scholarly journals Cascade Variabilities in TB Case Finding among People Living with HIV and the Use of IPT: Assessment in Three Levels of Care in Cross River State, Nigeria

2020 ◽  
pp. 9-18
Author(s):  
Michael Odo ◽  
Kingsley Chinedum Ochei ◽  
Emmanuel Ifeanyi Obeagu ◽  
Afirima Barinaadaa ◽  
Emmanuel Ugobo Eteng ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Health Centre ◽  
Case Finding ◽  
Categorical Variables ◽  
People Living With Hiv ◽  
Cross River ◽  
Cross River State ◽  
Test And Treat ◽  
Intensified Case Finding ◽  
Living With Hiv

TB is the most common cause of morbidity and mortality in people living with HIV/AIDS (PLHIV) as it accelerates the progression of HIV infection. Every PLHIV is at an annual risk of 10% and a lifetime risk of 50% to acquiring TB and TB is responsible for the death of 30-40% PLHIV. We undertook to assess the WHO recommended intensified TB case finding among PLHIVs in three of levels of ART clinics in cross River State, Nigeria. We used quantitative method to review retrospectively collected routine TB and HIV facility data from University of Calabar Teaching hospital, Calabar; Infectious disease Hospital, Calabar and primary Health Centre, Calabar Municipal ART clinics. The study population for intensified case finding and IPT comprised of available records of HIV- positive patients ≥15 years old seen at the selected facilities for clinical care and treatment from January to December 2016 and January to December 2018. A cohort sampling strategy was used to assess the ICF cascade and IPT uptake. Data collection lasted from 15th to 31st November 2019 in the first phase and had extension to February 2020 due to delayed ethical clearance from the University of Calabar Teaching hospital. Quantitative data was analysed using Stata 13.0 to produce descriptive statistics including frequencies and percentages for categorical variables. Of the 326 PLHIVs (115 females) in the records, 311 had their TB screening recorded (95%). 155(50%) were screen positive while 326(210%) were evaluated for TB in the lab, out of which 182 (56%) were TB confirmed. PLHIVs ages 25-29 years were most affected, with more persons being evaluated for TB before the `test and treat` policy. Of the 207 PLHIVs started on IPT, 103 (99%) started before `test and treat` compared to 102(91%) after policy. IPT uptake was highest among ages 25-29 years. This evaluation shows that intensified case finding among PLHIV is feasible and has a high prospect for TB case finding among PLHIVs. However, critical gaps exist- poor documentation and linkages on the clinical and diagnostic arm of the cascade makes it impossible to estimate yield in a cohort and present the situation of weak clinical interphase with people seeking care.

scholarly journals TB Infection Control in TB/HIV Settings in Cross River State, Nigeria: Policy Vs Practice

2020 ◽  
pp. 101-109
Author(s):  
Michael Odo ◽  
Kingsley Chinedum Ochei ◽  
Emmanuel Ifeanyi Obeagu ◽  
Afirima Barinaadaa ◽  
Ugobo Emmanuel Eteng ◽  
...  
Keyword(s):  
Health Care ◽  
Infection Control ◽  
Teaching Hospital ◽  
Health Centre ◽  
Health Concern ◽  
People Living With Hiv ◽  
Cross River ◽  
Cross River State ◽  
Attitudes And Practices ◽  
Tb Infection Control

TB and HIV remain a dangerous duo of significant public health concern across the globe. Both diseases require significant community and health system activities to be successfully managed. TB infection control is an important disease prevention strategy among the general population and among people living with HIV, in cost and management. We undertook to assess the situation of TB infection control at three levels of health care in Cross River State of Nigeria. A qualitative method was used to assess TB infection control (TBIC) knowledge, attitudes, and practices of the health care workers at each of the purposefully selected facilities using a semi-structured questionnaire - University of Calabar Teaching hospital, Calabar; Infectious disease Hospital, Calabar and primary Health Centre, Calabar Municipal, between 15th to 31st November, 2019 in the first phase, and an extension to February, 2020 due to delayed ethical clearance from the University of Calabar Teaching hospital. Data was collected and entered on an excel template and cleaned by trained data entry clerks. Charts and color diagrams were developed to compare specific descriptive data. There is wide variation between the written policies of TB infection control and the practices among health workers. Even though there are strong administrative protocols to support TB infection control in the higher levels of care, it is better practiced in the lower level PHC where the protocols were not spelt out.

