Background Tuberculosis (TB) disease is a common opportunistic infection among people living with HIV (PLHIV). WHO recommends at least 6 months of isoniazid Preventive Therapy (IPT) to reduce the risk of active TB. It is important to monitor the six-month IPT completion since a suboptimal dose may not protect PLHIV from TB infection. This study determined the six-month IPT completion and factors associated with six-month IPT completion among PLHIV aged 15 years or more in Dar es Salaam region, Tanzania. Methods Secondary analysis of routine data from PLHIV attending 58 care and treatment clinics in Dar es Salaam region was used. PLHIV, aged 15 years and above, who screened negative for TB symptoms and initiated IPT from January, 2013 to June, 2017 were recruited. Modified Poisson regression with robust standard errors was used to estimate prevalence ratios (PR) and 95% confidence interval (CI) for factors associated with IPT completion. Multilevel analysis was used to account for health facility random effects in order to estimate adjusted PR (APR) for factors associated with IPT six-month completion. Results A total of 29,382 PLHIV were initiated IPT, with 21,808 (74%) female. Overall 17,092 (58%) six-month IPT completion, increasing from 42% (773/1857) in year 2013 to 76% (2929/3856) in 2017. Multilevel multivariable model accounting for health facilities as clusters, showed PLHIV who were not on ART had 46% lower IPT completion compared to those were on ART (APR: 0.54: 95%CI: 0.45–0.64). There was 37% lower IPT completion among PLHIV who transferred from another clinic (APR: 0.63: 95% CI (0.54–0.74) compared to those who did not transfer. PLHIV aged 25–34 years had a 6% lower prevalence of IPT completion as compared to those aged 15 to 24 years (APR:0.94 95%CI:0.89–0.98). Conclusion The IPT completion rate in PLHIV increased over time, but there was lower IPT completion in PLHIV who transferred from other clinics, who were aged 25 to 34 years and those not on ART. Interventions to support IPT in these groups are urgently needed.
Background. Diabetic foot ulcers (DFU) is among major health problems which impact the socio economic burden globally. We aimed at assessing the susceptibility pattern of antimicrobials in DFU infections among patients admitted in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC). Methods. This descriptive cross-sectional study was conducted from September 2018 through March 2019. Pus swabs were collected on the first day of admission by deep wound swabbing after irrigation with normal saline solution. Kirby-Bauer method was done according to the Clinical and Laboratory Standard Institute (CLSI) guidelines. Results. Sixty diabetic ulcer patients had 62 bacterial isolates. Majority of the isolates were gram negative 49/62(79.03%). The most common isolate was Escherichia coli 15/62(24.19%) followed by Pseudomonas aeruginosa 14/62(22.58%), Proteus mirabilis 8/62(12.9%) and Staphylococcus aureus 5/62(8.06%). Klebsiella pneumoniae, Coagulase Negative Staphylococcus, Proteus Vulgaris, and Streptococcus pyogenes each contributed 4/62(6.25%) isolates. Of the 49/62(79.3%) gram negative isolates, 8/49(16.33%) were mono resistant, 30/49(61.22%) were multiresistant, and 11/49(22.45%) were susceptible. Of the multi-resistant isolates, E. coli 12/15(80.00%), and P.aeruginosa 7/14(50.00%) were predominant. A total of 39/62(62.90%) isolates in patients contributed to poorer outcomes including loss of body part. Patients with ulcers infected by P. aeruginosa 11/39 (28.21%) had the highest number of surgical removal of body parts followed by E. coli 8/39(20.51%). Gram negative bacteria were highly susceptible to amikacin 91.18%, meropenem 93.33% and imipenem 95.24%. Isolates susceptibility to ceftriaxone was 32%. Conclusions. Amikacin, meropenem and imipenem can be safely used as broad-spectrum antimicrobials in DFU. The Standard of care remains culture and sensitivity of isolated microorganisms in combating diabetic foot ulcers infections.
