB case detection among healthcare providers is needed to improve childhood TB case detection.
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Affiliation(s)
- Yom An
- Sustaining Technical and Analytical Resources (STAR Project), United States Agency for International Development, Phnom Penh, Cambodia. .,Department of Global Health, Graduate 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
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chan Yuda Huot
- National Centre for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Sivanna Tieng
- National Centre for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Kim Eam Khun
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.,National Centre for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Sok Heng Pheng
- National Centre for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Chhenglay Leng
- National Centre for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | | | - Ngak Song
- United States Agency for International Development, Phnom Penh, Cambodia
| | - Sotheara Nop
- United States Agency for International Development, Phnom Penh, Cambodia
| | - Daisuke Nonaka
- Department of Global Health, Graduate School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Siyan Yi
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Center for Global Health Research, Touro University California, Vallejo, CA, USA
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12
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Ghimire A, Mahendradhata Y, Paudel S, Lama Yonzon C, K. C. B, Sharma S, Utarini A. Implementation fidelity of tuberculosis preventive therapy for under five children exposed to sputum smear positive pulmonary tuberculosis in Kaski district, Nepal: An implementation research. PLoS One 2022; 17:e0263967. [PMID: 35171959 PMCID: PMC8849459 DOI: 10.1371/journal.pone.0263967] [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: 04/02/2021] [Accepted: 02/01/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction In line with the WHO recommendation, Nepal has started implementing Tuberculosis prevention therapy (TBPT) for under five children exposed to Sputum Smear Positive Pulmonary Tuberculosis, as one of the strategies for prevention, care and control of TB. Implementation fidelity study is important to assess on what extent preventive program is being implemented. The objective of the study measured the implementation fidelity of TBPT program Kaski district, Nepal. Methods We used a mixed-method explanatory sequential design study. Quantitative data were collected through retrospective review of records from April 2018 to May 2019 and level of adherence was established. Moderating factors influencing the implementation of TBPT were TBPT were assessed qualitatively. Sixteen in-depth interviews and a focus group discussion was conducted purposively with responsible stakeholders. The study was guided by the Conceptual Framework for Implementation Fidelity (CFIR) developed by Carroll. Results The majority of the components of the TBPT program were found to be implemented with a moderate level of fidelity. The proportion of under five years children initiate and complete the full course of TBPT was 72.5% and 75.86% respectively. The proportion of index cases traced for household contact, contact tracing within two months and timely initiation of therapy within two months were 54.19%, 82.73% and 86.20%. Moderating factors identified in the implementation of the program were contact tracing and enrollment, partnership and ownership, training resources, medication, awareness and information dissemination. Conclusion The TBPT program is being moderately implemented in Kaski districts. Addressing the key challenges identified in contact tracing, partnership/ownership, incentives, training and knowledge of health workers results in more identification of children eligible for TBPT.
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Affiliation(s)
- Ashmita Ghimire
- International Master Program in Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- * E-mail:
| | - Yodi Mahendradhata
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sagun Paudel
- International Master Program in Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Chhoden Lama Yonzon
- International Master Program in Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bhuvan K. C.
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Sushmita Sharma
- Province Health Logistic Management Centre, Gandaki Province, Pokhara, Nepal
| | - Adi Utarini
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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13
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Arega B, Negesso A, Taye B, Weldeyohhans G, Bewket B, Negussie T, Teshome A, Endazenew G. Impact of COVID-19 pandemic on TB prevention and care in Addis Ababa, Ethiopia: a retrospective database study. BMJ Open 2022; 12:e053290. [PMID: 35135769 PMCID: PMC8829833 DOI: 10.1136/bmjopen-2021-053290] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The current COVID-19 pandemic in Ethiopia could cause severe dysfunction in tuberculosis (TB) treatment, diagnostic services, and prevention and control efforts. In this study, we evaluated the effect of COVID-19 on TB service indicators in Addis Ababa, where more than two-thirds of the country's COVID-19 morbidity was recorded. DESIGN We performed a comparative retrospective study to evaluate the impact of COVID-19 on TB services during the pre-COVID-19 era (from April 2019 to March 2020) and the COVID-19 era (from April 2020 to March 2021) in Addis Ababa, Ethiopia. We extracted data on total TB detection rate, TB treatment success rate, isoniazid prophylaxis therapy, and drug susceptibility tests and others from the health information system. Using Poisson regression, we estimated the incidence rate ratios and the absolute number difference of the indicators (number per quarter and year) in the COVID-19 and pre-COVID-19 eras. RESULTS Compared with the pre-COVID-19 era, the total TB detection, bacteriologically confirmed TB, TB treatment success rate, latent TB infection treatment and community health workers' engagement in TB detection decreased, respectively, by 11%, 11.8%, 17%, 44.7% and 77.2% during the COVID-19 period. Rifampicin resistance increased by 27.7% during the same period. Comparative analysis showed a significant decline in these TB service indicators (p<0.001) CONCLUSION: The COVID-19 pandemic has had a negative impact on TB service indicators in Addis Ababa. This highlights the importance of reinforcing TB services, including adopting alternative digital health technology to screen for TB and integrating TB and COVID-19 services to mitigate COVID-19's challenges to TB prevention and care.
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Affiliation(s)
- Balew Arega
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Abebe Negesso
- Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
| | - Betelhem Taye
- Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
| | | | - Bekure Bewket
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | | | - Ayele Teshome
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
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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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15
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Takamiya M, Takarinda K, Balachandra S, Godfrey M, Radin E, Hakim A, Pearson ML, Choto R, Sandy C, Maphosa T, Rogers JH. Isoniazid preventive therapy use among adult people living with HIV in Zimbabwe. Int J STD AIDS 2021; 32:1020-1027. [PMID: 33978529 PMCID: PMC10719553 DOI: 10.1177/09564624211014404] [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] [Indexed: 11/15/2022]
Abstract
We assessed the prevalence of isoniazid preventive therapy (IPT) uptake and explored factors associated with IPT non-uptake among people living with HIV (PLHIV) using nationally representative data from the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) 2015-2016. This was a cross-sectional study of 3418 PLHIV ZIMPHIA participants eligible for IPT, aged ≥15 years and in HIV care. Logistic regression modeling was performed to assess factors associated with self-reported IPT uptake. All analyses accounted for multistage survey design. IPT uptake among PLHIV was 12.7% (95% confidence interval (CI): 11.4-14.1). After adjusting for sex, age, rural/urban residence, TB screening at the last clinic visit, and hazardous alcohol use, rural residence was the strongest factor associated with IPT non-uptake (adjusted OR (aOR): 2.39, 95% CI: 1.82-3.12). Isoniazid preventive therapy non-uptake having significant associations with no TB screening at the last HIV care (aOR: 2.07, 95% CI: 1.54-2.78) and with hazardous alcohol use only in urban areas (aOR: 10.74, 95% CI: 3.60-32.0) might suggest suboptimal IPT eligibility screening regardless of residence, but more so in rural areas. Self-reported IPT use among PLHIV in Zimbabwe was low, 2 years after beginning national scale-up. This shows the importance of good TB screening procedures for successful IPT implementation.
