Introduction Preliminary review of WDSS data at ZPS Head Office for period Jan-Oct 2009 revealed disparities in cases reported on weekly disease and T5 surveillance systems. Three of 10 mandated reporting health institutions were not... more
Introduction Preliminary review of WDSS data at ZPS Head Office for period Jan-Oct 2009 revealed disparities in cases reported on weekly disease and T5 surveillance systems. Three of 10 mandated reporting health institutions were not submitting data consistently. This has been a cause of concern which this study's findings intend to unravel. Methods and materials A descriptive cross sectional study was conducted in 10 prison health institutions in Harare province. Eleven health managers and 18 health workers were enrolled into study. Information on knowledge levels, resources required for operation and system attributes was collected using checklists and interviewer administered questionnaires. Main outcomes were attributes and usefulness of the system. Medians and proportions were generated using Epi info. Results Of 18 health workers interviewed, one was trained in disease surveillance, none was aware of periodic production of prison WDSS report as a main objective or report submission deadlines to head office. Eight of 10 health facilities visited neither had direct telephone lines nor clinical case definition charts displayed for diseases under surveillance. None of institutions had written guidelines on system's operation. Poor data quality was noted with data consistency ranging 75%-98%. Poor communication systems, critical shortage of stationary and lack of transport were cited as reasons for poor reporting. Discussion The prison WDSS in Harare province is useful, acceptable, representative but untimely and unstable. System computerization, training of health staff on disease surveillance, installation of direct / toll free lines in all prison health complexes and incentivisation of prison health staff may alleviate shortcomings.
SUMMARY: Objective: The objective of this study was to determine the outcome of TB patients lost to follow up during TB treatment and to identify the reasons of default. Patients and methods: It was a descriptive cross-sectional study... more
SUMMARY: Objective: The objective of this study was to determine the outcome of TB patients lost to follow up during TB treatment and to identify the reasons of default. Patients and methods: It was a descriptive cross-sectional study conducted from January 2010 to December 2011 at the Infectious Diseases Clinic of Fann Hospital in Dakar. All TB patients lost to follow-up during TB treatment more than a month and definitely before the end of prescribed duration of TB treatment were included. Some data were collected from medical records. To determine the reasons of default and patients outcome, an active search of loss to follow-up was made by phone. Results: Seventy-five patients were lost to follow up during TB treatment representing 15.2% of TB patients followed during the study period. The average age was 40.6 ± 12.1 years with extremes of 19 and 76 years old and the sex ratio (M / F) was 1.34. They were 21 cases of smear-positive (31.3%). HIV status was specified for 50 patients and 36 cases (72%) were noted HIV positive. Twenty-four HIV positive patients (66.7%) were initiated of ART during TB treatment. The reasons of default and patients outcome had been collected from 57 cases. The main reasons were the worsening of the disease (63.2%), long distance (54.4%), financial problems (50.9%), and the use of traditional medicine (22.8%). Regarding the outcome of patients, 22 were alive of whom 21 had completed their treatment in a local center and 35 had died. Conclusion: Earlier alert system, active search for default patients associated with Directly Observed Therapy Short-course (DOTS) strategy were necessary to reduce the rate of loss to follow up
Komunitas adalah aktor penting dalam respon daerah, nasional dan global terhadap masalah TB-HIV. Organisasi dan aktor komunitas tidak hanya merupakan kelompok yang menerima layanan kesehatan tetapi juga yang aktif berjuang memberikan... more
