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Wademan DT, Saule Z, Marthinus A, Viljoen L, Nortier E, Hughes J, Courtney I, Palmer M, Garcia-Prats AJ, Hesseling AC, Hoddinott G. Acceptability of clofazimine capsules in children and adolescents with rifampicin-resistant TB. Int J Tuberc Lung Dis 2024; 28:256-258. [PMID: 38659140 DOI: 10.5588/ijtld.23.0517] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Affiliation(s)
- D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Z Saule
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A Marthinus
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - L Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - E Nortier
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - J Hughes
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - I Courtney
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa;, University of Wisconsin-Madison, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, USA
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa;, University of Wisconsin-Madison, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, USA
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Anthony MG, Hoddinott G, Van Niekerk M, Dewandel I, McKenzie C, Bekker C, Rabie H, Redfern A, van der Zalm MM. The socioeconomic impact of the COVID-19 lockdown on families affected by childhood respiratory illnesses in Cape Town, South Africa. PLOS Glob Public Health 2024; 4:e0003020. [PMID: 38547177 PMCID: PMC10977803 DOI: 10.1371/journal.pgph.0003020] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 02/22/2024] [Indexed: 04/12/2024]
Abstract
The COVID-19 pandemic impacted families globally, directly and indirectly. Children presenting with respiratory illnesses are affected by emerging health systems and socioeconomic changes in the COVID-19 era. We explored the socioeconomic impacts of the COVID-19 lockdown on families with a respiratory illness diagnosed in their child in Cape Town, South Africa. This study was nested in a prospective observational cohort of children presenting with respiratory symptoms presumptive of COVID-19. We conducted 21 semi-structured interviews to explore the socioeconomic impact of the COVID-19 pandemic on families with a child affected by respiratory illnesses. We used case descriptive analysis and thematically organised common and divergent experiences. We found that socioeconomic challenges in low-income communities were exacerbated: 1) loss of pre-COVID sources of income (loss of income, employment and working hours), 2) shrinking employment opportunities due to business closures and strict preventative measures, 3) family network dependence to cope with financial pressures, 4) impact on education, implicating additional pressures due to lack of resources for adequate home schooling and 5) caregivers' mental health and wellbeing being impacted, causing stress and anxiety due to loss of income. This study shows that the COVID-19 lockdown impacted the socioeconomic aspects of families caring for a child with a respiratory illness. Care became more complicated and adversely impacted the family's emotional well-being and health-seeking behaviour. These impacts should be more carefully considered in order to strengthen health services and global health messaging in future pandemics.
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Affiliation(s)
- Michaile G. Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Margaret Van Niekerk
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Isabelle Dewandel
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carla McKenzie
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carien Bekker
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Helena Rabie
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Andrew Redfern
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Marieke M. van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Chaila MJ, Mcleod D, Vermund SH, Mbolongwe-Thornicroft M, Mbewe M, Mubekapi-Musadaidzwa C, Harper A, Schaap A, Floyd S, Hoddinott G, Hayes R, Fidler S, Ayles H, Shanaube K. Assessment of a screening tool to aid home-based identification of adolescents (aged 10-14) living with HIV in Zambia and South Africa: HPTN 071 (PopART) study. PLoS One 2024; 19:e0266573. [PMID: 38363733 PMCID: PMC10871489 DOI: 10.1371/journal.pone.0266573] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/05/2023] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION The HPTN071 (PopART) for Youth (P-ART-Y) study evaluated the acceptability and uptake of a community-level combination HIV prevention package including universal testing and treatment (UTT) among young people in Zambia and South Africa. We determined whether a four-question primary care level screening tool, validated for use in clinical settings, could enhance community (door-to-door) identification of undiagnosed HIV-positive younger adolescents (aged 10-14) who are frequently left out of HIV interventions. METHOD Community HIV-care Providers (CHiPs) contacted and consented adolescents in their homes and offered them participation in the PopART intervention. CHiPs used a four question-screening tool, which included: history of hospital admission; recurring skin problems; poor health in last 3 months; and death of at least one parent. A "yes" response to one or more questions was classified as being "at risk" of being HIV-positive. Rapid HIV tests were offered to all children. Data were captured through an electronic data capture device from August 2016 to December 2017. The sensitivity, specificity, positive predictive value and negative predictive value were estimated for the screening tool, using the rapid HIV test result as the gold standard. RESULTS In our 14 study sites, 33,710 adolescents aged 10-14 in Zambia and 8,610 in South Africa participated in the study. About 1.3% (427/33,710) and 1.2% (106/8,610) self-reported to be HIV positive. Excluding the self-reported HIV-positive, we classified 11.3% (3,746/33,283) of adolescents in Zambia and 17.5% (1,491/8,504) in South Africa as "at risk". In Zambia the estimated sensitivity was 35.3% (95% CI 27.3%-44.2%) and estimated specificity was 88.9% (88.5%-89.2%). In South Africa the sensitivity was 72.3% (26.8%-94.9%) and specificity was 82.5% (81.6-83.4%). CONCLUSION The sensitivity of the screening tool in a community setting in Zambia was low, so this tool should not be considered a substitute for universal testing where that is possible. In South Africa the sensitivity was higher, but with a wide confidence interval. Where universal testing is not possible the tool may help direct resources to adolescents more likely to be living with undiagnosed HIV. TRIAL REGISTRATION Clinical Trial Number: NCT01900977.
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Affiliation(s)
- Mwate Joseph Chaila
- Zambart, University of Zambia School of Medicine, Ridgeway Campus, Lusaka, Zambia
| | - David Mcleod
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sten H Vermund
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | - Madalitso Mbewe
- Zambart, University of Zambia School of Medicine, Ridgeway Campus, Lusaka, Zambia
| | - Constance Mubekapi-Musadaidzwa
- Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Abigail Harper
- Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Albertus Schaap
- Zambart, University of Zambia School of Medicine, Ridgeway Campus, Lusaka, Zambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Graeme Hoddinott
- Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Helen Ayles
- Zambart, University of Zambia School of Medicine, Ridgeway Campus, Lusaka, Zambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kwame Shanaube
- Zambart, University of Zambia School of Medicine, Ridgeway Campus, Lusaka, Zambia
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Shavuka O, Iipumbu E, Boois L, Günther G, Hoddinott G, Lin HH, Nepolo E, Niemann S, Ruswa N, Seddon J, Claassens MM. Enhanced active case finding of drug-resistant tuberculosis in Namibia: a protocol for the hotspots, hospitals, and households (H3TB) study. BMJ Open 2024; 14:e082665. [PMID: 38341211 PMCID: PMC10862302 DOI: 10.1136/bmjopen-2023-082665] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Namibia is a high tuberculosis (TB)-burden country with an estimated incidence of 460/100 000 (around 12 000 cases) per year. Approximately 4.5% of new cases and 7.9% of previously treated TB cases are multidrug resistant (MDR) and 47% of patients with MDR-TB are HIV coinfected. Published data suggest a clustering of MDR-TB transmission in specific areas. Identifying transmission clusters is key to implementing high-yield and cost-effective interventions. This includes knowing the yield of finding TB cases in high-transmission zones (eg, community hotspots, hospitals or households) to deliver community-based interventions. We aim to identify such transmission zones for enhanced case finding and evaluate the effectiveness of this approach. METHODS AND ANALYSIS H3TB is an observational cross-sectional study evaluating MDR-TB active case finding strategies. Sputum samples from MDR-TB cases in three regions of Namibia will be evaluated by whole genome sequencing (WGS) in addition to routine sputum investigations (Xpert MTB/RIF, culture and drug susceptibility testing). We will collect information on household contacts, use of community spaces and geographical map intersections between participants, synthesising these data to identify transmission hotspots. We will look at the feasibility, acceptability, yield and cost of case finding strategies in these hotspots, and in households of patients with MDR-TB and visitors of hospitalised patients with MDR-TB. A compartmental transmission dynamic model will be constructed to evaluate the impact and cost-effectiveness of the strategies if scaled. ETHICS AND DISSEMINATION Ethics approval was obtained. Participants will give informed consent. H3TB will capitalise on a partnership with the Ministry of Health and Social Services to follow up individuals diagnosed with MDR-TB and integrate WGS data with innovative contact network mapping, to allow enhanced case finding. Study data will contribute towards a systems approach to TB control. Equally important, it will serve as a role model for similar studies in other high-incidence settings.
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Affiliation(s)
- Olga Shavuka
- Department of Human Biological and Translational Medical Sciences, University of Namibia, Windhoek, Khomas, Namibia
| | - Etuhole Iipumbu
- Department of Human Biological and Translational Medical Sciences, University of Namibia, Windhoek, Khomas, Namibia
| | - Lorraine Boois
- Department of Human Biological and Translational Medical Sciences, University of Namibia, Windhoek, Khomas, Namibia
| | - Gunar Günther
- Department of Human Biological and Translational Medical Sciences, University of Namibia, Windhoek, Khomas, Namibia
- Inselspital, University of Bern, Bern, Switzerland
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | | | - Emmanuel Nepolo
- Department of Human Biological and Translational Medical Sciences, University of Namibia, Windhoek, Khomas, Namibia
| | - Stefan Niemann
- Department of Human Biological and Translational Medical Sciences, University of Namibia, Windhoek, Khomas, Namibia
- Molecular and Experimental Mycobacteriology Group, Forschungszentrum Borstel, Borstel, Germany
| | - Nunurai Ruswa
- National Tuberculosis and Leprosy Programme (NTLP), Windhoek, Namibia
| | - James Seddon
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
- Department of Infectious Disease, Imperial College London, London, UK
| | - Mareli M Claassens
- Department of Human Biological and Translational Medical Sciences, University of Namibia, Windhoek, Khomas, Namibia
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
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5
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Hayward SE, Vanqa N, Makanda G, Tisile P, Ngwatyu L, Foster I, Mcinziba A, Biewer A, Mbuyamba R, Galloway M, Bunyula S, Westhuizen HM, Friedland JS, Marino-Medina A, Viljoen L, Schoeman I, Hoddinott G, Nathavitharana RR. "As a patient I do not belong to the clinic, I belong to the community." Co-developing a multi-level, person-centred tuberculosis stigma intervention in Cape Town, South Africa. Res Sq 2024:rs.3.rs-3921970. [PMID: 38405783 PMCID: PMC10889064 DOI: 10.21203/rs.3.rs-3921970/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background Anticipated, internal, and enacted stigma are major barriers to TB care engagement, and directly impact patient well-being. Unfortunately, targeted stigma interventions are lacking. We aimed to co-develop a person-centred stigma intervention with TB-affected community members and health workers in South Africa. Methods Using a community-based participatory research approach, we conducted ten group discussions with people diagnosed with TB (past or present), caregivers, and health workers (total n=87) in Khayelitsha, Cape Town. Group discussions were facilitated by TB survivors. Discussion guides explored experiences and drivers of stigma and used human-centred design principles to co-develop solutions. Recordings were transcribed, coded, thematically analysed and then further interpreted using the socio-ecological model. Results Intervention components across socio-ecological levels shared common behaviour change strategies, namely education, empowerment, engagement, and innovation. At the individual level, participants recommended counselling to improve TB knowledge and provide ongoing support. TB survivors can guide messaging to nurture stigma resilience by highlighting that TB can affect anyone and is curable, and provide lived experiences of TB to decrease internal stigma. At the interpersonal level, support clubs and family-centred counselling were suggested to dispel TB-related myths and foster support. At the institutional level, health worker stigma reduction training informed by TB survivor perspectives was recommended. Consideration of how integration of TB/HIV care services may exacerbate TB/HIV intersectional stigma and ideas for restructured service delivery models were suggested to decrease anticipated and enacted stigma. At the community level, participants recommended awareness-raising events led by TB survivors, including TB information in school curricula. At the policy level, solutions focused on reducing the visibility generated by a TB diagnosis and resultant stigma in health facilities and shifting tasks to community health workers. Conclusions Decreasing TB stigma requires a multi-level approach. Co-developing a person-centred intervention with affected communities is feasible and generates stigma intervention components that are directed and implementable. Such community-informed intervention components should be prioritised by TB programs, including integrated TB/HIV care services.
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Affiliation(s)
| | | | | | | | | | | | | | - Amanda Biewer
- Beth Israel Deaconess Medical Center, Harvard Medical School
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Meehan SA, Hesseling AC, Boulle A, Chetty J, Connell L, Dlamini-Miti NJ, Dunbar R, Du Preez K, George G, Hoddinott G, Jennings K, Marx FM, Mudaly V, Naidoo P, Ndlovu N, Ngozo J, Smith M, Strauss M, Tanna G, Vanqa N, von Delft A, Osman M. Reducing Initial Loss to Follow-up Among People With Bacteriologically Confirmed Tuberculosis: LINKEDin, a Quasi-experimental Study in South Africa. Open Forum Infect Dis 2024; 11:ofad648. [PMID: 38221986 PMCID: PMC10787480 DOI: 10.1093/ofid/ofad648] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024] Open
Abstract
Every person diagnosed with tuberculosis (TB) needs to initiate treatment. The World Health Organization estimated that 61% of people who developed TB in 2021 were included in a TB treatment registration system. Initial loss to follow-up (ILTFU) is the loss of persons to care between diagnosis and treatment initiation/registration. LINKEDin, a quasi-experimental study, evaluated the effect of 2 interventions (hospital recording and an alert-and-response patient management intervention) in 6 subdistricts across 3 high-TB burden provinces of South Africa. Using integrated electronic reports, we identified all persons diagnosed with TB (Xpert MTB/RIF positive) in the hospital and at primary health care facilities. We prospectively determined linkage to care at 30 days after TB diagnosis. We calculated the risk of ILTFU during the baseline and intervention periods and the relative risk reduction in ILTFU between these periods. We found a relative reduction in ILTFU of 42.4% (95% CI, 28.5%-53.7%) in KwaZulu Natal (KZN) and 22.3% (95% CI, 13.3%-30.4%) in the Western Cape (WC), with no significant change in Gauteng. In KZN and the WC, the relative reduction in ILTFU appeared greater in subdistricts where the alert-and-response patient management intervention was implemented (KZN: 49.3%; 95% CI, 32.4%-62%; vs 32.2%; 95% CI, 5.4%-51.4%; and WC: 34.2%; 95% CI, 20.9%-45.3%; vs 13.4%; 95% CI, 0.7%-24.4%). We reported a notable reduction in ILTFU in 2 provinces using existing routine health service data and applying a simple intervention to trace and recall those not linked to care. TB programs need to consider ILTFU a priority and develop interventions specific to their context to ensure improved linkage to care.
