• Assessing and improving data quality from community health workers: a successful intervention in Neno, Malawi

      Admon, A J; Bazile, J; Makungwa, H; Chingoli, M A; Hirschhorn, L R; Peckarsky, M; Rigodon, J; Herce, M; Chingoli, F; Malani, P N; et al. (International Union Against TB and Lung Disease, 2013-03)
    • The burden and outcomes of childhood tuberculosis in Cotonou, Benin

      Ade, S; Harries, A D; Trébucq, A; Hinderaker, S G; Ade, G; Agodokpessi, G; Affolabi, D; Koumakpaï, S; Anagonou, S; Gninafon, M (International Union Against TB and Lung Disease, 2013-03)
    • Caesarean Sections in Rural Burundi: How Well Are Mothers Doing Two Years On?

      van den Boogaard, W; Manzi, M; De Plecker, E; Caluwaerts, S; Nanan-N'zeth, K; Duchenne, B; Etienne, W; Juma, N; Ndelema, B; Zachariah, R (International Union Against TB and Lung Disease, 2016-06-21)
      A caesarean section (C-section) is a life-saving emergency intervention. Avoiding pregnancies for at least 24 months after a C-section is important to prevent uterine rupture and maternal death.
    • Can We Get More HIV-Positive Tuberculosis Patients on Antiretroviral Treatment in a Rural District of Malawi?

      Zachariah, R; Teck, R; Ascurra, O; Gomani, P; Manzi, M; Humblet, P; Nunn, P; Salaniponi, F M L; Harries, A D; Medical Department (HIV-TB Operational Research), Brussels Operational Centre, Médecins sans Frontières, Brussels, Belgium. zachariah@internet.lu (International Union Against TB and Lung Disease, 2005-03)
      The World Health Organization (WHO) has set a target of treating 3 million people with antiretroviral treatment (ART) by 2005. In sub-Saharan Africa, HIV-positive tuberculosis (TB) patients could significantly contribute to this target. ART (stavudine/lamivudine/nevirapine) was initiated in Thyolo district, Malawi, in April 2003, and all HIV-positive TB patients were considered eligible and offered ART. Despite this, only 44 (13%) of 352 TB patients were eventually started on ART by the end of November 2003. Most TB patients leave hospital after 2 weeks to complete the initial phase of anti-tuberculosis treatment (rifampicin-based) in the community, and ART is offered to HIV-positive TB patients after they have started the continuation phase of treatment (isoniazid/ ethambutol). ART is only offered at hospital, while the majority of TB patients take their continuation phase of anti-tuberculosis treatment from health centres. HIV-positive TB patients therefore find it difficult to access ART. In this paper, we discuss a series of options to increase the uptake of ART among HIV-positive TB patients. The main options are: 1) to hospitalise HIV-positive TB patients with a view to starting ART in the continuation phase in hospital; 2) to decentralise ART delivery so ART can be delivered at health centres; 3) to replace nevirapine with efavirenz so ART can be started earlier in the initial phase of anti-tuberculosis treatment. Decentralisation of ART from hospitals to health centres would greatly improve ART access.
    • Characteristics and mortality of neonates in an emergency obstetric and neonatal care facility, rural Burundi

      Zuniga, I; Van den Bergh, R; Ndelema, B; Bulckaert, D; Manzi, M; Lambert, V; Zachariah, R; Reid, A J; Harries, A D (International Union Against TB and Lung Disease, 2013-12)
    • Compliance with Cotrimoxazole Prophylaxis for the Prevention of Opportunistic Infections in HIV-Positive Tuberculosis Patients in Thyolo District, Malawi.

