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Palliative care management committees: a model of collaborative governance for primary health care. 姑息治疗管理委员会:初级卫生保健协作治理模式。
IF 1.4
Public Health Action Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0028
A Kochuvilayil, S Rajalakshmi, A Krishnan, S M Vijayanand, V R Kutty, T Iype, R P Varma
{"title":"Palliative care management committees: a model of collaborative governance for primary health care.","authors":"A Kochuvilayil,&nbsp;S Rajalakshmi,&nbsp;A Krishnan,&nbsp;S M Vijayanand,&nbsp;V R Kutty,&nbsp;T Iype,&nbsp;R P Varma","doi":"10.5588/pha.22.0028","DOIUrl":"https://doi.org/10.5588/pha.22.0028","url":null,"abstract":"<p><strong>Setting: </strong>The community-based primary palliative care programme in Kerala, India, has received international acclaim. Programme functioning is supported through Palliative Care Management Committees (PMCs) at the local government (LG) level.</p><p><strong>Objective: </strong>To study the functioning of the PMCs within the decentralised governance space to identify achievements, gaps and notable innovations.</p><p><strong>Design: </strong>This qualitative study included seven key informant interviews (KIIs), 28 in-depth interviews and a review of relevant publicly available policies and documents. Major themes were recognised from the KII transcripts. Codes emerging from the document review and in-depth interview transcripts were mapped into the identified thematic areas.</p><p><strong>Results: </strong>Successful PMCs raised resources like money, human resource, equipment, had good skilled care options for symptom relief and facilitated reduced out-of-pocket expenditure by providing home care and free medicines, and improved access to interventions that addressed the social determinants of suffering like poverty. PMCs had varying managerial and technical capacities. In some LGs, the programme was weak and mostly limited to the supply of medicines, basic aids and appliances to patients' homes.</p><p><strong>Conclusion: </strong>Despite varied implementation patterns, PMCs in Kerala are examples of state-supported, community-owned care initiatives, that can potentially address medical and social determinants of suffering.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 Suppl 1","pages":"12-18"},"PeriodicalIF":1.4,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9983804/pdf/i2220-8372-13-s1-12.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9771012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Increase in rifampicin resistance among people previously treated for TB. 以前接受过结核病治疗的人对利福平的耐药性增加。
IF 1.4
Public Health Action Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0047
J Izudi, F Bajunirwe, A Cattamanchi
{"title":"Increase in rifampicin resistance among people previously treated for TB.","authors":"J Izudi,&nbsp;F Bajunirwe,&nbsp;A Cattamanchi","doi":"10.5588/pha.22.0047","DOIUrl":"https://doi.org/10.5588/pha.22.0047","url":null,"abstract":"<p><p>People previously treated for TB are at a higher risk of rifampicin-resistant or multidrug-resistant TB (RR/MDR-TB). Uganda's recent RR-TB estimates were not updated, including during the COVID-19 pandemic. Using programmatic data (2012-2021), we report on the distribution and trends in RR-TB among people previously treated for bacteriologically confirmed pulmonary TB (BC-PTB) across six TB clinics in Kampala, Uganda. The RR-TB prevalence between 2012 and 2015 was 0% (95% CI 0-2.3). The prevalence rose significantly in recent years to 7.0% (95% CI 4.4-10.8) between 2016 and 2021 (<i>P</i> < 0.001). RR-TB is increasing among people previously treated for BC-PTB in Kampala; surveillance for RR-TB should be enhanced.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 1","pages":"4-6"},"PeriodicalIF":1.4,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10162363/pdf/i2220-8372-13-1-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9432025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pooling sputum samples for Xpert® MTB/RIF and Xpert® Ultra testing for TB diagnosis. 集中痰液样本进行 Xpert® MTB/RIF 和 Xpert® Ultra 检测,以诊断结核病。
IF 1.3
Public Health Action Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0052
J S Bimba, O A Adekeye, V Iem, T T Eliya, I Osagie, K Kontogianni, T Edwards, J Dodd, S B Squire, J Creswell, L E Cuevas