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Affiliation(s)
- Sue-Ann Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Health and Wellness, Health Intelligence Directorate, Western Cape Government, Cape Town, South Africa
| | - Jolene Chetty
- Interactive Research and Development South Africa (IRD SA), Sandton, Johannesburg
| | - Lucy Connell
- Right to Care South Africa, Helen Joseph Hospital, Johannesburg, South Africa
| | | | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karen Du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
- Division of Social Medicine and Global Health, Lund University, Lund, Sweden
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karen Jennings
- City of Cape Town Health Department, Cape Town, South Africa
| | - Florian M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
- DSI-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Vanessa Mudaly
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - Pren Naidoo
- Bill and Melinda gates Foundation, Johannesburg, South Africa
| | - Neo Ndlovu
- Right to Care South Africa, Helen Joseph Hospital, Johannesburg, South Africa
| | - Jacqueline Ngozo
- Kwa-Zulu Natal Department of Health and Wellness, Pietermaritzburg, South Africa
| | - Mariette Smith
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Health and Wellness, Health Intelligence Directorate, Western Cape Government, Cape Town, South Africa
| | - Michael Strauss
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Gaurang Tanna
- Bill and Melinda gates Foundation, Johannesburg, South Africa
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Arne von Delft
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Health and Wellness, Health Intelligence Directorate, Western Cape Government, Cape Town, South Africa
| | - Muhammad Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Human Sciences, University of Greenwich, London, UK
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Foster I, Biewer A, Vanqa N, Makanda G, Tisile P, Hayward SE, Wademan DT, Anthony MG, Mbuyamba R, Galloway M, Human W, Westhuizen HM, Friedland JS, Marino-Medina A, Schoeman I, Hoddinott G, Nathavitharana RR. "This is an illness. No one is supposed to be treated badly": Community-based stigma assessments in South Africa to inform TB stigma intervention design. Res Sq 2023:rs.3.rs-3716733. [PMID: 38168425 PMCID: PMC10760241 DOI: 10.21203/rs.3.rs-3716733/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Though TB-related stigma is a recognized barrier to care, interventions are lacking and gaps remain in understanding the drivers and experiences of TB-related stigma. We undertook community-based mixed methods stigma assessments to inform stigma intervention design. Methods We adapted the Stop TB Partnership stigma assessment tool, and trained three peer research associates (PRAs; two TB survivors, one community health worker) to conduct surveys with people with TB (PWTB, n=93) and caregivers of children with TB (n=24) at peri-urban and rural clinic sites in Khayelitsha, Western Cape, and Hammanskraal, Gauteng Province, South Africa. We descriptively analyzed responses for each stigma experience (anticipated, internal, and enacted), calculated stigma scores, and undertook generalized linear regression analysis. We further conducted 25 in-depth interviews with PWTB (n=22) and caregivers TB (n=3). Using inductive thematic analysis, we performed open coding to identify emergent themes, and selective coding to identify relevant quotes. Themes were organised using the CARD (Constraints, Actions, Risks and Desires) framework. Results Surveys revealed at least one-third of PWTB and one-quarter of caregivers report experiences of anticipated, internal, and/or enacted stigma, which affected engagement throughout the care cascade. Participants in rural locations (compared to peri-urban) reported higher anticipated, internal, and enacted stigma (β-coefficient 0.72, 0.71, and 0.74). Interview participants described how stigma experiences, including HIV intersectional stigma, act individually and in concert as key constraints to impede care, and underpins failure to disclose a TB diagnosis, isolation, and exclusion. Stigma resilience arose through understanding that TB can affect anyone and should not diminish self-worth. Risks of stigma, driven by fears related to disease severity and infectiousness, led to care disengagement and impaired psychological wellbeing. Participants desired counselling, identifying a specific role for TB survivors as peer counsellors, and community education. Conclusions Stigma is highly prevalent and negatively impacts TB care and the well-being of PWTB, warranting its assessment as a primary outcome indicator rather than intermediary contributor to poor cascade outcomes. Multicomponent stigma interventions are needed, including counselling for PWTB and education for health workers and communities. Such interventions must incorporate contextual differences based on gender or setting, and use survivor-guided messaging to foster stigma resilience.
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Affiliation(s)
| | - Amanda Biewer
- Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | | | | | | | - Dillon T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Michaile G Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | | | | | | | | | | | | | | | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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8
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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Hesseling AC, Garcia-Prats AJ, Inabathina KR. A novel home-based method for preparing suspensions of anti-TB drugs. Int J Tuberc Lung Dis 2023; 27:810-815. [PMID: 37880886 PMCID: PMC10599413 DOI: 10.5588/ijtld.23.0165] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/08/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND: Tablets are the most widely available dosage form for the treatment of TB; however, adult tablets fail to meet the needs of young children who cannot swallow these tablets or require dose titration. We tested a new, simple device (XTEMP-R®) and the methodology for converting tablets of TB drugs into a homogeneous suspension for home use by children and caregivers.METHODS: XTEMP-R is a new device used for converting tablets into liquid preparations. Four TB drugs - pretomanid, delamanid, clofazimine and bedaquiline - were dispersed in the device utilizing water and simple syrup. The reproducibility of accurately delivering aliquots from the suspension upon preparation and upon redispersion after storing for 2 days was studied.RESULTS: Suspensions of each of the drugs tested were easily prepared in about 10 min and were visually uniform in consistency. Dosages in 2 and 5 mL were assessed in suspension, and those in 5 mL tested upon redispersion after 2 days. The observed range for these dosages spanned from 94.6% to 101.1% of the theoretical concentration for the suspensions under examination. The cleaned device had no detectable residual drug.CONCLUSION: XTEMP-R can be used at home by caregivers to prepare doses of suspensions accurately for children and patients who cannot swallow tablets.
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Affiliation(s)
- R Taneja
- Global Alliance for TB drug Development (TB Alliance), New York, NY
| | - M C Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, The Ohio State University, Columbus, OH
| | | | - P G Pande
- Global Alliance for TB drug Development (TB Alliance), New York, NY
| | | | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - C L Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R K Jew
- Institute for Safe Medication Practices, Plymouth Meeting, PA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - K Rao Inabathina
- Global Alliance for TB drug Development (TB Alliance), New York, NY
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Mcinziba A, Wademan D, Viljoen L, Myburgh H, Jennings L, Decloed E, Orrell C, van Zyl G, van Schalkwyk M, Gandhi M, Hoddinott G. Perspectives of people living with HIV and health workers about a point-of-care adherence assay: a qualitative study on acceptability. AIDS Care 2023; 35:1628-1634. [PMID: 36781407 PMCID: PMC10423296 DOI: 10.1080/09540121.2023.2174928] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/22/2023] [Indexed: 02/15/2023]
Abstract
Current antiretroviral therapy (ART) adherence monitoring is premised on patients' self-reported adherence behaviour (prone to recall error) and verified by blood viral load measurement (which can delay results). A newly developed Urine Tenofovir Rapid Assay (UTRA) assesses tenofovir in urine at point-of-care and is a novel tool to test and immediately respond to adherence levels of people living with HIV (PLHIV). We explored PLHIV and health workers' initial perceptions about integrating the UTRA into routine medical care for adherence support. We conducted a series of once-off in-depth qualitative interviews with PLHIV (n = 25) and health workers (n = 5) at a primary care health facility in Cape Town, South Africa. Data analysis involved descriptive summaries of key emergent themes with illustrative case examples. We applied a deductive, outcomes-driven analytic approach to the summaries using the Implementation Outcomes Framework proffered by Proctor et al. (2011). The three relevant concepts from this framework that guided our evaluation were: acceptability, appropriateness, and feasibility. We found positive perceptions about the UTRA from many PLHIV and health worker participants. Many PLHIV reported that the immediate results offered by the UTRA could enable them to have constructive discussions with health workers on how to resolve adherence challenges in real-time. Few PLHIV reported concerns that drinking alcohol could affect their UTRA results. Many health workers reported that the UTRA could help them identify patients at risk of treatment failure and immediately intervene through counselling, though some relayed that they would support the UTRA's implementation if more staff members could be added in their busy facility. Overall, these findings show that the UTRA was widely perceived to be acceptable and actionable by many PLHIV and health workers in the study.
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Affiliation(s)
- Abenathi Mcinziba
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Dillon Wademan
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Lario Viljoen
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Hanlie Myburgh
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Lauren Jennings
- Desmond Tutu Health Foundation, Institute of Infectious Diseases & Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Eric Decloed
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Catherine Orrell
- Desmond Tutu Health Foundation, Institute of Infectious Diseases & Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gert van Zyl
- Division of Medical Virology, Faculty of Medicine and Health Sciences and National Health Laboratory Service (NHLS) Tygerberg business unit, Stellenbosch University, Cape Town, South Africa
| | - Marije van Schalkwyk
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco (UCSF), San Francisco, United States of America
| | - Graeme Hoddinott
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
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10
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Myburgh H, Meehan SA, Wademan DT, Osman M, Hesseling AC, Hoddinott G. TB programme stakeholder views on lessons from the COVID-19 response in South Africa. Public Health Action 2023; 13:97-103. [PMID: 37736584 PMCID: PMC10446663 DOI: 10.5588/pha.23.0015] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/21/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The global COVID-19 pandemic has reversed many of the hard-won gains made in TB programmes and the associated reduction in the number of TB deaths, case notifications and incidence over the last three decades. Modelling estimates show that the impact will be lasting. There are global calls to recover the shortfalls along the TB care cascade that have resulted from COVID-19, with the recognition that the COVID-19 response holds lessons to inform more robust and comprehensive TB programmes and services. OBJECTIVE To explore lessons from response measures to the COVID-19 pandemic in two high TB burden South African provinces. DESIGN This was an exploratory qualitative study. We conducted interviews with TB programme stakeholders (managers and facility-level staff: n = 35) between February and June 2022. RESULTS We identified eight facilitators of the COVID-19 response, including political will, rapid policy development, multi-sectoral collaboration, patient-centred models of care delivery, community engagement, mHealth and telehealth technologies, rigorous contact tracing and widespread mask wearing. Political will was singled out as a critical driver of the response. CONCLUSION Leveraging COVID-19 inspired collaborations, technologies and avenues for health service delivery is an opportunity to maximise benefits for the TB programme. Reinvestment in national TB programmes and political prioritisation of TB are critical.
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Affiliation(s)
- H Myburgh
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam; Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, Netherlands
| | - S-A Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Human Sciences, Faculty of Education, Health & Human Sciences, University of Greenwich, London, UK
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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11
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Viljoen L, Acaba J, Agbassi YJP, Beko B, Goslett C, Hoddinott G, Kumar B, Kumar RG, McKenna L, Moses G, Sachs T, Seidel S, von Delft A. Community perspective on child-friendly medications for drug-resistant TB: importance, priorities and advocacy. Int J Tuberc Lung Dis 2023; 27:655-657. [PMID: 37608482 PMCID: PMC10443785 DOI: 10.5588/ijtld.23.0164] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/23/2023] [Indexed: 08/24/2023] Open
Affiliation(s)
- L Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - J Acaba
- The BENEFIT Kids Community Advisory Board (CAB), Asia Pacific Council of AIDS Service Organizations, Bangkok, Thailand
| | - Y J P Agbassi
- Global Tuberculosis Community Advisory Board (TB CAB)
| | - B Beko
- TB Proof, Cape Town, South Africa
| | - C Goslett
- The BENEFIT Kids Community Advisory Board (CAB), Desmond Tutu TB Centre CAB, Cape Town, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - B Kumar
- The BENEFIT Kids Community Advisory Board (CAB), Global Coalition of TB Advocates
| | - R G Kumar
- Touched by TB, National Coalition of People Affected by TB, India
| | - L McKenna
- Treatment Action Group, New York, NY
| | - G Moses
- Global Tuberculosis Community Advisory Board (TB CAB)
| | - T Sachs
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | - A von Delft
- The BENEFIT Kids Community Advisory Board (CAB), TB Proof, Cape Town, South Africa
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12
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Davis K, Pickles M, Gregson S, Hargreaves JR, Ayles H, Bock P, Pliakas T, Thomas R, Ohrnberger J, Bwalya J, Bell-Mandla N, Shanaube K, Probert W, Hoddinott G, Bond V, Hayes R, Fidler S, Hauck K. The effect of universal testing and treatment for HIV on health-related quality of life - An analysis of data from the HPTN 071 (PopART) cluster randomised trial. SSM Popul Health 2023; 23:101473. [PMID: 37575363 PMCID: PMC10413193 DOI: 10.1016/j.ssmph.2023.101473] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/26/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023] Open
Abstract
Background HIV treatment has clear Health-Related Quality-of-Life (HRQoL) benefits. However, little is known about how Universal Testing and Treatment (UTT) for HIV affects HRQoL. This study aimed to examine the effect of a combination prevention intervention, including UTT, on HRQoL among People Living with HIV (PLHIV). Methods Data were from HPTN 071 (PopART), a three-arm cluster randomised controlled trial in 21 communities in Zambia and South Africa (2013-2018). Arm A received the full UTT intervention of door-to-door HIV testing plus access to antiretroviral therapy (ART) regardless of CD4 count, Arm B received the intervention but followed national treatment guidelines (universal ART from 2016), and Arm C received standard care. The intervention effect was measured in a cohort of randomly selected adults, over 36 months. HRQoL scores, and the prevalence of problems in five HRQoL dimensions (mobility, self-care, performing daily activities, pain/discomfort, anxiety/depression) were assessed among all participants using the EuroQol-5-dimensions-5-levels questionnaire (EQ-5D-5L). We compared HRQoL among PLHIV with laboratory confirmed HIV status between arms, using adjusted two-stage cluster-level analyses. Results At baseline, 7,856 PLHIV provided HRQoL data. At 36 months, the mean HRQoL score was 0.892 (95% confidence interval: 0.887-0.898) in Arm A, 0.886 (0.877-0.894) in Arm B and 0.888 (0.884-0.892) in Arm C. There was no evidence of a difference in HRQoL scores between arms (A vs C, adjusted mean difference: 0.003, -0.001-0.006; B vs C: -0.004, -0.014-0.005). The prevalence of problems with pain/discomfort was lower in Arm A than C (adjusted prevalence ratio: 0.37, 0.14-0.97). There was no evidence of differences for other HRQoL dimensions. Conclusions The intervention did not change overall HRQoL, suggesting that raising HRQoL among PLHIV might require more than improved testing and treatment. However, PLHIV had fewer problems with pain/discomfort under the full intervention; this benefit of UTT should be maximised during roll-out.
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Affiliation(s)
- Katherine Davis
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - Michael Pickles
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - Simon Gregson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - James R. Hargreaves
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Helen Ayles
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
| | - Triantafyllos Pliakas
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Ranjeeta Thomas
- Department of Health Policy, London School of Economics, London, WC2A 2AE, UK
| | - Julius Ohrnberger
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - Justin Bwalya
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Nomtha Bell-Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
| | - Kwame Shanaube
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - William Probert
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LF, UK
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
| | - Virginia Bond
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Sarah Fidler
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, W2 1PG, UK
| | - Katharina Hauck
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - the HPTN 071 (PopART) Study Team
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
- Department of Health Policy, London School of Economics, London, WC2A 2AE, UK
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LF, UK
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, W2 1PG, UK
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13
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Mcinziba A, Bock P, Hoddinott G, Seeley J, Bond V, Fidler S, Viljoen L. Managing household income and antiretroviral therapy adherence among people living with HIV in a low-income setting: a qualitative data from the HPTN 071 (PopART) trial in South Africa. AIDS Res Ther 2023; 20:54. [PMID: 37542278 PMCID: PMC10401727 DOI: 10.1186/s12981-023-00549-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/18/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND South Africa is reported to have the highest burden of HIV with an estimated 8.2 million people living with HIV (PLHIV) in 2021- despite adopting the World Health Organisation (WHO) universal HIV test and treat (UTT) recommendations in 2016. As of 2021, only an estimated 67% (5.5 million) of all PLHIV were accessing antiretroviral therapy (ART), as per recorded clinic appointments attendance. Studies in sub-Saharan Africa show that people living in low-income households experience multiple livelihood-related barriers to either accessing or adhering to HIV treatment including lack of resources to attend to facilities and food insecurity. We describe the interactions between managing household income and ART adherence for PLHIV in low-income urban and semi-urban settings in the Western Cape, South Africa. METHODS We draw on qualitative data collected as part of the HPTN 071 (PopART) HIV prevention trial (2016 - 2018) to provide a detailed description of the interactions between household income and self-reported ART adherence (including accessing ART and the ability to consistently take ART as prescribed) for PLHIV in the Western Cape, South Africa. We included data from 21 PLHIV (10 men and 11 women aged between 18 and 70 years old) from 13 households. As part of the qualitative component, we submitted an amendment to the ethics to recruit and interview community members across age ranges. We purposefully sampled for diversity in terms of age, gender, and household composition. RESULTS We found that the management of household income interacted with people's experiences of accessing and adhering to ART in diverse ways. Participants reported that ART adherence was not a linear process as it was influenced by income stability, changing household composition, and other financial considerations. Participants reported that they did not have a fixed way of managing income and that subsequently caused inconsistency in their ART adherence. Participants reported that they experienced disruptions in ART access and adherence due to competing household priorities. These included difficulties balancing between accessing care and/or going to work, as well as struggling to cover HIV care-related costs above other basic needs. CONCLUSION Our analysis explored links between managing household income and ART adherence practices. We showed that these are complex and change over the course of treatment duration. We argued that mitigating negative impacts of income fluctuation and managing complex trade-offs in households be included in ART adherence support programmes.
