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Takamiya M, Takarinda K, Balachandra S, Musuka G, Radin E, Hakim A, Pearson ML, Choto R, Sandy C, Maphosa T, Rogers JH. Missed opportunities for TB diagnostic testing among people living with HIV in Zimbabwe: Cross-sectional analysis of the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) survey 2015-16. J Clin Tuberc Other Mycobact Dis 2024; 35:100427. [PMID: 38516197 PMCID: PMC10955630 DOI: 10.1016/j.jctube.2024.100427] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Background Using data from the Zimbabwe Population-based HIV Impact Assessment survey 2015-2016, we examined the TB care cascade and factors associated with not receiving TB diagnostic testing among adult PLHIV with TB symptoms. Methods Statistical Analysis was limited to PLHIV aged 15 years and older in HIV care. Weighted logistic regression with not receiving TB testing as outcome was adjusted for covariates with crude odd ratios (ORs) with p < 0.25. All analyses accounted for multistage survey design. Results Among 3507 adult PLHIV in HIV care, 2288 (59.7 %, 95 % CI:58.1-61.3) were female and 2425 (63.6 %, 95 % CI:61.1-66.1) lived in rural areas. 1197(48.7 %, 95 % CI:46.5-51.0) reported being screened for TB symptoms at their last HIV care visit. In the previous 12 months, 639 (26.0 %, 95 % CI:23.9-28.1) reported having symptoms and of those, 239 (37.8 %, 95 % CI:33.3-42.2) received TB testing. Of PLHIV tested for TB, 36 (49.5 %, 95 % CI:35.0-63.1) were diagnosed with TB; 32 (90.3 %, 95 % CI:78.9-100) of those diagnosed with TB received treatment. Never having used IPT was associated with not receiving TB testing. Conclusion The results suggest suboptimal utilization of TB screening and diagnostic testing among PLHIV. New approaches are needed to reach opportunities missed in the HIV/TB integrated services.
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Affiliation(s)
| | | | | | | | | | - Avi Hakim
- U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Michele L. Pearson
- U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Regis Choto
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Talent Maphosa
- U.S. Centers for Disease Control and Prevention (CDC), Harare, Zimbabwe
| | - John H. Rogers
- U.S. Centers for Disease Control and Prevention (CDC), Harare, Zimbabwe
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Takamiya M, Takarinda K, Balachandra S, Godfrey M, Radin E, Hakim A, Pearson ML, Choto R, Sandy C, Maphosa T, Rogers JH. Isoniazid preventive therapy use among adult people living with HIV in Zimbabwe. Int J STD AIDS 2021; 32:1020-1027. [PMID: 33978529 PMCID: PMC10719553 DOI: 10.1177/09564624211014404] [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: 11/15/2022]
Abstract
We assessed the prevalence of isoniazid preventive therapy (IPT) uptake and explored factors associated with IPT non-uptake among people living with HIV (PLHIV) using nationally representative data from the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) 2015-2016. This was a cross-sectional study of 3418 PLHIV ZIMPHIA participants eligible for IPT, aged ≥15 years and in HIV care. Logistic regression modeling was performed to assess factors associated with self-reported IPT uptake. All analyses accounted for multistage survey design. IPT uptake among PLHIV was 12.7% (95% confidence interval (CI): 11.4-14.1). After adjusting for sex, age, rural/urban residence, TB screening at the last clinic visit, and hazardous alcohol use, rural residence was the strongest factor associated with IPT non-uptake (adjusted OR (aOR): 2.39, 95% CI: 1.82-3.12). Isoniazid preventive therapy non-uptake having significant associations with no TB screening at the last HIV care (aOR: 2.07, 95% CI: 1.54-2.78) and with hazardous alcohol use only in urban areas (aOR: 10.74, 95% CI: 3.60-32.0) might suggest suboptimal IPT eligibility screening regardless of residence, but more so in rural areas. Self-reported IPT use among PLHIV in Zimbabwe was low, 2 years after beginning national scale-up. This shows the importance of good TB screening procedures for successful IPT implementation.
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Affiliation(s)
| | | | | | | | | | - Avi Hakim
- U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Regis Choto
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Talent Maphosa
- U.S. Centers for Disease Control and Prevention (CDC), Harare, Zimbabwe
| | - John H Rogers
- U.S. Centers for Disease Control and Prevention (CDC), Harare, Zimbabwe
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Mumbengegwi DR, Sturrock H, Hsiang M, Roberts K, Kleinschmidt I, Nghipumbwa M, Uusiku P, Smith J, Bennet A, Kizito W, Takarinda K, Ade S, Gosling R. Is there a correlation between malaria incidence and IRS coverage in western Zambezi region, Namibia? Public Health Action 2018; 8:S44-S49. [PMID: 29713594 DOI: 10.5588/pha.17.0077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/10/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: A comparison of routine Namibia National Malaria Programme data (reported) vs. household survey data (administrative) on indoor residual spraying (IRS) in western Zambezi region, Namibia, for the 2014-2015 malaria season. Objectives: To determine 1) IRS coverage (administrative and reported), 2) its effect on malaria incidence, and 3) reasons for non-uptake of IRS in western Zambezi region, Namibia, for the 2014-2015 malaria season. Design: This was a descriptive study. Results: IRS coverage in western Zambezi region was low, ranging from 42.3% to 52.2% for administrative coverage vs. 45.9-66.7% for reported coverage. There was no significant correlation between IRS coverage and malaria incidence for this region (r = -0.45, P = 0.22). The main reasons for households not being sprayed were that residents were not at home during spraying times or that spray operators did not visit the households. Conclusions: IRS coverage in western Zambezi region, Namibia, was low during the 2014-2015 malaria season because of poor community engagement and awareness of times for spray operations within communities. Higher IRS coverage could be achieved through improved community engagement. Better targeting of the highest risk areas by the use of malaria surveillance will be required to mitigate malaria transmission.
