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Harries AD, Lin Y, Thekkur P, Nair D, Chakaya J, Dongo JP, Luzze H, Chimzizi R, Mubanga A, Timire C, Kavenga F, Satyanarayana S, Kumar AMV, Khogali M, Zachariah R. Why TB programmes should assess for comorbidities, determinants and disability at the start and end of TB treatment. Int J Tuberc Lung Dis 2023; 27:495-498. [PMID: 37353872 DOI: 10.5588/ijtld.23.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Y Lin
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P Thekkur
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - D Nair
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - J Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya, Respiratory Society of Kenya, Nairobi, Kenya
| | - J P Dongo
- The Union-Uganda Office, Kampala, Uganda
| | - H Luzze
- National Leprosy and Tuberculosis Programme, Ministry of Health, Kampala, Uganda
| | - R Chimzizi
- Ministry of Health/USAID STAR Project, Lusaka, Zambia
| | - A Mubanga
- National Tuberculosis Programme, Ministry of Health, Lusaka, Zambia
| | - C Timire
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK, Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - F Kavenga
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India
| | - M Khogali
- Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - R Zachariah
- Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
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Mbau L, Harrison R, Kizito W, Timire C, Namusonge T, Muhula S, Nyanjau L, Owiti P. Case identification, retention and blood pressure control in Kenya. Public Health Action 2022; 12:58-63. [PMID: 35734002 PMCID: PMC9176190 DOI: 10.5588/pha.21.0051] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/31/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Prevalence of hypertension in Africa is rising but it remains underdiagnosed and poorly controlled. In Kenya, only 22% of individuals known to have hypertension were on treatment, and only 51.7% were controlled. This study will assess screening outcomes, retention and blood pressure (BP) control of a hypertension programme in Kenya. DESIGN This was a retrospective cohort study using data routinely collected between 2015 and 2018. All patients aged >18 years screened and treated in the programme were included. RESULTS Of 663,028 screening encounters, 70.4% were female; the median age was 34 years. Overall, 19% of the study population, mainly males and older persons, had high BP higher rates. Of 66,981 patients started on treatment, the majority were females (71.2%); the median age was 55 years. Only 12% of patients were reported as having been retained after 12 months, and 48.6% of patients on treatment 10.5-13.5 months after enrolment had controlled BP. Older age and treatment at primary care level were associated with better retention and females had better BP control. CONCLUSIONS The programme screened primarily females and younger individuals at lower risk. Retention was poor and close to half of patients retained had controlled BP. Hypertension programmes should target high-risk individuals, decentralise treatment, incorporate retention strategies and improve longitudinal data management.
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Affiliation(s)
- L. Mbau
- Kenya Cardiac Society, Nairobi, Kenya
| | | | - W. Kizito
- Medecins Sans Frontieres, Brussels, Belgium
| | - C. Timire
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | | | - S. Muhula
- Amref Health Africa in Kenya, Nairobi, Kenya
| | | | - P. Owiti
- International Union Against Tuberculosis and Lung Disease, Paris, France
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Chipinduro M, Timire C, Chirenda J, Matambo R, Munemo E, Makamure B, Nhidza AF, Tinago W, Chikwasha V, Ngwenya M, Mutsvangwa J, Metcalfe JZ, Sandy C. TB prevalence in Zimbabwe: a national cross-sectional survey, 2014. Int J Tuberc Lung Dis 2022; 26:57-64. [PMID: 34969430 DOI: 10.5588/ijtld.21.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
BACKGROUND: We conducted the first national TB prevalence survey to provide accurate estimates of bacteriologically confirmed pulmonary TB disease among adults aged ≥15 years in 2014.METHODS: A TB symptoms screen and chest X-ray (CXR) were used to identify presumptive TB cases who submitted two sputum samples for smear microscopy, liquid and solid culture. Bacteriological confirmation included acid-fast bacilli smear positivity confirmed using Xpert® MTB/RIF and/or culture. Prevalence estimates were calculated using random effects logistic regression with multiple imputations and inverse probability weighting.RESULTS: Of 43,478 eligible participants, 33,736 (78%) were screened; of these 5,820 (17%) presumptive cases were identified. There were 107 (1.9%) bacteriologically confirmed TB cases, of which 23 (21%) were smear-positive. The adjusted prevalences of smear-positive and bacteriologically confirmed TB disease were respectively 82/100,000 population (95% CI 47-118/100,000) and 344/100,000 (95% CI 268-420/100,000), with an overall all-ages, all-forms TB prevalence of 275/100,000 population (95% CI 217-334/100,000). TB prevalence was higher in males, and age groups 35-44 and ≥65 years. CXR identified 93/107 (87%) cases vs. 39/107 (36%) using the symptom screen.CONCLUSION: Zimbabwe TB disease prevalence has decreased relative to prior estimates, possibly due to increased antiretroviral therapy coverage and successful national TB control strategies. Continued investments in TB diagnostics for improved case detection are required.
