scholarly journals Assessment of training and mentoring for DR-TB care decentralization in Tanzania

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Dennis Lyakurwa ◽  
Johnson Lyimo ◽  
Christiaan Mulder ◽  
Puck T. Pelzer ◽  
Inge Koppelaar ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Group Discussion ◽  
Patient Treatment ◽  
Self Assessment ◽  
Loss To Follow Up ◽  
Final Treatment ◽  
Training Quality ◽  
Decentralized Care ◽  
Care Performance

Abstract Introduction Drug-resistant TB (DR-TB) care shifted from centralized to decentralized care in Tanzania in 2015. This study explored whether DR-TB training and mentoring supported healthcare workers’ (HCWs) DR-TB care performance. Methods This mixed study assessed HCWs’ DR-TB care knowledge, the training quality, and the mentoring around 454 HCWs who were trained across 55 DR-TB sites between January 2016 and December 2017. Pre- and post-training tests, end-of-training evaluation, supervisor’s interviews, DR-TB team self-assessment and team focus group discussion were conducted among trained HCWs. Interim and final treatment results of the national central site and the decentralized sites were compared. Results HCW’s knowledge increased for 15–20% between pre-training and post-training. HCWs and supervisors perceived mentoring as most appropriate to further develop their DR-TB competencies. Culture negativity after 6 months of treatment was similar for the decentralized sites compared to the national central site, 81% vs 79%, respectively, whereas decentralized sites had less loss to follow-up (0% versus 3%) and fewer deaths (3% versus 12%). Delays in laboratory results, stigma, and HCWs shortage were reported the main challenges of decentralized care. Conclusions Training and mentoring to provide DR-TB care at decentralized sites in Tanzania improved HCWs’ knowledge and skills in DR-TB care and supported observed good interim and final patient treatment outcomes despite health system challenges.

A simulation study of loss to follow up: The impact on time to event and prevention.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14097-e14097
Author(s):  
Donna Elise Levy ◽  
Bingyan Wu ◽  
Daniel Quinn ◽  
Sophie Jentzsch ◽  
Christine Lusk ◽  
...  
Keyword(s):  
Treatment Options ◽  
Patient Treatment ◽  
Future Research ◽  
Time To Event ◽  
Loss To Follow Up ◽  
Study Results ◽  
Patient Attrition ◽  
The Impact ◽  
Future Patient

e14097 Background: Patient attrition during study follow up is a concern in all clinical trials, although its impact on study results has rarely been assessed. In oncology, in particular, where studies are lengthier and may be extended into longitudinal studies, there is an increased likelihood of loss to follow up (LTFU) (Gill et al., 2018). This creates a heightened need to understand how it affects the trial’s validity. The loss of data from patients who have been LTFU can reduce a study’s precision and power. This imprecision not only impacts the results of the current study but can also affect future research as well as future patient treatment options. Studies have found that participant characteristics differ in individuals LTFU as compared to those who remain in follow up (Childs et al., 2011; Geng et al., 2008; Hochheimer et al., 2016). This further emphasizes how attrition can skew study results and their interpretation and supports the need to minimize patient attrition during follow up in order to reduce bias and generate robust study estimates. Methods: This study assessed the impact of LTFU rates on the study estimates through simulations using SAS software. While all endpoints can be affected by LTFU, this study assessed time-to-event endpoints. Exponential distribution was assumed with varying rates of LTFU. In addition, the work covered suggestions for reducing LTFU. Results: Even for low rates of LTFU, biases are introduced in time-to event endpoints. Conclusions: Researchers should make every effort to minimize the extent of LTFU in the design and of and conduct of their trials.

scholarly journals Monitoring Of Side Effects Of Anti-Tuberculosis Drugs (ATD) On The Intensive Phase Treatment Of Pulmonary TB Patients In Makassar

2017 ◽  
Vol 3 (1) ◽  
pp. 19
Author(s):  
Akhmadi Abbas
Keyword(s):  
Side Effects ◽  
Joint Pain ◽  
Health Workers ◽  
Treatment Compliance ◽  
Patient Treatment ◽  
Intensive Phase ◽  
Loss To Follow Up ◽  
Pulmonary Tb ◽  
Loss Of Appetite

