Delay for Tuberculosis Treatment and Its Predictors among Adult Tuberculosis Patients at Debremarkos Town Public Health Facilities, North West EthiopiaRead the full article
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Predictors of Adverse TB Treatment Outcome among TB/HIV Patients Compared with Non-HIV Patients in the Greater Accra Regional Hospital from 2008 to 2016
Introduction. The convergence of TB and HIV dual epidemics is a major public health challenge in Ghana as well as many developing countries. Treatment outcome monitoring is a vital part of the surveillance needed to successfully eliminate TB. The impact of HIV status and demographic and treatment-related factors on adverse TB treatment outcome has not been studied in the Greater Accra Regional Hospital. This study determined factors associated with TB treatment outcome in patients with TB-HIV coinfection and TB-only infection in the hospital. Method. A cross-sectional study was carried out in the Greater Accra Regional Hospital. We reviewed TB treatment cards of patients who received treatment for tuberculosis in the hospital from 2008 to 2016. Data on treatment outcome and sociodemographic and clinical characteristics were extracted on TB-only-infected and TB/HIV-coinfected patients. The chi-squared test and binary and multiple logistic regression models were used to assess factors associated with adverse treatment outcome. Results. Out of the 758 patient records analyzed, 174 (22.9%) were TB-HIV-coinfected patients. Overall treatment success for all TB patients was 88.1% (668/758). About 11.9% (90/758) of the patients had an adverse treatment outcome, including treatment failure 0.9% (7/758), defaulting 0.9% (7/758), and death 10.0% (76/758). TB-HIV-coinfected patients’ treatment success was 78.1% (136/174). TB-only patients’ treatment success was 91.4% (532/582). Independent predictors of adverse treatment outcome were found to be as follows: being HIV positive (aOR: 3.85, 95% CI: 2.19-6.75; ); aged 65 and above (aOR: 1.76, 95% CI: 1.44-1.54; ); and previously failed TB treatment (aOR: 5.02, 95% CI: 2.09-28.87; ). Conclusion. Treatment outcome for TB-HIV-coinfected patients is below the WHO target. HIV status, age, and category of patient of the TB patients were associated with adverse treatment outcome. Strengthening the TB/HIV collaborative efforts by stakeholders is required for good treatment outcomes.
Tuberculosis Case Finding Cascade and Treatment Outcomes among Male Inmates in Two Prisons in Zimbabwe
Setting. Zimbabwe is a high tuberculosis (TB) burden country, with an estimated prevalence of 344/100,000 population. Though prisons are known high-prevalence sites for TB, the paucity of data affects the quantification of the disease and treatment outcomes in these settings. We measured the prevalence of TB disease and treatment outcomes among inmates at two major prisons in Harare, Zimbabwe. Design. A cohort study using programmatic data was undertaken to assess TB diagnostic cascade in one of the study prisons for 2018. Treatment outcomes among male inmates with TB were assessed over a period of four years, in two study prisons. Results. A total of 405 (11%) inmates with presumptive TB were identified, and 370 (91%) of these were evaluated for TB, mostly using rapid molecular testing of sputum specimens. Twenty-five inmates were diagnosed with TB resulting in a prevalence of 649/100,000 population. Of these, 16 (64%) were started on treatment. Nine (36%) were lost to follow-up before treatment initiation. From 2015 to 2018, 280 adult male inmates with TB were started on treatment. Of these, 212 (76%) had pulmonary disease that was bacteriologically confirmed. Almost all (276/280, 99%) had known HIV status, 65% were HIV-infected, and 80% of these were on antiretroviral treatment. The TB treatment success rate (cured or treatment completed) was recorded for 209 (75%) inmates, whilst 14 (5%) died and 11 (4%) were lost to follow-up. The frequency of unfavourable treatment outcomes (death, lost to follow-up, and not evaluated) was higher (54%) among years than those in the age group of 45-59 years (17%). Conclusion. The findings revealed a threefold burden of TB in prisons, compared with what is reported by national survey. To decrease transmission of TB bacilli, it is essential to promote efforts that address missed opportunities in the TB diagnostic cascade, prompt treatment initiation, and ensure that tracking and documentation of treatment outcomes for all inmates are intensified.
