scholarly journals Estimating the effect of pretreatment loss to follow up on TB associated mortality at public health facilities in Uganda

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241611
Author(s):  
Stella Zawedde-Muyanja ◽  
Joseph Musaazi ◽  
Yukari C. Manabe ◽  
Achilles Katamba ◽  
Joaniter I. Nankabirwa ◽  
...  
Keyword(s):  
Public Health ◽  
Health Facility ◽  
Health Facilities ◽  
Vital Status ◽  
Loss To Follow Up ◽  
Public Health Facilities ◽  
Tb Treatment ◽  
Health Facility Level ◽  
Facility Level

Introduction Tuberculosis (TB) mortality estimates derived only from cohorts of patients initiated on TB treatment do not consider outcomes of patients with pretreatment loss to follow-up (LFU). We aimed to assess the effect of pretreatment LFU on TB-associated mortality in the six months following TB diagnosis at public health facilities in Uganda. Methods At ten public health facilities, we retrospectively reviewed treatment data for all patients with a positive Xpert®MTB/RIF test result from January to June 2018. Pretreatment LFU was defined as not initiating TB treatment within two weeks of a positive test. We traced patients with pretreatment LFU to ascertain their vital status. We performed Kaplan Meier survival analysis to compare the cumulative incidence of mortality, six months after diagnosis among patients who did and did not experience pretreatment LFU. We also determined the health facility level estimates of TB associated mortality before and after incorporating deaths prior to treatment initiation among patients who experienced pretreatment LFU. Results Of 510 patients with positive test, 100 (19.6%) experienced pretreatment LFU. Of these, we ascertained the vital status of 49 patients. In the six months following TB diagnosis, mortality was higher among patients who experienced pretreatment LFU 48.1/1000py vs 22.9/1000py. Hazard ratio [HR] 3.18, 95% confidence interval [CI] (1.61–6.30). After incorporating deaths prior to treatment initation among patients who experienced pretreatment LFU, health facility level estimates of TB associated mortality increased from 8.4% (95% CI 6.1%-11.6%) to 10.2% (95% CI 7.7%-13.4%). Conclusion Patients with confirmed TB who experience pretreatment LFU have high mortality within the first six months. Efforts should be made to prioritise linkage to treatment for this group of patients. Deaths that occur prior to treatment initation should be included when reporting TB mortality in order to more accurately reflect the health impact of TB.

scholarly journals Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda

2020 ◽  
Author(s):  
Stella Zawedde-Muyanja ◽  
Achilles Katamba ◽  
Adithya Cattamanchi ◽  
Barbara Castelnuovo ◽  
Yukari C Manabe
Keyword(s):  
Public Health ◽  
Health Facility ◽  
High Volume ◽  
Health Facilities ◽  
High Rate ◽  
Loss To Follow Up ◽  
Public Health Facilities ◽  
Factors Associated ◽  
Tb Treatment

Abstract Background: In 2018, Uganda started only 65% of persons with incident tuberculosis on treatment. Pretreatment loss to follow up is an important contributor to suboptimal treatment coverage. We aimed to describe the patient and health facility-level characteristics associated with pretreatment loss to follow up among patients diagnosed with pulmonary tuberculosis at public health facilities in Uganda. Methods: At ten public health facilities, laboratory register data was used to identify patients aged 15 years who had a positive Xpert®MTB/RIF test. Initiation on TB treatment was ascertained using the clinical register. Factors associated with not being initiated on TB treatment within two weeks of diagnosis were examined using a multilevel logistic regression model accounting for clustering by health facility. Results:From January to June 2018, 510 patients (61.2% male and 31.5% HIV co-infected) were diagnosed with tuberculosis. One hundred (19.6%) were not initiated on TB treatment within two weeks of diagnosis. Not having a phone number recorded in the clinic registers (aOR 7.93, 95%CI 3.93-13.05); being HIV-infected (aOR 1.83; 95% CI: 1.09-3.26) and receiving care from a high volume health facility performing more than 12 Xpert tests per day (aOR 4.37, 95%CI 1.69-11.29) and were significantly associated with pretreatment loss to follow up. Conclusion: In public health facilities in Uganda, we found a high rate of pretreatment loss to follow up especially among TBHIV co-infected patients diagnosed at high volume health facilities. Interventions to improve the efficiency of Xpert® MTB/RIF testing, including monitoring of the TB care cascade should be developed and implemented.

