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Ojukwu E, Pashaei A, Maia JC, Omobhude OF, Tawfik A, Nguyen Y. Repercussions of the COVID-19 pandemic on the HIV care continuum and related factors in economically disadvantaged nations: an integrated analysis using mixed-methods systematic review. Eur J Med Res 2024; 29:346. [PMID: 38926792 PMCID: PMC11202375 DOI: 10.1186/s40001-024-01917-1] [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: 12/13/2023] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic affected the self-management and care of people living with HIV, requiring adaptations in the way health services are provided. However, it is unclear how these changes impacted HIV care in low-income countries. METHODS A systematic review including the current evidence related to changes in HIV care continuum during COVID-19 was conducted through a systematic search in the online databases including CINAHL, OVID-Medline, CAB Direct, and OVID-Embase. A two-step screening process was carried out to include eligible papers and reports according to inclusion criteria. RESULTS From the searches we identified 21 total studies published between 2021 and 2024, the studies revealed mostly negative impacts on all stages of the HIV care continuum in low-income countries. There were impacts related to the blocking measures due to COVID-19, fear of contracting the disease, difficulties in providing resources such as income, food and transports, reductions in the provision of care from prevention to viral suppression. CONCLUSION Overall, researchers identified several negative impacts of COVID-19 restrictions on HIV care continuum during pandemic; however, some observations indicated indirect positive impacts on some aspects of HIV care. Decline in HIV care practices during pandemic compared to before pandemic were observed including using preventative methods, counseling and testing, receiving HIV healthcare services, HIV medical appointments, antiretroviral adherence, engagement with treatment, and poor viral suppression. However, in some evidence improvement in ART adherence and PrEP use were observed.
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Affiliation(s)
- Emmanuela Ojukwu
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Ava Pashaei
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.
| | | | | | - Abdulaziz Tawfik
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Yvonne Nguyen
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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She B, Mangal TD, Adjabeng AY, Colbourn T, Collins JH, Janoušková E, Li Lin I, Mnjowe E, Mohan S, Molaro M, Phillips AN, Revill P, Smith RM, Twea PD, Nkhoma D, Manthalu G, Hallett TB. The changes in health service utilisation in Malawi during the COVID-19 pandemic. PLoS One 2024; 19:e0290823. [PMID: 38232073 PMCID: PMC10793884 DOI: 10.1371/journal.pone.0290823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/17/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic and the restriction policies implemented by the Government of Malawi may have disrupted routine health service utilisation. We aimed to find evidence for such disruptions and quantify any changes by service type and level of health care. METHODS We extracted nationwide routine health service usage data for 2015-2021 from the electronic health information management systems in Malawi. Two datasets were prepared: unadjusted and adjusted; for the latter, unreported monthly data entries for a facility were filled in through systematic rules based on reported mean values of that facility or facility type and considering both reporting rates and comparability with published data. Using statistical descriptive methods, we first described the patterns of service utilisation in pre-pandemic years (2015-2019). We then tested for evidence of departures from this routine pattern, i.e., service volume delivered being below recent average by more than two standard deviations was viewed as a substantial reduction, and calculated the cumulative net differences of service volume during the pandemic period (2020-2021), in aggregate and within each specific facility. RESULTS Evidence of disruptions were found: from April 2020 to December 2021, services delivered of several types were reduced across primary and secondary levels of care-including inpatient care (-20.03% less total interactions in that period compared to the recent average), immunisation (-17.61%), malnutrition treatment (-34.5%), accidents and emergency services (-16.03%), HIV (human immunodeficiency viruses) tests (-27.34%), antiretroviral therapy (ART) initiations for adults (-33.52%), and ART treatment for paediatrics (-41.32%). Reductions of service volume were greatest in the first wave of the pandemic during April-August 2020, and whereas some service types rebounded quickly (e.g., outpatient visits from -17.7% to +3.23%), many others persisted at lower level through 2021 (e.g., under-five malnutrition treatment from -15.24% to -42.23%). The total reduced service volume between April 2020 and December 2021 was 8 066 956 (-10.23%), equating to 444 units per 1000 persons. CONCLUSION We have found substantial evidence for reductions in health service delivered in Malawi during the COVID-19 pandemic which may have potential health consequences, the effect of which should inform how decisions are taken in the future to maximise the resilience of healthcare system during similar events.
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Affiliation(s)
- Bingling She
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Tara D. Mangal
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Anna Y. Adjabeng
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
| | - Joseph H. Collins
- Institute for Global Health, University College London, London, United Kingdom
| | - Eva Janoušková
- Institute for Global Health, University College London, London, United Kingdom
| | - Ines Li Lin
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Sakshi Mohan
- Centre for Health Economics, University of York, York, United Kingdom
| | - Margherita Molaro
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Andrew N. Phillips
- Institute for Global Health, University College London, London, United Kingdom
| | - Paul Revill
- Centre for Health Economics, University of York, York, United Kingdom
| | - Robert Manning Smith
- Centre for Advanced Spatial Analysis (CASA), University College London, London, United Kingdom
| | - Pakwanja D. Twea
- Department of Planning and Policy Development, Ministry of Health and Population, Lilongwe, Malawi
| | - Dominic Nkhoma
- College of Medicine, University of Malawi, Lilongwe, Malawi
| | - Gerald Manthalu
- Department of Planning and Policy Development, Ministry of Health and Population, Lilongwe, Malawi
| | - Timothy B. Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
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Bbuye M, Muyanja SZ, Sekitoleko I, Padalkar R, Robertson N, Helwig M, Hopkinson D, Siddharthan T, Jackson P. Patient level barriers to accessing TB care services during the COVID-19 pandemic in Uganda, a mixed methods study. BMC Health Serv Res 2024; 24:52. [PMID: 38200524 PMCID: PMC10782633 DOI: 10.1186/s12913-023-10513-8] [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: 04/06/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Lockdown measure has been utilized widely to mitigate COVID-19 pandemic transmission and recently during the 2022 Sudan Ebola Virus Disease outbreak in Uganda. These have setback effects on the continuity of essential health services such as tuberculosis (TB) care, reversing progress made in the fight against tuberculosis (TB) over the past decade. We set out to understand patient-reported barriers to accessing TB care services during the COVID-19 pandemic in Uganda. METHODS Mixed methods study involving review of medical records of TB patients who received TB care from January to September 2020. We used quantitative and qualitative methods including phone questionnaires and in-depth interviews. We carried out descriptive statistics, a chi-square test and conducted a thematic analysis. RESULTS We carried out phone interviews with 672 participants. The majority (60%) were male and with an average of 35 years (SD:11). A significantly higher proportion of patients reported a barrier to TB care access during the COVID-19 lockdown than pre-lockdown (79.9% vs. 68.1% p = 0.027). We carried out in-depth interviews with 28 participants (54% (15/28): male). Barriers experienced by these participants included lack of a means of transport to reach the health facility, lack of money to pay the transport fares, long distances to the facility, fear of COVID-19 infection, stigma due to overlap between TB and COVID-19 symptoms, and few health care workers available during the lockdown period. CONCLUSION Lockdown measures instituted to mitigate the transmission of COVID1-19 affected access to TB care services in Uganda. Uganda is at risk of future emerging and re-emerging diseases of epidemic potential. Therefore, there should be measures to ensure the continuity of essential services such as tuberculosis care during the implementation of future epidemic response interventions such as a lockdown.