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Affiliation(s)
| | | | | | | | | | - Avi Hakim
- U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Regis Choto
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Talent Maphosa
- U.S. Centers for Disease Control and Prevention (CDC), Harare, Zimbabwe
| | - John H Rogers
- U.S. Centers for Disease Control and Prevention (CDC), Harare, Zimbabwe
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16
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Yaqoob A, Hinderaker SG, Fatima R, Shewade HD, Nisar N, Wali A. Diagnosis of childhood tuberculosis in Pakistan: Are national guidelines used by private healthcare providers? Int J Infect Dis 2021; 107:291-297. [PMID: 33895413 DOI: 10.1016/j.ijid.2021.04.055] [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: 01/31/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The National Tuberculosis Control Program (NTP) in Pakistan developed, with the Pakistan Paediatric Association, a pediatric scoring chart to aid diagnosis of childhood tuberculosis (TB). Our study compared the diagnostic practice of private healthcare providers in Pakistan with the NTP guidelines. METHODS A cross-sectional study comparing diagnosis of TB in children <15 years by Non-NTP private providers with the NTP's pediatric scoring chart. A generalized linear model was used to determine the difference in adherence by Non-NTP private providers to the NTP guidelines for childhood TB diagnosis by associated factors. RESULTS A total of 5193 (79.7% of presumptive childhood TB cases identified in the selected districts during the study) children were diagnosed with TB by Non-NTP private providers. A strong clinical suspicion of TB was present in 17.3%, and chest x-ray was suggestive of TB in 34.3%. The Kappa score between Non-NTP private providers and the NTP guidelines for diagnosing TB was 0.152. Only 47.8% of cases were diagnosed in line with the NTP guidelines. Children <5 years old with a history of TB contact had a higher chance of being diagnosed according to the NTP guidelines. CONCLUSION This study indicates a low adherence of NTP guidelines for diagnosing childhood TB by private providers in Pakistan.
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Affiliation(s)
- Aashifa Yaqoob
- Common Management Unit (TB, HIV/AIDS and Malaria), Islamabad, Pakistan; University of Bergen, Bergen, Norway.
| | | | - Razia Fatima
- Common Management Unit (TB, HIV/AIDS and Malaria), Islamabad, Pakistan
| | - Hemant D Shewade
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India
| | | | - Ahmed Wali
- Provincial TB Control Program, Quetta, Pakistan
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17
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Nabity SA, Gunde LJ, Surie D, Shiraishi RW, Kirking HL, Maida A, Auld AF, Odo M, Jahn A, Nyirenda RK, Oeltmann JE. Early-phase scale-up of isoniazid preventive therapy for people living with HIV in two districts in Malawi (2017). PLoS One 2021; 16:e0248115. [PMID: 33793577 PMCID: PMC8016323 DOI: 10.1371/journal.pone.0248115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 02/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background Isoniazid preventive therapy (IPT) against tuberculosis (TB) is a life-saving intervention for people living with HIV (PLHIV). In September 2017, Malawi began programmatic scale-up of IPT to eligible PLHIV in five districts with high HIV and TB burden. We measured the frequency and timeliness of early-phase IPT implementation to inform quality-improvement processes. Methods and findings We applied a two-stage cluster design with systematic, probability-proportional-to-size sampling of six U.S. Centers for Disease Control and Prevention (CDC)-affiliated antiretroviral therapy (ART) centers operating in the urban areas of Lilongwe and Blantyre, Malawi (November 2017). ART clinic patient volume determined cluster size. Within each cluster, we sequentially sampled approximately 50 PLHIV newly enrolled in ART care. We described a quality-of-care cascade for intensive TB case finding (ICF) and IPT in PLHIV. PLHIV newly enrolled in ART care were eligibility-screened for hepatitis and peripheral neuropathy, as well as for TB disease using a standardized four-symptom screening tool. Among eligible PLHIV, the overall weighted IPT initiation rate was 70% (95% CI: 46%–86%). Weighted IPT initiation among persons aged <15 years (30% [95% CI: 12%–55%]) was significantly lower than among persons aged ≥15 years (72% [95% CI: 47%–89%]; Rao-Scott chi-square P = 0.03). HIV-positive children aged <5 years had a weighted initiation rate of only 13% (95% CI: 1%–79%). For pregnant women, the weighted initiation rate was 67% (95% CI: 32%–90%), similar to non-pregnant women aged ≥15 years (72% [95% CI: 49%–87%]). Lastly, 95% (95% CI: 92%–97%) of eligible PLHIV started ART within one week of HIV diagnosis, and 92% (95% CI: 73%–98%) of patients receiving IPT began on the same day as ART. Conclusions Early-phase IPT uptake among adults at ART centers in Malawi was high. Child uptake needed improvement. National programs could adapt this framework to evaluate their ICF-IPT care cascades.
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Affiliation(s)
- Scott A Nabity
- Global Tuberculosis Prevention and Control Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laurence J Gunde
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Diya Surie
- Global Tuberculosis Prevention and Control Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ray W Shiraishi
- Global Tuberculosis Prevention and Control Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hannah L Kirking
- Global Tuberculosis Prevention and Control Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alice Maida
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Andrew F Auld
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Michael Odo
- Department of HIV and AIDS, Malawi Ministry of Health, Lilongwe, Malawi
| | - Andreas Jahn
- Department of HIV and AIDS, Malawi Ministry of Health, Lilongwe, Malawi
| | - Rose K Nyirenda
- Department of HIV and AIDS, Malawi Ministry of Health, Lilongwe, Malawi
| | - John E Oeltmann
- Global Tuberculosis Prevention and Control Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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How do private practitioners in Pakistan manage children suspected having tuberculosis? A cross sectional study. BMC Public Health 2021; 21:71. [PMID: 33413206 PMCID: PMC7791821 DOI: 10.1186/s12889-020-10053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 12/10/2020] [Indexed: 11/15/2022] Open
Abstract
Background In Pakistan, private providers provide a large portion of health care, including for tuberculosis (TB). All TB patients are supposed to be reported to the National Tuberculosis Program (NTP), which provides drugs free of charge in addition to monitoring, supervision, and support. However, diagnosis of TB in children is difficult. We aimed to assess the private health care providers’ investigation practices and management of childhood TB. Methods We used a cross-sectional study, which was based on a national survey measuring under-reporting of children with TB in 12 selected districts in Pakistan from April–June, 2016. We explored the practices of the private health care providers, including the health care workers i.e. general practitioners, pediatricians, pulmonologists and chest specialists, who were involved in the diagnosis of TB in children under 15 years for investigating and managing children suspected having TB. Results Among 6519 presumptive child TB cases, a total of 5193(79.7%) children under 15 years were diagnosed as TB by private health care providers during second quarter, 2016. Only 187(2.9%) were notified to NTP. The majority of presumptive child TB cases reported cough, fever, and failure to thrive; few had TB contacts with pulmonary TB patients. Failure to thrive, loss of body weight and absence of BCG (Bacillus Calmette–Guérin) scar was more common in female children. Private providers relied on chest X-ray in 46.1%, while tuberculin skin test and Gene-Xpert MTB/RIF testing was little utilized. Bacteriological confirmation was present in 7.6%, and clinical assessment was the only basis for diagnosis in 39.3%. Of children with presumptive TB, only 955(14.6%) children were treated by private provider, while 3121(47.9%) cases were referred for diagnosis and 2443(37.5%) were referred after diagnosis for treatment; among all the referred, 3812(68.5%) were sent for investigations to District TB Centre (NTP). Conclusion This study showed that many private providers referred children suspected having TB to laboratories for further diagnosis, but the cases identified in these investigations were often not notified to the NTP. This problem could be resolved by strengthening the referral linkages between private health providers, NTP laboratories and treatment centres through capacity building and training of their staff.