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Affiliation(s)
- M Chipinduro
- Department of Pathology, Faculty of Medicine and Health Sciences (FMHS), Midlands State University, Gweru, Zimbabwe
| | - C Timire
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, National TB Control Programme, Ministry of Health and Child Care, Harare, Zimbabwe
| | - J Chirenda
- Department of Community Medicine, FMHS, University of Zimbabwe, Harare, Zimbabwe
| | - R Matambo
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - E Munemo
- National Microbiology Reference Laboratory, Harare, Zimbabwe
| | - B Makamure
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - A F Nhidza
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - W Tinago
- Department of Community Medicine, FMHS, University of Zimbabwe, Harare, Zimbabwe, School of Medicine, University College Dublin, Dublin, Ireland
| | - V Chikwasha
- Department of Community Medicine, FMHS, University of Zimbabwe, Harare, Zimbabwe
| | - M Ngwenya
- World Health Organisation, Harare Country Office, Zimbabwe
| | - J Mutsvangwa
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - J Z Metcalfe
- Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA
| | - C Sandy
- National TB Control Programme, Ministry of Health and Child Care, Harare, Zimbabwe
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Chirenda J, Nhlema Simwaka B, Sandy C, Bodnar K, Corbin S, Desai P, Mapako T, Shamu S, Timire C, Antonio E, Makone A, Birikorang A, Mapuranga T, Ngwenya M, Masunda T, Dube M, Wandwalo E, Morrison L, Kaplan R. A feasibility study using time-driven activity-based costing as a management tool for provider cost estimation: lessons from the national TB control program in Zimbabwe in 2018. BMC Health Serv Res 2021; 21:242. [PMID: 33736629 PMCID: PMC7977596 DOI: 10.1186/s12913-021-06212-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Insufficient cost data and limited capacity constrains the understanding of the actual resources required for effective TB control. This study used process maps and time-driven activity-based costing to document TB service delivery processes. The analysis identified the resources required to sustain TB services in Zimbabwe, as well as several opportunities for more effective and efficient use of available resources. Methods A multi-disciplinary team applied time-driven activity-based costing (TDABC) to develop process maps and measure the cost of clinical pathways used for Drug Susceptible TB (DS-TB) at urban polyclinics, rural district and provincial hospitals, and community based targeted screening for TB (Tas4TB). The team performed interviews and observations to collect data on the time taken by health care worker-patient pairs at every stage of the treatment pathway. The personnel’s practical capacity and capacity cost rates were calculated on five cost domains. An MS Excel model calculated diagnostic and treatment costs. Findings Twenty-five stages were identified in the TB care pathway across all health facilities except for community targeted screening for TB. Considerable variations were observed among the facilities in how health care professionals performed client registration, taking of vital signs, treatment follow-up, dispensing medicines and processing samples. The average cost per patient for the entire DS-TB care was USD324 with diagnosis costing USD69 and treatment costing USD255. The average cost for diagnosis and treatment was higher in clinics than in hospitals (USD392 versus USD256). Nurses in clinics were 1.6 time more expensive than in hospitals. The main cost components were personnel (USD130) and laboratory (USD119). Diagnostic cost in Tas4TB was twice that of health facility setting (USD153 vs USD69), with major cost drivers being demand creation (USD89) and sputum specimen transportation (USD5 vs USD3). Conclusion TDABC is a feasible and effective costing and management tool in low-resource settings. The TDABC process maps and treatment costs revealed several opportunities for innovative improvements in the NTP under public health programme settings. Re-engineering laboratory testing processes and synchronising TB treatment follow-up with antiretroviral treatments could produce better and more uniform TB treatments at significantly lower cost in Zimbabwe.