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Affiliation(s)
- Mudarshiru Bbuye
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Stella Zawedde Muyanja
- Infectious Disease Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Isaac Sekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Roma Padalkar
- Hackensack University Medical Center, New Jersey, USA
| | - Nicole Robertson
- Hackensack University Medical Center, New Jersey, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Madeline Helwig
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Dennis Hopkinson
- Division of Pulmonary and Critical Care, Department of Medicine, Virginia Commonwealth University, Richmond, USA
- Division of Pulmonary and Critical Care, Duke University, Durham, NC, USA
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA
| | - Peter Jackson
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- Division of Pulmonary and Critical Care, Department of Medicine, Virginia Commonwealth University, Richmond, USA
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Mude W, Mwenyango H, Preston R, O'Mullan C, Vaughan G, Jones G. HIV Testing Disruptions and Service Adaptations During the COVID-19 Pandemic: A Systematic Literature Review. AIDS Behav 2024; 28:186-200. [PMID: 37548796 PMCID: PMC10803448 DOI: 10.1007/s10461-023-04139-4] [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] [Accepted: 07/12/2023] [Indexed: 08/08/2023]
Abstract
Access to treatment and care in safe clinical settings improves people's lives with HIV. The COVID-19 pandemic disrupted vital HIV programs and services, increasing the risk of adverse health outcomes for people with HIV and HIV transmission rates in the community. This systematic literature review provides a meta-analysis of HIV testing disruptions and a synthesis of HIV/AIDS services adapted during COVID-19. We searched scholarly databases from 01 January 2020 to 30 June 2022 using key terms on HIV testing rates and services during the COVID-19 pandemic. The process of how the included articles were identified, selected, appraised, and synthesised was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included 17 articles that reported changes in HIV testing during the COVID-19 pandemic and 22 that reported adaptations in HIV/AIDS services. We found that HIV testing decreased by 37% during the search period because of the COVID-19 pandemic. Service providers adopted novel strategies to support remote service delivery by expanding community antiretroviral therapy dispensing, setting up primary care outreach points, and instituting multi-month dispensing services to sustain client care. Therefore, service providers and policymakers should explore alternative strategies to increase HIV testing rates impacted by COVID-19 and leverage funding to continue providing the identified adapted services.
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Affiliation(s)
- William Mude
- School of Health Medical and Applied Sciences, Central Queensland University, Cairns Campus, 42-52 Abbott Street & Shields Street, Cairns, QLD, 4870, Australia.
| | - Hadijah Mwenyango
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN, UK
| | - Robyn Preston
- School of Health Medical and Applied Sciences, Central Queensland University, Townsville Campus, Townsville, Australia
| | - Catherine O'Mullan
- School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg Campus, Bundaberg, Australia
| | - Geraldine Vaughan
- School of Health Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, Australia
| | - Gary Jones
- Cohort Doctoral Studies Program, James Cook University, Cairns, Australia
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Chisenga T, Chihana M, Chishimba P, Chitembo L, Mulenga L, Silumesii A, Maman D, Johnson C. Maintaining HIV testing and treatment services in Zambia during COVID-19: a story of success and resilience. Glob Health Action 2023; 16:2175992. [PMID: 36809236 PMCID: PMC9946302 DOI: 10.1080/16549716.2023.2175992] [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] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by a virus called severe acute respiratory syndrome coronavirus. As countries struggled to control the spread of the virus through among other measures closure of health facilities, repurposing of health care workers, and restrictions on people's movement, HIV service delivery was affected. OBJECTIVES To assess the impact of COVID-19 on HIV service delivery in Zambia by comparing uptake of HIV services before and during COVID-19. METHODS We used repeated cross-sectional quarterly and monthly data on HIV testing, HIV positivity rate, people living with HIV initiating ART and use of essential hospital services from July 2018 to December 2020. We assessed quarterly trends and measured proportionate changes comparing periods before and during COVID-19 divided into three different comparison time frames: (1) annual comparison 2019 versus 2020; (2) April to December 2019 versus same period in 2020; and (3) Quarter 1 of 2020 as base period versus each of the other quarters of year 2020. RESULTS Annual HIV testing dropped by 43.7% (95%CI 43.6-43.7) in 2020 compared to 2019 and was similar by sex. Overall, annual recorded number of newly diagnosed PLHIV fell by 26.5% (95% CI 26.37-26.73) in 2020 compared to 2019, but HIV positivity rate was higher in 2020, 6.44% (95%CI 6.41-6.47) compared to 4.94% (95% CI 4.92-4.96) in 2019. Annual ART initiation dropped by 19.9% (95%CI 19.7-20.0) in 2020 compared to 2019 while use of essential hospital services dropped during the early months of COVID-19 April to August 2020 but picked up later in the year. CONCLUSION While COVID-19 had a negative impact on health service delivery, its impact on HIV service delivery was not huge. HIV policies that were implemented before COVID-19 on testing made it easier to adopt COVID-19 control measures and to continue providing HIV testing services without much disruption.
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Affiliation(s)
- Tina Chisenga
- Ministry of Health Zambia, Department of Communicable Diseases, Lusaka, Zambia
| | - Menard Chihana
- World Health Organization, Global HIV, Hepatitis and STI Programmes, Geneva, Switzerland,CONTACT Menard Chihana 760 Stellenberg Road, Roberts Place Unit 36, Equestria, Pretoria, Gauteng Province0184, South Africa
| | - Paul Chishimba
- Ministry of Health Zambia, Department of Monitoring and Evaluation, Lusaka, Zambia
| | - Lastone Chitembo
- World Health Organization, Department of HIV, Viral Hepatitis and STIs, Lusaka, Zambia
| | - Lloyd Mulenga
- Department of Infectious Disease, University Teaching Hospital, Lusaka, Zambia
| | - Andrew Silumesii
- Ministry of Health Zambia, Department of Monitoring and Evaluation, Lusaka, Zambia
| | - David Maman
- World Health Organization, Global HIV, Hepatitis and STI Programmes, Geneva, Switzerland,The Global Fund, Technical Advice and Partnership Department, Geneva, Switzerland
| | - Cheryl Johnson
- World Health Organization, Global HIV, Hepatitis and STI Programmes, Geneva, Switzerland
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Chakrabarti R, Agasty D, Majumdar A, Talukdar R, Bhatta M, Biswas S, Dutta S. Syndemic effect of COVID-19 outbreak on HIV care delivery around the globe: A systematic review using narrative synthesis. Health Promot Perspect 2023; 13:243-253. [PMID: 38235007 PMCID: PMC10790127 DOI: 10.34172/hpp.2023.30] [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: 06/02/2023] [Accepted: 07/10/2023] [Indexed: 01/19/2024] Open
Abstract
Background The burden of the COVID-19 pandemic on healthcare systems worldwide has been compromising the progress made in the fight against HIV. This paper aims to determine how the COVID-19 pandemic has impacted HIV comprehensive care service delivery globally as well as to consolidate the evidence and recommendations that may be useful in averting future crisis. Methods This review adheres to PRISMA guidelines. PubMed, DOAJ, Science Direct and other sources like Google Scholar and citations from included studies were searched methodically to locate studies evaluating the effects of COVID on services for HIV care. The NIH and JBI quality assessment tools were used for the quality assessment of individual studies. Results In the present review 31 eligible studies were included and the impact on HIV care cascade were summarised under six themes: Lab services, Treatment and allied services, Counselling services, Outreach services, Psycho-social impact and Implementation of sustainable strategies. The studies also presented many innovative alternatives which were lucidly highlighted in the present article. Conclusion Current evidence depicts multiple factors are responsible for the interruption of HIV care service delivery during the pandemic, especially in low resources settings. The prospective, alternative solutions that have been used to circumvent the threat have also been addressed in this review, in addition to the negative aspects that have been observed. Transition with new innovative, sustainable care paradigms may prove to be the building blocks in removing HIV-AIDS as a public health threat. Registration Open Science Framework (DOI: 10.17605/OSF.IO/74GHM).
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Affiliation(s)
| | - Debdutta Agasty
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Agniva Majumdar
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Rounik Talukdar
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Mihir Bhatta
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Subrata Biswas
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shanta Dutta
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
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Cox CM, Masiano S, Mazenga A, Stark M, Udedi M, Simon KR, Ahmed S, Nyasulu P, Kim MH. Phone-based psychosocial counseling for people living with HIV: Feasibility, acceptability and impact on uptake of psychosocial counseling services in Malawi. Glob Ment Health (Camb) 2023; 11:e3. [PMID: 38283875 PMCID: PMC10808978 DOI: 10.1017/gmh.2023.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/19/2023] [Accepted: 11/16/2023] [Indexed: 01/30/2024] Open
Abstract
People living with HIV experience psychosocial needs that often are not addressed. We designed an innovative low-resource model of phone-based psychosocial counseling (P-PSC). We describe cohort characteristics, acceptability, feasibility and utilization of P-PSC at health facilities supported by Baylor Foundation Malawi. Staff were virtually oriented at 120 sites concurrently. From facility-based phones, people with new HIV diagnosis, high viral load, treatment interruption or mental health concerns were referred without identifiable personal information to 13 psychosocial counselors via a WhatsApp group. Routine program data were retrospectively analyzed using univariate approaches and regressions with interrupted time series analyses. Clients utilizing P-PSC were 63% female, 25% youth (10-24 y) and 9% children (<10 y). They were referred from all 120 supported health facilities. Main referral reasons included new HIV diagnosis (32%), ART adherence support (32%) and treatment interruption (21%). Counseling was completed for 99% of referrals. Counseling sessions per month per psychosocial counselor increased from 77 before P-PSC to 216 in month 1 (95% CI = 82, 350, p = 0.003). Total encounters increased significantly to 31,642 in year 1 from ~6,000 during the 12 prior months, an over fivefold increase. P-PSC implementation at 120 remote facilities was acceptable and feasible with immediate, increased utilization despite few psychosocial counselors in Malawi.
