• A 'one-stop shop' approach in antenatal care: does this improve antiretroviral treatment uptake in Zimbabwe?

      Gunguwo, H; Zachariah, R; Bissell, K; Ndebele, W; Moyo, J; Mutasa-Apollo, T (International Union Against Tuberculosis and Lung Disease, 2014-03-25)
    • Open access for operational research publications from low- and middle-income countries: who pays?

      Zachariah, R; Kumar, A M V; Reid, A J; Van den Bergh, R; Isaakidis, P; Draguez, B; Delaunois, P; Nagaraja, S B; Ramsay, A; Reeder, J C; et al. (International Union Against Tuberculosis and Lung Disease, 2014-09-21)
    • 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.
    • Paediatric in-patient care in a conflict-torn region of Somalia: are hospital outcomes of acceptable quality?

      Ngoy, B B; Zachariah, R; Hinderaker, S G; Khogali, M; Manzi, M; van Griensven, J; Ayada, L; Jemmy, J P; Maalim, A; Amin, H (International Union Against Tuberculosis and Lung Disease, 2014-03-25)
    • Pattern of primary tuberculosis drug resistance and associated treatment outcomes in Transnistria, Moldova

      Dolgusev, O; Obevzenco, N; Padalco, O; Pankrushev, S; Ramsay, A; Van den Bergh, R; Manzi, M; Denisiuk, O; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2014-10-21)
    • Performance of decentralised facilities in tuberculosis case notification and treatment success in Armenia

      Davtyan, K; Zachariah, R; Davtyan, H; Ramsay, A; Denisiuk, O; Manzi, M; Khogali, M; Van den Bergh, R; Hayrapetyan, A; Dara, M (International Union Against Tuberculosis and Lung Disease, 2014-10-21)
    • Picking up the bill - improving health-care utilisation in the Democratic Republic of Congo through user fee subsidisation: a before and after study

      Maini, R; Van den Bergh, R; van Griensven, J; Tayler-Smith, K; Ousley, J; Carter, D; Mhatre, S; Ho, L; Zachariah, R (BioMed Central, 2014-11-05)
      BackgroundUser fees have been shown to constitute a major barrier to the utilisation of health-care, particularly in low-income countries such as the Democratic Republic of Congo (DRC). Importantly, such barriers can lead to the exclusion of vulnerable individuals from health-care. In 2008, a donor-funded primary health-care programme began implementing user fee subsidisation in 20 health zones of the DRC. In this study, we quantified the short and long-term effects of this policy on health-care utilisation.MethodsSixteen health zones were included for analysis. Using routinely collected health-care utilisation data before and after policy implementation, interrupted time series regression was applied to quantify the temporal impact of the user fee policy in the studied health zones. Payment of salary supplements to health-care workers and provision of free drugs - the other components of the programme - were controlled for where possible.ResultsFourteen (88%) health zones showed an immediate positive effect in health-care utilisation rates (overall median increase of 19%, interquartile range 11 to 43) one month after the policy was introduced, and the effect was significant in seven zones (P <0.05). This initial effect was sustained or increased at 24 months in five health zones but was only significant in one health zone at P <0.05. Utilisation reduced over time in the remaining health zones (overall median increase of 4%, interquartile range ¿10 to 33). The modelled mean health-care utilisation rate initially increased significantly from 43 consultations/1000 population to 51 consultations/1000 population during the first month following implementation (P <0.01). However, the on-going effect was not significant (P =0.69).ConclusionsOur research brings mixed findings on the effectiveness of user fee subsidisation as a strategy to increase the utilisation of services. Future work should focus on feasibility issues associated with the removal or reduction of user fees and how to sustain its effects on utilisation in the longer term.
    • Poor treatment outcomes among multidrug-resistant tuberculosis patients in Gomel Region, Republic of Belarus

      Khaliaukin, A; Kumar, A M V; Skrahina, A; Hurevich, H; Rusovich, V; Gadoev, J; Falzon, D; Khogali, M; de Colombani, P (International Union Against Tuberculosis and Lung Disease, 2014-10-21)
    • Prevalence and incidence of cervical intra-epithelial neoplasia among female sex workers in Korogocho, Kenya

      Njagi, S K; Mugo, N R; Reid, A J; Satyanarayana, S; Tayler-Smith, K; Kizito, W; Kwatampora, J; Waweru, W; Kimani, J; Smith, J S (2013-12-21)
    • Procurement and Supply Management System for MDR-TB in Nigeria: Are the Early Warning Targets for Drug Stock Outs and Over Stock of Drugs Being Achieved?

