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Michiels E, Frederix K. 78P High resolution in situ analysis reveals phenotypic and functional diversification within single pancreatic tumour ducts. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Hirsch-Moverman Y, Howard AA, Yuengling KA, Lebelo L, Frederix K, Hesseling AC, Nachman S, Maama LB, El-Sadr WM, Mantell JE. Effectiveness of a community-based intervention to prevent childhood TB in Lesotho. Int J Tuberc Lung Dis 2022; 26:612-622. [PMID: 35768915 DOI: 10.5588/ijtld.21.0558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Child contact management (CCM) is a recognized strategy to prevent TB; however, implementation is suboptimal. PREVENT was a cluster-randomized trial that evaluated the effectiveness and acceptability of a community-based intervention (CBI) to improve CCM in Lesotho.METHODS: Ten health facilities (HFs) were randomized to CBI or standard-of-care (SOC). CBI included nurse training/mentorship, health education by village health workers (VHW), adherence support, and multidisciplinary team meetings. Information on TB cases registered from February 2016 to June 2018 and their child contacts was abstracted. Outcomes were TB preventive treatment (TPT) initiation, TPT completion, and CBI acceptability. Generalized linear mixed models were used to test for differences between study arms and qualitative interview thematic analysis for acceptability.RESULTS: Among 547 registered children (CBI: n = 399; SOC: n = 148) of 426 adult TB patients, 46% were <2 years, 48% female, and 3% HIV-exposed/positive, with no significant differences between study arms. A total of 501 children initiated TPT-98% at CBI and 88% at SOC HFs (P < 0.0001). TPT completion was 82% in CBI vs. 59% in SOC sites (P = 0.048). Caregivers and providers reported that CBI was acceptable.CONCLUSION: The CBI was acceptable and significantly improved TPT initiation and completion in Lesotho, offering the opportunity to mitigate the threat of TB among children.
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Affiliation(s)
- Y Hirsch-Moverman
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - A A Howard
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - K A Yuengling
- ICAP at Columbia University, Mailman School of Public Health, New York, NY
| | - L Lebelo
- ICAP at Columbia University, Maseru, Lesotho
| | - K Frederix
- ICAP at Columbia University, Maseru, Lesotho
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - S Nachman
- Pediatric Infectious Diseases, State University of New York Stony Brook, Stony Brook, NY, USA
| | - L B Maama
- Lesotho Ministry of Health National Tuberculosis Programme, Maseru, Lesotho
| | - W M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - J E Mantell
- HIV Center for Clinical & Behavioral Studies, Gender, Sexuality and Health Area, at the New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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Hirsch-Moverman Y, Mantell JE, Lebelo L, Wynn C, Hesseling AC, Howard AA, Nachman S, Frederix K, Maama LB, El-Sadr WM. Tuberculosis preventive treatment preferences among care givers of children in Lesotho: a pilot study. Int J Tuberc Lung Dis 2019; 22:858-862. [PMID: 29991393 DOI: 10.5588/ijtld.17.0809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Shorter-duration regimens for preventing drug-susceptible tuberculosis (TB) have been shown to be safe and efficacious in children, and may improve acceptability, adherence, and treatment completion. While these regimens have been used in children in low TB burden countries, they are not yet widely used in high TB burden countries. SETTING Five health facilities in one district in Lesotho, a high TB burden country. OBJECTIVE Assess the preventive treatment preferences of care givers of child TB contacts. DESIGN Qualitative data were collected using in-depth interviews with 12 care givers whose children completed preventive treatment, and analyzed using grounded theory. FINDINGS Care givers were interested in being involved in the children's treatment decisions. Pill burden, treatment duration and related frequency of dosing were identified as important factors that influenced preventive treatment preferences among care givers. CONCLUSION Understanding care giver preferences and involving them in treatment decisions may facilitate efforts to implement successful preventive treatment for TB among children in high TB burden countries.