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Affiliation(s)
- Carrie M. Cox
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Baylor College of Medicine, Texas Children’s Hospital, Houston, USA
| | - Steven Masiano
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Alick Mazenga
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Madeline Stark
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Michael Udedi
- Curative, Medical and Rehabilitation Services – Mental Health, Malawi Ministry of Health, Lilongwe, Malawi
| | - Katherine R. Simon
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Baylor College of Medicine, Texas Children’s Hospital, Houston, USA
| | - Saeed Ahmed
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Baylor College of Medicine, Texas Children’s Hospital, Houston, USA
| | - Phoebe Nyasulu
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Maria H. Kim
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Baylor College of Medicine, Texas Children’s Hospital, Houston, USA
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Osei E, Amu H, Kye-Duodu G, Kwabla MP, Danso E, Binka FN, Kim SY. Impact of COVID-19 pandemic on Tuberculosis and HIV services in Ghana: An interrupted time series analysis. PLoS One 2023; 18:e0291808. [PMID: 37729176 PMCID: PMC10511085 DOI: 10.1371/journal.pone.0291808] [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: 10/25/2022] [Accepted: 09/06/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION The Coronavirus disease 2019 (COVID-19) burden, coupled with unprecedented control measures including physical distancing, travel bans, and lockdowns of cities, implemented to stop the spread of the virus, have undoubtedly far-reaching aftereffects on other diseases. In low and middle-income countries (LMICs), a particular worry is the potential impact on Human Immunodeficiency Virus (HIV) and Tuberculosis (TB), as a consequence of possible disruption to health services and limiting access to needed life-saving health care. In Ghana, there is a paucity of information regarding the impact of COVID-19 on disease control, particularly TB and HIV control. This study sought to contribute to bridging this knowledge gap. METHOD The study involved the analysis of secondary data obtained from the District Health Information Management System-2 (DHIMS-2) database of Ghana Health Service, from 2016 to 2020. Data were analysed using an interrupted time-series regression approach to estimate the impact of COVID-19 on TB case notification, HIV testing, and Antiretroviral Therapy (ART) initiations, using March 2020 as the event period. RESULTS The study showed that during the COVID-19 pandemic period, there was an abrupt decline of 20.5% (955CI: 16.0%, 24.5%) in TB case notifications in April and 32.7% (95%CI: 28.8%, 39.1%) in May 2020, with a median monthly decline of 21.4% from April-December 2020. A cumulative loss of 2,128 (20%; 95%CI: 13.3%, 26.7%) TB cases was observed nationwide as of December 2020. There was also a 40.3% decrease in people presenting for HIV tests in the first month of COVID-19 (April 2020) and a cumulative loss of 262620 (26.5%) HIV tests as of December 2020 attributable to the COVID-19 pandemic. ART initiations increased by 39.2% in the first month and thereafter decreased by an average of 10% per month from May to September 2020. Cumulatively, 443 (1.9%) more of the people living with HIV initiated ART during the pandemic period, however, this was not statistically significant. CONCLUSION This study demonstrated that the COVID-19 pandemic negatively impacted TB case notifications and HIV testing and counselling services, However, ART initiation was generally not impacted during the first year of the pandemic. Proactive approaches aimed at actively finding the thousands of individuals with TB who were missed in 2020 and increasing HIV testing and counselling and subsequent treatment initiations should be prioritised.
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Affiliation(s)
- Eric Osei
- Department of Population and Behavioural Sciences, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Hubert Amu
- Department of Population and Behavioural Sciences, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Gideon Kye-Duodu
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Mavis Pearl Kwabla
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Evans Danso
- Department of Policy Planning Monitoring and Evaluation, Mental Health Authority, Accra, Ghana
| | - Fred N. Binka
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - So Yoon Kim
- Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Korea
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Sakmamatov K, Kuznetsova Y, Istamov K, Shauer D, Tripathy JP, Harries AD, Osmonaliev K, Goncharova O. The Trend, Characteristics and Treatment Outcomes in Patients with Tuberculosis Undergoing Thoracic Surgery in the Kyrgyz Republic between 2017 and 2021. Trop Med Infect Dis 2023; 8:393. [PMID: 37624331 PMCID: PMC10458206 DOI: 10.3390/tropicalmed8080393] [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: 05/16/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Surgery has played an important role in managing complicated tuberculosis in former Soviet Union countries, including the Kyrgyz Republic. However, published information is limited. This study aimed to document the trend, characteristics and outcomes of tuberculosis patients who underwent thoracic surgery, using routinely collected data. Between 2017 and 2021, 4-7% of tuberculosis patients in the Kyrgyz Republic underwent thoracic surgery in two centres in Bishkek and Osh. In 2021, case records were retrieved in 264 (78%) of 340 patients undergoing thoracic surgery in the country. The most common indications for surgery were pleural exudate/empyema in 127 (44%) and tuberculoma in 83 (32%). Most patients (73%) underwent surgery within 30 days of starting TB treatment. Two-thirds of patients underwent radical surgery, and surgical outcomes were excellent in 99% of patients with one death. Post-operatively, 63 (23%) patients had no TB detected by the histology, with the two most common specified conditions being lung cancer and pulmonary hydatid disease. TB treatment was stopped in these patients. Of the 201 patients with confirmed TB after surgery, TB-treatment success was documented in 163 (81%), died/failure/lost to follow-up in 10 (5%) and not evaluated in 28 (14%). This study shows that thoracic surgery is feasible, safe and effective in the routine programme setting. Recommendations are made to strengthen referral and monitoring systems.
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Affiliation(s)
- Konushbek Sakmamatov
- Faculty of Medicine, Ala-Too International University, Bishkek 720000, Kyrgyzstan; (K.S.); (K.O.)
| | - Yulia Kuznetsova
- International Charitable Foundation “Alliance for Public Health”, 01601 Kiev, Ukraine
| | | | - Daniil Shauer
- National Centre of Phthisiology, Ministry of Health, Bishkek 720000, Kyrgyzstan; (D.S.); (O.G.)
| | - Jaya Prasad Tripathy
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur 441108, India;
| | - Anthony D. Harries
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France;
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, Keppel Street, London WC1E 7HT, UK
| | - Kudaibergen Osmonaliev
- Faculty of Medicine, Ala-Too International University, Bishkek 720000, Kyrgyzstan; (K.S.); (K.O.)
| | - Olga Goncharova
- National Centre of Phthisiology, Ministry of Health, Bishkek 720000, Kyrgyzstan; (D.S.); (O.G.)
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Zachariah R, Goncharova O, Kamarli C, Bazikov T, Ahmedov S, Osmonaliev K, Harries AD, Davtyan H, Thekkur P, Kalmambetova G, Kadyrov A. Strengthening the Operational Research Capacity of National Tuberculosis Control Programs: Necessity or Luxury? Trop Med Infect Dis 2023; 8:339. [PMID: 37505635 PMCID: PMC10384202 DOI: 10.3390/tropicalmed8070339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
'How to get research into practice: first get practice into research [...].
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Affiliation(s)
- Rony Zachariah
- United Nations Children Fund, United Nations Development Programme, World Bank, World Health Organization, Special Programme for Research and Training in Tropical Diseases (TDR), 20, Avenue Appia, CH-1211 Geneva, Switzerland
| | - Olga Goncharova
- National Center of Phthisiology, Bishkek 720000, Kyrgyzstan; (O.G.); (A.K.)
| | - Chynara Kamarli
- United States Agency for International Development, 171 Prospect Mira, Bishkek 720016, Kyrgyzstan; (C.K.); (T.B.)
| | - Timur Bazikov
- United States Agency for International Development, 171 Prospect Mira, Bishkek 720016, Kyrgyzstan; (C.K.); (T.B.)
| | - Sevim Ahmedov
- United States Agency for International Development, TB/HIV, Prevention and M&E Team Lead, Bureau for Global Health, TB Division, Washington, DC 20024, USA;
| | | | - Anthony D. Harries
- International Union against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (A.D.H.); (P.T.)