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Affiliation(s)
- Abenathi Mcinziba
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Virginia Bond
- School of Medicine, University of Zambia, Ridgeway Campus, Zambart, Lusaka, Zambia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Fidler
- Department of Medicine, Imperial College, London, UK
| | - Lario Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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14
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Chiang SS, Graham SM, Schaaf HS, Marais BJ, Sant'Anna CC, Sharma S, Starke JR, Triasih R, Achar J, Amanullah F, Armitage LY, Aurilio RB, Buck WC, Centis R, Chabala C, Cruz AT, Demers AM, du Preez K, Enimil A, Furin J, Garcia-Prats AJ, Gonzalez NE, Hoddinott G, Isaakidis P, Jaganath D, Kabra SK, Kampmann B, Kay A, Kitai I, Lopez-Varela E, Maleche-Obimbo E, Malaspina FM, Velásquez JN, Nuttall JJC, Oliwa JN, Andrade IO, Perez-Velez CM, Rabie H, Seddon JA, Sekadde MP, Shen A, Skrahina A, Soriano-Arandes A, Steenhoff AP, Tebruegge M, Tovar MA, Tsogt B, van der Zalm MM, Welch H, Migliori GB. Clinical standards for drug-susceptible TB in children and adolescents. Int J Tuberc Lung Dis 2023; 27:584-598. [PMID: 37491754 PMCID: PMC10365562 DOI: 10.5588/ijtld.23.0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND: These clinical standards aim to provide guidance for diagnosis, treatment, and management of drug-susceptible TB in children and adolescents.METHODS: Fifty-two global experts in paediatric TB participated in a Delphi consensus process. After eight rounds of revisions, 51/52 (98%) participants endorsed the final document.RESULTS: Eight standards were identified: Standard 1, Age and developmental stage are critical considerations in the assessment and management of TB; Standard 2, Children and adolescents with symptoms and signs of TB disease should undergo prompt evaluation, and diagnosis and treatment initiation should not depend on microbiological confirmation; Standard 3, Treatment initiation is particularly urgent in children and adolescents with presumptive TB meningitis and disseminated (miliary) TB; Standard 4, Children and adolescents should be treated with an appropriate weight-based regimen; Standard 5, Treating TB infection (TBI) is important to prevent disease; Standard 6, Children and adolescents should receive home-based/community-based treatment support whenever possible; Standard 7, Children, adolescents, and their families should be provided age-appropriate support to optimise engagement in care and clinical outcomes; and Standard 8, Case reporting and contact tracing should be conducted for each child and adolescent.CONCLUSION: These consensus-based clinical standards, which should be adapted to local contexts, will improve the care of children and adolescents affected by TB.
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Affiliation(s)
- S S Chiang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, Center for International Health Research, Rhode Island Hospital, Providence, RI, USA
| | - S M Graham
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Burnet Institute, Melbourne, VIC, Australia
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - B J Marais
- Department of Paediatrics and Child Health and the Sydney Infectious Diseases Institute (Sydney ID), Sydney, NSW, Department of Infectious Diseases, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - C C Sant'Anna
- Department of Paediatrics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - S Sharma
- Department of Paediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - J R Starke
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, Section of Infectious Diseases, Texas Children's Hospital, Houston, TX, USA
| | - R Triasih
- Department of Paediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - J Achar
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - F Amanullah
- Department of Paediatrics, The Indus Hospital and Health Network, Karachi, Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan
| | - L Y Armitage
- Heartland National TB Center, University of Texas Health Science Center at Tyler, San Antonio, TX, USA
| | - R B Aurilio
- Department of Paediatrics, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Department of Paediatrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - W C Buck
- Department of Pediatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - R Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italy
| | - C Chabala
- School of Medicine, Department of Paediatrics and Child Health, University of Zambia, Lusaka, Children's Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - A T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - A-M Demers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Division of Microbiology, Department of Laboratory Medicine, CHU Sainte-Justine, Montreal, Canada
| | - K du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Enimil
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
| | - N E Gonzalez
- División Neumotisiología, Hospital de Niños Pedro de Elizalde, Buenos Aires, Dirección General de Posgrado, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - P Isaakidis
- Southern Africa Medical Unit (SAMU), Médecins Sans Frontières, Cape Town, South Africa, Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - D Jaganath
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - S K Kabra
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - B Kampmann
- Charite Centre for Global Health, Charite Universitatsmedizin Berlin, Berlin, Germany, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - A Kay
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - I Kitai
- Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - E Lopez-Varela
- Hospital Clínic and ISGlobal, Universitat de Barcelona, Barcelona, Spain, Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - E Maleche-Obimbo
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | - F Mestanza Malaspina
- Department of Paediatrics, Hospital San Bartólome, Lima, Red Peruana de Tuberculosis Pediátrica, Dirección de Prevención y Control de Tuberculosis, Ministerio de Salud, Lima, Perú
| | - J Niederbacher Velásquez
- Department of Paediatrics, Universidad Industrial de Santander, Bucaramanga, Board of Directors, Asociación Colombiana de Neumología Pediátrica, Bogotá, Colombia
| | - J J C Nuttall
- Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - J N Oliwa
- Faculty of Health Sciences, Department of Paediatrics and Child Health, The University of Nairobi, Nairobi, Health Services Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - I Orozco Andrade
- Center of Diagnosis and Integral Treatment for Tuberculosis, Servicios Médicos de la Frontera, Juárez, Medical Coordination, Juntos Binational Tuberculosis Project, Juárez, México
| | - C M Perez-Velez
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - H Rabie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Infectious Disease, Imperial College London, London, UK
| | - M P Sekadde
- National TB and Leprosy Program, Ministry of Health, Kampala, Uganda
| | - A Shen
- Beijing Paediatric Research Institute, National Centre for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, Pediatric Research Institute, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - A Skrahina
- Clinical Department, The Republican Scientific and Practical Centre for Pulmonology and TB, Minsk, Belarus
| | - A Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Infection and Immunity in Children, Vall d'Hebron Research Institute, Barcelona, Spain
| | - A P Steenhoff
- Global Health Center and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA, Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - M Tebruegge
- Department of Infection, Immunity & Inflammation, University College London, Great Ormond Street Institute of Child Health, London, UK, Department of Paediatrics, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
| | - M A Tovar
- Socios En Salud Sucursal Perú, Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - B Tsogt
- Research and Innovation, Mongolian Anti-TB Coalition, Ulaanbaatar, Mongolia
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H Welch
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, Department of Paediatrics, The University of Papua New Guinea School of Medicine and Health Sciences, Port Moresby, Papua New Guinea
| | - G B Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italy
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15
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Yang B, Egg R, Brahmbhatt H, Matjeng M, Doro T, Mthembu Z, Muzah B, Foster B, Theunissen J, Frost A, Peetz A, Reichert K, Hoddinott G. Mental health experiences of HIV/TB healthcare workers during the COVID-19 pandemic - lessons for provider well-being and support from a qualitative study in seven South African provinces. BMC Health Serv Res 2023; 23:727. [PMID: 37403094 DOI: 10.1186/s12913-023-09716-w] [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: 05/26/2022] [Accepted: 06/19/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND COVID-19 has substantially reshaped health service delivery. Healthcare workers have had to serve more clients, work longer shifts, and operate in conditions of uncertainty. They have experienced multiple stressors related to the additional 'labour of care', including managing the frustration of inadequate therapeutic or symptom relief options, witnessing clients dying, and having to give this news to clients' family members. Ongoing psychological distress among healthcare workers can severely undermine performance, decision-making and well-being. We sought to understand the impact of the COVID-19 pandemic on the mental health experiences of healthcare workers delivering HIV and TB services in South Africa. METHODS We used a pragmatic and exploratory design to understand HCWs' mental health experiences with in-depth qualitative data. We implemented the study in ten high HIV/TB burden districts across seven of South Africa's nine provinces among healthcare workers employed by USAID-funded implementing partners. We conducted in-depth interviews (virtual) with 92 healthcare workers across 10 cadres. RESULTS Healthcare workers reported experiencing a range of extreme and rapidly fluctuating emotions because of COVID-19 that negatively impacted on their well-being. Among these, many healthcare workers report experienced a great deal of guilt at their inability to continue to provide quality care to their clients. In addition, a constant and pervasive fear of contracting COVID-19. Healthcare workers' stress coping mechanisms were limited to begin with, and often further interrupted by COVID-19 and non-pharmaceutical response measures e.g., 'lockdowns'. Healthcare workers reported a need for greater support for managing the everyday burden of work - not only when experiencing a mental well-being 'episode'. Further, that whenever they were exposed to stressor events, e.g., supporting a child living with HIV who reports sexual abuse to the healthcare worker, that this this would trigger additional support interventions and not rely on the healthcare worker seeking this out. Further, that supervisors spend more effort demonstrating appreciation toward staff. CONCLUSIONS The COVID-19 epidemic has added significant mental health burden for healthcare workers in South Africa. Addressing this requires broad and cross-cutting strengthening of everyday support for healthcare workers and centring staff's mental well-being as core to delivering quality health services.
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Affiliation(s)
- Blia Yang
- Panagora Group, Walker Creek Office Building, 90 Florence Ribeiro Ave, Muckleneuk, Pretoria, South Africa
| | - Rafaela Egg
- Panagora Group, Walker Creek Office Building, 90 Florence Ribeiro Ave, Muckleneuk, Pretoria, South Africa
| | | | | | | | | | - Batanayi Muzah
- USAID, 100 Totius St, Groenkloof, Pretoria, South Africa
| | - Brendon Foster
- Panagora Group, Walker Creek Office Building, 90 Florence Ribeiro Ave, Muckleneuk, Pretoria, South Africa
| | - Johanna Theunissen
- Panagora Group, Walker Creek Office Building, 90 Florence Ribeiro Ave, Muckleneuk, Pretoria, South Africa
| | - Ashley Frost
- USAID, 100 Totius St, Groenkloof, Pretoria, South Africa
| | - April Peetz
- USAID, 100 Totius St, Groenkloof, Pretoria, South Africa
| | - Katie Reichert
- Panagora Group, Walker Creek Office Building, 90 Florence Ribeiro Ave, Muckleneuk, Pretoria, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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16
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Wademan DT, Viljoen L, Jacobs S, Meyerson K, Nombewu Y, Busakwe L, Schaaf HS, Hesseling AC, Winckler J, Garcia-Prats AJ, Hoddinott G. Children´s priorities to improve the acceptability of MDR-TB treatment: qualitative data from South Africa. Int J Tuberc Lung Dis 2023; 27:543-550. [PMID: 37353869 DOI: 10.5588/ijtld.22.0573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND: Multidrug-resistant TB (MDR-TB) treatment for children frequently includes unpalatable drugs with low overall acceptability. This can negatively impact children and their caregivers´ treatment experiences and is an important contributor to poor adherence, and potentially, poor treatment outcomes. Children and their caregivers´ preferences for MDR-TB treatment are not well documented. We describe children and caregivers´ priorities to inform future MDR-TB treatment regimens.METHODS: We conducted a cross-sectional qualitative study at a TB hospital in South Africa using semi-structured interviews and participatory research activities with caregivers and children routinely diagnosed and treated for MDR-TB between June and August 2018.RESULTS: We conducted 15 interviews with children and their caregivers. Children ranged from 2 to 17 years of age (median age: 8.3 years). Children and caregivers had an overall negative experience of MDR-TB treatment. Children and caregivers described how future MDR-TB drugs and regimens should prioritise sweeter flavours, fewer pills, brighter colours, and formulations that are easy to prepare and administer and dispensed in colourful, small and discrete packaging.CONCLUSIONS: MDR-TB treatment acceptability remains low, and negatively impacts children and their caregivers´ treatment experiences. Improving the overall acceptability of MDR-TB treatment requires engaging with children and their caregivers to better understand their priorities for new treatment regimens and child-friendly formulations.
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Affiliation(s)
- D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - L Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - S Jacobs
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - K Meyerson
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Y Nombewu
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - L Busakwe
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - J Winckler
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa, Department of Paediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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17
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Garcia-Prats AJ, Hoddinott G, Howell P, Hughes J, Jean-Philippe P, Kim S, Palmer M, Schaaf HS, Seddon JA, Svensson E, Hesseling AC. Children deserve simple, short, safe, and effective treatment for rifampicin-resistant tuberculosis. Lancet Infect Dis 2023; 23:778-780. [PMID: 37245523 PMCID: PMC10577306 DOI: 10.1016/s1473-3099(23)00349-3] [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] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Anthony J Garcia-Prats
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, USA; Desmond Tutu TB Centre, Department of Paediatics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Pauline Howell
- Clinical HIV Research Unit, Sizwe Tropical Disease Hospital, Wits Health Consortium, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Jennifer Hughes
- Desmond Tutu TB Centre, Department of Paediatics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Patrick Jean-Philippe
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Soyeon Kim
- Department of Biostatistics, Frontier Science Foundation, Brookline, MA, USA
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Department of Infectious Disease, Imperial College London, London, UK
| | - Elin Svensson
- Department of Pharmacy, Uppsala University, Uppsala, Sweden; Department of Pharmacy, Research Institute for Medical Innovation, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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18
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Strauss M, Wademan DT, Mcinziba A, Hoddinott G, Rafique M, Jola LN, Streicher C, du Preez K, Osman M, Boffa J, Hausler H, Hesseling AC, Hirsch-Moverman Y. TB preventive therapy preferences among children and adolescents. Int J Tuberc Lung Dis 2023; 27:520-529. [PMID: 37353873 DOI: 10.5588/ijtld.22.0645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND: TB preventive therapy (TPT) is critical for ending TB, yet implementation remains poor. With new global guidelines expanding TPT eligibility and regimens, we aimed to understand TPT preferences among children, adolescents and caregivers.METHODS: We undertook a discrete choice experiment among 131 children, 170 adolescents and 173 caregivers, and conducted 17 in-depth interviews in 25 clinics in Cape Town, South Africa. The design included attributes for location, waiting time, treatment duration, dosing frequency, formulation/size, side effects, packaging and taste. Mixed-effects logistic regression models were used for analysis.RESULTS: Among children and caregivers, the number and size of pills, taste and side effects were important drivers of preferences. Among adolescents and caregivers, clinic waiting times and side effects were significant drivers of preferences. Adolescents expressed concerns about being stigmatised, and preferred services from local clinics to services delivered in the community. Dosing frequency and treatment duration were only significant drivers of choice among adolescents, and only if linked to fewer clinic visits.CONCLUSIONS: Introducing shorter TPT regimens in isolation without consideration of preferences and health services may not have the desired effect on uptake and completion. Developing TPT delivery models and formulations that align with preferences must be prioritised.
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Affiliation(s)
- M Strauss
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Mcinziba
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Rafique
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - L N Jola
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - C Streicher
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - K du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, School of Human Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
| | - J Boffa
- TB Think Tank, The Aurum Institute, Johannesburg, South Africa, Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - H Hausler
- TB HIV Care, Cape Town, South Africa, Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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19
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Zewdie K, Pickles M, Floyd S, Fidler S, Ayles H, Bock P, Hoddinott G, Mandla N, Shanaube K, Simwinga M, Fraser C, Seeley J, Piwowar-Manning E, Hayes R, Donnell D. Uptake of medical male circumcision with household-based testing, and the association of traditional male circumcision and HIV infection. AIDS 2023; 37:795-802. [PMID: 36727597 PMCID: PMC10023451 DOI: 10.1097/qad.0000000000003463] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Voluntary medical male circumcision (VMMC) is an important component of combination HIV prevention. Inclusion of traditionally circumcised HIV negative men in VMMC uptake campaigns may be important if traditional male circumcision is less protective against HIV acquisition than VMMC. METHODS We used data from the HIV Prevention Trials Network (HPTN) 071 (PopART) study. This cluster-randomized trial assessed the impact of a combination prevention package on population-level HIV incidence in 21 study communities in Zambia and South Africa. We evaluated uptake of VMMC, using a two-stage analysis approach and used discrete-time survival analysis to evaluate the association between the types of male circumcision and HIV incidence. RESULTS A total of 10 803 HIV-negative men with self-reported circumcision status were included in this study. At baseline, 56% reported being uncircumcised, 26% traditionally circumcised and 18% were medically circumcised. During the PopART intervention, 11% of uncircumcised men reported uptake of medical male circumcision. We found no significant difference in the uptake of VMMC in communities receiving the PopART intervention package and standard of care {adj. rate ratio=1·10 [95% confidence interval (CI) 0.82, 1.50, P = 0.48]}. The rate of HIV acquisition for medically circumcised men was 70% lower than for those who were uncircumcised adjusted hazard ratio (adjHR) = 0.30 (95% CI 0.16-0.55; P < 0.0001). There was no difference in rate of HIV acquisition for traditionally circumcised men compared to those uncircumcised adjHR = 0.84 (95% CI 0.54, 1.31; P = 0.45). CONCLUSIONS Household-based delivery of HIV testing followed by referral for medical male circumcision did not result in substantial VMMC uptake. Traditional circumcision is not associated with lower risk of HIV acquisition.