{"title":"Pooling sputum samples for Xpert® MTB/RIF and Xpert® Ultra testing for TB diagnosis.","authors":"J S Bimba, O A Adekeye, V Iem, T T Eliya, I Osagie, K Kontogianni, T Edwards, J Dodd, S B Squire, J Creswell, L E Cuevas","doi":"10.5588/pha.22.0052","DOIUrl":"10.5588/pha.22.0052","url":null,"abstract":"<p><strong>Background: </strong>The use of molecular amplification as-says for TB diagnosis is limited by their costs and cartridge stocks. Pooling multiple samples to test them together is reported to have similar accuracy to individual testing and to save costs.</p><p><strong>Methods: </strong>Two surveys of individuals with presumptive TB were conducted to assess the performance of pooled testing using Xpert® MTB/RIF (MTB/RIF) and Xpert® Ultra (Ultra).</p><p><strong>Results: </strong>A total of 500 individuals were tested using MTB/RIF, with 72 (14.4%) being MTB-positive. The samples were tested in 125 pools, with 50 pools having ⩾1 MTB-positive and 75 only MTB-negative samples: 46/50 (92%, 95% CI 80.8-97.8) MTB-positive pools tested MTB-positive and 71/75 (94.7%, 95% CI 86.9-98.5) MTB-negative pools tested MTB-negative in the pooled test (agreement: 93.6%, κ = 0.867). Five hundred additional samples were tested using Ultra, with 60 (12%) being MTB-positive. Samples were tested in 125 pools, with 42 having ⩾1 MTB-positive and 83 only MTB-negative samples: 35/42 (83.6%, 95% CI 68.6-93.0) MTB-positive pools tested MTB-positive and 82/83 (98.8%, 95% CI 93.5-100.0) MTB-negative pools tested MTB-negative in the pooled test (agreement: 93.6%, κ = 0.851; <i>P</i> > 0.1 between individual and pooled testing). Pooled testing saved 35% (MTB/RIF) and 46% (Ultra) of cartridges.</p><p><strong>Conclusions: </strong>Pooled and individual testing has a high level of agreement and improves testing efficiency.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 1","pages":"12-16"},"PeriodicalIF":1.3,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10162368/pdf/i2220-8372-13-1-12.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9432028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Health inequities around gender, disability and internal migration: are local governments doing enough. 围绕性别、残疾和国内移徙的卫生不平等:地方政府做得够不够?
IF 1.4
Public Health Action Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0032
M R Nair, S S Kumar, S S Babu, B A Chandru, K S Kunjumon, C S Divya, R P Varma
{"title":"Health inequities around gender, disability and internal migration: are local governments doing enough.","authors":"M R Nair,&nbsp;S S Kumar,&nbsp;S S Babu,&nbsp;B A Chandru,&nbsp;K S Kunjumon,&nbsp;C S Divya,&nbsp;R P Varma","doi":"10.5588/pha.22.0032","DOIUrl":"https://doi.org/10.5588/pha.22.0032","url":null,"abstract":"<p><strong>Setting: </strong>The Kerala health system in India has more than 25 years of decentralised implementation experience. Decentralization could assist in addressing health disparities such as gender, disability, and migration.</p><p><strong>Objective: </strong>To explore how inequity issues comprising gender, disability and internal migrations were being addressed at present by the decentralised Kerala health system.</p><p><strong>Design: </strong>Our approach was qualitative, using document review, key informant interviews and in-depth interviews with policy makers, health staff and other stakeholders.</p><p><strong>Results: </strong>Gender aspects were incorporated into planning and budgeting, with 10% funds earmarked for women. Projects were gender-specific to women, and within conventional social roles of livelihood, welfare or reproductive health. Recently, transgender focused projects were also initiated. Schemes for people with disabilities remained welfare-centric and driven by top-down policies. The local governments performed beneficiary identification and benefit disbursal. Migrant health aspects were focused on infectious diseases surveillance and later living conditions of migrant workers.</p><p><strong>Conclusion: </strong>The importance that health systems place on socioeconomic determinants of health and fundamental human rights is reflected in the health interventions for marginalised communities. In Kerala, there is now a passive application of central rules and a reluctance to utilise local platforms. Changing this is a necessary condition for achieving equal development.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 Suppl 1","pages":"6-11"},"PeriodicalIF":1.4,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9983809/pdf/i2220-8372-13-s1-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9787428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
The role of local governments in the implementation of evidence-based nutrition interventions in Kerala. 地方政府在喀拉拉邦实施循证营养干预措施中的作用。
IF 1.4
Public Health Action Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0026
J R Jith, R Bedamatta, K Rajamohanan, L K R Itty Amma, T S Sumitha, C S Divya, R Sadanandan, T Iype