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Hayk Davtyan
- Tuberculosis Research and Prevention Center NGO, Yerevan 0014, Armenia;
| | - Pruthu Thekkur
- International Union against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (A.D.H.); (P.T.)
| | - Gulmira Kalmambetova
- Department of Strategic Development and International Cooperation, TB National Reference Laboratory, 90a Akhunbaeva Str., Bishkek 720075, Kyrgyzstan;
| | - Abdullaat Kadyrov
- National Center of Phthisiology, Bishkek 720000, Kyrgyzstan; (O.G.); (A.K.)
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11
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Zaniku HR, Aron MB, Vrkljan K, Tyagi K, Ndambo MK, Banda GM, Nyirongo R, Mphande I, Mailosi B, Talama G, Munyaneza F, Connolly E, Dullie L, Barnhart DA, Ruderman T. COVID-19-Related Testing, Knowledge and Behaviors among Severe and Chronic Non-Communicable Disease Patients in Neno District, Malawi: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105877. [PMID: 37239604 DOI: 10.3390/ijerph20105877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/07/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
COVID-19-related knowledge and behaviors remain essential for controlling the spread of disease, especially among vulnerable patients with advanced, chronic diseases. We prospectively assessed changes over 11 months in COVID-19-related testing, knowledge, and behaviors among patients with non-communicable diseases in rural Malawi using four rounds of telephone interviews between November 2020 to October 2021. The most commonly reported COVID-19-related risks among patients included visiting health facilities (35-49%), attending mass gatherings (33-36%), and travelling outside the district (14-19%). Patients reporting having experienced COVID-like symptoms increased from 30% in December 2020 to 41% in October 2021. However, only 13% of patients had ever received a COVID-19 test by the end of the study period. Respondents answered 67-70% of the COVID-19 knowledge questions correctly, with no significant changes over time. Hand washing, wearing face masks and maintaining a safe distance were the most frequently reported strategies to prevent the spreading of COVID-19. Wearing face masks significantly improved over time (p < 0.001). Although the majority reported accurate knowledge about COVID-19 and enhanced adherence to infection prevention measures over time, patients commonly visited locations where they could be exposed to COVID-19. Government and other stakeholders should increase COVID-19 testing accessibility to primary and secondary facilities.
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Affiliation(s)
- Haules Robbins Zaniku
- Neno District Health Office, Ministry of Health, Neno P.O. Box 52, Malawi
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre 312225, Malawi
| | - Moses Banda Aron
- Partners In Health/Abwenzi Pa za Umoyo (PIH/APZU), Neno P.O. Box 56, Malawi
| | - Kaylin Vrkljan
- Harvard College, Harvard University, Cambridge, MA 02138, USA
| | - Kartik Tyagi
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Myness Kasanda Ndambo
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe P.O. Box 148, Malawi
| | | | | | - Isaac Mphande
- Partners In Health/Abwenzi Pa za Umoyo (PIH/APZU), Neno P.O. Box 56, Malawi
| | - Bright Mailosi
- Partners In Health/Abwenzi Pa za Umoyo (PIH/APZU), Neno P.O. Box 56, Malawi
| | | | - Fabien Munyaneza
- Partners In Health/Abwenzi Pa za Umoyo (PIH/APZU), Neno P.O. Box 56, Malawi
| | - Emilia Connolly
- Partners In Health/Abwenzi Pa za Umoyo (PIH/APZU), Neno P.O. Box 56, Malawi
- Division of Pediatrics, College of Medicine, University of Cincinnati, 3230 Eden Ave., Cincinnati, OH 45267, USA
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45529, USA
| | - Luckson Dullie
- Partners In Health/Abwenzi Pa za Umoyo (PIH/APZU), Neno P.O. Box 56, Malawi
| | - Dale A Barnhart
- Partners in Health/Inshuti Mu Buzima (PIH/IMB), Kigali P.O. Box 3432, Rwanda
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02138, USA
| | - Todd Ruderman
- Partners In Health/Abwenzi Pa za Umoyo (PIH/APZU), Neno P.O. Box 56, Malawi
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12
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The Impact of COVID-19 on Tuberculosis Program Performance in the Kingdom of Lesotho. Trop Med Infect Dis 2023; 8:tropicalmed8030165. [PMID: 36977166 PMCID: PMC10054999 DOI: 10.3390/tropicalmed8030165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Background: As tuberculosis (TB) is an airborne disease requiring multi-month therapy, systems of TB detection and care were profoundly impacted by the COVID-19 pandemic. The worsening economic situation, including income, food, and housing insecurity, impacted the social conditions in which TB—already a leading killer in resource-limited settings—thrives. This study assesses the impact of COVID-19 on TB detection and treatment in Lesotho. Methods: We used routine program data from 78 health facilities in Lesotho. We created time series models from July 2018 to March 2021 to quantify COVID-19-related disruptions to TB program indicators: outpatient visits; presumptive, diagnosed, treated, and HIV co-infected cases; and treatment outcomes including successful (cured and completed) and unsuccessful (death and treatment outcome unknown). Results: We observed a significant decline in cumulative outpatient visits (−37.4%, 95% prediction interval [PI]: −40.1%, −28.7%) and new TB cases diagnosed (−38.7%, 95%PI: −47.2%, −28.4%) during the pandemic, as well as TB-HIV co-infections (−67.0%, 95%PI: −72.6%, −60.0%). However, we observed no difference in treatment success (−2.1%, 95%PI: −17.0%, 15.8%). Conclusions: TB case detection in Lesotho fell during the COVID-19 pandemic, likely related to the uptake of overall health services. However, treatment success rates did not change, indicating a strong health system and the success of local strategies to maintain treatment programs.
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13
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Azanaw J, Endalew M, Zenbaba D, Abera E, Chattu VK. COVID-19 vaccine acceptance and associated factors in 13 African countries: A systematic review and meta-analysis. Front Public Health 2023; 10:1001423. [PMID: 36761336 PMCID: PMC9903367 DOI: 10.3389/fpubh.2022.1001423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 12/09/2022] [Indexed: 01/26/2023] Open
Abstract
Background The COVID-19 pandemic has severely affected the entire world, especially sub-Saharan Africa. As a result, researchers and government agencies are working to create effective COVID-19 vaccinations. While vaccination campaigns are moving rapidly in high-income nations, COVID-19 is still ruthlessly affecting people in low-income nations. However, this difference in the spread of the disease is not because of a lack of a COVID-19 vaccine but mainly due to people's reluctance. As a result, this review summarized the data on COVID-19 vaccination adoption and factors related among nations in sub-Saharan Africa. Method Comprehensive searches were conducted using PubMed, Embase, Medline, Web of Science, Google Scholar, and the Cochrane Library databases. The risk of bias and methodological quality of each published article that fit the selection criteria were evaluated using Critical Appraisal Checklist tools. All statistical analysis was done by STATA 16. Results This review was based on 29 studies with 26,255 participants from sub-Saharan Africa. Using a random-effects model, the pooled prevalence of COVID-19 vaccine acceptance among study participants was 55.04% (95 % CI: 47.80-62.27 %), I2 = 99.55%. Being male [POR = 1.88 (95% CI: 1.45, 2.44)], having a positive attitude toward the COVID-19 vaccine [POR = 5.56 (95% CI: 3.63, 8.51)], having good knowledge in the COVID-19 vaccine [POR = 4.61 (95% CI: 1.24, 8.75)], having government trust [POR = 7.10 (95% CI: 2.37, 21.32)], and having undergone COVID-19 testing in the past [POR = 4.41 (95%CI: (2.51, 7.75)] were significant predictor variables. Conclusion This analysis showed that respondents had a decreased pooled prevalence of COVID-19 vaccination acceptance. Sex, attitude, knowledge, government trust, and COVID-19 testing were statistically significantly correlated characteristics that affected the acceptability of the COVID-19 vaccine. All stakeholders should be actively involved in increasing the uptake of the COVID-19 vaccine and thereby reducing the consequences of COVID-19. The acceptance of the COVID-19 vaccination can be increased by using this conclusion as an indicator for governments, healthcare professionals, and health policymakers in their work on attitude, knowledge, government trust, and COVID-19 testing.