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19
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Seid G, Tsedalu T, Ayele M. Adherence to Isoniazid Preventive Therapy among Under-Five Children in Contact with Adult Bacteriologically Confirmed Pulmonary Tuberculosis Patients: A Mixed-Method Study. Int J Microbiol 2020; 2020:8834806. [PMID: 33061981 PMCID: PMC7542497 DOI: 10.1155/2020/8834806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/18/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The World Health Organization recommends that all children below the age of five who have household contact with an infectious tuberculosis case should receive isoniazid preventive treatment for at least six months after the active tuberculosis disease has been ruled out. This research aims to determine the adherence of children, eligible for isoniazid preventive treatment, to the treatment who had contact with pulmonary tuberculosis patients. METHODS A mixed study design was used to prospectively assess the adherence to IPT among children under the age of 5 in contact with pulmonary TB patients through the quantitative study design and barriers of adherence in view of health care professionals and the family of children through a descriptive qualitative study. The study was conducted from July 2019 to December 2019 in Addis Ababa. Data were collected by a structured datasheet from the selected health center registration book. Data were entered into Epi Data software and analyzed by using SPSS version 20. Descriptive statistical methods were used to summarize the sociodemographic characteristics of the study participants. RESULT The ratio of the total number of pulmonary tuberculosis index cases recruited into the study to the number of child contacts aged less than 5 years was 1 : 1.32. The total isoniazid preventive treatment uptake in this study was 75.2%; one-fifth (21.3%) of the children who started IPT did not complete the full course of six-month isoniazid preventive treatment. Except for HIV not to be tested (P < 0.001), there was no significant association of the listed risk factors in default to complete the full six months of preventive treatment. CONCLUSION Enrolment of eligible children for isoniazid preventive treatment in the urban city Addis Ababa was still below the target of the World Health Organization End tuberculosis strategy by 2030. The treatment adherence rate also needs a great deal of effort to achieve the strategy. Child default after the first visit indicates a lack of understanding about the benefit and safety of preventive therapy in young children among families of TB patients, and awareness-creating efforts by health extension workers will help to improve the outcomes.
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Affiliation(s)
- Getachew Seid
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Marta Ayele
- Addis Ababa Health Bureau, Addis Ababa, Ethiopia
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20
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Contact Screening and Isoniazid Preventive Therapy Initiation for Under-Five Children among Pulmonary Tuberculosis-Positive Patients in Bahir Dar Special Zone, Northwest Ethiopia: A Cross-Sectional Study. Tuberc Res Treat 2020; 2020:6734675. [PMID: 32566291 PMCID: PMC7294357 DOI: 10.1155/2020/6734675] [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: 02/19/2020] [Revised: 05/06/2020] [Accepted: 05/16/2020] [Indexed: 11/26/2022] Open
Abstract
Background Children are highly susceptible to Mycobacterium tuberculosis infection, and about 70% of children living in the same households with pulmonary tuberculosis-positive patients will become infected. However, pulmonary positive tuberculosis is a common phenomenon and the implementation of the recommended contact screening and initiation of isoniazid preventive therapy is very low. Therefore, this study is aimed at assessing contact screening practice and initiation of isoniazid preventive therapy of under-five children among pulmonary tuberculosis-positive patients in Bahir Dar, northwest Ethiopia. Methods A facility-based cross-sectional study was conducted from March 1 to 30, 2016. A total of 267 pulmonary tuberculosis-positive patients were included in this study. To identify independent predictors of contact screening and isoniazid preventive therapy initiation, we performed multivariable logistic regression analyses using SPSS version 20 with CI of 95% at p value < 0.05. Results A total of 230 (90.2%) pulmonary tuberculosis-positive patients had single contacts with their under-five children. One hundred nine (64.8%) children were screened. From those screened, 11 (7.4%) developed tuberculosis disease and started antituberculosis treatment. Forty-four (31.9%) children started isoniazid preventive therapy. Sex of the participants, place of service delivery, relationship with contacts, HIV status, and attitude of PTB+ cases were significant predictors of contact screening (p < .05). Participant's knowledge, attitude of participants, and relationship of the child with participant were significant predictors of isoniazid preventive therapy initiation (p < 0.05). Conclusion Contact screening practice and isoniazid preventive therapy initiation of children under the age of 5 in Bahir Dar zone were very low. Intimate family contact with pulmonary tuberculosis-positive patients, place of service delivery, and attitude towards screening are the key factors of contact screening. Participant's knowledge, attitude of participants, and relationship of the child with participant are the key factors of isoniazid preventive therapy initiation. Therefore, household contact screening and isoniazid preventive therapy initiation should be paid attention to reduce transmission.
