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Mecaskey J, Verboom B, Liverani M, Mijumbi-Deve R, Jessani NS. Improving institutional platforms for evidence-informed decision-making: getting beyond technical solutions. Health Res Policy Syst 2023; 21:5. [PMID: 36647051 PMCID: PMC9841961 DOI: 10.1186/s12961-022-00948-6] [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: 06/28/2022] [Accepted: 11/25/2022] [Indexed: 01/18/2023] Open
Abstract
Purely technical interventions aimed at enhancing evidence-informed decision-making (EIDM) have rarely translated into organizational institutionalization or systems change. A panel of four presentations at the Health Systems Global 2020 conference provides a basis for inference about contextual factors that influence the establishment and sustainability of institutional platforms to support EIDM. These cases include local structures such as citizen panels in Uganda, regional knowledge translation structures such as the West African Health Organization, global multilateral initiatives such as the "One Health" Quadrapartite and regional public health networks in South-East Asia. They point to the importance of political economy as well as technical capability determinants of evidence uptake and utilization at institutional, organizational and individual levels. The cases also lend support to evidence that third-party (broker and intermediary) supportive institutions can facilitate EIDM processes. The involvement of third-party supranational organizations, however, poses challenges in terms of legitimacy and accountability.
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Affiliation(s)
| | - Ben Verboom
- grid.4991.50000 0004 1936 8948University of Oxford, Oxford, United Kingdom
| | - Marco Liverani
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom ,grid.174567.60000 0000 8902 2273School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Rhona Mijumbi-Deve
- The Center for Rapid Evidence Synthesis (ACRES), Kampala, Uganda ,grid.412988.e0000 0001 0109 131XAfrica Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Nasreen S. Jessani
- grid.11956.3a0000 0001 2214 904XCentre for Evidence Based Health Care, Stellenbosch University, Cape Town, South Africa ,grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins University, Baltimore, MD United States of America
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Zhang X, Zhang Y, Xia W, Liu Y, Mao H, Bao L, Cao M. The relationship between vitamin D level and second acid-fast bacilli (AFB) smear-positive during treatment for TB patients was inferred by Bayesian network. PLoS One 2022; 17:e0267917. [PMID: 35507601 PMCID: PMC9067663 DOI: 10.1371/journal.pone.0267917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vitamin D is related to human immunity, so we used Bayesian network model to analyze and infer the relationship between vitamin D level and the acid-fast bacilli (AFB) smear-positive after two months treatment among pulmonary tuberculosis (TB) patients. METHODS This is a cross-sectional study. 731 TB patients whose vitamin D level were detected and medical records were collected from December 2019 to December 2020 in XinJiang of China. Logistic regression was used to analyze the influencing factors of second AFB smear-positive. Bayesian network was used to further analyze the causal relationship among vitamin D level and the second AFB smear-positive. RESULTS Baseline AFB smear-positive (OR = 6.481, 95%CI: 1.604~26.184), combined cavity (OR = 3.204, 95%CI: 1.586~6.472), full supervision (OR = 8.173, 95%CI:1.536~43.492) and full management (OR = 6.231, 95%CI:1.031~37.636) were not only the risk factors and can also be considered as the reasons for second AFB smear-positive in TB patients (Ensemnle > 0.5). There was no causal relationship between vitamin D level and second AFB smear-positive (Ensemnle = 0.0709). CONCLUSIONS The risk factors of second AFB smear-positive were baseline AFB smear-positive, combined cavity, full supervision and full management. The vitamin D level in TB patients was not considered as one of the reasons for the AFB smear-positive.