Komunitas adalah aktor penting dalam respon daerah, nasional dan global terhadap masalah TB-HIV. Organisasi dan aktor komunitas tidak hanya merupakan kelompok yang menerima layanan kesehatan tetapi juga yang aktif berjuang memberikan pelayanan kesehatan lewat berbagai dukungan pendanaan global (GHI). Keberadaan komunitas dalam sistem penanggulangan TB-HIV telah memunculkan perdebatan dan diskusi hangat terkait peran para mereka apakah hanya berhenti dalam pemberian layanan tetapi juga kegiatan organisasi lainnya. Bagaimanapun kemudian dukungan terhadap peran komunitas menjadi penting dipertahankan, kegiatan TB-HIV tanpa keterlibatan bermakna komunitas hanya akan cendurung berakhir sia-sia, sementara program yang memperhatikan keterlibatan penuh komunitas sangat mungkin mencapai target bebas TB dan HIV sekian tahun yang akan datang
Objectives: Antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are known to have a tuberculosis (TB) protective effect at the individual level among people living with HIV (PLHIV). In Zimbabwe where TB is driven by HIV... more
Objectives: Antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are known to have a tuberculosis (TB) protective effect at the individual level among people living with HIV (PLHIV). In Zimbabwe where TB is driven by HIV infection, we have assessed whether there is a population-level association between IPT and ART scale-up and annual TB case notification rates (CNRs) from 2000 to 2018. Design: Ecological study using aggregate national data. Setting: Annual aggregate national data on TB case notification rates (stratified by TB category and type of disease), numbers (and proportions) of PLHIV in ART care and of these, numbers (and proportions) ever commenced on IPT. Results: ART coverage in the public sector increased from <1% (8400 PLHIV) in 2004 to ~88% (>1.1 million PLHIV patients) by December 2018, while IPT coverage among PLHIV in ART care increased from <1% (98 PLHIV) in 2012 to ~33% (373 917 PLHIV) by December 2018. These HIV-related interventions were associated with significant declines in TB CNRs: between the highest CNR prior to national roll-out of ART (in 2004) to the lowest recorded CNR after national IPT roll-out from 2012, these were (1) for all TB case (510 to 173 cases/100 000 population; 66% decline, p<0.001); (2) for those with new TB (501 to 159 cases/100 000 population; 68% decline, p<0.001) and (3) for those with new clinically diagnosed PTB (284 to 63 cases/100 000 population; 77.8% decline, p<0.001). Conclusions: This study shows the population-level impact of the continued scale-up of ART among PLHIV and the national roll-out of IPT among those in ART care in reducing TB, particularly clinically diagnosed TB which is largely associated with HIV. There are further opportunities for continued mitigation of TB with increasing coverage of ART and in particular IPT which still has a low coverage.
TB-HIV co-infection is common in People Living with HIV/AIDS (PLHIV). Tuberculosis is an opportunistic infection (OI). OIS are infections that occur more often or are more severe in people with weakened immune systems than in people with... more
TB-HIV co-infection is common in People Living with HIV/AIDS (PLHIV). Tuberculosis is an opportunistic infection (OI). OIS are infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems. Human Immune Virus Infection (HIV) weakens the immune system, increasing the risk of TB in people with HIV. Infection with both HIV and TB is called TB-HIV co-infection. It is hospital based descriptive study conducted among the cases with TB-HIV co-infection. All the Patients consulting the investigating Physician of a department of medicine at a Seti provincial hospital in Far-western province of Nepal within study period were enrolled after informed consent. Out of 597 cases of ART taking patient were studied. Among them 54 were diagnosed TB-HIV co-infection, 74% (40) were married and 26% (14) were Unmarried. Among them 50% (27) were male and 50% (27) were female. Most of the cases were from village and semi-urban settings. TB-HIV co-infection is common opportunistic infection in patient with people living with HIV/AIDS (PLHIV).