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Tumusiime R, Mukasa C, Kisakya-Maria AK, Neumbe IM, Odyeny J, Maube B, Gavamukulya Y, Nekaka R. Baseline Assessment of Risk Factors of Presumptive Tuberculosis among under Five Children Living with an Index Client under Treatment in Mbale District, Eastern Uganda. MICROBIOLOGY RESEARCH JOURNAL INTERNATIONAL 2020; 30:1-8. [PMID: 34179569 PMCID: PMC8223506 DOI: 10.9734/mrji/2020/v30i530214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND AIMS Children in contact with adults having pulmonary Tuberculosis (TB) are vulnerable to TB infection and hence contact tracing and screening is important for early detection of infection. However, there are few contacts traced and the prevalence and risk factors for transmission are not well studied. The objective of this study was to determine the prevalence of infection and risk factors associated with TB transmission among under five children in household contact with adult pulmonary TB patients. MATERIALS AND METHODS A cross sectional study was carried out in three health facilities with a high TB burden in Mbale District, Eastern Uganda involving all under five household contacts of adults with pulmonary tuberculosis recorded in the TB register from October 2018 to March 2019 and still on treatment. Structured questionnaires were administered to the index clients to obtain their demographic and clinical data about TB, HIV as well as information on the children. Children were screened using the intensive case finding forms to identify presumptive cases. RESULTS The total number of index TB Clients line listed were 70. Number of clients traced was 38, 21 (%) of whom had children under five years and a total of 33 children were identified. The number of presumptive cases was 9/33 (27.27%). 77.8% of the presumptive cases were living in poorly ventilated houses. CONCLUSION The study identified children with presumptive TB and various risk factors for TB transmission. Intensive contact tracing can therefore help reduce TB transmission within the communities. It is recommended to undertake studies aiming at improving contact tracing and strategies to eliminate the risk factors to TB transmission.
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Affiliation(s)
- Rosemary Tumusiime
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box, 1460, Mbale, Uganda
| | - Charles Mukasa
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box, 1460, Mbale, Uganda
| | - Agatha K Kisakya-Maria
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box, 1460, Mbale, Uganda
| | - Irene Mildred Neumbe
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box, 1460, Mbale, Uganda
| | - Jerome Odyeny
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box, 1460, Mbale, Uganda
| | - Bernard Maube
- Busiu Health Center IV, Mbale District Local Government, Mbale District, Uganda
| | - Yahaya Gavamukulya
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, Busitema University, P.O. Box, 1460, Mbale, Uganda
| | - Rebecca Nekaka
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box, 1460, Mbale, Uganda
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Robert M, Todd J, Ngowi BJ, Msuya SE, Ramadhani A, Sambu V, Jerry I, Mujuni MR, Mahande MJ, Ngocho JS, Maokola W. Determinants of isoniazid preventive therapy completion among people living with HIV attending care and treatment clinics from 2013 to 2017 in Dar es Salaam Region, Tanzania. A cross-sectional analytical study. BMC Infect Dis 2020; 20:276. [PMID: 32276618 PMCID: PMC7147031 DOI: 10.1186/s12879-020-04997-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/27/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) disease is a common opportunistic infection among people living with HIV (PLHIV). WHO recommends at least 6 months of isoniazid Preventive Therapy (IPT) to reduce the risk of active TB. It is important to monitor the six-month IPT completion since a suboptimal dose may not protect PLHIV from TB infection. This study determined the six-month IPT completion and factors associated with six-month IPT completion among PLHIV aged 15 years or more in Dar es Salaam region, Tanzania. METHODS Secondary analysis of routine data from PLHIV attending 58 care and treatment clinics in Dar es Salaam region was used. PLHIV, aged 15 years and above, who screened negative for TB symptoms and initiated IPT from January, 2013 to June, 2017 were recruited. Modified Poisson regression with robust standard errors was used to estimate prevalence ratios (PR) and 95% confidence interval (CI) for factors associated with IPT completion. Multilevel analysis was used to account for health facility random effects in order to estimate adjusted PR (APR) for factors associated with IPT six-month completion. RESULTS A total of 29,382 PLHIV were initiated IPT, with 21,808 (74%) female. Overall 17,092 (58%) six-month IPT completion, increasing from 42% (773/1857) in year 2013 to 76% (2929/3856) in 2017. Multilevel multivariable model accounting for health facilities as clusters, showed PLHIV who were not on ART had 46% lower IPT completion compared to those were on ART (APR: 0.54: 95%CI: 0.45-0.64). There was 37% lower IPT completion among PLHIV who transferred from another clinic (APR: 0.63: 95% CI (0.54-0.74) compared to those who did not transfer. PLHIV aged 25-34 years had a 6% lower prevalence of IPT completion as compared to those aged 15 to 24 years (APR:0.94 95%CI:0.89-0.98). CONCLUSION The IPT completion rate in PLHIV increased over time, but there was lower IPT completion in PLHIV who transferred from other clinics, who were aged 25 to 34 years and those not on ART. Interventions to support IPT in these groups are urgently needed.
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Affiliation(s)
- Masanja Robert
- Department of Epidemiology and Biostatistics, Institute of Public Health Kilimanjaro Christian Medical University College (KCMUCo), P.O.Box 2240, Kilimanjaro, Tanzania
- Mwenge Catholic University (MWECAU), P.O.Box 1226, Moshi, Tanzania
| | - Jim Todd
- Department of Epidemiology and Biostatistics, Institute of Public Health Kilimanjaro Christian Medical University College (KCMUCo), P.O.Box 2240, Kilimanjaro, Tanzania
- London School of Hygiene and Tropical Medicine (LSTM), London, UK
| | - Bernard J. Ngowi
- National Institute for Medical Research-Muhimbili Medical Research Centre, P.O.Box 3436, Dar es Salaam, Tanzania
- University of Dar es Salaam College of Health and Allied Sciences, P.O.Box 68, Mbeya, Tanzania
| | - Sia E. Msuya
- Department of Epidemiology and Biostatistics, Institute of Public Health Kilimanjaro Christian Medical University College (KCMUCo), P.O.Box 2240, Kilimanjaro, Tanzania
| | - Angella Ramadhani
- Ministry of Health, Community Development, Gender, Elderly and Children (NACP), Dodoma, Tanzania
| | - Veryhel Sambu
- Ministry of Health, Community Development, Gender, Elderly and Children (NACP), Dodoma, Tanzania
| | - Isaya Jerry
- Ministry of Health, Community Development, Gender, Elderly and Children (NACP), Dodoma, Tanzania
| | - Martin R. Mujuni
- Department of Epidemiology and Biostatistics, Institute of Public Health Kilimanjaro Christian Medical University College (KCMUCo), P.O.Box 2240, Kilimanjaro, Tanzania
| | - Michael J. Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health Kilimanjaro Christian Medical University College (KCMUCo), P.O.Box 2240, Kilimanjaro, Tanzania
| | - James S. Ngocho
- Department of Epidemiology and Biostatistics, Institute of Public Health Kilimanjaro Christian Medical University College (KCMUCo), P.O.Box 2240, Kilimanjaro, Tanzania