Side effects of Anti-Tuberculosis Drugs (ATD) is a problem in the treatment of TB patients. The severity of the side effects experienced by patients will have an impact on treatment compliance and loss to follow-up rate. This study aimed to obtain information about ATD side effects experienced by pulmonary TB patients during the intensive phase treatment in Makassar. This type of research was observational descriptive with the time series design. The number of samples in this study were 58 people. The results showed that the percentage of patients who experienced ATD side effects during the intensive phase of treatment is the first week of 96.6%, 91.4% the second week, third week of 86.2%, 74.1% fourth week, the fifth week 74.1% , the sixth week 81%, the seventh week of 75.9% and 67.2% eighth week. The percentage of patients based on the type of side effects experienced is 81% joint pain, nausea 79.3%, 77.6% itching, loss of appetite 75.9%, 67.2% dizziness, tingling 50%, vomiting 41.4%, 34.5% abdominal pain, visual disturbances 27.6%, headache 24.1% and 6.9% hearing loss. This study showed that patients experienced ATD side effects every week during the intensive phase treatment. More side effects experienced during the first and the second weeks and tend to decrease until the end of the intensive phase. The main type of side effects experienced by TB patients are joint pain. Health workers should always conduct routine monitoring of ATD side effects experienced by TB patients in order to improve patient treatment compliance and prevent them from loss to follow-up of treatment. Keywords: Monitoring, Side effects, ATD, TB, Intensive phase

scholarly journals Penerapan Peraturan Desa Tentang Penemuan dan Pengawasan Pengobatan Kasus Malaria Berbasis Masyarakat

2019 ◽  
Author(s):  
Agung Puja Kesuma
Keyword(s):  
Healthcare Workers ◽  
Qualitative Method ◽  
Malaria Incidence ◽  
Group Discussion ◽  
Evaluation Study ◽  
Malaria Surveillance ◽  
Community Based ◽  
Depth Interviews ◽  
Village Health

Abstract. In Purbalingga, there was a Village Regulation for detecting and monitoring community-based malaria cases treatment that developed as a model of malaria control. The aim of this research was to evaluate influence of this Village Regulation on malaria incidence in Tetel. Policy evaluation study was done with qualitative method conducted in Tetel, Pengadegan District, Purbalingga, in March to October 2015. The data’s collected by in-depth interviews on community leaders and healthcare workers, focus group discussion (FGD) on a group of men and women, and documents review. Data’s were analyzed using content analysis. The Regulation socialized through village health forum meetings and other group meetings. Malaria case detection has done by the community that reported to Village Malaria Surveillance Officer/Juru Malaria Desa (JMD) to take suspect blood specimen immediately. Monitoring of malaria treatment was done by JMD with follow-up action. Malaria cases in Tetel tend to decrease even to zero after implementation of the regulation. Implementation of this regulation can be used as a model for other villages that still have problems with malaria.

KARAKTERISTIK KLINIS PASIEN YANG MENERIMA TERAPI ARV DI RSUD KABUPATEN BULELENG

2020 ◽  
Vol 6 (2) ◽  
pp. 212-216
Author(s):  
I Gusti Ngurah Putu Candra ◽  
Dewi Aprelia Meriyani ◽  
Luh Putu Desy Puspaningrat ◽  
Yopita Triguno ◽  
Ni Kadek Ayu Tamara Widya Sari
Keyword(s):  
Loss To Follow Up ◽  
Hiv Aids

