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Mapaona R, Williams V, Musarapasi N, Kibwana S, Maseko T, Chekenyere R, Gumbo S, Mdluli P, Byarugaba H, Galagedera D, Mafukidze A, Hurtado-de-Mendoza A, Adsul P, Bongomin P, Loffredo C, Dlamini X, Bazira D, Ojoo S, Haumba S. Cervical cancer screening outcomes for HIV-positive women in the Lubombo and Manzini regions of Eswatini-Prevalence and predictors of a positive visual inspection with acetic acid (VIA) screen. PLOS Glob Public Health 2024; 4:e0002760. [PMID: 38625931 PMCID: PMC11020862 DOI: 10.1371/journal.pgph.0002760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/04/2024] [Indexed: 04/18/2024]
Abstract
This study aimed to describe the prevalence and predictors of a positive VIA (visual inspection with acetic acid) cervical cancer screening test in women living with human immunodeficiency virus (HIV). We retrospectively analysed data from women aged ≥15 who accessed VIA screening from health facilities in the Lubombo and Manzini regions of Eswatini. Sociodemographic and clinical data from October 2020 to June 2023 were extracted from the client management information system (CMIS). VIA screening outcome was categorised into negative, positive, or suspicious. A logistic regression model estimated the adjusted odds ratio (AOR) of the predictors of a positive VIA screen at p<0.05 with 95% confidence intervals. Of 23,657 participants, 60.8% (n = 14,397) were from the Manzini region. The mean age was 33.3 years (standard deviation 7.0), and 33% (n = 7,714) were first-time screens. The prevalence of a positive VIA was 2.6% (95% CI: 2.2%, 3.0%): 2.8% (95% CI: 2.2%, 3.5%) in Lubombo and 2.4% (95% CI: 2.0%, 2.9%) in Manzini (p = 0.096). Screening at mission-owned (AOR 1.40; p = 0.001), NGO-owned (AOR 3.08; p<0.001) and industrial/workplace-owned health facilities (AOR 2.37; p = 0.044) were associated with increased odds of a positive VIA compared to government-owned health facilities. Compared to those aged 25-34, the odds of a positive VIA increased by 1.26 for those in the 35-44 age group (AOR 1.26; p = 0.017). Predictors with lower odds for a positive VIA test were: being on anti-retroviral therapy (ART) for 5-9 years (AOR 0.76; p = 0.004) and ≥10 years (AOR 0.66; p = 0.002) compared to <5 years; and having an undetectable viral load (AOR 0.39; p<0.001) compared to unsuppressed. Longer duration on ART and an undetectable viral load reduced the odds, while middle-aged women and screening at non-public health facilities increased the odds of a positive VIA screen.
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Affiliation(s)
- Rufaro Mapaona
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Victor Williams
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Normusa Musarapasi
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Sharon Kibwana
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
| | - Thokozani Maseko
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Rhinos Chekenyere
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Sidumo Gumbo
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Phetsile Mdluli
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Hugben Byarugaba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Dileepa Galagedera
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Arnold Mafukidze
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | | | - Prajakta Adsul
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America
| | - Pido Bongomin
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Christopher Loffredo
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America
| | - Xolisile Dlamini
- National Cancer Control Program, Ministry of Health, Mbabane, Eswatini
| | - Deus Bazira
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
| | - Sylvia Ojoo
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
| | - Samson Haumba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
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Williams V, Haumba S, Ngwenya-Ngcamphalala F, Mafukidze A, Musarapasi N, Byarugaba H, Chiripashi S, Dlamini M, Maseko T, Dlamini NA, Nyapokoto C, Kibwana S, Bongomin P, Mazibuko S, Bhembe F, Ojoo S, Okello V, Bazira D. Implementation of the Automated Medication Dispensing System-Early Lessons From Eswatini. Int J Public Health 2023; 68:1606185. [PMID: 37901592 PMCID: PMC10600347 DOI: 10.3389/ijph.2023.1606185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives: This article describes the implementation of an automated medication dispensing system (AMDS) in Eswatini to increase medication access and presents the early lessons from this implementation. Methods: The AMDS was installed at four health facilities across two regions through collaborative stakeholder engagement. Healthcare workers were trained, and clients who met the inclusion criteria accessed their medications from the system. Each step of the implementation was documented and summarised in this article. Results: Early lessons suggest that implementation of the AMDS is acceptable and feasible to clients and healthcare workers and that phased introduction of medication classes, commencing with antiretroviral therapy (ART) and incorporating other medications in later phases is feasible. Additionally, improved client-centred messaging and communication, consistent power supply and internet network connectivity, and scheduling medication pickup with other services increase AMDS system utilisation. Conclusion: Eswatini has many clients living with HIV and non-communicable diseases (NCDs). Easy, convenient, quick, non-stigmatising and client-centred access to ART and medication for NCDs is critical in addressing retention in care and achieving optimal treatment outcomes.