| | - Werner Maokola
- Mwenge Catholic University (MWECAU), P.O.Box 1226, Moshi, Tanzania
- Ministry of Health, Community Development, Gender, Elderly and Children (NACP), Dodoma, Tanzania
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Otero L, Battaglioli T, Ríos J, De la Torre Z, Trocones N, Ordoñez C, Seas C, Van der Stuyft P. Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data. Trop Med Int Health 2019; 25:346-356. [PMID: 31758837 DOI: 10.1111/tmi.13350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Contacts of pulmonary tuberculosis (TB) cases are at high risk of TB infection and progression to disease. Close and household contacts and those <5 years old have the highest risk. Isoniazid preventive therapy (IPT) can largely prevent TB disease among infected individuals. International and Peruvian recommendations include TB contact investigation and IPT prescription to eligible contacts. We conducted a study in Lima, Peru, to determine the number of close and household contacts who were evaluated, started on IPT, and who completed it, and the factors associated to compliance with national guidelines. METHODS We conducted a longitudinal retrospective study including all TB cases diagnosed between January 2015 and July 2016 in 13 health facilities in south Lima. Treatment cards, TB registers and clinical files were reviewed and data on index cases (sex, age, smear status, TB treatment outcome), contact investigation (sex, age, kinship to the index case, evaluations at month 0, 2 and 6) and health facility (number of TB cases notified per year, proportion of TB cases with treatment success) were extracted. We tabulated frequencies of contact evaluation by contact and index case characteristics. To investigate determinants of IPT initiation and completion, we used generalised linear mixed models. RESULTS A total of 2323 contacts were reported by 662 index cases; the median number of contacts per case was four (IQR, 2-5). Evaluation at month 0 was completed by 99.2% (255/257) of contacts <5 and 98.1% (558/569) of contacts aged 5-19 years. Of 191 eligible contacts <5 years old, 70.2% (134) started IPT and 31.4% (42) completed it. Of 395 contacts 5-19 years old, 36.7% (145) started IPT and 32.4% (47) completed it. Factors associated to not starting IPT among contacts <5 years old were being a second-degree relative to the index case (OR 6.6 95CI% 2.6-16.5), not having received a tuberculin skin test (TST) (OR 3.9 95%CI 1.4-10.8), being contact of a smear-negative index case (OR 5.5 95%CI 2.0-15.1) and attending a low-caseload health facility (OR 2.8 95%CI 1.3-6.2). Factors associated to not starting IPT among 5-19 year-olds were age (OR 13.7 95%CI 5.9-32.0 for 16-19 vs. 5-7 years old), being a second-degree relative (OR 3.0 95%CI 1.6-5.6), not having received a TST (OR 5.4, 95%CI 2.5-11.8), being contact of a male index case (OR 2.1 95CI% 1.2-3.5), with smear-negative TB (OR 1.9 95%CI 1.0-3.6), and attending a high-caseload health facility (OR 2.1 95%CI 1.2-3.6). Factors associated to not completing IPT, among contacts who started, were not having received a TST (OR 3.4 95%CI 1.5-7.9 for <5 year-olds, and OR 4.3 95%CI 1.7-10.8 for those 5-19 years old), being contact of an index case with TB treatment outcome other than success (OR 9.3 95%CI 2.6-33.8 for <5 year-olds and OR 15.3 95%CI 1.9-125.8 for those 5-19 years old), and, only for those 5-19 years old, attending a health facility with high caseload (OR 3.2 95%CI 1.4-7.7) and a health facility with low proportion of TB cases with treatment success (OR 4.4 95%CI 1.9-10.2). CONCLUSIONS We found partial compliance to TB contact investigation, and identified contact, index case and health facility-related factors associated to IPT start and completion that can guide the TB programme in increasing coverage and quality of this fundamental activity.
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Affiliation(s)
- Larissa Otero
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.,Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Tullia Battaglioli
- Unit of General Epidemiology and Disease Control, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Julia Ríos
- Dirección de Prevención y Control de la Tuberculosis, Ministry of Health, Lima, Peru
| | - Zayda De la Torre
- Dirección de Salud San Juan de Miraflores Villa María del Triunfo, Ministry of Health, Lima, Peru
| | - Nayda Trocones
- Dirección de Salud San Juan de Miraflores Villa María del Triunfo, Ministry of Health, Lima, Peru
| | - Cielo Ordoñez
- Dirección de Salud San Juan de Miraflores Villa María del Triunfo, Ministry of Health, Lima, Peru
| | - Carlos Seas
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.,Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patrick Van der Stuyft
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
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Mwangi PM, Wamalwa D, Marangu D, Obimbo EM, Ng’ang’a M. Implementation of Isoniazid Preventive Therapy Among HIV-Infected Children at Health Facilities in Nairobi County, Kenya: A Cross-Sectional Study. East Afr Health Res J 2019; 3:141-150. [PMID: 34308207 PMCID: PMC8279276 DOI: 10.24248/eahrj-d-19-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 10/29/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND HIV is the strongest risk factor for developing tuberculosis (TB) among people with latent or new Mycobacterium tuberculosis infection. Isoniazid preventive therapy (IPT) reduces the risk of active TB among people living with HIV by up to 62%. Despite evidence that IPT is safe and efficacious, its provision remains low globally. The current study aimed at documenting IPT uptake, adherence, and completion rates, as well as the correlates of IPT uptake among HIV-infected children in Kenya. The study also assessed the knowledge, attitude, and practices of health-care workers (HCWs) with regard to IPT. METHODS A health facility-based cross-sectional study was conducted. Data were collected from caregivers of HIV-infected children as well as HCWs using an interviewer-administered questionnaire. Logistic regression was used to determine the factors associated with IPT uptake. RESULTS The study enrolled 111 child-caregiver dyads. Most of the caregivers were female (n=75, 77.3%) and HIV-positive (n=82, 85.4%). The majority of children were male (n=65, 58.6%) and on ART (n=106, 95.5%). Overall, 59 children were on IPT (uptake of 53.2%, 95% confidence interval [CI], 43.9% to 62.4%). Out of the 25 children who had been on IPT for more than 6 months, 22 (88.0%) successfully completed the 6-month course of treatment. Further, 27 of the 34 children (78.4%) who were on IPT at the time of the study demonstrated satisfactory adherence to the therapy (no doses missed). The caregivers' attributes that were associated with IPT uptake included having a secondary school education (adjusted odds ratio [aOR] 0.13; 95% CI, 0.03 to 0.67) and having been on IPT (aOR 27.50; 95% CI, 5.39 to 140.28). The characteristics of children that were significantly associated with IPT uptake were higher median baseline CD4 count (P=.007) and higher median current CD4 count (P=.024). CONCLUSION The study demonstrated suboptimal IPT uptake but favourable adherence and treatment completion rates. There was almost universal awareness of IPT within the study sample. Furthermore, the majority of the HCWs had a favourable attitude towards IPT. However, the attendant IPT practices were inadequate, with majority of HCWs reporting that they had never initiated IPT, prescribed IPT within the last 12 months, or renewed an isoniazid prescription.
