Public Health Action最新文献

{"title":"Appraising perception, accessibility and uptake of DAT among patients with TB.","authors":"C Ogbudebe, B Odume, I Gordon, O Chukwuogo, N Nwokoye, S Useni, E Efo, M Gidado, E Aniwada, A Ihesie, D Nongo, R Eneogu, O Chijioke-Akaniro, C Anyaike","doi":"10.5588/pha.24.0009","DOIUrl":"10.5588/pha.24.0009","url":null,"abstract":"<p><strong>Introduction: </strong>Poor adherence to TB treatment poses a significant public health threat to TB control programmes. The sustainability of directly observed treatment has been questioned because of its non-patient-centred approach and resource-intensive nature, and Digital Adherence Technologies (DATs) provide a suitable alternative. This study assessed the feasibility and acceptability of DATs among patients with TB.</p><p><strong>Methods: </strong>This descriptive study was conducted in eight states in Nigeria among all patients with drug-susceptible TB.</p><p><strong>Result: </strong>A total of 230 patients (89.1%) own a phone that no one else uses, and 18 (7.0%) use a family phone. A higher proportion of 189 (73.3%) have airtime credit and 119 (46.1%) have internet credit on their phone. In addition, 216 (83.7%) stated that the reminders they received on their phone helped them remember to take their medicine. Only 11 (4.3%) patients missed a dose of the TB medicine. Equally, 11 (4.3%) patients had taken their TB medicine without using DAT. Of these, 7 (63.3%) did not use DATs because they forgot to text medication labels, and 3 (27.6%) did so because of poor network. Only four (1.6%) purchased additional items to support the use of DATs.</p><p><strong>Conclusion: </strong>DATs are acceptable in a wide variety of settings, even with reported challenges. Implementation efforts should ensure access, address technical challenges, and minimise additional cost to patients.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"14 2","pages":"66-70"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493920","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}

{"title":"Depression: an individual-level early warning indicator of virologic failure in HIV patients in South Africa.","authors":"J A Edwards, J Brijkumar, M Dudgeon, C Robichaux, B Johnson, L Rautman, R A Powers, Y V Sun, S Pillay, C Ordonez, J Castillo-Mancilla, F C Tanser, Z Asghar, P Mee, P Moodley, H Sunpath, D R Kuritzkes, V C Marconi, M-Y S Moosa","doi":"10.5588/pha.24.0017","DOIUrl":"10.5588/pha.24.0017","url":null,"abstract":"<p><strong>Objective: </strong>To identify individual-level early warning indicators of virologic failure in HIV patients receiving antiretroviral therapy (ART) in South Africa.</p><p><strong>Design: </strong>A matched case-control study of individuals with and without virologic failure (VF) (>5 months on ART and HIV-1 plasma viral load >1,000 copies/mL) was conducted between June 2014 and June 2018. Of the 1,000 participants enrolled in the parent cohort, 96 experienced VF, and 199 additional controls were identified from the parent cohort and matched 1:2 (some matched 1:3) for sex, age, ART duration, and site. Participants were interviewed while clinical, pharmacy refill, laboratory, and objective pharmacological data were obtained. Multivariate conditional logistic regression models were constructed using model selection to identify factors associated with VF. Significant determinants of VF were identified using an alpha level of 0.05.</p><p><strong>Results: </strong>In a full conditional model, higher cumulative ART adherence, quantified using tenofovir-diphosphate concentrations in dried blood spots (OR 0.26) and medication possession ratio (OR 0.98) were protective against VF, whereas an increase in total depression score (OR 1.20) was predictive of VF.</p><p><strong>Conclusion: </strong>This analysis demonstrates the importance of depression as a key individual-level early warning indicator of VF. Efforts to address mental health concerns among patients with people living with HIV could improve virologic suppression.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"14 2","pages":"76-81"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493921","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}