Assessment of Knowledge and Attitude of Tuberculosis Patients in Direct Observation Therapy Program towards Multidrug-Resistant Tuberculosis in Addis Ababa, Ethiopia: A Cross-Sectional Study
Background. Multidrug-resistant tuberculosis (MDR-TB) is becoming a major challenge of tuberculosis (TB) control program globally but more serious in developing countries like Ethiopia. In 2013, a survey result showed that in Ethiopia, tuberculosis patients from new cases and retreatment cases had resistance to at least isoniazid and rifampicin with a significant increase over time. Inadequate knowledge and wrong perception about MDR-TB by patients were detrimental to TB control programs. The study aimed at assessing the knowledge and attitude of TB patients of direct observation therapy program towards multidrug-resistant tuberculosis in health centres of Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted in 10 health centres of Addis Ababa which were selected by simple random sampling technique. A total of 422 TB patients were included in the study, and participants from each health centres were taken proportional to the number of clients in each health centres. Data was entered and analyzed using SPSS version 20. Association between outcome and independent variables was explored using logistic regression. Results. The level of knowledge of TB patients about MDR-TB was poor and only 55.0% of TB patients attained good overall knowledge. A significant association was found between good knowledge and attending tertiary level of education (, , 9.8), gender (, , 2.4), income of respondents’ family (, , 0.9), and sleeping practice (, , 15.7). Nearly three-fourths (73.5%) of TB patients had a favourable attitude towards MDR-TB. Occupational status (, , 7.6) and sleeping practices (, , 5.0) were significantly associated with the attitude of the TB patients. Conclusions. Knowledge of TB patients toward MDR-TB was poor. Although a large proportion of patients had a favourable attitude, it still needs to be improved. Hence, efforts should be made to implementing health education to improve awareness of TB patients about MDR-TB.
Contact Screening and Isoniazid Preventive Therapy Initiation for Under-Five Children among Pulmonary Tuberculosis-Positive Patients in Bahir Dar Special Zone, Northwest Ethiopia: A Cross-Sectional Study
Background. Children are highly susceptible to Mycobacterium tuberculosis infection, and about 70% of children living in the same households with pulmonary tuberculosis-positive patients will become infected. However, pulmonary positive tuberculosis is a common phenomenon and the implementation of the recommended contact screening and initiation of isoniazid preventive therapy is very low. Therefore, this study is aimed at assessing contact screening practice and initiation of isoniazid preventive therapy of under-five children among pulmonary tuberculosis-positive patients in Bahir Dar, northwest Ethiopia. Methods. A facility-based cross-sectional study was conducted from March 1 to 30, 2016. A total of 267 pulmonary tuberculosis-positive patients were included in this study. To identify independent predictors of contact screening and isoniazid preventive therapy initiation, we performed multivariable logistic regression analyses using SPSS version 20 with CI of 95% at value < 0.05. Results. A total of 230 (90.2%) pulmonary tuberculosis-positive patients had single contacts with their under-five children. One hundred nine (64.8%) children were screened. From those screened, 11 (7.4%) developed tuberculosis disease and started antituberculosis treatment. Forty-four (31.9%) children started isoniazid preventive therapy. Sex of the participants, place of service delivery, relationship with contacts, HIV status, and attitude of PTB+ cases were significant predictors of contact screening (). Participant’s knowledge, attitude of participants, and relationship of the child with participant were significant predictors of isoniazid preventive therapy initiation (). Conclusion. Contact screening practice and isoniazid preventive therapy initiation of children under the age of 5 in Bahir Dar zone were very low. Intimate family contact with pulmonary tuberculosis-positive patients, place of service delivery, and attitude towards screening are the key factors of contact screening. Participant’s knowledge, attitude of participants, and relationship of the child with participant are the key factors of isoniazid preventive therapy initiation. Therefore, household contact screening and isoniazid preventive therapy initiation should be paid attention to reduce transmission.