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Affiliation(s)
- Peninah M Mwangi
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Diana Marangu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Elizabeth M Obimbo
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Mugomeri E, Olivier D, van den Heever WMJ. Tracking the rate of initiation and retention on isoniazid preventive therapy in a high human immunodeficiency virus and tuberculosis burden setting of Lesotho. S Afr J Infect Dis 2019; 34:10. [PMID: 34485448 PMCID: PMC8378156 DOI: 10.4102/sajid.v34i1.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/07/2019] [Indexed: 12/02/2022] Open
Abstract
Background Tuberculosis (TB) remains a public health problem, particularly in people living with human immunodeficiency virus (PLHIV). Yet, efforts to reduce TB incidence using isoniazid preventive therapy (IPT) have been curtailed by poor uptake of this intervention. This study reviewed the rate of IPT initiation in the sub-Saharan country of Lesotho, which has one of the highest TB incidences in the world. Methods Time to IPT initiation in randomly sampled medical records of PLHIV was analysed using Cox’s proportional hazards regression. Differences in the periods of enrolment into Human immunodeficiency virus (HIV) care were controlled for by considering the year IPT was launched (2011) as the base year and stratifying the medical records into the 2004–2010 cohort (before the launch of IPT) and the 2011–2016 cohort (after the launch). Results Out of 2955 patients included in the final analysis, 68.8% had received IPT by the study exit time. However, the overall rate of IPT initiation was 20.6 per 100 person-years, with 135 (6.6%) treatment interruptions. Compared to the 2004–2010 cohort, the 2011–2016 had a significantly (p < 0.05) higher rate of initiation (15.8 vs. 27.0 per 100 person-years, respectively). Age group, district category and duration of antiretroviral therapy emerged as the most significant predictors of IPT initiation, while district category and gender significantly predicted IPT therapy interruption. Conclusion These findings indicate a high uptake of IPT with a slow rate of implementation. Significant factors associated with disparities in the initiation and interruption of IPT therapy in this study are important for policy review.
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Affiliation(s)
- Eltony Mugomeri
- Medical Laboratory Sciences, Africa University, Mutare, Zimbabwe
| | - Dedré Olivier
- Department of Health Sciences, Central University of Technology, Bloemfontein, South Africa
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Getting Treatment and Care Services Right for Children and Adolescents to Reach High Viral Suppression. J Acquir Immune Defic Syndr 2019; 78 Suppl 2:S128-S133. [PMID: 29994835 DOI: 10.1097/qai.0000000000001738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In August 2014, PEPFAR and the Children's Investment Fund Foundation launched the Accelerating Children's HIV/AIDS Treatment (ACT) initiative with the aim of doubling the number of children on antiretroviral treatment in 9 African countries. Increasing rates of pretreatment drug resistance and use of suboptimal treatment regimens and formulations result in poor adherence and high rates of viral failure. Supporting adherence and ensuring appropriate treatment monitoring are needed to maximize duration of first-line treatment and enable timely sequencing to subsequent lines of antiretroviral treatment. Although timely antiretroviral treatment is the core of clinical care for infants, children and adolescents living with HIV, ensuring a broader package of biomedical and non-biomedical interventions is also required to address highly prevalent comorbidities among children living with HIV. Providing such a comprehensive package has been challenging for health care workers who lack the necessary skills and confidence to care for pediatric populations. Efforts to simplify clinical management and specific training and mentorship are needed to address these challenges. In this article, we review the progress made during the ACT initiative and the persistent challenges in achieving and maintaining virological suppression across the age spectrum. We identify innovations needed to build on the success of the ACT initiative. Despite the challenges, achieving high levels of virological suppression in children and adolescents is possible. The complexity of pediatric HIV treatment can be offset as antiretroviral regimens become more effective, tolerable, and easier to prescribe and administer. Meanwhile, basic programmatic elements to address comorbidities as well as support health care workers remain critical. In this article we review the progress made through the ACT initiative, as well as identify innovations needed to address persistent challenges to viral suppression across the age spectrum.
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Honjepari A, Madiowi S, Madjus S, Burkot C, Islam S, Chan G, Majumdar SS, Graham SM. Implementation of screening and management of household contacts of tuberculosis cases in Daru, Papua New Guinea. Public Health Action 2019; 9:S25-S31. [PMID: 31579646 PMCID: PMC6735459 DOI: 10.5588/pha.18.0072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
SETTING Daru Island, Western Province, Papua New Guinea (PNG). OBJECTIVE To describe the implementation of a screening programme for household contacts of tuberculosis (TB) cases residing on Daru Island. DESIGN This was a retrospective descriptive study evaluating two periods of implementation: introduction and expansion of a screening programme for household contacts of drug-resistant TB (DR-TB) cases (March 2016 to September 2017), and inclusion of drug-susceptible TB (DS-TB) cases with provision of preventive therapy for eligible contacts between October 2017 and March 2018. RESULTS In the first period, the contact screening programme was established and strengthened by increasing coverage over time. There was a large number of contacts (median 8) in each household, and a high uptake of screening. In the second period of evaluation, respectively 412 and 223 contacts of 42 DS-TB and 25 DR-TB index cases were screened. Overall, 156 (24.6%) contacts reported TB-related symptoms and 9 (1.4%) were diagnosed with active TB. All 9 commenced TB treatment: 5 had DS-TB and 4 had DR-TB. Of 82 child contacts of DS-TB cases eligible for preventive therapy, 57 (69.5%) commenced treatment and 45 completed treatment. CONCLUSION Community-based household contact screening and management was successfully implemented under programme conditions in this high burden TB and DR-TB setting in PNG.
