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Introduction: Pregnancy can pose a risk to women on tuberculosis (TB) treatment with a threat to the mother, fetus, and family at large. Contraceptive counseling and provision should be an integral part of TB clinics. Physiological and... more
Introduction: Pregnancy can pose a risk to women on tuberculosis (TB) treatment with a threat to the mother, fetus, and family at large. Contraceptive counseling and provision should be an integral part of TB clinics. Physiological and stress-related effects result when pregnancy occurs on TB illness and while treatment. Hence, this study aimed to assess contraceptive utilization, unmet need among women on TB treatment, and integration of family planning (FP) services with TB clinics in Addis Ababa, Ethiopia.Methods: A facility-based cross-sectional study was conducted using an interviewer-administered questionnaire. A total of 316 women aged 18-49 who were on TB treatment were recruited from one TB referral hospital and five randomly selected health centers in Addis Ababa with a response rate of 100%. The contraceptive utilization rate, unmet need, and integration of FP and TB services were determined. Logistic regression models were conducted to identify factors associated with co...
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TB (tuberculosis) clubs were first introduced in the Estie district of South Gonder administrative zone, Amhara region of northwestern Ethiopia in January 1997, in an attempt to improve TB control in rural areas. Before the clubs were... more
TB (tuberculosis) clubs were first introduced in the Estie district of South Gonder administrative zone, Amhara region of northwestern Ethiopia in January 1997, in an attempt to improve TB control in rural areas. Before the clubs were introduced, patients who were family members or close neighbors were given different treatment follow-up dates. Walking long distances alone to secure treatment, patients often grew discouraged from continuing treatment once their health began to improve. However, upon the introduction of the TB clubs, neighboring patients, or those in the same family, had their follow-up appointment dates rearranged in the same clinics. Local neighborhoods were also used to group nearby patients in the same follow-up clinic. The patients then formed their own groups (TB clubs) and elected leaders. 3-10 members usually comprise each club, with the club leaders monitoring drug intake and new developments, such as drug side effects and toxic skin reactions. The social os...
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A rural district (Estie) in South Gonder, Ethiopia. To describe the contribution of 'TB clubs' (small support groups of patients based on where they live) to the performance of the tuberculosis control programme in Estie District.... more
A rural district (Estie) in South Gonder, Ethiopia. To describe the contribution of 'TB clubs' (small support groups of patients based on where they live) to the performance of the tuberculosis control programme in Estie District. A descriptive study of the formation of 'TB clubs', their contribution to case-finding and the treatment outcomes before and after formation of the 'TB clubs'. The proportion of actual among expected attendances of tuberculosis patients for follow-up during treatment at health facilities significantly increased (P < 0.001) after the introduction of the TB clubs. Community elders, community health agents and local health workers helped TB clubs to refer tuberculosis suspects, promote treatment adherence and trace defaulters as an integral part of a district tuberculosis programme. The TB clubs referred 181 tuberculosis suspects in the community for investigation, of whom 65% subsequently had a diagnosis of tuberculosis. TB clubs i...
Research Interests: Program Evaluation, Treatment, Developing Countries, Public Health, Ethiopia, and 15 moreMedicine, Self Help Groups, Humans, Female, Male, Exploration, Patient Compliance, The, Aged, Middle Aged, Adult, Rural Area, Communicable disease control, Rural Population, and Cardiovascular medicine and haematology
Global consensus has been achieved around the new interim policy on collaborative TB/HIV activities. However the implementation of joint TB/HIV activities has not yet been scaled up. Updating research priorities specifically aimed at... more
Global consensus has been achieved around the new interim policy on collaborative TB/HIV activities. However the implementation of joint TB/HIV activities has not yet been scaled up. Updating research priorities specifically aimed at informing future policy and improving the implementation of joint TB/HIV activities in the context of antiretroviral therapy programmes should accelerate scale-up. For this reason the Secretariat of the Global TB/HIV Working Group of the Stop TB Partnership in collaboration with WHOs Stop TB Department and Department of HIV/AIDS and the UNDP/UNICEF/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) convened an Expert Consultation on TB/HIV Research Priorities in Resource-limited Settings on 14–16 February 2005 in Geneva Switzerland. The specific objectives of the Consultation were 1) to define TB/HIV research priorities and outline their research relevance methods and feasibility in the context of programme activities ...