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Affiliation(s)
- Victor Williams
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Samson Haumba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, United States
| | - Fikile Ngwenya-Ngcamphalala
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Eswatini National AIDS Program, Mbabane, Eswatini
| | - Arnold Mafukidze
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Normusa Musarapasi
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Hugben Byarugaba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Simbarashe Chiripashi
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Makhosazana Dlamini
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Thokozani Maseko
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | | | | | - Sharon Kibwana
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, United States
| | - Pido Bongomin
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Sikhathele Mazibuko
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Mbabane, Eswatini
| | | | - Sylvia Ojoo
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, United States
| | | | - Deus Bazira
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, United States
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Hartsough K, Teasdale CA, Shongwe S, Geller A, Pimentel De Gusmao E, Dlamini P, Mafukidze A, Pasipamire M, Ao T, Ryan C, Modi S, Abrams EJ, Howard AA. Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini. PLOS Glob Public Health 2022; 2:e0000217. [PMID: 36962173 PMCID: PMC10021747 DOI: 10.1371/journal.pgph.0000217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/02/2022] [Indexed: 06/18/2023]
Abstract
Tuberculosis (TB) primarily affects women during their reproductive years and contributes to maternal mortality and poor pregnancy outcomes. For pregnant women living with HIV (WLHIV), TB is the leading cause of non-obstetric maternal mortality, and pregnant WLHIV with TB are at increased risk of transmitting both TB and HIV to their infants. TB diagnosis among pregnant women, particularly WLHIV, remains challenging, and TB preventive treatment (TPT) coverage among pregnant WLHIV is limited. This project aimed to strengthen integrated TB and reproductive, maternal, neonatal and child health (RMNCH) services in Eswatini to improve screening and treatment for TB disease, TPT uptake and completion among women receiving RMNCH services. The project was conducted from April-December 2017 at four health facilities in Eswatini and introduced enhanced monitoring tools and on-site technical support in RMNCH services. We present data on TB case finding among women, and TPT coverage and completion among eligible WLHIV. A questionnaire (S1 Appendix) measured healthcare provider perspectives on the project after three months of project implementation, including feasibility of scaling-up integrated TB and RMNCH services. A total of 5,724 women (HIV-negative or WLHIV) were screened for active TB disease while attending RMNCH services; 53 (0.9%) were identified with presumptive TB, of whom 37 (70%) were evaluated for TB disease and 6 (0.1% of those screened) were diagnosed with TB. Among 1,950 WLHIV who screened negative for TB, 848 (43%) initiated TPT and 462 (54%) completed. Forty-three healthcare providers completed the questionnaire, and overall were highly supportive of integrated TB and RMNCH services. Integration of TB/HIV services in RMNCH settings was feasible and ensured high TB screening coverage among women of reproductive age, however, symptom screening identified few TB cases, and further studies should explore various screening algorithms and diagnostics that optimize case finding in this population. Interventions should focus on working with healthcare providers and patients to improve TPT initiation and completion rates.