  ABSTRAK Latar Belakang Penyakit menular yang selalu memberikan dampak tidak hanya kesehatan tetapi social dan ekomoni adalha HIV/AIDS.Tujuan untuk mendeskripsikan kondisi klinis dan dmeografi pasien yang menerima terapi ARV.MetodePenelitian deskriptif dengan pendekatan secara kohort retrospektifmenggunakan data sekunder dari register kohort ARV dari tahun 2005-2015 (11 tahun terapi ARV). Analisis yang digunakan adalah analisis univariat menggunakan SPSS versi 17.Hasil Karakteristik klinis dan demografi pada odha yang menerima terapi ARV yaitu 45,32% dalam kondisi ambulatory, 75.42% mendapatkan regimen NNRTI jenis zidovudine, 75.82 % mendapatkan terapi regimen NRTI nevirapine, 79.66% pada kondisi stadium 3 dan 4, dengan klasifikasi umur produktif (< 40 tahun sebanyak 82.05%, sebagian besar berjenis kelamin laki-laki 62.96%, dan memiliki pengawas minum obat (PMO) sebesar 68.25%. Proporsi kematian sebesar  9.3 % (112 orang), LTFU (loss to follow up) 18.52% (223 orang), subsitusi regimen lini satu 9.88% (119 orang),rujuk keluar 1.83% (22 orang) dan yang masih dalam pengobatan sebesar 69.93% (842).Kesimpulan Pasien yang mengalami LTFU terbagi dalam beberapa kondisi yaitu LTFU dalam kondisi meninggal 3.07% (37 orang), LTFU dalam kondisi hidup 0.5% (6 orang), dan LTFU yang tidak diketahui kondisinya sebesar 14.95% (180 orang).Saran Monitoring dan evaluasi pada program pengobatan dilakukan secara berkelanjutan untuk meningkatkan konsistensi terapi yang dilakukan.  Kata Kunci : Karakteristik, Terapi, HIV/AIDS 

European Recommendations for the Management of Healthcare Workers Occupationally Exposed to Hepatitis

2018 ◽  
Vol 2 (1) ◽  
pp. 49
Author(s):  
Enis Uruci
Keyword(s):  
Occupational Exposure ◽  
Hepatitis B ◽  
Healthcare Workers ◽  
Antiviral Treatment ◽  
World Health ◽  
Antibody Concentration ◽  
Post Exposure Prophylaxis ◽  
Transferase Activity ◽  
Mediterranean Countries

Exposure prevention is the primary strategy to reduce the risk of occupational bloodborne pathogen infections in healthcare workers (HCW). HCWs should be made aware of the medicolegal and clinical relevance of reporting an exposure, and have ready access to expert consultants to receive appropriate counselling, treatment and follow-up. Vaccination against hepatitis B virus (HBV), and demonstration of immunisation before employment are strongly recommended. HCWs with postvaccinal anti-HBs levels, 1-2 months after vaccine completion, .or=10 mIU/mL are considered as responders. Responders are protected against HBV infection: booster doses of vaccine or periodic antibody concentration testing are not recommended. Alternative strategies to overcome non-response should be adopted. Isolated anti-HBc positive HCWs should be tested for anti-HBcIgM and HBV-DNA: if negative, anti-HBs response to vaccination can distinguish between infection (anti-HBs .or=50 mIU/ml 30 days after 1st vaccination: anamnestic response) and false positive results(anti-HBs .or=10 mUI/ml 30 days after 3rd vaccination: primary response); true positive subjects have resistance to re-infection. and do not need vaccination The management of an occupational exposure to HBV differs according to the susceptibility of the exposed HCW and the serostatus of the source. When indicated, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible (within 1-7 days). In the absence of prophylaxis against hepatitis C virus (HCV) infection, follow-up management of HCV exposures depends on whether antiviral treatment during the acute phase is chosen. Test the HCW for HCV-Ab at baseline and after 6 months; up to 12 for HIV-HCV co-infected sources. If treatment is recommended, perform ALT (amino alanine transferase) activity at baseline and monthly for 4 months after exposure, and qualitative HCV-RNA when an increase is detected. Introduction Bloodborne pathogens such as hepatitis B (HBV) and C virus (HCV) represent an important hazard for healthcare workers (HCWs) (1). In the general population, HCV prevalence varies geographically from about 0.5% in northern countries to 2% in Mediterranean countries, with some 5 million chronic carriers estimated in Europe; while HBV prevalence ranges from 0.3% to 3%. The World Health Organization (WHO) estimates that each year in Europe 304 000 HCWs are exposed to at least one percutaneous injury with a sharp object contaminated with HBV, 149 000 are exposed to HCV and 22 000 to HIV. The probability of acquiring a bloodborne infection following an occupational exposure has been estimated to be on average.

scholarly journals Predictors of loss to follow-up in art experienced patients in Nigeria: a 13 year review (2004–2017)

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Ahmad Aliyu ◽  
Babatunde Adelekan ◽  
Nifarta Andrew ◽  
Eunice Ekong ◽  
Stephen Dapiap ◽  
...  
Keyword(s):  
Patient Adherence ◽  
Cross Sectional Study ◽  
Emergency Plan ◽  
Cross Sectional ◽  
Loss To Follow Up ◽  
Viral Loads ◽  
Review Period ◽  
Lost To Follow Up ◽  
Differentiated Care