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Affiliation(s)
- A Honjepari
- Western Provincial Health Office, Daru, Western Province, Papua New Guinea (PNG)
| | - S Madiowi
- Western Provincial Health Office, Daru, Western Province, Papua New Guinea (PNG)
| | - S Madjus
- World Vision PNG, Daru, Western Province, PNG
| | - C Burkot
- Burnet Institute, Melbourne, Victoria, Australia
| | - S Islam
- Burnet Institute, Melbourne, Victoria, Australia
| | - G Chan
- Burnet Institute, Melbourne, Victoria, Australia
| | - S S Majumdar
- Burnet Institute, Melbourne, Victoria, Australia
| | - S M Graham
- Burnet Institute, Melbourne, Victoria, Australia
- Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia
- International Union Against Tuberculosis and Lung Disease, Paris, France
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Zawedde-Muyanja S, Nakanwagi A, Dongo JP, Sekadde MP, Nyinoburyo R, Ssentongo G, Detjen AK, Mugabe F, Nakawesi J, Karamagi Y, Amuge P, Kekitiinwa A, Graham SM. Decentralisation of child tuberculosis services increases case finding and uptake of preventive therapy in Uganda. Int J Tuberc Lung Dis 2019; 22:1314-1321. [PMID: 30355411 DOI: 10.5588/ijtld.18.0025] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A lack of capacity to diagnose tuberculosis (TB) in children at peripheral health facilities and limited contact screening and management contribute to low case finding in TB-endemic settings. OBJECTIVE To evaluate the implementation of a pilot project that strengthened diagnosis, treatment and prevention of child TB at peripheral health facilities in Uganda. METHODS In June 2015, health care workers at peripheral health facilities were trained to diagnose and treat child TB. Community health care workers were trained to screen household TB contacts. Before-and-after analysis as well as comparisons with non-intervention districts were used to evaluate impact on caseload and treatment outcomes. RESULTS By December 2016, the average number of children (age < 15 years) diagnosed with TB increased from 45 to 108 per quarter. The proportion of child TB among all TB cases increased from 8.8% to 15%, and the proportion completing treatment increased from 65% to 82%. Of 2270 child TB contacts screened, 55 (2.4%) were diagnosed with TB. Of 910 eligible child contacts, 670 (74%) started preventive therapy, 569 (85%) of whom completed therapy. CONCLUSION The strengthening of child TB services at peripheral health facilities in Uganda was associated with increased case finding, improved treatment outcomes and the successful implementation of contact screening and management.
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Affiliation(s)
- S Zawedde-Muyanja
- International Union Against Tuberculosis and Lung Disease, Paris, France;, The Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala
| | - A Nakanwagi
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J P Dongo
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - M P Sekadde
- The National Tuberculosis and Leprosy Programme, Ministry of Health, Kampala, Baylor College of Children's Medical Foundation, Kampala
| | | | - G Ssentongo
- Baylor College of Children's Medical Foundation, Kampala
| | - A K Detjen
- International Union Against Tuberculosis and Lung Disease, Paris, France;, United Nations Children's Fund, New York, USA
| | - F Mugabe
- The National Tuberculosis and Leprosy Programme, Ministry of Health, Kampala
| | | | | | - P Amuge
- Baylor College of Children's Medical Foundation, Kampala
| | - A Kekitiinwa
- Baylor College of Children's Medical Foundation, Kampala
| | - S M Graham
- International Union Against Tuberculosis and Lung Disease, Paris, France;, Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
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Burmen B, Mutai K, Malika T. Isoniazid Preventative Therapy uptake for child household contacts of tuberculosis index cases, Kisumu County, Kenya, 2014-2015. J Public Health Afr 2019; 10:827. [PMID: 31285812 PMCID: PMC6589639 DOI: 10.4081/jphia.2019.827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 02/19/2018] [Indexed: 11/22/2022] Open
Abstract
Isoniazid Preventative Therapy (IPT) is recommended for children aged less than 5 years that have been in contact with an open case of TB, and screen negative for TB, to prevent the risk of TB progression. We examined IPT uptake among child household contacts of TB index cases, within a TB case detection study, in a high TB burden region. A cross-sectional study involving all IPT-eligible children drawn from a TB case detection study was done in Kisumu County, Kenya between 2014 and 2015. By linking a subset of the study database to the TB program IPT register, we described Child contacts as initiated on IPT and TB index cases as having child contacts initiated on IPT based on whether their names or their child contacts names respectively, were found in the IPT register. Logistic regression analysis was used to describe index and contact characteristics associated with IPT initiation. Of 555 TB index cases recruited into the study, 243 (44%) had a total of 337 IPT-eligible child contacts. Forty-seven (19%) index cases that had child contacts initiated on IPT; they were more likely to have been diagnosed with smear positive TB compared to those who were diagnosed with smear negative TB (OR 5.1, 95%CI 1.1-23.2; P=0.03) and to reside in rural Kisumu compared to those in urban Kisumu (OR 3.3, 95% CI 1.6-6.8; P<0.01). The 51 (15%) child contacts that were initiated on IPT were more likely to be were first degree relatives of the index case compared to those who were not (OR 2.6, 95% CI 1.2-5.5; P=0.02) and to reside in rural Kisumu compared to those in urban Kisumu (OR 2.6, 95% CI 1.2-5.1; P<0.01). IPT initiation, which is influenced by index and contact characteristics, is suboptimal. The TB program should provide health worker training, avail appropriate pediatric TB diagnostic tools, job aids and monitoring tools, and ensure continuous supply of medication, and to facilitate IPT implementation. Additionally, targeted health education interventions should be formulated to reach those who are unlikely to accept IPT.
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Affiliation(s)
- Barbara Burmen
- Kenya Medical Research Institute/Center for Global Health Research, Kisumu
- Maseno University, Maseno
| | - Kennedy Mutai
- Kenya Medical Research Institute/Center for Global Health Research, Kisumu
| | - Timothy Malika
- National Tuberculosis, Leprosy and Lung Diseases Program, Kisumu County, Kenya
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Birungi FM, Graham S, Uwimana J, van Wyk B. Assessment of the Isoniazid Preventive Therapy Uptake and Associated Characteristics: A Cross-Sectional Study. Tuberc Res Treat 2018; 2018:8690714. [PMID: 29854455 PMCID: PMC5960530 DOI: 10.1155/2018/8690714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 02/02/2018] [Accepted: 03/25/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the uptake of isoniazid preventive therapy (IPT) by eligible children in Kigali, Rwanda, and associated individual, households, and healthcare systems characteristics. METHODS A cross-sectional study was conducted among child contacts of index cases having sputum smear-positive pulmonary tuberculosis. Data were collected from 13 selected primary health centres. Descriptive statistics were used to generate frequency tables and figures. Logistic regression models were performed to determine characteristics associated with IPT uptake. RESULTS Of 270 children (under 15 years), who were household contacts of 136 index cases, 94 (35%) children were less than 5 years old and eligible for IPT; and 84 (89%, 95% CI 81-94) were initiated on IPT. The reasons for not initiating IPT in the remaining 10 children were parents/caregivers' lack of information on the need for IPT, refusal to give IPT to their children, and poor quality services offered at health centres. Factors associated with no uptake of IPT included children older than 3 years, unfriendly healthcare providers, HIV infected index cases, and the index case not being the child's parent. CONCLUSION The National Tuberculosis Program's policy on IPT delivery was effectively implemented. Future interventions should find strategies to manage factors associated with IPT uptake.
