BackgroundLarge numbers of tuberculosis (TB) patients seek care from private for-profit providers. This study aimed to assess and compare TB control activities in the private for-profit and public sectors in Kenya between 2013 and 2017.MethodsWe conducted a retrospective cross-sectional study using routinely collected data from the National Tuberculosis, Leprosy and Lung Disease Program.ResultsOf 421 409 patients registered and treated between 2013 and 2017, 86 894 (21%) were from the private sector. Data collection was less complete in the private sector for nutritional assessment and follow-up sputum smear examinations (p<0.001). The private sector notified less bacteriologically confirmed TB (43.1% vs 52.6%; p<0.001) and had less malnutrition (body mass index <18.5 kg/m2; 36.4% vs 43.3%; p<0.001) than the public sector. Rates of human immunodeficiency virus (HIV) testing and antiretroviral therapy initiation were >95% and >90%, respectively, in both sectors, but more patients were HIV positive in the private sector (39.6% vs 31.6%; p<0.001). For bacteriologically confirmed pulmonary TB, cure rates were lower in the private sector, especially for HIV-negative patients (p<0.001). The private sector had an overall treatment success of 86.3% as compared with the public sector at 85.7% (p<0.001).ConclusionsThe private sector is performing well in Kenya although there are programmatic challenges that need to be addressed.
Background Occult hepatitis B virus (HBV) infections remain a safety concern worldwide. The prevalence in Kenya ranges from 2.6% to 4.4% among secondary school-going voluntary blood donors. This study estimated the prevalence of occult HBV infections among school-going voluntary blood donors through donations made to Kwale Satellite Blood Transfusion Center (KSBTC). Methods This was a retrospective cross-sectional study on data collected by the KSBTC between January 2020 and June 2021 among secondary school-going voluntary blood donors. Data were collected in MS Excel 2013 and analyzed in Epi Info 7. Descriptive statistics were calculated and we compared donors with positive Hepatitis B surface antigen (HBsAg) to those with negative HBsAg. Crude Prevalence Odds Ratios (cPOR) at 95% confidence intervals (CI) were calculated to identify factors associated with positive HBsAg. Results A total of 613 records were analyzed. The mean age of the donors was 19.1 years (± 1.8 years), there were 457 males (74.5%), 502 individuals were in the age group 18–25 years (82.3%), and the mean hemoglobin level was 14.1 g/dl (±1.6 g/dl). First-time blood donors made up 84.8% of all donors (513/605) and the mean inter-donation period was 20 months (±5.8 months) for repeat donors. The sero-positivity for HBsAg was 8.8% (54/613). Age category 16–17 years with positive HBsAg were 10.2% (11/108), femaleswere10.9% (17/156), and first-time donors were 9.4% (48/513). On bivariate analyses, first-time blood donors were 1.5 times more likely to test positive for HBsAg compared to repeat donors (cPOR = 1.5, 95% CI 0.61–3.57). Females were 1.4 times more likely to test positive for HBsAg compared to male donors (cPOR = 1.4, 95% CI 0.76–2.54). Conclusions The majority of the voluntary blood donors were males and the majority of occult HBV infections came in the first-time blood donor group. We recommend increasing targeted recruitment of repeat donors by encouraging healthy first-timer donors to be regular donors, and suggest this population should be vaccinated against HBV infections.
15Introduction: Isoniazid preventive therapy (IPT) taken by People Living with HIV (PLHIV) protects 16 against tuberculosis (TB). Despite its recommendation, there is scarcity of data on the uptake of 17 IPT among PLHIV and factors associated with treatment outcomes. We aimed to determine the 18 proportion of PLHIV initiated on IPT, IPT treatment outcomes and screening for TB during and 19 after IPT. 20Methods: A retrospective cohort study of a representative sample of PLHIV initiated on IPT 21 between July 2015 and June 2018 in Kenya. We abstracted information on socio-demographic, 22TB screening practices, IPT initiation, follow up, and outcomes from health facilities' patient 23 record cards, IPT cards and IPT registers. Further, we assessed baseline characteristics as 24 potential correlates of developing TB during and after treatment and IPT completion using 25 multivariable logistic regression. 26 Results: We enrolled 138,442 PLHIV into ART during the study period and initiated 95,431 27 (68.9%) into IPT. Abstracted files for 4708 patients initiated on IPT, out of which 3891(82.6%) 28 had IPT treatment outcomes documented, 4356(92.5%) had ever been screened for TB at every 29 clinic visit and 4,243(90.1%) had documentation of TB screening on the IPT tool before IPT Page | ii 30 initiation. 3712(95.4%) of patients with documented IPT treatment outcomes completed their 31 treatment. 42(0.89%) of the abstracted patients developed active TB ,16(38.1%) during and 32 26(61.9%) after completing IPT. Follow up for TB at 6-month post-IPT completion was done for 33 2729(73.5%) of patients with IPT treatment outcomes. Sex, Viral load suppression and clinic 34 type were associated with TB development (p<0.05). Levels 4, 5, FBO, and private facilities 35and IPT prescription practices were associated with IPT completion (p<0.05). 36Conclusion: Two-thirds of PLHIV were initiated on IPT, with a high completion rate. TB screening 37 practices were better during IPT than after completion. Development of TB during and after IPT 38 emphasises need for keen follow up.
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