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Affiliation(s)
- J Chirenda
- College of Health Sciences, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - B Nhlema Simwaka
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland.
| | - C Sandy
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - K Bodnar
- Harvard Business School, Boston, MA, USA
| | - S Corbin
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - P Desai
- Harvard Business School, Boston, MA, USA
| | - T Mapako
- College of Health Sciences, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.,National Blood Service, Harare, Zimbabwe
| | - S Shamu
- College of Health Sciences, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - C Timire
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - E Antonio
- Price Waterhouse Coopers (PWC), Harare, Zimbabwe
| | - A Makone
- Price Waterhouse Coopers (PWC), Harare, Zimbabwe
| | - A Birikorang
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - T Mapuranga
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - M Ngwenya
- World Health Organisation, Harare, Zimbabwe
| | - T Masunda
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - M Dube
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - E Wandwalo
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - L Morrison
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - R Kaplan
- Harvard Business School, Boston, MA, USA
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Goverwa-Sibanda TP, Mupanguri C, Timire C, Harries AD, Ngwenya S, Chikwati E, Mapfuma C, Mushambi F, Tweya H, Ndlovu M. Hepatitis B infection in people living with HIV who initiate antiretroviral therapy in Zimbabwe. Public Health Action 2020; 10:97-103. [PMID: 33134123 DOI: 10.5588/pha.20.0008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/18/2020] [Indexed: 11/10/2022] Open
Abstract
Setting There is little information about the diagnosis and treatment of hepatitis B virus (HBV) infection in people living with HIV (PLHIV) in Zimbabwe despite recommendations that tenofovir (TDF) + lamivudine (3TC) is the most effective nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) backbone of antiretroviral therapy (ART) in those with dual infection. Objective To determine 1) numbers screened for hepatitis B surface antigen (HBsAg); 2) numbers diagnosed HBsAg-positive along with baseline characteristics; and 3) NRTI backbones used among PLHIV initiating first-line ART at Mpilo Opportunistic Infections Clinic, Bulawayo, Zimbabwe, between October 2017 and April 2019. Design This was a cross-sectional study using routinely collected data. Results Of the 422 PLHIV initiating first-line ART (median age 34 years, IQR 25-43), 361 (85%) were screened for HBV, with 10% being HBsAg-positive. HBsAg positivity was significantly associated with anaemia (adjusted prevalence ratio [aPR] 2.3, 95%CI 1.1-4.7) and elevated ala-nine transaminase levels (aPR 2.9, 95%CI 1.5-5.8). Of 38 PLHIV who were diagnosed HBsAg-positive, 30 (79%) were started on ART based on tenofovir (TDF) and lamivudine (3TC), seven were given abacavir (ABC) + 3TC-based ART and one was given zido vudine (ZDV) + 3TC-based ART. Conclusion In PLHIV, HBV screening worked well, the prevalence of HIV-HBV co-infection was high and most patients received appropriate treatment for both conditions. Recommendations to improve screening, diagnosis and treatment of HIV-HBV co-infection are discussed.