scholarly journals Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Stella Zawedde-Muyanja ◽  
Achilles Katamba ◽  
Adithya Cattamanchi ◽  
Barbara Castelnuovo ◽  
Yukari C. Manabe
Keyword(s):  
Public Health ◽  
Health Facility ◽  
High Volume ◽  
Health Facilities ◽  
High Rate ◽  
Loss To Follow Up ◽  
Public Health Facilities ◽  
Factors Associated ◽  
Tb Treatment

Abstract Background In 2018, Uganda started only 65% of persons with incident tuberculosis on treatment. Pretreatment loss to follow up is an important contributor to suboptimal treatment coverage. We aimed to describe the patient and health facility-level characteristics associated with pretreatment loss to follow up among patients diagnosed with pulmonary tuberculosis at public health facilities in Uganda. Methods At ten public health facilities, laboratory register data was used to identify patients aged ≥ 15 years who had a positive Xpert®MTB/RIF test. Initiation on TB treatment was ascertained using the clinical register. Factors associated with not being initiated on TB treatment within two weeks of diagnosis were examined using a multilevel logistic regression model accounting for clustering by health facility. Results From January to June 2018, 510 patients (61.2% male and 31.5% HIV co-infected) were diagnosed with tuberculosis. One hundred (19.6%) were not initiated on TB treatment within 2 weeks of diagnosis. Not having a phone number recorded in the clinic registers (aOR 7.93, 95%CI 3.93–13.05); being HIV-infected (aOR 1.83; 95% CI: 1.09–3.26) and receiving care from a high volume health facility performing more than 12 Xpert tests per day (aOR 4.37, 95%CI 1.69–11.29) and were significantly associated with pretreatment loss to follow up. Conclusion In public health facilities in Uganda, we found a high rate of pretreatment loss to follow up especially among TBHIV co-infected patients diagnosed at high volume health facilities. Interventions to improve the efficiency of Xpert® MTB/RIF testing, including monitoring of the TB care cascade should be developed and implemented.

scholarly journals Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda 

2020 ◽  
Author(s):  
Stella Zawedde-Muyanja ◽  
Achilles Katamba ◽  
Adithya Cattamanchi ◽  
Barbara Castelnuovo ◽  
Yukari C Manabe
Keyword(s):  
Public Health ◽  
Health Facility ◽  
High Volume ◽  
Health Facilities ◽  
Loss To Follow Up ◽  
Public Health Facilities ◽  
Factors Associated ◽  
Tb Treatment ◽  
Incident Cases

Abstract Background: In 2018, Uganda only 65% of incident cases of tuberculosis were started on treatment. Pretreatment loss to follow up is an important contributor to suboptimal treatment coverage. We aimed to describe the patient and health facility-level characteristics associated with pretreatment loss to follow up among patients diagnosed with pulmonary tuberculosis at public health facilities in Uganda. Methods: At ten public health facilities, laboratory register data was used to identify patients aged 15 years who had a positive Xpert®MTB/RIF test. Initiation on TB treatment was ascertained using the clinical register. Factors associated with not being initiated on TB treatment within two weeks of diagnosis were examined using a multilevel logistic regression model accounting for clustering by health facility. Results:From January to June 2018, 510 patients (61.2% male and 31.5% HIV co-infected) were diagnosed with tuberculosis. One hundred (19.6%) were not initiated on TB treatment within two weeks of diagnosis. Not having a phone number recorded in the clinic registers (aOR 7.93, 95%CI 3.93-13.05); being HIV-infected (aOR 1.83; 95% CI: 1.09-3.26) and receiving care from a high volume health facility performing more than 12 Xpert tests per day (aOR 4.37, 95%CI 1.69-11.29) and were significantly associated with pretreatment loss to follow up. Conclusion: In public health facilities in Uganda, we found a high rate of pretreatment loss to follow up especially among TBHIV co-infected patients diagnosed at high volume health facilities. Interventions to improve the efficiency of Xpert® MTB/RIF testing, including monitoring of the TB care cascade should be developed and implemented.

scholarly journals Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda

2019 ◽  
Author(s):  
Stella Zawedde-Muyanja ◽  
Achilles Katamba ◽  
Adithya Cattamanchi ◽  
Barbara Castelnuovo ◽  
Yukari C Manabe
Keyword(s):  
Public Health ◽  
Health Facility ◽  
High Volume ◽  
Health Facilities ◽  
Loss To Follow Up ◽  
Public Health Facilities ◽  
Factors Associated ◽  
Tb Treatment ◽  
Incident Cases