      Zachariah, R; Harries, A D; Arendt, V; Wennig, R; Schneider, S; Spielmann M P; Panarotto, E; Gomani, P; Salaniponi, F M L; Medecins sans Frontieres-Luxembourg, Thyolo District, Malawi. msflblantyre@malawi.net (International Union Against TB and Lung Disease, 2001-09)
      OBJECTIVE: To verify compliance with cotrimoxazole prophylaxis in human immunodeficiency virus (HIV) infected tuberculosis (TB) patients during the continuation phase of anti-tuberculosis treatment, and to assess the sensitivity, specificity and positive predictive values of verbal verification and pill counts as methods of checking compliance. DESIGN: Cross-sectional study. METHODS: Cotrimoxazole compliance was assessed in a cohort of TB patients who were attending four TB follow-up centres during the continuation phase of anti-TB treatment between months 4 and 6. Verbal verification of drug intake, physical verification of pill count balance, and urine trimethoprim detection by gas chromatography and mass spectrometry were used for assessing compliance. RESULTS: Using urine trimethoprim detection as the gold standard for compliance, trimethoprim was detected in 82 (94%) of 87 patients in the cohort. Verbal verification of cotrimoxazole intake and objective pill count balances showed high sensitivity and positive predictive values compared with the gold standard of urine trimethoprim detection. CONCLUSIONS: In a rural district in Malawi, compliance with cotrimoxazole as an adjunct to anti-tuberculosis treatment in HIV-infected TB patients was good, and can be assessed simply and practically by verbal verification and pill counts.
    • Diabetes mellitus and smoking among tuberculosis patients in a tertiary care centre in Karnataka, India

      Jali, M V; Mahishale, V K; Hiremath, M B; Satyanarayana, S; Kumar, A M V; Nagaraja, S B; Isaakidis, P (International Union Against TB and Lung Disease, 2013-11)
    • Does One Size Fit All? Drug Resistance and Standard Treatments: Results of Six Tuberculosis Programmes in Former Soviet Countries.

      Bonnet, M; Sizaire, V; Kebede, Y; Janin, A; Doshetov, D; Mirzoian, B; Arzumanian, A; Muminov, T; Iona, E; Rigouts, L; et al. (International Union Against TB and Lung Disease, 2005-10)
      SETTING: After the collapse of the Soviet Union, countries in the region faced a dramatic increase in tuberculosis cases and the emergence of drug resistance. OBJECTIVE: To discuss the relevance of the DOTS strategy in settings with a high prevalence of drug resistance. DESIGN: Retrospective analysis of one-year treatment outcomes of short-course chemotherapy (SCC) and results of drug susceptibility testing (DST) surveys of six programmes located in the former Soviet Union: Kemerovo prison, Russia; Abkhasia, Georgia; Nagorno-Karabagh, Azerbaijan; Karakalpakstan, Uzbekistan; Dashoguz Velayat, Turkmenistan; and South Kazakhstan Oblast, Kazakhstan. Results are reported for new and previously treated smear-positive patients. RESULTS: Treatment outcomes of 3090 patients and DST results of 1383 patients were collected. Treatment success rates ranged between 87% and 61%, in Nagorno-Karabagh and Kemerovo, respectively, and failure rates between 7% and 23%. Any drug resistance ranged between 66% and 31% in the same programmes. MDR rates ranged between 28% in Karakalpakstan and Kemerovo prison and 4% in Nagorno-Karabagh. CONCLUSION: These results show the limits of SCC in settings with a high prevalence of drug resistance. They demonstrate that adapting treatment according to resistance patterns, access to reliable culture, DST and good quality second-line drugs are necessary.
    • Does research make a difference to public health? Time for scientific journals to cross the Rubicon

      Harries, A D; Zachariah, R; Ramsay, A; Kumar, A M V; Reid, A J; Terry, R F; Reeder, J C (International Union Against TB and Lung Disease, 2014-04-14)
    • Double Trouble: Tuberculosis and Substance Abuse in Nagaland, India

      Shenoy, R; Das, M; Mansoor, H; Anicete, R; Wangshu, L; Meren, S; Ao, I; Saranchuk, P; Reid, A J; Isaakidis, P (International Union Against TB and Lung Disease, 2015-09-21)
    • Ending Tuberculosis by 2030: Can We Do It?