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Affiliation(s)
- T P Goverwa-Sibanda
- AIDS Healthcare Foundation, Zimbabwe, Harare.,Mpilo Hospital, Ministry of Health and Child Care, Bulawayo, Zimbabwe
| | - C Mupanguri
- National AIDS/TB Programme, Ministry of Health and Child Care, Harare, Zimbabwe
| | - C Timire
- National AIDS/TB Programme, Ministry of Health and Child Care, Harare, Zimbabwe.,National University of Science and Technology, Bulawayo, Zimbabwe.,International Union Against Tuberculosis and Lung Disease (The Union) Zimbabwe, Harare, Zimbabwe
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - S Ngwenya
- Mpilo Hospital, Ministry of Health and Child Care, Bulawayo, Zimbabwe
| | - E Chikwati
- AIDS Healthcare Foundation, Zimbabwe, Harare
| | - C Mapfuma
- National University of Science and Technology, Bulawayo, Zimbabwe
| | - F Mushambi
- Parirenyatwa Group of Hospitals, Ministry of Health and Child Care, Harare, Zimbabwe
| | - H Tweya
- The Union, Paris, France.,The Lighthouse Clinic, Lilongwe, Malawi
| | - M Ndlovu
- Mpilo Hospital, Ministry of Health and Child Care, Bulawayo, Zimbabwe.,National University of Science and Technology, Bulawayo, Zimbabwe
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Sengai T, Timire C, Harries AD, Tweya H, Kavenga F, Shumba G, Tavengerwei J, Ncube R, Zishiri C, Mapfurira MJ, Mandizvidza V, Sandy C. Mobile targeted screening for tuberculosis in Zimbabwe: diagnosis, linkage to care and treatment outcomes. Public Health Action 2019; 9:159-165. [PMID: 32042608 DOI: 10.5588/pha.19.0040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/01/2019] [Indexed: 11/10/2022] Open
Abstract
Setting Targeted active screening for tuberculosis (Tas4TB) using mobile trucks in the community was implemented in 15 high TB burden districts in Zimbabwe. At-risk populations were screened for TB based on symptoms and chest radiography (CXR) results. Those with any positive symptom and/or an abnormal CXR had sputum collected for investigation and diagnosis and were linked to care and treatment if found to have TB. Objective To determine 1) the proportion and characteristics of those screened and diagnosed with TB; 2) the relationship between TB symptoms, CXR and diagnostic yields; and 3) the relationship between initiation of anti-TB treatment and treatment outcomes. Design Cohort study using routinely collected data. Results A total of 39 065 persons were screened, of whom 663 (1.7%) were diagnosed with TB; 126/663 (19.0%) were bacteriologically confirmed. The highest TB diagnostic yields were in symptomatic persons with CXRs suggestive of TB (19.4%), asymptomatic persons with CXRs suggestive of TB (8.4%) and persons at high-risk of TB (3.2%). For all diagnosed TB patients, pre-treatment loss to follow-up was 18.9% and treatment success was 59.9%. Conclusion Tas4TB resulted in high diagnostic yields; however, linkage of diagnosis to care was poor. Reasons for loss to follow-up need to be better understood and rectified.
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Affiliation(s)
- T Sengai
- Family AIDS Caring Trust, Mutare, Zimbabwe
| | - C Timire
- National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | | | - F Kavenga
- Family AIDS Caring Trust, Mutare, Zimbabwe
| | - G Shumba
- Family AIDS Caring Trust, Mutare, Zimbabwe
| | | | - R Ncube
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - C Zishiri
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - M J Mapfurira
- National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | | | - C Sandy
- National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
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Timire C, Sandy C, Ngwenya M, Woznitza N, Kumar AMV, Takarinda KC, Sengai T, Harries AD. Targeted active screening for tuberculosis in Zimbabwe: are field digital chest X-ray ratings reliable? Public Health Action 2019; 9:96-101. [PMID: 31803580 DOI: 10.5588/pha.19.0003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/12/2019] [Indexed: 11/10/2022] Open
Abstract
SETTING Fifteen purposively selected districts in Zimbabwe in which targeted active screening for tuberculosis (Tas4TB) was conducted among TB high-risk groups (HRGs). There were 230 patients started on TB treatment on the basis of chest X-ray (CXR) results without corresponding bacteriological confirmation. OBJECTIVES To determine 1) the percentage of agreements in digital CXR ratings by medical officers against final ratings by radiologist(s), 2) inter-rater agreement in CXR ratings between medical officers and radiologists, and 3) number (and proportion) of patients belonging to HRGs who were over-treated during Tas4TB. DESIGN This was a cross-sectional study using programme data. RESULTS A total of 168 patients had their CXRs rated by two independent radiologists. Discordances among the radiologists were resolved by a third index radiologist, who provided the final rating. κ scores were 0.01 (field ratings vs. Radiologist A); 0.02 (field ratings vs. Radiologist B); 0.74 (Radiologists A vs. B). The percentage agreement for field and final radiologist rating was 70% (95%CI 64-78). Around 29% (95%CI 23-36) of the patients were potentially over-treated during Tas4TB. CONCLUSION Over a quarter of patients with presumptive TB are potentially over-treated during Tas4TB. Over-treatment is highest among those with previous contact with TB patients. Trainings of radiographers and medical officers may improve CXR ratings.