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Affiliation(s)
- Kidist Zewdie
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Michael Pickles
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, UK
| | - Helen Ayles
- ZAMBART, University of Zambia, School of Medicine, Ridgeway Campus, Lusaka, Zambia; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Nomtha Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Kwame Shanaube
- ZAMBART, University of Zambia, School of Medicine, Ridgeway Campus, Lusaka, Zambia
| | - Musonda Simwinga
- ZAMBART, University of Zambia, School of Medicine, Ridgeway Campus, Lusaka, Zambia
| | - Christophe Fraser
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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20
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Nightingale R, Carlin F, Meghji J, McMullen K, Evans D, van der Zalm MM, Anthony MG, Bittencourt M, Byrne A, du Preez K, Coetzee M, Feris C, Goussard P, Hirasen K, Bouwer J, Hoddinott G, Huaman MA, Inglis-Jassiem G, Ivanova O, Karmadwala F, Schaaf HS, Schoeman I, Seddon JA, Sineke T, Solomons R, Thiart M, van Toorn R, Fujiwara PI, Romanowski K, Marais S, Hesseling AC, Johnston J, Allwood B, Muhwa JC, Mortimer K. Post-TB health and wellbeing. Int J Tuberc Lung Dis 2023; 27:248-283. [PMID: 37035971 PMCID: PMC10094053 DOI: 10.5588/ijtld.22.0514] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 04/11/2023] Open
Abstract
TB affects around 10.6 million people each year and there are now around 155 million TB survivors. TB and its treatments can lead to permanently impaired health and wellbeing. In 2019, representatives of TB affected communities attending the '1st International Post-Tuberculosis Symposium´ called for the development of clinical guidance on these issues. This clinical statement on post-TB health and wellbeing responds to this call and builds on the work of the symposium, which brought together TB survivors, healthcare professionals and researchers. Our document offers expert opinion and, where possible, evidence-based guidance to aid clinicians in the diagnosis and management of post-TB conditions and research in this field. It covers all aspects of post-TB, including economic, social and psychological wellbeing, post TB lung disease (PTLD), cardiovascular and pericardial disease, neurological disability, effects in adolescents and children, and future research needs.
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Affiliation(s)
- R Nightingale
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Respiratory Medicine, Liverpool University Hospitals NHS foundation Trust, Liverpool, UK
| | - F Carlin
- Department of Infectious Diseases, Liverpool University Hospitals NHS foundation Trust, Liverpool, UK
| | - J Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Respiratory Medicine, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - K McMullen
- Division of Neurology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - D Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M G Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M Bittencourt
- University Hospital, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | - A Byrne
- Department of Thoracic Medicine, St Vincent´s Hospital Clinical School University of New South Wales, Sydney, NSW, Australia
| | - K du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M Coetzee
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - C Feris
- Occupational Therapy Department, Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Namibia, Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Tygerberg, South Africa
| | - P Goussard
- Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - K Hirasen
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Paediatric Pulmonology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - J Bouwer
- Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M A Huaman
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - G Inglis-Jassiem
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - O Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, German Centre for Infection Research, Partner Site Munich, Munich, Germany
| | - F Karmadwala
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa, Department of Infectious Diseases, Imperial College London, London, UK
| | - T Sineke
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Solomons
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - M Thiart
- Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - R van Toorn
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - P I Fujiwara
- Task Force, Global Plan to End TB, 2023-2030, Stop TB Partnership, Geneva, Switzerland
| | - K Romanowski
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada, Provincial TB Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - S Marais
- Division of Neurology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa, Neurology Research Group, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - J Johnston
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada, Provincial TB Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - B Allwood
- Division of Pulmonology, Department of Medicine, Faculty of Medicine, Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J C Muhwa
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya
| | - K Mortimer
- Department of Respiratory Medicine, Liverpool University Hospitals NHS foundation Trust, Liverpool, UK, Department of Medicine, University of Cambridge, Cambridge, UK, Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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21
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Dewandel I, van Niekerk M, Ghimenton-Walters E, Palmer M, Anthony MG, McKenzie C, Croucamp R, Alter G, Demers AM, van Zyl G, Claassen M, Goussard P, Swanepoel R, Hoddinott G, Bosch C, Dunbar R, Allwood B, McCollum ED, Schaaf HS, Hesseling AC, van der Zalm MM. UMOYA: a prospective longitudinal cohort study to evaluate novel diagnostic tools and to assess long-term impact on lung health in South African children with presumptive pulmonary TB-a study protocol. BMC Pulm Med 2023; 23:97. [PMID: 36949477 PMCID: PMC10032249 DOI: 10.1186/s12890-023-02329-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/17/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Despite a high paediatric tuberculosis (TB) burden globally, sensitive and specific diagnostic tools are lacking. In addition, no data exist on the impact of pulmonary TB on long-term child lung health in low- and middle-income countries. The prospective observational UMOYA study aims (1) to build a state-of-the-art clinical, radiological, and biological repository of well-characterised children with presumptive pulmonary TB as a platform for future studies to explore new emerging diagnostic tools and biomarkers for early diagnosis and treatment response; and (2) to investigate the short and long-term impact of pulmonary TB on lung health and quality of life in children. METHODS We will recruit up to 600 children (0-13 years) with presumptive pulmonary TB and 100 healthy controls. Recruitment started in November 2017 and is expected to continue until May 2023. Sputum and non-sputum-based samples are collected at enrolment and during follow-up in TB cases and symptomatic controls. TB treatment is started by routine care services. Intensive follow-up for 6 months will allow for TB cases to retrospectively be classified according to international consensus clinical case definitions for TB. Long-term follow-up, including imaging, comprehensive assessment of lung function and quality of life questionnaires, are done yearly up to 4 years after recruitment. DISCUSSION The UMOYA study will provide a unique platform to evaluate new emerging diagnostic tools and biomarkers for early diagnosis and treatment response and to investigate long-term outcomes of pulmonary TB and other respiratory events on lung health in children.
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Affiliation(s)
- Isabelle Dewandel
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Margaret van Niekerk
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elisabetta Ghimenton-Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Newcastle-Upon-Tyne National Health Service Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michaile G Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carla McKenzie
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rolanda Croucamp
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Galit Alter
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard, Cambridge, MA, USA
- Moderna Therapeutics, Cambridge, MA, USA
| | - Anne-Marie Demers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Microbiology, Department of Laboratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, Quebec, Canada
- Department of Microbiology, Immunology and Infectious Diseases, Faculty of Medicine, University of Montreal, Quebec, Canada
| | - Gert van Zyl
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service, Tygerberg Business Unit, Cape Town, South Africa
| | - Mathilda Claassen
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Pierre Goussard
- Department of Paediatric Pulmonology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Ruan Swanepoel
- Department of Pulmonology and Lung Function, Tygerberg Hospital, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Corne Bosch
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Brian Allwood
- Department of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Eric D McCollum
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, USA
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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22
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Chiang SS, Waterous PM, Atieno VF, Bernays S, Bondarenko Y, Cruz AT, de Oliveira MCB, Del Castillo Barrientos H, Enimil A, Ferlazzo G, Ferrand RA, Furin J, Hoddinott G, Isaakidis P, Kranzer K, Maleche-Obimbo E, Mansoor H, Marais BJ, Mohr-Holland E, Morales M, Nguyen AP, Oliyo JO, Sant'Anna CC, Sawyer SM, Schaaf HS, Seddon JA, Sharma S, Skrahina A, Starke JR, Triasih R, Tsogt B, Welch H, Enane LA. Caring for Adolescents and Young Adults With Tuberculosis or at Risk of Tuberculosis: Consensus Statement From an International Expert Panel. J Adolesc Health 2023; 72:323-331. [PMID: 36803849 PMCID: PMC10265598 DOI: 10.1016/j.jadohealth.2022.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 02/19/2023]
Abstract
Background: Despite being a preventable and treatable disease, tuberculosis (TB) is a leading cause of death among young people globally. Each year, an estimated 1.8 million adolescents and young adults (AYAs; 10–24 years old) develop TB. In 2019, an estimated 161,000 AYAs died of the disease. AYAs have unique developmental, psychosocial, and healthcare needs, but these needs have been neglected in both TB care and research agendas. In order to improve outcomes in this age group, the specific needs of AYAs must be considered and addressed. Methods: Through a consensus process, an international panel of 34 clinicians, researchers, TB survivors, and advocates with expertise in child/adolescent TB and/or adolescent health proposed interventions for optimizing AYA engagement in TB care. The process consisted of reviewing the literature on TB in AYAs; identifying and discussing priority areas; and drafting and revising proposed interventions until consensus, defined a priori , was reached. Results: The panel acknowledged the dearth of evidence on best practices for identifying and managing AYAs with TB. The final consensus statement, based on expert opinion, proposes nine interventions to reform current practices that may harm AYA health and well-being, and nine interventions to establish high-quality AYA-centered TB services. Conclusion: AYA-specific interventions for TB care and research are critical for improving outcomes in this age group. In the absence of evidence on best practices, this consensus statement from an international group of experts can help address the needs of AYA with TB or at risk for TB.
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Affiliation(s)
- Silvia S Chiang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island; Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island.
| | - Patricia M Waterous
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Sarah Bernays
- School of Public Health, University of Sydney, Sydney, Australia; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Yaroslava Bondarenko
- Department of Phthisiology and Pulmonology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Andrea T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Márcia C B de Oliveira
- Department of Pediatrics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Pediatrics, Souza Marques School of Medicine, Rio de Janeiro, Brazil
| | | | - Anthony Enimil
- Child Health Department, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Child Health Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Gabriella Ferlazzo
- Médecins Sans Frontières, Cape Town, South Africa; Médecins Sans Frontières, Mumbai, India
| | - Rashida Abbas Ferrand
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom; Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Sentinel Project on Pediatric Drug-Resistant Tuberculosis, Boston, Massachusetts
| | - Graeme Hoddinott
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Petros Isaakidis
- Médecins Sans Frontières, Cape Town, South Africa; Médecins Sans Frontières, Mumbai, India
| | - Katharina Kranzer
- School of Public Health, University of Sydney, Sydney, Australia; Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | | | - Ben J Marais
- Sydney Infectious Diseases Institute (Sydney ID), University of Sydney, Sydney, Australia; Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia
| | | | | | | | | | - Clemax Couto Sant'Anna
- Department of Pediatrics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital and Murdoch Children's Research Institute, Melbourne, Australia; Department of Peadiatrics, The University of Melbourne, Melbourne, Australia
| | - H Simon Schaaf
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - James A Seddon
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa; Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Sangeeta Sharma
- Department of Paediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Alena Skrahina
- Clinical Department, The Republican Research and Practica Centre for Pulmonology and TB, Minsk, Belarus
| | - Jeffrey R Starke
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Rina Triasih
- Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | - Henry Welch
- Department of Pediatrics, Souza Marques School of Medicine, Rio de Janeiro, Brazil; Department of Pediatrics, School of Medicine and Health Sciences, The University of Papua New Guinea, Port Moresby, Papua New Guinea; Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Leslie A Enane
- Department of Pediatrics, The Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Center for Global Health, Indianapolis, Indiana.
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23
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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Garcia-Prats AJ, Hesseling AC. Stable, compounded bedaquiline suspensions to support practical implementation of pediatric dosing in the field. Int J Tuberc Lung Dis 2023; 27:189-194. [PMID: 36855042 PMCID: PMC9983625 DOI: 10.5588/ijtld.22.0440] [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] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND: Bedaquiline (BDQ) tablets are indicated as part of a combination regimen for the treatment of multidrug-resistant TB in adults, adolescents and children. A dispersible tablet formulation is now approved but is not currently available in all settings. The aim of this study was to develop stable extemporaneous liquid formulations of BDQ that can be stored at room temperature or 30°C for several weeks, to support pragmatic pediatric dosing in the field and reduce wastage.METHODS: BDQ tablets were suspended in simple syrup and a sugar-free vehicle. Each 20 mg/mL formulation was stored at room temperature or 30°C for 30 days in amber dispensing bottles. Appearance, BDQ potency, pH and microbial counts were determined on Days 0, 15 and 30.RESULTS: The BDQ potency in both formulations remained at 98-101% of the theoretical concentration for 30 days. The appearance, pH and microbial count of sugar-free formulation did not change during the 30-day storage. The simple syrup formulation was stable for 15 days as microbial growth was observed on Day 30.CONCLUSIONS: BDQ may be prepared in syrup or sugar-free suspensions: syrup suspensions can be stored for 15 days at room temperature and 30C, whereas sugar-free suspensions can be stored for 30 days at room temperature and 30C. This information will support practical BDQ dosing for children in the field.
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Affiliation(s)
- R Taneja
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - M C Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, The Ohio State University, Columbus, OH, USA
| | - J Scarim
- JSAS Services Inc Tucson, AZ, USA
| | - P G Pande
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - A Scarim
- JSAS Services Inc Tucson, AZ, USA
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - C L Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R K Jew
- Institute for Safe Medication Practices (ISMP), Plymouth Meeting, PA, USA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A J Garcia-Prats
- Department of Pediatrics University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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24
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Nicholson TJ, Hoddinott G, Seddon JA, Claassens MM, van der Zalm MM, Lopez E, Bock P, Caldwell J, Da Costa D, de Vaal C, Dunbar R, Du Preez K, Hesseling AC, Joseph K, Kriel E, Loveday M, Marx FM, Meehan SA, Purchase S, Naidoo K, Naidoo L, Solomon-Da Costa F, Sloot R, Osman M. A systematic review of risk factors for mortality among tuberculosis patients in South Africa. Syst Rev 2023; 12:23. [PMID: 36814335 PMCID: PMC9946877 DOI: 10.1186/s13643-023-02175-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/17/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Tuberculosis (TB)-associated mortality in South Africa remains high. This review aimed to systematically assess risk factors associated with death during TB treatment in South African patients. METHODS We conducted a systematic review of TB research articles published between 2010 and 2018. We searched BioMed Central (BMC), PubMed®, EBSCOhost, Cochrane, and SCOPUS for publications between January 2010 and December 2018. Searches were conducted between August 2019 and October 2019. We included randomised control trials (RCTs), case control, cross sectional, retrospective, and prospective cohort studies where TB mortality was a primary endpoint and effect measure estimates were provided for risk factors for TB mortality during TB treatment. Due to heterogeneity in effect measures and risk factors evaluated, a formal meta-analysis of risk factors for TB mortality was not appropriate. A random effects meta-analysis was used to estimate case fatality ratios (CFRs) for all studies and for specific subgroups so that these could be compared. Quality assessments were performed using the Newcastle-Ottawa scale or the Cochrane Risk of Bias Tool. RESULTS We identified 1995 titles for screening, 24 publications met our inclusion criteria (one cross-sectional study, 2 RCTs, and 21 cohort studies). Twenty-two studies reported on adults (n = 12561) and two were restricted to children < 15 years of age (n = 696). The CFR estimated for all studies was 26.4% (CI 18.1-34.7, n = 13257 ); 37.5% (CI 24.8-50.3, n = 5149) for drug-resistant (DR) TB; 12.5% (CI 1.1-23.9, n = 1935) for drug-susceptible (DS) TB; 15.6% (CI 8.1-23.2, n = 6173) for studies in which drug susceptibility was mixed or not specified; 21.3% (CI 15.3-27.3, n = 7375) for people living with HIV/AIDS (PLHIV); 19.2% (CI 7.7-30.7, n = 1691) in HIV-negative TB patients; and 6.8% (CI 4.9-8.7, n = 696) in paediatric studies. The main risk factors associated with TB mortality were HIV infection, prior TB treatment, DR-TB, and lower body weight at TB diagnosis. CONCLUSIONS In South Africa, overall mortality during TB treatment remains high, people with DR-TB have an elevated risk of mortality during TB treatment and interventions to mitigate high mortality are needed. In addition, better prospective data on TB mortality are needed, especially amongst vulnerable sub-populations including young children, adolescents, pregnant women, and people with co-morbidities other than HIV. Limitations included a lack of prospective studies and RCTs and a high degree of heterogeneity in risk factors and comparator variables. SYSTEMATIC REVIEW REGISTRATION The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018108622. This study was funded by the Bill and Melinda Gates Foundation (Investment ID OPP1173131) via the South African TB Think Tank.
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Affiliation(s)
- Tamaryn J Nicholson
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Mareli M Claassens
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Human, Biological and Translational Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elisa Lopez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- IS Global, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universidad de Barcelona, Barcelona, Spain
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Judy Caldwell
- Community Services and Health Directorate, City of Cape Town, Cape Town, South Africa
| | - Dawood Da Costa
- Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Celeste de Vaal
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karen Du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kay Joseph
- Community Services and Health Directorate, City of Cape Town, Cape Town, South Africa
| | - Ebrahim Kriel
- Metro Health Services, Southern and Western Substructure, Western Cape Government: Health, Cape Town, South Africa
| | - Marian Loveday
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa, CAPRISA-SA-MRC HIV-TB Pathogenesis and Treatment Research Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Florian M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Sue-Ann Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan Purchase
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa, CAPRISA-SA-MRC HIV-TB Pathogenesis and Treatment Research Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Lenny Naidoo
- Community Services and Health Directorate, City of Cape Town, Cape Town, South Africa
| | | | - Rosa Sloot
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Muhammad Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- School of Human Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich, London, United Kingdom.