Evaluation of TB/HIV Collaborative Activities: The Case of South Tongu District, Ghana
Background. There is a complex interaction between infection with human immunodeficiency virus (HIV) and tuberculosis (TB) infection that results in a synergistic increase in their prevalence, morbidity, and mortality. In Ghana, 32% of TB cases were estimated to be coinfected with the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) epidemic HIV, with the highest number of coinfections in the Volta Region. This study assessed the extent of linkage between the TB and HIV collaborative activities in the South Tongu District of Ghana. Method. The study employed both qualitative and quantitative methods to assess the coverage of activities to reduce the burden of TB in people living with HIV and the coverage of activities to reduce the burden of HIV in TB patients and explored the barriers to collaborative activities from the providers’ perspective. Results. The study showed that 344 (94.8%) HIV-positive clients were screened for TB, of which 10 (8.5%) were bacteriologically confirmed. Among those positive for TB, 6 (60%) received cotrimoxazole preventive therapy (CPT) and antiretroviral therapy. Sixty-seven (93.1%) TB patients were screened for HIV. Of these, 28 (38.9%) were retropositive, among whom 14 (50%) received anti-TB treatment. However, there were no records of isoniazid preventive therapy (IPT) for these patients. Inadequately trained personnel leading to work overload, manual record-keeping, lack of staff motivation, and absence of “enablers” packages for patients were identified as barriers to TB/HIV collaboration. Conclusion. Overall, there was a moderate linkage between TB and HIV collaborative activities in the study setting. Notwithstanding, there exist some barriers that mitigate against the successful implementation of the collaborative process from the providers’ perspective, hence we recommend for measures to ensure effective, efficient, and sustained integrated TB/HIV activities by addressing these barriers.
Cost of Tuberculosis Care in Programmatic Settings from Karnataka, India: Is It Catastrophic for the Patients?
Background. TB diagnostic and treatment services in India are provided free of cost in the programmatic context across the country. There are different costs incurred during health care utilization, and this study was conducted to estimate such costs. Methodology. A longitudinal study was conducted among patients of three urban tuberculosis units (TUs) of Davangere, Belagavi, and Bengaluru, Karnataka. Trained data collectors administered a validated questionnaire and recorded monthly costs incurred by the patients which are expressed in median Indian National Rupees (INR). The analysis was done using SPSS version 23.0. A value of <0.05 was taken as statistically significant. Results. Among 214 patients, about 37%, 42%, and 21% belonged to Davangere, Belagavi, and Bengaluru, respectively. Median total pre- and postdiagnostic costs incurred across the three TUs were 3800 and 4000 INR, respectively. The direct nonmedical cost was higher for accommodation (median cost of 800 INR) and direct medical cost for non-TB drugs (median cost of 2000 INR). However, maximum direct medical and nonmedical costs were attributed to hospital admissions (1200 INR) and accommodation costs (700 INR) in the postdiagnostic period, respectively. The median indirect cost incurred was 300 INR overall, and the maximum total indirect cost was 40000 INR in the postdiagnostic period. About one-third of patients faced loss of income and 19.6% faced coping costs. Patients spent about 6.7% (0.97%–52.3%) of their income on TB treatment. About 12.3% patients faced catastrophic expenditure. Median cost was significantly higher among those seeking private health care facilities (12100 INR in private vs. 6800 INR in public; ) during the prediagnostic period. Prediagnostic and diagnostic out-of-pocket expenditures (OPE) were significantly higher across all the three centres (). Conclusion. The TB patients experienced untoward expenditure under programmatic settings. The costs encountered by one in eight patients were catastrophic by nature.