      Jatau, B; Avong, Y; Ogundahunsi, O; Shah, S; Tayler Smith, K; Van den Bergh, R; Zachariah, R; van Griensven, J; Ekong, E; Dakum, P (Public Library of Science, 2015-06-22)
      The World Health Organisation (WHO) introduced the twelve early warning indicators for monitoring and evaluating drug Procurement and Supply management (PSM) systems, intended to prevent drug stock-outs and overstocking. Nigeria- one of the high Multi Drug Resistant Tuberculosis (MDR-TB) burden countries, scaled-up treatment in 2012 with the concurrent implementation of a PSM system.
    • Profile and treatment outcomes of elderly patients with tuberculosis in Delhi, India: implications for their management

      Patra, S; Lukhmana, S; Tayler Smith, K; Kannan, A T; Satyanarayana, S; Enarson, D A; Nagar, R K; Marcel, M; Reid, T; Department of Community Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India (Oxford University Press, 2013-11-04)
      Given India's high rate of TB, rising burden of non-communicable diseases (NCDs) and growing elderly population, elderly TB patients may be at higher risk of adverse outcomes including death, loss-to-follow-up (LTFU) and treatment failure. This may call for modifications in their management. This study thus aimed to compare the profile and treatment outcomes between elderly (≥60 years) and non-elderly (15-59 years) TB patients.
    • Provider-initiated HIV testing and counselling for TB in low HIV prevalence settings: is it worthwhile?

      Nagai, S; Robinson, R; Rahamefy, J R; Randriambeloson, S J; Ranaivomanana, D A; Razafindranaivo, T; Rakotobe, L; Ranaivo, A; Hinderaker, S G; Harries, A D; et al. (Oxford University Press, 2014-01-23)
      We assessed the HIV-positive yield of offering provider-initiated HIV testing and counselling (PITC) for TB and the costs, in Madagascar, which has a low HIV prevalence and a high TB burden.
    • Providing a gateway to prevention and care for the most at-risk populations in Bhutan: is this being achieved?

      Khandu, L; Zachariah, R; Van den Bergh, R; Wangchuk, D; Tshering, N; Wangmo, D; Ananthakrishnan, R; Dorji, T; Satyanarayana, S (International Union Against Tuberculosis and Lung Disease, 2014-03)
      Setting: Two free-standing urban human immunodeficiency virus (HIV) testing and counselling (HCT) centres in Bhutan offering services to the general population and targeting the most at-risk populations (MARPs). Objectives: To assess the trend in testing for HIV, hepatitis B and syphilis in both the general population and MARPs, and to determine if sociodemographic and risk behaviour characteristics are associated with HIV, hepatitis B and syphilis seropositivity. Design: Cross-sectional study using client records, 2009–2012. Results: Of 7894 clients, 3009 (38%) were from the general population, while 4885 (62%) were from MARPs. Over the 4-year period, testing declined progressively among the general population, while it increased or remained static for MARPs. Of 4885 MARPs, seropositivity was respectively 0.7%, 1.3% and 1.2% for HIV, hepatitis B and syphilis. Female sex workers (FSWs) (relative risk[RR] 4.4, P=0.03) and partners of person living with HIV(RR 25.9, P<0.001) had a higher risk of being HIV-positive. FSWs had also a greater risk of being syphilis-positive(RR 9.1, P<0.001). Conclusion: The increase in uptake of HCT services by MARPs is a welcome finding; however, the relatively static trends call for the introduction of community outreach approaches. The critical gateway being provided to MARPs is an ‘opportunity’ for the expansion of the current service package.
    • Providing emergency care and assessing a patient triage system in a referral hospital in Somaliland: a cross-sectional study

      Sunyoto, T; Van den Bergh, R; Valles, P; Gutierrez, R; Ayada, L; Zachariah, R; Yassin, A; Hinderaker, S; Harries, A D (2014-11-06)
      BackgroundIn resource-poor settings, where health systems are frequently stretched to their capacity, access to emergency care is often limited. Triage systems have been proposed as a tool to ensure efficiency and optimal use of emergency resources in such contexts. However, evidence on the practice of emergency care and the implementation of triage systems in such settings, is scarce. This study aimed to assess emergency care provision in the Burao district hospital in Somaliland, including the application of the South African Triage Scale (SATS) tool.MethodsA cross-sectional descriptive study was undertaken. Routine programme data of all patients presenting at the Emergency Department (ED) of Burao Hospital during its first year of service (January to December 2012) were analysed. The American College of Surgeons Committee on Trauma (ACSCOT) indicators were used as SATS targets for high priority emergency cases (¿high acuity¿ proportion), overtriage and undertriage (with thresholds of >25%, <50% and <10%, respectively).ResultsIn 2012, among 7212 patients presented to the ED, 41% were female, and 18% were aged less than five. Only 21% of these patients sought care at the ED within 24 hours of developing symptoms. The high acuity proportion was 22.3%, while the overtriage (40%) and undertriage (9%) rates were below the pre-set thresholds. The overall mortality rate was 1.3% and the abandon rate 2.0%. The outcomes of patients corresponds well with the color code assigned using SATS.ConclusionThis is the first study assessing the implementation of SATS in a post-conflict and resource-limited African setting showing that most indicators met the expected standards. In particular, specific attention is needed to improve the relatively low rate of true emergency cases, delays in patient presentation and in timely provision of care within the ED. This study also highlights the need for development of emergency care thresholds that are more adapted to resource-poor contexts. These issues are discussed.
    • Public Health Action for public health action

