Tuberculosis prevention in HIV-infected pregnant women in South Africa

Martin, Catherine; Black, Vivian

doi:10.4102/sajhivmed.v13i4.113

Cited by 6 publications

(9 citation statements)

References 22 publications

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“…IPT for HIV-infected adults (including pregnant women) and children should be included in the HIV national control program. [34][35][36]15,16,37 In resource-poor Republic of Congo, the current status quo will not allow for merger of the two separate programs. Whilst such resources are being sought, immediate priority areas for action are to increase communication and collaboration between programs, and to establish joint research and training activities.…”

Section: Towards Implementing Tb and Hiv Collaborative Service Reseamentioning

confidence: 99%

Health systems in the Republic of Congo: challenges and opportunities for implementing tuberculosis and HIV collaborative service, research, and training activities

Linguissi

Gwom

Nkenfou

et al. 2017

International Journal of Infectious Diseases

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The Republic of Congo is on the World Health Organization (WHO) list of 'high burden' countries for tuberculosis (TB) and HIV. TB is the leading cause of death among HIV-infected patients in the Republic of Congo. In this viewpoint, the available data on TB and HIV in the Republic of Congo are reviewed, and the gaps and bottlenecks that the National TB Control Program (NTCP) faces are discussed. Furthermore, priority requirements for developing and implementing TB and HIV collaborative service activities are identified. HIV and TB control programs operate as distinct entities with separate case management plans. The implementation of collaborative TB/HIV activities to evaluate and monitor the management of TB/HIV co-infected individuals remains inefficient in most regions, and these activities are sometimes non-existent. This reveals major challenges that require definition in order to improve the delivery of healthcare. The NTCP lacks adequate resources for optimal implementation of control measures of TB and HIV compliance and outcomes. The importance of aligning and integrating TB and HIV treatment services (including follow-up) and adherence support services through coordinated and collaborative efforts between individual TB and HIV programs is discussed. Aligning and integrating TB and HIV treatment services through coordinated and collaborative efforts between individual TB and HIV programs is required. However, the WHO recommendations are generic, and health services in the Republic of Congo need to tailor their TB and HIV programs according to the availability of resources and operational feasibility. This will also open opportunities for synergizing collaborative TB/HIV research and training activities, which should be prioritized by the donors supporting the TB/HIV programs.

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Section: Towards Implementing Tb and Hiv Collaborative Service Reseamentioning

confidence: 99%

Health systems in the Republic of Congo: challenges and opportunities for implementing tuberculosis and HIV collaborative service, research, and training activities

Linguissi

Gwom

Nkenfou

et al. 2017

International Journal of Infectious Diseases

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“…One of the targets of the millennium development goals is to reduce maternal mortality rate by 75% in the year 2015. However, it is difficult to achieve this unless due attention is given to the contribution of PTB-related maternal mortality and morbidity, [ 11 ] as maternal mortality and morbidity by TB are responsible for 15% of all maternal mortalities in high HIV-prevalent settings and for 15%–34% of indirect obstetric maternal mortality. [ 12 ]…”

Section: Introductionmentioning

confidence: 99%

A survey on undiagnosed active pulmonary tuberculosis among pregnant mothers in mekelle and surrounding Districts in Tigray, Ethiopia

Gebreegziabiher¹,

Adane²,

Abebe³

2017

Int J Mycobacteriol

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Objective/BackgroundTo determine the prevalence of undiagnosed active pulmonary tuberculosis (PTB) cases and sensitivity, specificity, and positive and negative predictive values of symptom combinations for undiagnosed TB infection in human immunodeficiency virus (HIV)-positive and HIV-negative pregnant mothers attending antenatal care (ANC) clinics. Mycobacterium TB and HIV are the leading causes of death among women of reproductive age worldwide. Symptom screening is the final step in the World Health Organization (WHO)-recommended TB intensified case finding algorithm for people living with HIV. However, the symptom-based PTB screening method for pregnant mothers is suboptimal and needs further optimization as some of the symptoms are obscured by the physiological changes during pregnancy.Materials and MethodsThis was a cross-sectional study, which was conducted from June 2014 to May 2015 at 16 public health institutions in Mekelle and its surrounding areas. All pregnant mothers who visited the maternity clinics for routine ANC follow-up examinations were screened for PTB symptoms. Those who had at least 2 weeks of cough, in addition to other symptoms, were enrolled in the study. Sociodemographic and clinical data and sputum samples were collected by midwives and nurses. The sputum samples were shipped to the Tigray Regional Laboratory and stored at −80°C until TB culture was performed.ResultsBetween June 2014 and May 2015, 9600 pregnant mothers were screened for PTB symptoms. We collected 174 sputum samples from pregnant mothers who had ≥2 weeks of productive cough. The participant’s median age was 27.5 years (interquartile range, 24–31 years). During enrollment, 604 (6.28%) participants were HIV seropositive. Among the HIV-positive mothers, 17 (38.1%) were informed about their HIV status when they visited the health institutions for ANC follow-up, whereas the remaining 27 (61.9%) were already on antiretroviral therapy. All sputum samples (n = 174) were cultured using Löwenstein–Jensen medium at the Tigray Regional Laboratory. One of the 174 sputum samples was positive (+1) in Ziehl–Neelsen staining technique, and none of them was TB culture positive. During the study, at all study sites, no pregnant mother was even presumptively diagnosed and treated for TB during the routine ANC services.ConclusionAlthough the survey did not find any active PTB case among pregnant mothers, we identified 174 PTB-susceptive cases during the routine ANC services. Therefore, it was concluded that the integration of the WHO-recommended four-part symptom-based intensified case finding as one of the core components of ANC services can enhance the early detection of PTB, especially in high TB-burden countries.

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“…20 It has been recommended that health care workers be made aware of the subtle signs of TB among pregnant women, and especially among those with HIV. 21 It is therefore of the utmost importance that greater effort be made to identify possible TB suspects, especially among those with HIV coinfection. 21 Furthermore, after the identification of HIV-positive pregnant women with suspected TB, integrated TB-HIV service delivery was found to be poor: none of the women who had signs and symptoms indicative of TB were referred for further TB investigation.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, none of the eligible women in our cohort received CPT treatment. This could lead to higher than normal rates of opportunistic bacterial and parasitic infections during pregnancy, 21 which may affect the health of the mother and baby or be detrimental to the development of the foetus, and may even result in death. Barriers commonly cited as being detrimental to the provision of CPT have been pharmacy stock-outs and unreliable drug supply chains.…”

Section: Discussionmentioning

confidence: 99%

Integration of TB-HIV services at an ANC facility in Frances Baard District, Northern Cape, South Africa

Peters

Heunis

Kigozi

et al. 2015

public health action

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Tuberculosis prevention in HIV-infected pregnant women in South Africa

Cited by 6 publications

References 22 publications

Health systems in the Republic of Congo: challenges and opportunities for implementing tuberculosis and HIV collaborative service, research, and training activities

Health systems in the Republic of Congo: challenges and opportunities for implementing tuberculosis and HIV collaborative service, research, and training activities

A survey on undiagnosed active pulmonary tuberculosis among pregnant mothers in mekelle and surrounding Districts in Tigray, Ethiopia

Integration of TB-HIV services at an ANC facility in Frances Baard District, Northern Cape, South Africa

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