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25
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De Villiers L, Swartz L, Bock P, Seeley J, Stangl AL, Bond V, Hargreaves J, Hoddinott G. HIV and gender identity expression among transfeminine women in the Western Cape, South Africa - a thematic analysis of data from the HPTN 071 (PopART) trial. Res Sq 2023:rs.3.rs-2486896. [PMID: 36798211 PMCID: PMC9934773 DOI: 10.21203/rs.3.rs-2486896/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction Transfeminine women in South Africa have a high HIV risk due to structural, behavioural, and psychosocial factors. Transfeminine women and feminine identifying men who have sex with men (MSM) are often conflated or grouped with transgender or MSM categories in HIV service programming, although they don't necessarily identify as either. We aimed to investigate gender expression among feminine identifying people who were assigned male at birth. We examined how local conceptualizations of sexuality and gender intersect with the key population label of 'transgender' imported into local HIV programming. Methods A qualitative cohort nested within the HPTN 071 (PopART) trial included longitudinal, in-depth interviews with eight transfeminine women (four who disclosed as living with HIV). Data were collected approximately every six weeks between January 2016 and October 2017. We discuss gender identification presented in participants' daily lives and in relation to HIV service access. Results Of the eight participants, only one accepted 'transgender' as a label, and even she used varying terms at different times to describe her identity. For participants, a feminine identity included dressing in normatively feminine clothes; using feminine terms, pronouns and names; and adopting stereotypically feminine mannerisms. Participants would switch between typically feminine and masculine norms in response to contextual cues and audience. For example, some participants accepted identification as masculine gay men amongst their family members, but amongst peers, they expressed a more effeminate identity and with partners they took on a feminine identity. Conclusions Our findings are amongst the first exploratory and descriptive data of transfeminine women in South Africa. We show how transfeminine women navigate fluid gender identities that could pose a challenge for accessing and utilizing HIV services that are currently set up for transgender individuals or MSM. More work needs to be done to understand and respond to the diverse and shifting ways people experience their gender identities in this high HIV burden context.
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26
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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Hesseling AC, Garcia-Prats AJ. Extemporaneously compounded liquid formulations of clofazimine. Int J Tuberc Lung Dis 2023; 27:106-112. [PMID: 36853102 PMCID: PMC9904399 DOI: 10.5588/ijtld.22.0331] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND: Clofazimine (CFZ) is routinely used worldwide for the treatment of leprosy and TB. However, no liquid or dispersible tablet formulations of CFZ are currently available commercially for patients with challenges ingesting soft gelatin capsules or solid formulations. The aim of this research was to develop stable extemporaneous liquid formulations of CFZ that can be stored at room temperature for several weeks to enable practical dosing in the field.METHODS: Two formulations were prepared in syrup and sugar-free vehicles with CFZ tablets using a simple method that can be used in a routine pharmacy. Suspensions were stored at room temperature and at 30°C for 30 days. Formulation aliquots were tested on Days 0, 15 and 30 for appearance, pH, potency and microbial counts.RESULTS: Appearance remained unchanged during storage. The pH of both formulations was between 4.0 and 6.0. Potency was between 90% and 110% for 30 days in the syrup formulation and for 15 days in the sugar-free formulation. Microbial counts met United States Pharmacopeia <1111> limits for oral aqueous liquids and specific organisms were absent.CONCLUSIONS: A simple field-friendly method was successfully developed for the preparation of CFZ liquid formulations using commonly available ingredients. This will permit practical dosing and titration for children and other patients with swallowing challenges.
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Affiliation(s)
- R Taneja
- Global Alliance for TB drug Development (TB Alliance), New York, NY, USA
| | - M C Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, The Ohio State University, Columbus, OH, USA
| | - J Scarim
- JSAS Services Inc, Tucson, AZ, USA
| | - P G Pande
- Global Alliance for TB drug Development (TB Alliance), New York, NY, USA
| | - A Scarim
- JSAS Services Inc, Tucson, AZ, USA
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - C L Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R K Jew
- Institute for Safe Medication Practices, Plymouth Meeting, PA, USA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Garcia-Prats AJ, Hesseling AC. Sugar and sugar-free liquid formulations of delamanid for patients with rifampicin-resistant TB. Int J Tuberc Lung Dis 2023; 27:13-18. [PMID: 36853133 PMCID: PMC9879082 DOI: 10.5588/ijtld.22.0329] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND: Delamanid (DLM) tablets are recommended for the treatment of rifampicin-resistant TB. However, no liquid or dispersible tablet formulation of DLM is currently commercially available for patients with challenges ingesting these tablets. The aim of this study was to develop stable extemporaneous liquid formulations of DLM that can be stored at room temperature for several weeks.METHODS: DLM tablets were suspended in 1) simple syrup and 2) a specially formulated sugar-free vehicle. These suspensions containing DLM 5 mg/mL were stored in plastic prescription bottles at room temperature or 30°C for 30 days. These suspensions were evaluated for appearance, potency, pH, and microbial counts at Days 0, 15, and 30.RESULTS: The potency of DLM in each formulation remained at 98-104% of the theoretical concentration for 30 days. The appearance, pH, and microbial count did not change for the sugar-free formulation during the 30-day storage period. Microbial growth, however, was observed in the simple syrup formulation on Day 30 but not on Day 15.CONCLUSION: DLM can be formulated in sugar or sugar-free suspensions and stored at room temperature or 30°C for at least 15 and 30 days, respectively.
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Affiliation(s)
- R Taneja
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - M C Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, The Ohio State University, Columbus, OH, USA
| | - J Scarim
- JSAS Services Inc, Tucson, AZ, USA
| | - P G Pande
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - A Scarim
- JSAS Services Inc, Tucson, AZ, USA
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - C L Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R K Jew
- Institute for Safe Medication Practices, Horsham, PA, USA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A J Garcia-Prats
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Myburgh H, Baloyi D, Loveday M, Meehan SA, Osman M, Wademan D, Hesseling A, Hoddinott G. A scoping review of patient-centred tuberculosis care interventions: Gaps and opportunities. PLOS Glob Public Health 2023; 3:e0001357. [PMID: 36963071 PMCID: PMC10021744 DOI: 10.1371/journal.pgph.0001357] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/20/2022] [Indexed: 02/05/2023]
Abstract
Tuberculosis (TB) is a leading cause of death globally. In 2015, the World Health Organization hailed patient-centred care as the first of three pillars in the End TB strategy. Few examples of how to deliver patient-centred care in TB programmes exist in practice; TB control efforts have historically prioritised health systems structures and processes, with little consideration for the experiences of people affected by TB. We aimed to describe how patient-centred care interventions have been implemented for TB, highlighting gaps and opportunities. We conducted a scoping review of the published peer-reviewed research literature and grey literature on patient-centred TB care interventions between January 2005 and March 2020. We found limited information on implementing patient-centred care for TB programmes (13 research articles, 7 project reports, and 19 conference abstracts). Patient-centred TB care was implemented primarily as a means to improve adherence, reduce loss to follow-up, and improve treatment outcomes. Interventions focused on education and information for people affected by TB, and psychosocial, and socioeconomic support. Few patient-centred TB care interventions focused on screening, diagnosis, or treatment initiation. Patient-centred TB care has to go beyond programmatic improvements and requires recognition of the diverse needs of people affected by TB to provide holistic care in all aspects of TB prevention, care, and treatment.
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Affiliation(s)
- Hanlie Myburgh
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, The Netherlands
| | - Dzunisani Baloyi
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marian Loveday
- HIV and other Infectious Diseases Research Unit (HIDRU), South African Medical Research Council (SAMRC), Cape Town, South Africa
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Sue-Ann Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Muhammad Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Human Sciences, Faculty of Education, Health & Human Sciences, University of Greenwich, London, United Kingdom
| | - Dillon Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Wademan DT, Palmer M, Purchase S, van der Zalm MM, Osman M, Garcia-Prats AJ, Seddon JA, Schaaf HS, Hesseling AC, Reis R, Reynolds LJ, Hoddinott G. Toward a conceptual framework of the acceptability of tuberculosis treatment in children using a theory generative approach. PLOS Glob Public Health 2022; 2:e0001267. [PMID: 36962908 PMCID: PMC10021666 DOI: 10.1371/journal.pgph.0001267] [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: 07/28/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
To describe an early-stage holistic framework towards evaluating factors that impact the overall acceptability of TB treatment along the TB care cascade in children. We developed a conceptual framework utilising a theory generative approach. Domains were developed through review of existing definitions and analysis of existing qualitative data undertaken in acceptability studies of TB treatment in children. Clarity of domain definitions was achieved through iterative refinement among the research team. Three domains, each comprising several dimensions, were identified to holistically evaluate treatment acceptability: (1) usability, which involves the alignment between the requirements of treatment use and caregivers' and children's ability to integrate TB treatment into their everyday routines, (2) receptivity, which describes the end-user's perception and expectations of treatment and its actual use, and (3) integration, which describes the relationship between available health services and caregivers/children's capacity to make use of those services. Our framework addresses the gaps in current research which do not account for the influence of caregivers' and children's contexts on TB treatment uptake and overall acceptability. This approach may support the development of more standard, holistic measures to improve TB treatment delivery and experiences and future research in children.
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Affiliation(s)
- Dillon T. Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan Purchase
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marieke M. van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Muhammad Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Human Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich, London, United Kingdom
| | - Anthony J. Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Paediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - James A. Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - H. Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ria Reis
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Lindsey J. Reynolds
- Department of Sociology and Social Anthropology, Faculty of Arts and Social Sciences, Stellenbosch University, Cape Town, South Africa
- Pivot Collective, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Anthony MG, Hoddinott G, Van Niekerk M, Mtshabe A, Pienaar A, Dewandel I, Mckenzie C, Goussard P, Hesseling AC, van der Zalm MM. Caregivers' perspectives on health-related quality of life in young children with TB and respiratory illnesses. Public Health Action 2022; 12:201-205. [PMID: 36561904 PMCID: PMC9716816 DOI: 10.5588/pha.22.0038] [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: 05/26/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is a lack of holistic health-related quality of life (HRQoL) measures for young children with respiratory disease, especially in low- and middle-income countries (LMICs). We aimed to understand caregivers' perceptions of the relevance of common HRQoL domains for children with respiratory diseases, including TB. METHODS This study was nested in a prospective observational cohort of children presenting with respiratory symptoms presumptive of pulmonary TB. We conducted 10 semi-structured interviews to explore caregivers' perceptions of the five commonly measured HRQoL domains: physical health, social support, emotional and psychological wellbeing, and schooling. We used case descriptive analysis and thematic coding. RESULTS Caregivers considered all five domains to be relevant. The socio-economic context framed their responses, with QoL requiring sufficient basic resources for children. HRQoL experiences varied according to the severity of the child's symptoms, but not between TB and non-TB illnesses. Manifestations in the psychological domain were difficult to distinguish from the emotional domain. Social support included broad support for family members, indirectly benefiting the children. Caregivers were concerned about their children's early developmental milestones and future schooling. CONCLUSION This exploratory study shows that HRQoL domains are relevant but require adaptation to be applicable for young children affected by respiratory illnesses living in LMICs.
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Affiliation(s)
- M. G. Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - G. Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - M. Van Niekerk
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - A. Mtshabe
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - A. Pienaar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - I. Dewandel
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - C. Mckenzie
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - P. Goussard
- Paediatric Pulmonology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A. C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - M. M. van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
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Baloyi DP, Anthony MG, Meyerson KA, Mazibuko S, Wademan D, Viljoen L, Myburgh H, du Preez K, Osman M, Hirsch-Moverman Y, Charalambous S, Hausler H, Hesseling AC, Hoddinott G. Reasons for poor uptake of TB preventive therapy in South Africa. Public Health Action 2022; 12:159-164. [PMID: 36561901 PMCID: PMC9716815 DOI: 10.5588/pha.22.0030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/03/2022] [Accepted: 08/19/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND South Africa has one the highest TB and HIV burdens globally. TB preventive therapy (TPT) reduces the risk of TB disease and TB-related mortality in adults and children living with HIV and is indicated for use in TB-exposed HIV-negative individuals and children. TPT implementation in South Africa remains suboptimal. METHODS We conducted a pragmatic review of TPT implementation using multiple data sources, including informant interviews (n = 134), semi-structured observations (n = 93) and TB patient folder reviews in 31 health facilities purposively selected across three high TB burden provinces. We used case descriptive analysis and thematic coding to identify barriers and facilitators to TPT implementation. RESULTS TPT programme implementation was suboptimal, with inadequate monitoring even in health districts with well-functioning TB services. Health workers reported scepticism about TPT effectiveness, deprioritised TPT in practice and expressed divergent opinions about the cadres of staff responsible for implementation. Service- and facility-level barriers included ineffective contact tracing, resource shortages, lack of standardised reporting mechanisms and insufficient patient education on TPT. Patient-level barriers included socio-economic factors. CONCLUSIONS Improving TPT implementation will require radically simplified and more feasible systems and training for all cadres of health workers. Partnership with communities to stimulate demand driven service uptake can potentially facilitate implementation.
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Affiliation(s)
- D. P. Baloyi
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M. G. Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - K. A. Meyerson
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - S. Mazibuko
- Department of Psychology, University of KwaZulu-Natal, Durban, South Africa
| | - D. Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - L. Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - H. Myburgh
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - K. du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M. Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
, School of Human Sciences, University of Greenwich, London, UK
| | - Y. Hirsch-Moverman
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
| | | | | | - A. C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - G. Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Swanepoel J, Zimri K, van der Zalm MM, Hoddinott G, Palmer M, Doruyter A, De Beer G, Kleynhans L, Johnson SM, Jongen V, Wademan D, Mcimeli K, Jacobs S, Swanepoel R, Van Zyl G, Allwood BW, Malherbe S, Heuvelings C, Griffith-Richards S, Whittaker E, Moore DAJ, Schaaf HS, Hesseling AC, Seddon JA. Understanding the biology, morbidity and social contexts of adolescent tuberculosis: a prospective observational cohort study protocol (Teen TB). BMJ Open 2022; 12:e062979. [PMID: 36600434 PMCID: PMC9772637 DOI: 10.1136/bmjopen-2022-062979] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION A considerable burden of the tuberculosis (TB) epidemic is found in adolescents. The reasons for increased susceptibility to TB infection and higher incidence of TB disease in adolescence, compared with the 5-10 years old age group, are incompletely understood. Despite the pressing clinical and public health need to better understand and address adolescent TB, research in this field remains limited. METHODS AND ANALYSIS Teen TB is an ongoing prospective observational cohort study that aims to better understand the biology, morbidity and social context of adolescent TB. The study plans to recruit 50 adolescents (10-19 years old) with newly diagnosed microbiologically confirmed pulmonary TB disease and 50 TB-exposed controls without evidence of TB disease in Cape Town, South Africa, which is highly endemic for TB. At baseline, cases and controls will undergo a detailed clinical evaluation, chest imaging, respiratory function assessments and blood collection for viral coinfections, inflammatory cytokines and pubertal hormone testing. At 2 weeks, 2 months and 12 months, TB disease cases will undergo further chest imaging and additional lung function testing to explore the patterns of respiratory abnormalities. At week 2, cases will complete a multicomponent quantitative questionnaire about psychological and social impacts on their experiences and longitudinal, in-depth qualitative data will be collected from a nested subsample of 20 cases and their families. ETHICS AND DISSEMINATION The study protocol has received ethical approval from the Stellenbosch University Health Research Ethics Committee (N19/10/148). The study findings will be disseminated through peer-reviewed publications, academic conferences and formal presentations to health professionals. Results will also be made available to participants and caregivers.