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Affiliation(s)
- Jember Azanaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mastewal Endalew
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Demisu Zenbaba
- Department of Public Health, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Eshetu Abera
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Vijay Kumar Chattu
- Department of Community Medicine, Faculty of Medicine, Datta Meghe Institute of Medical Sciences, Wardha, India
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Center for Transdisciplinary Research, Saveetha Institute of Medical and Technological Sciences, Saveetha University, Chennai, India
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14
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El Salih I, Njuguna FM, Widjajanto PH, Kaspers G, Bailey A, Mostert S. Impact of COVID-19 measures on the health and healthcare of children in East-Africa: Scoping review. Int J Health Plann Manage 2023; 38:579-598. [PMID: 36691260 DOI: 10.1002/hpm.3612] [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: 03/22/2022] [Revised: 11/29/2022] [Accepted: 12/22/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic is of grave concern. As scientific data is being collected about the nature of COVID-19, government leaders and policy makers are challenged. They might feel pressured to take strong measures to stop virus spread. However, decisions could cause more harm than do good. This study maps all existing literature regarding the impact of COVID-19 containment measures on the health and healthcare of children in East-Africa. METHODS This scoping review follows Population Concept Context guidelines of Arksey and O'Malley and PRISMA 2020 checklist. PubMed, Web of Science, and Embase were searched. All peer-reviewed literature published in English between January 2020 and October 2022 was considered. Initial screening of titles and abstracts was undertaken independently by two reviewers, with a third available in case of doubt. This was followed by full-text screening involving two independent reviewers. RESULTS In total, 70 studies were included. Eight containment measures affecting children's health and healthcare were distinguished: lockdowns, school closures, physical distancing, travel restrictions, business closures, stay-at-home orders, curfews, quarantine measures with contact tracing. The consensus in the studies is that containment measures could minimise COVID-19 spread but have adverse indirect effects on children in East-Africa. Seven indirect effects were distinguished: economic damage, limited education access, food insecurity, child abuse, limited healthcare access, disrupted health-programs, and mental health challenges. CONCLUSION Government leaders and policy makers should take adverse indirect effects of COVID-19 measures into account, particularly in resource-limited regions such as East-Africa, apply a holistic approach, and strengthen socioeconomic and health-systems to protect the most vulnerable.
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Affiliation(s)
- Ibrahim El Salih
- International Development Studies, Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands
| | - Festus Muigai Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | - Pudjo Hagung Widjajanto
- Department of Pediatric Oncology, Dr Sardjito General Hospital, Gadjah Mada University, Yogyakarta, Indonesia
| | - Gertjan Kaspers
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ajay Bailey
- International Development Studies, Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands
| | - Saskia Mostert
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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15
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Semitala FC, Katwesigye R, Kalibbala D, Mbuliro M, Lalitha R, Owachi D, Atine E, Nassazi J, Turyahabwe S, Sekadde M. Integration of COVID-19 and TB screening in Kampala, Uganda: healthcare provider perspectives. Implement Sci Commun 2023; 4:8. [PMID: 36650596 PMCID: PMC9844180 DOI: 10.1186/s43058-023-00391-w] [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: 03/15/2022] [Accepted: 12/27/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Following the first wave of the COVID-19 outbreak, Uganda experienced a 40% drop in tuberculosis (TB) screening by June 2020. We sought to identify barriers to and facilitators of integrated COVID-19 and TB screening from the perspective of healthcare providers (HCPs) at a National Referral Hospital in Kampala, Uganda. DESIGN/METHODS We conducted a cross-sectional study using in-depth interviews with 12 HCPs involved in TB activities in the outpatient and emergency departments at Kiruddu National Referral Hospital, Kampala, Uganda. We explored the HCP experiences at work in the setting of COVID-19, HCP perceived effect of COVID-19 on TB screening activities at the hospital, and perceptions about social and contextual factors that might influence the willingness of HCP to integrate screening of COVID-19 and TB. We analyzed the data using an inductive thematic approach and we denoted the emergent themes as barriers to and facilitators of COVID-19/TB integrated screening. We then mapped the themes to the Capability, Opportunity, Motivation, and Behavior (COM-B) model. RESULTS The facilitators to integrated COVID-19 and TB screening included the availability of TB focal persons and already existing training forums at the hospital that could be utilized to strengthen the capacity of HCP to integrate COVID-19 and TB screening. The barriers included HCP's inadequate knowledge on how to integrate screening of COVID-19 and TB, the absence of simple easy-to-use standard operating procedures and data collection tools for integrated screening, inconsistent supply of personal protective equipment (PPE), understaffing, and fear of contracting COVID-19 infection. The identified intervention functions to address the facilitators or barriers included education, persuasion, enablement, and training. CONCLUSIONS These findings provided a basis for designing contextually appropriate interventions targeting factors that are likely to influence HCP decisions and willingness to conduct TB screening in the context of COVID-19. Future studies should evaluate the effect of addressing these barriers to the integration of COVID-19 and TB as well as the effect of this on TB case finding in high-burden TB settings.
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Affiliation(s)
- Fred C. Semitala
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Rodgers Katwesigye
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Dennis Kalibbala
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Mary Mbuliro
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Rejani Lalitha
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Darius Owachi
- grid.513250.0Kiruddu National Referral Hospital, Kampala, Uganda
| | - Edgar Atine
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Josephine Nassazi
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Stavia Turyahabwe
- grid.415705.2Ministry of Health Uganda, National Tuberculosis and Leprosy Program, Kampala, Uganda
| | - Moorine Sekadde
- grid.415705.2Ministry of Health Uganda, National Tuberculosis and Leprosy Program, Kampala, Uganda
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16
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Ozdemir S, Oztomurcuk D, Oruc MA. Impact of the COVID-19 pandemic on tuberculosis patients and tuberculosis control programs in Turkey, review and analysis. Arch Public Health 2022; 80:252. [PMID: 36510320 PMCID: PMC9742654 DOI: 10.1186/s13690-022-01007-w] [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: 02/27/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many infectious diseases, including Tuberculosis (TB), have been put in the background with the COVID-19 pandemic. This study aimed to evaluate the changes in the number of TB patients, the parameters of the TB patients and tuberculosis control programs in the first year of the COVID-19 pandemic in Turkey when compared to the previous year. METHODS All TB patients who were recorded in Samsun province between March 1, 2019 and February 28, 2021 were included in this retrospective study. The data were analyzed in 2 groups as the COVID-19 period (March 2020 and February 2021) and the Pre-COVID-19 period (March 2019 and February 2020),the demographic and microbiological characteristics of the tuberculosis patients in both periods were compared according to months and years p < 0.05 was considered statistically significant. RESULTS The total number of TB patients was 320, although it was 172 in the Pre-COVID-19 period, it was 148 in the COVID-19 pandemic period. It was found that the TB incidence rate (IR) was 15.32%, the total number of examinations performed in TB dispensary decreased 33.54%, and the total number of contact examinations decreased by 53.54% during the pandemic period. The mean age of the patients decreased significantly during the COVID-19 period (p = 0.047), and it was found that culture positivity rates and smear positivity rates increased compared to the previous year (7.97%, p = 0.166, 1.86%; p = 0.507, respectively). SARS-CoV-2 PCR test result was found to be (-) in 46 (82.1%) of the 56 TB patients who were examined. CONCLUSIONS In the present study, it was found that the incidence of TB, the number of examinations, and the number of contact examinations decreased at significant levels. The decrease in TB patients was mostly in the first 3 months when COVID-19 precautions and restrictions were intense. As a conclusion, it was observed that the application of TB patients to the healthcare institution and TB control were affected negatively by the COVID-19 pandemic.