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Affiliation(s)
- C Timire
- Ministry of Health and Child Care, National AIDS & TB Programme, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - C Sandy
- Ministry of Health and Child Care, National AIDS & TB Programme, Harare, Zimbabwe
| | - M Ngwenya
- World Health Organization, Harare Country Office, Zimbabwe
| | - N Woznitza
- Homerton University Hospital & Canterbury Christ Church University, London, UK
| | - A M V Kumar
- The Union, Paris, France.,The Union, South East-Asia Office, New Delhi, India.,Yenepoya Medical College, Yenepoya (deemed University), Mangaluru, India
| | - K C Takarinda
- Ministry of Health and Child Care, National AIDS & TB Programme, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - T Sengai
- Family AIDS Caring Trust (FACT), Mutare, Zimbabwe
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
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Harries AD, Timire C, Takarinda KC, Sandy C. Ensuring that Xpert ® MTB/RIF is used to its maximum potential. Int J Tuberc Lung Dis 2019; 23:1043-1044. [PMID: 31615615 DOI: 10.5588/ijtld.19.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - C Timire
- International Union Against Tuberculosis and Lung Disease, Paris, France, Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France, Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - C Sandy
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
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Ncube RT, Dube SA, Machekera SM, Timire C, Zishiri C, Charambira K, Mapuranga T, Duri C, Sandy C, Dlodlo RA, Lin Y. Feasibility and yield of screening for diabetes mellitus among tuberculosis patients in Harare, Zimbabwe. Public Health Action 2019; 9:72-77. [PMID: 31417857 DOI: 10.5588/pha.18.0105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/19/2019] [Indexed: 01/26/2023] Open
Abstract
Setting A resource-limited urban setting in Zimbabwe with a high burden of tuberculosis (TB) and human immunodeficiency virus (HIV). Objectives To determine the feasibility and yield of diabetes mellitus (DM) screening among TB patients in primary health care facilities. Design A descriptive study. Results Of the 1617 TB patients registered at 10 pilot facilities, close to two thirds (60%) were male and 798 (49%) were bacteriologically confirmed. The median age was 37 years; two thirds (67%) were co-infected with HIV. A total of 1305 (89%) were screened for DM, and 111 (8.5%, 95% CI 7.0-10.2) were newly diagnosed with DM. Low TB notifying sites were more likely than high TB notifying sites to screen patients using random blood glucose (RBG) (83% vs. 79%; P < 0.04). Screening increased gradually per quarter over the study period. There were, however, notable losses along the screening cascade, the reasons for which will need to be explored in future studies. Conclusion The study findings indicate the feasibility of DM screening among TB patients, with considerable yield of persons newly diagnosed with DM. Scaling up of this intervention will need to address the observed losses along the screening cascade.
