Challenge TB project

AbstractBACKGROUND: Drug-resistant TB (DR-TB) remains a major public health concern. DR-TB patient data from ALERT (All Africa Leprosy, Tuberculosis and Rehabilitation Training Centre) Hospital, Addis Ababa, Ethiopia, who received bedaquiline (BDQ) and/or delamanid (DLM) containing regimens were analysed.RESULTS: From 2017 to 2019, 51 DR-TB patients were enrolled.

AbstractIn rapidly growing and high-burden urban centres, identifying tuberculosis (TB) transmission hotspots and understanding the potential impact of interventions can inform future control and prevention strategies.

Unpublished

We reviewed research repositories and compiled directories of research in Ethiopia from Jan 1, 2001 to Dec 30, 2017 to find evidence-based information for stakeholders and beneficiaries intervening in TB in Ethiopia. We presented literatures by four themes (biomedical and clinical; epidemiological; operational or implementation; and health systems). A total of 1,571 research studies and reports were accessed and revealed 635 epidemiological studies, followed by 538 clinical or biomedical studies, 257 operational or implementation research, and 141 health systems research. Interestingly, up to 2008 clinical or biomedical researchers were the leading researchers and from 2009 onwards, epidemiological researches held the largest constituency. TB or TB/HIV and MDR-TB literatures in Ethiopia have substantially increased over years. We suggest the need to focus on operational or implementation and health system research to decrease the spread and impact of the disease.

To evaluate the integration of tuberculosis (TB) screening and contact investigation into Integrated Maternal, Neonatal and Child Illnesses (IMNCI) and TB clinics in Addis Ababa, Ethiopia, this study used mixed methods with a stepped-wedge design, where 30 randomly selected health care facilities were randomized into three groups of 10 during August 2016-November 2017. Overall, 180,896 children attended 30 IMNCI clinics and 145,444 (80.4%) were screened for TB. A total of 688 (0.4%) children had presumptive TB and 47 (0.03%) had TB. Integrating TB screening into IMNCI clinics and intensifying contact investigation in TB clinics is feasible for improving TB screening, presumed TB cases, TB cases, contact screening and IPT coverage during the intervention period. Stool specimen could be non-invasive to address the challenge of sputum collection.

This is a mixed method cross-sectional study conducted in seven regions and two city administrations. We used multistage cluster sampling to randomly select 40 health centers and interviewed 21 TB patients per health center. We also conducted qualitative interviews to understand the reasons for delay. Of the total 844 TB patients enrolled, the median (IQR) patient, diagnostic and treatment initiation delays were 21 (10–45), 4 (2–10) and 2 (1–3) days respectively. The median (IQR) of total delay was 33 (19–67) days; 72.3% (595) of the patients started treatment after 21 days of the onset of the first symptom. TB patients’ delay in seeking care remains a challenge due to limited community interventions, cost of seeking care, prolonged diagnostics and treatment initiation. Therefore, targeted community awareness creation, cost reduction strategies and improving diagnostic capacity are vital to reduce delay in seeking TB care in Ethiopia.

To assess the use of Xpert for accurate diagnosis, timely initiation, and rational use of anti-TB treatment among childhood TB patients, we reviewed data trends over four consecutive years; two years before the arrival of the machine and two years following the implementation of Xpert. During the intervention period (2016–2017), 371 children with presumptive TB were evaluated using Xpert. A total of 199 (53.6%) childhood TB cases were notified, of which 88 (44.2%) were Xpert positive and 111 (55.8%) were treated as Xpert-negative probable TB cases. The tendency to initiate anti-TB treatment for unconfirmed TB cases was reduced by a third. Compared with smear AFB, Xpert improved accuracy of diagnosing pediatric TB cases two-fold. The average waiting time to start anti-TB treatment was 1.33 days. There was a significant reduction in the waiting time to start anti-TB treatment, with a mean time difference before and during intervention of 5.62 days. Xpert use was associated with a significant increase in the accuracy of identifying confirmed TB cases, reduced unnecessary anti-TB prescription, and shortened the time taken to start TB treatment.

To determine the yield of tuberculosis (TB) and the prevalence of human immuno-deficiency virus (HIV) among key populations in the selected hotspot towns of Ethiopia, we undertook cross-sectional implementation research during August 2017-January 2018. A total of 1878 vulnerable people were screened. There was a statistically significant association of active TB cases with previous history of TB (Adjusted Odds Ratio (AOR): 11 95% CI, 4.06–29.81), HIV infection (AOR: 7.7 95% CI, 2.24–26.40), and being a health care worker (HCW). The prevalence of TB in key populations was nine times higher than 164/100,000 national estimated prevalence rate. The prevalence of HIV was five times higher than 1.15% of the national survey. The highest yield of TB was among HCWs and a high HIV burden was detected among female sex workers and internal migratory workers. These suggest the need for community and health facility based integrated and enhanced case finding approaches for TB and HIV in hotspot settings.

BackgroundTuberculosis (TB) is a major public health problem. Its magnitude the required interventions are affected by changes in socioeconomic condition and urbanization. Ethiopia is among the thirty high burden countries with increasing effort to end TB.

Despite efforts to find and treat TB, about four million cases were missed globally in 2017. Barriers to accessing health care, inadequate health-seeking behavior of the community, poor socioeconomic conditions, and stigma are major determinants of this gap. This is the first national stigma survey conducted in seven regions and two city administrations of Ethiopia. A total of 3463 participants (844 TB patients, 836 from their families, and 1783 from the general population) were enrolled for the study. More than a third of Ethiopians have high scores for TB-related stigma, which were associated with educational status, poverty, and lack of awareness about TB. Stigma matters in TB prevention, care, and treatment and warrants stigma reduction interventions.

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