{"title":"<i>Mirage de tuberculose</i> in the 21^st century.","authors":"M B Kaelin, S Wieser, B Preiswerk, P W Schreiber, D Russenberger, P Kaiser, B Schulthess, J Nemeth","doi":"10.5588/pha.24.0056","DOIUrl":"10.5588/pha.24.0056","url":null,"abstract":"<p><p>The occurrence of transient culture positivity for <i>Mycobacterium tuberculosis</i> (MTB), known as <i>mirage de tuberculose</i>, poses significant challenges in understanding its spectrum and implications. Here, we report a case of transient culture positivity, oscillating between detectable and non-detectable MTB cultures with minimal radiological features and review the literature on this phenomenon. The scarcity of scientific literature on this subject stems from the inherent impossibility of systematically studying mirage de tuberculose. Ethical and public health concerns prevent withholding treatment to monitor spontaneous reversion to negative cultures. Based on the literature, we estimate that mirage de tuberculose occurs in approximately one-third of individuals infected with MTB who exhibit no symptoms. Despite the inherently limited nature of these findings, they suggest that the significance of mirage de tuberculose may be greater than currently perceived. Managing cases of mirage de tuberculose presents formidable challenges from a public health perspective. Striking a balance between prompt treatment initiation to prevent transmission and the risk of unnecessary treatment requires careful consideration. In conclusion, mirage de tuberculose remains a poorly understood clinical entity with very limited literature available. Advancing research and interdisciplinary collaborations are essential to unravel the intricacies of this phenomenon and develop effective strategies to address its public health challenges.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"14 2","pages":"51-55"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493919","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}

{"title":"Multisectoral action and community involvement are required for long-term improvements in public health.","authors":"G N Kazi, H D Blackbourn","doi":"10.5588/pha.24.0022","DOIUrl":"10.5588/pha.24.0022","url":null,"abstract":"","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"14 2","pages":"43-44"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493923","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}

{"title":"TB-related catastrophic costs in Ethiopia.","authors":"A A Deribew, Z G Dememew, K M Alemu, G Tefera, S G Negash, Y A Molla, A G Woldegiorgis, D G Datiko, P G Suarez","doi":"10.5588/pha.24.0006","DOIUrl":"10.5588/pha.24.0006","url":null,"abstract":"<p><strong>Objectives: </strong>To measure the progress towards reducing TB-related catastrophic costs in 19 zones of Amhara, Oromia, SNNP (Southern Nations and Nationalities, and Peoples) and Sidama Regions of Ethiopia.</p><p><strong>Methods: </strong>A baseline survey was conducted in randomly selected health facilities from all districts within the 19 zones from November 2020 to February 2021. Interventions targeting the major drivers of catastrophic costs identified in the baseline survey, such as installation of 126 GeneXpert and 13 Truenat machines, securing connectivity of 372 GeneXpert, establishing alternative specimen referral systems, and capacity-building of health workers, were implemented. A follow-up survey was conducted from October to December 2022. The WHO generic tool was used to collect data based on probability proportional to size. Data were entered into STATA software, and the proportion of catastrophic costs was calculated and compared between the two surveys.</p><p><strong>Results: </strong>A total of 433 and 397 patients participated in the baseline and follow-up surveys, respectively. The proportion of catastrophic costs reduced from 64.7% to 43.8% (<i>P</i> < 0.0001). The share of direct non-medical costs decreased from 76.2% to 19.2%, while medical and indirect costs increased from 11.6% and 12.3% to 30.4% and 52.4 %.</p><p><strong>Conclusion: </strong>The proportion of households facing TB-related catastrophic costs has significantly reduced over the 2-year period. However, it remains unacceptably high and varies among regions. Further reducing the catastrophic costs requires multisectoral response, reviewing the TB service exemption policy, further decentralisation and improving the quality of TB services.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"14 2","pages":"71-75"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493925","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}

