scholarly journals Discontinuation of tuberculosis treatment among children in the Kampala Capital City Authority health facilities: a mixed-methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Leonard Kibirige ◽  
Jonathan Izudi ◽  
Stephen Okoboi
Keyword(s):  
Healthcare Providers ◽  
Health Facilities ◽  
Capital City ◽  
Sub Saharan Africa ◽  
Tuberculosis Treatment ◽  
Directly Observed Therapy ◽  
City Authority ◽  
Tb Control ◽  
Tb Treatment ◽  
Provider Perspectives

Abstract Introduction Discontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death. DTT in children is understudied in Uganda. We examined the level and factors associated with DTT among children at four large health facilities in Kampala Capital City Authority and documented the reasons for DTT from treatment supporters and healthcare provider perspectives. Methods We conducted a retrospective analysis of records for children < 15 years diagnosed and treated for TB between January 2018 and December 2019. We held focus group discussions with treatment supporters and key informant interviews with healthcare providers. We defined DTT as the stoppage of TB treatment for 30 or more consecutive days. We used a stepwise generalized linear model to assess factors independently associated with DTT and content analysis for the qualitative data reported using sub-themes. Results Of 312 participants enrolled, 35 (11.2%) had discontinued TB treatment. The reasons for DTT included lack of privacy at healthcare facilities for children with TB and their treatment supporters, the disappearance of TB symptoms following treatment initiation, poor implementation of the community-based directly observed therapy short-course (CB-DOTS) strategy, insufficient funding to the TB program, and frequent stock-outs of TB drugs. DTT was more likely during the continuation phase of TB treatment compared to the intensive phase (Adjusted odds ratio (aOR), 5.22; 95% Confidence Interval (CI), 1.76–17.52) and when the treatment supporter was employed compared to when the treatment supporter was unemployed (aOR, 3.60; 95% CI, 1.34–11.38). Conclusion Many children with TB discontinue TB treatment and this might exacerbate TB morbidity and mortality. To mitigate DTT, healthcare providers should ensure children with TB and their treatment supporters are accorded privacy during service provision and provide more information about TB symptom resolution and treatment duration versus the need to complete treatment. The district and national TB control programs should address gaps in funding to TB care, the supply of TB drugs, and the implementation of the CB-DOTS strategy.

Discontinuation of tuberculosis treatment among children in the Kampala Capital City Authority health facilities: a retrospective cohort study

2021 ◽  
Author(s):  
Leonard Kibirige ◽  
Jonathan Izudi ◽  
Stephen Okoboi
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Health Facilities ◽  
Capital City ◽  
Sub Saharan Africa ◽  
Tuberculosis Treatment ◽  
City Authority ◽  
Tb Control ◽  
Tb Treatment ◽  
Provider Perspectives

Abstract Introduction: Discontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death. DTT in children is understudied in Uganda. We examined the level and factors associated with DTT among children at four large health facilities in Kampala Capital City Authority and documented the reasons for DTT from treatment supporters and healthcare provider perspectives. Methods: We conducted a retrospective cohort analysis of records for children <15 years diagnosed and treated for TB between January 2018 and December 2019. We held focus group discussions with treatment supporters and key informant interviews with healthcare providers. We defined DTT as the stoppage of TB treatment for 30 or more consecutive days. We used a stepwise generalized linear model to assess factors independently associated with DTT and content analysis for the qualitative data reported using sub-themes. Results: Of 312 participants enrolled, 35 (11.2%) had discontinued TB treatment. The reasons for DTT included lack of privacy at healthcare facilities for children with TB and their treatment supporters, the disappearance of TB symptoms following treatment initiation, poor implementation of the community-based directly observed therapy short-course (CB-DOTS) strategy, insufficient funding to the TB program, and frequent stock-outs of TB drugs. DTT was more likely during the continuation phase of TB treatment compared to the intensive phase (Adjusted odds ratio (aOR), 5.22; 95% Confidence Interval (CI), 1.76-17.52) and when the treatment supporter was employed compared to when the treatment supporter was unemployed (aOR, 3.60; 95% CI, 1.34-11.38). Conclusion: Many children with TB discontinue TB treatment and this might exacerbate TB morbidity and mortality. Treatment supporters of children with TB should be provided with detailed and consistent health education messages about TB treatment duration, the benefits of treatment completion, and risks of treatment discontinuation. The district and national TB control programs should address gaps in funding to TB care and the supply of TB drugs.