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Affiliation(s)
- Sule Ozdemir
- grid.510471.60000 0004 7684 9991Department of Public Health, Faculty of Medicine, Samsun University, Samsun, Turkey
| | - Derya Oztomurcuk
- Department of Public Health, Provincial Directorate of Health, Samsun, Turkey
| | - Muhammet Ali Oruc
- grid.510471.60000 0004 7684 9991Department of Family Medicine, Faculty of Medicine, Samsun University, Samsun, Turkey
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17
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Chiumia IK, Mosiwa BA, Nkhonjera J, Kazanga B, Mukondiwa AS, Twalibu A, Phuka J, Lucero‐Prisno DE. Emerging public health challenges during the COVID‐19 pandemic in Malawi: A review. PUBLIC HEALTH CHALLENGES 2022; 1:e40. [PMID: 37519312 PMCID: PMC9877808 DOI: 10.1002/puh2.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/28/2022] [Indexed: 06/28/2023]
Abstract
The ongoing COVID‐19 pandemic has posed new and has aggravated already existing public health challenges in Malawi and worldwide. Having a better understanding of these challenges can help facilitate the identification of solutions and designing further public health interventions and policies for effective management of the COVID‐19 pandemic. This article presents an overview of the situation of COVID‐19 in Malawi and identifies emerging public health challenges that the country is facing amidst this pandemic. It is based on a review of relevant key policy documents, reports, and publications. Some of the key emerging challenges identified in Malawi are worsening population health and socio‐economic status; health system challenges like inadequate financing and human resources, disruption of essential health services; a rise in mental health conditions and suicide rates; teenage pregnancies and early marriages; and changes in some health policies. The findings point to the need to invest more in strategies for health promotion, health system strengthening and avoiding disruptions and recovery of services. These should include COVID‐19 vaccination promotion campaigns, improvement of the public health surveillance system, strengthening the health workforce, implementation of health financing strategies, procurement of adequate essential medicines and supplies, and strengthening of youth‐friendly reproductive health services, community health services and community engagement. These will ensure that the health system in Malawi is well‐equipped to deliver resilient, sustainable and quality health services amidst and beyond the COVID‐19 pandemic thereby promoting progress toward the achievement of Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) in Malawi.
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Affiliation(s)
| | | | - Joe Nkhonjera
- Ministry of HealthPhalombe District HospitalPhalombeMalawi
| | - Betty Kazanga
- IRD, INSERMAix Marseille Univ, SESSTIM, ISSPAMMarseilleFrance
| | | | - Aisha Twalibu
- Schulich School of Medicine and DentistryUniversity of Western OntarioOntarioCanada
| | - John Phuka
- School of Global and Public HealthKamuzu College of Health ScienceLilongweMalawi
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18
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The Effect of the COVID-19 Pandemic on Pulmonary Tuberculosis Control in the Selected Upazila Health Complexes of Dhaka Division, Bangladesh. Trop Med Infect Dis 2022; 7:tropicalmed7110385. [DOI: 10.3390/tropicalmed7110385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Despite the enormous disruption of tuberculosis (TB) services reported globally, Bangladesh’s impact is not well documented. We aimed to assess the effect of the COVID-19 pandemic on the TB control program in Bangladesh from patients’ and service providers’ perspectives. We conducted a cross-sectional study from November–December 2021 at six conveniently selected Upazila Health Complexes (UHC) of the Dhaka division, Bangladesh. We conducted face-to-face interviews among 180 pulmonary TB service recipients and all TB service providers working in the selected UHC. We also reviewed TB registries from each UHC. All data were summarized using descriptive statistics tools. We found a 31% reduction in presumptive TB cases during 2021 compared to 2020. Other TB services, such as testing, were reduced by 16–36% during the same period. Service receivers reported a lack of transportation (95%), and a lack of adequate human resources (89%) as critical barriers to receiving and providing TB service, respectively. The findings of our study showed substantial interruption of TB service delivery during the COVID-19 pandemic, threatening the recent progress and pushback from achieving the 2035 End TB targets. Early mitigation of TB service delivery through adopting remote follow-ups using digital health technology and integrating COVID-19 and TB screening is essential for the continuity of essential TB services and achieving global TB targets.
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19
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VanBenschoten H, Kuganantham H, Larsson EC, Endler M, Thorson A, Gemzell-Danielsson K, Hanson C, Ganatra B, Ali M, Cleeve A. Impact of the COVID-19 pandemic on access to and utilisation of services for sexual and reproductive health: a scoping review. BMJ Glob Health 2022; 7:bmjgh-2022-009594. [PMID: 36202429 PMCID: PMC9539651 DOI: 10.1136/bmjgh-2022-009594] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/13/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction The COVID-19 pandemic has negatively impacted health systems globally and widened preexisting disparities. We conducted a scoping review on the impact of the COVID-19 pandemic on women and girls’ access to and utilisation of sexual and reproductive health (SRH) services for contraception, abortion, gender-based and intimate partner violence (GBV/IPV) and sexually transmitted infections (STIs). Methods We systematically searched peer reviewed literature and quantitative reports, published between December 2019 and July 2021, focused on women and girls’ (15–49 years old) access to and utilisation of selected SRH services during the COVID-19 pandemic. Included studies were grouped based on setting, SRH service area, study design, population and reported impact. Qualitative data were coded, organised thematically and grouped by major findings. Results We included 83 of 3067 identified studies and found that access to contraception, in-person safe abortion services, in-person services for GBV/IPV and STI/HIV testing, prevention and treatment decreased. The geographical distribution of this body of research was uneven and significantly less representative of countries where COVID-19 restrictions were very strict. Access was limited by demand and supply side barriers including transportation disruptions, financial hardships, limited resources and legal restrictions. Few studies focused on marginalised groups with distinct SRH needs. Conclusion Reports indicated negative impacts on access to and utilisation of SRH services globally, especially for marginalised populations during the pandemic. Our findings call for strengthening of health systems preparedness and resilience to safeguard global access to essential SRH services in ongoing and future emergencies.
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Affiliation(s)
- Hannah VanBenschoten
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | | | - Elin C Larsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden,WHO Collaborating Center for Human Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Margit Endler
- Department of Women and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Department of Obsetrics and Gynecology, Stockholm South General Hospital, Stockholm, Sweden
| | - Anna Thorson
- Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland,Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden,WHO Collaborating Center for Human Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden,Department of Disease Control, London School of Hygiene & Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Bela Ganatra
- Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland
| | - Moazzam Ali
- Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland
| | - Amanda Cleeve
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden,Department of Obsetrics and Gynecology, Stockholm South General Hospital, Stockholm, Sweden
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20
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Semitala FC, Katwesigye R, Kalibbala D, Mbuliro M, Opio R, Owachi D, Atine E, Nassazi J, Turyahabwe S, Sekadde M. Integration of COVID-19 and TB screening in Kampala, Uganda - Healthcare provider perspectives. RESEARCH SQUARE 2022:rs.3.rs-1448831. [PMID: 35702151 PMCID: PMC9196119 DOI: 10.21203/rs.3.rs-1448831/v1] [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: 02/04/2023]
Abstract
Background: Following the first wave of COVID-19 outbreak, Uganda experienced a 40% drop in Tuberculosis (TB) screening by June 2020. We sought to identify barriers to and facilitators of integrated COVID-19 and TB screening from the perspective of healthcare providers (HCP) at a National Referral Hospital in Kampala, Uganda. Design/Methods: We conducted a cross sectional study using in-depth interviews with 12 HCP involved in TB activities in the outpatient and emergency departments at Kiruddu National Referral hospital Kampala, Uganda. We explored the HCP experiences at work in the setting of COVID-19, HCP perceived effect of COVID-19 on TB screening activities at the Hospital, and perceptions about social and contextual factors that might influence the willingness of HCP to integrate screening of COVID-19 and TB. We analyzed the data using an inductive thematic approach and the emergent themes were denoted as barriers to and facilitators of COVID-19-TB integrated screening. We then mapped the themes to the Capability, Opportunity, Motivation and Behavior (COM-B) model. Results: The facilitators to integrated COVID-19 and TB screening included; HCP knowledge of how to separately screen for TB and COVID-19, availability of TB focal persons and interest in learning how to provide integrated screening for TB and COVID-19. The barriers included; HCP inadequate knowledge on how to integrate screening of TB and COVID-19, absence of simple standard operating procedures and data collection tools for integrated screening, inconsistent supply of personal protective equipment (PPE), under staffing, and fear of contracting COVID-19 infection. The identified intervention functions to address the facilitators or barriers included education, persuasion, enablement, and training. Conclusions: These findings provide a basis for designing contextually appropriate interventions targeting factors that are likely to influence HCP decisions and willingness to conduct TB screening in the context of COVID-19.