      Harries, A D; Bianchi, L; Jensen, P M; Pantages, M; Bissell, K; Kumar, A M V; Hinderaker, S G; Tayler-Smith, K; Van den Bergh, R; van den Boogaard, W; et al. (International Union Against Tuberculosis and Lung Disease, 2014-09-21)
    • Recurrent Tuberculosis and Associated Factors: A Five - Year Countrywide Study in Uzbekistan

      Gadoev, J; Asadov, D; Harries, AD; Parpieva, N; Tayler-Smith, K; Isaakidis, P; Ali, E; Hinderaker, SG; Ogtay, G; Ramsay, A; et al. (Public Library of Science, 2017-05-04)
      In Uzbekistan, despite stable and relatively high tuberculosis treatment success rates, relatively high rates of recurrent tuberculosis have recently been reported. Recurrent tuberculosis is when a patient who was treated for pulmonary tuberculosis and cured, later develops the disease again. This requires closer analysis to identify possible causes and recommend interventions to improve the situation. Using countrywide data, this study aimed to analyse trends in recurrent tuberculosis cases and describe their associations with socio-demographic and clinical factors.
    • Retention in pre-antiretroviral treatment care in a district of Karnataka, India: how well are we doing?

      Shankar, D; Kumar, A M V; Rewari, B; Kumar, S; Shastri, S; Satyanarayana, S; Ananthakrishnan, R; Nagaraja, S B; Devi, M; Bhargava, N; et al. (International Union Against Tuberculosis and Lung Disease, 2014-12-21)
    • Risk factors associated with loss to follow-up among multidrug-resistant tuberculosis patients in Georgia

      Kuchukhidze, G; Kumar, A M V; de Colombani, P; Khogali, M; Nanava, U; Blumberg, H M; Kempker, R R (International Union Against Tuberculosis and Lung Disease, 2014-10-21)
    • Scale-Up of ART in Malawi Has Reduced Case Notification Rates in HIV-Positive and HIV-Negative Tuberculosis

      Kanyerere, H; Girma, B; Mpunga, J; Tayler-Smith, K; Harries, A D; Jahn, A; Chimbwandira, FM (International Union Against Tuberculosis and Lung Disease, 2016-12-21)
      Setting: For 30 years, Malawi has experienced a dual epidemic of human immunodeficiency virus (HIV) infection and tuberculosis (TB) that has recently begun to be attenuated by the scale-up of antiretroviral therapy (ART). Objective: To report on the correlation between ART scale-up and annual national TB case notification rates (CNR) in Malawi, stratified by HIV-positive and HIV-negative status, from 2005 to 2015. Design: A retrospective descriptive ecological study using aggregate data from national reports. Results: From 2005 to 2015, ART was scaled up in Malawi from 28 470 to 618 488 total patients, with population coverage increasing from 2.4% to 52.2%. During this time, annual TB notifications declined by 35%, from 26 344 to 17 104, and the TB CNR per 100 000 population declined by 49%, from 206 to 105. HIV testing uptake increased from 51% to 92%. In known HIV-positive TB patients, the CNR decreased from a high of 1247/100 000 to 710/100 000, a 43% decrease. In known HIV-negative TB patients, the CNR also decreased, from a high of 66/100 000 to 49/100 000, a 26% decrease. Conclusion: TB case notifications have continued to decline in association with ART scale-up, with the decline seen more in HIV-positive than HIV-negative TB. These findings have programmatic implications for national TB control efforts.
    • Scientific Communication: Reporting on Mental Health Illness (MHI) in Kenya: how well are we doing?

      Gituma, KS; Hussein, S; Mwitari, J; Kizito, W; Edwards, JK; Kihara, AB; Owiti, PO; Tweya, H (African Journals Online, 2016-10)