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Affiliation(s)
- Y Hirsch-Moverman
- ICAP at Columbia University, Mailman School of Public Health, New York, Department of Epidemiology, Columbia University, New York
| | - J E Mantell
- HIV Center for Clinical & Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Columbia University, Department of Psychiatry, New York
| | - L Lebelo
- ICAP at Columbia University, Mailman School of Public Health, New York
| | - C Wynn
- Department of Sociomedical Sciences, Columbia University, New York, New York, 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
| | - A A Howard
- ICAP at Columbia University, Mailman School of Public Health, New York, Department of Epidemiology, Columbia University, New York
| | - S Nachman
- Pediatric Infectious Diseases, State University of New York Stony Brook, Stony Brook, New York, USA
| | - K Frederix
- ICAP at Columbia University, Mailman School of Public Health, New York
| | - L B Maama
- Lesotho Ministry of Health National Tuberculosis Program, Maseru, Lesotho
| | - W M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, Department of Epidemiology, Columbia University, New York
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Hayes-Larson E, Hirsch-Moverman Y, Saito S, Frederix K, Pitt B, Maama-Maime L, Howard AA. Depressive symptoms and hazardous/harmful alcohol use are prevalent and correlate with stigma among TB-HIV patients in Lesotho. Int J Tuberc Lung Dis 2018; 21:34-41. [PMID: 29025483 DOI: 10.5588/ijtld.17.0062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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
SETTING Limited data exist on the prevalence and correlates, including stigma, of mental health conditions, including depressive symptoms and alcohol use, among patients co-infected with tuberculosis (TB) and the human immunodeficiency virus (HIV) in sub-Saharan Africa, despite their negative impact on health outcomes. OBJECTIVE To assess the prevalence and correlates of depressive symptoms and hazardous/harmful alcohol use among TB-HIV patients in the Start TB patients on ART and Retain on Treatment (START) study. DESIGN START, a mixed-methods cluster-randomized trial, evaluated a combination intervention package vs. standard of care (SOC) to improve treatment outcomes in TB-HIV co-infected patients in Lesotho. Moderate/severe depressive symptoms and hazardous/harmful alcohol use were measured using baseline questionnaire data collected from April 2013 to March 2015. Demographic, psychosocial, and TB- and HIV-related knowledge and attitudes, including stigma, were assessed for association with both conditions using generalized linear mixed models. RESULTS Among 371 participants, 29.8% reported moderate/severe depressive symptoms, and 24.7% reported hazardous/harmful alcohol use; 7% reported both. Depressive symptoms were significantly associated with less education, more difficulty understanding written medical information, non-disclosure of TB, greater TB stigma, and the SOC study arm. Hazardous/harmful alcohol use was significantly associated with male sex, as well as greater TB and external HIV stigma. CONCLUSION Prevalence of depressive symptoms and hazardous/harmful alcohol use were high, suggesting a need for routine screening for, and treatment of, mental health disorders in TB-HIV patients.