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Affiliation(s)
- R T Ncube
- International Union Against Tuberculosis and Lung Disease, Harare, Zimbabwe
| | - S A Dube
- International Union Against Tuberculosis and Lung Disease, Harare, Zimbabwe
| | - S M Machekera
- International Union Against Tuberculosis and Lung Disease, Harare, Zimbabwe
| | - C Timire
- International Union Against Tuberculosis and Lung Disease, Harare, Zimbabwe.,Ministry of Health and Child Care, National TB Control Programme, Harare, Zimbabwe
| | - C Zishiri
- International Union Against Tuberculosis and Lung Disease, Harare, Zimbabwe
| | - K Charambira
- International Union Against Tuberculosis and Lung Disease, Harare, Zimbabwe
| | - T Mapuranga
- Ministry of Health and Child Care, National TB Control Programme, Harare, Zimbabwe
| | - C Duri
- City Health Department, Harare, Zimbabwe
| | - C Sandy
- Ministry of Health and Child Care, National TB Control Programme, Harare, Zimbabwe
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Y Lin
- International Union Against Tuberculosis and Lung Disease, Paris, France
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Machekera SM, Wilkinson E, Hinderaker SG, Mabhala M, Zishiri C, Ncube RT, Timire C, Takarinda KC, Sengai T, Sandy C. A comparison of the yield and relative cost of active tuberculosis case-finding algorithms in Zimbabwe. Public Health Action 2019; 9:63-68. [PMID: 31417855 DOI: 10.5588/pha.18.0098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/09/2019] [Indexed: 11/10/2022] Open
Abstract
Setting Ten districts and three cities in Zimbabwe. Objective To compare the yield and relative cost of identifying a case of tuberculosis (TB) using the three WHO-recommended algorithms (WHO2b, symptom inquiry only; WHO2d, chest X-ray [CXR] after a positive symptom inquiry; WHO3b, CXR only) and the Zimbabwe active case finding (ZimACF) algorithm (symptom inquiry plus CXR) to everyone. Design Cross-sectional study using data from the ZimACF project. Results A total of 38 574 people were screened from April to December 2017; 488 (1.3%) were diagnosed with TB using the ZimACF algorithm. Fewer TB cases would have been diagnosed with the WHO-recommended algorithms. This ranged from 7% fewer (34 cases) with WHO3b, 18% fewer (88 cases) with WHO2b and 25% fewer (122 cases) with WHO2d. The need for CXR ranged from 36% (WHO2d) to 100% (WHO3b). The need for bacteriological confirmation ranged from 7% (WHO2d) to 40% (ZimACF). The relative cost per case of TB diagnosed ranged from US$180 with WHO3b to US$565 for the ZimACF algorithm. Conclusion The ZimACF algorithm had the highest case yield, but at a much higher cost per case than the WHO algorithms. It is possible to switch to algorithm WHO3b, but the trade-off between cost and yield needs to be reviewed by the Zimbabwean National TB Programme.
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Affiliation(s)
- S M Machekera
- International Union Against Tuberculosis and Lung Diseases, Harare, Zimbabwe
| | - E Wilkinson
- Institute of Medicine, University of Chester, Chester, UK
| | - S G Hinderaker
- Centre of International Health, University of Bergen, Bergen, Norway
| | - M Mabhala
- Department of Public Health and Wellbeing, University of Chester, Chester, UK
| | - C Zishiri
- International Union Against Tuberculosis and Lung Diseases, Harare, Zimbabwe
| | - R T Ncube
- International Union Against Tuberculosis and Lung Diseases, Harare, Zimbabwe
| | - C Timire
- International Union Against Tuberculosis and Lung Diseases, Harare, Zimbabwe.,Ministry of Health and Child Care, Harare, Zimbabwe
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Diseases, Harare, Zimbabwe.,Ministry of Health and Child Care, Harare, Zimbabwe
| | - T Sengai
- Family AIDS Caring Trust, Mutare, Zimbabwe
| | - C Sandy
- Ministry of Health and Child Care, Harare, Zimbabwe
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11
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Takarinda KC, Choto RC, Mutasa-Apollo T, Chakanyuka-Musanhu C, Timire C, Harries AD. Scaling up isoniazid preventive therapy in Zimbabwe: has operational research influenced policy and practice? Public Health Action 2018; 8:218-224. [PMID: 30775283 DOI: 10.5588/pha.18.0051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/31/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Following the operational research study conducted during the isoniazid preventive therapy (IPT) pilot phase in Zimbabwe, recommendations for improvement were adopted by the national antiretroviral therapy (ART) programme. Objectives: To compare before (January 2013-June 2014) and after the recommendations (July 2014-December 2015), the extent of IPT scale-up and IPT completion rates, and after the recommendations the risk factors for IPT non-completion, in 530 ART clinics. Design: Retrospective cohort study. Results: People living with the human immunodeficiency virus newly initiating IPT increased every quarter (Q), from 585 in Q 1, 2013 to 4246 in Q 4, 2015, with 5648 new IPT initiations in the 18 months before the recommendations compared to 20 513 in the 18 months after the recommendations were made. The number of ART clinics initiating IPT increased from 10 (2%) in Q 1, 2013 to 198 (37%) in Q 4, 2015. Overall IPT completion rates were 89% in the post-recommendation period compared with 81% in the pilot phase (P < 0.001). After adjusting for confounders, being lost to follow-up from clinic review visits 1 year prior to IPT initiation was associated with a higher risk of not completing IPT, while having synchronised IPT and ART resupplies was associated with a lower risk. Conclusions: Implementation of recommendations from the initial operational research study have improved IPT scale-up in Zimbabwe.