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Affiliation(s)
- Kieran Hartsough
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | - Chloe A. Teasdale
- CUNY Graduate School of Public Health & Health Policy, Department of Epidemiology & Biostatistics, New York, NY, United States of America
| | - Siphesihle Shongwe
- ICAP-Columbia University, Mailman School of Public Health, Mbabane, Eswatini
| | - Amanda Geller
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB, Atlanta, GA, United States of America
| | | | - Phumzile Dlamini
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Arnold Mafukidze
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | | | - Trong Ao
- CDC-Eswatini, Division of Global HIV & TB, Mbabane, Eswatini
| | - Caroline Ryan
- CDC-Eswatini, Division of Global HIV & TB, Mbabane, Eswatini
| | - Surbhi Modi
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB, Atlanta, GA, United States of America
| | - Elaine J. Abrams
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Andrea A. Howard
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Hirsch-Moverman Y, Strauss M, George G, Mutiti A, Mafukidze A, Shongwe S, Dube GS, El Sadr WM, Mantell JE, Howard AA. Paediatric tuberculosis preventive treatment preferences among HIV-positive children, caregivers and healthcare providers in Eswatini: a discrete choice experiment. BMJ Open 2021; 11:e048443. [PMID: 34686549 PMCID: PMC8543650 DOI: 10.1136/bmjopen-2020-048443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 09/02/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Isoniazid preventive therapy initiation and completion rates are suboptimal among children. Shorter tuberculosis (TB) preventive treatment (TPT) regimens have demonstrated safety and efficacy in children and may improve adherence but are not widely used in high TB burden countries. Understanding preferences regarding TPT regimens' characteristics and service delivery models is key to designing services to improve TPT initiation and completion rates. We examined paediatric TPT preferences in Eswatini, a high TB burden country. DESIGN We conducted a sequential mixed-methods study utilising qualitative methods to inform the design of a discrete choice experiment (DCE) among HIV-positive children, caregivers and healthcare providers (HCP). Drug regimen and service delivery characteristics included pill size and formulation, dosing frequency, medication taste, treatment duration and visit frequency, visit cost, clinic wait time, and clinic operating hours. An unlabelled, binary choice design was used; data were analysed using fixed and mixed effects logistic regression models, with stratified models for children, caregivers and HCP. SETTING The study was conducted in 20 healthcare facilities providing TB/HIV care in Manzini, Eswatini, from November 2018 to December 2019. PARTICIPANTS Ninety-one stakeholders completed in-depth interviews to inform the DCE design; 150 children 10-14 years, 150 caregivers and 150 HCP completed the DCE. RESULTS Despite some heterogeneity, the results were fairly consistent among participants, with palatability of medications viewed as the most important TPT attribute; fewer and smaller pills were also preferred. Additionally, shorter waiting times and cost of visit were found to be significant drivers of choices. CONCLUSION Palatable medication, smaller/fewer pills, low visit costs and shorter clinic wait times are important factors when designing TPT services for children and should be considered as new paediatric TPT regimens in Eswatini are rolled out. More research is needed to determine the extent to which preferences drive TPT initiation, adherence and completion rates.
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Affiliation(s)
- Yael Hirsch-Moverman
- ICAP at Columbia University, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Michael Strauss
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Anthony Mutiti
- ICAP at Columbia University, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Arnold Mafukidze
- ICAP at Columbia University, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Siphesihle Shongwe
- ICAP at Columbia University, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Gloria Sisi Dube
- Eswatini National TB Control Programme, Eswatini Ministry of Health, Mbabane, Hhohho, Swaziland
| | - Wafaa M El Sadr
- ICAP at Columbia University, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Joanne E Mantell
- Department of Psychiatry, Gender, Sexuality and Health Area, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrea A Howard
- ICAP at Columbia University, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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Teasdale CA, Geller A, Shongwe S, Mafukidze A, Choy M, Magaula B, Yuengling K, King K, De Gusmao EP, Ryan C, Ao T, Callahan T, Modi S, Abrams EJ. Patient feedback surveys among pregnant women in Eswatini to improve antenatal care retention. PLoS One 2021; 16:e0248685. [PMID: 33760864 PMCID: PMC7990172 DOI: 10.1371/journal.pone.0248685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 03/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Uptake and retention in antenatal care (ANC) is critical for preventing adverse pregnancy outcomes for both mothers and infants. Methods We implemented a rapid quality improvement project to improve ANC retention at seven health facilities in Eswatini (October-December 2017). All pregnant women attending ANC visits were eligible to participate in anonymous tablet-based audio assisted computer self-interview (ACASI) surveys. The 24-question survey asked about women’s interactions with health facility staff (HFS) (nurses, mentor mothers, receptionists and lab workers) with a three-level symbolic response options (agree/happy, neutral, disagree/sad). Women were asked to self-report HIV status. Survey results were shared with HFS at monthly quality improvement sessions. Chi-square tests were used to assess differences in responses between months one and three, and between HIV-positive and negative women. Routine medical record data were used to compare retention among pregnant women newly enrolled in ANC two periods, January-February 2017 (‘pre-period’) and January-February 2018 (‘post-period’) at two of the participating health facilities. Proportions of women retained at 3 and 6 months were compared using Cochran-Mantel-Haenszel and Wilcoxon tests. Results A total of 1,483 surveys were completed by pregnant women attending ANC, of whom 508 (34.3%) self-reported to be HIV-positive. The only significant change in responses from month one to three was whether nurses listened with agreement increasing from 88.3% to 94.8% (p<0.01). Overall, WLHIV had significantly higher proportions of reported satisfaction with HFS interactions compared to HIV-negative women. A total of 680 pregnant women were included in the retention analysis; 454 (66.8%) HIV-negative and 226 (33.2%) WLHIV. In the pre- and post-periods, 59.4% and 64.6%, respectively, attended at least four ANC visits (p = 0.16). The proportion of women retained at six months increased from 60.9% in the pre-period to 72.7% in the post-period (p = 0.03). For HIV-negative women, pre- and post-period six-month retention significantly increased from 56.6% to 71.6% (p = 0.02); however, the increase in WLHIV retained at six months from 70.7% (pre-period) to 75.0% (post-period) was not statistically significant (p = 0.64). Conclusion The type of rapid quality improvement intervention we implemented may be useful in improving patient-provider relationships although whether it can improve retention remains unclear.