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Affiliation(s)
- Jeremi Swanepoel
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Klassina Zimri
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Alex Doruyter
- NuMeRI Node for Infection Imaging, Central Analytical Facilities, Stellenbosch University, Cape Town, South Africa
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa
| | - Gezila De Beer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leanie Kleynhans
- South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, DSI-NRF Centre of Excellence, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Sarah M Johnson
- Department of Infectious Disease, Imperial College London, London, UK
| | - Vita Jongen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Dillon Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Khanyisa Mcimeli
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephanie Jacobs
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ruan Swanepoel
- Division of Pulmonology, Department of Internal Medicine, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Gert Van Zyl
- Division of Medical Virology, Department of Pathology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Brian W Allwood
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Stephanus Malherbe
- South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, DSI-NRF Centre of Excellence, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Charlotte Heuvelings
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephanie Griffith-Richards
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | | | - David A J Moore
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Infectious Disease, Imperial College London, London, UK
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Van Wyk SS, Nliwasa M, Seddon JA, Hoddinott G, Viljoen L, Nepolo E, Günther G, Ruswa N, Lin HH, Niemann S, Gandhi NR, Shah NS, Claassens M. Case-Finding Strategies for Drug-Resistant Tuberculosis: Protocol for a Scoping Review. JMIR Res Protoc 2022; 11:e40009. [PMID: 36520530 PMCID: PMC9801265 DOI: 10.2196/40009] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Transmission of drug-resistant tuberculosis (DR-TB) is ongoing. Finding individuals with DR-TB and initiating treatment as early as possible is important to improve patient clinical outcomes and to break the chain of transmission to control the pandemic. To our knowledge systematic reviews assessing effectiveness, cost-effectiveness, acceptability, and feasibility of different case-finding strategies for DR-TB to inform research, policy, and practice have not been conducted, and it is unknown whether enough research exists to conduct such reviews. It is unknown whether case-finding strategies are similar for DR-TB and drug-susceptible TB and whether we can draw on findings from drug-susceptible reviews to inform decisions on case-finding strategies for DR-TB. OBJECTIVE This protocol aims to describe the available literature on case-finding for DR-TB and to describe case-finding strategies. METHODS We will screen systematic reviews, trials, qualitative studies, diagnostic test accuracy studies, and other primary research that specifically sought to improve DR-TB case detection. We will exclude studies that invited individuals seeking care for TB symptoms, those including individuals already diagnosed with TB, or laboratory-based studies. We will search the academic databases including MEDLINE, Embase, The Cochrane Library, Africa-Wide Information, CINAHL, Epistemonikos, and PROSPERO with no language or date restrictions. We will screen titles, abstracts, and full-text articles in duplicate. Data extraction and analyses will be performed using Excel (Microsoft Corp). RESULTS We will provide a narrative report with supporting figures or tables to summarize the data. A systems-based logic model, developed from a synthesis of case-finding strategies for drug-susceptible TB, will be used as a framework to describe different strategies, resulting pathways, and enhancements of pathways. The search will be conducted at the end of 2021. Title and abstract screening, full text screening, and data extraction will be undertaken from January to June 2022. Thereafter, analysis will be conducted, and results compiled. CONCLUSIONS This scoping review will chart existing literature on case-finding for DR-TB-this will help determine whether primary studies on effectiveness, cost-effectiveness, acceptability, and feasibility of different case-finding strategies for DR-TB exist and will help formulate potential questions for a systematic review. We will also describe case-finding strategies for DR-TB and how they fit into a model of case-finding pathways for drug-susceptible TB. This review has some limitations. One limitation is the diverse, inconsistent use of intervention terminology within the literature, which may result in missing relevant studies. Poor reporting of intervention strategies may also cause misunderstanding and misclassification of interventions. Lastly, case-finding strategies for DR-TB may not fit into a model developed from strategies for drug-susceptible TB. Nevertheless, such a situation will provide an opportunity to refine the model for future research. The review will guide further research to inform decisions on case-finding policies and practices for DR-TB. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40009.
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Affiliation(s)
- Susanna S Van Wyk
- Centre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Marriott Nliwasa
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - James A Seddon
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Graeme Hoddinott
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lario Viljoen
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Emmanuel Nepolo
- Department of Human, Biological and Translational Medical Science, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Gunar Günther
- Department of Human, Biological and Translational Medical Science, School of Medicine, University of Namibia, Windhoek, Namibia
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nunurai Ruswa
- Ministry of Health and Social Services, Windhoek, Namibia
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Stefan Niemann
- Molecular and Experimental Mycobacteriology Group, Forschungszentrum Borstel, Borstel, Germany
- National Reference Center for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany
| | - Neel R Gandhi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - N Sarita Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Mareli Claassens
- Department of Human, Biological and Translational Medical Science, School of Medicine, University of Namibia, Windhoek, Namibia
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Shanaube K, Gachie T, Hoddinott G, Schaap A, Floyd S, Mainga T, Bond V, Hayes R, Fidler S, Ayles H. Depressive symptoms and HIV risk behaviours among adolescents enrolled in the HPTN071 (PopART) trial in Zambia and South Africa. PLoS One 2022; 17:e0278291. [PMID: 36454874 PMCID: PMC9714741 DOI: 10.1371/journal.pone.0278291] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Mental health is a critical and neglected public health problem for adolescents in sub-Saharan Africa. In this paper we aim to determine the prevalence of depressive symptoms and the association with HIV risk behaviours in adolescents aged 15-19 years in Zambia and SA. METHODS We conducted a cross-sectional survey from August-November 2017 in seven control communities of HPTN 071 (PopART) trial (a community-randomised trial of universal HIV testing and treatment), enrolling approximately 1400 eligible adolescents. HIV-status was self-reported. Depressive symptoms were measured with the Short Mood and Feelings Questionnaire (SMFQ), with a positive screen if adolescents scored ≥12. We fitted a logistic regression model to identify correlates of depressive symptoms with subgroup analyses among those who self-reported ever having had sex, by gender and country. RESULTS Out of 6997 households approached, 6057 (86.6%) were enumerated. 2546 adolescents were enumerated of whom 2120 (83.3%) consented to participate and were administered the SMFQ. The prevalence of depressive symptoms was 584/2120 (27.6%) [95%CI: 25.7%-29.5%]. Adolescents in SA were less likely to experience depressive symptoms (Adjusted Odds Ratio [AOR] = 0.63 (95% CI: 0.50, 0.79), p-value<0.0001). Female adolescents (AOR = 1.46 (95% CI: 1.19, 1.81), p-value<0.0001); those who reported ever having sex and being forced into sex (AOR = 1.80 (95% CI: 1.45, 2.23), p-value<0.001) and AOR = 1.67 (95% CI: 0.99, 2.84); p-value = 0.057 respectively) were more likely to experience depressive symptoms. Among 850 (40.1%) adolescents who self-reported to ever having had sex; those who used alcohol/drugs during their last sexual encounter were more likely to experience depressive symptoms (AOR = 2.18 (95% CI: 1.37, 3.47); p-value = 0.001), whereas those who reported using a condom were less likely to experience depressive symptoms (AOR = 0.74 (95% CI: 0.55, 1.00); p-value = 0.053). CONCLUSION The prevalence of depressive symptoms among adolescents ranged from 25-30% and was associated with increased HIV-risk behaviour.
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Affiliation(s)
| | - Thomas Gachie
- Zambart, Lusaka, Zambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Albertus Schaap
- Zambart, Lusaka, Zambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sian Floyd
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Virginia Bond
- Zambart, Lusaka, Zambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Richard Hayes
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Fidler
- Department of infectious disease, Imperial College, London, Imperial College NIHR BRC, United Kingdom
| | - Helen Ayles
- Zambart, Lusaka, Zambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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van den Heuvel LL, Ahmed-Leitao F, du Plessis S, Hoddinott G, Spies G, Seedat S. Hazardous or harmful alcohol use and reward processing in people with HIV. J Neurovirol 2022; 28:514-526. [PMID: 36214999 DOI: 10.1007/s13365-022-01097-w] [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: 11/19/2021] [Revised: 08/11/2022] [Accepted: 09/12/2022] [Indexed: 01/13/2023]
Abstract
The intersecting epidemics of HIV and hazardous or harmful alcohol use (HAU) can have significant detrimental consequences. Both HIV and HAU have independent negative influences on executive function. Dysfunction in reward processing may play a role in these co-occurring epidemics. In this cross-sectional case-control study, we investigated the association of HAU with reward processing amongst people with HIV (PWH). We investigated the function of the ventral-striatal reward system using a functional MRI (fMRI) monetary incentive delay (MID) task in a sample of 60 South African adults (mean age 32.7 years): 42 living with HIV and on ART (21 with harmful alcohol use [HIV + HAU], 21 without [HIV-HAU]) and 18 healthy controls, matched for age, gender, and resident community. Education significantly influenced task performance, with those with a secondary level of education demonstrating a greater increase in reaction time (p = 0.048) and accuracy (p = 0.002) than those without. There were no significant differences in reward anticipation in the ventral striatum (VS) between HIV + HAU, HIV-HAU, and healthy controls when controlling for level of education. There were also no significant differences in reward outcome in the orbitofrontal cortex (OFC) between HIV + HAU, HIV-HAU, and healthy controls when controlling for level of education. In a sample of South African adults, we did not demonstrate significant differences in reward anticipation in the VS and reward outcome in the OFC in PWH, with and without HAU, and controls. Factors, such as task performance, education, and depression may have influenced our results. Further studies are needed to better delineate the potential links between HIV, HAU, and depression and reward system function.
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Affiliation(s)
- Leigh L van den Heuvel
- Department of Psychiatry, Clinical Building, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, PO Box 241, Cape Town, 8000, South Africa. .,Genomics of Brain Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
| | - Fatima Ahmed-Leitao
- Department of Psychiatry, Clinical Building, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, PO Box 241, Cape Town, 8000, South Africa.,DSI/NRF South African Research Chairs Initiative, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Stefan du Plessis
- Department of Psychiatry, Clinical Building, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, PO Box 241, Cape Town, 8000, South Africa.,Genomics of Brain Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Georgina Spies
- Genomics of Brain Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,DSI/NRF South African Research Chairs Initiative, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Clinical Building, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, PO Box 241, Cape Town, 8000, South Africa.,Genomics of Brain Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,DSI/NRF South African Research Chairs Initiative, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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36
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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Garcia-Prats AJ, Hesseling AC. Stable sugar and sugar-free suspensions of pretomanid. Int J Tuberc Lung Dis 2022; 26:1112-1117. [PMID: 36447311 PMCID: PMC9728945 DOI: 10.5588/ijtld.22.0330] [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] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND: Pretomanid (PMD) tablets are indicated as part of a combination regimen for the treatment of adults with pulmonary extensively drug-resistant, treatment-intolerant or non-responsive multidrug-resistant TB. No commercial liquid formulation is currently available for patients unable to swallow these tablets.OBJECTIVE: To develop stable extemporaneous liquid formulations of PMD that can be stored at room temperature or 30°C for at least 4 weeks.METHODS: Crushed PMD tablets were formulated into 20 mg/mL suspensions in a simple syrup and sugar-free formulation. The PMD formulations were stored at room temperature and at 30°C for 30 days in dispensing bottles. Appearance, pH, potency and microbial counts of the suspensions were determined on Days 0, 15 and 30.RESULTS: The potency of PMD remained at 99.7-103.4% of the theoretical concentration in each formulation. The appearance, pH and microbial count did not change during the 30-day storage period. Simple syrup formulations did not require preservatives for microbial stability.CONCLUSIONS: PMD oral suspension formulations in simple syrup or in sugar-free vehicle were easily prepared by utilising commonly available equipment and ingredients and were stable for 30 days. These formulations are appropriate alternatives for patients with swallowing difficulties.
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Affiliation(s)
- R. Taneja
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - M. C. Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, Ohio State University, Columbus, OH, USA
| | | | - P. G. Pande
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | | | - G. Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - C. L. Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R. K. Jew
- Institute for Safe Medication Practices, Horsham, PA, USA
| | - H. S. Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A. J. Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
,Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - A. C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Macleod D, Shanaube K, Skalland T, Limbada M, Mandla N, Bwalya J, Schaap A, Yang B, Donnell D, Piwowar-Manning E, Eshleman SH, Hoddinott G, Bond V, Moore A, Griffith S, Bock P, Ayles H, Fidler S, Hayes R, Floyd S. Viral suppression and self-reported ART adherence after 3 years of universal testing and treatment in the HPTN 071 (PopART) community-randomised trial in Zambia and South Africa: a cross-sectional analysis. Lancet HIV 2022; 9:e751-e759. [PMID: 36332652 PMCID: PMC9646982 DOI: 10.1016/s2352-3018(22)00237-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 07/25/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In 2014, UNAIDS set the target that 90% of individuals on antiretroviral therapy (ART) be virally suppressed. Here, we use data from the HPTN 071 (PopART) trial to report whether the introduction of universal testing and treatment has affected viral suppression or treatment adherence among individuals who self-reported they were taking ART, and identify risk factors for these outcomes. METHODS This was a cross-sectional study nested within the randomly selected population cohort of the PopART trial. The trial took place in 21 communities in Zambia and South Africa. Analyses included 3570 HIV-positive participants who were seen at the second follow-up visit in 2016-17 and who self-reported that they were currently taking ART. Viral suppression was defined as HIV RNA of less than 400 copies per mL from a blood sample collected during the cohort visit, and ART adherence was measured using self-reporting (reported as no missed pills in last 7 days). Prevalences of these outcomes were compared across three trial arms using a two-stage approach suitable for clustered data. Each arm consisted of seven communities, with one arm receiving a combination HIV prevention package including immediate ART initiation, one receiving a combination HIV prevention package excluding immediate ART initiation and one arm receving standard of care. Risk factors for each of the outcomes were assessed using logistic regression. FINDINGS Among the 3570 participants who self-reported that they were currently on ART, 416 (11·7%) of 3554 were not virally suppressed (16 were missing viral suppression status) and 345 (9·7%) of 3566 reported being non-adherent to ART (four were missing adherence status). The proportion not virally suppressed was higher in communities in South Africa (195 [16·4%] of 1191) than in Zambia (221 [9·4%] of 2363). There was no evidence that the prevalence of the outcomes differed between trial arms. There was evidence that men, younger individuals, individuals who reported participating in harmful alcohol use, and those who reported internalised stigma were more likely to be non-adherent, and not virally suppressed. INTERPRETATION The results assuaged concerns that early ART initiation in a universal testing and treatment setting could lead to reduced adherence and viral suppression. FUNDING US National Institute of Allergy and Infectious Diseases (which is a part of the National Institutes of Health), the International Initiative for Impact Evaluation with support from the Bill & Melinda Gates Foundation, US President's Emergency Plan for AIDS Relief, and Medical Research Council UK.
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Affiliation(s)
- David Macleod
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Kwame Shanaube
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Mohammed Limbada
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Nomtha Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Justin Bwalya
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Ab Schaap
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Blia Yang
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Deborah Donnell
- HPTN Statistical and Data Management Centre, Seattle, WA, USA
| | | | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Virginia Bond
- Global Health and Development Department, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Ayana Moore
- FHI 360, HIV Prevention Trials Network, Durham, NC, USA
| | - Sam Griffith
- FHI 360, HIV Prevention Trials Network, Durham, NC, USA
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Helen Ayles
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Sarah Fidler
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Richard Hayes
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sian Floyd
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Wilson E, Donnell D, Skalland T, Floyd S, Moore A, Bell-Mandla N, Bwalya J, Kasese N, Dunbar R, Shanaube K, Kosloff B, Laeyendecker O, Agyei Y, Hoddinott G, Bock P, Fidler S, Hayes R, Ayles H. Impact of universal testing and treatment on sexual risk behaviour and herpes simplex virus type 2: a prespecified secondary outcomes analysis of the HPTN 071 (PopART) community-randomised trial. Lancet HIV 2022; 9:e760-e770. [PMID: 36332653 PMCID: PMC9646971 DOI: 10.1016/s2352-3018(22)00253-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 08/23/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Comprehensive HIV prevention strategies have raised concerns that knowledge of interventions to reduce risk of HIV infection might mitigate an individual's perception of risk, resulting in riskier sexual behaviour. We investigated the prespecified secondary outcomes of the HPTN 071 (PopART) trial to determine whether a combination HIV prevention strategy, including universal HIV testing and treatment, changed sexual behaviour; specifically, we investigated whether there was evidence of sexual risk compensation. METHODS HPTN 071 (PopART) was a cluster-randomised trial conducted during 2013-18, in which we randomly assigned 21 communities with high HIV prevalence in Zambia and South Africa (total population, approximately 1 million) to combination prevention intervention with universal antiretroviral therapy (ART; arm A), prevention intervention with ART provided according to local guidelines (universal since 2016; arm B), or standard of care (arm C). The trial included a population cohort of approximately 2000 randomly selected adults (aged 18-44 years) in each community (N=38 474 at baseline) who were followed up for 36 months. A prespecified secondary objective was to evaluate the impact of the PopART intervention compared with standard of care on herpes simplex virus type 2 (HSV-2) and sexual behaviour (N=20 422 completed final visit). Secondary endpoints included differences in sexual risk behaviour measures at 36 months and were assessed using a two-stage method for matched cluster-randomised trials. This trial is registered with ClinicalTrials. gov, number NCT01900977. FINDINGS The PopART intervention did not substantially change probability of self-reported multiple sex partners, sexual debut, or pregnancy in women at 36 months. Adjusted for baseline community prevalence, reported condomless sex was significantly lower in arm A versus arm C (adjusted prevalence ratio 0·80 [95% CI 0·64-0·99]; p=0·04) but not in arm B versus arm C (0·94 [0·76-1·17]; p=0·55). 3-year HSV-2 incidence was reduced in arm B versus arm C (adjusted risk ratio 0·76 [95% CI 0·63-0·92]; p=0·010); no significant change was shown between arm A versus arm C (0·89 [0·73-1·08]; p=0·199). INTERPRETATION We found little evidence of any change in sexual behaviour owing to the PopART interventions, and reassuringly for public health, we saw no evidence of sexual risk compensation. The findings do not help to explain the differences between the two intervention groups of the HPTN 071 (PopART) trial. FUNDING National Institute of Allergy and Infectious Diseases, the National Institutes of Health, the International Initiative for Impact Evaluation (3ie), the Bill & Melinda Gates Foundation, the US President's Emergency Plan for AIDS Relief, and the Medical Research Council UK.
