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Maratim A, Kamar K, Ngindu A, Akoru C, Diero L, Sidle J. Safranin staining of Cyclospora cayetanensis oocysts not requiring microwave heating. Br J Biomed Sci 2016. [DOI: 10.1080/09674845.2002.11783644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A.C. Maratim
- Moi University Faculty of Health Sciences, Eldoret, Kenya
| | - K.K. Kamar
- Moi University Faculty of Health Sciences, Eldoret, Kenya
| | - A. Ngindu
- Moi University Faculty of Health Sciences, Eldoret, Kenya
| | - C.N. Akoru
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - L. Diero
- Moi University Faculty of Health Sciences, Eldoret, Kenya
| | - J. Sidle
- Indiana University School of Medicine, Indianapolis, IN, USA
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Owiti P, Zachariah R, Bissell K, Kumar AMV, Diero L, Carter EJ, Gardner A. Integrating tuberculosis and HIV services in rural Kenya: uptake and outcomes. Public Health Action 2015; 5:36-44. [PMID: 26400600 DOI: 10.5588/pha.14.0092] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 11/13/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Seventeen rural public health facilities in Western Kenya that introduced three models of integrated care for tuberculosis (TB) and human immunodeficiency virus (HIV) patients. OBJECTIVE To assess the uptake and timing of cotrimoxazole preventive therapy (CPT) and antiretroviral treatment (ART) as well as anti-tuberculosis treatment outcomes among HIV-infected TB patients before (March-October 2010) and after (March-October 2012) the introduction of integrated TB-HIV care. DESIGN A before-and-after cohort study using programme data. RESULTS Of 501 HIV-infected TB patients, 357 (71%) were initiated on CPT and 178 (39%) on ART in the period before the introduction of integrated TB-HIV care. Following the integration of services, respectively 316 (98%) and 196 (61%) of 323 HIV-infected individuals were initiated on CPT and on ART (P < 0.001). The median time to CPT and ART initiation dropped from 7 to 2 days and from 42 to 34 days during the pre- and post-integration phases, respectively. Overall TB success rates did not vary with integration or with type of model instituted. CONCLUSION Integration of TB and HIV services enhanced uptake and reduced delay in instituting CPT and ART in rural health facilities. There is a need to increase impetus in these efforts.
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Affiliation(s)
- P Owiti
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - R Zachariah
- Médecins Sans Frontières (MSF), Brussels Operational Centre, Luxembourg
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - A M V Kumar
- The Union, South East Asia Regional Office, New Delhi, India
| | - L Diero
- Academic Model Providing Access to Healthcare, Eldoret, Kenya ; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - E J Carter
- Academic Model Providing Access to Healthcare, Eldoret, Kenya ; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - A Gardner
- Academic Model Providing Access to Healthcare, Eldoret, Kenya ; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA ; Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya ; Department of Medicine, School of Medicine, Indiana University, Bloominton, Indiana, USA
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Ballif M, Nhandu V, Wood R, Dusingize JC, Carter EJ, Cortes CP, McGowan CC, Diero L, Graber C, Renner L, Hawerlander D, Kiertiburanakul S, Du QT, Sterling TR, Egger M, Fenner L. Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries. Int J Tuberc Lung Dis 2015; 18:1327-36. [PMID: 25299866 DOI: 10.5588/ijtld.14.0106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
SETTING Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons. OBJECTIVE To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries. DESIGN We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs. RESULTS Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages. CONCLUSIONS Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.