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Affiliation(s)
- Xiaoxu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Yan Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Wenjun Xia
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Yajie Liu
- Medical Record Room, Third Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Hongkai Mao
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Liangliang Bao
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - MingQin Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
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de Groot LM, Straetemans M, Maraba N, Jennings L, Gler MT, Marcelo D, Mekoro M, Steenkamp P, Gavioli R, Spaulding A, Prophete E, Bury M, Banu S, Sultana S, Onjare B, Efo E, Alacapa J, Levy J, Morales MLL, Katamba A, Bogdanov A, Gamazina K, Kumarkul D, Ekaterina OL, Cattamanchi A, Khan A, Bakker MI. Time Trend Analysis of Tuberculosis Treatment While Using Digital Adherence Technologies-An Individual Patient Data Meta-Analysis of Eleven Projects across Ten High Tuberculosis-Burden Countries. Trop Med Infect Dis 2022; 7:tropicalmed7050065. [PMID: 35622692 PMCID: PMC9145978 DOI: 10.3390/tropicalmed7050065] [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: 12/24/2021] [Revised: 03/04/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023] Open
Abstract
Worldwide, non-adherence to tuberculosis (TB) treatment is problematic. Digital adherence technologies (DATs) offer a person-centered approach to support and monitor treatment. We explored adherence over time while using DATs. We conducted a meta-analysis on anonymized longitudinal adherence data for drug-susceptible (DS) TB (n = 4515) and drug-resistant (DR) TB (n = 473) populations from 11 DAT projects. Using Tobit regression, we assessed adherence for six months of treatment across sex, age, project enrolment phase, DAT-type, health care facility (HCF), and project. We found that DATs recorded high levels of adherence throughout treatment: 80% to 71% of DS-TB patients had ≥90% adherence in month 1 and 6, respectively, and 73% to 75% for DR-TB patients. Adherence increased between month 1 and 2 (DS-TB and DR-TB populations), then decreased (DS-TB). Males displayed lower adherence and steeper decreases than females (DS-TB). DS-TB patients aged 15−34 years compared to those >50 years displayed steeper decreases. Adherence was correlated within HCFs and differed between projects. TB treatment adherence decreased over time and differed between subgroups, suggesting that over time, some patients are at risk for non-adherence. The real-time monitoring of medication adherence using DATs provides opportunities for health care workers to identify patients who need greater levels of adherence support.
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Affiliation(s)
- Liza M. de Groot
- KIT Royal Tropical Institute, Global Health, 1092 AD Amsterdam, The Netherlands; (L.M.d.G.); (M.S.)
| | - Masja Straetemans
- KIT Royal Tropical Institute, Global Health, 1092 AD Amsterdam, The Netherlands; (L.M.d.G.); (M.S.)
| | - Noriah Maraba
- The Aurum Institute, Parktown, Johannesburg 2193, Gauteng, South Africa;
| | - Lauren Jennings
- Desmond Tutu Health Foundation, P.O. Box 13801, Mowbray, Cape Town 7705, Western Cape, South Africa;
| | - Maria Tarcela Gler
- De La Salle Medical and Health Sciences Institute, City of Dasmariñas Cavite 4114, Philippines; (M.T.G.); (D.M.)
| | - Danaida Marcelo
- De La Salle Medical and Health Sciences Institute, City of Dasmariñas Cavite 4114, Philippines; (M.T.G.); (D.M.)
| | - Mirchaye Mekoro
- Health Poverty Action, London EC1V 2NX, UK; (M.M.); (P.S.); (R.G.)
| | - Pieter Steenkamp
- Health Poverty Action, London EC1V 2NX, UK; (M.M.); (P.S.); (R.G.)
| | - Riccardo Gavioli
- Health Poverty Action, London EC1V 2NX, UK; (M.M.); (P.S.); (R.G.)
| | - Anne Spaulding
- Health Through Walls, Port-au-Prince HT 6110, Haiti; (A.S.); (E.P.); (M.B.)
| | - Edwin Prophete
- Health Through Walls, Port-au-Prince HT 6110, Haiti; (A.S.); (E.P.); (M.B.)
| | - Margarette Bury
- Health Through Walls, Port-au-Prince HT 6110, Haiti; (A.S.); (E.P.); (M.B.)
| | - Sayera Banu
- Icddr,b, GPO Box 128, Dhaka 1000, Bangladesh; (S.B.); (S.S.)
| | - Sonia Sultana
- Icddr,b, GPO Box 128, Dhaka 1000, Bangladesh; (S.B.); (S.S.)
| | - Baraka Onjare
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Egwuma Efo
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Jason Alacapa
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Jens Levy
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Mona Lisa L. Morales
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Achilles Katamba
- Department of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda;
| | | | | | - Dzhumagulova Kumarkul
- The Red Crescent National Society of the Kyrgyz Republic, Bishkek 720040, Kyrgyzstan; (D.K.); (O.-L.E.)
| | - Orechova-Li Ekaterina
- The Red Crescent National Society of the Kyrgyz Republic, Bishkek 720040, Kyrgyzstan; (D.K.); (O.-L.E.)
| | - Adithya Cattamanchi
- School of Medicine, University of California San Francisco, San Francisco, CA 94110, USA;
| | - Amera Khan
- Stop TB Partnership, 1218 Geneva, Switzerland
- Correspondence: (A.K.); (M.I.B.)
| | - Mirjam I. Bakker
- KIT Royal Tropical Institute, Global Health, 1092 AD Amsterdam, The Netherlands; (L.M.d.G.); (M.S.)
- Correspondence: (A.K.); (M.I.B.)
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