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Affiliation(s)
- E Hayes-Larson
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Epidemiology Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Y Hirsch-Moverman
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Epidemiology Mailman School of Public Health, Columbia University, New York, New York, USA
| | - S Saito
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Epidemiology Mailman School of Public Health, Columbia University, New York, New York, USA
| | - K Frederix
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - B Pitt
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - L Maama-Maime
- National Tuberculosis Control Programme, Lesotho Ministry of Health, Maseru Lesotho
| | - A A Howard
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Epidemiology Mailman School of Public Health, Columbia University, New York, New York, USA
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O'Connor DE, Frederix K, Saito S, Maama LB, Hirsch-Moverman Y, Pitt B, Hayes-Larson E, Lebelo L, Shale M, Howard AA. Pulmonary tuberculosis diagnostic practices among people living with the human immunodeficiency virus in Lesotho. Int J Tuberc Lung Dis 2018; 21:1133-1138. [PMID: 28911357 DOI: 10.5588/ijtld.17.0297] [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
SETTING Twelve health facilities in Berea District, Lesotho, that participated in the Start TB Patients on ART and Retain on Treatment (START) Study, a mixed-methods cluster-randomized trial evaluating a combination intervention package to improve early initiation of antiretroviral therapy (ART) and anti-tuberculosis treatment success among patients with tuberculosis (TB) and human immunodeficiency virus (HIV). OBJECTIVE To assess TB and HIV diagnostic practices among TB-HIV patients. DESIGN A standardized survey assessed services at each facility at baseline. Routine clinical data were abstracted for all newly registered adult TB-HIV patients during the study period. Descriptive statistics were used to assess TB diagnostic practices, timing of the HIV diagnosis, and ART status at TB treatment initiation. RESULTS Between April 2013 and March 2015, 1233 TB-HIV patients were enrolled. Among 1215 patients with available data, 87.2% had pulmonary TB, of which 34.8% were bacteriologically confirmed, 40.9% tested negative and 24.3% were not tested. Among 1138 patients with available data, 53.3% had an existing HIV diagnosis, of whom 39.3% were ART-naïve. CONCLUSIONS The majority of pulmonary TB patients were clinically diagnosed, and many were unaware of their HIV status or were ART-naïve despite known status. The Test and Treat Strategy holds promise to prevent TB and reduce TB-related mortality among people living with HIV; however, enhanced TB diagnostic capacity and improved HIV case detection are urgently needed.
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Affiliation(s)
- D E O'Connor
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - K Frederix
- ICAP at Columbia University, Maseru, Lesotho
| | - S Saito
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - L B Maama
- National Tuberculosis Program, Lesotho Ministry of Health, Maseru, Lesotho
| | - Y Hirsch-Moverman
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - B Pitt
- ICAP at Columbia University, Maseru, Lesotho
| | - E Hayes-Larson
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - L Lebelo
- ICAP at Columbia University, Maseru, Lesotho
| | - M Shale
- ICAP at Columbia University, Maseru, Lesotho
| | - A A Howard
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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Frederix K, Chauhan A, Kisucka J, Spronk H, Wagner D, ten Cate H. CHARACTERIZATION OF THE ROLE OF PLATELET ADHESION MOLECULES IN A MURINE MODEL OF PHOTOSENSITIZER-INDUCED STROKE. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb03013.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Spronk H, Frederix K, Kooter I, van Oerle R, Fens D, Hamulyak K, Gerlofs-Nijland M, ten Cate H. PO-64 Induction of tissue factor and loss of thrombomodulin activities upon inflammatory stimulation in vivo. Thromb Res 2007. [DOI: 10.1016/s0049-3848(07)70217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ponnet M, Frederix K, Petdachai W, Wilson D, Eksaengsri A, Zachariah R. A drug dosage table is a useful tool to facilitate prescriptions of antiretroviral drugs for children in Thailand. Int J STD AIDS 2005; 16:420-6. [PMID: 15969776 DOI: 10.1258/0956462054094114] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Scaling up of antiretroviral treatment (ART) for children in countries like Thailand will require decentralization and management by non-specialist doctors. We describe (a) the formulation of a standardized drug dosage table to facilitate antiretroviral drug (ARV) prescriptions for children, (b) the acceptability of such a table among doctors and (c) the safety and efficacy of drug doses in the table. Acceptability was assessed using a questionnaire. Safety and efficacy were assessed on the basis of incidence of adverse effects and virological response to treatment, respectively. Of all doctors (n=18), 17 (94%) found that the table was practical to use, avoided miscalculations and made them more confident with prescriptions. Of 49 children prescribed ARVs, less than 5% had adverse side-effects. All ARV-naïve children achieved undetectable viral loads within six months of ART. In our setting, a standardized drug dosage table provided a simple and reliable tool that facilitated ARV prescriptions for children.
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Affiliation(s)
- M Ponnet
- Médecins Sans Frontières, Bangkok, Thailand
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