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Affiliation(s)
| | | | | | | | - Rejani Opio
- Makerere University Faculty of Medicine: Makerere University College of Health Sciences
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21
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Manhiça I, Augusto O, Sherr K, Cowan J, Cuco RM, Agostinho S, Macuacua BC, Ramiro I, Carimo N, Matsinhe MB, Gloyd S, Chicumbe S, Machava R, Tembe S, Fernandes Q. COVID-19-related healthcare impacts: an uncontrolled, segmented time-series analysis of tuberculosis diagnosis services in Mozambique, 2017-2020. BMJ Glob Health 2022; 7:bmjgh-2021-007878. [PMID: 35443938 PMCID: PMC9021460 DOI: 10.1136/bmjgh-2021-007878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/27/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Currently, COVID-19 dominates the public health agenda and poses a permanent threat, leading to health systems’ exhaustion and unprecedented service disruption. Primary healthcare services, including tuberculosis services, are at increased risk of facing severe disruptions, particularly in low-income and middle-income countries. Indeed, corroborating model-based forecasts, there is increasing evidence of the COVID-19 pandemic’s negative impact on tuberculosis case detection. Methods Applying a segmented time-series analysis, we assessed the effects of COVID-19-related measures on tuberculosis diagnosis service across districts in Mozambique. Ministry health information system data were used from the first quarter of 2017 to the end of 2020. The model, performed under the Bayesian premises, was estimated as a negative binomial with random effects for districts and provinces. Results A total of 154 districts were followed for 16 consecutive quarters. Together, these districts reported 96 182 cases of all forms of tuberculosis in 2020. At baseline (first quarter of 2017), Mozambique had an estimated incidence rate of 283 (95% CI 200 to 406) tuberculosis cases per 100 000 people and this increased at a 5% annual rate through the end of 2019. We estimated that 17 147 new tuberculosis cases were potentially missed 9 months after COVID-19 onset, resulting in a 15.1% (95% CI 5.9 to 24.0) relative loss in 2020. The greatest impact was observed in the southern region at 40.0% (95% CI 30.1 to 49.0) and among men at 15% (95% CI 4.0 to 25.0). The incidence of pulmonary tuberculosis increased at an average rate of 6.6% annually; however, an abrupt drop (15%) was also observed immediately after COVID-19 onset in March 2020. Conclusion The most significant impact of the state of emergency was observed between April and June 2020, the quarter after COVID-19 onset. Encouragingly, by the end of 2020, clear signs of health system recovery were visible despite the initial shock.
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Affiliation(s)
| | - Orvalho Augusto
- Saude da Comunidade, Faculdade de Medicina, Cidade de Maputo, Mozambique.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - James Cowan
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | | | - Isaías Ramiro
- Comité para a Saúde de Moçambique, Maputo City, Mozambique
| | - Naziat Carimo
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Stélio Tembe
- Ministerio da Saude, Maputo, Mozambique.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Quinhas Fernandes
- Ministerio da Saude, Maputo, Mozambique .,Department of Global Health, University of Washington, Seattle, Washington, USA
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22
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Chilot D, Woldeamanuel Y, Manyazewal T. COVID-19 Burden on HIV Patients Attending Antiretroviral Therapy in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study. Front Med (Lausanne) 2022; 9:741862. [PMID: 35308528 PMCID: PMC8924523 DOI: 10.3389/fmed.2022.741862] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/07/2022] [Indexed: 12/18/2022] Open
Abstract
Background There has been promising progress toward screening, testing, and retaining patients with HIV in care in Ethiopia. Concern exists that possible disruptions in HIV programs due to coronavirus disease 2019 (COVID-19) could result in a more HIV-related mortality and new HIV infections. This study aimed to investigate the real-time burden of COVID-19 on patients with HIV attending antiretroviral therapy. Methods We conducted a facility-based, multicenter, and cross-sectional study among patients with HIV attending antiretroviral therapy in 10 healthcare facilities in Addis Ababa, Ethiopia, in the COVID-19 pandemic period. Data were collected using adapted, interviewer-based questionnaires, and entered into EpiInfo version 7 and exported to SPSS version 26 for analysis. Result A total of 212 patients with HIV were included. The participants who missed visits for refill were 58 (27.4%). When the effects of other independent variables on appointments/visits for refill were controlled, the following characteristics were found to be the most important predictors of missed appointments (p< 0.05): age ≥ 55 [adjusted odds ratio (AOR) = 6.73, 95% CI (1.495-30.310)], fear of COVID-19 [AOR = 24.93, 95% CI (2.798-222.279)], transport disruption [AOR = 4.90, 95% CI (1.031-23.174)], reduced income for traveling to a health facility [AOR = 5.64, 95% CI (1.234-25.812)], limited access to masks [AOR = 7.67, 95% CI (1.303-45.174)], sanitizer [AOR = 0.07, 95% CI (0.007-0.729)], and non-medical support [AOR = 2.32, 95% CI (1.547-12.596)]. The participants were well aware of the COVID-19 preventive measures. The most costly COVID-19 preventive measures that cause financial burden to the patients were the costs for buying face masks (63.7%), disinfectants (55.2%), and soap for handwashing (22.2%). The participants who missed follow-up diagnostic tests were 56 (26.4%). Variables, which were found to be statistically significant, include the following: age ≥ 55 [AOR = 0.22, 95% CI (0.076-0.621)], partial lockdown [AOR = 0.10, 95% CI (0.011-0.833)], limited access to health services [AOR = 0.15, 95% CI (0.045-0.475)], reduced income for traveling to health facility [AOR = 0.18, 95% CI (0.039-0.784)], and unable to get masks [AOR = 0.12, 95% CI (0.026-0.543)]. The participants who missed counseling services were 55 (25.9%). In multivariate logistic regression, the following were statistically significant: age ≥ 55 [AOR = 0.21, 95% CI (0.078-0.570)], fear of COVID-19 [AOR = 0.11, 95% CI (0.013-0.912)], reduced income [AOR = 0.17, 95% CI (0.041-0.699)], unable to get face masks [AOR = 0.19, 95% CI (0.039-0.959)], and partial lockdown [AOR = 0.08, 95% CI (0.008-0.790)]. Conclusions The COVID-19 had a significant burden on patients with HIV to attend their routine clinical care and treatment, which may lead to treatment failure and drug resistance. The impact was on their appointments for medication refills and clinical and laboratory follow-ups. Targeted initiatives are needed to sustain HIV clinical care and treatment services and improve the well-being of people living with HIV.
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Affiliation(s)
- Dagmawi Chilot
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yimtubezinash Woldeamanuel
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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23
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Chisale MR, Nyambalo BW, Mitambo C, Kumwenda P, Mwale SE, Mbakaya BC. Comparative characterisation of COVID-19 patients with hypertension comorbidity in Malawi: a 1:2 matched retrospective case-control study. IJID REGIONS 2022; 2:25-29. [PMID: 35721435 PMCID: PMC8606319 DOI: 10.1016/j.ijregi.2021.11.005] [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] [Received: 10/08/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of this study was to characterize COVID-19 cases and explore the risk factors associated with mortality among hypertensive patients with COVID-19 across Malawi. METHODS A retrospective case-control study design was used to provide a detailed account of cases and to explore the risk factors associated with mortality among hypertensive patients with COVID-19. In total, 441 patients were included in the study in a ratio of one case to two controls (1:2), matched by age. RESULTS Deaths due to COVID-19 varied with hypertensive condition, with more deaths registered in hypertensive patients. Clinical signs and symptoms varied greatly between hypertensive and non-hypertensive COVID-19 patients, tending to be milder in the latter group. The risk of death due to COVID-19 among hypertensive patients increased with age, and was meaningfully associated with underlining comorbidities, such as HIV, TB, cardiovascular disease, and liver disease. CONCLUSION Our study revealed predictive factors for mortality in hypertensive COVID-19 patients, which can be used by policy makers and healthcare practitioners to identify those at a higher risk, and to determine the appropriate treatment approach to achieve the best possible clinical outcomes.
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Affiliation(s)
| | | | | | | | - Saul E. Mwale
- Biological Sciences Department, Mzuzu University, Mzuzu, Malawi
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24
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Leggat PA, Frean J, Blumberg L. COVID-19: Current Challenges and Future Perspectives. Trop Med Infect Dis 2022; 7:tropicalmed7020016. [PMID: 35202212 PMCID: PMC8879616 DOI: 10.3390/tropicalmed7020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Peter A. Leggat
- World Health Organization Collaborating Centre for Vector-borne and Neglected Tropical Diseases, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Correspondence: ; Tel.: +61-7-4781-6108
| | - John Frean
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; (J.F.); (L.B.)
| | - Lucille Blumberg
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; (J.F.); (L.B.)