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The City Council of Versailles awarded the Ville de Versailles Medal to the Stop TB Partnership in recognition of its achievements in global TB control. The Partnership established in 2000 comprises a network of some 400 members including... more
The City Council of Versailles awarded the Ville de Versailles Medal to the Stop TB Partnership in recognition of its achievements in global TB control. The Partnership established in 2000 comprises a network of some 400 members including international and national organizations and institutions donor agencies from the public and private sectors governmental and nongovernmental organizations. It was hailed as a successful partnership characterized by clear objectives dynamic spirit and enthusiasm which is playing a key role in coordinating the global response to the TB epidemic. The Deputy Mayor of Versailles Mr Stephane Buffetaut presented the medal to the Executive Secretary of the Stop TB Partnership Dr Marcos Espinal during the opening session of the meeting. Dr Espinal thanked all members of the Partnership worldwide the Partnership Secretariat and many other collaborators past and present whose strong commitment to TB control had made this award possible. He said this recognit...
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LABORATORIES FORM the foundation of the national tuberculosis control programme (NTP) and are one of the first points of contact for tuberculosis (TB) suspects. Confidence or mistrust of TB patients in the health system and the NTP will... more
LABORATORIES FORM the foundation of the national tuberculosis control programme (NTP) and are one of the first points of contact for tuberculosis (TB) suspects. Confidence or mistrust of TB patients in the health system and the NTP will be initiated at this point. As highlighted in the new World Health Organization (WHO) Stop TB Strategy launched on World TB Day 2006,1 bacteriology is vital for DOTS expansion and control of drug resistance. A network of wellperforming laboratories is crucial for implementing the strategy. By responding quickly and providing quality services, including culture, the laboratory network will enable the early diagnosis of TB, hence reducing transmission of both drug-susceptible and -resistant TB, enabling appropriate treatment of disease and minimising the risk of possible complications, including death. Early laboratory diagnosis of TB still relies on the microscopic examination of respiratory specimens for acid-fast bacilli (AFB). The technique, althou...
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OBJECTIVE To examine the use of symptoms, chest X-ray (CXR) abnormalities, and combinations of symptoms and CXR in excluding active pulmonary tuberculosis (TB) before treating for latent tuberculous infection (LTBI) in high TB burden... more
OBJECTIVE To examine the use of symptoms, chest X-ray (CXR) abnormalities, and combinations of symptoms and CXR in excluding active pulmonary tuberculosis (TB) before treating for latent tuberculous infection (LTBI) in high TB burden countries. METHODS We updated a systematic review and meta-analysis of studies on the sensitivities, specificities, predictive values, diagnostic odds ratios and areas under the curve for index tests. The analysis was conducted using the hierarchical summary receiver operating characteristic method in R software. RESULTS We included 24 publications in the systematic review and meta-analysis. 'Any CXR abnormality' had the highest sensitivity (94.1%, 95%CI 85.8-97.7) among all index tests. 'CXR abnormality suggestive of TB' had a higher specificity (92.2%, 95%CI 89.7-94.1) than 'any CXR abnormality' (86.8%, 95%CI 79.7-91.7). The sensitivity for 'any TB symptom' was 73.0% (95%CI 64.1-80.4), while 'prolonged cough' of ≥2 weeks had a specificity of 94.3% (95%CI 92.2-95.9). There was no significant difference in the sensitivity and specificity of all screening tools stratified by human immunodeficiency virus (HIV) settings, with the exception of 'CXR abnormality suggestive of TB', which had a significantly higher sensitivity in low than in high HIV prevalence settings (effect estimate 2.26, 95%CI 0.69-3.82; P = 0.002). CONCLUSION In countries with a high TB burden, the absence of any TB symptom and any CXR abnormality can be used to exclude active pulmonary TB before initiating treatment for LTBI in household contacts aged ≥5 years of patients with bacteriologically confirmed pulmonary TB. .