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Affiliation(s)
- D R Mumbengegwi
- Science, Technology & Innovation Division, Multidisciplinary Research Center, University of Namibia, Windhoek, Namibia
| | - H Sturrock
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, USA
| | - M Hsiang
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, USA.,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pediatrics, UCSF, San Francisco, California, USA
| | - K Roberts
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, USA
| | - I Kleinschmidt
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Department of Pathology, School of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - M Nghipumbwa
- National Vector-Borne Disease Control Programme, Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - P Uusiku
- National Vector-Borne Disease Control Programme, Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - J Smith
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, USA
| | - A Bennet
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, USA
| | - W Kizito
- Operational Centre of Brussels-Kenya Mission, Médecins Sans Frontières, Nairobi, Kenya
| | - K Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France.,AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - S Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R Gosling
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, USA
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Charambira K, Ade S, Harries AD, Ncube RT, Zishiri C, Sandy C, Mutunzi H, Takarinda K, Owiti P, Mafaune P, Chonzi P. Diagnosis and treatment of TB patients with rifampicin resistance detected using Xpert(®) MTB/RIF in Zimbabwe. Public Health Action 2016; 6:122-8. [PMID: 27358806 DOI: 10.5588/pha.16.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/18/2016] [Indexed: 11/10/2022] Open
Abstract
SETTING In Zimbabwe, there are concerns about the management of tuberculosis (TB) patients with rifampicin (RMP) resistance diagnosed using Xpert(®) MTB/RIF. OBJECTIVE To assess linkages between diagnosis and treatment for these patients in Harare and Manicaland provinces in 2014. DESIGN A retrospective cohort study. RESULTS Of 20 329 Xpert assays conducted, 90% were successful, 11% detected Mycobacterium tuberculosis and 4.5% showed RMP resistance. Of 77 patients with RMP-resistant TB diagnosed by Xpert, 70% had samples sent to the reference laboratory for culture and drug susceptibility testing (CDST); 53% of the samples arrived. In 21% the samples showed M. tuberculosis growth, and in 17% the DST results were recorded, all of which confirmed RMP resistance. Of the 77 patients, 34 (44%) never started treatment for multidrug-resistant (MDR) TB, with documented reasons being death, loss to follow-up and incorrect treatment. Of the 43 patients who started MDR-TB treatment, 12 (71%) in Harare and 17 (65%) in Manicaland started within 2 weeks of diagnosis. CONCLUSION Xpert has been rolled out successfully in two Zimbabwe provinces. However, the process of confirming CDST for Xpert-diagnosed RMP-resistant TB works poorly, and many patients are either delayed or never initiate MDR-TB treatment. These shortfalls must be addressed at the programmatic level.
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Affiliation(s)
- K Charambira
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe
| | - S Ade
- The Union, Paris, France ; National Tuberculosis Programme, Cotonou, Benin
| | - A D Harries
- The Union, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - R T Ncube
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe
| | - C Zishiri
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe
| | - C Sandy
- Ministry of Health and Child Care, Harare, Zimbabwe
| | - H Mutunzi
- Ministry of Health and Child Care, Harare, Zimbabwe
| | - K Takarinda
- The Union, Paris, France ; Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - P Mafaune
- Ministry of Health and Child Care, Harare, Zimbabwe
| | - P Chonzi
- Harare City Health Department, Harare, Zimbabwe
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Apollo T, Takarinda K, Mugurungi O, Chakanyuka C, Simbini T, Harries AD. A report on the Zimbabwe Antiretroviral Therapy (ART) programme progress towards achieving MGD6 target 6B: achievement and challenges. Cent Afr J Med 2010; 56:12-14. [PMID: 23457867] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Zimbabwe's target to achieve Universal Access to treatment for HIV and AIDS, was severely affected by a decade long economic recession that threatened to reverse all the country's social and economic indicators. Despite these challenges, by September 2010, 282,916 adults and children (47.7% of those in need of treatment) were on treatment at 509 sites countrywide since national scale up started. ART services are predominantly offered through the public sector, with the private sector being an untapped potential resource for ART services for the future. Challenges of skilled and adequately trained human resources have hindered progress towards service availability. Providing access to children in particular has been constrained by lack of clinical mentorship for health workers, weak systems for support supervision, and inadequate HIV diagnostic services especially for children under 18 months and challenges with follow up of the HIV-exposed infants. Though the country has not met its target of Universal Access by 2010, significant progress has been made with over a 30-fold increase in service availability.
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Affiliation(s)
- T Apollo
- AIDS and TB Unit, Ministry of Health and Child Welfare, Harare, Zimbabwe.
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