{"title":"Perception, acceptability and challenges of digital adherence technology among TB healthcare workers.","authors":"I Gordon, B Odume, C Ogbudebe, O Chukwuogo, N Nwokoye, S Useni, E Efo, M Gidado, E Aniwada, A Ihesie, D Nongo, R Eneogu, O Chijioke-Akaniro, C Anyaike","doi":"10.5588/pha.24.0008","DOIUrl":"10.5588/pha.24.0008","url":null,"abstract":"<p><strong>Introduction: </strong>Successful treatment of TB requires high levels of adherence to treatment. This has been found to be below optimal with directly observed therapy (DOT), and digital adherence technologies (DATs) offer a promising approach to non-adherence to medication and improving treatment outcomes. This study explores the perception, acceptability, and challenges of DATs among healthcare workers (HCWs).</p><p><strong>Methods: </strong>The study was conducted in eight states in Nigeria among Health Care workers involved in treating patients with TB. This was a descriptive cross-sectional study using an open questionnaire and analysed using IBM SPSS v25.</p><p><strong>Results: </strong>Twenty-three HCWs (95.8%) agreed that DATs helped them provide better support and counselling to their patients. All of them would recommend DATs to their patients and found it easy to explain them. Eleven (45.8%) of them were not able to use DATs on a few occasions; their reasons were poor network (<i>n</i> = 9, 37.5%) and (<i>n</i> = 1, 4.2%) power failure.</p><p><strong>Conclusion: </strong>DATs help HCWs provide better support and care regarding real-time tracking of their patients' adherence to treatment and possibly reduction of attrition. This implies that DATs are a suitable alternative to DOT to help HCWs provide the best care and support to their patients towards achieving the End TB targets.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"14 2","pages":"61-65"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493924","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}

{"title":"The effect of an intervention to promote isoniazid preventive therapy on leadership and management abilities.","authors":"C Christian, E Kakande, V Nahurira, L B Balzer, A Owaraganise, J R Nugent, W DiIeso, D Rast, J Kabami, J J Peretz, C S Camlin, S B Shade, M R Kamya, D V Havlir, G Chamie","doi":"10.5588/pha.24.0002","DOIUrl":"10.5588/pha.24.0002","url":null,"abstract":"<p><strong>Background: </strong>Across sub-Saharan Africa, mid-level healthcare managers oversee implementation of national guidelines. It remains unclear whether leadership and management training can improve population health outcomes.</p><p><strong>Methods: </strong>We sought to evaluate leadership/management skills among district-level health managers in Uganda participating in the SEARCH-IPT randomised trial to promote isoniazid preventive therapy (IPT) for persons with HIV (PWH). The intervention, which led to higher IPT rates, included annual leadership/management training of managers. We conducted a cross-sectional survey assessing leadership/management skills among managers at trial completion. The survey evaluated self-reported use of leadership/management tools and general leadership/management. We conducted a survey among a sample of providers to understand the intervention's impact. Targeted minimum loss-based estimation (TMLE) was used to compare responses between trial arms.</p><p><strong>Results: </strong>Of 163 managers participating in the SEARCH-IPT trial, 119 (73%) completed the survey. Intervention managers reported more frequent use of leadership/management tools taught in the intervention curriculum than control managers (+3.64, 95% CI 1.98-5.30, <i>P</i> < 0.001). There were no significant differences in self-reported leadership skills in the intervention as compared to the control group. Among providers, the average reported quality of guidance and supervision was significantly higher in intervention vs control districts (+1.08, 95% CI 0.63-1.53, <i>P</i> = 0.001).</p><p><strong>Conclusions: </strong>A leadership and management training intervention increased the use of leadership/management tools among mid-level managers and resulted in higher perceived quality of supervision among providers in intervention vs control districts in Uganda. These findings suggest improved leadership/management among managers contributed to increased IPT use among PWH in the intervention districts of the SEARCH-IPT trial.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"14 2","pages":"56-60"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493926","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}