scholarly journals Connected diagnostics to improve accurate diagnosis, treatment, and conditional payment of malaria services in Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shannen M. C. van Duijn ◽  
Angela K. Siteyi ◽  
Sherzel Smith ◽  
Emmanuel Milimo ◽  
Leon Stijvers ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Healthcare Providers ◽  
Malaria Treatment ◽  
Sub Saharan Africa ◽  
Structured Interviews ◽  
National Guidelines ◽  
Private Providers ◽  
Provider Perspectives ◽  
Treatment Data ◽  
Sub Saharan

Abstract Background In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system. International funding for malaria is currently not sufficient to control malaria. Transition to domestic funding is challenged by UHC efforts and recent COVID-19 outbreak. Herewith we present a digital approach to improve efficiencies in diagnosis and treatment of malaria in endemic Kisumu, Kenya: Connected Diagnostics. The objective of this study is to evaluate the feasibility, user experience and clinical performance of this approach in Kisumu. Methods Our intervention was performed Oct 2017–Dec 2018 across five private providers in Kisumu. Patients were enrolled on M-TIBA platform, diagnostic test results digitized, and only positive patients were digitally entitled to malaria treatment. Data on socio-demographics, healthcare transactions and medical outcomes were analysed using standard descriptive quantitative statistics. Provider perspectives were gathered by 19 semi-structured interviews. Results In total 11,689 febrile patients were digitally tested through five private providers. Malaria positivity ranged from 7.4 to 30.2% between providers, significantly more amongst the poor (p < 0.05). Prescription of antimalarials was substantially aberrant from National Guidelines, with 28% over-prescription (4.6–63.3% per provider) and prescription of branded versus generic antimalarials differing amongst facilities and correlating with the socioeconomic status of clients. Challenges were encountered transitioning from microscopy to RDT. Conclusion We provide full proof-of-concept of innovative Connected Diagnostics to use digitized malaria diagnostics to earmark digital entitlements for correct malaria treatment of patients. This approach has large cost-saving and quality improvement potential.

scholarly journals Provider-perceived barriers to diagnosis and treatment of acute coronary syndrome in Tanzania: a qualitative study

2019 ◽  
Vol 12 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Julian T Hertz ◽  
Godfrey L Kweka ◽  
Preeti Manavalan ◽  
Melissa H Watt ◽  
Francis M Sakita
Keyword(s):  
Acute Coronary Syndrome ◽  
Healthcare Providers ◽  
Care Patient ◽  
Cost Of Care ◽  
Sub Saharan Africa ◽  
Coronary Syndrome ◽  
Provider Perspectives ◽  
Northern Tanzania ◽  
Sub Saharan ◽  
Clinical Officers

Abstract Background The incidence of acute coronary syndrome (ACS) is growing across sub-Saharan Africa and many healthcare systems are ill-equipped for this growing burden. Evidence suggests that healthcare providers may be underdiagnosing and undertreating ACS, leading to poor health outcomes. The goal of this study was to examine provider perspectives on barriers to ACS care in Tanzania in order to identify opportunities for interventions to improve care. Methods Semistructured in-depth interviews were conducted with physicians and clinical officers from emergency departments and outpatient departments in northern Tanzania. Thematic analysis was conducted using an iterative cycle of coding and consensus building. Results The 11 participants included six physicians and five clinical officers from health centers, community hospitals and one referral hospital. Providers identified barriers related to providers, systems and patients. Provider-related barriers included inadequate training regarding ACS and poor application of textbook-based knowledge. System-related barriers included lack of diagnostic equipment, unavailability of treatments, referral system delays, lack of data regarding disease burden, absence of locally relevant guidelines and cost of care. Patient-related barriers included inadequate ACS knowledge, inappropriate healthcare-seeking behavior and non-adherence. Conclusions This study identified actionable barriers to ACS care in northern Tanzania. Multifaceted interventions are urgently needed to improve care.