{"title":"The role of local governments in the implementation of evidence-based nutrition interventions in Kerala.","authors":"J R Jith,&nbsp;R Bedamatta,&nbsp;K Rajamohanan,&nbsp;L K R Itty Amma,&nbsp;T S Sumitha,&nbsp;C S Divya,&nbsp;R Sadanandan,&nbsp;T Iype","doi":"10.5588/pha.22.0026","DOIUrl":"https://doi.org/10.5588/pha.22.0026","url":null,"abstract":"<p><strong>Objective: </strong>To study the involvement and influence of local participatory governments consisting of <i>Panchayat Raj</i> institutions (PRIs) in implementing evidence-based interventions for eliminating maternal and child undernutrition in the state of Kerala, India.</p><p><strong>Methods: </strong>In-depth interviews were carried out among stakeholders in six selected local governments using a semi-structured questionnaire. Transcribed interviews were coded and thematically analysed.</p><p><strong>Results: </strong>PRIs facilitated nutrition interventions through additional resource mobilisation, nutrition monitoring and surveillance, acting as a more approachable point of governance, utilising general acceptance to mobilise volunteers to tackle local challenges, enabling formal and informal platforms for community participation and spaces of co-creation. Changes in the attitude of different stakeholders, timely policy backing and support, and interconnections at the local level aided the process. Gaps exist in awareness creation, dietary diversification, feeding behaviours, maternal mental health, infrastructure development, monitoring of anthropometric indicators and planning for nutrition interventions during emergencies.</p><p><strong>Conclusion: </strong>Results illustrate complex linkages PRIs have within the health system and how these linkages help in the implementation of interventions. The study explored previously identified pathways from the literature and identified additional pathways through which local participatory governance contributes to the successful implementation of nutrition interventions.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 Suppl 1","pages":"26-31"},"PeriodicalIF":1.4,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9983806/pdf/i2220-8372-13-s1-26.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9219720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Decentralisation, health and Sustainable Development Goal 3. 权力下放、卫生和可持续发展目标3。
IF 1.4
Public Health Action Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0034
R Anju, R Sadanandan, K Vijayakumar, V Raman Kutty, B Soman, R M Ravindran, R P Varma
{"title":"Decentralisation, health and Sustainable Development Goal 3.","authors":"R Anju,&nbsp;R Sadanandan,&nbsp;K Vijayakumar,&nbsp;V Raman Kutty,&nbsp;B Soman,&nbsp;R M Ravindran,&nbsp;R P Varma","doi":"10.5588/pha.22.0034","DOIUrl":"https://doi.org/10.5588/pha.22.0034","url":null,"abstract":"<p><strong>Setting: </strong>Kerala State, India, implemented decentralising reforms of healthcare institutions 25 years ago through transfer of administrative control and a sizeable share of the financial allocation.</p><p><strong>Objective: </strong>To describe the main impacts of decentralisation in Kerala on local policy formulation, programme implementation and service delivery for sustainable health systems.</p><p><strong>Design: </strong>This was part of a broader qualitative study on decentralisation and health in Kerala. We conducted 25 in-depth interviews and reviewed 31 government orders or policy documents, five related transcripts and five thematic reports from the main study.</p><p><strong>Results: </strong>Liaising between health system and local governments has improved over time. A shift from welfare-centric projects to infrastructure, human resources and services was evident. Considerable heterogeneity existed due to varying degrees of involvement, capacity, resources and needs of the community. State-level discourse and recent augmentation efforts for moving towards the UN Sustainable Development Goals (SDGs) strongly uphold the role of local governments in planning, financing and implementation.</p><p><strong>Conclusion: </strong>The 25-year history of decentralised healthcare administration in Kerala indicates both successes and failures. Central support without disempowering the local governments can be a viable option to allow flexible decision-making consistent with broader system goals.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 Suppl 1","pages":"51-56"},"PeriodicalIF":1.4,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9983807/pdf/i2220-8372-13-s1-51.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9787426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Evaluating TB diagnosis and care in the Union of the Comoros. 评估科摩罗联盟的结核病诊断和治疗。
IF 1.4
Public Health Action Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0057