scholarly journals Performance of Clinical Screening Algorithms for Tuberculosis Intensified Case Finding among People Living with HIV in Western Kenya

PLoS ONE ◽  
2016 ◽  
Vol 11 (12) ◽  
pp. e0167685 ◽  
Author(s):  
Surbhi Modi ◽  
Joseph S. Cavanaugh ◽  
Ray W. Shiraishi ◽  
Heather L. Alexander ◽  
Kimberly D. McCarthy ◽  
...  
Keyword(s):  
Case Finding ◽  
People Living With Hiv ◽  
Clinical Screening ◽  
Western Kenya ◽  
Intensified Case Finding ◽  
Living With Hiv

scholarly journals Reducing time to differentiated service delivery for newly diagnosed people living with HIV in Kigali, Rwanda: study protocol for a pilot, unblinded, randomised controlled study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e047443
Author(s):  
Jonathan Ross ◽  
Gad Murenzi ◽  
Sarah Hill ◽  
Eric Remera ◽  
Charles Ingabire ◽  
...  
Keyword(s):  
Service Delivery ◽  
Health Centre ◽  
Albert Einstein College ◽  
Secondary Outcome ◽  
Controlled Study ◽  
People Living With Hiv ◽  
Newly Diagnosed ◽  
Differentiated Service ◽  
Viral Loads ◽  
Living With Hiv

IntroductionCurrent HIV guidelines recommend differentiated service delivery (DSD) models that allow for fewer health centre visits for clinically stable people living with HIV (PLHIV). Newly diagnosed PLHIV may require more intensive care early in their treatment course, yet frequent appointments can be burdensome to patients and health systems. Determining the optimal parameters for defining clinical stability and transitioning to less frequent appointments could decrease patient burden and health system costs. The objectives of this pilot study are to explore the feasibility and acceptability of (1) reducing the time to DSD from 12 to 6 months after antiretroviral therapy (ART) initiation,and (2) reducing the number of suppressed viral loads required to enter DSD from two to one.Methods and analysesThe present study is a pilot, unblinded trial taking place in three health facilities in Kigali, Rwanda. Current Rwandan guidelines require PLHIV to be on ART for ≥12 months with two consecutive suppressed viral loads in order to transition to less frequent appointments. We will randomise 90 participants to one of three arms: entry into DSD at 6 months after one suppressed viral load (n=30), entry into DSD at 6 months after two suppressed viral loads (n=30) or current standard of care (n=30). We will measure feasibility and acceptability of this intervention; clinical outcomes include viral suppression at 12 months (primary outcome) and appointment attendance (secondary outcome).Ethics and disseminationThis clinical trial was approved by the institutional review board of Albert Einstein College of Medicine and by the Rwanda National Ethics Committee. Findings will be disseminated through conferences and peer-reviewed publications, as well as meetings with stakeholders.Trial registration numberNCT04567693.

scholarly journals 947. Stroke demographics and risk factor profile in HIV infected individuals in Florida

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S506-S506
Author(s):  
Folusakin Ayoade ◽  
Dushyantha Jayaweera
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Clinical Research ◽  
Stroke Risk ◽  
Research Network ◽  
Categorical Variables ◽  
People Living With Hiv ◽  
Risk Factor Profile ◽  
Stroke Risk Factors ◽  
Living With Hiv