scholarly journals Factors associated with treatment failure, dropout, and death in a cohort of tuberculosis patients in Recife, Pernambuco State, Brazil

2007 ◽  
Vol 23 (7) ◽  
pp. 1573-1582 ◽  
Author(s):  
Maria de Fátima Pessoa Militão de Albuquerque ◽  
Ricardo Arraes de Alencar Ximenes ◽  
Norma Lucena-Silva ◽  
Wayner Vieira de Souza ◽  
Andréa Tavares Dantas ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Treatment Outcomes ◽  
Group Treatment ◽  
Healthcare Access ◽  
Treatment Delay ◽  
Tuberculosis Treatment ◽  
Directly Observed Therapy ◽  
Factors Associated ◽  
Family Health Program ◽  
Tb Treatment

A cohort of cases initiating tuberculosis treatment from May 2001 to July 2003 was followed in Recife, Pernambuco State, Brazil, to investigate biological, clinical, social, lifestyle, and healthcare access factors associated with three negative tuberculosis treatment outcomes (treatment failure, dropout, and death) separately and as a group. Treatment failure was associated with treatment delay, illiteracy, and alcohol consumption. Factors associated with dropout were age, prior TB treatment, and illiteracy. Death was associated with age, treatment delay, HIV co-infection, and head of family's income. Main factors associated with negative treatment outcomes as a whole were age, HIV co-infection, illiteracy, alcoholism, and prior TB treatment. We suggest the following strategies to increase cure rates: further training of the Family Health Program personnel in TB control, awareness-raising on the need to tailor their activities to special care for cases (e.g., literacy training); targeting use of directly observed therapy for higher risk groups; establishment of a flexible referral scheme to handle technical and psychosocial problems, including alcoholism; and increased collaboration with the HIV/AIDS program.

scholarly journals Intermittent screening and treatment with dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy: implementation feasibility in a routine healthcare system setting in western Kenya

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Jenny Hill ◽  
Peter Ouma ◽  
Seth Oluoch ◽  
Jane Bruce ◽  
Simon Kariuki ◽  
...  
Keyword(s):  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Standard Of Care ◽  
Health Facilities ◽  
Malaria In Pregnancy ◽  
Sub Saharan Africa ◽  
Directly Observed Therapy ◽  
Western Kenya ◽  
Sub Saharan ◽  
In Pregnancy