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BACKGROUND Uptake of preventive treatment for tuberculosis (TB) remains poor. A 3-month regimen of rifapentine (RPT) plus isoniazid (INH) (3HP) could facilitate its scale-up. We conducted a systematic review to assess the effects of 3HP... more
BACKGROUND Uptake of preventive treatment for tuberculosis (TB) remains poor. A 3-month regimen of rifapentine (RPT) plus isoniazid (INH) (3HP) could facilitate its scale-up. We conducted a systematic review to assess the effects of 3HP compared with daily 6- or 9-month INH monotherapy. METHODS We searched the following databases to identify randomised controlled trials: PubMed, Embase, the Web of Science, Cochrane Central Register of Controlled Trials, three ongoing trial registers and conference abstracts up to 24 January 2017. Where possible, we pooled data using a random-effects model. RESULTS Four studies were included. Of those, we included two studies that compared 3HP with daily 6- or 9-month INH (6/9H) among adults with human immunodeficiency virus (HIV) co-infection, one among HIV-negative adults and one among predominantly HIV-negative children and adolescents. Risk of active TB was not significantly different between 3HP and 6/9H (risk ratio [RR] 0.73, 95%CI 0.23-2.29, in adults with HIV; RR 0.44, 95%CI 0.18-1.07, in adults without HIV; RR 0.13, 95%CI 0.01-2.54, in children and adolescents). Risk of hepatotoxicity was significantly lower in the 3HP group among adults with HIV (RR 0.26, 95%CI 0.12-0.55) and those without HIV (RR 0.16, 95%CI 0.10-0.27). 3HP was also associated with a higher completion rate in all subgroups. CONCLUSIONS HP was shown to have a preventive effect similar to that of INH monotherapy, with fewer adverse events and higher completion rates. 3HP can contribute significantly to the scale-up of preventive treatment.
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Global survey among low tuberculosis (TB) burden countries, which are primary target countries for the World Health Organization (WHO) guidelines on the programmatic management of latent tuberculous infection (LTBI). To perform a baseline... more
Global survey among low tuberculosis (TB) burden countries, which are primary target countries for the World Health Organization (WHO) guidelines on the programmatic management of latent tuberculous infection (LTBI). To perform a baseline assessment of policies and practices for the programmatic management of LTBI. Online and paper-based pre-tested questionnaire filled out by national TB programme managers or their equivalents from 108 countries. Of 74 respondent countries, 75.7% (56/74) had a national policy on LTBI. The majority of the countries (67/74, 90.5%) provided LTBI testing and treatment for child contacts of TB cases, while almost two thirds (49/74, 66%) reported provision of LTBI testing and treatment to people living with the human immunodeficiency virus (PLHIV). Six countries (8.1%) did not report providing LTBI management to child contacts and PLHIV. Among countries that reported both the availability of policy and practice of testing and treatment of LTBI for at-risk populations, a system for recording and reporting data was available in 62% (33/53) for child contacts and in 53% (21/40) for PLHIV. Countries need to ensure that national LTBI policies and a standardised monitoring and evaluation system are in place to promote the programmatic management of LTBI.
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Research Interests: Health Professional Education, Developing Countries, Health, Ethiopia, Curriculum, and 15 moreHealth Care reform, Humans, Female, Job Search, Health Professionals, Career Choice, Adult, Cross Section, Career Mobility, Health Workers, Cross Sectional Analysis, Community Based Mental Health Services, Health Personnel, Health Sector Reform, and Community health services
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A community based cross sectional study was conducted in April 1997 to assess the perspective of the rural community towards Tuberculosis (TB) and TB patients and identify prevailing misconceptions and other problems related with TB in... more
A community based cross sectional study was conducted in April 1997 to assess the perspective of the rural community towards Tuberculosis (TB) and TB patients and identify prevailing misconceptions and other problems related with TB in the south Gonder administrative zone of the Amhara region. A total of 1000 heads of household were interviewed and disease information was obtained for 5078 family members. The prevalence of productive cough lasting more than 3 weeks was 4.6% (233/5078) and cervical, axillary or inguinal swelling with or with out a sinus tract that lasted more than 12 months was 1.0% (52/5078). TB treatment defaulters were found in 10% of the rural households. Apparent clinical improvement after the intensive phase was the commonest reason for defaulting (45%) followed by far distance of the health institution (25.3%). Evil spirit and sexual intercourse were incriminated as a cause for TB in 19.9% and 4.7% of respondents respectively. TB was believed as curable diseas...
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An institution based cross sectional study was conducted in June 1996 at a rural health centre in South Gonder Administrative Zone of Northern Ethiopia. Interview and respective review of medical records of patients were done. A total of... more
An institution based cross sectional study was conducted in June 1996 at a rural health centre in South Gonder Administrative Zone of Northern Ethiopia. Interview and respective review of medical records of patients were done. A total of 211 tuberculosis (TB) patients were included in the study, 133 (63%) males and 78 (37%) females. Majority (79.6%) of patients had pulmonary disease. Clinical observation based on symptoms and signs suggestive of tuberculosis was used as a sole criteria to prescribe anti-tuberculosis treatment in 54.1% (114/211) of all the patients. Acid fast staining of sputum was done for 51.2% (86/168) of the pulmonary patients out of whom only 31.4% were smear positive. Social ostracism was observed to have been affecting tuberculosis patients and their families to a great extent. Divorce rate due to tuberculosis among patients was 29.1% (37/127). Patients have reported loss or threat to lose their job. Dietary misconceptions were rampant. The TB control activiti...