Background: Tuberculosis (TB) disease is a common opportunistic infection among people living with HIV (PLHIV). WHO recommends at least six months of isoniazid Preventive Therapy (IPT) to reduce the risk of active TB. It is important to monitor completion of IPT, as a suboptimal dose may not protect PLHIV from TB infection. This study determined IPT completion and its determinants among PLHIV aged 15 years or more in Dar es Salaam region, Tanzania. Methods: A Cross-sectional analytical study was conducted using secondary analysis of routine data from 58 care and treatment clinics in Dar es Salaam region. The study recruited clients who screened negative for TB symptoms and initiated IPT between January 2013 and June 2017. Modified Poisson regression model with robust standard errors were used to estimate prevalence ratios (PR) and 95% confidence interval (CI) for factors associated with IPT completion. Multilevel analysis was used to account the health facility random effects in order to estimate independent factors associated with IPT completion. Results : A total of 29,382 clients were initiated on IPT, with 21,808 (74%) female. Overall 17,092 (58%) completed IPT, increasing from 42% (773/1,857) in year 2013 to 76% (2,929/3,856) in 2017. Multilevel multivariable model accounting for health facility as clusters, found that clients with CD4 counts between 100 to 349 cells/ had 3% lower prevalence of IPT completion as compared to those with 100 cells/ (PR:0.97: 95%CI:0.94-1.01). Patients who were not on ART had 46% lower IPT completion compared to those were on ART (PR: 0.54: 95%CI: 0.45-0.64). There was lower IPT completion among clients who transferred to another clinic compared to those attended the same clinic where they were initiated IPT (PR: 0.63: 95% CI (0.54-0.74). Conclusion: IPT completion is low at care and treatment clinics although it increased over time. Lower IPT completion was seen in PLHIV with CD4 counts between 100 to 349 cells/ , those who transferred to other clinics and those not on ART. Thus it indicates the need for better IPT interventions with greater support PLHIV in those groups.
Background: Tuberculosis (TB) disease is a common opportunistic infection among people living with HIV (PLHIV). WHO recommends at least six months of isoniazid Preventive Therapy (IPT) to reduce the risk of active TB. It is important to monitor completion of IPT, as a suboptimal dose may not protect PLHIV from TB infection. This study determined IPT completion and its determinants among PLHIV aged 15 years or more in Dar es Salaam region, Tanzania. Methods: A Cross-sectional analytical study was conducted using secondary analysis of routine data from 58 care and treatment clinics in Dar es Salaam region. The study recruited clients who screened negative for TB symptoms and initiated IPT between January 2013 and June 2017. Modified Poisson regression model with robust standard errors were used to estimate prevalence ratios (PR) and 95% confidence interval (CI) for factors associated with IPT completion. Multilevel analysis was used to account the health facility random effects in order to estimate independent factors associated with IPT completion. Results : A total of 29,382 clients were initiated on IPT, with 21,808 (74%) female. Overall 17,092 (58%) completed IPT, increasing from 42% (773/1,857) in year 2013 to 76% (2,929/3,856) in 2017. Multilevel multivariable model accounting for health facility as clusters, found that clients with CD4 counts between 100 to 349 cells/ had 3% lower prevalence of IPT completion as compared to those with 100 cells/ (PR:0.97: 95%CI:0.94-1.01). Patients who were not on ART had 46% lower IPT completion compared to those were on ART (PR: 0.54: 95%CI: 0.45-0.64). There was lower IPT completion among clients who transferred to another clinic compared to those attended the same clinic where they were initiated IPT (PR: 0.63: 95% CI (0.54-0.74). Conclusion: IPT completion is low at care and treatment clinics although it increased over time. Lower IPT completion was seen in PLHIV with CD4 counts between 100 to 349 cells/ , those who transferred to other clinics and those not on ART. Thus it indicates the need for better IPT interventions with greater support PLHIV in those groups.
Background: Tuberculosis (TB) disease is a common opportunistic infection among people living with HIV (PLHIV). WHO recommends at least six months of isoniazid Preventive Therapy (IPT) to reduce the risk of active TB. It is important to monitor completion of IPT, as a suboptimal dose may not protect PLHIV from TB infection. This study determined IPT completion and its determinants among PLHIV aged 15 years or more in Dar es Salaam region, Tanzania. Methods: A Cross-sectional analytical study was conducted using secondary analysis of routine data from 58 care and treatment clinics in Dar es Salaam region. The study recruited clients who screened negative for TB symptoms and initiated IPT between January 2013 and June 2017. Modified Poisson regression model with robust standard errors were used to estimate prevalence ratios (PR) and 95% confidence interval (CI) for factors associated with IPT completion. Multilevel analysis was used to account the health facility random effects in order to estimate independent factors associated with IPT completion. Results : A total of 29,382 clients were initiated on IPT, with 21,808 (74%) female. Overall 17,092 (58%) completed IPT, increasing from 42% (773/1,857) in year 2013 to 76% (2,929/3,856) in 2017. Multilevel multivariable model accounting for health facility as clusters, found that clients with CD4 counts between 100 to 349 cells/ had 3% lower prevalence of IPT completion as compared to those with 100 cells/ (PR:0.97: 95%CI:0.94-1.01). Patients who were not on ART had 46% lower IPT completion compared to those were on ART (PR: 0.54: 95%CI: 0.45-0.64). There was lower IPT completion among clients who transferred to another clinic compared to those attended the same clinic where they were initiated IPT (PR: 0.63: 95% CI (0.54-0.74). Conclusion: IPT completion is low at care and treatment clinics although it increased over time. Lower IPT completion was seen in PLHIV with CD4 counts between 100 to 349 cells/ , those who transferred to other clinics and those not on ART. Thus it indicates the need for better IPT interventions with greater support PLHIV in those groups.
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