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Affiliation(s)
- M Ballif
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - V Nhandu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - R Wood
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - J C Dusingize
- Women's Equity in Access to Care & Treatment, Kigali, Rwanda
| | - E J Carter
- United States Agency for International Development Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - C P Cortes
- University of Chile School of Medicine, Santiago, Chile
| | - C C McGowan
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - L Diero
- United States Agency for International Development Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - C Graber
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - L Renner
- University of Ghana Medical School, Accra, Ghana
| | - D Hawerlander
- Centre Intégré de Recherches Biocliniques, Abidjan, Côte d'Ivoire
| | - S Kiertiburanakul
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Children's Hospital, Ho Chi Minh City, Viet Nam
| | - Q T Du
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - T R Sterling
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - M Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - L Fenner
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
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Oyieng'o D, Park P, Gardner A, Kisang G, Diero L, Sitienei J, Carter J. Community-based treatment of multidrug-resistant tuberculosis: early experience and results from Western Kenya. Public Health Action 2012; 2:38-42. [PMID: 26392946 DOI: 10.5588/pha.12.0002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 01/09/2012] [Accepted: 04/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the light of the 2010 World Health Organization estimation of 650 000 cases of multidrug-resistant tuberculosis (MDR-TB) globally, the need to develop, implement and scale up MDR-TB treatment programs is clear. The need is greatest and urgent in resource-poor countries, such as Kenya, with a high TB burden and an anticipated rise in reported cases of MDR-TB with increasing access to drug susceptibility testing. OBJECTIVES To describe the set-up of a community-based program, early clinical outcomes, challenges and possible solutions. SETTING The Moi Teaching and Referral Hospital (Moi Hospital) catchment areas: Western and North Rift Provinces, Kenya. DESIGN Program description and retrospective chart review. RESULTS An MDR-TB team established a community-based program with either home-based DOT or local facility-based DOT. Following referral, the team instituted a home visit, identified and hired a DOT worker, trained family and local health care professionals in MDR-TB care and initiated community-based MDR-TB treatment. In the first 24 months, 14 patients were referred, 5 died prior to initiation of treatment and one had extensively drug-resistant TB. Among eight patients who initiated community-based DOT, 87% underwent culture conversion by 6 months, and 75% were cured with no relapse after a median follow-up of 15.5 months. Multiple challenges were experienced, including system delays, stigma and limited funding. CONCLUSION Despite multiple challenges, our model of an MDR-TB team that establishes a community-based treatment system encircling diagnosed cases of MDR-TB is feasible, with acceptable treatment outcomes.
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Affiliation(s)
- D Oyieng'o
- Internal Medicine, Brown University, Providence, Rhode Island, USA
| | - P Park
- Internal Medicine, Duke University, Durham, North Carolina, USA
| | - A Gardner
- Internal Medicine, Brown University, Providence, Rhode Island, USA
| | - G Kisang
- Internal Medicine, Moi University, Eldoret, Rift Valley, Kenya
| | - L Diero
- Internal Medicine, Moi University, Eldoret, Rift Valley, Kenya
| | - J Sitienei
- Division of Leprosy, Tuberculosis and Lung Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - J Carter
- Internal Medicine, Brown University, Providence, Rhode Island, USA
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Maratim AC, Kamar KK, Ngindu A, Akoru CN, Diero L, Sidle J. Safranin staining of Cyclospora cayetanensis oocysts not requiring microwave heating. Br J Biomed Sci 2002; 59:114-5. [PMID: 12113399] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- A C Maratim
- Moi University Faculty of Health Sciences, Eldoret, Kenya
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Ngindu A, Kamar K, Choge A, Maritim A, Akoru C, Diero L, Smith J, Bartlett M. Survey of faecal parasites in patients from western Kenya. J Egypt Soc Parasitol 2002; 32:1-7. [PMID: 12049246] [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: 02/25/2023]
Abstract
Faecal specimens were collected from patients complaining of diarrhoea and abdominal or epigastric discomfort at two hospitals. Information obtained by questionnaires completed at the time of specimens collection, included demographic and clinical data. Specimens were preserved in 10% formalin and polyvinyl alcohol (PVA) and examined, as wet mounts and stained with Wheatley's Trichrome, Weber, modified acid-fast and hot safranin stains. One hundred patients were examined, in 30 of them parasites were detected. The most common organism identified was Cryptosporidium parvum, in specimens of five patients, followed by Entamoeba histolytica/E. dispar in four patients. The recently described "emerging parasites" were detected. Helminth eggs were found in two patients only. HIV status was not known for most of the patients, and the parasites commonly proliferate in the immuno-compromised individuals were not frequently found.
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Affiliation(s)
- A Ngindu
- Moi University, Faculty of Health Sciences, Eldoret, Kenya
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