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25
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Llibre A, Dedicoat M, Burel JG, Demangel C, O’Shea MK, Mauro C. Host Immune-Metabolic Adaptations Upon Mycobacterial Infections and Associated Co-Morbidities. Front Immunol 2021; 12:747387. [PMID: 34630426 PMCID: PMC8495197 DOI: 10.3389/fimmu.2021.747387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022] Open
Abstract
Mycobacterial diseases are a major public health challenge. Their causative agents include, in order of impact, members of the Mycobacterium tuberculosis complex (causing tuberculosis), Mycobacterium leprae (causing leprosy), and non-tuberculous mycobacterial pathogens including Mycobacterium ulcerans. Macrophages are mycobacterial targets and they play an essential role in the host immune response to mycobacteria. This review aims to provide a comprehensive understanding of the immune-metabolic adaptations of the macrophage to mycobacterial infections. This metabolic rewiring involves changes in glycolysis and oxidative metabolism, as well as in the use of fatty acids and that of metals such as iron, zinc and copper. The macrophage metabolic adaptations result in changes in intracellular metabolites, which can post-translationally modify proteins including histones, with potential for shaping the epigenetic landscape. This review will also cover how critical tuberculosis co-morbidities such as smoking, diabetes and HIV infection shape host metabolic responses and impact disease outcome. Finally, we will explore how the immune-metabolic knowledge gained in the last decades can be harnessed towards the design of novel diagnostic and therapeutic tools, as well as vaccines.
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Affiliation(s)
- Alba Llibre
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Martin Dedicoat
- Department of Infectious Diseases, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Julie G. Burel
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, United States
| | - Caroline Demangel
- Immunobiology of Infection Unit, Institut Pasteur, INSERM U1224, Paris, France
| | - Matthew K. O’Shea
- Department of Infectious Diseases, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Claudio Mauro
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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26
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Impact of COVID-19 on Tuberculosis Case Detection and Treatment Outcomes in Sierra Leone. Trop Med Infect Dis 2021; 6:tropicalmed6030154. [PMID: 34449755 PMCID: PMC8396336 DOI: 10.3390/tropicalmed6030154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 11/25/2022] Open
Abstract
The COVID-19 pandemic has adversely affected tuberculosis (TB) care delivery in high burden countries. We therefore conducted a retrospective study to assess the impact of COVID-19 on TB case detection and treatment outcomes at the Chest Clinic at Connaught Hospital in Freetown, Sierra Leone. Overall, 2300 presumptive cases were tested during the first three quarters of 2020 (intra-COVID-19) versus 2636 in 2019 (baseline), representing a 12.7% decline. Testing declined by 25% in women, 20% in children and 81% in community-initiated referrals. Notwithstanding, laboratory-confirmed TB cases increased by 37.0% and treatment success rate was higher in 2020 (55.6% vs. 46.7%, p = 0.002). Multivariate logistic regression analysis found that age < 55 years (aOR 1.74, 95% CI (1.80, 2.56); p = 0.005), new diagnosis (aOR 1.69, 95% CI (1.16, 2.47); p = 0.007), pulmonary TB (aOR 3.17, 95% CI (1.67, 6.04); p < 0.001), HIV negative status (aOR 1.60, 95%CI (1.24, 2.06); p < 0.001) and self-administration of anti-TB drugs through monthly dispensing versus directly observed therapy (DOT) (aOR 1.56, 95% CI (1.21, 2.03); p = 0.001) independently predicted treatment success. These findings may have policy implications for DOTS in this setting and suggest that more resources are needed to reverse the negative impact of the COVID-19 pandemic on TB program activities in Sierra Leone.
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Chilot D, Woldeamanuel Y, Manyazewal T. COVID-19 Burden on HIV Patients Attending Antiretroviral Therapy in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study. RESEARCH SQUARE 2021. [PMID: 34341785 PMCID: PMC8328071 DOI: 10.21203/rs.3.rs-699963/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background There has been promising progress towards screening, testing, and retaining HIV patients in care in Ethiopia. Concern exists that possible disruptions in HIV programs due to COVID-19 could result in more HIV-related mortality and new HIV infections. This study aimed to investigate the real-time burden of COVID-19 on HIV patients attending antiretroviral therapy. Methods We conducted a facility-based, multicentre, cross-sectional study among HIV patients attending antiretroviral therapy in 10 healthcare facilities in Addis Ababa, Ethiopia, in the COVID-19 pandemic period. Data was collected using adapted, interviewer-based questionnaires, and entered into Epi Info version 7 and exported to SPSS version 26 for analysis. Result A total of 212 patients with HIV were included. Participants who missed visits for refill were 58 (27.4%). When the effects of other independent variables on appointments/visits for refill were controlled, the following characteristics were found to be the most important pridictors of missed appointments (P < 0.05): age ≥ 55 [AOR = 6.73, 95% CI (1.495–30.310)], fear of COVID-19 [AOR = 24.93, 95% CI (2.798-222.279)], transport disruption [AOR = 4.90, 95% CI (1.031–23.174)], reduced income for traveling to health facility [AOR = 5.64, 95% CI (1.234–25.812)], and limited access to mask [AOR = 7.67, 95% CI (1.303–45.174)], sanitizer [AOR = 0.07, 95% CI (0.007–0.729)] and non-medical support [AOR = 2.32, 95% CI (1.547–12.596)]. The participants were well aware of the COVID-19 preventive measures. The most costly COVID-19 preventive measures that cause financial burden to the patients were costs for buying facemasks (63.7%), disinfectants (55.2) and sops for handwashing (22.2). Participants who missed follow-up diagnostic tests were 56 (26.4%). Variables which were found to be statistically significant include the following: age ≥ 55 [AOR = 0.22, 95% CI (0.076–0.621)], partial lockdown [AOR = 0.10, 95% CI (0.011–0.833)], limited access to health services [AOR = 0.15, 95% CI (0.045–0.475)], reduced income for traveling to health facility [AOR = 0.18, 95% CI (0.039–0.784)], and unable to get mask [AOR = 0.12, 95% CI (0.026–0.543)]. Participants who missed counseling services were 55 (25.9%). In multivariate logistic regression the following were statisticaly significant: age ≥ 55 [AOR = 0.21, 95% CI (0.078–0.570)], fear of COVID-19 [AOR = 0.11, 95% CI (0.013–0.912)], reduced income [AOR = 0.17, 95% CI (0.041–0.699)], unable to get face mask [AOR = 0.19, 95%CI (0.039–0.959)], and partial lockdown [AOR = 0.08, 95% CI (0.008–0.790)]. Conclusions COVID-19 had a significant burden on HIV patients to attend their routine clinical care and treatment, which may lead to treatment failure and drug resistance. The impact was on their appointments for medication refills and clinical and laboratory follow-ups. Targeted initiatives are needed to sustain HIV clinical care and treatment services and improve the wellbeing of people living with HIV.
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28
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Real-Time Operational Research: Case Studies from the Field of Tuberculosis and Lessons Learnt. Trop Med Infect Dis 2021; 6:tropicalmed6020097. [PMID: 34201324 PMCID: PMC8293385 DOI: 10.3390/tropicalmed6020097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 01/02/2023] Open
Abstract
Real-time operational research can be defined as research on strategies or interventions to assess if they are feasible, working as planned, scalable and effective. The research involves primary data collection, periodic analysis during the conduct of the study and dissemination of the findings to policy makers for timely action. This paper aims to illustrate the use of real-time operational research and discuss how to make it happen. Four case studies are presented from the field of tuberculosis. These include (i) mis-registration of recurrent tuberculosis in Malawi; (ii) HIV testing and adjunctive cotrimoxazole to reduce mortality in TB patients in Malawi; (iii) screening TB patients for diabetes mellitus in India; and (iv) mitigating the impact of COVID-19 on TB case detection in capital cities in Kenya, Malawi and Zimbabwe. The important ingredients of real-time operational research are sound ethics; relevant research; adherence to international standards of conducting and reporting on research; consideration of comparison groups; timely data collection; dissemination to key stakeholders; capacity building; and funding. Operational research can improve the delivery of established health interventions and ensure the deployment of new interventions as they become available, irrespective of diseases. This is particularly important when public health emergencies, including pandemics, threaten health services.
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