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Affiliation(s)
- Ethan Wilson
- Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | | | | | - Sian Floyd
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Nomtha Bell-Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Barry Kosloff
- London School of Hygiene and Tropical Medicine, London, UK; Zambart, Lusaka, Zambia
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA; Johns Hopkins Univiersity School of Medicine, Baltimore, MD, USA
| | - Yaw Agyei
- Johns Hopkins Univiersity School of Medicine, Baltimore, MD, USA
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sarah Fidler
- Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
| | - Richard Hayes
- London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Ayles
- London School of Hygiene and Tropical Medicine, London, UK; Zambart, Lusaka, Zambia
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Simwinga M, Ndubani R, Schaap A, Ziba D, Bwalya C, Belemu S, Ngwenya F, Bwalya J, Shanaube K, Hoddinott G, White R, Bock P, Fidler S, Hayes R, Seeley J, Ayles H, Bond V. Disseminating complex primary outcome results from a community-randomised trial to Zambian communities: lessons learned using a community dialogue approach in the HPTN 071 (PopART) trial. Lancet HIV 2022; 9:e801-e808. [PMID: 36191598 PMCID: PMC10577308 DOI: 10.1016/s2352-3018(22)00226-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 10/14/2022]
Abstract
The HPTN 071 (PopART) trial of universal HIV testing and treatment to reduce HIV incidence was conducted in nine communities in South Africa and 12 in Zambia. The trial's primary outcome results were complicated to explain. Dissemination of these complicated results in participating communities in Zambia was done using a community dialogue approach. The approach, which involved interactive activities and a gradual and systematic approach to discussion of results in each community, facilitated respect and inclusion of participants in the dissemination process. The use of local language, pictures, images, and familiar analogies enhanced comprehension of the findings and created a two-way communication process between researchers and participants. The dialogue approach enabled both groups to use community perspectives, lived experiences, and local socio-structural features to interpret the trial results. Further, community members reflected on what the results meant to them individually and collectively. Although this community dialogue was both productive and appreciated, making this community interpretation apparent across disciplines in key quantitative scientific outputs remained a challenge.
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Affiliation(s)
| | | | - Albertus Schaap
- Zambart, Lusaka, Zambia; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene &Tropical Medicine, London, UK
| | | | | | | | | | | | | | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene &Tropical Medicine, London, UK
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene &Tropical Medicine, London, UK
| | - Helen Ayles
- Zambart, Lusaka, Zambia; Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London, UK
| | - Virginia Bond
- Zambart, Lusaka, Zambia; Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene &Tropical Medicine, London, UK
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Viljoen L, Hendricks P, Hoddinott G, Vanqa N, Osman M, Hesseling AC, Meehan SA. Early interactions with newly diagnosed TB patients in hospital can support linkage to care. Public Health Action 2022; 12:121-127. [PMID: 36160718 PMCID: PMC9484593 DOI: 10.5588/pha.22.0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: In South Africa, failure to link individuals diagnosed with TB to care remains an important gap in the TB care cascade. Compared to people diagnosed at primary healthcare (PHC) facilities, people diagnosed in hospitals are more likely to require additional support to be linked with PHC TB treatment services. We describe a patient interaction process to support linkage to TB care. METHODS: We implemented a step-by-step early patient interaction process with 84 adults newly diagnosed with TB in one district hospital in Khayelitsha, Cape Town, South Africa (August 2020–March 2021). We confirmed patient contact details, provided TB and health information, shared information on accessing care at PHC facilities and answered patients’ questions in their home language. RESULTS: Most patients (54/84, 64%) provided updated telephone numbers, and 19/84 (23%) reported changes in their physical address. Patients welcomed practical and health information in their home language. The majority (74/84, 88%) were linked to care after hospital discharge. CONCLUSIONS: A simple early patient interaction process implemented as part of routine care is a feasible strategy to facilitate early TB treatment initiation and registration.
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Affiliation(s)
- L. Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - P. Hendricks
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - G. Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - N. Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - M. Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa, School of Human Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich,
Greenwich, UK
| | - A. C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - S-A. Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Hargreaves JR, Pliakas T, Hoddinott G, Mainga T, Mubekapi‐Musadaidzwa C, Donnell D, Wilson E, Piwowar‐Manning E, Agyei Y, Bell‐Mandla NF, Dunbar R, Schaap A, Macleod D, Floyd S, Bock P, Fidler S, Seeley J, Stangl A, Bond V, Ayles H, Hayes RJ. The association between HIV stigma and HIV incidence in the context of universal testing and treatment: analysis of data from the HPTN 071 (PopART) trial in Zambia and South Africa. J Int AIDS Soc 2022; 25 Suppl 1:e25931. [PMID: 35818869 PMCID: PMC9274206 DOI: 10.1002/jia2.25931] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/03/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION To investigate the association between individual and community-level measures of HIV stigma and HIV incidence within the 21 communities participating in the HPTN (071) PopART trial in Zambia and South Africa. METHODS Secondary analysis of data from a population-based cohort followed-up over 36 months between 2013 and 2018. The outcome was rate of incident HIV infection among individuals who were HIV negative at cohort entry. Individual-level exposures, measured in a random sample of all participants, were: (1) perception of stigma in the community, (2) perception of stigma in health settings and (3) fear and judgement towards people living with HIV. Individual-level analyses were conducted with adjusted, individual-level Poisson regression. Community-level HIV stigma exposures drew on data reported by people living with HIV, health workers and community members. We used linear regression to explore the association between HIV stigma and community-level HIV incidence. RESULTS Among 8172 individuals who were HIV negative and answered individual-level stigma questions at enrolment to the cohort, there was no evidence of a statistically significant association between any domain of HIV stigma and risk of incident HIV infection. Among the full cohort of 26,110 individuals among whom HIV incidence was measured, there was no evidence that community-level HIV incidence was associated with any domain of HIV stigma. CONCLUSIONS HIV stigma is often cited as a barrier to the effectiveness of HIV prevention programming. However, in the setting for the HPTN 071 "PopART trial," measured stigma alone was not associated with the risk of HIV infection.
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Affiliation(s)
- James R. Hargreaves
- Department of Public Health, Environments and Society, Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Triantafyllos Pliakas
- Department of Public Health, Environments and Society, Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Tila Mainga
- Zambart, School of Public HealthUniversity of ZambiaLusakaZambia
| | - Constance Mubekapi‐Musadaidzwa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | | | - Ethan Wilson
- Fred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | | | - Yaw Agyei
- Johns Hopkins UniversitySchool of MedicineBaltimoreMarylandUSA
| | - Nomtha F. Bell‐Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Ab Schaap
- Zambart, School of Public HealthUniversity of ZambiaLusakaZambia
| | - David Macleod
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Sarah Fidler
- Department of Medicine, Imperial College NIHR BRCImperial College LondonLondonUK
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Anne Stangl
- International Center for Research on WomenWashingtonDCUSA
- Hera SolutionsBaltimoreMarylandUSA
| | - Virginia Bond
- Zambart, School of Public HealthUniversity of ZambiaLusakaZambia
- Department of Global Health and Development, Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Helen Ayles
- Zambart, School of Public HealthUniversity of ZambiaLusakaZambia
- Department of Clinical Research, Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
| | - Richard J. Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
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Sabapathy K, Stöckl H, Mulubwa C, Mubekapi-Musadaidzwa C, Hoddinott G, Floyd S, Seeley J, Bond V, Bock P, Fidler S, Ayles H, Hayes R. Intimate Partner Violence (IPV) and Associated Factors in HPTN 071 (PopART) Study Communities in Zambia and South Africa-A Comparison by HIV Status. AIDS Behav 2022; 26:1355-1365. [PMID: 35165795 PMCID: PMC9001629 DOI: 10.1007/s10461-021-03492-6] [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] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
The HPTN 071(PopART) study was a community-randomised trial in Zambia and South Africa, examining the impact of combination-prevention including universal testing and treatment (UTT), on HIV-incidence. This sub-study evaluated factors associated with IPV (physical and/or sexual) to identify differences by HIV status. During 2015-16, a random subset of adults who participated in the first year of the PopART intervention were recruited and standardised questionnaires were administered. Logistic regression was performed to estimate odds ratios of factors associated with IPV. Among > 700 women studied (300 HIV-negative;400 HIV-positive), ~ 20% reported experiencing physical and/or sexual violence in the last 12-months. Sexual violence was similar by HIV status, but physical violence and reporting both physical/sexual violence was more common among HIV-positive women. Spending nights away from the community in the last 12-months was associated with higher odds of IPV among both HIV-negative (aOR 3.17, 95% CI 1.02-9.81) and HIV-positive women (aOR 1.79, 95% CI 0.99-3.24). Among HIV-positive women, financial autonomy was associated with reduced IPV (aOR:0.41,95%CI:0.23-0.75) while pregnancy in the last 12-months (aOR 2.25, 95% CI 1.07-4.74), risk of alcohol dependence (aOR 2.75, 95% CI 1.51-5.00) and risk of mental distress (aOR 2.62, 95% CI 1.33-5.16) were associated with increased IPV. Among HIV-negative women reporting sex in the last 12-months, transactional sex (aOR 3.97, 95% CI 1.02-15.37) and not knowing partner's HIV status (aOR 3.01, 95% CI 1.24-7.29) were associated with IPV. IPV was commonly reported in the study population and factors associated with IPV differed by HIV status. The association of mobility with IPV warrants further research. The high prevalence of harmful alcohol use and mental distress, and their association with IPV among HIV-positive women require urgent attention.
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Affiliation(s)
- K. Sabapathy
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - H. Stöckl
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Ludwig-Maximilians-University, Munich, Germany
| | - C. Mulubwa
- Zambia AIDS Related TB Project, University of Zambia, Lusaka, Zambia
| | | | - G. Hoddinott
- Desmond Tutu TB Centre, Stellenbosch University, Stellenbosch, Western Cape South Africa
| | - S. Floyd
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - J. Seeley
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - V. Bond
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Zambia AIDS Related TB Project, University of Zambia, Lusaka, Zambia
| | - P. Bock
- Desmond Tutu TB Centre, Stellenbosch University, Stellenbosch, Western Cape South Africa
| | | | - H. Ayles
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Zambia AIDS Related TB Project, University of Zambia, Lusaka, Zambia
| | - R. Hayes
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - on behalf of HPTN 071 (PopART) Study Team
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Ludwig-Maximilians-University, Munich, Germany
- Zambia AIDS Related TB Project, University of Zambia, Lusaka, Zambia
- Desmond Tutu TB Centre, Stellenbosch University, Stellenbosch, Western Cape South Africa
- Imperial College London, London, UK
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Foster I, Galloway M, Human W, Anthony M, Myburgh H, Vanqa N, Wademan DT, Makanda G, Tisile P, Schoeman I, Hoddinott G, Nathavitharana RR. Analysing interventions designed to reduce tuberculosis-related stigma: A scoping review. PLOS Glob Public Health 2022; 2:e0000989. [PMID: 36962638 PMCID: PMC10022226 DOI: 10.1371/journal.pgph.0000989] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/08/2022] [Indexed: 03/17/2023]
Abstract
Stigma is a critical barrier for TB care delivery; yet data on stigma reduction interventions is limited. This review maps the available literature on TB stigma reduction interventions, using the Health Stigma and Discrimination framework and an implementation analysis to identify research gaps and inform intervention design. Using search terms for TB and stigma, we systematically searched PubMed, EMBASE and Web of Science. Two independent reviewers screened all abstracts, full-texts, extracted data, conducted a quality assessment, and assessed implementation. Results were categorized by socio-ecological level, then sub-categorized by the stigma driver or manifestation targeted. After screening 1865 articles, we extracted data from nine. Three studies were implemented at the individual and interpersonal level using a combination of TB clubs and interpersonal support to target internal and anticipated stigma among persons with TB. Two studies were implemented at the interpersonal level using counselling or a video based informational tool delivered to households to reduce stigma drivers and manifestations. Three studies were implemented at the organizational level, targeting drivers of stigma among healthcare workers (HW) and enacted stigma among HWs. One study was implemented at the community level using an educational campaign for community members. Stakeholder consultation emphasized the importance of policy level interventions and education on the universality of risk to destigmatize TB. Review findings suggest that internal and anticipated TB stigma may be addressed effectively with interventions targeted towards individuals using counselling or support groups. In contrast, enacted TB stigma may be better addressed with information-based interventions implemented at the organizational or community level. Policy level interventions were absent but identified as critical by stakeholders. Implementation barriers included the lack of high-quality training and integration with mental health services. Three key gaps must be addressed in future research: consistent stigma definitions, standardized stigma measurement, and measurement of implementation outcomes.
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Affiliation(s)
- Isabel Foster
- TB Proof, Cape Town, South Africa
- Global Health, International Development Research Centre, Ottawa, Canada
| | | | | | - Michaile Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Hanlie Myburgh
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Dillon T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | | | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ruvandhi R Nathavitharana
- TB Proof, Cape Town, South Africa
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
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Marx FM, Meehan SA, Jivan D, Dunbar R, Hoddinott G, Hesseling AC, Osman M. Use of interactive messaging to reduce pre-diagnosis loss to follow-up for TB care. Int J Tuberc Lung Dis 2022; 26:26-32. [PMID: 34969425 DOI: 10.5588/ijtld.21.0332] [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
OBJECTIVE: To investigate the uptake and usage of a WhatsApp-based interactive communication strategy to avert pre-diagnosis loss to follow-up (LTFU) from TB care in a high-incidence setting.METHODS: We enrolled adults (≥18 years) who underwent routine sputum TB testing in two primary healthcare clinics in Khayelitsha, Cape Town, South Africa. The intervention consisted of structured WhatsApp-based reminders (prompts) sent prior to a routine clinic appointment scheduled 2-3 days after the diagnostic visit. Pre-diagnosis LTFU was defined as failure to return for the scheduled appointment and within 10 days.RESULTS: We approached 332 adults with presumptive TB, of whom 103 (31%) were successfully enrolled; 213 (64%) did not own a WhatsApp-compatible phone. Of 103 participants, 74 (72%) actively responded to WhatsApp prompts; 69 (67%) opted to include a close contact in group communication to co-receive reminders. Pre-diagnosis LTFU was low overall (n = 7, 6.8%) and was not associated with failure to respond to WhatsApp prompts.CONCLUSION: In this high-incidence setting, enrolment in a WhatsApp-based communication intervention among adults with presumptive TB was low, mainly due to low availability of WhatsApp-compatible phones. Among participants, we observed high message response rates and low LTFU, suggesting potential for interactive messaging services to support pre-diagnosis TB care.
