SummaryWe implemented community-based direct observation of treatment, short course (DOTS), including a randomized controlled trial of direct observation either by community health workers (CHWs) or family members, under operational conditions in a region of Swaziland. There was a high death rate of 15%, due to the high HIV rates in the region. There was no significant difference in the cure and completion rate between direct observation of treatment by CHWs and family members [2% difference (95% CI )3% to 7%), exact P ¼ 0.52]. A before-and-after comparison of outcomes demonstrated that the cure and treatment completion rate improved from a baseline of 27-67% following implementation of community-based DOTS. We conclude that community-based tuberculosis DOTS can improve successful outcomes of treatment. However, direct observation can be undertaken effectively using either daily family or CHW supervision. The choice of treatment supporter should be based on access, patient preference and availability of CHW resource.

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BackgroundAntiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. We evaluate the effectiveness of nurse led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting.MethodsWe undertook a prospective, controlled evaluation of planned service change in Lubombo, Swaziland. Clinically stable adults with a CD4 count > 100 and on antiretroviral treatment for at least four weeks at the district hospital were assigned to either nurse led primary care based antiretroviral treatment care or usual hospital care. Assignment depended on the location of the nearest primary care clinic. The main outcome measures were clinic attendance and patient experience.ResultsThose receiving primary care based treatment were less likely to miss an appointment compared with those continuing to receive hospital care (RR 0·37, p < 0·0001). Average travel cost was half that of those receiving hospital care (p = 0·001). Those receiving primary care based, nurse led care were more likely to be satisfied in the ability of staff to manage their condition (RR 1·23, p = 0·003). There was no significant difference in loss to follow-up or other health related outcomes in modified intention to treat analysis. Multilevel, multivariable regression identified little inter-cluster variation.ConclusionsClinic attendance and patient experience are better with nurse led primary care based antiretroviral treatment care than with hospital care; health related outcomes appear equally good. This evidence supports efforts of the WHO to scale-up universal access to antiretroviral treatment in sub Saharan Africa.

Global inequalities are increasing rapidly and international partnership has an important role in tackling this threat. Partnerships should be based on sustainable, long-term links with a strong foundation of trust and mutual support. Effective leadership, good communication, clinical engagement and interagency collaboration are pre-requisites for the successful implementation of success.

In this work, we introduce the multipartite intrinsic non-locality as a resource quantifier for the multipartite scenario of device-independent (DI) conference key agreement. We prove that this quantity is additive, convex, and monotone under a class of free operations called local operations and common randomness. As one of our technical contributions, we establish a chain rule for multipartite mutual information, which we then use to prove that the multipartite intrinsic non-locality is additive. This chain rule may be of independent interest in other contexts. All of these properties of multipartite intrinsic non-locality are helpful in establishing the main result of our paper: multipartite intrinsic non-locality is an upper bound on secret key rate in the general multipartite scenario of DI conference key agreement. We discuss various examples of DI conference key protocols and compare our upper bounds for these protocols with known lower bounds. Finally, we calculate upper bounds on recent experimental realizations of DI quantum key distribution.