Scale‐up of TB and HIV programme collaborative activities in Zambia – a 10‐year review

Kapata, Nathan; Chanda‐Kapata, Pascalina; Grobusch, M. P.; O’Grady, Justin; Schwank, Samana; Bates, Matthew; Jansenn, S; Mwinga, Alwyn; Cobelens, Frank; Mwaba, Peter; Zumla, Alimuddin

doi:10.1111/j.1365-3156.2012.02981.x

Cited by 34 publications

(37 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This was higher than CPT uptake reported in another study carried out in Addis Ababa which reported that only 43.6% patients benefited from CPT (Denegetu and Dolamo, 2014) while in a referral hospital in North-West Ethiopia, 45.9% of patients eligible for CPT actually received treatment (Alemayehu (Kapata et al, 2012). The possible reasons for a relatively higher CPT uptake in the present study might be attributed to trainings provided to health workers on importance of initiation of CPT.…”

Section: Discussioncontrasting

confidence: 55%

Time for initiation of antiretroviral therapy in HIV co-infected tuberculosis patients in Addis Ababa, Ethiopia

Haile¹,

Zewdu²,

Klinkenberg³

et al. 2018

J. AIDS HIV Res.

View full text Add to dashboard Cite

Provision of integrated care for human immunodeficiency virus (HIV) co-infected tuberculosis (TB) patients is challenging. Many persons with TB and HIV co-infectionare not yet receiving anti-retroviral therapy (ART) and initiation of ART is not always timely. This study investigated ART uptake among HIV co-infected TB patients and its time of initiation in an urban primary health care facility in Ethiopia. A retrospective cohort study was conducted using routine program data. All adult HIV co-infected TB patients registered in a large TB-HIV clinic in Addis Ababa from September, 2008 to August, 2014 were included. Both descriptive and inferential statistics were used to summarize and analyse findings. A total of 993 TB patients were registered in the study period and included. HIV counselling and testing was offered to 738 (74.5%) and HIV testing was performed for 678 (68.3%) patients. Of those tested, 226 (33.3%) were HIV co-infected of whom 125 (57.6%) were started on ART. The median period from commencement of TB treatment to starting of ART was 41 days. ART initiation was delayed beyond the period advised in the National TB-HIV Guideline for 31 (27%) of HIV co-infected TB patients. For 109 (48.2%) of co-infected TB patients the ART status evaluation could not be done due to missing data. A considerable proportion of HIV co-infected TB patients did either not receive ART or started it later than recommended by national guidelines. For better outcomes to HIV co-infected TB patients, the actual implementation of national recommendations on when to start ART needs to be monitored closely.

show abstract

Section: Discussioncontrasting

confidence: 55%

Time for initiation of antiretroviral therapy in HIV co-infected tuberculosis patients in Addis Ababa, Ethiopia

Haile¹,

Zewdu²,

Klinkenberg³

et al. 2018

J. AIDS HIV Res.

View full text Add to dashboard Cite

show abstract

“…The prevalence of HIV among the TB cases tested in the survey was up to five times lower than routinely reported among clinical cases at facility level in the programmatic setting, where co-infection rates of 60–62% are reported [9, 15]. This implies that facility based data on co-infection rates alone may not reflect the true epidemiological picture of the general population.…”

Section: Discussionmentioning

confidence: 80%

“…The difference is likely explained by two processes. On the one hand, TB-HIV co-infected patients are known to have poorer treatment outcomes [9] and therefore TB/HIV co-infected patients who do not seek care or cannot access care are likely to die early and do not remain as prevalent cases in the community. Furthermore, it is possible that TB/HIV co-infected individuals who fall sick are more likely to go to the health facility earlier because of the severity of symptoms and are thus potentially diagnosed earlier.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The prevalence of HIV among adults with pulmonary TB at a population level in Zambia