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A community based cross sectional study was conducted in a rural district of North West Ethiopia between February and April 1997 to determine the magnitude of marriage through abduction ('Telefa') and identify problems associated... more
A community based cross sectional study was conducted in a rural district of North West Ethiopia between February and April 1997 to determine the magnitude of marriage through abduction ('Telefa') and identify problems associated with it. Randomly selected and currently married 1,168 women were interviewed. The prevalence of marriage through abduction was 6.2% (72/1168). All the abductions reported were only once in lifetime during the first marriage. The median age at first marriage of abducted women was 13 years with a range of 13 (Minimum = 7 and Maximum 20). About two third (66.7%) of abducted women had been married more than once in their life time. Following a multivariate analysis in a logistic regression model abducted women were likely to be victims of abortion [Adjusted OR (95% CI) = 1.71 (1.10-3.05)], marital instability [Adjusted OR (95% CI) = 1.87 (1.10-3.18)], rape [Adjusted OR (95% CI) = 7.77 (3.78-15.95)] and domestic violence [Adjusted OR (95% CI) = 1.69 (1....
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A rural district (Estie) in South Gonder, Ethiopia. To describe the contribution of 'TB clubs' (small support groups of patients based on where they live) to the performance of the tuberculosis control programme in Estie District.... more
A rural district (Estie) in South Gonder, Ethiopia. To describe the contribution of 'TB clubs' (small support groups of patients based on where they live) to the performance of the tuberculosis control programme in Estie District. A descriptive study of the formation of 'TB clubs', their contribution to case-finding and the treatment outcomes before and after formation of the 'TB clubs'. The proportion of actual among expected attendances of tuberculosis patients for follow-up during treatment at health facilities significantly increased (P < 0.001) after the introduction of the TB clubs. Community elders, community health agents and local health workers helped TB clubs to refer tuberculosis suspects, promote treatment adherence and trace defaulters as an integral part of a district tuberculosis programme. The TB clubs referred 181 tuberculosis suspects in the community for investigation, of whom 65% subsequently had a diagnosis of tuberculosis. TB clubs i...
Research Interests: Program Evaluation, Treatment, Developing Countries, Public Health, Ethiopia, and 15 moreMedicine, Self Help Groups, Humans, Female, Male, Exploration, Patient Compliance, The, Aged, Middle Aged, Adult, Rural Area, Communicable disease control, Rural Population, and Cardiovascular medicine and haematology
Three hundred and thirty three patients in the lathyrism endemic rural Estie district of Northern Ethiopia were interviewed and examined to assess the psychosocial impacts of neurolathyrism. The majority of the affected were in the age... more
Three hundred and thirty three patients in the lathyrism endemic rural Estie district of Northern Ethiopia were interviewed and examined to assess the psychosocial impacts of neurolathyrism. The majority of the affected were in the age group of 11-20 years (43%) followed by 21-30 years (29%). Males were more affected than females (4.8:1). Peak occurrences of neurolathyrism was observed at time of mobilization of the population in villagization and land diversification schemes. Females were affected to lesser extent and at an earlier age than males. Neurolathyrism affected matrimony among the rural farming population where marriage is considered as the most significant social achievement of any young member of the society. Divorce rate due to paralysis was 28%. It also influenced the choice of occupation among the afflicted rural people. Many males went into ecclesiastical professions. A significant number of males also took up occupations which traditionally were considered to be ex...