      Suthar, A B; Zachariah, R; Harries, A D (International Union Against TB and Lung Disease, 2016-06-30)
      The Sustainable Development Goals aim to end tuberculosis (TB) related deaths, transmission and catastrophic costs by 2030. Multisectorial action to accelerate socio-economic development, a new vaccine and novel diagnostics and medicines for treatment are key advances needed to end TB transmission. Achieving 90-90-90 targets for TB (i.e., 90% of vulnerable populations screened, 90% diagnosed and started on treatment, and at least 90% cured) will help accelerate progress towards reductions in mortality; however, passive case detection strategies, multidrug-resistant TB, human immunodeficiency virus coinfection and outdated pathways to care need to be overcome. Ending the catastrophic costs associated with TB will require expansion of health insurance coverage, comprehensive coverage of TB services, and limited indirect costs by vulnerable and poor populations.
    • Epidemiology and interaction of diabetes mellitus and tuberculosis and challenges for care: a review [Review article]

      Harries, A D; Satyanarayana, S; Kumar, A M V; Nagaraja, S B; Isaakidis, P; Malhotra, S; Achanta, S; Naik, B; Wilson, N; Zachariah, R; et al. (International Union Against TB and Lung Disease, 2013-11)
    • High Mortality in Tuberculosis Patients Despite HIV Interventions in Swaziland

      Mchunu, G; van Griensven, J; Hinderaker, S G; Kizito, W; Sikhondze, W; Manzi, M; Dlamini, T; Harries, A D (International Union Against TB and Lung Disease, 2016-06-21)
    • High prevalence of undiagnosed diabetes among tuberculosis patients in peripheral health facilities in Kerala

      Nair, S; Kumari, A K; Subramonianpillai, J; Shabna, D S; Kumar, S M; Balakrishnan, S; Naik, B; Kumar, A M V; Isaakidis, P; Satyanarayana, S (International Union Against TB and Lung Disease, 2013-11)
    • Identification of Patients Who Could Benefit from Bedaquiline or Delamanid: a Multisite MDR-TB Cohort Study

      Bonnet, M; Bastard, M; du Cros, P; Khamraev, A; Kimenye, K; Khurkhumal, S; Hayrapetyan, A; Themba, D; Telnov, A; Sanchez-Padilla, E; et al. (International Union Against TB and Lung Disease, 2016-02-01)
      The World Health Organization recommends adding bedaquiline or delamanid to multidrug-resistant tuberculosis (MDR-TB) regimens for which four effective drugs are not available, and delamanid for patients at high risk of poor outcome.
    • Implementing Joint TB and HIV Interventions in a Rural District of Malawi: Is There a Role for an International Non-Governmental Organisation?

      Zachariah, R; Teck, R; Harries, A D; Humblet, P; Operational Research (HIV-TB), Médecins Sans Frontières, Medical Department, Brussels Operational Centre, Brussels, Belgium. zachariah@internet.lu (International Union Against TB and Lung Disease, 2004-09)
      In a rural district in Malawi, poorly motivated health personnel, shortages of human and financial resources, weak dialogue between existing tuberculosis (TB) and human immunodeficiency virus (HIV) programmes and poor community involvement are constraints to establishing joint TB-HIV interventions. The presence of a non-governmental organisation (NGO), Médecins Sans Frontières (MSF), in the health care delivery system provided an opportunity to bridge some of these gaps. The main inputs provided by MSF included additional staff, supplementary drugs including antiretroviral drugs, technical assistance and infrastructure development. The introduction of a scheme of monthly performance-linked incentives for health personnel proved successful in improving their performance, as judged by attendance rates as well as the quality and quantity of activities. This initiative also provided the district management with a tool for exerting pressure on health staff to improve their performance. The availability of independent NGO funds and a logistics team for construction of new infrastructure allowed the rapid initiation of new interventions at the district level without having to wait for disbursements of funds from the central level. This introduced a new dynamic of decentralised operational flexibility at the district level which improved access to care and support for people with TB-HIV.
    • Is screening for diabetes among tuberculosis patients feasible at the field level?