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Affiliation(s)
- F M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, DSI-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - S-A Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - D Jivan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Wademan DT, Hoddinott G, Purchase SE, Seddon JA, Hesseling AC, Garcia-Prats AJ, Reis R, Reynolds LJ. Practical and psychosocial challenges faced by caregivers influence the acceptability of multidrug-resistant tuberculosis preventive therapy for young children. PLoS One 2022; 17:e0268560. [PMID: 35834509 PMCID: PMC9282439 DOI: 10.1371/journal.pone.0268560] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 05/03/2022] [Indexed: 11/18/2022] Open
Abstract
Drug-resistant (DR) strains of Mycobacterium tuberculosis (M. tb) are increasingly recognised as a threat to global tuberculosis (TB) control efforts. Identifying people with DR-TB exposure/ infection and providing TB preventive therapy (TPT) is a public health priority. TB guidelines advise the evaluation of household contacts of newly diagnosed TB cases, with the provision of TPT to vulnerable populations, including young children (<5 years). Many children become infected with TB through exposure in their household. Levofloxacin is under evaluation as TPT in children exposed to M. tb strains with resistance to rifampicin and isoniazid (multidrug-resistant TB; MDR-TB). Prior to opening a phase 3 prevention trial in children <5 years exposed to MDR-TB, the pharmacokinetics and safety of a novel formulation of levofloxacin given daily was evaluated as part of a lead-in study. We conducted an exploratory qualitative study of 10 caregivers' experiences of administering this formulation. We explored how the acceptability of levofloxacin as TPT is shaped by the broader impacts of MDR-TB on the overall psychological, social, and financial wellbeing of caregivers, many of whom also had experienced MDR-TB. Caregivers reported that the novel levofloxacin formulation was acceptable. However, caregivers described significant psychosocial challenges in the process of incorporating TPT administration to their children into their daily lives, including financial instability, withdrawal of social support and stigma. When caregivers themselves were sick, these challenges became even more acute. Although new child-friendly formulations can ameliorate some of the pragmatic challenges related to TPT preparation and administration, the overall psychosocial burden on caregivers responsible for administering TPT remains a major determinant of effective MDR-TB prevention in children.
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Affiliation(s)
- Dillon T. Wademan
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Stellenbosch, South Africa
- * E-mail:
| | - Graeme Hoddinott
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Stellenbosch, South Africa
| | - Susan E. Purchase
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Stellenbosch, South Africa
| | - James A. Seddon
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Stellenbosch, South Africa
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Anneke C. Hesseling
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Stellenbosch, South Africa
| | - Anthony J. Garcia-Prats
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Stellenbosch, South Africa
- Department of Paediatrics, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Ria Reis
- Department of Public Health & Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- Amsterdam Institute for Social Sciences, University of Amsterdam, Amsterdam, The Netherlands
- The Children’s Institute, University of Cape Town, Cape Town, South Africa
| | - Lindsey J. Reynolds
- Faculty of Arts and Social Sciences, Department of Sociology and Social Anthropology, Stellenbosch University, Stellenbosch, South Africa
- Pivot Collective, Cape Town, South Africa
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Spies G, Ahmed-Leitao F, Hoddinott G, Seedat S. Effects of unhealthy alcohol use on brain morphometry and neurocognitive function among people with HIV. J Neurovirol 2021; 28:35-45. [PMID: 34882280 DOI: 10.1007/s13365-021-01027-2] [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: 08/24/2021] [Revised: 10/13/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
Individual impacts of alcohol misuse and HIV on brain structure and function have been well demonstrated; however, the potential compounded effect of these conditions is seldom considered, despite the high prevalence of alcohol use in HIV infection. We aimed to determine the effects of unhealthy alcohol use on brain morphometry and cognitive function amongst people with HIV (PWH). In 27 (50.9%) HIV-positive users of alcohol and 26 (49.1%) HIV-positive abstainers from alcohol, results revealed significant differences for left and right amygdala (p < 0.01), left and right hippocampus (p = 0.05), left and right posterior cingulate (p < 0.01), left and right precuneus (p < 0.01), left insula (p < 0.01), left and right caudate (p < 0.01), right thalamus (p < 0.01), and corpus callosum (p < 0.05). Mean volume of these regions was significantly smaller in HIV-positive alcohol users compared to HIV-positive abstainers. Homogeneity of slopes ANCOVA revealed significant associations between anterior cingulate cortex, precuneus, amygdala, hippocampus, and insula volumes and cognitive function in the domains of learning and delayed recall, motor function, speed of information processing, executive function, attention/working memory, and language. Among PWH, unhealthy alcohol use is associated with negative effects on brain structure and cognitive function.
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Affiliation(s)
- Georgina Spies
- DSI/NRF South African Research Chairs Initiative in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. .,Department of Psychiatry, South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.
| | - Fatima Ahmed-Leitao
- DSI/NRF South African Research Chairs Initiative in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Soraya Seedat
- DSI/NRF South African Research Chairs Initiative in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Department of Psychiatry, South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa
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Moscibrodzki P, Enane LA, Hoddinott G, Brooks MB, Byron V, Furin J, Seddon JA, Meyersohn L, Chiang SS. The Impact of Tuberculosis on the Well-Being of Adolescents and Young Adults. Pathogens 2021; 10:1591. [PMID: 34959546 PMCID: PMC8706072 DOI: 10.3390/pathogens10121591] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 01/26/2023] Open
Abstract
The health needs of adolescents and young adults (AYAs) have been neglected in tuberculosis (TB) care, control, and research. AYAs, who are distinct from younger children and older adults, undergo dynamic physical, psychological, emotional, cognitive, and social development. Five domains of adolescent well-being are crucial to a successful transition between childhood and adulthood: (1) Good health; (2) connectedness and contribution to society; (3) safety and a supportive environment; (4) learning, competence, education, skills, and employability; and (5) agency and resilience. This review summarizes the evidence of the impact of TB disease and treatment on these five domains of AYA well-being.
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Affiliation(s)
- Patricia Moscibrodzki
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Leslie A. Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (G.H.); (J.A.S.)
| | - Meredith B. Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.B.B.); (V.B.); (J.F.)
| | - Virginia Byron
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.B.B.); (V.B.); (J.F.)
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.B.B.); (V.B.); (J.F.)
- Sentinel Project on Pediatric Drug-Resistant Tuberculosis, Boston, MA 02115, USA
| | - James A. Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (G.H.); (J.A.S.)
- Department of Infectious Diseases, Imperial College London, London W2 1NY, UK
| | - Lily Meyersohn
- Center for International Health Research, Rhode Island Hospital, Providence, RI 02903, USA; (L.M.); (S.S.C.)
| | - Silvia S. Chiang
- Center for International Health Research, Rhode Island Hospital, Providence, RI 02903, USA; (L.M.); (S.S.C.)
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI 02903, USA
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Vanqa N, Hoddinott G, Mbenyana B, Osman M, Meehan SA. Linkage to TB care: A qualitative study to understand linkage from the patients' perspective in the Western Cape Province, South Africa. PLoS One 2021; 16:e0260200. [PMID: 34797855 PMCID: PMC8604355 DOI: 10.1371/journal.pone.0260200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Delayed linkage to tuberculosis (TB) treatment leads to poor patient outcomes and increased onward transmission. Between 12% and 25% of people diagnosed with TB are never linked to a primary health care facility for continued care. The TB health program is for creating processes that promote and facilitates easy access to care. We explored how TB patients experience TB services and how this influenced their choices around linkage to TB care and treatment. METHODS We enrolled 20 participants routinely diagnosed with TB in hospital or at primary health care facilities (PHC) in a high TB/HIV burdened peri-urban community in South Africa. Using the Western Cape Provincial Health Data centre (PHDC) which consolidates person-level clinical data, we used dates of diagnosis and treatment initiation to select participants who had been linked (immediately, after a delay, or never). Between June 2019 and January 2020, we facilitated in-depth discussions to explore both the participants' experience of their TB diagnosis and their journey around linking to TB care at a primary health care facility. We analysed the data using case descriptions. RESULTS Twelve of twenty (12/20) participants interviewed who experienced a delay linking were diagnosed at the hospital. Participants who experienced delays in linking or never linked explained this as a result of lack of information and support from health care providers. Unpleasant previous TB treatment episodes made it difficult to 'face' TB again and being uncertain of their TB diagnosis. In contrast, participants said the main motivator for linking was a personal will to get better. CONCLUSION The health care system, especially in hospitals, should focus on strengthening patient-centred care. Communication and clear messaging on TB processes is key, to prepare patients in transitioning from a hospital setting to PHC facilities for continuation of care. This should not just include a thorough explanation of their TB diagnosis but ensure that patients understand treatment processes. Former TB patients may require additional counselling and support to re-engage in care.
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Affiliation(s)
- Nosivuyile Vanqa
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa
- * E-mail: ,
| | - Graeme Hoddinott
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa
| | - Baxolele Mbenyana
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa
| | - Muhammad Osman
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa
| | - Sue-Ann Meehan
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa
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Viljoen L, Hoddinott G, Malunga S, Vanqa N, Mhlakwaphalwa T, Marthinus A, Mcimeli K, Bond V, Seeley J, Bock P, Hayes R, Reynolds L. Women's sexual scripting in the context of universal access to antiretroviral treatment-findings from the HPTN 071 (PopART) trial in South Africa. BMC Womens Health 2021; 21:370. [PMID: 34689783 PMCID: PMC8543855 DOI: 10.1186/s12905-021-01513-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 10/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND HIV treatment-based prevention modalities present new opportunities for women to make decisions around sex, intimacy, and prevention. The Universal test and treat (UTT) strategy, where widespread HIV testing is implemented and all people with HIV can access treatment, has the potential to change how sex is understood and HIV prevention incorporated into sexual relationships. We use the frame of sexual scripting to explore how women attribute meaning to sex relative to UTT in an HIV prevention trial setting. Exploring women's sexual narratives, we explored how HIV prevention feature in the sexual scripts for women who had access to UTT in South Africa (prior to treatment guideline changes) and increased HIV prevention messaging, compared to places without widespread access to HIV testing and immediate access to treatment. METHODS We employed a two-phased thematic analysis to explore longitudinal qualitative data collected from 71 women (18-35 years old) between 2016 and 2018 as part of an HIV prevention trial in the Western Cape Province, South Africa. Of the participants, 58/71 (82%) were from intervention communities while 13/71 (18%) lived in control communities without access to UTT. Twenty participants self-disclosed that they were living with HIV. RESULTS We found no narrative differences between women who had access to UTT and those who did not. HIV and HIV prevention, including treatment-based prevention modalities, were largely absent from women's thinking about sex. In their scripts, women idealised romantic sex, positioned sex as 'about relationships', and described risky sex as 'other'. When women were confronted by HIV risk (for example, when a partner disclosed his HIV-positive status) this created a point of disjuncture between this new perception of risk and their accepted relationship scripts. CONCLUSION These findings suggest that HIV-negative women did not include their partners' use of antiretroviral therapy in their sexual partnership choices. For these women, the preventive benefits of UTT are experienced passively-through community-wide viral suppression-rather than through their own behaviour change explicitly related to the availability of treatment as prevention. We propose that prevention-based modalities should be made available and supported and framed as an intervention to promote relationship well-being.
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Affiliation(s)
- Lario Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Department of Sociology and Social Anthropology, Stellenbosch University, Stellenbosch, South Africa.
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Samantha Malunga
- AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tembeka Mhlakwaphalwa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Arlene Marthinus
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Khanyisa Mcimeli
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Virginia Bond
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Lindsey Reynolds
- Department of Sociology and Social Anthropology, Stellenbosch University, Stellenbosch, South Africa
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50
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Migliori GB, Marx FM, Ambrosino N, Zampogna E, Schaaf HS, van der Zalm MM, Allwood B, Byrne AL, Mortimer K, Wallis RS, Fox GJ, Leung CC, Chakaya JM, Seaworth B, Rachow A, Marais BJ, Furin J, Akkerman OW, Al Yaquobi F, Amaral AFS, Borisov S, Caminero JA, Carvalho ACC, Chesov D, Codecasa LR, Teixeira RC, Dalcolmo MP, Datta S, Dinh-Xuan AT, Duarte R, Evans CA, García-García JM, Günther G, Hoddinott G, Huddart S, Ivanova O, Laniado-Laborín R, Manga S, Manika K, Mariandyshev A, Mello FCQ, Mpagama SG, Muñoz-Torrico M, Nahid P, Ong CWM, Palmero DJ, Piubello A, Pontali E, Silva DR, Singla R, Spanevello A, Tiberi S, Udwadia ZF, Vitacca M, Centis R, D Ambrosio L, Sotgiu G, Lange C, Visca D. Clinical standards for the assessment, management and rehabilitation of post-TB lung disease. Int J Tuberc Lung Dis 2021; 25:797-813. [PMID: 34615577 PMCID: PMC8504493 DOI: 10.5588/ijtld.21.0425] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR).METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement).RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR.CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD.
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Affiliation(s)
- G B Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - F M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, DSI-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - N Ambrosino
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | - E Zampogna
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - B Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, South Africa
| | - A L Byrne
- Heart Lung Clinic St Vincent´s Hospital and Clinical School, University of New South Wales, Sydney, NSW, Australia, Partners In Health (Socios En Salud Sucursal), Lima, Peru
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - R S Wallis
- Aurum Institute, Johannesburg, South Africa
| | - G J Fox
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - C C Leung
- Hong Kong Tuberculosis, Chest and Heart Diseases Association, Hong Kong
| | - J M Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - B Seaworth
- Heartland National TB Center of Excellence, San Antonio, TX, University of Texas Health Science Center, Tyler, TX, USA
| | - A Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany, German Center for Infection Research (DZIF), Partner Site Munich, Germany
| | - B J Marais
- The Children´s Hospital at Westmead and the University of Sydney WHO Collaborating Center in Tuberculosis, University of Sydney, Sydney, NSW, Australia
| | - J Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA
| | - O W Akkerman
- University of Groningen, University Medical Center Groningen, department of Pulmonary diseases and Tuberculosis, Groningen, the Netherlands, University of Groningen, University Medical Center Groningen, TB center Beatrixoord, Groningen, the Netherlands
| | - F Al Yaquobi
- TB and Acute Respiratory Diseases Section, Department of Communicable Diseases, Directorate General of Disease Surveillance and Control, Ministry of Health, Oman
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
| | - S Borisov
- Moscow Research and Clinical Center for Tuberculosis Control, Moscow Health Department, Moscow, Russian Federation
| | - J A Caminero
- Mycobacterial Unit, Pneumology Department. University General Hospital of Gran Canaria "Dr. Negrin", Las Palmas, Gran Canaria, ALOSA TB Academy, Spain
| | - A C C Carvalho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - D Chesov
- Department of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - L R Codecasa
- TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
| | - R C Teixeira
- National Institute of Respiratory Diseases and the Environment (INERAM), Asunción, Paraguay, Radboud University Medical Center, TB Expert Center Dekkerswald, Department of Respiratory Diseases, Nijmegen - Groesbeek, The Netherlands
| | - M P Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - S Datta
- Department of clinical sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Innovation For Health And Development (IFHAD) Laboratory for Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru, Innovacion Por la Salud Yel Desarollo, (IPSYD) Asociación Benéfica PRISMA, Lima, Peru
| | - A-T Dinh-Xuan
- Université de Paris, APHP Centre, Lung Function Unit, Department of Respiratory Diseases, Cochin Hospital, Paris, France
| | - R Duarte
- Institute of Public Health, Porto University; Medical School, Porto University; Hospital Centre of Vila Nova de Gaia/Espinho, Porto, Portugal
| | - C A Evans
- Innovation For Health And Development (IFHAD) Laboratory for Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru, Innovacion Por la Salud Yel Desarollo, (IPSYD) Asociación Benéfica PRISMA, Lima, Peru, Department of Infectious Diseases, Imperial College London, London, UK
| | | | - G Günther
- Department of Pulmonology, Inselspital Bern, University of Bern, Switzerland
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - S Huddart
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, UCSF Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - O Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany, German Center for Infection Research (DZIF), Partner Site Munich, Germany
| | - R Laniado-Laborín
- Clínica de Tuberculosis, Hospital General Tijuana, Universidad Autónoma De Baja California, Mexico
| | - S Manga
- Medecins Sans Frontieres (MSF), Operational Center, Paris, France
| | - K Manika
- Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - A Mariandyshev
- Northern State Medical University, Northern Arctic Federal University, Arkhangelsk, Russian Federation
| | - F C Q Mello
- Thoracic Diseases Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - S G Mpagama
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro, Tanzania
| | - M Muñoz-Torrico
- Tuberculosis Clinic, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City
| | - P Nahid
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, UCSF Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - C W M Ong
- Infectious Disease Translational Research Programme, Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, National University of Singapore Institute for Health Innovation & Technology (iHealthtech), Singapore
| | - D J Palmero
- Pulmonology Division, Municipal Hospital F.J. Muñiz and Instituto Vaccarezza, Buenos Aires, Argentina
| | | | - E Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - D R Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - R Singla
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - A Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy
| | - S Tiberi
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK, Blizard Institute, Queen Mary University of London, London, UK
| | - Z F Udwadia
- Department of Respiratory Medicine, Hinduja Hospital & Research Center, Mumbai, India
| | - M Vitacca
- Respiratory Unit, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane (BS), Italy
| | - R Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - L D Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany, German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Germany, Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
| | - D Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy
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