Abstract Background: In 2017, Uganda only 53% of incident cases of tuberculosis were started on treatment. Pretreatment loss to follow up is an important contributor to suboptimal treatment coverage. We aimed to describe the patient and health facility-level characteristics associated with pretreatment loss to follow up among patients diagnosed with pulmonary tuberculosis at public health facilities in Uganda. Methods: At ten public health facilities, laboratory register data was used to identify patients aged 15 years who had a positive Xpert®MTB/RIF test. Initiation on TB treatment was ascertained using the clinical register. Factors associated with not being initiated on TB treatment within two weeks of diagnosis were examined using a multilevel logistic regression model accounting for clustering by health facility. Results: From January to June 2018, 510 patients (61% male and 31.5% HIV co-infected) were diagnosed with tuberculosis. One hundred (19.6%) were not initiated on TB treatment within two weeks of diagnosis. Not having a phone number recorded in the clinic registers (aOR 7.93, 95%CI 3.93-13.05); being HIV-infected (aOR 1.83; 95% CI: 1.09-3.26) and receiving care from a high volume health facility performing more than 12 Xpert tests per day (aOR 4.37, 95%CI 1.69-11.29) and were significantly associated with pretreatment loss to follow up. Conclusion: In public health facilities in Uganda, we found a high rate of pretreatment loss to follow up especially among TBHIV co-infected patients diagnosed at high volume health facilities. Interventions to improve the efficiency of Xpert® MTB/RIF testing, including monitoring of the TB care cascade should be developed and implemented.

scholarly journals Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative

2021 ◽  
Vol 6 (6) ◽  
pp. e005833
Author(s):  
Leena N Patel ◽  
Samantha Kozikott ◽  
Rodrigue Ilboudo ◽  
Moreen Kamateeka ◽  
Mohammed Lamorde ◽  
...  
Keyword(s):  
Health Facility ◽  
Healthcare Workers ◽  
National Level ◽  
Lessons Learned ◽  
Health Facilities ◽  
Infection Prevention And Control ◽  
Health Facility Level ◽  
Ensure Patient Safety ◽  
Increased Risk ◽  
Facility Level

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.

scholarly journals Effectiveness of delivering integrated COPD care at public healthcare facilities: a cluster randomised trial in Pakistan

BJGP Open ◽  
2019 ◽  
Vol 3 (1) ◽  
pp. bjgpopen18X101634
Author(s):  
Muhammad Amir Khan ◽  
Nida Khan ◽  
John D Walley ◽  
Muhammad Ahmar Khan ◽  
Joseph Hicks ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Outcome ◽  
Clinical Care ◽  
Randomised Trial ◽  
Health Facilities ◽  
Cluster Randomised Trial ◽  
Public Healthcare ◽  
Public Health Facilities ◽  
Cluster Randomised

BackgroundIn Pakistan chronic obstructive pulmonary disease (COPD) prevalence is 2.1% in adults aged >40 years. Despite being a health policy focus, integrated COPD care has remained neglected, with wide variation in practice.AimTo assess whether enhanced care at public health facilities resulted in better control of COPD, treatment adherence, and smoking cessation.Design & settingA two-arm cluster randomised controlled trial was undertaken in 30 public health facilities (23 primary and 7 secondary), across three districts of Punjab, between October 2014–December 2016. Both arms had enhanced diagnosis and patient recording processes. Intervention facilities also had clinical care guides; drugs for COPD; patient education flipcharts; associated staff training; and mobile phone follow-up.MethodFacilities were randomised in a 1:1 ratio (sealed envelope independent lottery method), and 159 intervention and 154 control patients were recruited. The eligibility criteria were as follows: diagnosed with COPD, aged ≥18 years, and living in the catchment area. The primary outcome was change in BODE (Body mass index, airway Obstruction, Dyspnoea, Exercise capacity) index score from baseline to final follow-up visit. Staff and patients were not blinded.ResultsSix-month primary outcomes were available for 147/159 (92.5%) intervention and 141/154 (91.6%) control participants (all clusters). The primary outcome results cluster-level analysis were as follows: mean intervention outcome = -1.67 (95% confidence intervals [CI] = -2.18 to -1.16); mean control outcome = -0.66 (95% CI = -1.09 to -0.22); and covariate-adjusted mean intervention–control difference = -0.96 (95% CI = -1.49 to -0.44; P = 0.001).ConclusionThe findings of this trial and a separate process evaluation study support the scaling of this integrated COPD care package at primary and secondary level public health facilities in Pakistan and similar settings.

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