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Affiliation(s)
- Chloe A. Teasdale
- Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States of America
- Mailman School of Public Health, ICAP-Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- * E-mail:
| | - Amanda Geller
- US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Siphesihle Shongwe
- Mailman School of Public Health, ICAP-Columbia University, New York, NY, United States of America
| | - Arnold Mafukidze
- Mailman School of Public Health, ICAP-Columbia University, New York, NY, United States of America
| | - Michelle Choy
- Mailman School of Public Health, ICAP-Columbia University, New York, NY, United States of America
| | - Bhekinkhosi Magaula
- Mailman School of Public Health, ICAP-Columbia University, New York, NY, United States of America
| | - Katharine Yuengling
- Mailman School of Public Health, ICAP-Columbia University, New York, NY, United States of America
| | - Katherine King
- NYC Department of Health and Mental Hygiene, NYC Health Training—Clinical Operations and Technical Assistance Program, New York, NY, United States of America
| | | | - Caroline Ryan
- US Centers for Disease Control and Prevention, Mbabane, Eswatini
| | - Trong Ao
- US Centers for Disease Control and Prevention, Mbabane, Eswatini
| | - Tegan Callahan
- US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Surbhi Modi
- US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Elaine J. Abrams
- Mailman School of Public Health, ICAP-Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, United States of America
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Vambe D, Kay AW, Furin J, Howard AA, Dlamini T, Dlamini N, Shabangu A, Hassen F, Masuku S, Maha O, Wawa C, Mafukidze A, Altaye K, Sikhondze W, Gwitima T, Keus K, Simelane T, Kerschberger B. Bedaquiline and delamanid result in low rates of unfavourable outcomes among TB patients in Eswatini. Int J Tuberc Lung Dis 2020; 24:1095-1102. [DOI: 10.5588/ijtld.20.0082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Since 2015, Eswatini has been scaling up bedaquiline (BDQ) and delamanid (DLM) based drug-resistant TB treatment regimens under programmatic conditions.OBJECTIVE: Identification of factors associated with treatment outcomes in patients receiving BDQ and/or
DLM either as a new treatment initiation or drug substitution.DESIGN: This is a retrospective cohort study of patients receiving BDQ and/or DLM in Eswatini between March 2015 and October 2018. We describe factors associated with unfavourable treatment outcomes (death, lost to follow-up,
treatment failure and amplification of resistance) and culture conversion using multivariable flexible parametric survival and competing-risks regression analyses.RESULTS: Of 352 patients receiving BDQ and/or DLM, 7.8% and 21.2% had an unfavourable treatment outcome at 6 and 24
months, respectively. Predictors were age ≥ 60 years (adjusted hazard ratio aHR 4.49, 95%CI 1.61–12.57) vs. age 20–39 years, and a treatment regimen combining both drugs (aHR 4.49, 95%CI 1.61–12.57) vs. BDQ only. The probability of culture conversion was increased for
two health facilities and patients with a poly resistance profile (adjusted sub-hazard ratio 2.01, 95%CI 1.13–3.59) vs. multidrug resistance.CONCLUSION: Single use of BDQ or DLM was associated with low rates of unfavourable outcomes, suggesting that these medications may be
effectively adopted at scale under routine programmatic conditions. Combined use of BDQ and DLM was a risk factor for unfavourable outcomes and should prompt for collection of more data on the combined use of these medications.