      Naik, B; Kumar, A M V; Satyanarayana, S; Suryakant, M D; Swamy, N M V; Nair, S; Isaakidis, P; Harries, A D (International Union Against TB and Lung Disease, 2013-11)
    • Managing and Monitoring Chronic Non-Communicable Diseases in a Primary Health Care Clinic, Lilongwe, Malawi

      Manjomo, R C; Mwagomba, B; Ade, S; Ali, E; Ben-Smith, A; Khomani, P; Bondwe, P; Nkhoma, D; Douglas, G P; Tayler-Smith, K; et al. (International Union Against TB and Lung Disease, 2016-06-21)
      Setting: Patients with chronic non-communicable diseases attending a primary health care centre, Lilongwe, Malawi. Objective: Using an electronic medical record monitoring system, to describe the quarterly and cumulative disease burden, management and outcomes of patients registered between March 2014 and June 2015. Design: A cross-sectional study. Results: Of 1135 patients, with new registrations increasing each quarter, 66% were female, 21% were aged 65 years, 20% were obese, 53% had hypertension alone, 18% had diabetes alone, 12% had asthma, 10% had epilepsy and 7% had both hypertension and diabetes. In every quarter, about 30% of patients did not attend the clinic and 19% were registered as lost to follow-up (not seen for 1 year) in the last quarter. Of those attending, over 90% were prescribed medication, and 80–90% with hypertension and/or diabetes had blood pressure/blood glucose measured. Over 85% of those with epilepsy had no seizures and 60–75% with asthma had no severe attacks. Control of blood pressure (41–51%) and diabetes (15–38%) was poor. Conclusion: It is feasible to manage patients with non-communicable diseases in a primary health care setting in Malawi, although more attention is needed to improve clinic attendance and the control of hypertension and diabetes.
    • Oh no! Power out, internet down! Two challenges in running training courses in low- and middle-income countries [Editorial]

      Demez, C; Zachariah, R; Reid, T; Harries, A D (International Union Against TB and Lung Disease, 2013-06)
    • Outcomes of Antiretroviral Therapy Among Younger Versus Older Adolescents and Adults in an Urban Clinic, Zimbabwe

      Matyanga, C M J; Takarinda, K C; Owiti, P; Mutasa-Apollo, T; Mugurungi, O; Buruwe, L; Reid, A J (International Union Against TB and Lung Disease, 2016-06-21)
      Setting: A non-governmental organisation-supported clinic offering health services including antiretroviral therapy (ART). Objective: To compare ART retention between younger (age 10–14 years) vs. older (age 15–19 years) adolescents and younger (age 20–29 years) vs. older (age 30 years) adults and determine adolescent- and adult-specific attrition-associated factors among those initiated on ART between 2010 and 2011. Design: Retrospective cohort study. Results: Of 110 (7%) adolescents and 1484 (93%) adults included in the study, no differences in retention were observed between younger vs. older adolescents at 6, 12 and 24 months. More younger adolescents were initiated with body mass index 16 kg/m2 compared with older adolescents (64% vs. 47%; P = 0.04). There were more females (74% vs. 52%, P  0.001) and fewer patients initiating ART with CD4 count 350 cells/mm3 (77% vs. 81%, P = 0.007) among younger vs. older adults. Younger adults demonstrated more attrition than older adults at all time-points. No attrition risk factors were observed among adolescents. Attrition-associated factors among adults included being younger, having a lower CD4 count and advanced human immunodeficiency virus disease at initiation, and initiation on a stavudine-based regimen. Conclusion: Younger adults demonstrated greater attrition and may require more attention. We were unable to demonstrate differences in attrition among younger vs. older adolescents. Loss to follow-up was the main reason for attrition across all age groups. Overall, earlier presentation for ART care appears important for improved ART retention among adults.