Abstract Background Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for preventing malaria in pregnancy in areas of moderate-to-high transmission in sub-Saharan Africa. However, due to increasing parasite resistance to SP, research on alternative strategies is a priority. The study assessed the implementation feasibility of intermittent screening and treatment (ISTp) in the second and third trimester at antenatal care (ANC) with malaria rapid diagnostic tests (RDTs) and treatment of positive cases with dihydroartemisinin-piperaquine (DP) compared to IPTp-SP in western Kenya. Methods A 10-month implementation study was conducted in 12 government health facilities in four sub-counties. Six health facilities were assigned to either ISTp-DP or IPTp-SP. Evaluation comprised of facility audits, ANC observations, and exit interviews. Intermediate and cumulative effectiveness analyses were performed on all processes involved in delivery of ISTp-DP including RDT proficiency and IPTp-SP ± directly observed therapy (DOT, standard of care). Logistic regression was used to identify predictors of receiving each intervention. Results A total of 388 and 389 women were recruited in the ISTp-DP and IPTp-SP arms, respectively. For ISTp-DP, 90% (289/320) of eligible women received an RDT. Of 11% (32/289) who tested positive, 71% received the correct dose of DP and 31% the first dose by DOT, and only 6% were counselled on subsequent doses. Women making a sick visit and being tested in a facility with a resident microscopist were more likely to receive ISTp-DP (AOR 1.78, 95% CI 1.31, 2.41; and AOR 3.75, 95% CI 1.31, 2.40, respectively). For IPTp-SP, only 57% received a dose of SP by DOT. Payment for a laboratory test was independently associated with receipt of SP by DOT (AOR 6.43, 95% CI 2.07, 19.98). Conclusions The findings indicate that the systems effectiveness of ANC clinics to deliver ISTp-DP under routine conditions was poor in comparison to IPTp-SP. Several challenges to integration of ISTp with ANC were identified that may need to be considered by countries that have introduced screening at first ANC visit and, potentially, for future adoption of ISTp with more sensitive RDTs. Understanding the effectiveness of ISTp-DP will require additional research on pregnant women’s adherence to ACT.

scholarly journals Connected Diagnostics to Improve Accurate Diagnosis, Treatment, and Conditional Payment of Malaria Services in Kenya.

2020 ◽  
Author(s):  
Shannen Van Duijn ◽  
Angela Siteyi ◽  
Sherzel Smith ◽  
Emmanuel Milimo ◽  
Leon Stijvers ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Healthcare Providers ◽  
Malaria Treatment ◽  
Sub Saharan Africa ◽  
Structured Interviews ◽  
Medical Outcomes ◽  
Provider Perspectives ◽  
Treatment Data ◽  
Sub Saharan ◽  
Quantitative Statistics

Abstract Background: In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system. International funding for malaria is decreasing and transition to domestic funding is challenged by UHC efforts and recent COVID-19 outbreak. Herewith we present a digital approach to markedly improve efficiencies in diagnosis and treatment of malaria in endemic Kisumu, Kenya. The objective of this study is to evaluate feasibility, user experience, clinical performance and of Connected Diagnostics in Kisumu and to assess over-prescription of antimalarials. Methods: Our intervention was performed Oct 2017 – Dec 2018 across seven providers in Kisumu. Patients were enrolled on M-TIBA platform, diagnostic test results digitized, and only positive patients were digitally entitled for malaria treatment. Data on socio-demographics, healthcare transactions and medical outcomes were analysed using standard descriptive quantitative statistics. Provider perspectives were gathered by 19 semi-structured interviews. Results: In total 11,689 febrile patients were tested. Malaria positivity rates ranged from 7.4% to 30.2% between providers, with significantly more positive cases amongst the poor (p< 0.05). Over-prescription of antimalarials was 28%, fluctuating between 4.6% to 63.3% per provider. Prescription of branded versus generic antimalarials was dichotomous. Challenges were encountered transitioning from microscopy to RDT. Conclusion: We provide full proof-of-concept of innovative Connected Diagnostics to use digitized malaria diagnostics to earmark digital entitlements for correct malaria treatment of patients. This approach has large cost-saving and quality improving potential.

scholarly journals Treatment success for patients with tuberculosis receiving care in areas severely affected by Hurricane Matthew – Haiti, 2016

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247750
Author(s):  
Macarthur Charles ◽  
Milo Richard ◽  
Mary R. Reichler ◽  
Jean Baptiste Koama ◽  
Willy Morose ◽  
...  
Keyword(s):  
Treatment Success ◽  
Lessons Learned ◽  
Health Facilities ◽  
Hiv Status ◽  
Severe Damage ◽  
Convenience Sample ◽  
Tb Control ◽  
Tb Treatment ◽  
One Year ◽  
The Impact