et al. 2017

View full text Add to dashboard Cite

BackgroundTuberculosis and HIV co-infection is one of the main drivers of poor outcome for both diseases in Zambia. HIV infection has been found to predict TB infection/disease and TB has been reported as a major cause of death among individuals with HIV. Improving case detection of TB/HIV co-infection has the potential to lead to early treatment of both conditions and can impact positively on treatment outcomes. This study was conducted in order to determine the HIV prevalence among adults with tuberculosis in a national prevalence survey setting in Zambia, 2013–2014.MethodsA countrywide cross sectional survey was conducted in 2013/2014 using stratified cluster sampling, proportional to population size for rural and urban populations. Each of the 66 countrywide clusters represented one census supervisory area with cluster size averaging 825 individuals. Socio-demographic characteristics were collected during a household visit by trained survey staff. A standard symptom-screening questionnaire was administered to 46,099 eligible individuals across all clusters, followed by chest x-ray reading for all eligible. Those symptomatic or with x-ray abnormalities were confirmed or ruled out as TB case by either liquid culture or Xpert MTBRif performed at the three central reference laboratories. HIV testing was offered to all participants at the survey site following the national testing algorithm with rapid tests. The prevalence was expressed as the proportion of HIV among TB cases with 95% confidence limits.ResultsA total of 265/6123 (4.3%) participants were confirmed of having tuberculosis. Thirty-six of 151 TB survey cases who accepted HIV testing were HIV-seropositive (23.8%; 95% CI 17.2–31.4). The mean age of the TB/HIV cases was 37.6 years (range 24–70). The majority of the TB/HIV cases had some chest x-ray abnormality (88.9%); were smear positive (50.0%), and/or had a positive culture result (94.4%). None of the 36 detected TB/HIV cases were already on TB treatment, and 5/36 (13.9%) had a previous history of TB treatment. The proportion of TB/HIV was higher in urban than in the rural clusters. The HIV status was unknown for 114/265 (43.0%) of the TB cases.ConclusionsThe TB/HIV prevalence in the general population was found to be lower than what is routinely reported as incident TB/HIV cases at facility level. However; the TB/HIV co-infection was higher in areas with higher TB prevalence. Innovative and effective strategies for ensuring TB/HIV co-infected individuals are detected and treated early are required.

show abstract

“…The worrisome situation in Zambia has triggered the development of various TB strategies and public health efforts [15, 16]. Despite a longstanding DOT and sensitisation programmes, Zambia still struggles with optimizing its NTP to avoid pre-hospital delay and treatment non-compliance of TB patients.…”

Section: Introductionmentioning

confidence: 99%

Tuberculosis patients’ pre-hospital delay and non-compliance with a longstanding DOT programme: a mixed methods study in urban Zambia

et al. 2016

View full text Add to dashboard Cite

BackgroundTuberculosis (TB) remains a major health problem in Zambia, despite considerable efforts to control and prevent it. With this study, we aim to understand how perceptions and cultural, social, economic, and organisational factors influence TB patients’ pre-hospital delay and non-compliance with care provided by the National Tuberculosis Programme (NTP).MethodsA mixed methods study was conducted with 300 TB patients recruited at Kanyama clinic for structured interviews. Thirty were followed-up for multiple in-depth interviews. Six focus group discussions were organised and participant observation was conducted. Ten biomedical care providers, 10 traditional healers, and 10 faith healers were interviewed. Factors associated with non-compliance (disruption of treatment > one week) were assessed by applying logistic regression analyses; qualitative analysis was used to additionally assess factors influencing pre-hospital delay and for triangulation of study findings.ResultsTB treatment non-compliance was low (10 %), no association of outcome with cultural or socio-economic factors was found. Only patients’ time constraints and long distance to the clinic indicated a possible association with a higher risk of non-compliance (OR 0.52; 95 % CI 0.25, 1.10, p = 0.086). Qualitative data showed that most TB patients combined understandings of biomedical and traditional TB knowledge, used herbal, traditional and/or faith healing, suffered from stigmatizing attitudes, experienced poverty and food shortages, and faced several organisational obstacles while being on treatment. This led in some cases to pre-hospital delay or treatment non-compliance.ConclusionsMixed methods analysis demonstrated the importance of in-depth information ascertained by qualitative approaches to understand how cultural, socio-economic and organisational factors are influencing patients’ pre-hospital delay and treatment compliance. To strengthen the Zambian NTP, combating stigma is of utmost priority coupled with programmes addressing poverty. Organisational barriers and co-operation between (private) clinics and traditional/faith healers should be considered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3771-9) contains supplementary material, which is available to authorized users.

show abstract

Scale‐up of TB and HIV programme collaborative activities in Zambia – a 10‐year review

Cited by 34 publications

References 5 publications

Time for initiation of antiretroviral therapy in HIV co-infected tuberculosis patients in Addis Ababa, Ethiopia

Time for initiation of antiretroviral therapy in HIV co-infected tuberculosis patients in Addis Ababa, Ethiopia

The prevalence of HIV among adults with pulmonary TB at a population level in Zambia

Tuberculosis patients’ pre-hospital delay and non-compliance with a longstanding DOT programme: a mixed methods study in urban Zambia

Contact Info

Product

Resources

About