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Affiliation(s)
- Francine Mwayuma Birungi
- Department of Epidemiology and Biostatistics, School of Public Health of the College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Stephen Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's, Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
- International Union against Tuberculosis and Disease, Paris, France
| | - Jeannine Uwimana
- Department of Epidemiology and Biostatistics, School of Public Health of the College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Brian van Wyk
- Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
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Kebede BA, Fekadu L, Jerene D. Ethiopia's experience on scaling up latent TB infection management for people living with HIV and under-five child household contacts of index TB patients. J Clin Tuberc Other Mycobact Dis 2018; 10:29-31. [PMID: 31720382 PMCID: PMC6830128 DOI: 10.1016/j.jctube.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 12/14/2017] [Accepted: 12/31/2017] [Indexed: 11/05/2022] Open
Abstract
Management of latent tuberculosis infection (LTBI) is one of the globally recommended key strategies to end tuberculosis. However, there is limited experience with translation of global recommendations into action at country levels. We present Ethiopia's experience in implementing LTBI management. Our objective is to share promising practices, existing opportunities and to suggest specific steps required for further scale up of the services. Our report is based on synthesis of data from secondary sources including official routine reports of Ministry of Health, materials presented at review meetings, and findings from supervisory visits to districts and health facilities. Our results suggest that Ethiopia has made significant strides toward strengthening LTBI management in people living with HIV and among under-five-year-old household contacts of TB patients. The use of contact investigation as entry point for LTBI management could be taken as best practice. More effort is needed to further strengthen implementation of LTBI management, and it should be supported through context-specific implementation and operational research activities.
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Affiliation(s)
- Blen Ayele Kebede
- National TB and Leprosy Control Program, Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Lelisa Fekadu
- National TB and Leprosy Control Program, Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Degu Jerene
- Management Sciences for Health, Addis Ababa, Ethiopia
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Mwasubila YK, Sabi I, Kabyemera R, Ntinginya NE, Sauve R, Kidenya B. Tuberculosis Contact Screening and Isoniazid Preventive Therapy Among Children Under 5 in the Mbeya and Songwe Regions, Tanzania. East Afr Health Res J 2018; 2:29-32. [PMID: 34308172 PMCID: PMC8279253 DOI: 10.24248/eahrj-d-17-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 03/15/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction: The World Health Organization (WHO) recommends contact screening and initiation of isoniazid preventive therapy (IPT) for children under 5 years of age exposed to a sputum smear-positive (SS+) tuberculosis (TB) source case. We conducted this study in order to assess implementation of these recommendations in southwestern Tanzania. Methods: We conducted this cross-sectional study from June to August 2015 in 12 selected health facilities in the Mbeya and Songwe regions of Tanzania. Adult SS+ pulmonary TB patients living in the same household as children under 5 were enrolled. Structured questionnaires were used to obtain sociodemographic information and details about screening and intervention activity related to contact children under 5. Data were analysed using Stata version 11.0. Results: We enrolled 257 index cases, who collectively had 433 contact children under 5. The median age of the index cases was 34 years (interquartile range 28 to 41) and 52.9% were male. Out of 433 contacts, 31 (7.2%) were screened for TB, of whom 7 (22.6%) were treated for presumptive TB. Among those screened, 24 were not diagnosed with TB, of whom only 8 (33.3%) received IPT. Conclusion: Low uptake of TB contact screening and IPT administration among eligible children under 5 was observed in this study. Health-care workers should be sensitized to screening of household contacts of adults with SS+ TB and initiate IPT in those who are eligible.
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Affiliation(s)
- Yesaya K Mwasubila
- Department of Health, Songea District Council, Ruvuma, Tanzania.,School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Issa Sabi
- Mbeya Medical Research Centre, National Institute for Medical Research, Mbeya, Tanzania
| | - Rogatus Kabyemera
- Department of Paediatrics and Child Health, Bugando Medical Centre, Mwanza, Tanzania.,Department of Paediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Nyanda E Ntinginya
- Mbeya Medical Research Centre, National Institute for Medical Research, Mbeya, Tanzania
| | - Reginald Sauve
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.,Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Benson Kidenya
- Department of Biochemistry, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Szkwarko D, Hirsch-Moverman Y, Du Plessis L, Du Preez K, Carr C, Mandalakas AM. Child contact management in high tuberculosis burden countries: A mixed-methods systematic review. PLoS One 2017; 12:e0182185. [PMID: 28763500 PMCID: PMC5538653 DOI: 10.1371/journal.pone.0182185] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/13/2017] [Indexed: 12/02/2022] Open
Abstract
Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide. Considering the World Health Organization recommendation to implement child contact management (CCM) for TB, we conducted a mixed-methods systematic review to summarize CCM implementation, challenges, predictors, and recommendations. We searched the electronic databases of PubMed/MEDLINE, Scopus, and Web of Science for studies published between 1996–2017 that reported CCM data from high TB-burden countries. Protocol details for this systematic review were registered on PROSPERO: International prospective register of systematic reviews (#CRD42016038105). We formulated a search strategy to identify all available studies, published in English that specifically targeted a) population: child contacts (<15 years) exposed to TB in the household from programmatic settings in high burden countries (HBCs), b) interventions: CCM strategies implemented within the CCM cascade, c) comparisons: CCM strategies studied and compared in HBCs, and d) outcomes: monitoring and evaluation of CCM outcomes reported in the literature for each CCM cascade step. We included any quantitative, qualitative, mixed-methods study design except for randomized-controlled trials, editorials or commentaries. Thirty-seven studies were reviewed. Child contact losses varied greatly for screening, isoniazid preventive therapy initiation, and completion. CCM challenges included: infrastructure, knowledge, attitudes, stigma, access, competing priorities, and treatment. CCM recommendations included: health system strengthening, health education, and improved preventive therapy. Identified predictors included: index case and clinic characteristics, perceptions of barriers and risk, costs, and treatment characteristics. CCM lacks standardization resulting in common challenges and losses throughout the CCM cascade. Prioritization of a CCM-friendly healthcare environment with improved CCM processes and tools; health education; and active, evidence-based strategies can decrease barriers. A focused approach toward every aspect of the CCM cascade will likely diminish losses throughout the CCM cascade and ultimately decrease TB related morbidity and mortality in children.
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Affiliation(s)
- Daria Szkwarko
- Department of Family Medicine and Community Health, The University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- * E-mail:
| | - Yael Hirsch-Moverman
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, United States of America
- Department of Epidemiology, Columbia University, New York, New York, United States of America
| | - Lienki Du Plessis
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Karen Du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Catherine Carr
- Lamar Soutter Library, The University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Anna M. Mandalakas
- Global TB Program, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
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Graham SM. The management of infection with Mycobacterium tuberculosis in young children post-2015: an opportunity to close the policy-practice gap. Expert Rev Respir Med 2016; 11:41-49. [DOI: 10.1080/17476348.2016.1267572] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stephen M. Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia
- Department of Tuberculosis and HIV, International Union Against Tuberculosis and Lung Disease, Paris, France
- Centre for International Health, The Burnet Institute, Melbourne, Australia
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