Background: Despite the availability of highly effective treatment for decades, Tuberculosis (TB) remains a major health problem in Nigeria due to the increasing association between HIV and TB observed over the past three decades when HIV... more
Background: Despite the availability of highly effective treatment for decades, Tuberculosis (TB) remains a major health problem in Nigeria due to the increasing association between HIV and TB observed over the past three decades when HIV was discovered. However, the proportion of TB and or TB/HIV co-infected patients who have successful TB treatment outcome is not well known. This study determined the treatment outcome of TB/HIV co-infected patients with HIV negative patients in two states in Nigeria. Materials and Methods: A retrospective study of secondary data from eight Directly Observed Treatment Short (DOTS) course and Anti-Retroviral Therapy (ART) service providers in Benue and Federal Capital Territory (FCT), Nigeria, was carried out. The period under review covers January, 2010 to December, 2013. Results: Out of the total 5266 TB cases reviewed, the HIV prevalence rate was 52%. They were predominantly (53.3%) male with mean age of 34.4 years (SD = 15.1 years). More than two-third (72.5%) of HIV-negative patients had successful treatment compared to 1718 (62.7%) HIV-positive patients. Of the 2334 HIV co-infected patients, 19.5% defaulted, 11.5% had died, 5.6% were transferred out and 0.7% failed treatment compared to HIV-negative patients amongst whom 18.3% defaulted, 3.6% died, 3.9% were transferred out and 1.6% failed treatment (p < 0.05). TB/HIV co-infected patients with baseline CD4 of ≥300 cell/mm 3 are more likely to have successful treatment outcome {OR-1.541 (95% CI = 1.030-2.305) p = 0.035}. Patients ≥45 years old and those not on Co-trimoxazole Preventive Therapy (CPT) are more likely to have unsuccessful treatment outcome {OR-1.022 (95% CI = 0.643-1.488) p = 0.918 and OR-1.306 (95% CI = 0.956-1.555) respectively. A. Hassan et al. 123 Conclusion: The favourable treatment outcome of HIV-negative patients is more than that of HIV-positive patients and the most probable predictable factor responsible is the CD4 count of patient; indicating that TB/HIV co-infection has remained a major public health problem in Benue state and FCT. Hence there is the need for sustained strengthening and expansion of the national TB/HIV programmes.
Background: Children co-infected with Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) require concurrent treatment with anti-tuberculosis drugs and Antiretroviral therapy (ART). Drug interaction between nevirapine and rifampicin... more
Background: Children co-infected with Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) require concurrent treatment with anti-tuberculosis drugs and Antiretroviral therapy (ART). Drug interaction between nevirapine and rifampicin leads to decreased nevirapine levels. The impact of this drug-drug interaction on virologic and immunologic outcomes in the treatment of HIV - TB co-infected children has not been fully studied. A retrospective analysis was conducted to compare the response to nevirapine-based ART regimen among HIV- infected Ugandan children on a rifampicin containing anti-TB regimen for TB disease versus those only on ART. Methods: We analyzed data from HIV infected children aged 6 months to 12 years attending a Paediatric HIV clinic in Kampala, Uganda who between October 2004-June 2006 were enrolled into an ART program based on the 2002 World Health Organization (WHO) ART guidelines for Resource Limited Settings. In this retrospective analysis, children were divided into two groups; those on nevirapine based ART and rifampicin containing anti-TB treatment (TB group) and those on ART alone (no TB group). CD4 cell percent and viral load data obtained at baseline and thereafter 12 weekly until 48 weeks was compared using Wilcoxon rank sum test. Kaplan Meir plots were used to compare virologic success between the two groups over the 48 week follow up period. Results: The analysis included a total of 127 children of whom 20% (26/127) were in the TB group. Median log10 HIV RNA (Interquatile range-IQR) at baseline was 5.69 (5.19-6.19) in the TB group versus 5.59 (4.86-6.32) in the no TB group; p=0.576. Median viral load was undetectable for all children by 12 weeks post ART initiation and this was sustained through 48 weeks irrespective of receiving rifampicin. Baseline median