J Noeske, A Mzembaba, Y Assoumani, S Maoulida, A Makpenon
{"title":"Evaluating TB diagnosis and care in the Union of the Comoros.","authors":"J Noeske,&nbsp;A Mzembaba,&nbsp;Y Assoumani,&nbsp;S Maoulida,&nbsp;A Makpenon","doi":"10.5588/pha.22.0057","DOIUrl":"https://doi.org/10.5588/pha.22.0057","url":null,"abstract":"<p><strong>Setting: </strong>The Union of the Comoros has experienced a persistent notification gap in TB cases despite several strategic changes, including molecular diagnosis and contact investigation. We therefore performed a TB patient pathway analysis (PPA) under the National Tuberculosis Programme (NTP).</p><p><strong>Objective: </strong>To assess the alignment of healthcare-seeking behaviour and TB service availability to clarify the reasons for these missing cases.</p><p><strong>Design: </strong>Three primary data sources, including a national list of health facilities, TB surveillance data and care-seeking behaviour data, were analysed at the national and regional levels to determine access to TB diagnosis and the initial point of care-seeking. Summary data were visualised using the standardised PPA Wizard programme, and the analysis was completed using demographic and socio-economic data.</p><p><strong>Results: </strong>At the initial point of care-seeking, 18% of patients had access to TB services, available only in nine centralised public health facilities. Furthermore, 30% of patients initially consulted in the informal sector and 45% in the formal public or private sector in health facilities, both of which lacked the capacity for TB diagnosis or first-line treatment.</p><p><strong>Conclusion: </strong>The concentration of and limited access to TB services at the intermediate and central levels of care indicate a need for decentralisation efforts.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 1","pages":"23-27"},"PeriodicalIF":1.4,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10162367/pdf/i2220-8372-13-1-23.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9485212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Role of decentralised governance in implementing the National AIDS Control Programme in Kerala. 权力下放管理在实施喀拉拉邦国家艾滋病控制计划中的作用。
IF 1.3
Public Health Action Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0029
R Kamala, R M Ravindran, R A Krishnan, S Nair, R P Varma, S Srilatha, T Iype, K Vidhukumar
{"title":"Role of decentralised governance in implementing the National AIDS Control Programme in Kerala.","authors":"R Kamala, R M Ravindran, R A Krishnan, S Nair, R P Varma, S Srilatha, T Iype, K Vidhukumar","doi":"10.5588/pha.22.0029","DOIUrl":"10.5588/pha.22.0029","url":null,"abstract":"<p><strong>Setting: </strong>In alignment with the UN Sustainable Development Goals (SDGs), Kerala State in India aims to end the HIV/AIDS epidemic, using its strong background in local governance to implement the National AIDS Control Programme (NACP).</p><p><strong>Objective: </strong>To examine the role of local governments in the implementation of NACP in tune with SDGs.</p><p><strong>Design: </strong>We conducted a state-wide exploratory study using document reviews, key informant and in-depth interviews, which were analysed thematically.</p><p><strong>Results: </strong>Four overarching themes that emerged were 1) preparation for programme implementation, 2) positive impact of local government involvement, 3) convergence with other organisations, and 4) barriers to implementation. Local government commitment to implementing the programme was evidenced by their adoption of the HIV/AIDS policy, facilitative interdepartmental coordination and local innovations. Interventions focused on improving awareness about the disease and treatment, and social, financial and rehabilitative support, which were extended even during the COVID-19 pandemic. Fund shortages and poor visibility of the beneficiaries due to preference for anonymity were challenges to achieving the expected outcomes.</p><p><strong>Conclusion: </strong>The NACP is ably supported by local governments in its designated domains of interventions, prevention, treatment, and care and support. The programme can achieve its target to end the AIDS epidemic by overcoming the stigma factor, which still prevents potential beneficiaries from accessing care.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 Suppl 1","pages":"1-5"},"PeriodicalIF":1.3,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9983810/pdf/i2220-8372-13-s1-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9787427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Perspectives of TB survivors and policymakers on post-TB disability. 结核病幸存者和政策制定者对结核病后残疾的看法。
IF 1.4
Public Health Action Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0050