Abstract Background The risk of ischemic stroke (IS) is known to be higher in people living with HIV (PLWH) than uninfected controls. However, information about the demographics and risk factors for hemorrhagic stroke (HS) in PLWH is scant. Specifically, very little is known about the differences in the stroke risk factors between HS and IS in PLWH. The goal of this study was to determine the demographics and risk factor differences between HS and IS in PLWH. Methods We retrospectively analyzed the demographic and clinical data of PLWH in OneFlorida (1FL) Clinical Research Consortium from October 2015 to December 2018. 1FL is a large statewide clinical research network and database which contains health information of over 15 million patients, 1240 clinical practices, and 22 hospitals. We compared HS and IS based on documented ICD 9 and 10 diagnostic codes and extracted information about sociodemographic data, traditional stroke risk factors, Charlson comorbidity scores, habits, HIV factors, diagnostic modalities and medications. Statistical significance was determined using 2-sample T-test for continuous variables and adjusted Pearson chi square for categorical variables. Odds ratio (OR) and 95% confidence intervals (CI) between groups were compared. Results Overall, from 1FL sample of 13986 people living with HIV, 574 subjects had strokes during the study period. The rate of any stroke was 18.2/1000 person-years (PYRS). The rate of IS was 10.8/1000 PYRS while the rate of HS was 3.7/1000 PYRS, corresponding to 25.4% HS of all strokes in the study. Table 1 summarizes the pertinent demographic and risk factors for HS and IS in PLWH in the study. Table 1: Summary of pertinent demographic and risk factors for hemorrhagic and ischemic strokes in people living with HIV from One Florida database Conclusion In this large Floridian health database, demographics and risk factor profile differs between HS and IS in PLWH. Younger age group is associated with HS than IS. However, hypertension, hyperlipidemia and coronary artery disease are more likely to contribute to IS than HS in PLWH. Further research is needed to better understand the interplay between known and yet unidentified risk factors that may be contributing to HS and IS in PLWH. Disclosures All Authors: No reported disclosures

scholarly journals Clinical and biological profiles of older adults aged 50 and over compared to those under 50 in people living with HIV attending Kinshasa University Teaching Hospital (DR Congo)

2021 ◽  
Vol 5 (2) ◽  
pp. 087-095
Author(s):  
Mbula MMK ◽  
Longo-Mbenza B ◽  
Situakibanza HNT ◽  
Mananga GL ◽  
Makulo JRR ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Teaching Hospital ◽  
University Teaching ◽  
People Living With Hiv ◽  
Chi Square ◽  
Stage 4 ◽  
History Of ◽  
Student’S T ◽  
Living With Hiv ◽  
Student’S T Test

Background: The survival of people living with HIV (PLWHIVs) is increased and Health systems will have to deal with the early-aging-associated medical conditions. Objective: The objective of this study is to compare the clinical and biological profiles of PLWHIVs aged 50 and over and those aged less than 50 years. Material and methods: This study conducted at Kinshasa University Teaching Hospital (KUTH) covers 6 years. The clinical and biological characteristics of PLWHIVs aged 50 and over were compared with those under 50. Statistical analysis used the means ± SD, the calculation of frequencies, Student’s t-test and Chi-square. Results: PLWHIVs aged 50 or over represented 35.1%. Their average age was 58.0 ± 4.8 years. Women predominate among those under 50 and men among those 50 and over. Married people were more numerous (54% among those under 50). There were more unemployed (50% of PLHIV under 50). Patients 50 years and older were significantly classified as WHO stage 4 with a high frequency of history of tuberculosis, genital herpes, high blood pressure, smoking, vomiting, hepatomegaly, moderate elevation of diastolic blood pressure (DBP) and sytolic blood pressure (SBP), tuberculosis and anemia. Those under 50 had a significantly increased frequency of shingles, hepatitis B-hepatitis C, headaches and more survivals. The mean of Hb, HDL-C, and CD4s+ were significantly lower in patients 50 years and older, and urea, LDL-C, and ALAT levels were significantly higher. Conclusion: The average age was higher from 50 years old. These PLWHIVs were more frequently in WHO stage 4 with more common TB and anemia. Their Hb, HDL-C, and CD4s+ levels were lower while their urea, LDL-C and ALAT levels were significantly elevated.

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