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Affiliation(s)
- D. Vambe
- Eswatini National Tuberculosis Control Programme, Manzini, Eswatini
| | - A. W. Kay
- Baylor College of Medicine, Houston, TX, USA, Baylor Children´s Foundation, Mbabane, Eswatini
| | - J. Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - A. A. Howard
- ICAP at Columbia University, New York, NY, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - T. Dlamini
- Eswatini National Tuberculosis Control Programme, Manzini, Eswatini
| | - N. Dlamini
- Eswatini National Tuberculosis Control Programme, Manzini, Eswatini
| | | | - F. Hassen
- National TB Referral Hospital, Manzini
| | - S. Masuku
- Eswatini National Tuberculosis Control Programme, Manzini, Eswatini
| | - O. Maha
- Eswatini National Tuberculosis Control Programme, Manzini, Eswatini, Matsapha Comprehensive Care Clinic, Manzini
| | - C. Wawa
- Eswatini National Tuberculosis Control Programme, Manzini, Eswatini, Mankanyane Hospital, Manzini
| | | | - K. Altaye
- ICAP at Columbia University, Mbabane
| | - W. Sikhondze
- Eswatini National Tuberculosis Control Programme, Manzini, Eswatini
| | | | - K. Keus
- Médecins Sans Frontières (MSF) Operational Centre Amsterdam, Manzini
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Furin J, Mafukidze A, Brigden G, du Cros P, Golin R, Harausz E, Seddon JA, Ustero P, Garcia-Prats AJ. A bitter pill to swallow: the need for better medications for drug-resistant tuberculosis in children. Int J Tuberc Lung Dis 2016; 19 Suppl 1:55-60. [PMID: 26564544 DOI: 10.5588/ijtld.15.0380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The large and growing access gap between the number of children who become sick with drug-resistant tuberculosis (DR-TB) and those who are treated for the disease each year represents a significant health systems failure. While there are multiple reasons why children with DR-TB are not diagnosed and treated, a serious challenge is the medications used to treat the disease. This paper presents three child DR-TB cases who were treated incorrectly; the cases are used to illustrate some of the problems with existing second-line medications. Challenges, including the perception that the drugs are more dangerous than the disease, lack of proper dosing recommendations and formulations, and the high cost of current treatment, all contribute to a perverse situation in which the most vulnerable pediatric patients are provided with a lower standard of care. This situation can be reversed with novel partnerships and training models, pharmacokinetic studies of the relevant drugs, increased collaboration, and dedicated funding, grounded in a rights-based approach to DR-TB in children.
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Affiliation(s)
- J Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - A Mafukidze
- University Research Corporation, Mbabne, Swaziland
| | - G Brigden
- Access Campaign, Médecins Sans Frontières (MSF), Geneva, Switzerland
| | | | - R Golin
- Baylor International Paediatric AIDS Initiative, Mbabane, Swaziland
| | - E Harausz
- TB Research Unit, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - P Ustero
- Global TB Childhood Programme, Baylor College of Medicine, Swaziland
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
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Mafukidze A, Harausz E, Furin J. An update on repurposed medications for the treatment of drug-resistant tuberculosis. Expert Rev Clin Pharmacol 2016; 9:1331-1340. [DOI: 10.1080/17512433.2016.1208562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Satti H, Mafukidze A, Jooste PL, McLaughlin MM, Farmer PE, Seung KJ. High rate of hypothyroidism among patients treated for multidrug-resistant tuberculosis in Lesotho. Int J Tuberc Lung Dis 2012; 16:468-72. [DOI: 10.5588/ijtld.11.0615] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- H. Satti
- Partners In Health Lesotho, Maseru, Lesotho; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - P. L. Jooste
- Nutritional Intervention Research Unit, Medical Research Council, Tygerberg, Cape Town, South Africa
| | - M. M. McLaughlin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - P. E. Farmer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA; and Partners in Health, Boston, Massachusetts,
USA
| | - K. J. Seung
- Partners In Health Lesotho, Maseru, Lesotho; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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