O Nkereuwem, E Nkereuwem, O Owolabi, P Johm, U Egere, K Mortimer, B Kampmann, T Togun
{"title":"Perspectives of TB survivors and policymakers on post-TB disability.","authors":"O Nkereuwem,&nbsp;E Nkereuwem,&nbsp;O Owolabi,&nbsp;P Johm,&nbsp;U Egere,&nbsp;K Mortimer,&nbsp;B Kampmann,&nbsp;T Togun","doi":"10.5588/pha.22.0050","DOIUrl":"https://doi.org/10.5588/pha.22.0050","url":null,"abstract":"<p><strong>Background: </strong>An international multistakeholder participatory workshop was hosted in the Gambia, West Africa, in November 2021.</p><p><strong>Objectives: </strong>To explore the experiences, challenges and recommendations of workshop participants on health and wellbeing after TB treatment.</p><p><strong>Methods: </strong>An exploratory, descriptive, qualitative approach was used for data collection through facilitator-guided group discussions. Workshop participants included adolescent and adult TB survivors, and representatives of TB advocacy groups and the policy sector. Discussions were audio-recorded and transcribed verbatim, and the data were analysed using a deductive thematic approach.</p><p><strong>Results: </strong>Overall, 38 participants (22 women) from six West African countries participated in the workshop, comprising 33 TB survivors and advocacy group representatives and 5 participants from the policy sector. Although some TB survivors noted improved ability to carry out physical activities, others continued to experience detrimental effects on their family life, social interactions, physical health and ongoing stigma. Policymakers emphasised the lack of data and clear guidelines on post-TB disability.</p><p><strong>Conclusions: </strong>Some TB survivors continue to suffer detrimental effects of the illness even after treatment completion. However, available data on post-TB disability is inadequate to support policy adoption. Therefore, there is an urgent need for increased advocacy, awareness and research to bridge knowledge gaps.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 1","pages":"17-22"},"PeriodicalIF":1.4,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10162366/pdf/i2220-8372-13-1-17.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9432024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Breakthrough TB among people living with HIV on TB preventive therapy. 艾滋病毒感染者结核病预防治疗取得突破性进展。
IF 1.4
Public Health Action Pub Date : 2022-12-21 DOI: 10.5588/pha.22.0016
S Nyangu, M Kagujje, I Mwaba, D Luhanga, R Hambwalula, S Maliko, T Mushili, E Mwamba, Mukaba Mulai, Monde Muyoyeta
{"title":"Breakthrough TB among people living with HIV on TB preventive therapy.","authors":"S Nyangu,&nbsp;M Kagujje,&nbsp;I Mwaba,&nbsp;D Luhanga,&nbsp;R Hambwalula,&nbsp;S Maliko,&nbsp;T Mushili,&nbsp;E Mwamba,&nbsp;Mukaba Mulai,&nbsp;Monde Muyoyeta","doi":"10.5588/pha.22.0016","DOIUrl":"https://doi.org/10.5588/pha.22.0016","url":null,"abstract":"<p><strong>Background: </strong>Zambia has an estimated TB incidence of 319/100,000 population and a HIV prevalence of 11.1%. In 2020, only 49% of new people living with HIV (PLHIV) received TB preventive therapy (TPT) in Zambia. Misconceptions about the reliability of symptom screening and drug resistance among people who develop TB while on TPT are barriers to TPT scale-up. We determined the incidence and predictors of breakthrough TB during TPT among PLHIV in Zambia.</p><p><strong>Method: </strong>This was a retrospective analysis of routine TPT programme data among PLHIV collected between October 2016 and October 2019 from select primary health facilities in Zambia.</p><p><strong>Results: </strong>Of 48,581 PLHIV enrolled on TPT, 130 (0.3%) developed breakthrough TB during TPT. Of the 130, 90 client records were accessed. The median age of the breakthrough TB cases was 35 years; 68% were males. Overall, 96% of the breakthrough TB cases had been on antiretroviral therapy (ART) for ⩽3 months; 24% were symptomatic at the beginning of TPT, 22% were asymptomatic and others had missing data. Of the 130 breakthrough TB cases, 79% developed TB in the first month after TPT initiation. The median time to TB diagnosis was 10 days (IQR 4-16).</p><p><strong>Conclusion: </strong>Breakthrough TB during TPT is rare among PHLIV on ART, and very rare after the first month of TPT initiation. It should therefore not be a barrier to TPT scale-up.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"12 4","pages":"153-158"},"PeriodicalIF":1.4,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716823/pdf/i2220-8372-12-4-153.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10414614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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