Background On October 4, 2016, Hurricane Matthew struck southwest Haiti as a category 4 storm. The goal of this study was to evaluate the impact of the hurricane on tuberculosis (TB) services and patient outcomes in the three severely affected departments–Sud, Grand’Anse, and Nippes–of southwest Haiti. Methods We developed a standard questionnaire to assess a convenience sample of health facilities in the affected areas, a patient tracking form, and a line list for tracking all patients with drug-susceptible TB registered in care six months before the hurricane. We analyzed data from the national TB electronic surveillance system to determine outcomes for all patients receiving anti-TB treatment in the affected areas. We used logistic regression analysis to determine factors associated with treatment success. Results Of the 66 health facilities in the three affected departments, we assessed 31, accounting for 536 (45.7%) of 1,174 TB patients registered in care when Hurricane Matthew made landfall in Haiti. Three (9.7%) health facilities sustained moderate to severe damage, whereas 18 (58.1%) were closed for <1 week, and five (16.1%) for ≥1 week. Four weeks after the hurricane, 398 (73.1%) of the 536 patients in the assessed facilities were located. Treatment success in the affected departments one year after the hurricane was 81.4%. Receiving care outside the municipality of residence (adjusted odds ratio [aOR]: 0.46, 95% confidence interval [CI]: 0.27–0.80) and HIV positivity (aOR: 0.31, 95% CI: 0.19–0.51) or unknown HIV status (aOR: 0.49, 95% CI: 0.33–0.74) were associated with significantly lower rates of treatment success. Conclusions Despite major challenges, a high percentage of patients receiving anti-TB treatment before the hurricane were located and successfully treated in southwest Haiti. The lessons learned and results presented here may help inform policies and guidelines in similar settings for effective TB control after a natural disaster.

scholarly journals Video directly observed therapy for supporting and monitoring adherence to tuberculosis treatment in Uganda: a pilot cohort study

2020 ◽  
Vol 6 (1) ◽  
pp. 00175-2019 ◽  
Author(s):  
Juliet N. Sekandi ◽  
Esther Buregyeya ◽  
Sarah Zalwango ◽  
Kevin K. Dobbin ◽  
Lynn Atuyambe ◽  
...  
Keyword(s):  
Cohort Study ◽  
Primary Outcome ◽  
Health Workers ◽  
Secondary Analysis ◽  
Directly Observed Therapy ◽  
Tb Control ◽  
Tb Treatment ◽  
Kampala City ◽  
The Mean

IntroductionNonadherence to treatment remains an obstacle to tuberculosis (TB) control worldwide. The aim of this study was to evaluate the feasibility of using video directly observed therapy (VDOT) for supporting TB treatment adherence in Uganda.MethodsFrom May to December 2018, we conducted a pilot cohort study at a TB clinic in Kampala City. We enrolled patients aged 18–65 years with ≥3 months remaining of their TB treatment. Participants were trained to use a smartphone app to record videos of medication intake and submit them to a secured system. Trained health workers logged into the system to watch the submitted videos. The primary outcome was adherence measured as the fraction of expected doses observed (FEDO). In a secondary analysis, we examined differences in FEDO by sex, age, phone ownership, duration of follow-up, reasons for missed videos and patients' satisfaction at study exit.ResultsOf 52 patients enrolled, 50 were analysed. 28 (56%) were male, the mean age was 31 years (range 19–50 years) and 35 (70%) owned smartphones. Of the 5150 videos expected, 4231 (82.2%) were received. The median FEDO was 85% (interquartile range 66%–94%) and this significantly differed by follow-up duration. Phone malfunction, uncharged battery and VDOT app malfunctions were the commonest reasons for missed videos. 92% of patients reported being very satisfied with using VDOT.ConclusionVDOT was feasible and acceptable for monitoring and supporting TB treatment. It resulted in high levels of adherence, suggesting that digital technology holds promise in improving patient monitoring in Uganda.

scholarly journals Connected Diagnostics to improve accurate diagnosis, treatment, and conditional payment of malaria services in Kenya.