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Research Interests: Anthropology, Health Education, Community, Ethiopia, Adolescent, and 15 moreComparative Study, Knowledge, Humans, Female, Attitude, Aged, Adult, Cross Section, Educational Status, Health Workers, Cross Sectional Studies, Health Personnel, Family Characteristics, Interviews as topic, and Climatic condition
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Non-compliance is a major problem in the treatment of tuberculosis (TB). This paper assesses the effectiveness of &quot;TB clubs&quot; in improving compliance with TB treatment and their impact in improving societal attitudes... more
Non-compliance is a major problem in the treatment of tuberculosis (TB). This paper assesses the effectiveness of &quot;TB clubs&quot; in improving compliance with TB treatment and their impact in improving societal attitudes associated with TB. The study utilised both quantitative (cohort study) and qualitative (focus group discussion and an in-depth interview) methods. The cohort study was conducted in two rural districts of Northern Ethiopia. A total of 128 sputum positive pulmonary patients were enrolled and followed, 64 in the TB club and 64 in the comparison groups, to determine treatment outcome of anti-TB therapy. The impact of the TB clubs in changing societal attitudes and behaviour associated with TB was assessed using qualitative methods. The treatment completion rate was significantly better (X2=5.41, P&lt;0.02) in the TB club group, 44 out of 64 patients (68.7%) completed treatment in TB club while only 30 of the 64 (46.8%) completed treatment in the comparison group. The defaulter rate was also significantly lower (X2=11.57, P&lt;0.001) in the TB club group 8/64 (12.5%) compared to 26/64 (40.6%) in the comparison group. The qualitative part of the study also demonstrated remarkable changes in patients&#39; understanding of TB, patients&#39; initial reaction to a TB diagnosis, misconceptions as to the cause and treatment of TB, the social isolation and compliance and belief in the modern health care in the TB club area. The complementary results obtained from the quantitative and qualitative components of the study indicate that the TB club approach has a significant impact in improving patients&#39; compliance to anti-TB treatment and in building positive attitudes and practice in the community regarding TB. This study, thus, provides convincing evidences that the TB club approach is useful in delivering TB treatment successfully in rural populations. Further large-scale studies are needed to find out whether this approach is applicable on a national scale and to other developing countries.
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To review the available published and non-published literature on patient empowerment in tuberculosis (TB) control, describe what it entails, identify possible trends and conclusions, and suggest areas both for informing policy makers and... more
To review the available published and non-published literature on patient empowerment in tuberculosis (TB) control, describe what it entails, identify possible trends and conclusions, and suggest areas both for informing policy makers and for orienting further research.
Research Interests: Prejudice, Tropical Medicine, Empowerment, Evaluation, Tropical medicine (Health Sciences), and 10 moreTuberculosis, Humans, TB, Patient Compliance, Theoretical Models, Public health systems and services research, Patient Participation, Patient Centered Care, Patient Advocacy, and Health Services Accessibility
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Research Interests: Research Design, Poverty, Developing Countries, Comorbidity, Humans, and 15 moreHuman Resources for Health, Female, Male, Meta Analysis, Prevalence, Middle Aged, Adult, Fever, Observational Study, Cough, Predictive value of tests, Health Resources, mass Screening, Medical and Health Sciences, and HIV infections
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Research Interests: Program Evaluation, Research Methodology, Global Health, Medical Microbiology, Evaluation, and 15 moreDeveloping Countries, Health, Medicine, Disease Outbreaks, Humans, Measurement, HIV Prevention, Resource Limitation, Impact, Clinical Sciences, Health System, Prevalence, Health Services Accessibility, opportunistic infection, and HIV infections
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Research Interests: Medicine, Disease Outbreaks, Antiretroviral Therapy, Tuberculosis, Humans, and 12 moreInfection Control, Multidrug Resistance, Resource Limitation, Risk factors, Human immunodeficiency virus, Highly Active Antiretroviral Therapy, Risk Factors, Isoniazid, JAMA, Patient care management, Medical and Health Sciences, and HIV infections
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To provide a comprehensive summary of the prevention, diagnosis and treatment of HIV-related tuberculosis (TB) in people who inject drugs (PWIDs), and recommend actions to enhance the clinical and programmatic responses to the epidemic.... more
To provide a comprehensive summary of the prevention, diagnosis and treatment of HIV-related tuberculosis (TB) in people who inject drugs (PWIDs), and recommend actions to enhance the clinical and programmatic responses to the epidemic. People who live with HIV and inject drugs have a 2-6-fold increased risk of developing TB compared with noninjectors, and commonly have comorbidities with hepatitis B (HBV) and C viral (HCV) infection. Among PWIDs who develop TB, at least one in three will also have HIV and two out of three will have HCV antibodies. They are also at increased risk of criminalization and incarceration. The risk of TB disease in prisons is on average 23 times higher than the level in the general population. Key recent developments to address HIV-related TB among PWIDs include the use of simplified symptom-based algorithm to provide isoniazid-preventive therapy, molecular DNA detection methods for Mycobacterium tuberculosis and the immediate provision of antiretroviral therapy within the first 2 weeks of initiation of anti-TB treatment. Addressing the challenge posed by HIV-associated TB among PWIDs requires a systematic and integrated response to viral hepatitis and incarceration-related health issues, in addition to ensuring HIV and TB prevention, diagnosis and treatment as core components of harm reduction services. Regionally tailored measures, taking into consideration the epidemiology of these comorbidities, the policy and programmatic environment, and the infrastructure of the health system are needed.