Abstract Background Expanded access to antiretroviral therapy (ART) leads to improved HIV/AIDS treatment outcomes in Nigeria, however, increasing rates of loss to follow-up among those on ART is threatening optimal standard achievement. Therefore, this retrospective cross-sectional study is aimed at identifying correlates and predictors of loss to follow-up in patients commencing ART in a large HIV program in Nigeria. Methods Records of all patients from 432 US CDC Presidents Emergency Plan for AIDS Relief (PEPFAR) supported facilities across 10 States and FCT who started ART from 2004 to 2017 were used for this study. Bivariate and multivariate analysis of the demographic and clinical parameters of all patients was conducted using STATA version 14 to determine correlates and predictors of loss to follow-up. Results Within the review period, 245,257 patients were ever enrolled on anti-retroviral therapy. 150,191 (61.2%) remained on treatment, 10,960 (4.5%) were transferred out to other facilities, 6926 (2.8%) died, 2139 (0.9%) self-terminated treatment and 75,041 (30.6%) had a loss to follow-up event captured. Males (OR: 1.16), Non-pregnant female (OR: 4.55), Patients on ≥ 3-monthly ARV refills (OR: 1.32), Patients with un-suppressed viral loads on ART (OR: 4.52), patients on adult 2nd line regimen (OR: 1.23) or pediatric on 1st line regimen (OR: 1.70) were significantly more likely to be lost to follow-up. Conclusion Despite increasing access to anti-retroviral therapy, loss to follow-up is still a challenge in the HIV program in Nigeria. Differentiated care approaches that will focus on males, non-pregnant females and paediatrics is encouraged. Reducing months of Anti-retroviral drug refill to less than 3 months is advocated for increased patient adherence.

scholarly journals Understanding factors, outcomes and reasons for loss to follow-up among women in Option B+ PMTCT programme in Lilongwe, Malawi

2014 ◽  
Vol 19 (11) ◽  
pp. 1360-1366 ◽  
Author(s):  
Hannock Tweya ◽  
Salem Gugsa ◽  
Mina Hosseinipour ◽  
Colin Speight ◽  
Wingston Ng'ambi ◽  
...  
Keyword(s):  
Pmtct Programme ◽  
Loss To Follow Up

scholarly journals Prevalence and Course of IgA and IgG Antibodies against SARS-CoV-2 in Healthcare Workers during the First Wave of the COVID-19 Outbreak in Germany: Interim Results from an Ongoing Observational Cohort Study

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 498
Author(s):  
Mark Reinwald ◽  
Peter Markus Deckert ◽  
Oliver Ritter ◽  
Henrike Andresen ◽  
Andreas G. Schreyer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Healthcare Workers ◽  
Significant Proportion ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Observational Cohort Study ◽  
Igg Antibodies ◽  
University Hospitals ◽  
Observational Cohort

(1) Background: Healthcare workers (HCWs) are prone to intensified exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the ongoing pandemic. We prospectively analyzed the prevalence of antibodies against SARS-CoV-2 in HCWs at baseline and follow up with regard to clinical signs and symptoms in two university hospitals in Brandenburg, Germany. (2) Methods: Screening for anti-SARS-CoV-2 IgA and IgG antibodies was offered to HCWs at baseline and follow up two months thereafter in two hospitals of Brandenburg Medical School during the first wave of the COVID-19 pandemic in Germany in an ongoing observational cohort study. Medical history and signs and symptoms were recorded by questionnaires and analyzed. (3) Results: Baseline seroprevalence of anti-SARS-CoV-2 IgA was 11.7% and increased to 15% at follow up, whereas IgG seropositivity was 2.1% at baseline and 2.2% at follow up. The rate of asymptomatic seropositive cases was 39.5%. Symptoms were not associated with general seropositivity for anti-SARS-CoV-2; however, class switch from IgA to IgG was associated with increased symptom burden. (4) Conclusions: The seroprevalence of antibodies against SARS-CoV-2 was low in HCWs but higher compared to population data and increased over time. Screening for antibodies detected a significant proportion of seropositive participants cases without symptoms.

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