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Affiliation(s)
- K C Takarinda
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R C Choto
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - T Mutasa-Apollo
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | | | - C Timire
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Tropical Hygiene & Medicine, London, United Kingdom
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12
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Jokwiro A, Timire C, Harries AD, Gwinji PT, Mulema A, Takarinda KC, Mafaune PT, Sandy C. Has the utilisation of Xpert ® MTB/RIF in Manicaland Province, Zimbabwe, improved with new guidance on whom to test? Public Health Action 2018; 8:124-129. [PMID: 30271728 DOI: 10.5588/pha.18.0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/06/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Manicaland Province, Zimbabwe. Objectives: To compare the utilisation and results of deploying Xpert® MTB/RIF in 13 (one provincial, six district and six rural) hospitals between January and June 2016, when Xpert was recommended only for those with presumptive multidrug-resistant tuberculosis (MDR-TB) and coinfection with human immunodeficiency virus (HIV), and between January and June 2017, when Xpert was recommended for all presumptive TB patients. Design: This was a cross-sectional study. Results: Xpert assays averaged 759 monthly in 2016 and 1430 monthly in 2017 (88% increase). Utilisation of Xpert averaged 22% monthly in 2016 and 42% in 2017 (88% increase). In 2017, utilisation of Xpert was significantly higher in provincial (82%) than in district (51%) and rural (26%) hospitals (P < 0.001). The proportion of successful assays that detected TB decreased significantly from 13% in 2016 to 7% in 2017 (a 46% decrease, P < 0.001); this phenomenon was observed in all types of hospital. The proportion of persons detected with rifampicin-resistant TB was similar between hospitals (4% in 2016 and 3% in 2017). The proportion of registered TB cases with bacteriological confirmation increased from 48% in 2016 to 53% in 2017 (P = 0.04). Conclusion: Xpert use in all presumptive TB patients led to a significant increase in assay numbers and utilisation of Xpert instruments, resulting in more bacteriological confirmation of cases.