CD4% was not significantly different between the two groups. The median CD4% (IQR) during follow- up for the TB group versus the no TB group was: 17.0 (8.0-26) versus 20.9 (8.0- 33.8), p=0.147 by 12 weeks; 26.0 (12.7-39.3) versus 22.9 (7.5-38.3), p=0.472 by 24 weeks; 26.6 (13.6-39.6) versus 26.4 (12.3- 40.5), p=0.927 by 36 weeks and 29.0 (20.0-38) versus 28.9 (16.8-41), p=0.931 by 48 weeks respectively. Conclusion: HIV/TB co-infected children receiving rifampicin demonstrated satisfactory immunologic and virologic responses to nevirapine based ART, similar to children not on anti- TB treatment. These findings provide evidence that nevirapine based ART may remain effective
Background: In Zimbabwe, Harare was the first province to implement “Treat All” for people living with human immunodeficiency virus (PLHIV). Since its rollout in July 2016, no study has been conducted to assess the changes in key... more
Background: In Zimbabwe, Harare was the first province to implement “Treat All” for people living with human immunodeficiency virus (PLHIV). Since its rollout in July 2016, no study has been conducted to assess the changes in key programme indicators. We compared antiretroviral therapy (ART) uptake, time to ART initiation from diagnosis, and retention before and during “Treat All”. Methods: We conducted an ecological study to assess ART uptake among all PLHIV newly diagnosed before and during “Treat All”. We conducted a cohort study to assess time to ART initiation and retention in care among all PLHIV newly initiated on ART from all electronic patient management system-supported sites (n=50) before and during “Treat All”. Results: ART uptake increased from 65% (n=4619) by the end of quarter one, 2014 to 85% (n=5152) by the end of quarter four, 2018. A cohort of 2289 PLHIV were newly initiated on ART before (April-June 2015) and 1682 during “Treat all” (April-June 2017). Their age and gender distribution was similar. The proportion of PLHIV in early stages of disease was significantly higher during “Treat all” (73.2% vs. 55.6%, p<0.001). The median time to ART initiation was significantly lower during “Treat All” (31 vs. 88 days, p<0.001). Cummulative retention at three, six and 12 months was consistently lower during “Treat all” and was significant at six months (74.9% vs.78.1% p=0.022). Conclusion: Although there were benefits of early ART initiation during “Treat All”, the programme should consider strategies to improve retention.
Background: Tuberculosis (TB) is among the world's top public health challenges and the leading killer of people with HIV, yet is a treatable disease. This study aimed to assess, in a real-world setting, the implementation of... more
Background: Tuberculosis (TB) is among the world's top public health challenges and the leading killer of people with HIV, yet is a treatable disease. This study aimed to assess, in a real-world setting, the implementation of antiretroviral therapy (ART) and Cotrimoxazole preventive therapy (CPT) policy, specific interventions proven to benefit patients in HIV-associated TB care.
Introduction: Nutrition plays an important role in stimulating the immune response to varied pathogens especially in patients with tuberculosis. Cytokine response to antitubercular therapy is highly variable in patients with HIV... more
Introduction: Nutrition plays an important role in stimulating the immune response to varied pathogens especially in patients with tuberculosis. Cytokine response to antitubercular therapy is highly variable in patients with HIV infection and Nutrition plays an important role in determining this response Objectives: To study the effect of body mass index in the levels of cytokines IL-10, IP-10, IL-4 and Interferon- Gamma before and after treatment with anti tuber-cular therapy in patients with HIV infection Material and methods: It is a prospective cross sectional study , with a population of 50 individuals with HIV infection with tu- berculosis were studied. Results: The mean levels of cytokines IFN-Gamma, IP-10, IL-10 and IL-4 in low BMI group before initiation of ATT are respectively. The mean levels of cytokines IFN-Gamma, IP-10, IL-10 and IL-4 in normal BMI group before initiation of ATT are 22.32, 4.17, 11.25 and 0.78. The levels after completion of 02 months of ATT are 17.10, 4.56 , 9.14 and 0.57 respectively. Conclusions: BMI as surrogate marker for nutrition pals an important role in cytokine response. The change in levels of Inter-