{"title":"Care-seeking pathways and diagnostic delays in extrapulmonary TB patients","authors":"Ahmad Wali, N. Safdar, A. Ambreen, S. Tahseen, T. Mustafa","doi":"10.5588/pha.23.0037","DOIUrl":"https://doi.org/10.5588/pha.23.0037","url":null,"abstract":"SETTING: This study was conducted at a private tertiary hospital engaged with the TB control programme in the city of Lahore, Pakistan. OBJECTIVE: To assess the healthcare-seeking pathways, different delays and factors associated with delays among the patients who presented in the outpatient department with tuberculous lymphadenitis and pleuritis, the most common manifestations of extrapulmonary TB. DESIGN: This cross-sectional study was conducted prospectively from April 2016 to August 2017. RESULTS: The median age of the 339 patients analysed was 22 years (IQR 17–30); tuberculous lymphadenitis was predominant in females (63%), while pleuritis affected more males (64%). Overall, 62% reported seeking care from healthcare providers before diagnosis, of whom 62% sought care from private facilities, 32% visited facilities >2 times and 8% visited traditional healers. Diagnostic delay was associated with tuberculous lymphadenitis, age 15–44 years, poor socio-economic status and poor TB knowledge. CONCLUSION: There was considerable delay in the management of extrapulmonary TB patients, and the health-system delay was the major contributor, leading to increased patient suffering. Efforts towards minimising health-system delay need to be prioritised for patient screening and diagnosis, with a feasible algorithm that is workable in resource-limited settings.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":" 25","pages":"148 - 154"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138618327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Descriptors of multidrug-resistant TB deaths in Ethiopia","authors":"Usaid Emawayish Tesema, Z. Dememew, D. G. Datiko, A. Gebreyohannes, Y. Molla, A. Tefera, G. Gizatie, T. Bogale, M. Million, P. G. Suarez, M. M. Aseressa, D. Jerene, M. Biru","doi":"10.5588/pha.23.0030","DOIUrl":"https://doi.org/10.5588/pha.23.0030","url":null,"abstract":"Deaths related to multidrug-resistant TB among patients who had received a second-line anti-TB drugs in Ethiopia were analysed. Respectively 38/704 (5.4%) and 44/995 (4.4%) deaths were identified in two cohorts (2015 and 2022). In the 2015 cohort, severe malnutrition was less prevalent, previous treatment rates were three times higher, hypokalaemia was more frequent, and the use of the Xpert® MTB/RIF assay, respiratory failure and severe anaemia/pancytopenia were less common than in the 2022 cohort. We observed that there were variations in adverse events when different treatment regimens were used over different time periods. To ensure proper patient care, correct guidance must be consistently implemented.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":" 5","pages":"123 - 125"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138614244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The TB Surge intervention: an optimized approach to TB case-finding in Nigeria","authors":"O. Chukwuogo, C. Ogoamaka, O. Bethrand, U. Lotanna, O. Chidubem, U. Sani, N. Nkiru, B. Mamman, E. Daniel, O. Chijioke, N. Oloruntobi, I. Austin, N. Debby, E. Rupert, O. Omosalewa, U. Emperor, A. Chukwuma","doi":"10.5588/pha.23.0039","DOIUrl":"https://doi.org/10.5588/pha.23.0039","url":null,"abstract":"INTRODUCTION: TB remains one of the leading causes of death in Nigeria, and despite progress in treatment coverage, a 56% gap in national case notifications remains. This gap is attributable in part to underdiagnosis due to missed cases in health facilities. The TB Surge intervention presented an opportunity to address barriers to optimal case detection in public health facilities. METHODS: KNCV Nigeria implemented the TB Surge intervention under the USAID-funded TB-LON Project in 1,041 public facilities from June 2020 to September 2022. Trained ad-hoc staff screened hospital attendees, linked identified presumptive TB cases to diagnosis and confirmed TB cases to treatment. Data were reported using the Commcare application. Robust project monitoring was used to address gaps. RESULTS: Of a total of 12,195,874 hospital attendees screened for TB, 729,369 identified as presumptive TB were tested and 65,029 TB cases were diagnosed; 8% of the TB cases were children. Overall TB yield was 9%. Medical ward service delivery point had the highest TB yield of 21%. The number needed to test was 11 and the number needed to screen was 188. CONCLUSION: The TB Surge intervention was of strategic importance in addressing missed cases and barriers to prompt TB diagnosis in health facilities.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"84 s372","pages":"136 - 141"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138622084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}