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Affiliation(s)
- A Jokwiro
- Ministry of Health and Child Care Zimbabwe, Nyanga District, Nyanga, Zimbabwe
| | - C Timire
- International Union Against Tuberculosis and Lung Disease, Harare, Zimbabwe.,National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - P T Gwinji
- Ministry of Health and Child Care Zimbabwe, Nyanga District, Nyanga, Zimbabwe
| | - A Mulema
- Ministry of Health and Child Care Zimbabwe, Nyanga District, Nyanga, Zimbabwe
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Harare, Zimbabwe
| | - P T Mafaune
- Manicaland Directorate, Ministry of Health and Child Care Zimbabwe, Mutare, Zimbabwe
| | - C Sandy
- National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
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13
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Rufu A, Chitimbire VTS, Nzou C, Timire C, Owiti P, Harries AD, Apollo T. Implementation of the 'Test and Treat' policy for newly diagnosed people living with HIV in Zimbabwe in 2017. Public Health Action 2018; 8:145-150. [PMID: 30271732 DOI: 10.5588/pha.18.0030] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/24/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Sixteen mission hospitals in Zimbabwe that are implementing the 'Test and Treat' programme for people living with the human immunodeficiency virus (HIV). Objectives: To assess linkages of HIV diagnosis to care and treatment, time taken from being diagnosed with HIV infection to initiation of antiretroviral therapy (ART) and 3-month programmatic outcomes for those starting ART. Design: Cross-sectional study using secondary data. Results: Among 972 people newly diagnosed with HIV, 915 (94%) enrolled for HIV care and 771 (79%) were initiated on ART. Enrolment in care and initiation on ART on the same day as testing occurred in respectively 864 (89%) and 628 (65%) newly diagnosed patients. Over 80% of those who underwent HIV testing in maternal and child health departments initiated ART on the same day. Of the 144 (16%) people in care who were not initiated on ART, the principal reason in 102 (71%) was being transferred out. Most patients (90%) on ART were retained in care at 3 months, with transfer out accounting for most of the remainder. Conclusion: The 'Test and Treat' approach was feasible and successful in getting newly HIV-infected people initiated early on ART. More research is needed to better understand the processes, benefits and potential risks.
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Affiliation(s)
- A Rufu
- Zimbabwe Association of Church-Related Hospitals, Harare, Zimbabwe
| | - V T S Chitimbire
- Zimbabwe Association of Church-Related Hospitals, Harare, Zimbabwe
| | - C Nzou
- Zimbabwe Association of Church-Related Hospitals, Harare, Zimbabwe
| | - C Timire
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - P Owiti
- Academic Model Providing Access to Healthcare, Eldoret, Kenya.,The Union, Paris, France
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - T Apollo
- National AIDS Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
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14
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Timire C, Takarinda KC, Sandy C, Zishiri C, Kumar AMV, Harries AD. Has TB CARE I sputum transport improved access to culture services for retreatment tuberculosis patients in Zimbabwe? Public Health Action 2018; 8:66-71. [PMID: 29946522 DOI: 10.5588/pha.17.0117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/28/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Retreatment tuberculosis (TB) patients in Zimbabwe are investigated using microscopy, Xpert® MTB/RIF and culture + drug susceptibility testing (CDST). TB CARE I, a sputum transport service using motorcycles, was introduced to transport specimens between peripheral health facilities and laboratories, including National Reference Laboratories (NRLs). Objectives: To compare access to CDST and treatment outcomes among retreatment TB patients in facilities with and those without TB CARE I support. Design: This was a retrospective cohort study. Results: There were 187 patients from TB CARE I-supported facilities and 116 from non-TB CARE I facilities, with no difference in demographic characteristics. Altogether, specimens from 22 (12%) retreatment TB patients had successful CDST from TB CARE I facilities, which was not statistically significantly different from non-supported facilities (n = 14, 12%; P = 0.94). The median number of days from sputum collection to receipt at the NRL was lower in TB CARE I facilities than in non-supported facilities (median 6, interquartile range [IQR] 4-8 vs. median 8, IQR 6-13.5; P = 0.000). Favourable treatment outcomes were documented in 65% of patients under TB CARE I, significantly more than among patients in non-supported facilities (47%, P < 0.01). Conclusion: The process of sputum specimen collection for CDST was not different between TB CARE I and non-TB CARE I-supported health facilities, apart from a slightly shorter time. Ways to improve the current system are discussed.
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Affiliation(s)
- C Timire
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France.,Ministry of Health and Child Care, National TB Control Programme, Harare, Zimbabwe
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France.,Ministry of Health and Child Care, National AIDS Programme, Harare, Zimbabwe
| | - C Sandy
- Ministry of Health and Child Care, National TB Control Programme, Harare, Zimbabwe
| | - C Zishiri
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe
| | - A M V Kumar
- The Union, Paris, France.,The Union, South-East Asia Office, New Delhi, India
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
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