2020 ◽  
Author(s):  
Shannen Van Duijn ◽  
Angela Siteyi ◽  
Sherzel Smith ◽  
Emmanuel Milimo ◽  
Leon Stijvers ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Healthcare Providers ◽  
Malaria Treatment ◽  
Sub Saharan Africa ◽  
Structured Interviews ◽  
National Guidelines ◽  
Private Providers ◽  
Provider Perspectives ◽  
Treatment Data ◽  
Sub Saharan

Abstract Background: In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system. International funding for malaria is currently not sufficient to control malaria. Transition to domestic funding is challenged by UHC efforts and recent COVID-19 outbreak. Herewith we present a digital approach to improve efficiencies in diagnosis and treatment of malaria in endemic Kisumu, Kenya: Connected Diagnostics. The objective of this study is to evaluate the feasibility, user experience and clinical performance of this approach in Kisumu.Methods: Our intervention was performed Oct 2017 – Dec 2018 across five private providers in Kisumu. Patients were enrolled on M-TIBA platform, diagnostic test results digitized, and only positive patients were digitally entitled to malaria treatment. Data on socio-demographics, healthcare transactions and medical outcomes were analysed using standard descriptive quantitative statistics. Provider perspectives were gathered by 19 semi-structured interviews.Results: In total 11,689 febrile patients were digitally tested through five private providers. Malaria positivity ranged from 7.4% to 30.2% between providers, significantly more amongst the poor (p< 0.05). Prescription of antimalarials was substantially aberrant from National Guidelines, with 28% over-prescription (4.6%-63.3% per provider) and prescription of branded versus generic antimalarials differing amongst facilities and correlating with the socioeconomic status of clients. Challenges were encountered transitioning from microscopy to RDT.Conclusion: We provide full proof-of-concept of innovative Connected Diagnostics to use digitized malaria diagnostics to earmark digital entitlements for correct malaria treatment of patients. This approach has large cost-saving and quality improvement potential.

scholarly journals A survey to assess the extent of public-private mix DOTS in the management of tuberculosis in Zambia

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Gershom Chongwe ◽  
Nathan Kapata ◽  
Mwendaweli Maboshe ◽  
Charles Michelo ◽  
Olusegun Babaniyi
Keyword(s):  
Private Sector ◽  
Healthcare Providers ◽  
Health Sector ◽  
Control Programme ◽  
Health Facilities ◽  
World Health ◽  
National Guidelines ◽  
Tb Control ◽  
Stop Tb Strategy ◽  
Public Private Mix

Background: Involving all relevant healthcare providers in tuberculosis (TB) management through public-private mix (PPM) approaches is a vital element in the World Health Organization’s (WHO) Stop TB Strategy. The control of TB in Zambia is mainly done in the public health sector, despite the high overall incidence rates.Aim: We conducted a survey to determine the extent of private-sector capacity, participation, practices and adherence to national guidelines in the control of TB.Setting: This survey was done in the year 2012 in 157 facilities in three provinces of Zambia where approximately 85% of the country’s private health facilities are found.Methods: We used a structured questionnaire to interview the heads of private health facilities to assess the participation of the private health sector in TB diagnosis, management and prevention activities.Results: Out of 157 facilities surveyed, 40.5% were from the Copperbelt, 4.4% from Central province and 55.1% from Lusaka province. Only 23.8% of the facilities were able to provide full diagnosis and management of TB patients. Although 47.4% of the facilities reported that they do notify their cases to the National TB control programme, the majority (62.7%) of these facilities did not show evidence of notifications.Conclusion: Our results show that the majority of the facilities that diagnose and manage TB in the private sector do not report their TB activities to the National TB Control Programme (NTP). There is a need for the NTP to improve collaboration with the private sector with respect to TB control activities and PPM for Directly Observed Treatment, Short Course (DOTS).

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